Abnormal Face-hand Testing is Associated with Anosognosia in Patients with Neuropathologically-confirmed Alzheimer's disease

We investigated elements of the neurological and neuropsychological evaluation that might be associated with anosognosia for memory impairment in subjects with Alzheimer’s disease. Anosognosia was defined by a discrepancy between 1) the patient’s self-report and results of testing, and/or 2) the patient’s self-report and the caregiver’s report regarding memory impairment. A total of 61 subjects were included, 34 with anosognosia and 27 without anosognosia. The anosognosic group performed worse on two tests of frontal systems function letter fluency (COWAT) (p=0.010) and a score derived from the Trailmaking test (Trailmaking B time – Trailmaking A time) (p=0.015). In addition, significantly more anosognosic subjects (92%) had abnormal results on face-hand testing (double simultaneous stimulation) compared to non-anosognosic subjects (62% abnormal; p=0.018). In this study of patients with moderate Alzheimer’s disease (mean CDR=2), the anosognosic group showed significantly greater impairment on tests of frontal/executive function. In addition, this group had a significantly higher rate of abnormal face-hand testing, consistent with right parietal pathology. The FHT may prove useful as a marker for anosognosia risk in AD. Discussion and Conclusions