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Cognition and psychopathology in nonagenarians and centenarians living in geriatric nursing homes in Switzerland: a focus on anosognosia

Authors

  • Jean-Frédéric Mall,

    Corresponding author
    1. Service of Old Age Psychiatry, Department of Psychiatry, Centre Hospitalier Universitaire Vaudois (CHUV), Prilly-Lausanne, Switzerland
    • Correspondence: Dr Jean-Frédéric Mall MD, Service of Old Age Psychiatry, Department of Psychiatry, Centre Hospitalier Universitaire Vaudois (CHUV), Site de Cery, CH-1008, Prilly-Lausanne, Switzerland. Email: jean-frederic.mall@chuv.ch

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  • Leila Chouiter,

    1. Service of Old Age Psychiatry, Department of Psychiatry, Centre Hospitalier Universitaire Vaudois (CHUV), Prilly-Lausanne, Switzerland
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  • Jean-Philippe Antonietti,

    1. Institute of Psychology, University of Lausanne, Lausanne-Dorigny, Switzerland
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  • Karsten Ebbing,

    1. Service of Old Age Psychiatry, Department of Psychiatry, Centre Hospitalier Universitaire Vaudois (CHUV), Prilly-Lausanne, Switzerland
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  • Armin von Gunten

    1. Service of Old Age Psychiatry, Department of Psychiatry, Centre Hospitalier Universitaire Vaudois (CHUV), Prilly-Lausanne, Switzerland
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Abstract

Background

The number of nonagenarians and centenarians is rising dramatically, and many of them live in nursing homes. Very little is known about psychiatric symptoms and cognitive abilities other than memory in this population. This exploratory study focuses on anosognosia and its relationship with common psychiatric and cognitive symptoms.

Methods

Fifty-eight subjects aged 90 years or older were recruited from geriatric nursing homes and divided into five groups according to Mini-Mental State Examination scores. Assessment included the five-word test, executive clock-drawing task, lexical and categorical fluencies, Anosognosia Questionnaire-Dementia, Neuropsychiatric Inventory, and Charlson Comorbidity Index.

Results

Subjects had moderate cognitive impairment, with mean ± SD Mini-Mental State Examination being 15.41 ± 7.04. Anosognosia increased with cognitive impairment and was associated with all cognitive domains, as well as with apathy and agitation. Subjects with mild global cognitive decline seemed less anosognosic than subjects with the least or no impairment. Neither anosognosia nor psychopathological features were related to physical conditions.

Conclusions

Anosognosia in oldest-old nursing home residents was mostly mild. It was associated with both cognitive and psychopathological changes, but whether anosognosia is causal to the observed psychopathological features requires further investigation.

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