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Latgé-Tovar S, Bertrand E, Piolino P, Mograbi DC. The use of virtual reality as a perspective-taking manipulation to improve self-awareness in Alzheimer's disease. Front Aging Neurosci 2024; 16:1376413. [PMID: 38725536 PMCID: PMC11079167 DOI: 10.3389/fnagi.2024.1376413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
Lack of awareness of symptoms or having a condition referred to as anosognosia is a common feature of individuals with Alzheimer's Disease (AD). Previous literature on AD reported difficulties in evaluating self-abilities, often showing underestimation of limitations. There is increasing evidence that the perspective through which information is presented may moderate the performance appraisal and that anosognosia in AD might be a consequence of a deficit in assuming a third-person perspective. In this context, some studies showed that subjects may better recognize self-and other-difficulties when exposed to a third-person perspective. Considering the variety of approaches aiming to investigate the lack of awareness, there is still a scarcity of methods that provide great ecological validity and consider more than one facet of awareness, thus failing to offer more accurate evaluations of daily experiences. The present paper primarily addresses the theme of the multidimensional character of awareness of abilities in AD and the effect of perspective-taking on its trajectories. The focus turns to virtual reality as a promising tool for a greater evaluation of perspective-taking and self-awareness. Particularly, these systems offer the possibility to involve users in cognitive and sensorimotor tasks that simulate daily life conditions within immersive and realistic environments, and a great sense of embodiment. We propose that virtual reality might allow a great level of complexity, veracity, and safety that is needed for individuals with AD to behave according to their actual abilities and enable to explore the liaison between the subject's viewpoint, performance, and self-evaluation. In addition, we suggest promising clinical implications of virtual reality-based methods for individualized assessments, investigating specific impacts on subjects' life and possible improvements in their awareness.
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Affiliation(s)
- Sofia Latgé-Tovar
- Institute of Psychiatry - Center for Alzheimer’s Disease, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Elodie Bertrand
- Laboratoire Mémoire, Cerveau et Cognition (LMC), Institut de Psychologie, Université Paris Cité, Paris, France
| | - Pascale Piolino
- Laboratoire Mémoire, Cerveau et Cognition (LMC), Institut de Psychologie, Université Paris Cité, Paris, France
| | - Daniel C. Mograbi
- Institute of Psychiatry - Center for Alzheimer’s Disease, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
- Institute of Psychiatry – Psychology and Neuroscience King’s College London, London, United Kingdom
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Mayelle A, Hazebrouck C, El Haj M, Mograbi DC, Antoine P. Awareness for People With Alzheimer’s Disease: Profiles and Weekly Trajectories. Front Aging Neurosci 2022; 13:781426. [PMID: 35095469 PMCID: PMC8792992 DOI: 10.3389/fnagi.2021.781426] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: To understand awareness and fluctuations of awareness in Alzheimer’s disease (AD), it is fruitful to consider the objects of awareness, e.g., cognitive functioning or recognition of the disease, as well as the mechanisms and modes of expression underlying awareness. With a holistic and discourse-centered approach, we aimed to identify different awareness profiles and test whether these profiles were stable or whether transitions from one profile to another occurred over short time intervals. Methods: Twenty-eight residents of nursing homes with a diagnosis of AD participated in four semistructured interviews at biweekly intervals. These interviews were cluster analyzed to determine profiles of awareness. A Markov chain was applied to model their fluctuation. Results: Five awareness profiles were observed that differed in terms of objects and underlying processes. Awareness proved to be quite stable for four of the five profiles. Interindividual variability in awareness was also observed through numerous different trajectories that were identified. Discussion: Self-awareness and disease awareness are characterized by profiles that vary subtly between individuals. Fluctuations in awareness underscore the need to employ assessment intervals that closely reflect daily life in institutions.
