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Insight, cognition and quality of life in Alzheimer's disease
  1. CS Hurt1,
  2. S Banerjee2,
  3. C Tunnard2,
  4. DL Whitehead2,
  5. M Tsolaki3,
  6. P Mecocci4,
  7. I Kłoszewska5,
  8. H Soininen6,
  9. B Vellas7,
  10. S Lovestone2 onbehalf of the AddNeuroMed Consortium
  1. 1Department of Psychology, King's College London, Institute of Psychiatry, London, UK
  2. 2King's College London, Institute of Psychiatry, London, UK
  3. 3Memory and Dementia Centre, Aristotle University of Thessaloniki, Thessaloniki, Greece
  4. 4Department of Gerontology and Geriatrics, University of Perugia, Perugia, Italy
  5. 5Department of Old Age Psychiatry and Psychotic Disorders, Medical University of Lodz, Lodz, Poland
  6. 6Department of Neurology, Kuopio University Hospital, Kuopio, Finland
  7. 7Centre Mémoire de Ressources et de Recherché de Toulouse, Toulouse, France
  1. Correspondence to Dr Catherine S Hurt, King's College London, Institute of Psychiatry, Department of Psychology PO77, De Crespigny Park, London SE5 8AF, UK; Catherine.hurt{at}


Background The detrimental impact of dementia upon patient health-related quality of life (HRQL) is well established, as is the importance of improving HRQL. However, relatively little is known about the natural history of HRQL in dementia and those factors influencing it. This limited knowledge potentially restricts the evaluation of the efficacy of interventions designed to improve HRQL. One such area concerns the relationship between HRQL and patient insight. It remains unclear what impact, if any, impaired insight has upon a patient's HRQL. The present study aimed to investigate the relationship between insight and HRQL in a sample of patients with Alzheimer's disease (AD) and their carers.

Methods 256 patients with AD were recruited as part of AddNeuroMed, a multicentre European AD biomarkers study. Of these, 174 completed a quality-of-life measure in addition to a comprehensive battery of clinical and neuropsychological assessments.

Results Insight was found to be differentially related to patient perceptions of HRQL in mild and moderate dementia. Within moderate dementia, impaired insight was associated with better perceived HRQL. Conversely, cognition, but not insight, was associated with impaired HRQL in mild dementia. Insight was not found to be associated with carer perceptions of patient HRQL.

Conclusion Impairment of insight is associated with better HRQL in moderate dementia. This finding has implications for interventions which focus on increasing patient awareness and orientation, as impairment of insight appears to have a positive impact upon HRQL.

  • Quality of life
  • awareness
  • Alzheimer disease
  • cognition
  • insight

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  • Competing interests None.

  • Ethics approval Ethics approval was provided by the South London and Maudsley NHS Foundation Trust ethics committee, and appropriate ethical approval was gained in all other participating countries.

  • Provenance and peer review Not commissioned; externally peer reviewed.