The meta-memory ratio: a new cohort-independent way to measure cognitive awareness in asymptomatic individuals at risk for Alzheimer's disease

Alzheimers Res Ther. 2020 May 14;12(1):57. doi: 10.1186/s13195-020-00626-1.


Background: Lack of awareness of cognitive decline (ACD) has been described at the preclinical and prodromal stages of Alzheimer's disease (AD). In this study, we introduced a meta-memory ratio (MMR) and explored how it is associated with neuroimaging AD biomarkers in asymptomatic individuals at risk for AD.

Method: Four hundred forty-eight cognitively healthy participants from two cohorts of subjective memory complainers (INSIGHT-PreAD and ADNI) were included. Regression models were used to assess the impact of AD biomarkers on the MMR.

Result: In both cohorts, there was a significant quadratic effect of cerebral amyloidosis on the MMR value. In particular, participants had a high ACD up to the amyloid positivity threshold, above which a decrease of ACD was eventually observed as the amyloid load increased.

Conclusion: This nonlinear evolution of ACD in very early AD must be taken into account in clinical care and for trial enrollment as well.

Keywords: Alzheimer’s disease; Awareness; Preclinical.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Alzheimer Disease* / diagnosis
  • Amyloid
  • Amyloid beta-Peptides
  • Biomarkers
  • Cognitive Dysfunction* / diagnosis
  • Humans
  • Metacognition*
  • Neuroimaging


  • Amyloid
  • Amyloid beta-Peptides
  • Biomarkers