Skip to main content
Advertisement
  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Specialty Sites
    • Equity, Diversity and Inclusion
    • Innovations in Care Delivery
    • Without Borders
  • Collections
    • Topics A-Z
    • Residents & Fellows
    • Infographics
    • Patient Pages
    • Null Hypothesis
    • Translations
  • Podcast
  • CME
    • Article CME
    • Podcast CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center

Advanced Search

Main menu

  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Specialty Sites
    • Equity, Diversity and Inclusion
    • Innovations in Care Delivery
    • Without Borders
  • Collections
    • Topics A-Z
    • Residents & Fellows
    • Infographics
    • Patient Pages
    • Null Hypothesis
    • Translations
  • Podcast
  • CME
    • Article CME
    • Podcast CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Residents & Fellows

User menu

  • Subscribe
  • My alerts
  • Log in

Search

  • Advanced search
Neurology
Home
The most widely read and highly cited peer-reviewed neurology journal
  • Subscribe
  • My alerts
  • Log in
Site Logo
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Residents & Fellows

Share

March 13, 2018; 90 (11) ArticleOpen Access

Anosognosia predicts default mode network hypometabolism and clinical progression to dementia

Joseph Therriault, Kok Pin Ng, Tharick A. Pascoal, Sulantha Mathotaarachchi, Min Su Kang, Hanne Struyfs, Monica Shin, Andrea L. Benedet, Ishan C. Walpola, Vasavan Nair, Serge Gauthier, Pedro Rosa-Neto, For the Alzheimer's Disease Neuroimaging Initiative
First published February 14, 2018, DOI: https://doi.org/10.1212/WNL.0000000000005120
Joseph Therriault
From the Translational Neuroimaging Laboratory (J.T., K.P.N., T.A.P., S.M., M.S.K., H.S., M.S., A.L.B., P.R.-N.) and Alzheimer's Disease Research Unit (K.P.N., S.G., P.R.-N.), The McGill University Research Centre for Studies in Aging, Montreal, Canada; Department of Neurology (K.P.N.), National Neuroscience Institute, Singapore; Reference Center for Biological Markers of Dementia (BIODEM) (H.S.), University of Antwerp, Belgium; Center for Mind and Brain (I.C.W.), University of Sydney, Australia; Douglas Hospital Research Centre (V.N.), Department of Psychiatry (V.N.), and Department of Neurology and Neurosurgery (P.R.-N.), McGill University; and Montreal Neurological Institute (P.R.-N.), Canada.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Kok Pin Ng
From the Translational Neuroimaging Laboratory (J.T., K.P.N., T.A.P., S.M., M.S.K., H.S., M.S., A.L.B., P.R.-N.) and Alzheimer's Disease Research Unit (K.P.N., S.G., P.R.-N.), The McGill University Research Centre for Studies in Aging, Montreal, Canada; Department of Neurology (K.P.N.), National Neuroscience Institute, Singapore; Reference Center for Biological Markers of Dementia (BIODEM) (H.S.), University of Antwerp, Belgium; Center for Mind and Brain (I.C.W.), University of Sydney, Australia; Douglas Hospital Research Centre (V.N.), Department of Psychiatry (V.N.), and Department of Neurology and Neurosurgery (P.R.-N.), McGill University; and Montreal Neurological Institute (P.R.-N.), Canada.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Tharick A. Pascoal
From the Translational Neuroimaging Laboratory (J.T., K.P.N., T.A.P., S.M., M.S.K., H.S., M.S., A.L.B., P.R.-N.) and Alzheimer's Disease Research Unit (K.P.N., S.G., P.R.-N.), The McGill University Research Centre for Studies in Aging, Montreal, Canada; Department of Neurology (K.P.N.), National Neuroscience Institute, Singapore; Reference Center for Biological Markers of Dementia (BIODEM) (H.S.), University of Antwerp, Belgium; Center for Mind and Brain (I.C.W.), University of Sydney, Australia; Douglas Hospital Research Centre (V.N.), Department of Psychiatry (V.N.), and Department of Neurology and Neurosurgery (P.R.-N.), McGill University; and Montreal Neurological Institute (P.R.-N.), Canada.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sulantha Mathotaarachchi
From the Translational Neuroimaging Laboratory (J.T., K.P.N., T.A.P., S.M., M.S.K., H.S., M.S., A.L.B., P.R.-N.) and Alzheimer's Disease Research Unit (K.P.N., S.G., P.R.-N.), The McGill University Research Centre for Studies in Aging, Montreal, Canada; Department of Neurology (K.P.N.), National Neuroscience Institute, Singapore; Reference Center for Biological Markers of Dementia (BIODEM) (H.S.), University of Antwerp, Belgium; Center for Mind and Brain (I.C.W.), University of Sydney, Australia; Douglas Hospital Research Centre (V.N.), Department of Psychiatry (V.N.), and Department of Neurology and Neurosurgery (P.R.-N.), McGill University; and Montreal Neurological Institute (P.R.-N.), Canada.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Min Su Kang
From the Translational Neuroimaging Laboratory (J.T., K.P.N., T.A.P., S.M., M.S.K., H.S., M.S., A.L.B., P.R.-N.) and Alzheimer's Disease Research Unit (K.P.N., S.G., P.R.-N.), The McGill University Research Centre for Studies in Aging, Montreal, Canada; Department of Neurology (K.P.N.), National Neuroscience Institute, Singapore; Reference Center for Biological Markers of Dementia (BIODEM) (H.S.), University of Antwerp, Belgium; Center for Mind and Brain (I.C.W.), University of Sydney, Australia; Douglas Hospital Research Centre (V.N.), Department of Psychiatry (V.N.), and Department of Neurology and Neurosurgery (P.R.-N.), McGill University; and Montreal Neurological Institute (P.R.-N.), Canada.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Hanne Struyfs
From the Translational Neuroimaging Laboratory (J.T., K.P.N., T.A.P., S.M., M.S.K., H.S., M.S., A.L.B., P.R.-N.) and Alzheimer's Disease Research Unit (K.P.N., S.G., P.R.-N.), The McGill University Research Centre for Studies in Aging, Montreal, Canada; Department of Neurology (K.P.N.), National Neuroscience Institute, Singapore; Reference Center for Biological Markers of Dementia (BIODEM) (H.S.), University of Antwerp, Belgium; Center for Mind and Brain (I.C.W.), University of Sydney, Australia; Douglas Hospital Research Centre (V.N.), Department of Psychiatry (V.N.), and Department of Neurology and Neurosurgery (P.R.-N.), McGill University; and Montreal Neurological Institute (P.R.-N.), Canada.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Monica Shin
