Awareness of Memory Loss 
Declines Before Dementia Onset

“These observations suggest that unawareness of amnestic dysfunction is part of the natural history of late-life dementia and is driven by accumulation of dementia-related pathologies,” said Dr. Wilson. Unawareness of memory impairment typically becomes apparent at the time of dementia diagnosis and may require a history of cognitive decline to be based on expert judgment or a knowledgeable informant, rather than self-report.

One of the study’s strengths, according to the investigators, was that participants were followed at regular intervals for several years and participated in follow-up and brain autopsy at high rates, which minimized the likelihood that selective attrition affected the results. The focus on persons who were cognitively healthy at baseline and later developed dementia enabled the researchers to link the development of memory awareness to the natural history of dementia. The primary limitation, according to the authors, is that participants were selected, which entails that the results need to be replicated in other cohorts. “The extent to which these findings apply to awareness of other dementia signs is also uncertain,” Dr. Wilson concluded.

—Erik Greb