Metacognition in alzheimer's disease

Abstract

It has long been recognized that a significant proportion of patients with Alzheimer's disease (AD) display some degree of unawareness for disease related memory loss. Historically, the majority of studies examining awareness in AD have implemented subjective assessment tools including clinician rating scales and informant based discrepancy measures. In the past two decades, there has been increasing focus on the objective assessment of metacognition in AD. These studies have made important strides in advancing our understanding of the nature of awareness deficits in AD and the mechanisms which may contribute to metacognitive variability in AD. However, there are several methodological issues that may complicate interpretation of existing data and that require consideration as this field moves forward. This chapter will: (1) review several commonly used subjective and objective approaches to measuring memory awareness in AD; (2) highlight important dissociations that characterize metacognitive functioning in AD; (3) evaluate specific models of metacognitive deficits (i.e., anosognosia) in AD and; (4) discuss future directions for metacognitive research in AD.