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Cognitive erosion and its implications in Alzheimer’s disease
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Kognitiv erosion och dess betydelse vid Alzheimers sjukdom (Swedish)
Abstract [en]

The aim of the present thesis was twofold, first to map the semantic memory decline in Alzheimer patients over time, second to take the patient’s perspective and create a multifaceted picture of the individual with Alzheimer’s disease through the study of memory, awareness, central coherence and emotions. Further issues concerned how Alzheimer individuals handled their cognitive erosion in everyday life and if they were well calibrated with their spouse in disease related matters.

Two studies were performed, the first involved a longitudinal study of sematic deterioration, the second had a mixed methods design involving both quantitative and qualitative measures as in neuropsychological assessment and interviews.

Through the longitudinal study it could be concluded that the nature of semantic deterioration is best described as loss of memory information rather than problems in accessing the information. It was further concluded that semantic concepts gradually lose their specific features during course of illness.

The results from the second study revealed that the Alzheimer individuals were aware of their disease although they could not foresee the implications of their cognitive shortcomings in their everyday life. They evidenced weak central coherence, in that they were unable to infer details into a meaningful whole. This implies that they perceive their surrounding world in a fragmented way as consisting of separate objects rather than a comprehensible context. Concerning emotions it was found that they responded to negatively valenced words in the same way as normal ageing individuals, although being impaired in their response to positively and neutral words. Finally, the Alzheimer individuals and their spouses were not well calibrated regarding disease related issues.

The findings of the present thesis have important clinical implications and gives valuable input to the understanding of the individual with Alzheimer’s disease.

Abstract [sv]

Föreliggande avhandling hade två huvudsyften; dels att kartlägga försämringen av semantiskt minne hos Alzheimerpatienter över tid; dels att ta patientens perspektiv och skapa en mångfacetterad bild av individen med Alzheimers sjukdom. Fyra begrepp studerades i relation till detta, nämligen minne, medvetande, central koherens och emotioner. Ytterligare aspekter som studerades var hur Alzheimerindivider hanterar sina kognitiva tillkortakommanden i sin vardag samt hur väl kalibrerade de är med sin make/maka angående sjukdomsrelaterade frågor.

Två studier genomfördes varav den första var en longitudinell studie av semantisk minnesförsämring och den andra hade en ’mixed methods’ design, inkluderande både kvantitativa (neuropsykologiska tester) och kvalitativa (intervjuer) metoder.

Resultaten från den longitudinella studien avslöjade att semantiska begrepp som inte längre är välrepresenterade hos individen har gått förlorade snarare än att det skulle vara från om att individerna inte kan plocka fram informationen. Vidare kunde konstateras att semantiska begrepp gradvis tappar sina nyanser i takt med att sjukdomen fortskrider.

Den andra studien visade att Alzheimerindividerna var medvetna om sin sjukdom och sina minnesproblem men att de inte kunde förutsäga vilka problem deras kognitiva tillkortakommanden skapade i deras vardag. De konstaterades ha svag central koherens vilket innebär att de ser sin omgivning på ett fragmentariskt sätt utan att kunna få ihop de olika objekten runt omkring sig till en meningsfull kontext. Vad gäller emotioner så kunde konstateras att Alzheimerindivider reagerar likadant som normalt åldrande individer på negativt laddade ord men att de är signifikant försämrade i förmågan att känna igen positiva och neutrala ord. Alzheimerindividerna och deras make/maka var inte väl kalibrerade vad gäller sjukdomsrelaterade frågor.

Avhandlingens resultat har viktiga kliniska implikationer och ger ett värdefullt bidrag till förståelsen av en individ med Alzheimers sjukdom.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. , 72 p.
Series
Linköping Studies in Arts and Science, ISSN 0282-9800 ; 582Linköping Studies in Behavioural Science, ISSN 1654-2029 ; 175Studies from the Swedish Institute for Disability Research, ISSN 1650-1128 ; 49
Keyword [en]
Alzheimer’s disease, longitudinal study, mixed methods design, semantic memory, awareness, metacognition, central coherence, emotions
Keyword [sv]
Alzheimers sjukdom, longitudinell studie, mixed methods design, semantiskt minne, medvetande, metakognition, central koherens, emotioner
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-91890ISBN: 978-91-7519-612-1 (print)OAI: oai:DiVA.org:liu-91890DiVA: diva2:619481
Public defence
2013-05-24, Eklundska salen, Hus I, Campus Valla, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2013-05-03 Created: 2013-05-03 Last updated: 2013-05-05Bibliographically approved
List of papers
1. A longitudinal study of semantic memory impairment in patients with Alzheimer’s disease
Open this publication in new window or tab >>A longitudinal study of semantic memory impairment in patients with Alzheimer’s disease
2013 (English)In: Cortex, ISSN 0010-9452, E-ISSN 1973-8102, Vol. 49, no 2, 528-533 p.Article in journal (Refereed) Published
Abstract [en]

Introduction

The present study explored the nature of the semantic deterioration normally displayed in the course of Alzheimer’s disease (AD). The aim was to disentangle the extent to which semantic memory problems in patients with AD are best characterized as loss of semantic knowledge rather than difficulties in accessing semantic knowledge.

