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Martyr A, Nelis SM, Morris RG, Marková IS, Roth I, Woods RT, Clare L. Exploring longitudinal changes in implicit awareness of dementia: An investigation of the emotional Stroop effect in healthy ageing and mild dementia. J Neuropsychol 2024; 18:226-238. [PMID: 37658549 DOI: 10.1111/jnp.12344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 09/03/2023]
Abstract
The aim of the study was to investigate responses to dementia-relevant words in healthy older people and to investigate changes in response over 20-months in people with early-stage dementia. An emotional Stroop task, using colour-naming dementia-relevant words, was used as an indicator of implicit awareness of dementia. Overall, 24 people with dementia and 24 healthy older people completed an emotional Stroop task (T1). People with dementia completed the same task again after 12 (T2) and 20 (T3) months. For people with dementia emotional Stroop performance was contrasted with ratings of explicit awareness based on a detailed interview at T1 and at T2. For healthy older people and people with dementia response times to dementia-relevant words were significantly longer than those for neutral words. The effect was absent for people with dementia at T3. This decline in the emotional Stroop effect was not associated with cognitive decline as measured by the MMSE. Ratings of explicit awareness showed no significant change over time. There was no association between explicit awareness and implicit awareness. Implicit awareness of the condition is evident in early-stage dementia and can be elicited even where there is reduced explicit awareness. The emotional Stroop effect for dementia-relevant words in people with dementia appears to decline over time, independently of changes in MMSE score, suggesting that implicit awareness fades as time progresses.
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Affiliation(s)
- Anthony Martyr
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Sharon M Nelis
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Robin G Morris
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ivana S Marková
- Hull York Medical School, Allam Medical Building University of Hull, Hull, UK
| | - Ilona Roth
- School of Life, Health and Chemical Sciences, STEM Faculty, The Open University, Milton Keynes, UK
| | - Robert T Woods
- Dementia Services Development Centre (DSDC) Wales, School of Medical & Health Sciences, Bangor University, Bangor, UK
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
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2
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Salmon E, Meyer F, Genon S, Collette F, Bastin C. Neural correlates of impaired cognitive processes underlying self-unawareness in Alzheimer's disease. Cortex 2024; 171:1-12. [PMID: 37977109 DOI: 10.1016/j.cortex.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/05/2023] [Accepted: 10/19/2023] [Indexed: 11/19/2023]
Abstract
Self-unawareness concerning current symptoms remains a clinical challenge in Alzheimer's disease. Reduced self-awareness likely depends on complex biopsychosocial mechanisms that comprise multiple cognitive processes, regulated by personal goals and values. We specifically reviewed the cognitive processes impaired in unaware participants with AD by emphasizing the related impaired brain activity observed during task-based fMRI. Unawareness can be explained by a failure in functioning of or in connection between brain regions that intervene in access, retrieval and updating of (present or extended) self-information (posterior midline, medial temporal, inferior parietal cortices), or in its monitoring, evaluation, or control (medial and lateral prefrontal cortices). Although one must be cautious when relating function to brain regions, impaired processes were tentatively related to the Cognitive Awareness Model. Although brain function depends on neural networks, impaired brain activity during cognitive processes was discussed according to previous studies reporting correlations between brain regions and scores of anosognosia. The review provides a framework to help clinicians considering processes that can explain unawareness in dementia. In patients at early stages of AD, different levels of awareness of cognitive or social clinical changes might be described as impairment in the interaction between specific cognitive processes and contents.
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Affiliation(s)
- Eric Salmon
- GIGA Cyclotron Research Centre in Vivo Imaging, University of Liege, Liege, Belgium.
| | - François Meyer
- GIGA Cyclotron Research Centre in Vivo Imaging, University of Liege, Liege, Belgium.
| | - Sarah Genon
- GIGA Cyclotron Research Centre in Vivo Imaging, University of Liege, Liege, Belgium; Institute of Systems Neuroscience, Heinrich Heine University Duesseldorf, Duesseldorf, Germany; Institute of Neuroscience and Medicine (INM-7), Research Centre Juelich, Juelich, Germany.
| | - Fabienne Collette
- GIGA Cyclotron Research Centre in Vivo Imaging, University of Liege, Liege, Belgium.
| | - Christine Bastin
- GIGA Cyclotron Research Centre in Vivo Imaging, University of Liege, Liege, Belgium.
