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Martyr A, Gamble LD, Nelis SM, Collins R, Alexander CM, Morris RG, Quinn C, Pentecost C, Rusted JM, Victor C, Thom JM, Matthews FE, Clare L. Predictors of Awareness of Functional Ability in People with Dementia: The Contribution of Personality, Cognition, and Neuropsychiatric Symptoms - Findings from the IDEAL Program. Dement Geriatr Cogn Disord 2022; 51:221-232. [PMID: 35533657 DOI: 10.1159/000524607] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/07/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Discrepancy scores reflecting the difference between parallel ratings made by people living with dementia (PwD) in the mild-to-moderate stages and by their informants provide a way to investigate awareness of functional ability in relation to activities of daily living (ADL). METHODS Two measures of ADL (Functional Activities Questionnaire; Dependence Scale) were completed by 1,227 PwD and their informants in the IDEAL cohort study baseline assessment. Self-rated and informant-rated scores were used to calculate discrepancies, which were used as an indicator of awareness of functional ability. Smaller discrepancy scores were considered to reflect greater awareness on the part of PwD. PwD completed questionnaires on depression, personality, comorbidities, neuropsychiatric symptoms, and completed a measure of cognition. Informants provided ratings of stress. Univariable and multiple regressions were used to investigate factors related to ADL discrepancy. RESULTS A similar pattern of associations were found for both ADL discrepancy scores. Smaller discrepancy scores were associated with higher levels of depression, higher neuroticism, fewer neuropsychiatric symptoms, higher comorbidity, lower carer stress, and receipt of less than 1 hour of care per day from the informant. DISCUSSION/CONCLUSION There was a clear pattern of factors that were associated with greater awareness for both measures of functional ability. These factors associated with smaller discrepancy scores could be used to identify PwD who might benefit from targeted interventions to support their independence.
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Affiliation(s)
- Anthony Martyr
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, United Kingdom
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sharon M Nelis
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, United Kingdom
| | - Rachel Collins
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, United Kingdom
| | - Catherine M Alexander
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, United Kingdom
| | - Robin G Morris
- Department of Psychology, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Catherine Quinn
- Centre for Applied Dementia Studies, University of Bradford, Bradford, United Kingdom.,Wolfson Centre for Applied Health Research, Bradford, United Kingdom
| | - Claire Pentecost
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, United Kingdom
| | - Jennifer M Rusted
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Christina Victor
- Department of Health Sciences, College of Health, Medicine and Life Sciences, Brunel University London, London, United Kingdom
| | - Jeanette M Thom
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Fiona E Matthews
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, United Kingdom.,NIHR Applied Research Collaboration South-West Peninsula, Exeter, United Kingdom
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Alexander CM, Martyr A, Gamble LD, Savage SA, Quinn C, Morris RG, Collins R, Clare L. Does awareness of condition help people with mild-to-moderate dementia to live well? Findings from the IDEAL programme. BMC Geriatr 2021; 21:511. [PMID: 34563135 PMCID: PMC8467163 DOI: 10.1186/s12877-021-02468-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/06/2021] [Indexed: 01/07/2023] Open
Abstract
Background People living with dementia vary in awareness of their abilities. We explored awareness of the condition and diagnosis in people with mild-to-moderate dementia, and how this relates to quality of life, well-being, life satisfaction, and caregiver stress. Methods This study was a cross-sectional exploratory analysis of data from the IDEAL cohort, which recruited people with dementia living at home and available caregivers from 29 research sites in Great Britain. Our study included 917 people with mild-to-moderate dementia and 755 carers. Low and high awareness groups were derived from self-reported responses to a dementia representation measure. Logistic regression was used to explore predictors of awareness of condition and diagnosis using demographic, cognitive, functional and psychological measures, and the relationship with quality of life, well-being and life satisfaction (‘living well’), and caregiver stress. Results There were 83 people with low awareness of their condition. The remaining 834 people showed some awareness and 103 of these had high awareness of their condition and diagnosis. Psychosocial factors were stronger predictors of awareness than cognitive and functional ability. Those with higher awareness reported lower mood, and lower scores on indices of living well as well as lower optimism, self-efficacy and self-esteem. Low awareness was more likely in those aged 80y and above, and living in more socially deprived areas. No relationship was seen between caregiver stress and awareness. Conclusions Awareness of the condition and diagnosis varies in people with mild-to-moderate dementia and is relevant to the capability to live well. Awareness should be considered in person-centered clinical care. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02468-4.
