Alzheimer’s disease and impairment of the Self

Effect of self-imagination on memory for older adults and aMCI patients

Imagining an event from a personal perspective has been found to be able to enhance memory for words and sentences for healthy younger adults and brain-injured patients. However, little is known about how people with amnestic mild cognitive impairment (aMCI) respond to self-imagination, in comparison to healthy older adults. In the current study, participants were asked to process a group of objects using either a self-imagination approach or a baseline strategy in which the self was not heavily involved. Self-imagination shows a mnemonic advantage over the control strategy, though this pattern emerged more clearly for healthy older adults. Furthermore, suggestive evidence indicates that cognitive ability supports self-reference benefits for healthy older adults, but not aMCI patients. These findings extended previous research to reveal the effectiveness of self-imagination for older adults using pictorial stimuli and supported the viewpoint that aMCI could qualitatively change the way that cognitive resources are engaged.

Patient-Reported Outcome Measures to Inform Care of People With Dementia-A Systematic Scoping Review

BACKGROUND AND OBJECTIVES

Patient-reported outcome measures (PROMs) captures the patient's perspective regarding quality of life, daily functioning, symptom severity, and overall health, and how these may be impacted by health care or other interventions. PROMs are used in clinical quality registries (CQRs) for a number of diseases to assess the patient's perspective of the impact of clinical care on quality-of-life. This scoping review aimed to identify dementia-specific PROMs, determine how the PROMs are being used, and whether they are used within dementia registries.

RESEARCH DESIGN AND METHODS

Three electronic databases were searched using Medical Subject Heading terms for dementia, quality of life, and patient-reported outcomes. Data were extracted on the PROMs used and the methods and mode of administering the PROM.

RESULTS

Seven dementia-specific PROMs were identified, however none were used in a dementia registry. All the PROMs were used at the patient level to identify patient needs and health service impacts. Three PROMs were also used at a system level to examine difference in care models. The majority of the PROMs were administered via a researcher or clinician and were predominantly completed by a proxy.

DISCUSSION AND IMPLICATIONS

PROMs provide an opportunity for a patient with dementia to share experiences and perspectives of care. A number of dementia-specific PROMs exist, yet none are used in dementia registries and the majority of studies utilize PROMs via a proxy. The use of PROM for patients with dementia, particularly in the context of dementia registries, requires further exploration and consideration.

The picture of the past: Pictures to cue autobiographical memory in Alzheimer's disease

INTRODUCTION

This study investigated the effect of pictorial cues on autobiographical memory in Alzheimer's disease (AD). We assessed autobiographical memory of patients with AD and cognitively normal older adults in two conditions.

METHODS

In one condition, the participants were provided with verbal instructions to retrieve three autobiographical memories. In the second condition, the same verbal instructions were provided; however, the participants were simultaneously presented with three pictures. We analyzed autobiographical memory regarding specificity, that is, the ability to remember unique events situated in time and space.

RESULTS

Analysis demonstrated higher autobiographical memory after verbal-and-visual cuing than after the no cue condition in both patients with AD and cognitively normal older adults.

DISCUSSION

Pictorial cues seem to be an effective method to alleviate autobiographical compromise in AD.

Could Self-Consciousness Be Enhanced in Alzheimer’s Disease? An Approach from Emotional Sensorial Stimulation

Alzheimer’s disease (AD) provides a valuable field of research into impairment of self-consciousness (SC), because AD patients have a reduced capacity to understand their mental world, to experience and relive previous personal events, as well as to interpret thoughts, feelings, and beliefs about themselves. Several studies observed that AD patients had an altered SC, but not a complete abolition of it. Emotions are an integral part of the construction of personal identity, therefore of Self. In general, most studies on emotion in AD patients have observed that emotion is not completely abolished and it lets them better remember autobiographical events with greater emotional charge. The positive effect of autobiographical memories rich in emotional content, evoked directly/automatically by sensorial stimuli such as familiar odors or music, could be used to reestablish/reinforce the permanence and coherence of the Self in AD. We studied the research of empirical evidence supporting the power of the sensorial cues associated with emotion, which could be capable of enhancing the SC in AD. We presented the studies about “Emotional stimulations” using odor, music, or taste cues in AD. All studies have shown to have a positive impact on SC in AD patients such as odor-evoked autobiographical memories, taste/odor-evoked autobiographical memories, emotional sensorial stimulation using musical cues, and multi-sensorial stimulations using healing gardens. We found research supporting the notion that emotional sensorial stimulations can even temporarily exalt memory, affective state, and personal identity, that is, the SC in AD. The emotional sensory stimulations could be used as a tool to activate the SC in AD and hence improve the quality of life of patients and caregivers.