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Affiliation(s)
- Amandine Mayelle
- Univ. Lille, CNRS, UMR 9193—SCALab—Sciences Cognitives et Sciences Affectives, Lille, France
| | - Capucine Hazebrouck
- Etablissements Pour Personnes Âgées Dépendantes La Colombe, Roncq and L’Orée du Monde, Halluin, France
| | - Mohamad El Haj
- Nantes Université, Univ Angers, Laboratoire de Psychologie des Pays de la Loire (LPPL—EA 4638), Nantes, France
- Unité de Gériatrie, Centre Hospitalier de Tourcoing, Tourcoing, France
- Institut Universitaire de France, Paris, France
| | - Daniel C. Mograbi
- Pontifical Catholic University, Rio de Janeiro, Brazil
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Pascal Antoine
- Univ. Lille, CNRS, UMR 9193—SCALab—Sciences Cognitives et Sciences Affectives, Lille, France
- *Correspondence: Pascal Antoine,
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Jacus JP, Voltzenlogel V, Mayelle A, Antoine P, Cuervo-Lombard CV. Awareness dimensions and associated factors in Alzheimer's disease. Rev Neurol (Paris) 2021; 178:363-369. [PMID: 34565625 DOI: 10.1016/j.neurol.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/21/2021] [Accepted: 05/27/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We recently reported the major role depression and apathy in awareness among Alzheimer patients, using the stage of the disease as an exposure factor and exploring different assessment methods. Using the same patient data, we aimed here to explore the different dimensions of awareness assessed by different sub-scales in awareness scales. METHOD Sixty-one Alzheimer patients were examined using four awareness scales relating to three assessment methods: (a) patient-caregiver discrepancy; (b) clinical rating; and (c) prediction of performance discrepancy. Global cognition, executive functioning, autonomy, depression and apathy were also assessed. Multivariate logistic models were performed using disease stage as an exposure factor for awareness scales and sub-scales. Correlations across the different factors and patient and caregiver awareness ratings were computed. RESULTS The patient-caregiver discrepancy and clinical rating methods (a, b) both identified the factors associated with awareness in the overall scales and the sub-scales as being depression and/or apathy. Depression correlated with patient self-ratings while apathy correlated with caregiver ratings. The prediction of performance discrepancy method (c) identified different factors in the overall scale, executive factors in three sub-scales involving executive domains and the memory factor in a sub-scale involving the mnesic domain. DISCUSSION The awareness scales using a referential based on a human rating (a, b) suggest that awareness is unidimensional, with depression impacting self-reports and apathy influencing caregiver/clinical reports. Scales based on a test rating (c) appear to be more closely associated with the dimensions assessed. This highlights the role of the reference system for awareness assessment in Alzheimer's disease.
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Affiliation(s)
- J-P Jacus
- CH des vallées de l'Ariège, EHPAD et consultations mémoire, Foix, France; University Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, 59000 Lille, France.
| | - V Voltzenlogel
- CERPPS, Centre d'Etudes et de Recherche en Psychopathologie et Psychologie de la Santé, EA7411, Université Jean Jaurès, Toulouse, France
| | - A Mayelle
- University Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, 59000 Lille, France
| | - P Antoine
- University Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, 59000 Lille, France; LabEx DISTALZ - Development of Innovative Strategies for a Transdisciplinary approach to ALZheimer's disease, 59000 Lille, France
| | - C-V Cuervo-Lombard
- CERPPS, Centre d'Etudes et de Recherche en Psychopathologie et Psychologie de la Santé, EA7411, Université Jean Jaurès, Toulouse, France
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Bajic V, Misic N, Stankovic I, Zaric B, Perry G. Alzheimer's and Consciousness: How Much Subjectivity Is Objective? Neurosci Insights 2021; 16:26331055211033869. [PMID: 34350401 PMCID: PMC8295942 DOI: 10.1177/26331055211033869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/02/2021] [Indexed: 01/03/2023] Open
Abstract
Does Alzheimer Disease show a decline in cognitive functions that relate to the awareness of external reality? In this paper, we will propose a perspective that patients with increasing symptoms of AD show a change in the awareness of subjective versus objective representative axis of reality thus consequently move to a more internal like perception of reality. This paradigm shift suggests that new insights into the dynamicity of the conscious representation of reality in the AD brain may give us new clues to the very early signs of memory and self-awareness impairment that originates from, in our view the microtubules. Dialog between Adso and William, in Umberto Eco's The Name of the Rose, Third Day: Vespers. "But how does it happen," I said with admiration, "that you were able to solve the mystery of the library looking at it from the outside, and you were unable to solve it when you were inside?" "Thus, God knows the world, because He conceived it in His mind, as if it was from the outside, before it was created, and we do not know its rule, because we live inside it, having found it already made."
