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Determining Levels of Unawareness in Dementia Research

Received May 21, 2001; revised September 13, 2001; accepted September 18, 2001. From the Neuropsychology Program, Drexel University, Philadelphia, Pennsylvania, and Neuropsychology Service, Crozer Chester Medical Center, Upland, Pennsylvania (M.L., D.J.L.); Center for Research on Occupational and Environmental Toxicology, Oregon Health Sciences University, Portland, Oregon (M.R.L.); and Department of Psychiatry MCP/Hahnemann, Philadelphia (D.J.L.). Address correspondence to Dr. Lamar, National Institute on Aging, NIH, Laboratory of Personality and Cognition, GRC, 5600 Nathan Shock Blvd., Baltimore, MD 21224. E-mail: lamarm{at}lpc.grc.nia.nih.gov

Clinical methods used to determine unawareness in dementia exist; however, their applicability to empirical research is limited. The authors present a statistically derived approach to determining unawareness that addresses these limitations. Dementia patients (n=32) completed an awareness questionnaire. On an identical questionnaire, collateral sources (relatives or friends; n=32) provided their best estimate of participants' abilities. The authors compared cluster analysis, the proposed empirical approach, to a currently used standard deviation cutoff score approach. Cluster analysis included all participants, displayed sound statistical properties, and was more sensitive to between-group differences in psychotic symptoms than standard deviation cutoff. Cluster analysis appears more appropriate for understanding the overall spectrum of unawareness in dementia research.

Key Words: Dementia • Anosognosia • Research

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