Anosognosia for behavioral disorder is related to confidence for false self-related memories in Alzheimer’s disease

Impaired self-awareness (i.e. anosognosia) and altered metacognitive monitoring in memory tasks have both been evidenced in AD. Furthermore, cognitive studies showed disrupted interaction between self and memory cognitive systems in AD, reducing cognitive advantages of self-related memories (i.e. decreasing self reference effect, SRE) in these patients. However, how anosognosia relates to impaired metacognitive monitoring in AD, particularly for self-related memories, is still an open question. To investigate this question, an ecological memory task based on face-name associations was administrated to 20 healthy older controls (HC) and 20 mild AD patients. The influence of self-reference at encoding was assessed on subsequent name recall and recollective experience, as well as on predictive (feeling-of-knowing, FOK) and postretrieval (judgments-of-confidence, JOC) metacognitive judgments on name recognition in all participants. Furthermore relationships between metacognitive outcomes and awareness of daily cognitive and behavioral impairment was examined in AD. Altered SRE was evidenced in name recall and recollective experience in AD. Patients also showed impaired FOK and JOC, as well as lower awareness of their daily functioning impairment (anosognosia). Nevertheless, differential effect of self on metacognitive judgment in AD and HC was only observed on JOC for false memories. Importantly, anosognosia for behavioral disorders was related to post-retrieval confidence for false recognition of self-related items in AD patients. Thus, anosognosia concerning behavioral disorder and altered post-retrieval monitoring of self-related memories appear to be related in AD. We hypothesized that impaired monitoring of personal false memories may lead AD patients to rely on distorted recent reality when providing judgment about their everyday behavioral functioning