PAPER

Self awareness and personality change in dementia

K P Rankin, E Baldwin, C Pace-Savitsky, J H Kramer and B L Miller

University of California San Francisco Memory and Aging Center, 350 Parnassus Avenue, Suite 706, San Francisco, CA 94143-1207, USA

Correspondence to:
Correspondence to:
Dr K P Rankin
UCSF Memory and Aging Center, 350 Parnassus Avenue, Suite 706, San Francisco, CA 94143-1207, USA; krankin{at}memory.ucsf.edu

Background: Loss of insight is a core diagnostic criterion for frontotemporal dementia (FTD), whereas failure to recognise cognitive deficits and unawareness of disease (anosognosia) are well established findings in Alzheimer’s disease (AD). However, self awareness of personality has not been quantified in these patient groups.

Methods: Twenty two patients (12 with frontal variant FTD; 10 with early AD) and 11 older adult normal controls completed self report questionnaires (the Interpersonal Adjectives Scales) describing their current personality. First degree relative informants completed two questionnaires, one describing the subject’s current personality, the other retrospectively describing the subject’s personality before disease onset. Differences between subject and informant reports of current personality were used to measure the accuracy of self awareness.

Results: Discriminant function analysis showed significant differences in self awareness among the three groups, with those in the FTD group showing the greatest magnitude of error in the largest number of personality dimensions (dominance, submissiveness, cold heartedness, introversion, and ingenuousness). Despite personality changes over time, patients with AD showed accurate self awareness in all personality dimensions except submissiveness and extraversion. Normal controls showed a pattern of underestimating positive qualities, whereas patients with FTD exaggerated positive qualities and minimised negative qualities. For the personality facets showing impaired insight, the self reports of patients with FTD and AD most closely matched their premorbid personalities, suggesting a failure to update their self image after disease onset.

Conclusions: This study operationalises research criteria for loss of insight in FTD.

Abbreviations: AD, Alzheimer’s disease; CDR, Clinical Dementia Rating scale; FTD, frontotemporal dementia; IAS, Interpersonal Adjectives Scale; InsNow, insight into current personality; VL, vector length

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Mendez, M. F., Lauterbach, E. C., Sampson, S. M., ANPA Committee on Research, (2008). An Evidence-Based Review of the Psychopathology of Frontotemporal Dementia: A Report of the ANPA Committee on Research. J. Neuropsychiatry Clin. Neurosi. 20: 130-149 [Abstract] [Full Text]  
• Orfei, M. D., Robinson, R. G., Bria, P., Caltagirone, C., Spalletta, G. (2008). Unawareness of Illness in Neuropsychiatric Disorders: Phenomenological Certainty versus Etiopathogenic Vagueness. Neuroscientist 14: 203-222 [Abstract]  
• Salmon, E, Perani, D, Collette, F, Feyers, D, Kalbe, E, Holthoff, V, Sorbi, S, Herholz, K (2008). A comparison of unawareness in frontotemporal dementia and Alzheimer's disease. J. Neurol. Neurosurg. Psychiatry 79: 176-179 [Abstract] [Full Text]  
• Narushima, K., Moser, D. J., Robinson, R. G. (2008). Correlation Between Denial of Illness and Executive Function Following Stroke: A Pilot Study. J. Neuropsychiatry Clin. Neurosi. 20: 96-100 [Abstract] [Full Text]  
• Woolley, J. D., Wilson, M. R., Hung, E., Gorno-Tempini, M.-L., Miller, B. L., Shim, J. (2007). Frontotemporal Dementia and Mania. Am. J. Psychiatry 164: 1811-1816 [Full Text]  
• Duchek, J. M., Balota, D. A., Storandt, M., Larsen, R. (2007). The Power of Personality in Discriminating Between Healthy Aging and Early-Stage Alzheimer's Disease. Journals of Gerontology Series B: Psychological Sciences and Social Science 62: P353-P361 [Abstract] [Full Text]  
• Hutchinson, A D, Mathias, J L (2007). Neuropsychological deficits in frontotemporal dementia and Alzheimer's disease: a meta-analytic review. J. Neurol. Neurosurg. Psychiatry 78: 917-928 [Abstract] [Full Text]  
• O'Keeffe, F. M., Murray, B., Coen, R. F., Dockree, P. M., Bellgrove, M. A., Garavan, H., Lynch, T., Robertson, I. H. (2007). Loss of insight in frontotemporal dementia, corticobasal degeneration and progressive supranuclear palsy. Brain 130: 753-764 [Abstract] [Full Text]  
• Saxe, R., Moran, J. M, Scholz, J., Gabrieli, J. (2006). Overlapping and non-overlapping brain regions for theory of mind and self reflection in individual subjects. Soc Cogn Affect Neurosci 0: nsl034v1-6 [Abstract] [Full Text]  
• Sturm, V. E., Rosen, H. J., Allison, S., Miller, B. L., Levenson, R. W. (2006). Self-conscious emotion deficits in frontotemporal lobar degeneration. Brain 129: 2508-2516 [Abstract] [Full Text]  
• Eckstein, D., Clemmer, F., Fierro, A. (2006). The Use of Image Exchange in Examining Relationship Role Perceptions. The Family Journal 14: 71-76 [Abstract]