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Gott JA, Stücker S, Kanske P, Haaker J, Dresler M. Acetylcholine and metacognition during sleep. Conscious Cogn 2024; 117:103608. [PMID: 38042119 DOI: 10.1016/j.concog.2023.103608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 10/03/2023] [Accepted: 11/16/2023] [Indexed: 12/04/2023]
Abstract
Acetylcholine is a neurotransmitter and neuromodulator involved in a variety of cognitive functions. Additionally, acetylcholine is involved in the regulation of REM sleep: cholinergic neurons in the brainstem and basal forebrain project to and innervate wide areas of the cerebral cortex, and reciprocally interact with other neuromodulatory systems, to produce the sleep-wake cycle and different sleep stages. Consciousness and cognition vary considerably across and within sleep stages, with metacognitive capacity being strikingly reduced even during aesthetically and emotionally rich dream experiences. A notable exception is the phenomenon of lucid dreaming-a rare state whereby waking levels of metacognitive awareness are restored during sleep-resulting in individuals becoming aware of the fact that they are dreaming. The role of neurotransmitters in these fluctuations of consciousness and cognition during sleep is still poorly understood. While recent studies using acetylcholinesterase inhibitors suggest a potential role of acetylcholine in the occurrence of lucid dreaming, the underlying mechanisms by which this effect is produced remains un-modelled and unknown; with the causal link between cholinergic mechanisms and upstream psychological states being complex and elusive. Several theories and approaches targeting the association between acetylcholine and metacognition during wakefulness and sleep are highlighted in this review, moving through microscopic, mesoscopic and macroscopic levels of analysis to detail this phenomenon at several organisational scales. Several exploratory hypotheses will be developed to guide future research towards fully articulating how metacognition is affected by activity at the acetylcholine receptor.
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Affiliation(s)
- Jarrod A Gott
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sina Stücker
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Philipp Kanske
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Jan Haaker
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Dresler
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands.
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Andrade K, Guieysse T, Medani T, Koechlin E, Pantazis D, Dubois B. The dual-path hypothesis for the emergence of anosognosia in Alzheimer's disease. Front Neurol 2023; 14:1239057. [PMID: 38020610 PMCID: PMC10654627 DOI: 10.3389/fneur.2023.1239057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Although neurocognitive models have been proposed to explain anosognosia in Alzheimer's disease (AD), the neural cascade responsible for its origin in the human brain remains unknown. Here, we build on a mechanistic dual-path hypothesis that brings error-monitoring and emotional processing systems as key elements for self-awareness, with distinct impacts on the emergence of anosognosia in AD. Proceeding from the notion of anosognosia as a dimensional syndrome, varying between a lack of concern about one's own deficits (i.e., anosodiaphoria) and a complete lack of awareness of deficits, our hypothesis states that (i) unawareness of deficits would result from primary damage to the error-monitoring system, whereas (ii) anosodiaphoria would more likely result from an imbalance between emotional processing and error-monitoring. In the first case, a synaptic failure in the error-monitoring system, in which the anterior and posterior cingulate cortices play a major role, would have a negative impact on error (or deficits) awareness, preventing patients from becoming aware of their condition. In the second case, an impairment in the emotional processing system, in which the amygdala and the orbitofrontal cortex play a major role, would prevent patients from monitoring the internal milieu for relevant errors (or deficits) and assigning appropriate value to them, thus biasing their impact on the error-monitoring system. Our hypothesis stems on two scientific premises. One comes from preliminary results in AD patients showing a synaptic failure in the error-monitoring system along with a decline of awareness for cognitive difficulties at the time of diagnosis. Another comes from the somatic marker hypothesis, which proposes that emotional signals are critical to adaptive behavior. Further exploration of these premises will be of great interest to illuminate the foundations of self-awareness and improve our knowledge of the underlying paths of anosognosia in AD and other brain disorders.
