Making sense of self in Alzheimer's disease: reflective function and memory

Abstract

Findings suggest that deficits in new learning ability contribute to a reduced ability of people with early AD to understand their mental world and interpret thoughts, feelings, and beliefs about themselves. This impaired capacity to self-reflect will be intrusive in daily activities that require monitoring of current self-performance. Furthermore, with reduced speed of information processing found to impact on ability to reflect on social relations, individuals with AD are placed at risk of reduced ability to understand their social world, including communicating and interacting with others. Notwithstanding the overall group findings, individual variability was evident which reinforces the need for person-centred care in dementia.

Processing of Self versus Non-Self in Alzheimer’s Disease

“…The cognitive mechanisms that mediate theory of mind and the regulation of emotional inter-personal behavior, though not explicitly addressed in this study, are relevant to any consideration of impaired self-processing in AD. On cognitive and neurobiological grounds, these processes are likely to interact: interpreting others’ mental states and understanding the effects of one’s own behavior on others facilitate the modulation of self-image and self boundaries through experience and self-other integration ( Mehta et al, 2014 ; Sommer et al, 2014 ; Bradford et al, 2015 ; Cheng et al, 2015 ; Simm et al, 2015 ; van der Weiden et al, 2015 ). Moreover, theory of mind and emotion regulation are targeted by neurodegenerative diseases and derangements thereof contribute to clinical symptoms in AD and other dementias ( Goodkind et al, 2010 ; Bora et al, 2015 ; Simm et al, 2015 ).…”

“…On cognitive and neurobiological grounds, these processes are likely to interact: interpreting others’ mental states and understanding the effects of one’s own behavior on others facilitate the modulation of self-image and self boundaries through experience and self-other integration ( Mehta et al, 2014 ; Sommer et al, 2014 ; Bradford et al, 2015 ; Cheng et al, 2015 ; Simm et al, 2015 ; van der Weiden et al, 2015 ). Moreover, theory of mind and emotion regulation are targeted by neurodegenerative diseases and derangements thereof contribute to clinical symptoms in AD and other dementias ( Goodkind et al, 2010 ; Bora et al, 2015 ; Simm et al, 2015 ). Although theory of mind impairment in AD has generally been deemphasised in relation to frontotemporal dementia ( Bora et al, 2015 ), it is possible that patients with AD may have more specific deficits in interpreting their own mental states linked to defective self-processing ( Simm et al, 2015 ).…”

“…From first principles, these operations are likely to include the maintenance of perceptual and conceptual boundaries between the self and non-self (the world at large, including other people), internalization of an appropriate self-image, and updating of that image based on experience. Shaping of the self-image and regulation of one’s own emotional and social behavior depend on understanding of one’s own mental states, how others relate to self and the impact of self on others: these processes in turn involve awareness and interpretation of others’ feelings and beliefs in relation to one’s own (‘theory of mind’: Mehta et al, 2014 ; Sommer et al, 2014 ; Bradford et al, 2015 ; Cheng et al, 2015 ; Simm et al, 2015 ; van der Weiden et al, 2015 ), while emotional contagion is a basic mechanism for synchronizing one’s own physiological and behavioral states to those of others, captured using measures such as the Inter-personal Reactivity Index (IRI; assessing the extent to which an individual experiences self- versus non-self oriented feelings in emotionally charged social situations) ( Davis, 1980 ; Sturm et al, 2013 ). Despite much recent interest, the effects of neurodegenerative diseases on the component operations of self-processing have not been explored in detail.…”

“…Patients with AD may exhibit reduced awareness of their own behavior, personality, mood and cognitive deficits ( Kashiwa et al, 2005 ; Rankin et al, 2005 ; Banks and Weintraub, 2008 ; Zamboni et al, 2013 ), and a heightened propensity to react to the emotions of those around them (emotional contagion) ( Sturm et al, 2013 ), raising the possibility that self/non-self boundaries may become more permeable in AD. Reduced understanding of one’s own mental states (impaired theory of own mind) has been linked to an attenuated sense of self in AD ( Simm et al, 2015 ). More fundamentally, AD has been associated with impaired body schema processing and loss of self-recognition ( Grewal, 1994 ; Mozaz and Morris, 1997 ; Connors and Coltheart, 2011 ), these features becoming more prominent as the disease evolves.…”

Executive Function and Personality Predict Instrumental Activities of Daily Living in Alzheimer Disease

“…14,18 Patients in early stages of AD have a diminished capacity for personal and social self-reflection. 30 Furthermore, patients with dementia may have trouble with comprehension of questionnaire items, leading to errors in ratings. 31 In our sample, 16 patients were unable to complete the NEO-FFI survey because of comprehension difficulties.…”