Different Awareness Domains Contributes to Explain Emotional and Behavioral Disorders in Mild Alzheimer's DiseaseAuthor(s): Leonardo Sacco*, Nadia Parietti, Stefania Rossi, Carlo A Defanti, Pietro Tiraboschi
Background: The relationship between awareness domains and behavioural-psychological symptoms in Alzheimer's disease (AD) is unclear. Objective: To investigate the effects of awareness domains on mild AD patients’ emotional-behavioural disturbances and caregivers’ stress accounting for demographic and clinical variables. Methods: Overall awareness and cognitive, emotional and functional domains were investigated in 60 mild AD patients and 60 related caregivers using the Questionnaire of identification of deficits. The patients’ cognitive functioning and psycho-affective/psychiatric symptoms, and their caregivers’ stress, were also assessed. Patients were classified as preserved (AD_AP) and impaired (AD_AI) awareness. Hierarchical linear models were applied to explore the effects of awareness domains on psychological and behavioural measures. Results: Unawareness was more frequent for emotional and functional disturbances than for cognitive deficits. AD_AP patients were less engaged in social and leisure activities and had higher rates of psycho-affective disturbances, while AD_AI had higher rates of psychiatric and behavioural disorders. Higher global awareness and higher awareness of cognitive alterations respectively explained 32% and 25 % of the variance for depression (both p: <0.001), higher awareness of emotional disturbances explained 23% of the variance for anxiety (p=0.022). Impaired awareness explained 33% of the variance for apathy symptom (p<0.001). Unawareness was also associated with higher caregivers’ stress. Conclusions: In mild AD patients, frequency of unawareness is domain-dependent. The relationship between awareness domains and emotionalbehavioural disturbances is independent of demographic and clinical factors.