Event Abstract

Self-awareness of cognitive and driving ability in patients with Mild Cognitive Impairment, Alzheimer’s disease and healthy elderly

  • 1 Medical School University of Athens, Greece
  • 2 National and Kapodistrian University of Athens, Department of Transportation Planning and Engineering, Greece

Introduction Self-assessment describes an inherent ability to monitor and evaluate subjectively performance with relatively objective terms. Mild Cognitive Impairment (MCI) is thought to be the transitional stage between normal aging and Alzheimer’s disease (AD) (McKhann et al., 2011). Studies examining the self-awareness of patients with MCI regarding their cognitive and functional limitations have not yet drawn definite conclusions (Tremont & Alosco, 2011). Impaired self-awareness in the MCI is generally considered to share common ground with impaired self-awareness observed in patients with AD but with a milder and less prominent phenotype (Orfei et al. 2010). In the latter, impaired self-awareness seems to associate with disease severity where individuals with greater levels of cognitive impairment exhibit more conspicuous signs of anosognosia (Kazui et al. 2006; Barrett et al., 2005). What is more, self-awareness seems to differentiate in the specific population across cognitive and functional domains (Clare et al., 2005; Okonkwo et al., 2009). Driving is one of the most common yet complex functional activities. In the elderly population, where driving fitness decreases, self-assessment of driving ability is a key component for the proper adjustment of driving habits (Devlin et al., 2014). Although the majority of patients with MCI or AD voluntarily limit or cease driving (Man-Son-Hing et al., 2007), several of them continue to drive (Wong et al., 2012). According to current research, those individuals who continue driving tend to overestimate their driving abilities (Okonkwo et al., 2009; Brown et al., 2005) and are less likely to regulate their driving behavior (Wong et al., 2012). Aims: Aim of the present study was to investigate self-awareness patterns in patients with MCI and mild AD both under neuropsychological testing and under a simulator driving evaluation. Methodology: The current study included twenty-nine patients with amnestic MCI (Age=67.5±7.5, Driving experience= 40.7±5.4), 16 patients with mild AD (Age=73.6±5.1, Driving experience= 45.8±6.9) and 24 healthy elderly drivers (Age=61.8±8.1, Driving experience= 45.8±6.9). In order to participate in the study, they should all be active and regular drivers, have a score in the Clinical Dementia Rating Scale (CDR) ≤ 0.5 for the MCI and ≤1 for the AD patients, along with the absence of any significant psychiatric illness or any significant motor or visual impairment. Participants underwent a detailed neurological and neuropsychological examination as well as a 45 min. driving simulator experiment in a rural driving environment without any distractors. After both assessment conditions, they were asked to self -evaluate their performance by comparing it to what they considered as average for people of their age and educational level. This self-evaluation was reported on a scale ranging from -100 to +100, where the number 0 (zero) indicated average performance and the extreme values (-100/+100) indicated a strikingly better or worse performance in comparison to the mean average performance. In the case of the neuropsychological assessment, participants were asked to self-evaluate their performance after every neuropsychological test while in the case of the driving simulator, participants were asked to self-evaluate their performance after the driving assessment on specific variables, namely average speed, lateral position, headway distance, reaction time and steer wheel variation. Results According to our results, MCI and AD patients presented significant discrepancies in their self-evaluation abilities in both conditions examined. Such a discrepancy was more prominent in the AD group indicating in comparison to the other groups examined. As regards the neuropsychological condition, both clinical groups seemed to overestimate their performance in every neuropsychological test examined in contrast to the control group who underestimated their performance. As regards the driving condition, a similar pattern seemed to be present. More specifically, MCI patients presented inaccurate estimations in three driving variables (speed, headway distance and reaction time) while AD patients presented inaccurate estimation in four of the driving variables examined (speed, lateral position, headway distance and reaction time). Discussion The current findings indicate that a certain degree of impaired self-awareness arises even at the milder stages of cognitive impairment for cognitive and functional abilities. However, the impaired ability to monitor and evaluate performance seems to be more prominent in certain conditions than others. More specifically, cognitively impaired patients seem to exhibit greater difficulties in evaluating their performance under the unfamiliar and novel situation of a formal neuropsychological assessment where they receive minimal cues as regards their optimal performance. On the other hand, as regards driving, which is a condition they have been familiarized with over the years, they seem more prone to evaluate at a certain degree their performance. However, a specific difficulty in accurately evaluating their performance also arises and worsens as the level of cognitive impairment increases. Such findings support the notion that impaired self-awareness may indeed be a clinical characteristic of an AD pathology which can be present even at the milder stages of the disease and should be taken under consideration during a medical evaluation.