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Affiliation(s)
- Catherine M Alexander
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter Medical School, University of Exeter, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter Medical School, University of Exeter, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sharon A Savage
- School of Psychology, The University of Newcastle, Australia, Newcastle, Australia
| | - Catherine Quinn
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Robin G Morris
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Rachel Collins
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter Medical School, University of Exeter, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter Medical School, University of Exeter, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK.,National Institute for Health Research Applied Research Collaboration South-West Peninsula, Exeter, UK
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Wilson RS, Barnes LL, Rajan KB, Boyle PA, Sytsma J, Weuve J, Evans DA. Antecedents and consequences of unawareness of memory impairment in dementia. Neuropsychology 2018; 32:931-940. [PMID: 30047756 PMCID: PMC6234063 DOI: 10.1037/neu0000437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To assess the prevalence, antecedents, and consequences of unawareness of memory impairment in dementia. METHOD Persons (n = 1,862) from a geographically defined community without dementia at enrollment subsequently underwent clinical classification (248 with dementia, 611 with mild cognitive impairment, 1,003 with no cognitive impairment), memory testing, and self-appraisal of memory. Memory performance was regressed on self-appraised memory, and the residuals served as an index of memory awareness. After clinical classification, participants completed brief cognitive testing at 3-year intervals for up to 15 years. RESULTS When unawareness was defined as a score at or below thresholds ranging from the 15th to 25th percentiles, it was more common in dementia (67%-83%) and mild cognitive impairment (15%-33%) than in no cognitive impairment (2%-6%; all p < .001). A continuous measure of awareness (M = 0.00, SD = 0.61) was reduced by 0.37-unit in mild cognitive impairment (SE = 0.04, p < .001) and 1.04-unit in dementia (SE = 0.06), p < .001) compared with those without cognitive impairment, and these associations were weaker in Black persons than White persons (estimate for dementia by race = 0.37, SE = 0.12, p = .003; estimate for mild cognitive impairment by race = 0.30, SE = 0.08, p < .001). Higher premorbid neuroticism was associated with better memory awareness in dementia. Higher memory awareness was not related to mortality in mild cognitive impairment or dementia but had a marginal association with slower cognitive decline in mild cognitive impairment. CONCLUSIONS Unawareness of memory impairment is a common manifestation of dementia, particularly in White persons, but is not strongly related to adverse disease outcomes. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
- Robert S. Wilson
- Rush Alzheimer’s Disease Center, Department of Neurological Sciences, Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Lisa L. Barnes
- Rush Alzheimer’s Disease Center, Department of Neurological Sciences, Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Kumar B. Rajan
- Rush Institute for Healthy Aging, Department of Internal Medicine, Rush University Medical Center, Chicago, IL
| | - Patricia A. Boyle
- Rush Alzheimer’s Disease Center, Department of Neurological Sciences, Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Joel Sytsma
- Rush Alzheimer’s Disease Center, Department of Neurological Sciences, Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Jennifer Weuve
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA
| | - Denis A. Evans
- Rush Institute for Healthy Aging, Department of Internal Medicine, Rush University Medical Center, Chicago, IL
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Repressive Coping Does Not Contribute to Anosognosia in First-Diagnosis Patients With Alzheimer Disease. Alzheimer Dis Assoc Disord 2018; 31:249-255. [PMID: 27819840 DOI: 10.1097/wad.0000000000000169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Anosognosia is common in patients with Alzheimer disease (AD) even in early stages. Although neural correlates and the impact of cognitive dysfunctions have been described, possible psychodynamic processes such as a repressive coping style as described in other illnesses, have not been examined. Our study aimed to examine possible psychological influence factors on illness perception embracing a repressive coping style and cognitive functions in AD patients in the diagnostic process. Fifty-four subjects with mild AD diagnosed in our memory clinic were enrolled. Anosognosia was evaluated using a patient-caregiver discrepancy rating. All patients underwent comprehensive neuropsychological testing. In addition, characteristics of a repressive coping style were assessed. In total, 79.6% of our patients showed a lack of awareness at least to some degree. 33.3% of the patients were classified as repressors. Repressors and nonrepressors did not differ in cognition, or the unawareness score. Multivariate regression analysis showed that repressive coping style did not significantly contribute to anosognosia, but that verbal memory and naming ability had a strong influence. Although our data indicate that a high proportion of patients with mild AD show characteristics of repressive coping, this possible defense mechanism had no influence on the awareness of illness-related deficits measured by caregiver patient discrepancy.
