DENIAL UNAWARENESS OF IMPAIRMENT AND SYMBOLIC BEHAVIOR IN ALZHEIMERS-DISEASE

Disease features in Alzheimer's disease patients with and without deni al of their disease status, were contrasted in a three year longitudin al follow-up study, inpatient and outpatient departments, Clinical Cen ter, and the NIH. Twenty-one patients with AD who denied or appeared u naware of impairment were compared to 20 who acknowledged deficits. Th e groups were not differentiated by severity or duration of disease, b ut denial/unawareness was significantly associated with confabulation, reduplicative delusions and misidentifications, and symbolic or delus ional environmental disorientation. It also occurred significantly mor e often when the initial manifestations were of memory loss and behavi oral disturbance suggestive of frontal and paralimbic involvement, tha n with deficits in reading, writing, calculations and visuospatial ori entation indicative of predominant posterior brain involvement. We con cluded denial/unawareness is distinguished from loss of insight by lac k of correlation with severity of dementia, and by its adaptive symbol ic features.