This study investigates the factors associated with the impairment of awareness in mild dementia.

Using a longitudinal design, 69 people with mild Alzheimer's disease (AD), and their family caregivers were interviewed and reassessed after one year. The dyads completed the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD), the Quality of Life in Alzheimer's Disease Scale (QoL-AD), the Mini-Mental State Examination (MMSE), the Clinical Dementia Rating (CDR) scale, the Cornell Scale for Depression in Dementia (CSDD), the Pfeffer Functional Activities Questionnaire (PFAQ), the Neuropsychiatric Inventory (NPI), and the Zarit Burden Interview (ZBI). Univariate and ordinal regression analyses were conducted to examine the contribution of the various factors.

The level of awareness of disease presented a significant difference (p<0.001) between baseline and after one year. After one year, there was no change in the level of awareness of disease in 61.8%, whereas 25.4% worsened. However, the level of awareness improved in 12.3%. At baseline, ordinal regression showed that impaired awareness was associated with cognitive function (p<0.05) and ADL (p<0.001). After one year, the predictors of impaired awareness were ADL (p<0.001), low levels of PwD QoL-AD reported by caregivers (p<0.05) and higher levels of caregivers’ formal education (p<0.05).

At least in the earlier stages of dementia, it should not be assumed that awareness will inevitably decrease as dementia progresses. The results confirmed that awareness and cognition are relatively independent, and showed that in mild PwD awareness is mainly manifested by poor recognition of changes in ADLs.