Antecedents and Consequences of Unawareness of Memory Impairment in Dementia

Robert S. Wilson, Lisa L. Barnes, Kumar B. Rajan, Patricia A. Boyle, Joel Sytsma, Jennifer Weuve, Denis A. Evans

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective: To assess the prevalence, antecedents, and consequences of unawareness of memory impairment in dementia. Method: Persons (n = 1,862) from a geographically defined community without dementia at enrollment subsequently underwent clinical classification (248 with dementia, 611 with mild cognitive impairment, 1,003 with no cognitive impairment), memory testing, and self-appraisal of memory. Memory performance was regressed on self-appraised memory, and the residuals served as an index of memory awareness. After clinical classification, participants completed brief cognitive testing at 3-year intervals for up to 15 years. Results: When unawareness was defined as a score at or below thresholds ranging from the 15th to 25th percentiles, it was more common in dementia (67%-83%) and mild cognitive impairment (15%-33%) than in no cognitive impairment (2%-6%; all p < .001). A continuous measure of awareness (M = 0.00, SD = 0.61) was reduced by 0.37-unit in mild cognitive impairment (SE = 0.04, p < .001) and 1.04-unit in dementia (SE = 0.06), p < .001) compared with those without cognitive impairment, and these associations were weaker in Black persons than White persons (estimate for dementia by race = 0.37, SE = 0.12, p = .003; estimate for mild cognitive impairment by race = 0.30, SE = 0.08, p < .001). Higher premorbid neuroticism was associated with better memory awareness in dementia. Higher memory awareness was not related to mortality in mild cognitive impairment or dementia but had a marginal association with slower cognitive decline in mild cognitive impairment. Conclusions: Unawareness of memory impairment is a common manifestation of dementia, particularly in White persons, but is not strongly related to adverse disease outcomes.

Original languageEnglish (US)
StateAccepted/In press - Jul 26 2018


  • Anosognosia
  • Cognitive decline
  • Dementia
  • Mortality, neuroticism

ASJC Scopus subject areas

  • Neuropsychology and Physiological Psychology


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