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Am J Psychiatry 1993; 150:748-751
Copyright © 1993 by American Psychiatric Association
Denial of memory deficit in Alzheimer's disease
S Sevush and N Leve
Department of Psychiatry, University of Miami School of Medicine, FL 33136.
OBJECTIVE: Patients with probable Alzheimer's disease often deny or
underestimate the severity of their memory impairment. The authors examined
the relationships between denial and severity of cognitive impairment and
between denial and the presence of depressed mood and sad affect in 128
patients with probable Alzheimer's disease. METHOD: Denial of memory
deficit was evaluated by structured interview. Cognition was evaluated with
a quantitative examination that assessed performance on 16 subtests.
Depression was rated by using a scale that included patients' self-ratings
as well as caregivers' and examiners' assessments of the patient's mood and
affect. Pearson correlation coefficients were used to quantify the
relationship between denial and demographic, cognitive, and depression
variables. Stepwise multiple regression analysis was used to further
examine the relationship between denial and individual cognitive subset
scores. RESULTS: Denial did not correlate with age at onset of Alzheimer's
disease, duration of illness, or educational background. It did correlate
with gender: women exhibited greater denial than men. A significant
correlation was found between denial and overall severity of cognitive
deficit and particularly with impairment in object naming. A negative
correlation was found between denial and depression. CONCLUSIONS: The
association between denial and cognitive impairment may suggest that denial
of probable Alzheimer's disease results from disruption of cognitive
abilities needed for awareness of illness. The negative association between
denial and depression may suggest that depression in Alzheimer's disease is
in part reactive in nature.
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