{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T21:13:32Z","timestamp":1774559612500,"version":"3.50.1"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Caregiver distress in dementia is multifactorial. The contribution of disease specific factors including anosognosia (poor awareness of cognitive\/behavioral deficits) and theory of mind (ToM) deficit (difficulty with understanding other\u2019s perspective) requires further investigation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Cross sectional secondary analysis was performed on a dataset of 205 research participants (age\u202f=\u202f64.2\u202f\u00b1\u202f9.46): 57 Alzheimer\u2019s disease, 38 behavioral variant frontotemporal dementia, 12 non-fluent primary progressive aphasia (PPA), 24 semantic variant PPA, 18 progressive supranuclear palsy syndrome, 14 corticobasal syndrome, and 42 cognitively normal controls (NC). Anosognosia was measured using the Patient Competency Rating Scale (PCRS-self minus PCRS-caregiver; clinically meaningful anosognosia &amp;gt;20 points difference), ToM deficit was evaluated using The Awareness of Social Inference Test: Social Inference-Enriched (TASIT-SIE), and caregiver distress was measured using the Neuropsychiatric Inventory Questionnaire (NPI-Q) Total Distress score. Differences across syndromes were evaluated controlling for age and sex, and multivariable linear regression was used to determine predictors of caregiver distress.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Clinically meaningful anosognosia (patient overestimation of function) and ToM deficit were significantly higher in all dementia syndromes compared to NCs. Anosognosia and ToM deficit each independently predicted caregiver distress and had an additive effect (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Our findings are consistent with other research showing that anosognosia in individuals with chronic neurological disorders including dementia can increase caregiver distress; however, our results highlight the additive importance of patients\u2019 theory of mind deficits above and beyond their anosognosia. Evaluation of both patient anosognosia and ToM deficit in clinical contexts may provide meaningful information to predict which caregivers are at particular risk for adverse outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1724172","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T20:24:22Z","timestamp":1774556662000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Additive effect of patient anosognosia and theory of mind deficit on dementia caregiver distress"],"prefix":"10.3389","volume":"17","author":[{"given":"Manizhe","family":"Eslami-Amirabadi","sequence":"first","affiliation":[{"name":"Department of Neurology, Memory and Brain Wellness Center, University of Washington School of Medicine","place":["Seattle, WA, United States"]},{"name":"Department of Neurology, Edward and Pearl Fein Memory and Aging Center, University of California, San Francisco","place":["San Francisco, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron","family":"Scheffler","sequence":"additional","affiliation":[{"name":"Department of Neurology, Edward and Pearl Fein Memory and Aging Center, University of California, San Francisco","place":["San Francisco, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joel H.","family":"Kramer","sequence":"additional","affiliation":[{"name":"Department of Neurology, Edward and Pearl Fein Memory and Aging Center, University of California, San Francisco","place":["San Francisco, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Luisa","family":"Gorno-Tempini","sequence":"additional","affiliation":[{"name":"Department of Neurology, Edward and Pearl Fein Memory and Aging Center, University of California, San Francisco","place":["San Francisco, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William W.","family":"Seeley","sequence":"additional","affiliation":[{"name":"Department of Neurology, Edward and Pearl Fein Memory and Aging Center, University of California, San Francisco","place":["San Francisco, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Howard","family":"Rosen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Edward and Pearl Fein Memory and Aging Center, University of California, San Francisco","place":["San Francisco, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gil D.","family":"Rabinovici","sequence":"additional","affiliation":[{"name":"Department of Neurology, Edward and Pearl Fein Memory and Aging Center, University of California, San Francisco","place":["San Francisco, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruce L.","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Neurology, Edward and Pearl Fein Memory and Aging Center, University of California, San Francisco","place":["San