A cross-sectional study to inquire the relationship between aging and cognitive insight

Background: Cognitive insight is the ability to revaluate one’s own beliefs in order to make thoughtful conclusion. The Beck Cognitive Insight Scale (BCIS) assesses two dimensions of cognitive insight: self-reflectiveness (SR) which is the attitude to questioning one’s beliefs and self-certainty (SC) which is the unwillingness to modify own conviction. Here we investigated the relationship between cognitive insight and aging, both in healthy and pathological aging. Furthermore, we investigated the neuropsychological and neuropsychiatric correlates of cognitive insight. Design: Cross-sectional study. Methods: One hundred and three healthy subjects were included and categorized in three age classes: a) “middle aged” (56-63 years); b) “early elderlies” (64-71) and c) “old/late elderlies” (72-79). Furthermore, ninety patients affected by pre-MCI, MCI and AD were included (N=30 for each diagnostic group). Results: Cognitive insight did not differ among age classes in the healthy group. Episodic long-term memory was related to self-reflection in middle aged; moreover, poorer performances on an inhibitory control task were related to BCIS R-C global index (reflective attitude minus certain attitude) in middle aged while was associated with SC in early elderlies. Within the pathological continuum, pre-MCI subjects were more self-reflective than AD and the latter more self-certain than MCI. Better performance in episodic memory was related to R-C in pre-MCI. Furthermore, significant correlations were found between self-certainty and irritability and between somatic symptoms of depression and irritability and R-C in pre-MCI. In AD subjects apathy and anxiety severity scores were related to the R-C index while awareness of illness was related to self-certainty. Conclusion: This study is the first who investigated cognitive insight through age classes in healthy people and within the dementia continuum from pre-MCI to AD. In general, cognitive insight seems stable in healthy aging from middle-aged onwards, while its sub-dimensions vary within the pathological continuum, in particular between prodromal and early stages of Alzheimer’s disease.