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Affiliation(s)
- Vladan Bajic
- Department of Radiobiology and
Molecular Genetics, Vinca Institute, University of Belgrade, Belgrade, Serbia
| | | | - Ivana Stankovic
- Institute of Chemistry, Technology and
Metallurgy, University of Belgrade, Belgrade, Serbia
| | - Bozidarka Zaric
- Department of Radiobiology and
Molecular Genetics, Vinca Institute, University of Belgrade, Belgrade, Serbia
| | - George Perry
- Department of Biology, The University
of Texas at San Antonio, San Antonio, TX, USA
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El Haj M, Moustafa AA, Gallouj K. Higher Depression of Patients with Alzheimer's Disease During than Before the Lockdown. J Alzheimers Dis 2021; 81:1375-1379. [PMID: 33896844 DOI: 10.3233/jad-210190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We assessed depression in 72 patients with Alzheimer's disease (AD) who live in retirement homes during the COVID-19-related lockdown. We invited caregivers of 72 patients with AD who live in retirement homes to rate depression in the patients both before and during the lockdown. Analysis demonstrated increased depression in the patients during the lockdown. We attribute this increased depression to the restrictive measures on activities, visits, and physical contact between patients with AD and family members during the lockdown.
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Affiliation(s)
- Mohamad El Haj
- Laboratoire de Psychologie des Pays de la Loire (LPPL - EA 4638), Nantes Université, University of Angers, Nantes, France.,Unité de Gériatrie, Centre Hospitalier de Tourcoing, Tourcoing, France.,Institut Universitaire de France, Paris, France
| | - Ahmed A Moustafa
- School of Psychology & Marcs Institute for Brain and Behaviour, University of Western Sydney, Sydney, Australia.,Department of Human Anatomy and Physiology, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Karim Gallouj
- Unité de Gériatrie, Centre Hospitalier de Tourcoing, Tourcoing, France
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de Ruijter NS, Schoonbrood AMG, van Twillert B, Hoff EI. Anosognosia in dementia: A review of current assessment instruments. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12079. [PMID: 33024810 PMCID: PMC7527687 DOI: 10.1002/dad2.12079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Anosognosia is a common but underrated symptom in dementia and has significant impact on both patients and caregivers. A proper evaluation of anosognosia is therefore desirable. There are three common methods to determine anosognosia: (1) clinical rating, (2) patient-caregiver discrepancies, and (3) prediction of performance discrepancies. Each of them includes different instruments. This review gives an overview of the current instruments used for the assessment of anosognosia in patients with dementia and aims to determine the most suitable instrument for routine use in clinical practice. METHODS A search of the literature in PubMed was performed. Furthermore, electronic databases (PsycINFo, ClinicalKey, and Cochrane Library) and reference lists were searched for additional articles. RESULTS Forty-six articles were included in this study, comprising 10 clinical rating instruments, 25 patient-caregiver discrepancy instruments, and 14 prediction-performance discrepancy instruments. For every publication, the aims of the study, the included population, the assessment instrument used, the assessed domains, and the psychometric properties of the assessment instruments are described. CONCLUSIONS Currently, there is no consensus on the most suitable method to determine anosognosia in dementia. We recommend the Clinical Insight Rating scale and the Abridged Anosognosia Questionnaire-Dementia as the most appropriate for routine use in clinical practice.
