Self-awareness in Dementia: a Taxonomy of Processes, Overview of Findings, and Integrative Framework

Author: Daniel C Mograbi1,2, Jonathan Huntley3,4, Hugo Critchley5,6
1 Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil.
2 Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, PO Box 078, London, SE5 8AF, UK.
3 Division of Psychiatry, University College London, London, UK.
4 Wellcome Centre for Human Neuroimaging, University College London, London, UK.
5 Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK.
6 Psychiatry Department of Neuroscience, Brighton and Sussex Medical School, Brighton, UK.
Conference/Journal: Curr Neurol Neurosci Rep
Date published: 2021 Nov 24
Other: Volume ID: 21 , Issue ID: 12 , Pages: 69 , Special Notes: doi: 10.1007/s11910-021-01155-6. , Word Count: 159

Purpose of review:
Self-awareness, the capacity of becoming the object of one's own awareness, has been a frontier of knowledge, but only recently scientific approaches to the theme have advanced. Self-awareness has important clinical implications, and a finer understanding of this concept may improve the clinical management of people with dementia. The current article aims to explore self-awareness, from a neurobiological perspective, in dementia.

Recent findings:
A taxonomy of self-awareness processes is presented, discussing how these can be structured across different levels of cognitive complexity. Findings on self-awareness in dementia are reviewed, indicating the relative preservation of capacities such as body ownership and agency, despite impairments in higher-level cognitive processes, such as autobiographical memory and emotional regulation. An integrative framework, based on predictive coding and compensatory abilities linked to the resilience of self-awareness in dementia, is discussed, highlighting possible avenues for future research into the topic.

Keywords: Agency; Dementia; Interoception; Metacognition; Self-awareness; Selfhood.

PMID: 34817738 DOI: 10.1007/s11910-021-01155-6