Awareness in early-stage Alzheimer's disease: A review of methods and evidence

Purpose. This review has three main aims: (1) To illustrate the strengths and limitations of current approaches to assessing awareness of difficulties and impairments in people with early-stage Alzheimer's disease (AD). (2) To consider the evidence regarding factors associated with level of awareness. (3) To highlight the implications for assessment and intervention. Methods. A comprehensive range of literature on awareness in AD published in the past 20 years is critically reviewed. Results. Four main approaches to the assessment of awareness can be discerned, each with significant conceptual and methodological limitations. These limitations affect the quality of the available evidence regarding factors associated with level of awareness, which is contradictory, with few clear findings emerging. Awareness does, however, appear to be related to the outcome of rehabilitation, and this has important implications for the selection of appropriate and sensitive interventions. Conclusions. The review highlights the need for a broad conceptualization of awareness. Greater clarity about theoretical frameworks, and improved assessment methods, are required in order to enhance understanding of variations in awareness in early-stage AD. Awareness is an important variable for clinicians to consider.