From the Translational Neuroimaging Laboratory (J.T., K.P.N., T.A.P., S.M., M.S.K., H.S., M.S., A.L.B., P.R.-N.) and Alzheimer's Disease Research Unit (K.P.N., S.G., P.R.-N.), The McGill University Research Centre for Studies in Aging, Montreal, Canada; Department of Neurology (K.P.N.), National Neuroscience Institute, Singapore; Reference Center for Biological Markers of Dementia (BIODEM) (H.S.), University of Antwerp, Belgium; Center for Mind and Brain (I.C.W.), University of Sydney, Australia; Douglas Hospital Research Centre (V.N.), Department of Psychiatry (V.N.), and Department of Neurology and Neurosurgery (P.R.-N.), McGill University; and Montreal Neurological Institute (P.R.-N.), Canada.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Andrea L. Benedet
From the Translational Neuroimaging Laboratory (J.T., K.P.N., T.A.P., S.M., M.S.K., H.S., M.S., A.L.B., P.R.-N.) and Alzheimer's Disease Research Unit (K.P.N., S.G., P.R.-N.), The McGill University Research Centre for Studies in Aging, Montreal, Canada; Department of Neurology (K.P.N.), National Neuroscience Institute, Singapore; Reference Center for Biological Markers of Dementia (BIODEM) (H.S.), University of Antwerp, Belgium; Center for Mind and Brain (I.C.W.), University of Sydney, Australia; Douglas Hospital Research Centre (V.N.), Department of Psychiatry (V.N.), and Department of Neurology and Neurosurgery (P.R.-N.), McGill University; and Montreal Neurological Institute (P.R.-N.), Canada.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Ishan C. Walpola
From the Translational Neuroimaging Laboratory (J.T., K.P.N., T.A.P., S.M., M.S.K., H.S., M.S., A.L.B., P.R.-N.) and Alzheimer's Disease Research Unit (K.P.N., S.G., P.R.-N.), The McGill University Research Centre for Studies in Aging, Montreal, Canada; Department of Neurology (K.P.N.), National Neuroscience Institute, Singapore; Reference Center for Biological Markers of Dementia (BIODEM) (H.S.), University of Antwerp, Belgium; Center for Mind and Brain (I.C.W.), University of Sydney, Australia; Douglas Hospital Research Centre (V.N.), Department of Psychiatry (V.N.), and Department of Neurology and Neurosurgery (P.R.-N.), McGill University; and Montreal Neurological Institute (P.R.-N.), Canada.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Vasavan Nair
From the Translational Neuroimaging Laboratory (J.T., K.P.N., T.A.P., S.M., M.S.K., H.S., M.S., A.L.B., P.R.-N.) and Alzheimer's Disease Research Unit (K.P.N., S.G., P.R.-N.), The McGill University Research Centre for Studies in Aging, Montreal, Canada; Department of Neurology (K.P.N.), National Neuroscience Institute, Singapore; Reference Center for Biological Markers of Dementia (BIODEM) (H.S.), University of Antwerp, Belgium; Center for Mind and Brain (I.C.W.), University of Sydney, Australia; Douglas Hospital Research Centre (V.N.), Department of Psychiatry (V.N.), and Department of Neurology and Neurosurgery (P.R.-N.), McGill University; and Montreal Neurological Institute (P.R.-N.), Canada.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Serge Gauthier
From the Translational Neuroimaging Laboratory (J.T., K.P.N., T.A.P., S.M., M.S.K., H.S., M.S., A.L.B., P.R.-N.) and Alzheimer's Disease Research Unit (K.P.N., S.G., P.R.-N.), The McGill University Research Centre for Studies in Aging, Montreal, Canada; Department of Neurology (K.P.N.), National Neuroscience Institute, Singapore; Reference Center for Biological Markers of Dementia (BIODEM) (H.S.), University of Antwerp, Belgium; Center for Mind and Brain (I.C.W.), University of Sydney, Australia; Douglas Hospital Research Centre (V.N.), Department of Psychiatry (V.N.), and Department of Neurology and Neurosurgery (P.R.-N.), McGill University; and Montreal Neurological Institute (P.R.-N.), Canada.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Pedro Rosa-Neto
From the Translational Neuroimaging Laboratory (J.T., K.P.N., T.A.P., S.M., M.S.K., H.S., M.S., A.L.B., P.R.-N.) and Alzheimer's Disease Research Unit (K.P.N., S.G., P.R.-N.), The McGill University Research Centre for Studies in Aging, Montreal, Canada; Department of Neurology (K.P.N.), National Neuroscience Institute, Singapore; Reference Center for Biological Markers of Dementia (BIODEM) (H.S.), University of Antwerp, Belgium; Center for Mind and Brain (I.C.W.), University of Sydney, Australia; Douglas Hospital Research Centre (V.N.), Department of Psychiatry (V.N.), and Department of Neurology and Neurosurgery (P.R.-N.), McGill University; and Montreal Neurological Institute (P.R.-N.), Canada.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
From the Translational Neuroimaging Laboratory (J.T., K.P.N., T.A.P., S.M., M.S.K., H.S., M.S., A.L.B., P.R.-N.) and Alzheimer's Disease Research Unit (K.P.N., S.G., P.R.-N.), The McGill University Research Centre for Studies in Aging, Montreal, Canada; Department of Neurology (K.P.N.), National Neuroscience Institute, Singapore; Reference Center for Biological Markers of Dementia (BIODEM) (H.S.), University of Antwerp, Belgium; Center for Mind and Brain (I.C.W.), University of Sydney, Australia; Douglas Hospital Research Centre (V.N.), Department of Psychiatry (V.N.), and Department of Neurology and Neurosurgery (P.R.-N.), McGill University; and Montreal Neurological Institute (P.R.-N.), Canada.
Full PDF
Citation
Anosognosia predicts default mode network hypometabolism and clinical progression to dementia
Joseph Therriault, Kok Pin Ng, Tharick A. Pascoal, Sulantha Mathotaarachchi, Min Su Kang, Hanne Struyfs, Monica Shin, Andrea L. Benedet, Ishan C. Walpola, Vasavan Nair, Serge Gauthier, Pedro Rosa-Neto, For the Alzheimer's Disease Neuroimaging Initiative
Neurology Mar 2018, 90 (11) e932-e939; DOI: 10.1212/WNL.0000000000005120