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Affiliation(s)
- Katia Andrade
- Institute of Memory and Alzheimer’s Disease (IM2A), Department of Neurology, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France
- Frontlab, Paris Brain Institute (Institut du Cerveau, ICM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Thomas Guieysse
- Institute of Memory and Alzheimer’s Disease (IM2A), Department of Neurology, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France
| | - Takfarinas Medani
- Signal and Image Processing Institute, University of Southern California, Los Angeles, CA, United States
| | - Etienne Koechlin
- École Normale Supérieure, Laboratoire de Neurosciences Cognitives et Computationnelles, Paris, France
| | - Dimitrios Pantazis
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Bruno Dubois
- Institute of Memory and Alzheimer’s Disease (IM2A), Department of Neurology, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France
- Frontlab, Paris Brain Institute (Institut du Cerveau, ICM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
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Gou XY, Li YX, Guo LX, Zhao J, Zhong DL, Liu XB, Xia HS, Fan J, Zhang Y, Ai SC, Huang JX, Li HR, Li J, Jin RJ. The conscious processing of emotion in depression disorder: a meta-analysis of neuroimaging studies. Front Psychiatry 2023; 14:1099426. [PMID: 37448490 PMCID: PMC10338122 DOI: 10.3389/fpsyt.2023.1099426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 05/02/2023] [Indexed: 07/15/2023] Open
Abstract
Background Depression is generally accompanied by a disturbed conscious processing of emotion, which manifests as a negative bias to facial/voice emotion information and a decreased accuracy in emotion recognition tasks. Several studies have proved that abnormal brain activation was responsible for the deficit function of conscious emotion recognition in depression. However, the altered brain activation related to the conscious processing of emotion in depression was incongruent among studies. Therefore, we conducted an activation likelihood estimation (ALE) analysis to better understand the underlying neurophysiological mechanism of conscious processing of emotion in depression. Method Electronic databases were searched using the search terms "depression," "emotion recognition," and "neuroimaging" from inceptions to April 10th, 2023. We retrieved trials which explored the neuro-responses of depressive patients to explicit emotion recognition tasks. Two investigators independently performed literature selection, data extraction, and risk of bias assessment. The spatial consistency of brain activation in conscious facial expressions recognition was calculated using ALE. The robustness of the results was examined by Jackknife sensitivity analysis. Results We retrieved 11,365 articles in total, 28 of which were included. In the overall analysis, we found increased activity in the middle temporal gyrus, superior temporal gyrus, parahippocampal gyrus, and cuneus, and decreased activity in the superior temporal gyrus, inferior parietal lobule, insula, and superior frontal gyrus. In response to positive stimuli, depressive patients showed hyperactivity in the medial frontal gyrus, middle temporal gyrus, and insula (uncorrected p < 0.001). When receiving negative stimuli, a higher activation was found in the precentral gyrus, middle frontal gyrus, precuneus, and superior temporal gyrus (uncorrected p < 0.001). Conclusion Among depressive patients, a broad spectrum of brain areas was involved in a deficit of conscious emotion processing. The activation of brain regions was different in response to positive or negative stimuli. Due to potential clinical heterogeneity, the findings should be treated with caution. Systematic review registration https://inplasy.com/inplasy-2022-11-0057/, identifier: 2022110057.
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Affiliation(s)
- Xin-yun Gou
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yu-xi Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Liu-xue Guo
- Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jing Zhao
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dong-ling Zhong
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiao-bo Liu
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hai-sha Xia
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jin Fan
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yue Zhang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shuang-chun Ai
- Department of Rehabilitation, Mianyang Hospital of Traditional Chinese Medicine, Mianyang, China
| | - Jia-xi Huang
- Mental Health Center, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Hong-ru Li
- Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Juan Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Rong-jiang Jin
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Geurten M, Lemaire P. Influence of emotional stimuli on metacognition: A study in arithmetic. Conscious Cogn 2022; 106:103430. [PMID: 36283195 DOI: 10.1016/j.concog.2022.103430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 01/27/2023]
Abstract
We investigate the role of negative emotional stimuli on direct and indirect metacognition, and document age-related differences in this role during adulthood. Participants were presented with negative or neutral pictures while asked to select which of two available strategies was the better strategy to find approximate estimates of two-digit multiplication problems. Following each strategy selection, participants provided either a direct (confidence judgment; Expt. 1) or an indirect (opt-out judgment; Expt. 2) evaluation of their strategy choice. Negative emotional stimuli decreased metacognitive accuracy for arithmetic strategy selection, but only when indirect metacognitive measures were collected. No differences were found when direct metacognitive judgments were requested. The effects of emotional stimuli on indirect metacognition and lack of effects on direct metacognition were found in both young and older adults. These findings have important implications for our understanding of the mechanisms underlying the effects of emotion on metacognition in young and older adults.
