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Clinical Manifestations.

Manuela Tondelli1, Daniela Ballotta1, Riccardo Maramotti1,2,3

  • 1Università di Modena e Reggio Emilia, Modena, Italy.

Alzheimer'S & Dementia : the Journal of the Alzheimer'S Association
|December 25, 2025
PubMed
Summary
This summary is machine-generated.

Alzheimer's disease awareness is linked to brain network function. Hyperaware individuals show altered Default-Mode Network connectivity, while unaware individuals exhibit changes in Salience and Fronto-Parietal Networks.

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Area of Science:

  • Neuroscience
  • Cognitive Science

Background:

  • Anosognosia in Alzheimer's disease (AD) is linked to dysregulation in the Default-Mode (DMN), Salience (SN), and Fronto-Parietal (FPN) networks.
  • Investigating the trajectory of this functional connectivity dysregulation across the awareness spectrum (hypernosognosia to anosognosia) is crucial.

Purpose of the Study:

  • To examine how functional connectivity within the DMN, SN, and FPN differs across varying levels of awareness in patients with mild cognitive impairment and AD dementia.
  • To determine if specific network connectivity patterns correlate with hypernosognosia, normal awareness, or anosognosia.

Main Methods:

  • Sixty patients with mild cognitive impairment (MCI) and AD dementia underwent functional MRI (fMRI) and neuropsychological testing.
  • Participants were categorized into hyperaware (hyAW), unaware (uAW), and aware (AW) groups based on Anosognosia Questionnaire for Dementia (AQ-D) discrepancy scores.
  • Resting-state fMRI data were analyzed using Independent Component Analysis (ICA) to assess functional connectivity within the DMN, SN, and FPN.

Main Results:

  • Hyperaware (hyAW) subjects showed increased DMN connectivity in the posterior cingulate cortex and midcingulate cortex.
  • Unaware (uAW) subjects displayed heightened SN connectivity in the anterior cingulate cortex, anterior insula, and basal ganglia compared to aware groups.
  • Unaware (uAW) subjects also demonstrated enhanced FPN connectivity in the inferior frontal gyrus compared to hyperaware subjects.

Conclusions:

  • Awareness levels in Alzheimer's disease are associated with distinct functional connectivity patterns in the DMN, SN, and FPN.
  • Network recruitment follows a gradient across the awareness spectrum, offering insights into the neural basis of awareness deficits in AD.