Michael H. Connors

Predictors of Institutionalization in Dementia: A Three Year Longitudinal Study

Patients with dementia often require institutionalization when they can no longer care for themselves. The study examined demographic and clinical variables that predict the time until institutionalization in patients with dementia attending memory clinics. Of 970 patients recruited from nine memory clinics around Australia, 779 patients had dementia at baseline. Measures of dementia severity, cognition, functional ability, neuropsychiatric symptoms, caregiver burden, and medication use were completed for all patients. Patients were followed for three years. Overall, 197 (25.3%) of the patients with dementia were institutionalized within three years. Lower cognitive ability, lower functional ability, and more neuropsychiatric symptoms at baseline predicted a shorter time until institutionalization, as did use of antipsychotic medication. In addition, greater deterioration in cognitive ability, functional ability, and neuropsychiatric symptoms over the initial three months predicted a shorter time to institutionalization. The findings confirm that clinical features of dementia at baseline predict the time to institutionalization, as do greater changes in symptoms over three months independent of baseline levels.

Mirrored-self misidentification in the hypnosis laboratory: Recreating the delusion from its component factors

Introduction. Mirrored-self misidentification is the delusional belief that ones reflection in the mirror is a stranger. According to Langdon and Colthearts (2000) “two-factor” theory of monothematic delusions, the delusion can arise from deficits in face processing (Factor 1) and belief evaluation (Factor 2). This study gave participants separate hypnotic suggestions for these two factors to create a hypnotic analogue of the delusion. Method. Forty-six high hypnotisable participants received a hypnotic suggestion for either Factor 1 alone or for Factors 1 and 2, either with hypnosis (hypnosis condition) or without (wake condition). Participants were asked to look into a mirror and to describe what they saw. Participants who reported seeing a stranger in the mirror also received a series of challenges. Results. Overall, 70% of participants in the hypnosis condition passed the delusion; only 22% of participants in the wake condition passed. Importantly, in hypnosis, the Factor 1 alone suggestion was just as effective in creating the delusion as the combined Factor 1 and Factor 2 suggestion. Conclusion. These results suggest that hypnotic suggestion can recreate the mirrored-self misidentification delusion from its component factors. Notably, the hypnotic context, itself known to disrupt belief evaluation, can act as Factor 2.

On the behaviour of senile dementia patients vis-à-vis the mirror: Ajuriaguerra, Strejilevitch and Tissot (1963).

Mirror agnosia is the inability to use mirror knowledge when interacting with mirrors, while mirrored-self misidentification is the delusional belief that ones reflection in the mirror is a stranger. Ajuriaguerra, Strejilevitch, and Tissot (1963) conducted a detailed study of these two conditions before they became widely known in the English literature. We present a translation of this important paper. In their study, Ajuriaguerra et al. (1963) examined the behaviour of 30 dementia patients with respect to the mirror. Their examination focussed on three criteria: (1) recognition of own reflection; (2) use of reflected space; and (3) designation of parts of the body. The study found three distinct levels of impairment when interacting with mirrors. Patients with the most severe dementia were unable to recognise their own reflection and displayed the mirrored-self misidentification delusion. Patients with moderate dementia showed mirror agnosia. Finally, patients with mild dementia were unable to designate parts of their body in the mirror. These findings have important implications for understanding mirror agnosia and the mirrored-self misidentification delusion. In a commentary, we discuss the importance of the findings and place them within the context of subsequent research.

A cognitive account of belief: a tentative road map

Over the past decades, delusions have become the subject of growing and productive research spanning clinical and cognitive neurosciences. Despite this, the nature of belief, which underpins the construct of delusions, has received little formal investigation. No account of delusions, however, would be complete without a cognitive level analysis of belief per se. One reason for this neglect is the assumption that, unlike more established and accessible modular psychological process (e.g., vision, audition, face-recognition, language-processing, and motor-control systems), beliefs comprise more distributed and therefore less accessible central cognitive processes. In this paper, we suggest some defining characteristics and functions of beliefs. Working back from cognitive accounts of delusions, we consider potential candidate cognitive processes that may be involved in normal belief formation. Finally, we advance a multistage account of the belief process that could provide the basis for a more comprehensive model of belief.

Cognition and mortality in older people: the Sydney Memory and Ageing Study

BACKGROUND Both cognitive ability and cognitive decline have been shown to predict mortality in older people. As dementia, a major form of cognitive decline, has an established association with shorter survival, it is unclear the extent to which cognitive ability and cognitive decline predict mortality in the absence of dementia. OBJECTIVE To determine whether cognitive ability and decline in cognitive ability predict mortality in older individuals without dementia. DESIGN The Sydney Memory and Ageing Study is an observational population-based cohort study. Participants completed detailed neuropsychological assessments and medical examinations to assess for risk factors such as depression, obesity, hypertension, diabetes, hypercholesterolaemia, smoking and physical activity. Participants were regularly assessed at 2-year intervals over 8 years. SETTING A community sample in Sydney, Australia. SUBJECTS One thousand and thirty-seven elderly people without dementia. RESULTS Overall, 236 (22.8%) participants died within 8 years. Both cognitive ability at baseline and decline in cognitive ability over 2 years predicted mortality. Decline in cognitive ability, but not baseline cognitive ability, was a significant predictor of mortality when depression and other medical risk factors were controlled for. These relationships also held when excluding incident cases of dementia. CONCLUSIONS The findings indicate that decline in cognition is a robust predictor of mortality in older people without dementia at a population level. This relationship is not accounted for by co-morbid depression or other established biomedical risk factors.

