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Orientador: Edison Duarte / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Educação Fisica / Made available in DSpace on 2018-08-08T06:18:41Z (GMT). No. of bitstreams: 1 Lovo_ThaisMariaAlbani_M.pdf: 783238 bytes, checksum: fcf9637bfab0a5ee6d188db02d2db41d (MD5) Previous issue date: 2006 / Resumo: Pessoas portadoras de deficiência física podem sofrer algum tipo de alteração em sua imagem corporal. Os indivíduos com hemiplegia, pela perda motora e alterações de sensibilidade, em um lado do corpo podem sofrer alterações na imagem corporal, sejam elas temporárias ou definitivas. Para melhor conhecimento da imagem corporal na hemiplegia vimos a necessidade de desenvolver uma revisão de literatura sobre essas complexas e intrincadas relações. Relatamos conceitos e discussões a respeito de imagem corporal, com seus aspectos fisiológicos, afetivos ou libidinais e sociais, sobre a hemiplegia e a relação entre essa mudança corporal ocorrida devido à seqüela neurológica relacionada aos aspectos neurológicos como a anosognosia, aspectos afetivos e sociais da imagem corporal. A pesquisa bibliográfica foi realizada em bases de dados da Web Spirs, Web of Science, Bireme, Acervus ( Unicamp) e Cruesp, onde estão as bases como Medline, Sport discus, Psycinfo, Lilacs , Scielo, Biological Abstracts, Sociological Abstracts, entre outras. A escolha das respectivas bases foi feita após uma seleção entre as que dizem respeito a área de Ciências Biológicas e Ciências da Saúde. Nas bases foram selecionados os idiomas: Inglês, Português e Espanhol. A pesquisa foi feita por assunto, utilizando algumas palavras-chave como: ?body image e hemiplegia?, ?body image e anosognosia? e ?body image e stroke?. Através da análise e organização dos materiais encontrados na pesquisa e selecionados para esta dissertação, procuramos enfatizar alguns aspectos que tiveram destaque nos estudos, como a anosognosia. Diante dos resultados encontrados na pesquisa bibliográfica o conteúdo foi organizado em três temas: imagem corporal e deficiência física, aspectos neurológicos da imagem corporal e aspectos psicossociais da imagem corporal, todos relacionados à hemplegia / Abstract: People carrying any physical deficiency can suffer some kind of alteration in their body image. The individuals with hemiplegia having motor loss and sensitivity alterations in a side of the body can suffer alterations in their body image that are either temporary or definitive . In order to achieve a better knowledge about body image in hemiplegia we needed to develop a literature revision on these complex and intricate relations. Indeed, concepts and arguments regarding body image with its physiological, affective or libidinal and social aspects in relation to hemiplegia were reported, as well as the relation of this body change due to a neurological sequel of some neurological aspects as the anosognosia, and affective and social aspects of body image. The bibliographical research was carried through in following databases: Web Spirs, Web of Science, Bireme, Acervus (Unicamp) and Cruesp; where there are the bases Medline, Sport discus, Psycinfo, Lilacs, Scielo, Biological Abstracts, Sociological Abstracts among others. The choice of the respective bases was made after an election among the ones connected with Biological and Health Sciences. In the bases the selected languages were: English, Portuguese and Spanish. The research was made by subject, and some word-keys were used: "body image and hemiplegia", "body image and anosognosia" and "body image and stroke". Through the analysis and organization of the materials found and chosen to this thesis, we emphasized some aspects that had prominence in the studies, as the anosognosia. Based in the found results in the bibliographical research the content was organized in three subjects: body image and physical deficiency, neurological aspects of the body image, and psychological and social aspects of the body image, all related to the hemplegia / Mestrado / Atividade Fisica, Adaptação e Saude / Mestre em Educação Física

The phenomenon whereby people suffering from an illness or disability seem to be unaware of their symptoms was termed anosognosia, by Joseph Babinksi in 1914 (Langer & Levine, 2014). Originally described as a specific inability to recognise or acknowledge left-sided hemiplegia after lesions to the right hemisphere of the brain, the term now incorporates unawareness of a range of post-stroke impairments, such as hemianopia (Bisiach, Vallar, Perani, Papagno & Berti, 1986), hemianaesthesia (Pia et al., 2014), aphasia (Cocchini, Gregg, Beschin, Dean & Della Sala, 2010) and unilateral neglect (Jehkonen, Ahonen, Dastidar, Laippala & Vilkki, 2000). Anosognosia has also been observed in association with several other disorders, including Alzheimer’s disease (Agnew & Morris, 1998) and traumatic brain injury (Prigatano, 2010a). While advances have been made in understanding anosognosia, there are still many contradictory findings in relation to the nature and expression of impaired self-awareness (Prigatano, 2010a), which are partly attributable to diverse methodological approaches. Furthermore, research into anosognosia frequently rests on the assumption that neurologically intact individuals have accurate insight into their own abilities, particularly in