Evaluation of Anosognosia in Alzheimer's Disease Using the Symptoms of Early Dementia-11 Questionnaire (SED-11Q)

Abstract

Aims: The objective is to propose a brief method to evaluate anosognosia in Alzheimer's disease (AD) using the Symptoms of Early Dementia-11 Questionnaire (SED-11Q), a short informant-based screening questionnaire for identifying dementia.

Methods: The participants were 107 elderly individuals: 13 with a Clinical Dementia Rating (CDR) of 0.5, 73 with mild AD of CDR 1, and 21 with moderate AD of CDR 2. The patients and caregivers answered the SED-11Q independently, and the degree of discrepancy indicated the severity of anosognosia.

Results: THE SCORES WERE AS FOLLOWS: caregiver scores were 2.46 ± 1.85 (mean ± SD) in CDR 0.5, 6.36 ± 3.02 in CDR 1, and 9.00 ± 1.14 in CDR 2; patient scores were 2.00 ± 1.78, 2.55 ± 2.33, and 1.33 ± 2.46, respectively. Discrepancy was 0.46 ± 1.61, 3.81 ± 3.95, and 7.67 ± 2.87, respectively, and the caregiver assessments were significantly higher than the patient assessments in CDR 1 and CDR 2 (p < 0.001 in both groups). The SED-11Q for anosognosia was validated with the standardized Anosognosia Questionnaire for Dementia (AD-Q). The caregiver scores were moderately correlated with behavioral and psychological symptoms of dementia scores (r = 0.524), and the patient scores were moderately correlated with depression scores (r = 0.561).

Conclusion: The SED-11Q serves a dual purpose: caregiver assessment is useful for the screening of dementia, and any discrepancy between the patient and the caregiver assessment is considered as an indication of the severity of anosognosia; this can be informative for caregivers and essential for successful care.

Keywords: Alzheimer's disease; Anosognosia; Behavioral and psychological symptoms of dementia; Caregiver burden; Dementia; Dementia care; Metacognition; Mild cognitive impairment; Screening test.

Fig. 1

SED-11Q (a) and SED-11Qp (b). The SED-11Qp asks the same questions as the SED-11Q. However, the title was changed to avoid using the word ‘dementia’. ‘Patient Name’ and ‘Patient ID’ were changed to ‘Name’ and ‘ID’. Two additional questions about delusions and illusions in SED-11Q were not included in the SED-11Qp. The questionnaires can be completed by interview.

Fig. 2

Scores of the SED-11Q. A higher score indicates more severe symptoms. Caregiver assessments, which were regarded as the objective standard of patient dysfunction, increased as the disease progressed, whereas patient assessments were not significantly different among the 3 stages. The discrepancy between caregiver and patient scores indicated the severity of anosognosia. In the CDR 0.5 group, there was no significant difference, which suggested that patients retain self-awareness of the disease. In the CDR 1 and 2 groups, the caregiver assessment was significantly higher than the patient assessment, and the discrepancy was larger in the CDR 2 than in the CDR 1 group. *** p < 0.001.

Fig. 3

The ratio (percentile) is shown for each item in CDR 1: both caregiver and patient aware (Cg+ Pt+), caregiver aware and patient unaware (anosognosia or hyponosognosia, Cg+ Pt-), caregiver unaware and patient aware (hypernosognosia, Cg- Pt+), and both caregiver and patient unaware (Cg- Pt-). The ratios of cases in which patients were aware and caregivers were unaware were 9.6% in difficulties in cleaning up, 12.3% in forgetting one of two items, and 12.3% in time-consuming behavior.