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Affiliation(s)
- Marie Geurten
- Psychology and Neuroscience of Cognition Unit, University of Liège, Belgium; National Fund for Scientific Research (F.R.S - FNRS), Belgium.
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Tondelli M, Benuzzi F, Ballotta D, Molinari MA, Chiari A, Zamboni G. Eliciting Implicit Awareness in Alzheimer’s Disease and Mild Cognitive Impairment: A Task-Based Functional MRI Study. Front Aging Neurosci 2022; 14:816648. [PMID: 35493936 PMCID: PMC9042287 DOI: 10.3389/fnagi.2022.816648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background Recent models of anosognosia in dementia have suggested the existence of an implicit component of self-awareness about one’s cognitive impairment that may remain preserved and continue to regulate behavioral, affective, and cognitive responses even in people who do not show an explicit awareness of their difficulties. Behavioral studies have used different strategies to demonstrate implicit awareness in patients with anosognosia, but no neuroimaging studies have yet investigated its neural bases. Methods Patients with amnestic mild cognitive impairment and dementia due to Alzheimer’s disease underwent functional magnetic resonance imaging (fMRI) during the execution of a color-naming task in which they were presented with neutral, negative, and dementia-related words (Dementia-Related Emotional Stroop). Results Twenty-one patients were recruited: 12 were classified as aware and 9 as unaware according to anosognosia scales (based on clinical judgment and patient-caregiver discrepancy). Behavioral results showed that aware patients took the longest time to process dementia-related words, although differences between word types were not significant, limiting interpretation of behavioral results. Imaging results showed that patients with preserved explicit awareness had a small positive differential activation of the posterior cingulate cortex (PCC) for the dementia-related words condition compared to the negative words, suggesting attribution of emotional valence to both conditions. PCC differential activation was instead negative in unaware patients, i.e., lower for dementia-related words relative to negative-words. In addition, the more negative the differential activation, the lower was the Stroop effect measuring implicit awareness. Conclusion Posterior cingulate cortex preserved response to dementia-related stimuli may be a marker of preserved implicit self-awareness.
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Affiliation(s)
- Manuela Tondelli
- Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università di Modena e Reggio Emilia, Modena, Italy
- U.O. Neurologia, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
- Dipartimento di Cure Primarie, Azienda Unitá Sanitaria Locale (AUSL) Modena, Modena, Italy
| | - Francesca Benuzzi
- Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università di Modena e Reggio Emilia, Modena, Italy
| | - Daniela Ballotta
- Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università di Modena e Reggio Emilia, Modena, Italy
| | | | - Annalisa Chiari
- U.O. Neurologia, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
| | - Giovanna Zamboni
- Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università di Modena e Reggio Emilia, Modena, Italy
- U.O. Neurologia, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
- *Correspondence: Giovanna Zamboni,
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Warren A. Preserved Consciousness in Alzheimer's Disease and Other Dementias: Caregiver Awareness and Communication Strategies. Front Psychol 2021; 12:790025. [PMID: 34950092 PMCID: PMC8688803 DOI: 10.3389/fpsyg.2021.790025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/09/2021] [Indexed: 11/17/2022] Open
Abstract
Alzheimer's disease is an insidious onset neurodegenerative syndrome without effective treatment or cure. It is rapidly becoming a global health crisis that is overwhelming healthcare, society, and individuals. The clinical nature of neurocognitive decline creates significant challenges in bidirectional communication between caregivers and persons with Alzheimer's disease (AD) that can negatively impact quality-of-life. This paper sought to understand how and to what extent would awareness training about the levels of consciousness in AD influence the quality-of-life interactions in the caregiver-patient dyad. A literature review of multiple databases was conducted utilizing a transdisciplinary approach. The sum of findings indicates a positive relationship between enhanced caregiver awareness and training, positive interactions, and improved QOL measures among patients and caregivers. A multidirectional relationship was found among healthcare policies, training and education resources, caregivers, and persons with AD. Specifically, the current lack of policy and inadequate training and educational resources has various detrimental effects on patients and caregivers, while improvements in training and education of caregivers yields positive outcomes in communication and QOL. Furthermore, evidence of preserved consciousness in persons with AD was demonstrated from multiple disciplines, including neurobiological, psychological, and biopsychosocial models. The literature further revealed several methods to access the preserved consciousness in persons with AD and related dementias, including sensory, emotional, and cognitive stimulations. The evidence from the literature suggests a reframed approach to our understanding and treatment of persons with AD is not only warranted, but crucial to address the needs of those affected by AD.