regard to motor skill. The experiments reported in this thesis highlight that this may be a false assumption. Through a series of interrelated studies, I demonstrate that the type of questions typically asked of anosognosic patients may be inappropriate to elicit the manifestations of chronic stage unawareness after a stroke, that underestimation may be just as prevalent as overestimation, and that healthy individuals are not always able to monitor whether their executed movements match their intended movements. Moreover, those with poorer motor skills are less able to judge movement successes and failures than their more skilled counterparts, suggesting a mechanism analogous to the anosognosia observed in clinical populations. Chapter 1 provides an overview of the main neuropsychological models that have been proposed to account for anosognosia for hemiplegia (AHP); unawareness in the context of other impairments is discussed in the introductions to individual chapters. Chapter 2 presents some background research investigating stroke clinicians’ knowledge of the lateralization of right hemisphere cognitive symptoms, and their judgements of the impact of selected symptoms on the lives of patients and caregivers. While the clinicians were equally able to identify cognitive symptoms associated with left or right brain damage, they were far more likely to misattribute symptoms to right brain damage, suggesting a lack of confidence in their knowledge of the cognitive functions of the right hemisphere. They also regarded anosognosia as having relatively low impact on the lives of patients and caregivers, in stark contrast with the highly negative impact reported in the literature (Jehkonen, Laihosalo & Kettunen, 2006a). Chapters 3 and 4 present two experimental studies investigating different facets of awareness in two groups of stroke patients. Chapter 3 reports the development and testing of a tool designed to measure chronic unawareness of functional difficulties, the Visual Analogue Test of Anosognosia for impairments in Activities of Daily Living (VATA-ADL), with preliminary data from a group of chronic stroke patients. Approximately one third of the patients exhibited mild or moderate levels of overestimation of their ability to carry out day-to-day activities. This contrasts with previous reports that anosognosia is rare in the chronic stages, a discrepancy that may be explained in part by the inappropriateness of the measures typically used to measure it. Overestimation was observed in both right-brain-damaged and left-brain-damaged patients, and was not associated with higher levels of cognitive impairment. The study reported in Chapter 4 examined whether acute stage stroke patients who under- or overestimated their motor skills, similarly under- or overestimated performance on cognitive tasks in the domains of language, memory and attention and executive function. Contrary to the many dissociations between unawareness of different impairment reported in the neuropsychological literature, this study found that patients classed as overestimators of motor ability were also overly optimistic about their cognitive abilities. Overestimators were more likely to have right hemisphere lesions, higher levels of general cognitive impairments, and specific deficits in attention and executive function. Furthermore, by including patients with a range of functional ability, this study revealed that participants were just as likely to underestimate as overestimate their abilities. This unique finding presents a challenge to anosognosia research, suggesting that there may be factors other than neurological damage that predispose stroke patients to over- or under-estimate their abilities and that a baseline of accurate self-insight among control populations cannot be assumed. Chapter 5 reports three different experiments conducted with younger and older, neurologically healthy adults. Using a target-directed reaching task, these experiments investigated whether the participants’ ability to monitor the success of their movements, on a trial by trial basis, depended upon their motor skill level, and whether participants with lower skill were inclined to overestimate their ability, in line with a famous observation from cognitive psychology that people who perform worst in a given task tend to be unaware of how poorly they are performing (Kruger and Dunning, 1999). Overall, the results demonstrated an association between higher accuracy levels and faster movement times, and better ability to monitor success and failure. To my knowledge, this represents that first evidence of a relationship between motor performance ability and self-monitoring ability in healthy individuals, highlighting that some of the mechanisms underpinning anosognosia may also be evident in neurologically intact populations. However, contrary to the findings from cognitive psychology, poor performance was not associated with a specific bias toward overestimation. A similar relationship between task performance and self-monitoring ability was also observed for a visual memory task. Chapter 6 discusses the implications of the results of the clinical and self-monitoring studies for neuropsychological models of anosognosia, particularly those based on motor planning and control, and considers potential ways forward for research in this field.