The current research was carried out within the framework of the Operational Program "Education and Lifelong Learning" of the National Strategic Reference Framework (NSRF), namely the Research Funding Program: THALES. Investing in knowledge society through the European Social Fund, and the Action: ARISTEIA (Action’s Beneficiary: General Secretariat for Research and Technology), co-financed by the European Union (European Social Fund -ESF) and Greek national funds.



Barrett, A.M., Eslinger, P.J., Ballentine, N.H., Heilman, K.M. (2005). Unawareness of cognitive deficit (cognitive anosognosia) in probable AD and control subjects. Neurology. 64:4, 693-699. doi: http://dx.doi.org/10.1212/01.WNL.0000151959.64379.1B

Brown L.B, Ott B.R., Papandonatos G.D., Sui Y., Ready R.E., Morris J.C. (2005). Prediction of On Road Driving Performance in Patients with Early Alzheimer's Disease. J Am Geriatr Soc. 53:1, 94-98. doi: 10.1111/j.1532-5415.2005.53017.x

Clare, L., Marková, I., Verhey, F., Kenny, G. (2005). Awareness in dementia: A review of assessment methods and measures. Aging Ment Health. 9:5, 394-413. doi: 10.1080/13607860500142903

Devlin, A., & McGillivray, J.A. (2014). Self‐regulation of older drivers with cognitive impairment: A systematic review. Australas J Ageing. 33:2, 74-80. doi: 10.1111/ajag.12061

Kazui, H., Hirono, N., Hashimoto, M., Nakano, Y., Matsumoto, K., Takatsuki, Y et al. (2006). Symptoms underlying unawareness of memory impairment in patients with mild Alzheimer’s disease. J Geriatr Psychiatry Neurol. 19:1, 3-12. doi: 10.1177/0891988705277543

Man-Son-Hing M, Marshall S, Molnar F, Wilson K. (2007). Systematic review of driving risk and the efficacy of compensatory strategies in persons with dementia. J Am Geriatr Soc. 55:6. 878– 884. doi: 10.1111/j.1532-5415.2007.01177.x

McKhann, G.M., Knopman, D.S., Chertkow, H., Hyman, B.T., Jack, C.R., Kawas, C.H. et al. (2011). The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 7:3, 263-269. doi: http://dx.doi.org/10.1016/j.jalz.2011.03.005

Okonkwo, O.C., Griffith, H.R., Vance, D.E., Marson, D.C., Ball, K.K., Wadley, V. G. (2009). Awareness of functional difficulties in mild cognitive impairment: a multidomain assessment approach. J Am Geriatr Soc. 57:6. 978-984. doi: 10.1111/j.1532-5415.2009.02261.x

Orfei, M.D., Blundo, C., Celia, E., Casini, A.R., Caltagirone, C., Spalletta, G., et al. (2010). Anosognosia in mild cognitive impairment and mild Alzheimer's disease: frequency and neuropsychological correlates. Am J Geriatr Psychiatry. 18:12, 1133-1140. doi: 10.1097/JGP.0b013e3181dd1c50

Tremont, G., and Alosco, M.L. (2011). Relationship between cognition and awareness of deficit in mild cognitive impairment. Int J Geriatr Psychiatry. 26:3, 299-306. doi:10.1002/gps.2529

Wong I, Smith S, Sullivan K. (2012). The relationship between cognitive ability, insight and self-regulatory behaviors: Findings from the older driver population. Accid Anal Prev. 49, 316–321. doi:10.1016/j.aap.2012.05.031

Keywords: self-awareness, anosognosia, driving, Mild Cognitive Impairment, Alzheimer Disease, driving simulator

Conference: SAN2016 Meeting, Corfu, Greece, 6 Oct - 9 Oct, 2016.

Presentation Type: Poster Presentation in SAN2016 Conference

Topic: Posters

Citation: Fragkiadaki S, Beratis IN, Kontaxopoulou D, Papadimitriou E, Andronas N, Yannis G and Papageorgiou SG (2016). Self-awareness of cognitive and driving ability in patients with Mild Cognitive Impairment, Alzheimer’s disease and healthy elderly. Conference Abstract: SAN2016 Meeting. doi: 10.3389/conf.fnhum.2016.220.00114

Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters.

The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated.

Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed.

For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions.

Received: 29 Jul 2016; Published Online: 01 Aug 2016.

* Correspondence: Prof. Sokratis G Papageorgiou, Medical School University of Athens, Athens, Greece, sokpapa@med.uoa.gr