Objective: While much is known about cognitive deficits in beginning dementia behavioral disturbances in early phases have not been sufficiently studied yet. Thus, the link between cognitive decline and concomitant behavioral disturbances is still poorly understood. Awareness of the "Self" and its link to cognitive impairment has, to our knowledge, not yet been assessed in patients with Mild Cognitive Impairment (MCI). We have assessed Self-Consciousness and awareness in Mild Cognitive Impairment (MCI) patients and aimed to explore the link to global cognitive functioning.
Design: We assessed a group of 20 MCI-patients who were recruited in the Memory Clinic of a neurological department. Diagnosis of “Mild Cognitive Impairment” (MCI) was based on Petersen criteria and CDR stage (0,5). 10 women and 10 men, mean age of 74 years (+3,1), mean MMSE score (27,9 +1,4) and mean DemTect score of 10,6 points (+1,2) underwent a series of neuropsychological tests, assessing global cognitive and non-cognitive functioning (anosognosia, Self-Consciousness, and social knowledge).
Materials and Methods: Global cognitive functions were assessed using DemTect (Calabrese, Kessler, 2002) and MMSE (Folstein, 1975). In the non-cognitive domain, “Self-Consciousness” (SCS) was assessed by the “Self-Consciousness-Scale” (Gil et al., 2001), awareness of own deficits/anosognosia (AS) by using the “Anosognosia Scale” (Derouesné et al., 1999) as well as with the EMD ("Exploration Module for Dementia", Calabrese, 2002), a new screening tool that assesses not only cognition, but also behavioral disturbances and anosognosia. Social knowledge (SKQ) was assessed with the “Social Knowledge Questionnaire” (McEvoy et al., 1996).
Results: Both global cognitive screening tools, MMSE and DemTect as well as CDR stage, were highly and significantly intercorrelated. Furthermore they showed significant correlations to impaired social knowledge, as measured by the SKQ. Further, we detected an confirmed an overall decrease of awareness of deficits in MCI-patients on the anosognosia-scale (AS). No correlation was found between SCS and other cognitive or non-cognitive variables.
Conclusion: Our study indicates that early stages of dementia are not only characterized by mild cognitive decline but are also accompanied by an overall decrease in self-awareness. While anosognosia is correlated to DemTect and EMD, MMSE-scores do not seem to reflect these changes. Furthermore, MCI-patients show a substantial decrease of social knowledge which seems to be correlated to cognitive decline indicating a simultaneous emergence of cognitive and non-cognitive deficits in early stages of the disease.
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