Selective forgetting of self-threatening statements: Mnemic neglect for dementia information in people with mild dementia

Effect of stimuli type on affective memory of patients with different severities of cognitive impairment

OBJECTIVES

To understand the differences in affective memory performance under different degrees of cognitive impairment, this study recruited older people with different degrees of cognitive impairment, to perform emotion recognition memory tasks.

METHODS

Fifty-four elderly participants aged (65-85 years) were recruited. Of these, 18 had mild cognitive impairment, 18 had a mild form of Alzheimer's disease, and the remaining 18 were healthy. Factors such as the different emotional valences (positive, neutral, or negative) and stimulus types (pictures, words, or sounds) were manipulated to explore their influences on the emotion recognition memory of people with different degrees of cognitive impairment.

RESULTS

The results showed that people's performance to positive stimuli worsened as their degree of cognitive impairment increased. All participants had difficulty processing memory of affective sound stimuli compared to the other two stimulus types.

CONCLUSIONS

The results explain the decline in the cognitive ability process, in affective memory performance, of people with different degrees of cognitive impairment. This abnormal decline on affective memory performance could be an early diagnostic indicator of Alzheimer's disease. The results can hopefully be used as a reference for subsequent research on cognition-related diseases and age-related decline, especially regarding affective memory.

The Development and Validation of the Threat of Dementia Scale

Dementia represents a substantial threat to the self. However, to date, there is no reliable way to measure how threatened people feel by dementia. This article reports on two online studies. In Study 1, 248 participants rated statements about dementia according to their threat to well-being. In Study 2, 99 participants (all students at the University of the West of England) completed the emerging scale (the Threat of Dementia Scale or ToDS). We validated this by examining its associations with conceptually related measures, including the revised Fraboni Scale of Ageism and the Fear of Alzheimer's Disease Scale. Study 1 yielded 13 statements that were highly intercorrelated and comprised a single factor. In Study 2, the ToDS demonstrated good construct validity and acceptable test-retest reliability. Higher levels of distancing predicted lower scores on the ToDS. The ToDS is a reliable and valid instrument that is the first statistically validated method of examining the extent to which dementia threatens well-being.

The mnemic neglect effect and information about dementia: age differences in recall

Dementia represents a more immediate threat for older than for younger adults. Consequently, different strategies may be used to defend the self against the threat of dementia. We hypothesised that older (compared to younger) adults are more likely to manifest mnemic neglect (in which information that is threatening to the self is selectively forgotten) to reduce distress for dementia-related information.Fifty-nine participants aged under 50 and 44 participants aged over 50 recalled 24 dementia-related statements that were either high or low in negativity. Participants were randomised to recall statements that referred either to themselves or another person. High-negativity, self-referent statements had the most substantial threat potential. The recall of older (but not younger) participants for high-negativity (vs. low-negativity) dementia-related statements was impaired when these statements referred to the self rather than to another person. These results indicate that older adults evince mnemic neglect in response to self-threatening information about dementia.

Predictors of Perceived Social Support for Patients with Dementia: A Mixed-Methods Study

Purpose

Perceived social support (PSS) is closely linked to health outcomes in dementia patients. However, its continuous benefits are unclear. This mixed-methods study examined the impact of social support perceptions and differentiation among patients and carers during disease progression.

Patients and Methods

Persons with dementia (PWDs), family caregivers, and community family physicians were recruited from nine community health centers. Semi-structured interviews conducted with 12 PWDs (7 PWDs in mild dementia and 5 in moderate dementia), 12 family caregivers, and 6 community family physicians and conventional content analysis were used to explore social support perspectives at different dementia stages. A total of 470 PWDs were divided into mild (n=224), moderate (n=190), and severe (n=56) groups. Demographic, physical, and psychological factors related to PSS were examined by the group using multiple regression analysis. The group-based characteristics were entered into three prediction models.

Results

In the qualitative study, three themes of social support were identified: two viewpoints refer to social support; different needs and preferences in each stage; non-personalized support services. Quantitatively, the mild group scored lowest in perceived social support, while the severe group scored highest (χ²=64.70, P<0.001). The mild group PSS was predicted by depression (β=−0.07, P=0.04), cognitive capacity (β=−0.18, P<0.001), and instrumental ability (β=−0.78, P<0.001), which differed from the moderate and severe groups.

Conclusion

This study provided comprehensive insight into PSS from PWDs’ perspective at different stages of the disease. Results indicated the need for a stratified care approach and direction for further research on intervention.