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Roy S, Ficarro S, Duberstein P, Chapman BP, Dubovsky S, Paroski M, Szigeti K, Benedict RHB. Executive Function and Personality Predict Instrumental Activities of Daily Living in Alzheimer Disease. Am J Geriatr Psychiatry 2016; 24:1074-1083. [PMID: 27618644 PMCID: PMC5647863 DOI: 10.1016/j.jagp.2016.06.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/29/2016] [Accepted: 06/30/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Previous research shows that executive function (EF) and personality independently predict functional decline. Our objective was to determine whether personality traits predict independence with instrumental activities of daily living (IADLs), after accounting for executive dysfunction, in a mixed sample of patients with amnestic mild cognitive impairment (MCI) and Alzheimer disease (AD). METHODS In a cross-sectional analysis at a university medical center, 63 healthy older adults (median age: 67.6 years; 71% women) and 119 patients (median age: 75.0 years; 58% women) with varying degrees of AD (probable AD: 85; possible AD: 3; amnestic MCI: 31) were studied. Standardized neuropsychological measures, NEO Five-Factor Inventory (NEO-FFI), and informant-report Lawton and Brody IADL scales were used. All participants underwent neuropsychological evaluation, including administration of self- and informant-report NEO-FFI. Patients additionally underwent neurologic examination, and their informants completed the Lawton and Brody IADL scale. RESULTS When testing the association between EF and personality on IADLs in the patient sample, conceptual card sorting, informant-report Openness, and informant-report Conscientiousness all significantly predicted IADLs, after accounting for age, education, and depression. In addition, a significant interaction showed that low Conscientiousness and executive dysfunction, in combination, can predict impairment of IADLs. CONCLUSION Personality has a unique association with IADLs in patients with AD pathology that is not explained by EF. The findings confirm prior speculation that personality, in addition to cognitive dysfunction, is a risk factor for functional decline. Early identification of vulnerable individuals may allow for intervention to prolong functional independence.
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Affiliation(s)
- Shumita Roy
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Stephanie Ficarro
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Paul Duberstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
| | - Benjamin P Chapman
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
| | - Steven Dubovsky
- Department of Psychiatry, University at Buffalo, State University of New York (SUNY), Buffalo, NY
| | - Margaret Paroski
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Kinga Szigeti
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Ralph H B Benedict
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY.