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Affiliation(s)
- Alison Warren
- The Department of Clinical Research and Leadership, The George Washington University, Washington, DC, United States
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Bomilcar I, Bertrand E, Morris RG, Mograbi DC. The Seven Selves of Dementia. Front Psychiatry 2021; 12:646050. [PMID: 34054604 PMCID: PMC8160244 DOI: 10.3389/fpsyt.2021.646050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
The self is a complex and multifaceted phenomenon, encompassing a variety of cognitive processes and psychosocial influences. Considering this, there is a multiplicity of "selves," the current review suggesting that seven fundamental self-processes can be identified that further our understanding of the experience of dementia. These include (1) an embodied self, manifest as corporeal awareness; (2) an agentic self, related to being an agent and influencing life circumstances; (3) an implicit self, linked to non-conscious self-processing; (4) a critical self, which defines the core of self-identity; (5) a surrogate self, based on third-person perspective information; (6) an extended self, including external objects or existences that are incorporated into the self; and, finally, (7) an emergent self, a property of the self-processes that give rise to the sense of a unified self. These are discussed in relation to self-awareness and their use in making sense of the experience of dementia.
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Affiliation(s)
- Iris Bomilcar
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Elodie Bertrand
- Laboratoire Mémoire, Cerveau et Cognition (LMC2, URP 7536), Institut de Psychologie, Université de Paris, Paris, France
| | - Robin G. Morris
- Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Daniel C. Mograbi
- Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
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Huntley JD, Fleming SM, Mograbi DC, Bor D, Naci L, Owen AM, Howard R. Understanding Alzheimer's disease as a disorder of consciousness. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12203. [PMID: 34877398 PMCID: PMC8630359 DOI: 10.1002/trc2.12203] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/28/2021] [Accepted: 07/28/2021] [Indexed: 11/07/2022]
Abstract
People with Alzheimer's disease (AD) demonstrate a range of alterations in consciousness. Changes in awareness of cognitive deficit, self-awareness, and introspection are seen early in AD, and dysfunction of awareness and arousal progresses with increasing disease severity. However, heterogeneity of deficits between individuals and a lack of empirical studies in people with severe dementia highlight the importance of identifying and applying biomarkers of awareness in AD. Impairments of awareness in AD are associated with neuropathology in regions that overlap with proposed neural correlates of consciousness. Recent developments in consciousness science provide theoretical frameworks and experimental approaches to help further understand the conscious experience of people with AD. Recognition of AD as a disorder of consciousness is overdue, and important to both understand the lived experience of people with AD and to improve care.
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Affiliation(s)
- Jonathan D. Huntley
- Division of PsychiatryUniversity College LondonLondonUK
- Wellcome Centre for Human NeuroimagingUniversity College LondonLondonUK
| | - Stephen M. Fleming
- Wellcome Centre for Human NeuroimagingUniversity College LondonLondonUK
- Department of Experimental PsychologyUniversity College LondonLondonUK
- Max Planck‐UCL Centre for Computational Psychiatry and Ageing ResearchUniversity College LondonLondonUK
| | - Daniel C. Mograbi
- Department of PsychologyPontifical Catholic University of Rio de JaneiroRio de JaneiroBrazil
- Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Daniel Bor
- Department of PsychologyUniversity of CambridgeCambridgeUK
| | - Lorina Naci
- School of PsychologyGlobal Brain Health InstituteTrinity College DublinDublinIreland
| | - Adrian M. Owen
- Brain and Mind InstituteDepartment of Physiology and Pharmacology and Department of PsychologyUniversity of Western OntarioLondonOntarioCanada
| | - Robert Howard
- Division of PsychiatryUniversity College LondonLondonUK
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