Error unawareness as a driver of cognitive decline in individuals at risk for Alzheimer’s disease
Abstract
Anosognosia, or unawareness of one’s deficits, predicts faster clinical progression in Alzheimer’s disease (AD), though its mechanisms remain unclear. We investigated five-year trajectories of response awareness and error-monitoring efficiency using second-order judgments from an annual word recognition memory task in cognitively unimpaired individuals at risk for AD from the INSIGHT-preAD cohort. Participants were divided into three groups according to amyloid status at baseline (positive, A + ; negative, A–) and clinical progression (controls, CTRL A+ or A–; and progressors, PROG). Task accuracy declined in PROG, while CTRL A+ showed continued learning, and CTRL A– remained accurate. Inefficient error-monitoring predicted subsequent performance decline in the PROG, with a strong interaction between accuracy and error-monitoring already at baseline. This effect was primarily driven by error unawareness. These findings provide first evidence that error unawareness — a core feature of anosognosia — may foster cognitive decline through the disruption of error-feedback learning mechanisms, potentially accelerating AD progression. This study advances understanding of AD progression by linking anosognosia-related error unawareness to disrupted error-feedback learning and cognitive decline from the preclinical stage, with implications for disease modeling, prognosis, and therapy.
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BibTeX
@article{andrade2026error,
title = {{Error unawareness as a driver of cognitive decline in individuals at risk for Alzheimer’s disease}},
author = {Katia Andrade and François-Xavier Lejeune and Nesma Houmani and Rita Yabouri and Michel Thiebaut de Schotten and Valentina Pacella},
journal = {Communications Biology},
year = {2026},
month = jun,
doi = {10.1038/s42003-026-10461-z},
url = {https://hal.science/hal-05852649v1},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Error unawareness as a driver of cognitive decline in individuals at risk for Alzheimer’s disease
AU - Katia Andrade
AU - François-Xavier Lejeune
AU - Nesma Houmani
AU - Rita Yabouri
AU - Michel Thiebaut de Schotten
AU - Valentina Pacella
PY - 2026
DA - 2026/06/11
JO - Communications Biology
DO - 10.1038/s42003-026-10461-z
UR - https://hal.science/hal-05852649v1
AB - Anosognosia, or unawareness of one’s deficits, predicts faster clinical progression in Alzheimer’s disease (AD), though its mechanisms remain unclear. We investigated five-year trajectories of response awareness and error-monitoring efficiency using second-order judgments from an annual word recognition memory task in cognitively unimpaired individuals at risk for AD from the INSIGHT-preAD cohort. Participants were divided into three groups according to amyloid status at baseline (positive, A + ; negative, A–) and clinical progression (controls, CTRL A+ or A–; and progressors, PROG). Task accuracy declined in PROG, while CTRL A+ showed continued learning, and CTRL A– remained accurate. Inefficient error-monitoring predicted subsequent performance decline in the PROG, with a strong interaction between accuracy and error-monitoring already at baseline. This effect was primarily driven by error unawareness. These findings provide first evidence that error unawareness — a core feature of anosognosia — may foster cognitive decline through the disruption of error-feedback learning mechanisms, potentially accelerating AD progression. This study advances understanding of AD progression by linking anosognosia-related error unawareness to disrupted error-feedback learning and cognitive decline from the preclinical stage, with implications for disease modeling, prognosis, and therapy.
SN - 2399-3642
ER -