Francisco, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Winston","family":"Chiong","sequence":"additional","affiliation":[{"name":"Department of Neurology, Edward and Pearl Fein Memory and Aging Center, University of California, San Francisco","place":["San Francisco, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine P.","family":"Rankin","sequence":"additional","affiliation":[{"name":"Department of Neurology, Edward and Pearl Fein Memory and Aging Center, University of California, San Francisco","place":["San Francisco, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"ref1","volume-title":"Alzheimer\u2019s Disease, Facts and Figures","year":"2025"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"277","DOI":"10.3233\/JAD-150471","article-title":"Cost related to dementia in the young and the impact of etiological subtype on cost","volume":"49","author":"Kandiah","year":"2015","journal-title":"J Alzheimer's Dis"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1007\/s11920-017-0818-2","article-title":"Dementia caregiver burden: a research update and critical analysis","volume":"19","author":"Cheng","year":"2017","journal-title":"Curr Psychiatry Rep"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1016\/j.jalz.2011.03.005","article-title":"The diagnosis of dementia due to Alzheimer\u2019s disease: recommendations from the National Institute on Aging-Alzheimer\u2019s association workgroups on diagnostic guidelines for Alzheimer\u2019s disease","volume":"7","author":"McKhann","year":"2011","journal-title":"Alzheimers Dement"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1105","DOI":"10.3233\/JAD-2012-121360","article-title":"Clinical differences in patients with Alzheimer\u2019s disease according to the presence or absence of anosognosia: implications for perceived quality of life","volume":"33","author":"Conde-Sala","year":"2013","journal-title":"J Alzheimer's Dis"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1016\/j.cortex.2014.07.019","article-title":"Anosognosia in Alzheimer\u2019s disease: diagnosis, frequency, mechanism and clinical correlates","volume":"61","author":"Starkstein","year":"2014","journal-title":"Cortex"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1880","DOI":"10.1007\/s00415-022-11518-9","article-title":"Awareness impairment in Alzheimer\u2019s disease and frontotemporal dementia: a systematic MRI review","volume":"270","author":"Leocadi","year":"2023","journal-title":"J Neurol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"631518","DOI":"10.3389\/fpsyt.2021.631518","article-title":"Anosognosia in mild cognitive impairment: lack of awareness of memory difficulties characterizes prodromal Alzheimer\u2019s disease","volume":"12","author":"Bastin","year":"2021","journal-title":"Front Psych"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1329","DOI":"10.1016\/j.cortex.2011.08.003","article-title":"Comprehension of insincere communication in neurodegenerative disease: lies, sarcasm, and theory of mind","volume":"48","author":"Shany-Ur","year":"2012","journal-title":"Cortex"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1016\/j.jocn.2020.05.028","article-title":"The role of mind theory in patients affected by neurodegenerative disorders and impact on caregiver burden","volume":"78","author":"Formica","year":"2020","journal-title":"J Clin Neurosci"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1186\/s13195-016-0179-9","article-title":"Cognitive and affective theory of mind in dementia with Lewy bodies and Alzheimer\u2019s disease","volume":"8","author":"Heitz","year":"2016","journal-title":"Alzheimer's Res Ther"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1080\/13554794.2010.522588","article-title":"Anosognosia in neurodegenerative disease","volume":"17","author":"Rosen","year":"2011","journal-title":"Neurocase"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.bandc.2018.08.002","article-title":"Anosognosia in degenerative brain diseases: the role of the right hemisphere and of its dominance for emotions","volume":"127","author":"Gainotti","year":"2018","journal-title":"Brain Cogn"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1136","DOI":"10.3390\/diagnostics12051136","article-title":"Anosognosia in dementia: evaluation of perfusion correlates using 99mTc-HMPAO SPECT and automated Brodmann areas analysis","volume":"12","author":"Valotassiou","year":"2022","journal-title":"Diagnostics"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1080\/17470910600989847","article-title":"Theory of mind in frontotemporal dementia","volume":"1","author":"Kipps","year":"2006","journal-title":"Soc Neurosci"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"3026","DOI":"10.1093\/brain\/aws237","article-title":"My belief or yours? Differential theory of mind deficits in frontotemporal dementia and Alzheimer\u2019s