| Research investigating the relationship between depression and anosognosia, or lack of insight, in Alzheimer's disease has reported positive, negative, and no correlation. Descrepant findings may be due to depression not being accurately assessed or clearly defined. Overlap between the symptoms of depression and dementia make discerning the presence of depression in dementia difficult, especially when diagnosed by interview or self-report methods. Further, the role cognitive dysfunction associated with Alzheimer's disease and premorbrid psychological functioning play in depression and anosognosia also remain poorly understood, as does the effect of the phenomenological perspective of the individual with Alzheimer's disease. The present study sought to clarify these issues by utilizing the Rorschach Inkblot test in conjunction with the Comprehension Scoring system to assess depression and other variables possibly contributing to this construct using projective testing methodology.; Forty-two individuals diagnosed with Alzheimer's disease were assessed with a self-report instrument, the Geriatric Depression Scale (GDS), the Mini-Mental State Exam, and the Rorschach. Variables taken or derived from the Rorschach consisted of an indicator of depression, the DEPI; an assessment of ability to moderate and process affective, AFFECT; a gauge of perceived social inadequacy, the CDI; and, the three Rorschach variables of the Cognitive Triad. A brief indicator of past psychological functioning was obtained and the phenomenological perspective of each participant was considered.; Correlations between self-report measures of depression and projective measures were non-significant, as were correlations between DEPI, CDI and anosognosia. ANCOVA's showed no significant difference between the means of DEPI or CDI based on past psychological history or anosognosia status. Stepwise linear regression indicated that AFFECT, CDI, and Cognitive Mediation accounted for a significant amount of variation of depression, but past psychological history or anosoposia did not account for any additional variation. Phenomenological interviews yielded new insight into how anosognosia affects the individual's perception of the world and may contribute to depression. Integration of all analyses suggests that depression and anosognosia are multidimensional constructs, as is cognitive dysfunction in Alzheimer's disease, making a single unidimensional relationship unlikely. Instead, the variability reported should be considered a reflection of the complexity of the constructs involved. |
