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Review
. 2025 Sep 26:16:1649627.
doi: 10.3389/fneur.2025.1649627. eCollection 2025.

The association between anosognosia and neuropsychiatric symptoms in neurodegenerative dementias: a narrative review

Affiliations
Review

The association between anosognosia and neuropsychiatric symptoms in neurodegenerative dementias: a narrative review

Chiara Gallingani et al. Front Neurol. .

Abstract

Anosognosia, or unawareness of disease, is a common clinical feature in neurodegenerative dementias. Frequently reported as an early symptom, its presence has been associated with faster dementia progression and greater cognitive impairment. Similarly, neuropsychiatric symptoms (NPS) encompass non-cognitive behavioral and psychiatric disturbances that commonly affect individuals with dementia. Both aosognosia and NPS are clinically relevant in neurodegenerative diseases due to their significant implications in disease management and caregiver burden. In this narrative review, we examined studies investigating the direct relationship between anosognosia and NPS across different neurodegenerative dementias, including Alzheimer's Disease (AD), Frontotemporal Dementia (FTD) and α-synucleinopathies, such as Parkinson's Disease (PD) and Dementia with Lewy Bodies (DLB). A total of 46 studies were identified, the majority of which focused on AD. Despite considerable heterogeneity in participant selection, assessed domains, and measures of anosognosia and NPS investigated, consistent association emerged between anosognosia and global NPS scores as well as individual symptoms. Across studies, the most common finding was a negative association between anosognosia and depression and a positive association between anosognosia and apathy. Possible underlying mechanisms and shared neuroanatomical substrates of these findings are discussed. The review provides a deepened insight into key symptoms with critical implications for dementia research, clinical management, and caregiving strategies.

Keywords: Alzheimer’s disease; anosognosia; dementia; frontotemporal dementia; neuropsychiatric symptoms; unawareness.

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Conflict of interest statement

GZ has received speaker honoraria from Ely Lilly. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Flowchart of study selection process.
Figure 2
Figure 2
Sankey diagram illustrating the association between anosognosia and neuropsychiatric symptoms in neurodegenerative dementias. On the left, the neurodegenerative diseases investigated in the review with significant findings; on the right, the neuropsychiatric symptoms associated with anosognosia. The thickness of each connection represents the number of studies focusing on a specific association (i.e., the association between anosognosia and depression was assessed in 28 studies on AD, 1 study on FTD, and 6 studies on PD; the association between anosognosia and apathy was assessed in 13 studies on AD, 1 study on FTD, and 1 study on PD; the association between anosognosia and impulse dyscontrol symptoms was assessed in 9 studies on AD; the association between anosognosia and affective dysregulation symptoms was assessed in 6 studies on AD; the association between anosognosia and psychosis was assessed in 5 studies on AD; the association between anosognosia and sleep and appetite was assessed in 2 studies on AD; the association between anosognosia and empathy was assessed in 1 study on FTD).

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