disease","volume":"135","author":"Le Bouc","year":"2012","journal-title":"Brain"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1093\/brain\/awr309","article-title":"Theory of mind impairments in patients with semantic dementia","volume":"135","author":"Duval","year":"2012","journal-title":"Brain"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"2456","DOI":"10.1093\/brain\/awr179","article-title":"Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia","volume":"134","author":"Rascovsky","year":"2011","journal-title":"Brain"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1212\/WNL.0b013e31827f0fd1","article-title":"Criteria for the diagnosis of corticobasal degeneration","volume":"80","author":"Armstrong","year":"2013","journal-title":"Neurology"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"853","DOI":"10.1002\/mds.26987","article-title":"Clinical diagnosis of progressive supranuclear palsy: the movement disorder society criteria","volume":"32","author":"H\u00f6glinger","year":"2017","journal-title":"Mov Disord"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.1212\/WNL.0b013e31821103e6","article-title":"Classification of primary progressive aphasia and its variants","volume":"76","author":"Gorno-Tempini","year":"2011","journal-title":"Neurology"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1111\/jgs.15690","article-title":"Association of informal caregiver distress with health outcomes of community-dwelling dementia care recipients: a systematic review","volume":"67","author":"Stall","year":"2019","journal-title":"J Am Geriatr Soc"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1525","DOI":"10.3390\/ijerph21111525","article-title":"Alcohol use and abuse among family caregivers of people living with dementia in the United States: a scoping review","volume":"21","author":"Hazzan","year":"2024","journal-title":"Int J Environ Res Public Health"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1017\/S1041610219000176","article-title":"Burden of caregivers of patients with frontotemporal lobar degeneration- a scoping review","volume":"33","author":"Karnatz","year":"2021","journal-title":"Int Psychogeriatr"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1186\/s12877-018-0801-8","article-title":"Effect of the WeCareAdvisor\u2122 on family caregiver outcomes in dementia: a pilot randomized controlled trial","volume":"18","author":"Kales","year":"2018","journal-title":"BMC Geriatr"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"762","DOI":"10.1111\/jgs.12730","article-title":"Management of neuropsychiatric symptoms of dementia in clinical settings: recommendations from a multidisciplinary expert panel","volume":"62","author":"Kales","year":"2014","journal-title":"J Am Geriatr Soc"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1002\/gps.4447","article-title":"The contribution of caregiver psychosocial factors to distress associated with behavioural and psychological symptoms in dementia","volume":"32","author":"Feast","year":"2017","journal-title":"Int J Geriatr Psychiatry"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1016\/j.ijnurstu.2006.08.016","article-title":"Relationships between income, subjective health and caregiver burden in caregivers of people with dementia in group living care: a cross-sectional community-based study","volume":"44","author":"Andr\u00e9n","year":"2007","journal-title":"Int J Nurs Stud"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"104558","DOI":"10.1016\/j.archger.2021.104558","article-title":"The influence of cohabitation type on the psychological vulnerability of family caregivers of people with dementia: results from a community health survey of 324,078 people in Korea","volume":"98","author":"Park","year":"2022","journal-title":"Arch Gerontol Geriatr"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1002\/gps.4394","article-title":"Anosognosia increases caregiver burden in mild cognitive impairment","volume":"31","author":"Kelleher","year":"2016","journal-title":"Int J Geriatr Psychiatry"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1002\/gps.3824","article-title":"Burden associated with the presence of anosognosia in Alzheimer\u2019s disease","volume":"28","author":"Turr\u00f5-Garriga","year":"2013","journal-title":"Int J Geriatr Psychiatry"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1649627","DOI":"10.3389\/fneur.2025.1649627","article-title":"The association between anosognosia and neuropsychiatric symptoms in neurodegenerative dementias: a narrative review","volume":"16","author":"Gallingani","year":"2025","journal-title":"Front Neurol"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"e067855","DOI":"10.1002\/alz.067855","article-title":"Cognitive and emotional theory of mind in dementia. Impact on real life behaviors","volume":"19","author":"Zegarra-Valdivia","year":"2023","journal-title":"Alzheimers