This study proposed an experimental test of theoretical models related to emotion and space representation in the brain. Previous research has established that emotion is represented, processed, expressed, and regulated largely by the right hemisphere. Furthermore, there is evidence from experimental paradigms and clinical case reports to suggest that the same hemisphere plays a dominant role in the processing of external space. A conceptual difficulty of clinical and neural network overlap arises when right hemisphere disorders of emotion are compared with those of spatial representation. The current experiment tested some of these hypotheses about emotion regulation and spatial representation in the right hemisphere using nonclinical subjects under a cortical stress paradigm designed to mimic the conditions of cortical duress. An additional goal was an extension of a previous study that examined emotional influence on spatial orientation. Results did not support our initial hypotheses. Subsequent analyses did provide some evidentiary support for some theories related to emotion and brain function. Additionally, patterns of subject performance were observed that support traditionally held theories of differential hemispheric function with regard to emotion and spatial behavior. These findings are discussed within the context of theories of emotion, spatial function, and disorders secondary to right hemisphere damage. / Doctor of Philosophy / This is a study examining the role of emotion and stress on the allocation of attention in the individual’s external environment. Further examined was the role that brain systems involved in attention, emotion, and spatial representation and the correlation with brain damage and syndromes that result in disruption to these systems. Conceptual difficulties regarding overlapping brain areas that contribute to different functions serve as the foundation for understanding both how these systems work and the behavioral manifestations of their dysfunction. Finally, further elucidating the role of these neural systems in contributing to self-awareness, emotion regulation, and the representation of external space was the ultimate objective of this study.

The purpose of this study was to explore the nature of reduced patient awareness of oropharyngeal dysphagia. While patient awareness of dysphagia has been explored in individuals before participating in formal swallowing assessments, no studies have been identified in the literature that have explored awareness after patients have participated in an examination and received information about their dysphagia. In addition, the relationship between patient compliance and reduced awareness, as well as the application of stages of change in this population were explored. Twenty-one inpatients and outpatients, newly diagnosed with oropharyngeal dysphagia, participated in this study. A retrospective analysis found that 40% of participants demonstrated reduced awareness of their dysphagia before participating in a videofluoroscopic swallowing examination. Reduced pre-examination awareness of dysphagia occurred most frequently in those with general medical diagnoses versus neurological or structural diagnoses. Reduced pre-examination awareness was not significantly associated with a reduced cough response following aspiration. Exploration of post-examination patient awareness of dysphagia, the primary intent of this study, revealed that 19% of patients demonstrated reduced awareness of their dysphagia, even after receiving specific verbal and visual information regarding their diagnosis. Reduced post-examination awareness of dysphagia occurred equally in those with structural and neurological diagnoses and was not noted in those with general medical diagnoses. Reduced post-examination awareness was not significantly associated with a reduced cough response following aspiration. Consistent with the literature on reduced patient awareness of deficit, patient awareness of dysphagia was modality specific. That is, some patients with reduced awareness of dysphagia demonstrated awareness of other deficits and vice versa. Overall, participants demonstrated more awareness of concomitant speech impairments than dysphagia and less awareness of concomitant cognitive impairments than dysphagia. No significant relationship between general cognitive impairment and reduced patient awareness of dysphagia was found. Exploration of diet compliance in inpatient participants revealed no instances of noncompliance, while hospitalized, from the day of the swallowing examination until the day of participation in the study. However, only 67% of these patients requested permissible foods or drinks when compliance was sampled during the study protocol, suggesting that inpatients with newly diagnosed dysphagia may be less compliant if restricted items become accessible. No significant relationship between patient awareness of dysphagia and diet compliance, as sampled during the study protocol, was found in both inpatients and outpatients. The relationships between patient awareness of dysphagia and patient compliance for both swallowing strategies and exercise regimens were also not significant, though these analyses were limited by the small number of participants who had been prescribed strategies and independent exercise programs at the time of their study participation. Lastly, analysis of the relationship between patient compliance and action or post-action stages of change, revealed no significant association between these variables.