Method

A longitudinal approach was applied. The same semantic tests as well as same items were used across three test occasions a year apart. Twelve Alzheimer patients and 20 matched control subjects, out of a total of 25 cases in each group, remained at the final test occasion.

Results and Conclusions

Alzheimer patients were impaired in all the semantic tasks as compared to the matched comparison group. A progressing deterioration was evident during the study period. Our findings suggest that semantic impairment is mainly due to loss of information rather than problems in accessing semantic information.

Place, publisher, year, edition, pages
Elsevier, 2013
Keyword
Alzheimer’s disease; Semantic memory impairment; Longitudinal study
National Category
Psychology
Identifiers
urn:nbn:se:liu:diva-89593 (URN)10.1016/j.cortex.2012.02.004 (DOI)000316926800016 ()22445445 (PubMedID)
Available from: 2013-02-27 Created: 2013-02-27 Last updated: 2017-12-06Bibliographically approved
2. Aspects of awareness in patients with Alzheimer's disease
Open this publication in new window or tab >>Aspects of awareness in patients with Alzheimer's disease
2013 (English)In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 25, no 7, 1167-1179 p.Article in journal (Refereed) Published
Abstract [en]

Background: The purpose of the present study was to gain insight into Alzheimer's disease (AD) patients' perception of the world through the study of a few aspects of awareness. The aspects in focus of the study were disease awareness, metacognition, managing of everyday life, and as a complement, the agreement (calibration) between patients and their spouses on the studied aspects was considered.

Method: A mixed-method evaluation design was used involving 15 AD patients, their spouses, and 15 elderly healthy control subjects. The study comprised both a semistructured interview (AD patients and spouse) and a neuropsychological assessment (AD patients and control subjects).

Results: The patients were aware of their disease and able to report on their illness. Despite this awareness, they were unable to realize and manage the practical and cognitive implications of their impairment. The results also indicate that patients and spouses were not well calibrated regarding thoughts about the disease and problems in handling the cognitive deterioration.

Conclusions: The findings of our study have relevance to patients' well being and how they manage everyday life. An open dialogue on these issues between spouses and in the care for AD patients would hopefully enhance quality of life for all parties involved.

Place, publisher, year, edition, pages
Cambridge University Press, 2013
Keyword
Alzheimer's disease; awareness; metacognition; patients’ experiences; mixed methods
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-91884 (URN)10.1017/S1041610212002335 (DOI)000321262200014 ()23425334 (PubMedID)
Available from: 2013-05-03 Created: 2013-05-03 Last updated: 2017-12-06Bibliographically approved
3. Weak central coherence in patients with Alzheimer’s disease
Open this publication in new window or tab >>Weak central coherence in patients with Alzheimer’s disease
2013 (English)In: Neural Regeneration Research, ISSN 1673-5374, E-ISSN 1876-7958, Vol. 8, no 8Article in journal (Refereed) Published
Abstract [en]

Central coherence refers to the ability to interpret details of information into a whole. To date, the concept of central coherence is mainly used in research of autism, Asperger’s syndrome and recently in the research on eating disorders. The main purpose of the present study was to examine central coherence in patients with Alzheimer’s disease. Nine Alzheimer’s disease patients and ten age- and gender-matched control subjects, who differed significantly in neurological assessment, were shown a picture of a fire. Compared to control subjects, the Alzheimer’s disease patients described the picture in a fragmented way by mentioning details and separate objects without perceiving the context of the fire. In conclusion, patients with Alzheimer’s disease are at the weak end of central coherence, and hence suffer from a fragmented view of their surroundings. The findings have important clinical implications for the understanding of patients with Alzheimer’s diseaseand also for the possibility of caregivers to meet the Alzheimer’s disease individual in an appropriate way in the everyday care.

Keyword
Neural regeneration; neurodegenerative diseases; clinical practice; Alzheimer’s disease; senile dementia; central coherence; cognition; perception; information processing; neuroregeneration
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-91887 (URN)10.3969/j.issn.1673-5374.2013.08.011 (DOI)000317029900011 ()
Available from: 2013-05-03 Created: 2013-05-03 Last updated: 2017-12-06Bibliographically approved
4. Emotion and recollective experience in Alzheimer’s disease
Open this publication in new window or tab >>Emotion and recollective experience in Alzheimer’s disease
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Emotional changes are common in Alzheimer’s disease (AD). In addition, damage to brain regions involved in emotion is abundant in AD. Although these finding imply that emotion memory is severely compromised in AD, absolute or relative sparing of emotional memory has occasionally been reported. Hence, we wanted to clarify how well AD patients can remember emotion words. Eighteen AD patients and fifteen healthy older persons participated in the experiment. Participants studied neutral, positive, and negative words. Implicit and explicit memory was assessed in two tasks: a word-fragment completion task and a recognition task, respectively. In the latter task, participants were asked to provide recollective judgments when they indicated that they recognized a word from previous study. Results indicated that AD patients responded to valence, and in particular negative valence, similar to controls, that AD patients evidenced severe deficits as to recollective experience, and that implicit memory remained intact in AD.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-91889 (URN)
Available from: 2013-05-03 Created: 2013-05-03 Last updated: 2013-05-05Bibliographically approved

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