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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(04): 334-342
DOI: 10.1590/0004-282X-ANP-2020-0247
VIEW AND REVIEW

Anosognosia in dementia with Lewy bodies: a systematic review

Anosognosia na demência com corpos de Lewy: uma revisão sistemática
Victor CALIL 
1   Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro RJ, Brazil.
2   Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Programa de Pós-Graduação em Clínica Médica, Rio de Janeiro RJ, Brazil.
,
Felipe Kenji SUDO 
1   Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro RJ, Brazil.
,
Gustavo SANTIAGO-BRAVO 
1   Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro RJ, Brazil.
,
Marco Antonio LIMA 
2   Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Programa de Pós-Graduação em Clínica Médica, Rio de Janeiro RJ, Brazil.
3   Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Departamento de Neurologia, Rio de Janeiro RJ, Brazil.
4   Fundação Oswaldo Cruz, Rio de Janeiro RJ, Brazil.
,
Paulo MATTOS 
1   Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro RJ, Brazil.
5   Universidade Federal do Rio de Janeiro, Instituto de Ciências Biomédicas, Programa de Ciências Morfológicas, Rio de Janeiro RJ, Brazil.
6   Universidade Federal do Rio de Janeiro, Instituto de Psiquiatria, Rio de Janeiro RJ, Brazil.
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ABSTRACT

Background: Anosognosia, i.e. lack of awareness of one’s own symptoms, is a very common finding in patients with dementia and is related to neuropsychiatric symptoms and worse prognosis. Although dementia with Lewy bodies (DLB) is the second most common form of degenerative dementia, literature on anosognosia in this disease is scarce. Objectives: This paper aimed to review the current evidence on anosognosia in patients with DLB, including its prevalence in comparison with other neurological conditions, its severity and anatomical correlations. Methods: Database searches were performed in PubMed, Web of Knowledge and PsycINFO for articles assessing anosognosia in DLB. A total of 243 studies were retrieved, but only six were included in the review. Results: Potential risk of selection, comparison or outcome biases were detected in relation to all the studies selected. Most of the studies used self-report memory questionnaires to assess cognitive complaints and compared their results to scores from informant-based instruments or to participants’ cognitive performance in neuropsychological tasks. Subjects with DLB had worse awareness regarding memory than healthy older controls, but the results concerning differences in anosognosia between DLB and Alzheimer’s disease (AD) patients were inconsistent across studies. Presence of AD pathology and neuroimaging biomarkers appeared to increase the prevalence of anosognosia in individuals with DLB. Conclusion: Anosognosia is a common manifestation of DLB, but it is not clear how its prevalence and severity compare with AD. Co-existence of AD pathology seems to play a role in memory deficit awareness in DLB.

RESUMO

Introdução: Anosognosia, i.e. a perda da consciência dos próprios sintomas, é um achado muito comum em pacientes com demência e está relacionada a sintomas neuropsiquiátricos e a pior prognóstico. Embora a doença por Corpos de Lewy (DCL) seja a segunda demência degenerativa mais comum, há pouca evidência sobre anosognosia nessa doença. Objetivos: Este artigo teve como objetivo revisar a evidência disponível sobre anosognosia em pacientes com DCL, incluindo sua prevalência em comparação a outras condições neurológicas, gravidade e correlações anatômicas. Métodos: Foram feitas buscas nos bancos de dados PubMed, Web of Knowledge e PsycINFO por artigos que avaliassem anosognosia na DCL. Um total de 243 estudos foi encontrado, mas apenas 6 foram incluídos nesta revisão. Resultados: Potenciais riscos de viés de seleção, comparação ou resultado foram encontrados em todos os estudos selecionados. A maior parte dos estudos utilizou questionários de memória preenchidos pelo próprio paciente e os comparou a resultados de instrumentos preenchidos por informantes ou à performance cognitiva em tarefas neuropsicológicas. Indivíduos com DCL têm pior consciencia de memória do que idosos saudáveis, mas os resultados tocantes à diferença de anosognosia entre DCL e doença de Alzheimer (DA) são inconsistentes entre estudos. A presença de achados patológicos e de neuroimagem de DA parece aumentar a prevalência de anosognosia entre pacientes com DCL. Conclusão: Anosognosia é uma manifestação comum da DCL, mas não é possível afirmar como sua prevalência e gravidade se comparam à DA. A coexistência de achados patológicos de DA parece influenciar a consciência de déficits de memória na DCL.

Keywords:

Lewy Body Disease - Dementia - Metacognition

Palavras-chave:

Doença por Corpos de Lewy - Demência - Metacognição

Authors’ contribution:

VC: formulated the question of the study, selected the articles, analyzed the data and wrote the paper. FKS: supervised the selection of articles and data analysis and wrote the paper. GSB: selected the articles and helped with data analysis. MAL: supervised the data analysis and assisted with writing the paper. PM: supervised the data analysis and assisted with writing the paper.




Publikationsverlauf

Eingereicht: 28. Mai 2020

Angenommen: 30. Juli 2020

Artikel online veröffentlicht:
01. Juni 2023

© 2021. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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