The construction of awareness in early-stage Alzheimer's disease: A review of concepts and models

Objectives. This review considers the concepts and models that, often implicitly, underlie accounts and studies of variations in awareness of difficulties in people with early-stage Alzheimer's disease (AD). In order to do this, it is necessary to draw on explanations presented within the discourses of different disciplines. The review aims to explore the key tensions and debates that arise in attempting to conceptualize awareness, and attempts to specify what kind of conceptual framework is needed in order to advance our understanding of variations in awareness in AD. Methods. A range of literature relating to concepts and models of awareness, drawn from different disciplines and published during the past 30 years, is critically reviewed. Results. The literatures of different disciplines present varying constructions of the concept of awareness. Neuropsychological, psychiatric and psychosocial explanations are considered and their relevance to understanding awareness in early-stage AD is discussed. Conclusions. An understanding of variations in awareness in early-stage AD requires a biopsychosocial model of awareness that incorporates the influence of both neuropsychological impairments and psychosocial responses. Improved understanding of variations in awareness is essential for the development of person-centred approaches to intervention and care in AD.