Dissertação (mestrado)—Universidade de Brasília, Instituto de Psicologia, Departamento de Processos Psicológicos Básicos, Pós-Graduação em Ciências do Comportamento, 2014. / Submitted by Albânia Cézar de Melo (albania@bce.unb.br) on 2014-07-09T13:55:55Z No. of bitstreams: 1 2014_RicardoMendesGomesPereira.pdf: 1880374 bytes, checksum: 7bf4d96d3bc0f8bc213a9d1e9d08bbf8 (MD5) / Approved for entry into archive by Guimaraes Jacqueline(jacqueline.guimaraes@bce.unb.br) on 2014-07-09T14:36:59Z (GMT) No. of bitstreams: 1 2014_RicardoMendesGomesPereira.pdf: 1880374 bytes, checksum: 7bf4d96d3bc0f8bc213a9d1e9d08bbf8 (MD5) / Made available in DSpace on 2014-07-09T14:36:59Z (GMT). No. of bitstreams: 1 2014_RicardoMendesGomesPereira.pdf: 1880374 bytes, checksum: 7bf4d96d3bc0f8bc213a9d1e9d08bbf8 (MD5) / A demência de Alzheimer (DA) apresenta como um de seus sintomas a anosognosia, definida como um prejuízo da capacidade de o indivíduo julgar as alterações decorrentes da doença. Esse prejuízo é relacionado a diversos comprometimentos cognitivos e comportamentais e se relaciona a dificuldade na tomada de decisões sobre o tratamento, a adesão ao uso de medicamentos e pode limitar o engajamento a atividades de reabilitação. É apontada como tendo significativo impacto sobre a qualidade de vida dos cuidadores. O presente estudo avaliou o impacto da anosognosia relacionada à DA sobre a qualidade de vida (QV) de cuidadores, utilizando o método da detecção da anosognosia por meio da avaliação da discrepância entre as avaliações de pacientes e cuidadores. Foram avaliados 50 pares paciente-cuidador através do Exame Cognitivo de Addenbrooke, Questionário de Demência Ampliado e Escala de Qualidade de vida na DA (versão do cuidador), sendo observado que cuidadores de pacientes com sinais de anosognosia apresentavam menores escores na avaliação de qualidade de vida (p<0,01) e estes pacientes apresentavam pior quadro cognitivo (p<0,05). Escores de anosognosia e QV apresentaram correlação de -,849 (p<0,01), enquanto QV e quadro cognitivo apresentou correlação de ,613 (p<0,01). Tentando-se controlar o quadro cognitivo, observamos que a anosognosia apresenta maior impacto na QV em indivíduos com quadro cognitivo mais grave, mas esse impacto é observado em todos os grupos. Intervenções que visem diminuir o impacto da anosognosia poderiam influenciar positivamente a qualidade de vida de cuidadores, independente do quadro cognitivo em que o paciente se encontra. ______________________________________________________________________________ ABSTRACT / Alzheimer's disease (AD) has anosognosia as one of its symptoms, it is defined as a change in the individual's ability to judge their difficulties. It is related to several cognitive and behavioral impairments and it is linked to difficulty in making decisions regarding treatment, adherence to medication use and can limit rehabilitation activities engagement. It is observed as having a significant impact on quality of life of caregivers. The present study evaluated the impact of anosognosia related to AD in quality of life (QoL) of caregivers, using the detection of anosognosia method of evaluating the discrepancy between assessments of patients and caregivers. 50 patient - caregiver pairs were evaluated through the Addenbrooke's Cognitive Examination, Dementia Questionnaire - expanded and scale of quality of life in AD (caregiver version). It was observed that caregivers of patients with signs of anosognosia had lower scores on the QoL assessment (p < 0.01) and these patients had a worse cognitive potential (p < 0.05). Anosognosia and QoL scores were negatively correlated (-,849, p < 0.01 ) , while QoL and cognitive functioning presented correlation of ,613 ( p < .01 ) . Trying to control the cognitive functioning we observed that anosognosia has greater impact on QoL in individuals with more severe cognitive impairments but this impact appears in all groups. Interventions aimed at reducing the impact of anosognosia could influence the quality of life of caregivers, regardless of cognitive functioning of the patient.

