Brain regions associated with anosognosia for memory disturbance in Alzheimer’s disease: a magnetic resonance imaging study

BACKGROUND AND OBJECTIVE: Patients with Alzheimer’s disease (AD) are frequently unaware of their cognitive symptoms and medical diagnosis. The term “anosognosia” is used to indicate a general lack of awareness of one’s disease or disorder. The neural substrate underlying anosognosia in AD is unclear. Since anosognosia for memory disturbance might be an initial sign of AD, it is important to determine the neural correlates. This study was designed to investigate the characteristics and neural correlates of anosognosia for memory disturbance in patients with mild AD. METHODS: The subjects were 49 patients with mild AD who participated in a retrospective cross-sectional study. None of the patients had been treated with cholinesterase inhibitors, memantine, or psychotropic drugs. All patients underwent magnetic resonance imaging (MRI). Anosognosia for memory disturbance was assessed based on the discrepancy between questionnaire scores of patients and their caregivers. Structural MRI data were analyzed to explore the association between anosognosia and brain atrophy, using a voxel-based approach. Statistical parametric mapping software was used to explore neural correlations. In image analysis, multiple regression analysis was performed to examine the relationship between anosognosia score and regional gray matter volume. Age, years of education, and total intracranial volume were entered as covariates. RESULTS: The anosognosia score for memory disturbance was significantly negatively correlated with gray matter volume in the left superior frontal gyrus. CONCLUSION: The left superior frontal gyrus was involved in anosognosia for memory disturbance, while the medial temporal lobe, which is usually damaged in mild AD, was not associated with anosognosia. The left superior frontal gyrus might be an important region for anosognosia in mild AD.