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Permissions

Make Comment

See Comments

Downloads
2530

Share

  • Article
  • Figures & Data
  • Info & Disclosures
Loading

Abstract

Objective To identify the pathophysiologic mechanisms and clinical significance of anosognosia for cognitive decline in mild cognitive impairment.

Methods We stratified 468 patients with amnestic mild cognitive impairment into intact and impaired awareness groups, determined by the discrepancy between the patient and the informant score on the Everyday Cognition questionnaire. Voxel-based linear regression models evaluated the associations between self-awareness status and baseline β-amyloid load, measured by [18F]florbetapir, and the relationships between awareness status and regional brain glucose metabolism measured by [18F]fluorodeoxyglucose at baseline and at 24-month follow-up. Multivariate logistic regression tested the association of awareness status with conversion from amnestic mild cognitive impairment to dementia.

Results We found that participants with impaired awareness had lower [18F]fluorodeoxyglucose uptake and increased [18F]florbetapir uptake in the posterior cingulate cortex at baseline. In addition, impaired awareness in mild cognitive impairment predicted [18F]fluorodeoxyglucose hypometabolism in the posterior cingulate cortex, left basal forebrain, bilateral medial temporal lobes, and right lateral temporal lobe over 24 months. Furthermore, participants with impaired awareness had a nearly 3-fold increase in likelihood of conversion to dementia within a 2-year time frame.