The recall of dementia-related and neutral words by people with dementia: The ironic process of thought suppression

OBJECTIVE

Thought suppression may not work effectively when people have a cognitive impairment. This study tests whether participants with dementia showed lessened or enhanced recall and recognition of dementia-related words compared with a control population.

METHODS

Fifty participants living with dementia with mild levels of cognitive impairment and a control group of 52 participants without a diagnosis of dementia took part. A list of 12 words, composed of six dementia-related and six neutral words matched for frequency and length, was read out on four occasions, with the word order being varied for each presentation. Recognition was also assessed.

RESULTS

There was an interaction between word-type and participant group at both recall and recognition. While control participants recalled more neutral than dementia-related words, there was no difference for dementia participants. However, dementia participants recognised a significantly higher proportion of the dementia-related words, while there was no difference in word-type recognition for control participants.

CONCLUSIONS

This study adapts a social psychological paradigm to explore whether an important psychological mechanism for reducing distress can be affected by cognitive impairment. Our findings suggest that for people living with dementia, thought suppression may be either ineffective in reducing conscious awareness of distal threats or operate in an ironic fashion. While threatening proximal material may be repressed from awareness, distal threats may return into implicit awareness. This casts new light on research and has clinical implications.

Insight: the concept, the assessment and the label

This refreshment summarises some of the ways in which ‘insight’ has been understood in psychiatric practice and offers some critical thoughts about the notion.

DECLARATION OF INTEREST

None.

Selective forgetting of self-threatening statements: Mnemic neglect for dementia information in people with mild dementia

OBJECTIVE

We tested whether people with dementia manifest selective forgetting for self-threatening information, the mnemic neglect effect (MNE). This selective forgetting is observed among healthy adults in the recall, but not the recognition, of self-threatening feedback.

METHODS

Sixty-four statements about dementia were rated for their level of negativity by 280 staff and students at University of the West of England. The 12 statements rated as most negative and the 12 statements rated as least negative were then read to 62 people with dementia. Participants were randomized to 1 of 2 conditions with the statements referring either to self or to another person. High-negativity and self-referent statements had strong threat potential. Participants recalled the statements and then completed a recognition task, which consisted of the 24 previously read statements and 24 new statements.

RESULTS

Participants manifested the MNE: They recalled fewer high-negativity (compared with low-negativity) statements, but only when these referred to the self rather than another person. This pattern occurred independently of levels of depression or anxiety. Participants also made more self-protective intrusion errors when the statements referred to the self than another person. Participants did not differ in their recognition of statements.

CONCLUSION

The MNE occurs among people with dementia. The selective forgetting of highly negative, self-referent statements serves to protect the self against the threat that dementia represents. Given the similarities between the MNE and the clinical phenomenon of repression, the findings may mark psychological processes that are implicated in the acceptance (or lack thereof) of a dementia diagnosis.

Psychological and Mnemonic Benefits of Nostalgia for People with Dementia

BACKGROUND

Studies with non-clinical populations show that nostalgia increases psychological resources, such as self-esteem and social connectedness.

OBJECTIVES

Our objectives were to find out if the benefits of nostalgia in non-clinical populations generalize to people with dementia and if nostalgia facilitates recall of dementia-related information.

METHODS

All three experiments recruited participants with mild or moderate levels of dementia. Experiment 1 tested whether nostalgia (compared to control) enhances psychological resources among 27 participants. Experiment 2 used music to induce nostalgia (compared to control) in 29 participants. Experiment 3 compared recall for self-referent dementia statements among 50 participants randomized to either a nostalgia or control condition. Findings across experiments were synthesized with integrative data analysis.

RESULTS

Nostalgia (compared to control) significantly increased self-reported social connectedness, meaning in life, self-continuity, optimism, self-esteem, and positive (but not negative) affect (Experiments 1-3). Compared to controls, nostalgic participants also recalled significantly more self-referent dementia-related information (Experiment 3).

CONCLUSION

This series of experiments extends social psychological research with non-clinical populations into dementia care, providing evidence that nostalgia significantly enhances psychological resources. The finding that nostalgia increased recall of self-referent statements about dementia suggests that this emotion lends participants the fortitude to face the threat posed by their illness. The finding has potentially important clinical implications both for the development of reminiscence therapy and for facilitating adjustment to a diagnosis of dementia.