Anosognosia for hemiplegia (AHP) is relatively common among patients who suffer from a stroke. It is characterized as a denial of bodily paralysis and the complexity of studying it is evident. Anosognosia is a neuropsychological deficit of self-awareness and most frequently associated with both cortical and subcortical lesions distributed within the right hemisphere, resulting in a left hemiplegia. The purpose of this review is to provide a comprehensive overview of AHP by presenting theoretical, clinical, and neural aspects. Different diagnostic procedures have attempted to clinically evaluate patients with AHP. The timing of assessment and the characteristic differences between these procedures are crucial factors to consider. Various theories regarding the underlying mechanisms of AHP are also discussed in this review, suggesting the cause of AHP from different perspectives. In order to confirm or disconfirm these theories, several studies are presented concerning the neural aspects, such as the frequency, related disorders, and anatomical correlates of AHP.

The primary purpose of this integrative review of the literature is to describe healthcare provider’s recognition of anosognosia in individuals with comorbid mental health disorders, as a differentiating diagnosis needing preeminent early intervention. The secondary purpose is to examine how anosognosia influences outcomes in the population of individuals with severe mental illness. It is expected that early recognition by clinicians and implementation of additional interventions to address anosognosia as the most influential comorbidity of schizophrenia, will decrease exacerbations and improve treatment and patient outcomes. A literature review exploring clinician’s acknowledgement of anosognosia was performed using various databases. Search terms included: Anosognosia, Lack of Insight, Denial of Illness, and Schizophrenia. The data was conformed into tables and synthesized the relationships to identify consistent findings as well as gaps in the current literature. Initial review of the articles retrieved 73 articles relevant to the topic and 18 articles that met inclusion criteria. The studies suggest that mental health conditions with anosognosia have increased rates of adverse outcomes. Anosognosia is a difficult disorder to identify. While many studies have explored the biological basis of anosognosia, the studies performed on safety with mental illness fail to acknowledge anosognosia as a co-morbid condition. Evaluation and clinical guidelines remain inconsistent with research to support the need for recognition of this co-morbidity.

Yes / Discrepancy scores reflecting the difference between parallel ratings made by people living with dementia (PwD) in the mild-to-moderate stages and by their informants provide a way to investigate awareness of functional ability in relation to activities of daily living (ADL). Methods: Two measures of ADL (Functional Activities Questionnaire; Dependence Scale) were completed by 1,227 PwD and their informants in the IDEAL cohort study baseline assessment. Self-rated and informant-rated scores were used to calculate discrepancies, which were used as an indicator of awareness of functional ability. Smaller discrepancy scores were considered to reflect greater awareness on the part of PwD. PwD completed questionnaires on depression, personality, comorbidities, neuropsychiatric symptoms, and completed a measure of cognition. Informants provided ratings of stress. Univariable and multiple regressions were used to investigate factors related to ADL discrepancy. Results: A similar pattern of associations were found for both ADL discrepancy scores. Smaller discrepancy scores were associated with higher levels of depression, higher neuroticism, fewer neuropsychiatric symptoms, higher comorbidity, lower carer stress, and receipt of less than 1 hour of care per day from the informant. Discussion/Conclusion: There was a clear pattern of factors that were associated with greater awareness for both measures of functional ability. These factors associated with smaller discrepancy scores could be used to identify PwD who might benefit from targeted interventions to support their independence. / Economic and Social Research Council (ESRC) and the National Institute for Health and Care Research (NIHR) grant ES/L001853/2; Alzheimer’s Society as a Centre of Excellence, grant number 348, AS-PR2-16-001

[pt] A falta de consciência da doença, também denominada anosognosia, é um sintoma comum da Doença de Alzheimer (DA). Sua estrutura funcional e seus mecanismos subjacentes, contudo, não são inteiramente compreendidos. O nível de consciência possui grande relevância para o sucesso do tratamento e para o fardo do cuidador. Outro fator de considerável impacto nas relações interpessoais e, portanto, no bem-estar dos pacientes e cuidadores, é o processamento emocional. A presente tese explora esses tópicos através de quatro artigos. No Artigo 1, utiliza-se a modelagem de equações estruturais (SEM, do inglês structural equation modeling) em uma grande amostra de pessoas com DA para investigar a natureza da relação entre função cognitiva, estado de humor e funcionalidade na previsão do nível de consciência da condição. Os resultados demonstraram que uma menor funcionalidade cognitiva e um maior nível de estado depressivo de humor influenciaram negativamente a