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Woods RT, Nelis SM, Martyr A, Roberts J, Whitaker CJ, Markova I, Roth I, Morris R, Clare L. What contributes to a good quality of life in early dementia? Awareness and the QoL-AD: a cross-sectional study. Health Qual Life Outcomes 2014; 12:94. [PMID: 24919416 PMCID: PMC4061777 DOI: 10.1186/1477-7525-12-94] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 06/03/2014] [Indexed: 11/17/2022] Open
Abstract
Background Self-report quality of life (QoL) measures for people with dementia are widely used as outcome measures in trials of dementia care interventions. Depressed mood, relationship quality and neuropsychiatric symptoms predict scores on these measures, whereas cognitive impairment and functional abilities typically do not. This study examines whether these self-reports are influenced by personality and by the person’s awareness of his/her impairments. A strong negative association between QoL and awareness of deficits would have implications for the validity of self-report in this context and for therapeutic interventions aiming to increase adjustment and coping. Methods Participants were 101 individuals with early‒stage dementia and their family carers participating in the Memory Impairment and Dementia Awareness (MIDAS) Study. QoL was assessed using the QoL-AD scale, and awareness was assessed in relation to memory, activities of daily living and social functioning. Self-concept, conscientiousness, quality of relationship and mood were assessed and a brief neuropsychological battery administered. Carers rated their own stress and well-being and reported on neuropsychiatric symptoms. A series of regression analyses predicting QoL-AD were carried out, identifying key variables in each domain of assessment to take forward to an overall model. Results Cognitive impairment was not related to QoL. The final model accounted for 57% of the variance in QoL-AD scores, with significant contributions from depressed mood, severity of irritability shown by the person with dementia, self-concept, quality of relationship (rated by the person with dementia) and male gender. The bivariate relationships of QoL-AD with awareness of memory function, awareness of functional abilities and conscientiousness were mediated by both depressed mood and self-concept. Conclusions This study reports the most comprehensive approach to evaluation of awareness to date. Most of the indices of awareness used are not related to self-reported QoL. Discrepancies in evaluative judgements of memory function and functional abilities between people with dementia and carers are related to QoL, but this relationship is mediated by both depressed mood and self-concept, which have a much stronger relationship with QoL. The validity of self-report measures of QoL in people with early stage dementia is supported by these results.
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Affiliation(s)
- Robert T Woods
- DSDC Wales, Bangor University, Ardudwy, Holyhead Road, Bangor, UK.
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Clemerson G, Walsh S, Isaac C. Towards living well with young onset dementia: An exploration of coping from the perspective of those diagnosed. DEMENTIA 2013; 13:451-66. [PMID: 24339066 DOI: 10.1177/1471301212474149] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is increasing recognition that dementia in people under 65 years represents a unique challenge to sufferers and services alike. However, by either ignoring this population or sampling them together with older adults, current research has failed to reflect this. This study explored the specific experience of living and coping with Alzheimer's disease in younger life from the perspective of those diagnosed. Semi-structured interviews were analysed using interpretive phenomenological analysis, and four themes were identified: 'disruption of the life-cycle', 'identity', 'social orientation' and 'agency'. The experience of living and coping with young onset Alzheimer's disease was strongly situated within an individual's social context. Most significantly, participants felt too young to develop the disease and felt out of time with age-related psychological tasks. Coping strategies that attempted to redress and normalise the life-cycle were identified. The contributions of the study are discussed in the context of the human development literature.
