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J Neurol Neurosurg Psychiatry doi:10.1136/jnnp.2007.122853

A comparison of unawareness in frontotemporal dementia and Alzheimer’s disease

  1. Eric Salmon (eric.salmon{at}ulg.ac.be)
  1. University of Liège, Belgium
    1. Daniela Perani (danielap{at}mednuc.hsr.it)
    1. Vita Salute San Raffaele University, IRCCS H San Raffaele, IBFM-CNR, Milan, Italy
      1. Fabienne Collette (f.collette{at}ulg.ac.be)
      1. University of Liège, Belgium
        1. Dorothée Feyers (do.feyers{at}ulg.ac.be)
        1. University of Liège, Belgium
          1. Elke Kalbe (kalbe{at}nf.mpg.de)
          1. Department of Neurology, University of Cologne, Germany
            1. Vjera Holthoff (holthoff{at}rcs.urz.tu-dresden.de)
            1. Department of Psychiatry and Psychotherapy, Dresden University of Technology, Dresden, Germany
              1. Sandro Sorbi (sorbi{at}mail.unifi.it)
              1. Department of Neurological and Psychiatric Sciences, University of Florence, Italy
                1. Karl Herholz (karl.herholz{at}manchester.ac.uk)
                1. Wolfson Molecular Imaging Centre, University of Manchester, United Kingdom
                  • Published Online First 26 September 2007

                  Abstract

                  Background: Loss of insight is a core diagnostic feature of frontotemporal dementia (FTD) and anosognosia is frequently reported in Alzheimer’s disease (AD) Aim: To compare unawareness (anosognosia) for different symptoms, measured with a discrepancy score between patient’s and caregiver’s assessment, in AD and FTD.

                  Method: In a prospective multicenter study, 123 probable AD patients, selected according to NINCDS-ADRDA procedure, were matched for age, sex, education, disease duration and dementia severity to FTD subjects (n=41), selected according to international consensus criteria. A research complaint questionnaire was used to obtained patient’s and caregiver’s assessment concerning neuropsychological and behavioral symptoms. Data were compared in each group and between groups. Unawareness (measured by discrepancy scores) was compared between AD and FTD patients.

                  Results: The caregivers generally assessed symptoms more severely than patients did, but both patients groups reported changes in affect (depressive mood or irritability) as their caregivers did. Unawareness was greater in FTD than in AD patients for language and executive difficulties, and for changes in behavior and daily activities.

                  Conclusion: The main finding is that unawareness was observed in both FTD and AD patients for most clinical domains. However, qualitative and quantitative differences showed that lack of awareness was greater in FTD subjects

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