capacidade dos pacientes de realizar atividades da vida cotidiana, o que, por sua vez, se mostrou associada a uma maior consciência da doença. O Artigo 2 investigou as origens executivas e mnemônicas da anosognosia na DA, utilizando uma tarefa de tempo de reação e medindo a consciência a respeito da performance na tarefa. Os dados demonstraram que o monitoramento online dos pacientes estava preservado, enquanto o monitoramento a médio e longo prazo esteve comprometido. Tal achado foi corroborado por resultados de dados eletrofisiológicos. Dessa forma, os resultados fortalecem as evidências favoráveis a uma natureza mnemônica, e não executiva, da anosognosia na DA, o que se mostra de acordo com o Cognitive Awareness Model (CAM). O Artigo 3 investigou a reatividade emocional a imagens negativas, auto-relevantes e neutras utilizando medidas de excitação e valência, gravações de expressões faciais e dados eletrofisiológicos. A reatividade emocional dos pacientes de DA foi similar à de jovens adultos, mas as respostas eletrofisiológicas foram elevadas quando comparadas às de idosos saudáveis, o que pode ser explicado por uma falta de mecanismos de controle cognitivo. A apatia esteve associada a menores respostas eletrofisiológicas a figuras negativas, e a consciência de prejuízos sociais se relacionou com maiores níveis de excitação em imagens auto-relevantes. Por sua vez, o Artigo 4 discutiu como a DA afeta as habilidades emocionais através de uma revisão de literatura sobre a empatia desses pacientes. Os aspectos afetivos da empatia deste grupo clínico estiveram relativamente preservados, enquanto foram apresentados déficits nos componentes cognitivos. Os prejuízos relacionados aos componentes afetivos foram principalmente atribuídos a um declínio cognitivo geral. Nossos achados ressaltam que diferentes fatores influenciam a consciência da doença na DA, enfatizando o papel de sintomas neuropsiquiátricos, do funcionamento cognitivo e das atividades da vida diária. Além disso, processos executivos pareceram estar preservados, ao passo que dificuldades em atualizar e consolidar esse conhecimento podem ser uma possível causa de anosognosia na DA. Ademais, sugerimos que as habilidades emocionais são amplamente preservadas em pacientes de DA. Tais resultados são de grande importância para a prática clínica. Pesquisas translacionais são necessárias para implementar os achados de pesquisas em abordagens terapêuticas específicas. / [en] Lack of awareness of condition, also termed anosognosia, is a common symptom in Alzheimer s disease (AD). However, its functional structure and underlying mechanisms are not fully understood. Level of awareness has great relevance for treatment success and caregiver burden. Another factor that has considerable impact on interpersonal relationships and thus on well-being of patients and caregivers is emotional processing. The current thesis explores these topics through four articles. In Article 1, structural equation modeling (SEM) was used in a large sample of people with AD (PwAD) to investigate the nature of the relationship between cognitive function, mood state, and functionality in predicting awareness. Results showed that lower cognitive function and higher level of depressive mood state negatively influenced PwAD s ability to perform daily living activities, which in turn were associated with better awareness. Article 2 investigated executive and mnemonic origins of anosognosia in AD, with a reaction time task being applied to examine awareness of task performance. The findings demonstrated that online monitoring was preserved, while medium- and long-term monitoring were impaired. This was supported by results from electrophysiological data. The results strengthen the evidence for a mnemonic rather than executive nature of anosognosia in PwAD in accordance with the Cognitive Awareness Model (CAM). Article 3 investigated emotional reactivity to negative, self-relevant, and neutral pictures using ratings of arousal and valence, facial expression recordings and electrophysiological data. Emotional reactivity of PwAD was similar to young adults, but electrophysiological responses were elevated compared to healthy older adults, which might be explained by a lack of cognitive control mechanisms. Apathy was associated with reduced electrophysiological responses for negative pictures, and awareness of social impairments was linked to higher arousal ratings of self-relevant pictures. Article 4 discussed how higher emotional abilities are affected by AD, through a review of the literature on empathy in this clinical group. PwAD showed a pattern of relatively preserved affective aspects and impairments in cognitive components of empathy, whereby impairments in affective components can mainly be attributed to a general cognitive decline. Our findings highlight that different factors influence awareness in AD, emphasizing the role of neuropsychiatric symptoms (NPS), cognitive functioning and activities of daily living. Moreover, executive processes seem to be preserved, whereas impairments in updating and consolidation of this knowledge seem to be a possible cause for anosognosia in AD. Furthermore, we suggested that emotional abilities are largely preserved in PwAD. Our results have great significance for clinical practice. Translational research is needed to implement research findings into specific therapeutic approaches.