Using memories to support the self in Alzheimer's disease

The impact of memory loss on the self in Alzheimer's disease (AD) is poorly understood. Previous research is mixed on whether episodic or semantic memories are most important for supporting identity. The present study examined autobiographical memories cued by self-images (e.g., I am a father) and non-self-related cues in 16 AD patients and 29 healthy older adults. The AD group generated fewer self-images and memories compared to controls, but demonstrated similar temporal organization of self-cued memories. In both groups, self-images were supported by semantic memories that were temporally clustered around times of identity-formation. These self-supporting memories are proposed to form a scaffold to support the self and may persist the longest in AD, as opposed to memories from early adulthood per se. In both AD and control groups, self-images cued more semantic memories than non-self-relevant cues, further suggesting that semantic autobiographical memories play a fundamental role in supporting the self. These findings demonstrate that the self remains largely intact in AD, in spite of severe episodic memory deficits and global cognitive decline. In later stages of the disease, these self-supporting memories could provide effective tools for reminiscence therapy.

Influence of self-referential mode on memory for aMCI patients

One's concept of the self can act as a schema, in some cases facilitating memory performance but in other cases making memory more prone to errors. In this study, we attempted to induce long-lasting self-reference effects through an autobiographical mode in younger and older adults, as well as patients with amnestic mild cognitive impairment (aMCI), predicting that a self-referential mode of thought would benefit memory. Participants first either recalled autobiographical memories or described three neutral photographs in a narrative condition. This was followed by a conventional self-referencing task. At retrieval, participants completed a recognition task. Contrary to our prediction, the self-referencing benefit emerged consistently under autobiographical and narrative modes across all groups. Although our findings indicate that self-referencing can benefit memory, it carries the risk of increasing false alarm rates when induced through an autobiographical mode and consequently the strategy should be utilized with caution.

Music Intervention Approaches for Alzheimer's Disease: A Review of the Literature

Music interventions have been widely adopted as a potential non-pharmacological therapy for patients with Alzheimer's disease (AD) to treat cognitive and/or behavioral symptoms of the disease. In spite of the prevalence of such therapies, evidence for their effectiveness report mixed results in the literature. The purpose of this narrative review is to investigate the effectiveness of various intervention strategies (music therapy vs. music listening techniques) and music type used in the intervention (individualized vs. non-individualized music) on cognitive and behavioral outcomes for persons with AD. Databases were searched for studies using either active music therapy or music listening techniques over the last 10 years. These studies were in English, included persons with AD dementia, and whose protocol gathered pre- and post-intervention outcome measures. We initially identified 206 papers which were then reduced to 167 after removing duplicates. Further review yielded 13 papers which were extensively reviewed, resulting in a final sample of six papers. Our analysis of these papers suggested that, regardless of the music intervention approach, individualized music regimens provided the best outcomes for the patient. Furthermore, music listening may act as a relaxation technique and therefore provide a long-term impact for the patient, while active music therapy may acts to engage participants through social interaction and provide acute benefits. Our findings suggest that music techniques can be utilized in various ways to improve behavior and cognition.

A short cut to the past: Cueing via concrete objects improves autobiographical memory retrieval in Alzheimer's disease patients

Older adults diagnosed with Alzheimer's disease (AD) have difficulties accessing autobiographical memories. However, this deficit tends to spare memories dated to earlier parts of their lives, and may partially reflect retrieval deficits rather than complete memory loss. Introducing a novel paradigm, the present study examines whether autobiographical memory recall can be improved in AD by manipulating the sensory richness, concreteness and cultural dating of the memory cues. Specifically, we examine whether concrete everyday objects historically dated to the participants' youth (e.g., a skipping rope), relative to verbal cues (i.e., the verbal signifiers for the objects) facilitate access to autobiographical memories. The study includes 49 AD patients, and 50 healthy, older matched control participants, all tested on word versus object-cued recall. Both groups recalled significantly more memories, when cued by objects relative to words, but the advantage was significantly larger in the AD group. In both groups, memory descriptions were longer and significantly more episodic in nature in response to object-cued recall. Together these findings suggest that the multimodal nature of the object cues (i.e. vision, olfaction, audition, somatic sensation) along with specific cue characteristics, such as time reference, texture, shape, may constrain the retrieval search, potentially minimizing executive function demands, and hence strategic processing requirements, thus easing access to autobiographical memories in AD.

Making sense of self in Alzheimer's disease: reflective function and memory

OBJECTIVE

The current investigation examined the relationship between cognitive impairment and sense of self in Alzheimer's disease (AD).