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Pocnet C, Rossier J, Antonietti JP, von Gunten A. Personality features and cognitive level in patients at an early stage of Alzheimer’s disease. PERSONALITY AND INDIVIDUAL DIFFERENCES 2013. [DOI: 10.1016/j.paid.2012.08.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Clare L, Nelis SM, Martyr A, Whitaker CJ, Marková IS, Roth I, Woods RT, Morris RG. 'She might have what I have got': the potential utility of vignettes as an indirect measure of awareness in early-stage dementia. Aging Ment Health 2012; 16:566-75. [PMID: 22360671 DOI: 10.1080/13607863.2011.652594] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES In early-stage dementia, awareness at the meta-representational level involving a person's appraisal of his/her own condition and its implications has usually been assessed by interview, but contextual factors may influence responding. We examined the utility of an indirect, vignette-based method of eliciting awareness. METHOD Three vignettes describing early-stage dementia, established dementia and healthy ageing were used to elicit views of the problem and the kinds of advice that might be helpful for the characters depicted. Responses were obtained from 91 people with early-stage Alzheimer's, vascular or mixed dementia, 87 carers and 80 older controls. For the participants with dementia, awareness was assessed in separate in-depth interviews and rated on a five-point scale for comparison purposes. RESULTS Participants with dementia were often able to correctly identify the problems described in the vignettes, although scoring lower than carers or controls. Participants with dementia were also able to offer advice for those depicted, although to a lesser extent than carers or controls. Ability to offer advice was greater where MMSE scores were higher. For participants with dementia, vignette scores were moderately correlated with ratings derived from interviews, and those showing limited or no awareness offered fewer items of advice than those showing some or good awareness. In addition, 29% of participants with dementia spontaneously pointed out similarities between their own condition and that of the person depicted. CONCLUSIONS The vignette method may be useful where resources preclude the use of in-depth interviews, and may supplement in-depth interviews as part of a multi-dimensional assessment of awareness.
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Affiliation(s)
- Linda Clare
- School of Psychology, Bangor University, Bangor, Gwynedd, UK.
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Gilleen J, Greenwood K, Archer N, Lovestone S, David AS. The role of premorbid personality and cognitive factors in awareness of illness, memory, and behavioural functioning in Alzheimer's disease. Cogn Neuropsychiatry 2012; 17:227-45. [PMID: 21929281 DOI: 10.1080/13546805.2011.588007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Research has suggested an association between personality factors and awareness in patients with dementia, yet valid measurement of premorbid personality is problematic. The present study aimed to better reveal the relationship between premorbid personality and awareness by using improved methodology. Moreover, the study aims to contrast the strength of the relationship of premorbid personality and awareness with that of cognitive factors. METHODS Awareness of illness, symptoms, mnemonic and behavioural impairments, and treatment compliance were measured in 27 patients with mild-to-moderate Alzheimer's disease (AD) diagnosed by standard criteria for probable AD. Participant premorbid personality was measured using average retrospective Neuroticism-Extroversion-Openness Inventory (NEO-FFI) scores from two informants. Correlations were performed to investigate the relationship between awareness and personality dimensions, as well as measures of cognitive style, neuropsychological function, mood, carer burden, and sociodemographic factors. RESULTS There was little relationship between awareness and personality scores, but modest associations between awareness and mood, age, and age of onset of first symptoms. Awareness of memory was related to memory functioning. Increased carer burden was associated with lack of awareness of cognitive-behavioural deficits but there were only few and weak associations between awareness and measures of cognitive functioning. CONCLUSIONS There was little support for an association between previous personality and awareness in dementia. However, increased carer burden was associated specifically with lack of awareness of cognitive-behavioural deficits not deficits in ADL, whereas lower awareness of ADL and not cognitive-behavioural deficits was associated with age. Awareness of memory appeared to be a metamemory capacity. Mood and age rather than personality and cognition are stronger predictors of awareness in early Alzheimer's disease.
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Affiliation(s)
- J Gilleen
- Psychological Medicine, Department of Old Age Psychiatry, Institute of Psychiatry, King's College London, London, UK.
