Neuropsychological and Behavioral Disturbance Correlates of Unawareness of Memory Impairment in Dementia: A Population-Based Study

Introduction: This study investigated in a community sample associations of 2 different measures of unawareness of memory impairment in dementia with cognitive variables and behavioral and psychological symptoms of dementia.Method: Designcross-sectional, population-based survey. Settingscommunity samples (n = 15 022) from 3 world regions (Latin America, China, and India). Participants829 people with dementia identified from standardized interviews and diagnostic algorithms. Measurementsunawareness of memory deficits was measured in 2 ways: comparison of participant subjective report with either objective performance on memory tests or informant report (IR). Associations were investigated using prevalence ratios and Poisson regressions. Differences in frequency of unawareness were explored with McNemar tests for each region and agreement between variables calculated with Cohen .Results: the unawareness variable based on comparison with performance was associated with cognitive variables, such as fluency (in China) and visuospatial impairments (Latin America and India), and behavioral symptoms, such as mania (Latin America) and hallucinations (China). the unawareness variable based on IR was associated only with behavioral symptoms, such as anxiety (in China and India) and hallucinations and mania (Latin America). Frequency of unawareness was significantly higher in the unawareness variable based on performance in India. Agreement between the 2 unawareness variables was moderate in Latin America and China but only slight in India.Conclusion: Different ways of measuring unawareness are differentially associated with influencing factors. Informant-based unawareness measures may be more subjective and less sensitive than variables taking into account actual performance on cognitive tests.Wellcome TrustWorld Health OrganisationUS Alzheimer's AssociationFONDACITRockefeller FoundationGlaxoSmithKlineNovartisLundbeckPfizerEisaiCoordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Department of Health via the National Institute for Health Research (NIHR) Specialist Biomedical Research Centre for Mental HealthInstitute of Psychiatry at King's College LondonKCL, Inst Psychiat, Dept Psychol, London SE5 8AF, EnglandKCL, Inst Psychiat, Epidemiol Sect, London SE5 8AF, EnglandUniversidade Federal de São Paulo, Dept Psychobiol, São Paulo, BrazilHosp Alemao Oswaldo Cruz, Inst Hlth Educ & Sci, São Paulo, BrazilUniv Fed Rio de Janeiro, Inst Vital Brazil, Ctr Res & Studies Aging, Inst Psychiat, Rio de Janeiro, BrazilUniversidade Federal de São Paulo, Dept Psychobiol, São Paulo, BrazilWellcome Trust: GR066133Wellcome Trust: GR08002US Alzheimer's Association: IIRG-04-1286CAPES: 4276060Web of Scienc