A-66: The Risk of Anosognosia: Insight Deficits Predict and Moderate Dementia Conversion in Mild Cognitive Impairment

Abstract

Objective: Anosognosia, or reduced awareness of one's cognitive difficulties, may differentiate mild cognitive impairment (MCI) presentations and predict dementia conversion. This study examined whether anosognosia predicted MCI-to-dementia conversion above and beyond cognitive performance and whether it moderated the relationship between cognitive performance and conversion. Method/Data Selection: 55 patients diagnosed with MCI at a memory clinic completed follow-up evaluations with complete caregiver data. 23.6% converted to dementia during repeat evaluation (mean interval = 27.1 months). Anosognosia was operationalized as the difference between caregiver- and self-rated AD8 Dementia Screening Interview (AD8) scores. Hierarchical logistic regression examined baseline Montreal Cognitive Assessment (MoCA) performance, AD8 discrepancy, and their interaction as predictors of conversion, controlling for age. Results/Data Synthesis: Age did not predict conversion (p=.916). MoCA predicted conversion (OR=0.682, 95% CI [0.502, 0.926], p=.014). AD8 discrepancy (OR=2.271, 95% CI [1.313, 3.929], p=.003) predicted conversion above and beyond MoCA. A significant MoCA × AD8 discrepancy interaction indicated that the predictive effect of insight deficits on conversion strengthened at higher MoCA scores (OR=1.141, 95% CI [1.023, 1.272], p=.017). The final model explained 45% of variance (Nagelkerke R2=.451). Conclusions: Anosognosia predicted conversion beyond cognitive performance and moderated its protective effect, suggesting that MoCA scores alone may underestimate risk, particularly when insight deficits are present. Brief informant-based insight measures may be a practical addition to prognostic screening, especially in patients with relatively intact MoCA scores. Given the modest sample size, replication in larger samples is needed before routine clinical application.