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Robins Wahlin TB, Byrne GJ. Personality changes in Alzheimer's disease: a systematic review. Int J Geriatr Psychiatry 2011; 26:1019-29. [PMID: 21905097 DOI: 10.1002/gps.2655] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 09/27/2010] [Indexed: 11/12/2022]
Abstract
OBJECTIVE People with Alzheimer's disease (AD) commonly exhibit changes in personality that sometimes precede the other early clinical manifestations of the condition, such as cognitive impairment and mood changes. Although these personality changes reflect the impact of progressive brain damage, there are several possible patterns of personality change with dementia. Early identification of personality change might assist with the timely diagnosis of AD. The objective of this study was to review studies of personality change in AD. METHODS Systematic searches of the PubMed, Ovid Medline, EBSCOhost, PsychINFO and CINAHL databases were undertaken from inception to November 2009. Published studies of informant-rated personality traits in AD patients were identified. Studies that mapped changes in traits from the five-factor model of personality which includes factors for Neuroticism, Extraversion, Openness, Agreeableness and Conscientiousness, were selected for analysis. The change in each of these five traits was calculated as the mean difference in score before and after the diagnosis of AD. RESULTS There was a mean increase in Neuroticism of 10-20 T scores (equivalent to 1-2 SD), a decrease of the same magnitude in Extraversion, consistently reduced Openness and Agreeableness, and a marked decrease in Conscientiousness of about 20-30 T scores (equivalent to 2-3 SD). These changes were systematic and consistent. Particularly striking was the similarity of both the magnitude and direction of change in all studies reviewed. CONCLUSIONS Conscientiousness and Neuroticism are the personality traits that exhibit the most change in dementia. These traits might be useful early markers of dementia.
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Abstract
OBJECTIVES People caring for family members who have dementia often experience considerable levels of anxiety and depression. However, relatively little is known about the awareness of carer distress among people with dementia. This study investigated whether or not people with dementia are aware of the level of distress experienced by their carers. METHOD Two groups of participants were studied, a dementia group and a control group of people with arthritis. Each group consisted of pairs of people, the person with dementia or arthritis and the family member who acted as their main carer; 40 pairs participated in total. For both groups, the carer's psychological health was rated by the carer themselves and by the care-recipient, using the Hospital Anxiety and Depression Scale. For the dementia group, memory functioning in the person with dementia was rated by the care-recipient themselves and by the carer, using the Memory Function Scale. The ratings made by the carer and care-recipient were compared to give an indication of the level of awareness in the care-recipient. RESULTS People with dementia have a significant level of awareness of their carers' state of psychological health. Their awareness follows the same pattern as that shown by a control group of people with arthritis. The level of awareness of carer psychological health shown by the dementia group was not related to their level of awareness of their own memory difficulties. CONCLUSION The clinical implications of awareness of carer distress in people with dementia should be considered.
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Affiliation(s)
- Astri Ablitt
- Department of Psychology, University of Warwick, Coventry, UK.
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Clare L, Woods RT, Whitaker R, Wilson BA, Downs M. Development of an awareness-based intervention to enhance quality of life in severe dementia: trial platform. Trials 2010; 11:73. [PMID: 20579370 PMCID: PMC2908603 DOI: 10.1186/1745-6215-11-73] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 06/25/2010] [Indexed: 12/04/2022] Open
Abstract
Background Quality of residential care for people with severe dementia is in urgent need of improvement. One reason for this may be the assumption that people with severe dementia are unaware of what is happening to them. However, there is converging evidence to suggest that global assumptions of unawareness are inappropriate. This trial platform study aims to assist care staff in perceiving and responding to subtle signs of awareness and thus enhance their practice. Methods/Design In Stage One, a measure of awareness in severe dementia will be developed. Two focus groups and an expert panel will contribute to item and scale development. In Stage Two observational data will be used to further develop the measure. Working in four care homes, we will recruit 40 individuals with severe dementia who have no, or very limited, verbal communication. Data on inter-rater reliability and frequency of all items and exploratory factor analysis will be used to identify items to be retained. Test-retest and inter-rater reliability for the new measure will be calculated. Correlations with scores for well-being and behaviour and with proxy ratings of quality of life will provide an indication of concurrent validity. In Stage Three the new measure will be used in a single blind cluster randomised trial. Eight care homes will participate, with 10 residents recruited in each giving a total sample of 80 people with severe dementia. Homes will be randomised to intervention or usual care conditions. In the intervention condition, staff will receive training in using the new measure and will undertake observations of designated residents. For residents with dementia, outcomes will be assessed in terms of change from baseline in scores for behaviour, well-being and quality of life. For care staff, outcomes will be assessed in terms of change from baseline in scores for attitudes, care practice, and well-being. Discussion The results will inform the design of a larger-scale trial intended to provide definitive evidence about the benefits of increasing the sensitivity of care staff to signs of awareness in residents with severe dementia. Trial Registration ISRCTN59507580 http://www.controlled-trials.com.
