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Published on: January 24, 2020
Error unawareness as a driver of cognitive decline in individuals at risk for Alzheimer's disease
Katia Andrade1,2, François-Xavier Lejeune3, Nesma Houmani4
1Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France. katia.santosandrade@gmail.com.
Abstract:
Anosognosia, or unawareness of one's deficits, predicts faster clinical progression in Alzheimer's disease (AD), though its mechanisms remain unclear. We investigated five-year trajectories of response awareness and error-monitoring efficiency using second-order judgments from an annual word recognition memory task in cognitively unimpaired individuals at risk for AD from the INSIGHT-preAD cohort. Participants were divided into three groups according to amyloid status at baseline (positive, A + ; negative, A-) and clinical progression (controls, CTRL A+ or A-; and progressors, PROG). Task accuracy declined in PROG, while CTRL A+ showed continued learning, and CTRL A- remained accurate. Inefficient error-monitoring predicted subsequent performance decline in the PROG, with a strong interaction between accuracy and error-monitoring already at baseline. This effect was primarily driven by error unawareness. These findings provide first evidence that error unawareness - a core feature of anosognosia - may foster cognitive decline through the disruption of error-feedback learning mechanisms, potentially accelerating AD progression.
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