Conclusions Our results suggest that anosognosia is linked to Alzheimer disease pathophysiology in vulnerable structures, and predicts subsequent hypometabolism in the default mode network, accompanied by an increased risk of progression to dementia. This highlights the importance of assessing awareness of cognitive decline in the clinical evaluation and management of individuals with amnestic mild cognitive impairment.

Glossary

Aβ=
β-amyloid;
AD=
Alzheimer disease;
ADAS-Cog=
Alzheimer's Disease Assessment Scale–cognitive subscale;
ADNI=
Alzheimer's Disease Neuroimaging Initiative;
ANCOVA=
analysis of covariance;
CI=
confidence interval;
DMN=
default mode network;
ECog=
everyday cognition;
MCI=
mild cognitive impairment;
MMSE=
Mini-Mental State Examination;
OR=
odds ratio;
p-tau=
phosphorylated tau;
PCC=
posterior cingulate cortex;
RAVLT-D=
Rey Auditory Verbal Learning Task–delayed recall;
RAVLT-IM=
Rey Auditory Verbal Learning Task–immediate recall memory;
SUVR=
standardized uptake value ratio;
TMT-A=
Trail-Making Test part A;
TMT-B=
Trail-Making Test part B

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Coinvestigators are listed at links.lww.com/WNL/A236.

  • Data used in preparation of this article were obtained from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database (adni.loni.usc.edu). As such, the investigators within the ADNI contributed to the design and implementation of ADNI and/or provided data but did not participate in analysis or writing of this report. A complete listing of ADNI investigators can be found at adni.loni.usc.edu/wp-content/uploads/how_to_apply/ADNI_Acknowledgement_List.pdf.

  • The Article Processing Charge was funded by the authors.

  • Received August 7, 2017.
  • Accepted in final form December 5, 2017.
  • Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

View Full Text

Disputes & Debates: Rapid online correspondence

No comments have been published for this article.
Comment

NOTE: All authors' disclosures must be entered and current in our database before comments can be posted. Enter and update disclosures at http://submit.neurology.org. Exception: replies to comments concerning an article you originally authored do not require updated disclosures.

  • Stay timely. Submit only on articles published within the last 8 weeks.
  • Do not be redundant. Read any comments already posted on the article prior to submission.
  • 200 words maximum.
  • 5 references maximum. Reference 1 must be the article on which you are commenting.
  • 5 authors maximum. Exception: replies can include all original authors of the article.
  • Submitted comments are subject to editing and editor review prior to posting.

More guidelines and information on Disputes & Debates

Compose Comment

More information about text formats

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
NOTE: The first author must also be the corresponding author of the comment.
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Publishing Agreement
NOTE: All authors, besides the first/corresponding author, must complete a separate Disputes & Debates Submission Form and provide via email to the editorial office before comments can be posted.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

You May Also be Interested in

Back to top
  • Article
    • Abstract
    • Glossary
    • Methods
    • Results
    • Discussion
    • Author contributions
    • Study funding
    • Disclosure
    • Footnotes
    • References
  • Figures & Data
  • Info & Disclosures
Advertisement

Related Articles

  • No related articles found.

Topics Discussed

  • Alzheimer's disease
  • PET
  • Assessment of cognitive disorders/dementia
  • MCI (mild cognitive impairment)

Alert Me

  • Alert me when this article is cited
  • Alert me if a correction is posted
  • Alert me when eletters are published
Neurology: 93 (24)

Articles

  • Ahead of Print
  • Current Issue
  • Past Issues
  • Popular Articles
  • Translations

About

  • About the Journals
  • Ethics Policies
  • Editors & Editorial Board
  • Contact Us
  • Advertise

Submit

  • Author Center
  • Submit a Manuscript
  • Information for Reviewers
  • AAN Guidelines
  • Permissions

Subscribers

  • Subscribe
  • Activate a Subscription
  • Sign up for eAlerts
  • RSS Feed
Site Logo
  • Visit neurology Template on Facebook
  • Follow neurology Template on Twitter
  • Visit Neurology on YouTube
  • Neurology
  • Neurology: Clinical Practice
  • Neurology: Genetics
  • Neurology: Neuroimmunology & Neuroinflammation
  • AAN.com
  • AANnews
  • Continuum
  • Brain & Life
  • Neurology Today

Wolters Kluwer Logo

Neurology | Print ISSN:0028-3878
Online ISSN:1526-632X

© 2019 American Academy of Neurology

  • Privacy Policy
  • Feedback
  • Advertise