Anosognosia for memory deficit in amnestic mild cognitive impairment and Alzheimer’s disease Filomena Galeone 1 , Stella Pappalardo 1 , Sergio Chieffi 2 , Alessandro Iavarone 3,4 and Sergio Carlomagno 5 1 Dipartimento Assistenza Anziani, Napoli, Italy 2 Dipartimento di Medicina Clinica e Sperimentale, Seconda Universita ` di Napoli, Napoli, Italy 3 UO Neurologia, Ospedale CTO, Napoli, Italy 4 Dipartimento di Scienze Relazionali, Universita ` ‘‘Federico II’’, Napoli, Italy 5 Dipartimento di Psicologia, Universita ` di Trieste, Trieste, Italy Correspondence to: S. Carlomagno, MD, E-mail: scarlomagno@units.it Objective: to investigate patterns of anosognosia for memory deficit in subjects with amnestic mild cognitive impairment (MCI) and Alzheimer’s disease (AD). Methods: the study involved twenty-five subjects with MCI, 15 with mild AD and 21 normal controls (NC). Subjective rating of memory functioning was assessed with a six-items questionnaire that was administered before and after memory testing; an informant version from caregivers gave a discrepancy score (SRD). In the Objective Judgement (OJ) task, aiming to evaluate memory-monitoring abilities, subjects were requested three times to predict their memory performance in recalling words from a list of ten. Then they had to recall the words. Prediction accuracy was computed by subtracting the predicted performance from the actual performance. Results: MCI and AD showed reduced awareness of memory difficulties at the SRD and did not change their rating of these difficulties after memory testing. At the OJ task, MCI and AD consistently overestimated their memory performances as compared with NC. The SRD and OJ measures were not correlated with some patients being impaired on only one measure. Only the OJ measure was significantly related to executive functioning. Conclusions: AD and MCI subjects show unawareness for memory deficit and significant memory- monitoring disorder. This confirms that anosognosia is an important symptom of MCI. Similarities of patterns of impaired awareness between AD and MCI supports the view of a continuum of the anosognosia phenomenon in MCI and AD. Copyright # 2010 John Wiley & Sons, Ltd. Key words: anosognosia; memory; neuropsychology History: Received 3 December 2009; Accepted 3 June 2010; Published online 23 December 2010 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/gps.2583 Introduction Mild cognitive impairment (MCI) is a condition affecting older adults who, in spite of being free from overt dementia, exhibit significant decline in memory, and often in other domains of cognition. This condition has been shown conferring significant risk for Alzheimer’s disease (AD) (Petersen et al., 2001). Unawareness for memory deficit may be considered as an important clinical symptom of MCI, being present in a proportion of subjects approaching the level seen in AD (Duke et al., 2002; Vogel et al., 2004, 2005; Ries et al., 2007). Like in the AD subjects, awareness for memory deficit in MCI can be quite variable, ranging from full insight about memory difficulties to severe anosognosia, and factors underpinning such variability are poorly defined (Vogel et al., 2005, 2006). Because of these similarities, it has been proposed that anosog- nosia in MCI subjects is an early symptom of their memory deficit predicting greater conversion to AD (Tabert et al., 2002). However, not all the studies agree with these positions (Kalbe et al., 2005). RESEARCH ARTICLE Copyright # 2010 John Wiley & Sons, Ltd. Int J Geriatr Psychiatry 2011; 26: 695–701.