Work

Additive effect of patient anosognosia and theory of mind deficit on dementia caregiver distress

Year: 2026

Type: article

Abstract: Introduction: Caregiver distress in dementia is multifactorial. The contribution of disease specific factors including anosognosia (poor awareness of cognitive/behavioral deficits) and theory of mind (ToM) deficit (difficulty with understanding other's perspective) requires further investigation. Method: Cross sectional secondary analysis was performed on a dataset of 205 research participants (age = 64.2 ± 9.46): 57 Alzheimer's disease, 38 behavioral variant frontotemporal dementia, 12 non-fluent primary progressive aphasia (PPA), 24 semantic variant PPA, 18 progressive supranuclear palsy syndrome, 14 corticobasal syndrome, and 42 cognitively normal controls (NC). Anosognosia was measured using the Patient Competency Rating Scale (PCRS-self minus PCRS-caregiver; clinically meaningful anosognosia >20 points difference), ToM deficit was evaluated using The Awareness of Social Inference Test: Social Inference-Enriched (TASIT-SIE), and caregiver distress was measured using the Neuropsychiatric Inventory Questionnaire (NPI-Q) Total Distress score. Differences across syndromes were evaluated controlling for age and sex, and multivariable linear regression was used to determine predictors of caregiver distress. Results: < 0.05). Discussion: Our findings are consistent with other research showing that anosognosia in individuals with chronic neurological disorders including dementia can increase caregiver distress; however, our results highlight the additive importance of patients' theory of mind deficits above and beyond their anosognosia. Evaluation of both patient anosognosia and ToM deficit in clinical contexts may provide meaningful information to predict which caregivers are at particular risk for adverse outcomes.

Source: Frontiers in Neurology

DOI: 10.3389/fneur.2026.1724172