Lack of Awareness Makes Dementia a Bigger Problem

Sometimes, what you don't know about may be the very thing that brings you down. This is particularly true for dementia.

Doctors who work with men and women who have an increased risk of dementia have long suspected that one group is far more at risk than others. They've seen that patients who are not aware of their memory problems are at a greater risk of seeing their condition get worse much faster than those who are aware. And now, that suspicion has been confirmed by a team of McGill University clinician scientists.

The ten-dollar word for a patient who doesn't understand that they have a medical problem is anosognosia. And as you would imagine, anosognosia is often associated with Alzheimer's disease. In a recently published study in Neurology, Dr. Pedro Rosa-Neto's team from McGill's Translational Neuroimaging Laboratory showed that individuals who experience this lack of awareness are three times more likely to develop dementia in the following two years.

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To discover this remarkable association, researchers analyzed 450 patients who experienced mild memory deficits, but who were still capable of taking care of themselves. They asked the patients to rate their cognitive function. They also asked their close relatives to rate them as well. When a patient reported having no cognitive problems, but the family members reported significant difficulties, he was considered to have poor awareness of his illness. Here's what happened.

The researchers compared the metabolic brain function and brain scan imaging of the anosognosia group to the ones who were aware of their memory problems. They discovered that the men and women suffering from anosognosia had impaired brain metabolic function and higher rates of amyloid deposition. Both of these findings indicate the likelihood of Alzheimer's disease. Then, after a two-year follow up period, they found that the anosognosia patients were more likely to have developed dementia, even when taking into account other factors like genetic risk, age, gender, and education. The increased progression to dementia was also associated with decreased brain metabolic function in those areas of the brain vulnerable to Alzheimer's disease.

So, if the people closest to you see a problem with your brain function that you're not aware of, it may not be a plot. It may indicate that you are at an increased risk of developing dementia. And it might be in your best interest to see your doctor for some specialized testing. The sooner dementia is diagnosed, the better the outcome.

Yours for better health,

Frank Shallenberger, MD

Sources:

Therriault J et al. Anosognosia predicts default mode network hypometabolism and clinical progression to dementia, Neurology (2018).