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Affiliation(s)
- Linda Clare
- School of Psychology, Bangor University, Gwynedd LL57 2AS, UK.
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von Gunten A, Pocnet C, Rossier J. The impact of personality characteristics on the clinical expression in neurodegenerative disorders—A review. Brain Res Bull 2009; 80:179-91. [DOI: 10.1016/j.brainresbull.2009.07.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 07/05/2009] [Accepted: 07/06/2009] [Indexed: 11/27/2022]
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Naylor E, Clare L. Awareness of memory functioning, autobiographical memory and identity in early-stage dementia. Neuropsychol Rehabil 2008; 18:590-606. [DOI: 10.1080/09602010701608681] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Evans S. ‘Beyond forgetfulness’: How psychoanalytic ideas can help us to understand the experience of patients with dementia. PSYCHOANALYTIC PSYCHOTHERAPY 2008. [DOI: 10.1080/02668730802323494] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Clare L, Rowlands J, Bruce E, Surr C, Downs M. ‘I don't do like I used to do’: A grounded theory approach to conceptualising awareness in people with moderate to severe dementia living in long-term care. Soc Sci Med 2008; 66:2366-77. [DOI: 10.1016/j.socscimed.2008.01.045] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Indexed: 10/22/2022]
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Oyebode JR, Telling AL, Hardy RM, Austin J. Awareness of memory functioning in early Alzheimer's disease: lessons from a comparison with healthy older people and young adults. Aging Ment Health 2007; 11:761-7. [PMID: 18074264 DOI: 10.1080/13607860701366277] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
To compare awareness of memory in people with early Alzheimer's disease (AD) with older and younger control groups in order to clarify the contributions of disease and ageing. Twenty-one individuals with early AD, 32 older people (OP) and 32 younger people (YP) estimated their performance before and following each of four tests of memory. Those with AD significantly overestimated performance prior to testing, confirming the presence of unawareness for prediction. Their estimates were adjusted for age in a similar way to those of OP, who predicted their performance accurately. Younger people significantly underestimated their performance. Following memory tests, YP and those with AD significantly adjusted their ratings towards greater accuracy but on average those with AD still overestimated. There were variations in post-test ratings from over to under prediction in all three groups. Heightened awareness post-performance may open possibilities of cognitive rehabilitation to consolidate momentary into more long-term awareness, whilst the operation of possible psychosocial influences suggests that emotion oriented interventions to increase acceptance and decrease shame might be helpful.
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Affiliation(s)
- J R Oyebode
- School of Psychology, University of Birmingham, UK.
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Twigg P, Burgener SC, Popovich A. Measurement and relevance of personality characteristics in persons with dementia: a longitudinal perspective. Res Theory Nurs Pract 2007; 21:13-31. [PMID: 17378462 DOI: 10.1891/rtnpij-v21i1a004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Studies of personality and outcomes in persons with dementia (PWD) have focused primarily on disease stages or change from premorbid personality following diagnosis. Data from a longitudinal study of 96 caregiver/PWD dyads was used to evaluate psychometric properties of two personality measures: one rated by proxies, the other by PWD. Proxy ratings indicate change in strength of personality traits across disease stages; self-ratings were stable, excepting decreased extroversion. Items detracting from reliability of some subscales reflected disease-related changes in PWD rather than true shifts in personality. Findings support importance of collecting both proxy and self-ratings of personality, examining individual items contributing to low reliability, and evaluating change in personality within the context of expected changes inherent in dementia.
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Current awareness in geriatric psychiatry. Int J Geriatr Psychiatry 2006; 21:500-7. [PMID: 16739260 DOI: 10.1002/gps.1490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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