A – 105 The Anosognosia of Cognitive Impairment Sign in Neurocognitive Disorders: Diagnostic Utility and Associated Clinical Features

Abstract Objective Anosognosia of cognitive impairment is frequently observed during clinical evaluation of individuals with neurocognitive disorders. A patient may have minimal cognitive complaints despite physician or informant concerns of cognitive decline. This clinical scenario, termed the anosognosia of cognitive impairment sign (ACIS), was investigated for diagnostic utility in neurocognitive disorders. Method The ACIS was investigated in 590 patients (M age = 63.40, SD = 14.22) referred for neuropsychological evaluation of suspected cognitive decline at a large medical center in the Northwest United States. Analysis included calculations of sensitivity and specificity with 95% confidence intervals. Results The ACIS was observed in 86/590 patients (14.6%). The ACIS was common in dementia (68/142; 47.8%), uncommon in mild neurocognitive disorder (18/246; 7.3%), and absent in patients with a primary psychiatric diagnosis (0/157) and cognitively normal patients with no diagnosis (0/43). The ACIS was associated with older age, the head-turning sign, lower scores on tests of complex attention and short-term memory, and lower scores on self-report measures of anxiety and depression. The diagnostic utility of the ACIS for neurocognitive disorders had perfect specificity (95% CI = 0.98 – 1.00) at 0.22 sensitivity (95% CI = 0.18 – 0.26) with an overall classification accuracy of 0.48. Conclusion The ACIS is a highly specific sign of neurocognitive disorders that is absent in patients with a primary psychiatric diagnosis and cognitively normal individuals. The ACIS can be combined with other easily observed clinical signs of neurocognitive disorders to further enhance diagnostic decision-making.