METHOD

Forty-nine participants with dementia associated with AD were recruited through memory clinics in Victoria, Australia. The 26 participants of the healthy control sample were recruited from a retirement village. Self was measured via the Reflective Self-Function Scale - a theory of mind indicator that provides personal and social self-reflection scores. Cognitive assessment included measures of new learning, executive function, and speed of information processing.

RESULTS

A reduction in sense of self in mild AD was demonstrated in both personal and social domains, as compared to healthy adults of a similar age. With a focus on specific cognitive impairment relationships, new learning was found to predict personal self-reflection, whereas speed of information processing predicted social self-reflection capacity.

CONCLUSION

Findings suggest that deficits in new learning ability contribute to a reduced ability of people with early AD to understand their mental world and interpret thoughts, feelings, and beliefs about themselves. This impaired capacity to self-reflect will be intrusive in daily activities that require monitoring of current self-performance. Furthermore, with reduced speed of information processing found to impact on ability to reflect on social relations, individuals with AD are placed at risk of reduced ability to understand their social world, including communicating and interacting with others. Notwithstanding the overall group findings, individual variability was evident which reinforces the need for person-centred care in dementia.

Self, cortical midline structures and the resting state: Implications for Alzheimer's disease

Different aspects of the self have been reported to be affected in many neurological or psychiatric diseases such as Alzheimer's disease (AD), including mainly higher-level cognitive self-unawareness. This higher sense of self-awareness is most likely related to and dependent on episodic memory, due to the proper integration of ourselves in time, with a permanent conservation of ourselves (i.e., sense of continuity across time). Reviewing studies in this field, our objective is thus to raise possible explanations, especially with the help of neuroimaging studies, for where such self-awareness deficits originate in AD patients. We describe not only episodic (and autobiographical memory) impairment in patients, but also the important role of cortical midline structures, the Default Mode Network, and the resting state (intrinsic brain activity) for the processing of self-related information.

Similarity between remembering the past and imagining the future in Alzheimer's disease: Implication of episodic memory

Recent studies suggest that common cognitive processes and neuroanatomical substrates underlie the ability to remember the past and imagine the future. We studied these cognitive processes in patients with Alzheimer's Disease (AD). We asked 27 participants with AD and 30 older controls, matched by age, sex, and educational level, to generate past and future autobiographical events. Autobiographical generation was analyzed with respect to theme, general autobiographical performance, contextual performance, self-defining memories, and autonoetic reliving/re-experiencing. Unlike older controls, most AD participants evoked similar themes when generating past and future events (n=23/30 participants). These participants also showed similar autobiographical and contextual performance, similar amount of self-defining memories, and similar autonoetic states when generating past and future events. Further, significant correlations were detected between hippocampal-dependent memory decline in AD participants and their ability to relive past and future events. These outcomes suggest striking similarities between remembering the past and imagining the future in AD. Due to their memory decline, imagining the future in AD patients is likely to draw heavily from the little amount of available information from past episodes, resulting in striking similarities between remembering the past and imagining the future. Finally, and unlike AD participants, older controls mentally "try out" alternative approaches to upcoming situations without replicating the same schemes of past events.

Sense of identity in advanced Alzheimer's dementia: a cognitive dissociation between sameness and selfhood?

We looked at whether sense of identity persists in patients with Alzheimer's disease (AD) and if its profile remains the same between two examinations. A specifically designed protocol was administered to 16 AD patients in the mild to severe stages of dementia and to 16 matched healthy controls, both living in the same institution. We showed that sense of identity was broadly preserved in AD patients. The patterns of their responses were similar to those of controls, and remained consistent over a two-week period. However, some qualitative characteristics of sense of identity in AD patients differed significantly from those of controls, suggesting that AD patients may not be able to update their self-knowledge, probably because of their episodic memory deficit. These results are discussed in the light of both current models of the self and philosophical concepts such as sameness and selfhood.

Familiar music as an enhancer of self-consciousness in patients with Alzheimer's disease

The main objective of this paper is to examine the impact of familiar music on self-consciousness (SC) in patients with Alzheimer's disease (AD). For this purpose, two AD groups of 20 patients matched by age, educational level, gender, illness duration, and cognitive state were assessed using an SC questionnaire before and after music intervention. The SC questionnaire measured several aspects: personal identity, anosognosia, affective state, body representation, prospective memory, introspection and moral judgments. One AD group received familiar music stimulation and another AD group unfamiliar music stimulation over three months. The AD patients who received a familiar music intervention showed a stabilization or improvement in aspects of SC. By contrast, control AD group showed a deterioration of most of the SC aspects after unfamiliar music stimulation, except the SC aspects of body representation and affective state. Familiar music stimulation could be considered as an enhancer of SC in patients with Alzheimer's disease.