Understanding domains of awareness in Alzheimer's disease: a longitudinal study.

Abstract

Objectives: Awareness refers to the ability to recognize deficits associated with disease progression. This study aimed to investigate the pattern of impairment of domains of awareness over three-time points and examine the relationship between domains and clinical aspects of Alzheimer's Disease (AD).

Method: We selected 158 people with mild-to-moderate AD and their caregivers. After 24 months, forty-one completed the evaluation. We examined five domains of awareness using the Assessment Scale of Psychological Impact of the Diagnosis of Dementia (ASPIDD): cognitive functioning and health condition, functional activity impairments, emotional state, social functioning and relationships, and disease itself.

Results: We conducted a post-hoc analysis to understand impairment patterns across domains. Between moments 1 and 3, most domains showed significant impairments over time, except the ASPIDD emotional state, which remained stable. Principal Component Analysis indicated that ASPIDD emotional state and ASPIDD social functioning are similar; both were related to neuropsychiatric symptoms and caregiver burden during moments 1 and 2. Cognitive and functional factors impacted all domains during moment 3.

Conclusion: The pattern of impairment in the domains of awareness is not a linear process since some domains did not decline over time. Each domain was influenced by different clinical aspects related to the disease.