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Affiliation(s)
- Naomi S de Ruijter
- Department of Neurology Zuyderland Medical Centre Heerlen the Netherlands
| | | | - Björn van Twillert
- Department of Medical Psychology Zuyderland Medical Centre Heerlen the Netherlands
| | - Erik I Hoff
- Department of Neurology Zuyderland Medical Centre Heerlen the Netherlands
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Jacus JP, Mayelle A, Voltzenlogel V, Cuervo-Lombard CV, Antoine P. Modelling Awareness in Alzheimer's Disease. J Alzheimers Dis 2020; 76:89-95. [PMID: 32417778 DOI: 10.3233/jad-200017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to provide a model of awareness in Alzheimer's disease using the stage of the disease as a risk factor. Awareness was assessed using three methods (patient-caregiver discrepancy, prediction-performance discrepancy, clinical rating). Twenty-five healthy control subjects and sixty-one patients participated, with measures of cognition, apathy, depression, and awareness. These measures were introduced into a manual backward regression. Confounding factors impacting at least 15% of the exposure factor estimate were maintained in the model. Except for the prediction performance discrepancy, also presenting cognitive associations, the other awareness assessments suggested a major role of depression and apathy as impacting factors.
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Affiliation(s)
- Jean-Pierre Jacus
- CH des vallées de l'Ariège, Consultations mémoire, Foix, France.,Univ. Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Lille, France
| | - Amandine Mayelle
- Univ. Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Lille, France
| | - Virginie Voltzenlogel
- CERPPS, Centre d'Etudes et de Recherche en Psychopathologie et Psychologie de la Santé, EA7411, Université Jean Jaurès, Toulouse, France
| | - Christine-Vanessa Cuervo-Lombard
- CERPPS, Centre d'Etudes et de Recherche en Psychopathologie et Psychologie de la Santé, EA7411, Université Jean Jaurès, Toulouse, France
| | - Pascal Antoine
- Univ. Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Lille, France
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Mayelle A, El Haj M, Antoine P. "What" and "How": A New Perspective for Understanding Unawareness in Alzheimer's Disease Through a Combination of Two Perspectives. Am J Alzheimers Dis Other Demen 2020; 35:1533317520925333. [PMID: 32508159 PMCID: PMC10624057 DOI: 10.1177/1533317520925333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Assessments of unawareness in Alzheimer's disease mainly focus on the objects (the "what") of unawareness. A recent person-centered approach proposes to also assess the processes (the "how"). The present study combines 2 approaches to understand this heterogeneity in assessments of unawareness. METHOD We recruited 46 participants from 8 nursing homes. They underwent a semi-structured interview and were assessed using a prediction-performance paradigm. Spearman correlations were calculated, and generalized additive models were established. RESULTS The 2 approaches are associated through cognitive deficits, confrontation with difficulties and identity changes. Objects (the what), mechanisms, and modes of expression (the how) explain at least 29.6% of the variance of unawareness. CONCLUSIONS Unawareness is more than simply being unaware of something; it is a synergy between the objects and processes of arousal and expression. Moreover, unawareness extends beyond the disease to include the self. Considering the entire person seems to be necessary.
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Affiliation(s)
- Amandine Mayelle
- University Lille, CNRS, UMR 9193 – SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France
| | - Mohamad El Haj
- Laboratoire de Psychologie des Pays de la Loire (LPPL - EA 4638), Nantes Université, Univ Angers, F-44000 Nantes, France
- Unité de Gériatrie, Centre Hospitalier de Tourcoing, Tourcoing 59200, France
- Institut Universitaire de France, Paris 75000, France
| | - Pascal Antoine
- University Lille, CNRS, UMR 9193 – SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France
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