Why do some people with Alzheimer’s disease lose awareness of their cognitive difficulties early and others remain aware even in the most advanced stages of the disease?
Why do they sometimes develop false beliefs and ideas of persecution while others never have these symptoms?
Is it possible that these symptoms have the same brain mechanisms?
From these questions was born UnaWireD – Anosognosia and delusions in the diseased brain, the clinical research funded by the European Research Council (ERC) which aims to understand the mechanisms of some symptoms, indicated as anosognosia (lack of awareness) and delusional ideas, present in various neurological diseases.
Many people affected by Alzheimer’s disease are convinced that they do not have any cognitive disorder. Others develop real delusions of persecution, theft or other delusional ideas. These patients are the most difficult to help because they do not trust those close to them, they refuse any help and any treatment, so much so that these symptoms become the cause of great suffering, both for the patient and for their family members.
What is UnaWireD?
UnaWireD is a clinical research that mainly involves people with a diagnosis of Alzheimer’s disease but also people with other neurodegenerative diseases such as, for example, Parkinson’s disease and Huntington’s disease, as well as their caregivers, the people who take care of of them. Furthermore, it also involves cognitively healthy people of similar age, gender, and education level to the recruited patients, who serve as a control group.
The recruited patients are asked to undergo neuropsychological evaluations (even repeated over time) and one or more brain magnetic resonance imaging. Caregivers are instead asked to answer questions regarding the behavior and personality of their loved one, also taking into consideration any changes compared to the past. Healthy controls are also asked to undergo a neuropsychological evaluation, several questionnaires, and a brain MRI.
Methods
The neuropsychological evaluation is an interview in which an examiner administers various tests to the patient (using pen and paper or computerized) to measure his/her performance in different cognitive domains such as memory, language, and attention.
Brain MRI is usually used to measure atrophy, or the loss of brain cells, in different areas of the brain. Through advanced methodologies used in UnaWireD, resonance can also be used to visualize the functioning of the brain, its circuits, or cerebral “networks”, both at rest and during the execution of tasks.
Objectives
Through these procedures, UnaWireD aims to demonstrate whether the development of complex symptoms such as anosognosia and delusions depends on how people have used and shaped their brain throughout life, on their personality and habits, as well as on which connections brains have strengthened rather than weakened, well before developing the disease itself.
This will allow the UnaWireD Team to identify behavioral strategies to prevent the occurrence of these symptoms. A further objective is also to identify if there is a specific neurotransmitter underlying these symptoms, in order to modulate it pharmacologically and treat anosognosia and delusions.