Mirror agnosia and the mirrored-self misidentification delusion : a hypnotic analogue

Introduction. Mirrored-self misidentification is the delusional belief that ones reflection in the mirror is a stranger. Current theories suggest that one pathway to the delusion is mirror agnosia (a deficit in which patients are unable to use mirror knowledge when interacting with mirrors). This study examined whether a hypnotic suggestion for mirror agnosia can recreate features of the delusion. Method. Ten high hypnotisable participants were given either a suggestion to not understand mirrors or to see the mirror as a window. Participants were asked to look into a mirror and describe what they saw. Participants were tested on their understanding of mirrors and received a series of challenges. Participants then received a detailed postexperimental inquiry. Results. Three of five participants given the suggestion to not understand mirrors reported seeing a stranger and maintained this belief when challenged. These participants also showed signs of mirror agnosia. No participants given the suggestion to see a window reported seeing a stranger. Conclusion. Results indicate that a hypnotic suggestion for mirror agnosia can be used to recreate the mirrored-self misidentification delusion. Factors influencing the effectiveness of hypnotic analogues of psychopathology, such as participants’ expectations and interpretations, are discussed.

Expertise in Complex Decision Making: The Role of Search in Chess 70 Years After de Groot

One of the most influential studies in all expertise research is de Groots (1946) study of chess players, which suggested that pattern recognition, rather than search, was the key determinant of expertise. Many changes have occurred in the chess world since de Groots study, leading some authors to argue that the cognitive mechanisms underlying expertise have also changed. We decided to replicate de Groots study to empirically test these claims and to examine whether the trends in the data have changed over time. Six Grandmasters, five International Masters, six Experts, and five Class A players completed the think-aloud procedure for two chess positions. Findings indicate that Grandmasters and International Masters search more quickly than Experts and Class A players, and that both groups today search substantially faster than players in previous studies. The findings, however, support de Groots overall conclusions and are consistent with predictions made by pattern recognition models.

Jumping to delusions in early psychosis

Introduction Patients with delusions typically seek less information when making decisions than controls (“jumping-to-conclusions”, JTC) and paradoxically over-adjust to counter-evidence on probabilistic reasoning tasks. Previous studies have examined JTC bias across the delusion-prone continuum, but have not considered the co-occurrence of both biases at early stages of psychosis. This was our aim. Method Twenty-three early psychosis patients and 19 healthy controls completed two versions of the probabilistic reasoning task: a “draws-to-decision” version (to assess JTC) and a “graded-estimates” version (to assess over-adjustment). Both versions have been used previously with clinically delusional people with schizophrenia. IQ, memory and executive function were also examined. Results Patients took fewer trials to reach a decision in the draws-to-decision version and showed greater over-adjustment to counter-evidence in the graded-estimates version than controls. Across groups, those who jumped to conclusions showed greater over-adjustment. Poor executive function predicted more extreme biases in controls but not in patients. Task performances were unrelated to memory. Similar results were evident in patient and control subgroups matched on IQ, and years of formal education. Conclusions A jumping-to-conclusions bias and an over-adjustment bias co-occurred in the early psychosis patients. Implications are discussed concerning the role of such biases in delusion-proneness.

Screening for Dementia in Primary Care: A Comparison of the GPCOG and the MMSE

Background/Aims: The General Practitioner Assessment of Cognition (GPCOG) is a brief cognitive test. This study compared the GPCOG to the Mini-Mental State Examination (MMSE), the most widely used test, in terms of their ability to detect likely dementia in primary care. Methods: General practitioners across three states in Australia recruited 2,028 elderly patients from the community. A research nurse administered the GPCOG and the MMSE, as well as the Cambridge Examination for Mental Disorders of the Elderly Cognitive Scale-Revised that we used to define likely dementia. Results: Overall, the GPCOG and the MMSE were similarly effective at detecting likely dementia. The GPCOG, however, had a higher sensitivity than the MMSE when using published cutpoints. Conclusion: The GPCOG is an effective screening tool for dementia in primary care. It appears to be a viable alternative to the MMSE, whilst also requiring less time to administer.

Theory of mind in early psychosis

A deficit in theory of mind – the ability to infer and reason about the mental states of others – might underpin the poor social functioning of patients with psychosis. Unfortunately, however, there is considerable variation in how such a deficit is assessed. The current study compared three classic tests of theory of mind in terms of their ability to detect impairment in patients in the early stages of psychosis.