Dement"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1002\/ana.24885","article-title":"Typical and atypical pathology in primary progressive aphasia variants","volume":"81","author":"Spinelli","year":"2017","journal-title":"Ann Neurol"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"2368","DOI":"10.1093\/brain\/awu161","article-title":"Self-awareness in neurodegenerative disease relies on neural structures mediating reward-driven attention","volume":"137","author":"Shany-Ur","year":"2014","journal-title":"Brain"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1097\/WAD.0b013e31822c55c4","article-title":"Longitudinal trajectories of awareness in early-stage dementia","volume":"26","author":"Clare","year":"2012","journal-title":"Alzheimer Dis Assoc Disord"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"S10","DOI":"10.1212\/wnl.48.5_suppl_6.10s","article-title":"The neuropsychiatric inventory: assessing psychopathology in dementia patients","volume":"48","author":"Cummings","year":"1997","journal-title":"Neurology"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"2308","DOI":"10.1212\/wnl.44.12.2308","article-title":"The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia","volume":"44","author":"Cummings","year":"1994","journal-title":"Neurology"},{"key":"ref39","first-page":"S60","article-title":"The PCRS is a useful measure of anosognosia in neurodegenerative disease","volume":"60","author":"Lin","year":"2012","journal-title":"J Am Geriatr Soc"},{"key":"ref40","first-page":"1058","article-title":"Impaired awareness of behavioral limitations after traumatic brain injury","volume":"71","author":"Prigatano","year":"1990","journal-title":"Arch Phys Med Rehabil"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1093\/arclin\/acab096","article-title":"Modification of the patient competency rating scale to measure Anosodiaphoria after severe acquired brain injury: preliminary findings","volume":"37","author":"Bivona","year":"2022","journal-title":"Arch Clin Neuropsychol"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1080\/0269905021000010113","article-title":"Measurement of impaired self-awareness after traumatic brain injury: a comparison of the patient competency rating scale and the awareness questionnaire","volume":"17","author":"Sherer","year":"2003","journal-title":"Brain Inj"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"1529","DOI":"10.1080\/09638280600646185","article-title":"Reliability and validity of the awareness of social inference test (TASIT): a clinical test of social perception","volume":"28","author":"McDonald","year":"2006","journal-title":"Disabil Rehabil"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1177\/0891988719856697","article-title":"Anosognosia is associated with greater caregiver burden and poorer executive function in Huntington disease","volume":"33","author":"Wibawa","year":"2020","journal-title":"J Geriatr Psychiatry Neurol"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1017\/S1041610215001441","article-title":"The biggest problem we\u2019ve ever had to face: how families manage driving cessation with people with dementia","volume":"28","author":"Liddle","year":"2016","journal-title":"Int Psychogeriatr"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1177\/13872877251317683","article-title":"Validation of the cognitive-emotional perspective taking test in patients with neurodegeneration","volume":"104","author":"Zegarra-Valdivia","year":"2025","journal-title":"J Alzheimer's Dis"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1016\/j.jagp.2015.07.005","article-title":"The impact of young onset dementia on informal caregivers compared with late onset dementia: results from the NeedYD study","volume":"24","author":"Millenaar","year":"2016","journal-title":"Am J Geriatr Psychiatry"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"537","DOI":"10.3233\/JAD-170409","article-title":"High caregiver burden in young onset dementia: what factors need attention?","volume":"61","author":"Lim","year":"2017","journal-title":"J Alzheimer's Dis"},{"key":"ref49","doi-asserted-by":"publisher","DOI":"10.1177\/18796397251390252","article-title":"Emotion recognition in people with Huntington\u2019s disease: a comprehensive systematic review","author":"Zarotti","year":"2025","journal-title":"J Huntingtons Dis"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1724172\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T20:24:24Z","timestamp":1774556664000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1724172\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,26]]},"references-count":49,"alternative-id":["10.3389\/fneur.2026.1724172"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1724172","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,26]]},"article-number":"1724172"}}