Insight and MCI?

[futureapppsy2]

Hi, neuropsych folk,

How common is insight into MCI? Context: female patient in her mid-80s, increasing memory issues over the past few years. She frequently refers to "before I lost my memory..." or "when I could remember things..." To my understanding, insight in dementia isn't typically common, but am I wrong and/or is MCI a different game with regards to insight?

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[AcronymAllergy]

Can really vary depending on the individual and etiology. In general, you're less likely to observe insight in many neurodegenerative processes, particularly Alzheimer's. With vascular, TBI, toxic/metabolic, and other etiologies, it can be mixed. There's also a correlation between memory complaints and affective distress (particularly depression), and what you're describing is something I'll often see/hear in depressed patients. Conversely, there's typically little to no correlation between objective memory performance and subjective memory complaints. But at the same time, memory complaints and depressed mood correlate with things like white matter changes, so new onset of anxiety or depression late in life can be a symptom of neurocognitive disease.

 

[futureapppsy2]

Can really vary depending on the individual and etiology. In general, you're less likely to observe insight in many neurodegenerative processes, particularly Alzheimer's. With vascular, TBI, toxic/metabolic, and other etiologies, it can be mixed. There's also a correlation between memory complaints and affective distress (particularly depression), and what you're describing is something I'll often see/hear in depressed patients. Conversely, there's typically little to no correlation between objective memory performance and subjective memory complaints. But at the same time, memory complaints and depressed mood correlate with things like white matter changes, so new onset of anxiety or depression late in life can be a symptom of neurocognitive disease.

Thanks. It definitely appears to be “true” MCI (periodically forgetting who her children are, etc).

 

[PsyDr]

Dependent on location and degree of pathology. Trends towards more anxiety than confabulation.

 

[WisNeuro]

Given age, a more typical progression. I see insight in the early stages, but it can sometimes be "explained away." As mentioned by others, the anxiety and comments about "losing memory" are also very common in the worried well. Longer time recalling names in and of itself not necessarily dementia. Worth a referral to at least get a baseline and see if anything else is present.

 

[Sanman]

Agreed with the others that self-report and objective measures are unlikely to be related. What is the person's level of functioning with regard to IADLs? Is the person still working? I tend to see a lot of over-reporting among the highest functioning adults who tend to be responding to normal declines in cognition as result of aging and a mismatch in their personal schedules (still working or sitting on boards, caring for an ailing spouse, supporting children, etc) and accompanying mood symptoms. I tend to see under-reporting in lower educational levels where children have taken over IADLs and no one notices them missing bills, appts, etc. Given the base rates for MCI in that age range, definitely worth at least a screening and maybe a referral.