Pascal Antoine

Conscience des déficits et anosognosie dans la maladie d’Alzheimer

Resume Cet article propose une synthese des etudes portant sur la conscience des troubles dans la maladie d’Alzheimer. Trois types de mesure de l’anosognosie existent selon que l’evaluation de reference est realisee par un aidant, un soignant ou a l’aide de tests cognitifs. Les avantages et limites de ces differentes methodes ainsi que leur equivalence sont discutes. Les principaux resultats concernant la prevalence et la nature de l’anosognosie ainsi que les troubles associes sont analyses. En particulier, la notion d’heterogeneite de l’anosognosie ainsi que les liens avec la depression, le niveau de demence et le dysfonctionnement des fonctions executives sont developpes. Cet article presente enfin les courants theoriques majeurs explicatifs de l’anosognosie dans la demence et propose en conclusion des pistes de recherches afin de depasser les limites methodologiques et conceptuelles rencontrees dans la litterature.

Autobiographical memory decline in Alzheimer's disease, a theoretical and clinical overview.

Autobiographical memory, or memory for personal experiences, allows individuals to define themselves and construct a meaningful life story. Decline of this ability, as observed in Alzheimers disease (AD), results in an impaired sense of self and identity. In our model (AMAD: Autobiographical Memory in Alzheimers Disease), we present a critical review of theories and findings regarding cognitive and neuroanatomical underpinnings of autobiographical memory and its decline in AD and highlight studies on its clinical rehabilitation. We propose that autobiographical recall in AD is mainly characterized by loss of associated episodic information, which leads to de-contextualization of autobiographical memories and a shift from reliving past events to a general sense of familiarity. This decline refers to retrograde, but also anterograde amnesia that affects newly acquired memories besides remote ones. One consequence of autobiographical memory decline in AD is decreased access to memories that shape self-consciousness, self-knowledge, and self-images, leading to a diminished sense of self and identity. The link between autobiographical decline and compromised sense of self in AD can also manifest itself as low correspondence and coherence between past memories and current goals and beliefs. By linking cognitive, neuroanatomical, and clinical aspects of autobiographical decline in AD, our review provides a theoretical foundation, which may lead to better rehabilitation strategies.

Flexibility decline contributes to similarity of past and future thinking in Alzheimer's disease

A striking similarity has been suggested between past and future thinking in Alzheimers Disease (AD), a similarity attributable to abnormalities in common modular cognitive functions and neuroanatomical substrates. This study extends this literature by identifying specific executive function deficits underlying past and future thinking in AD. Twenty‐four participants with a clinical diagnosis of probable (mild) AD and 26 older controls generated past and future events and underwent tests of binding and the executive functions of flexibility, inhibition, and updating. AD patients showed similar autobiographical performances in past and future event generation, and so did control participants. In each group, the similarity of past and future thinking was predicted by flexibility. Furthermore, AD patients with low flexibility showed higher similarity of past and future thinking than those with high flexibility. These findings are interpreted in terms of involvement of the hippocampus and frontal lobes in future thinking. Deficits in these brain regions in AD are likely to compromise the ability to recombine episodic information into novel and flexible configurations as scenarios for the future.

Motives for the social sharing of an emotional experience

Previous studies demonstrated that people socially share both their positive and negative emotional experiences. This article reports two studies aimed to clarify and assess the motives underlying this human propensity to share emotions. A large number of motives were collected from 182 participants (Study 1). A content analysis resulted in 8 categories of motives; 72 representative items were retained to create a Social Sharing Motives Scale (SSMS). The final structure of the SSMS, tested with 719 respondents, includes 39 items organized into 7 factors, namely “clarification and meaning,” “rehearsing,” “venting,” “arousing empathy/attention,” “informing and/or warning,” “assistance/support and comfort/consolation,” and “advice and solutions” (Study 2). This scale will usefully contribute to the investigation of the role played by interpersonal processes in emotional regulation.

Phenomenological Reliving and Visual Imagery During Autobiographical Recall in Alzheimer's Disease.

Multiple studies have shown compromise of autobiographical memory and phenomenological reliving in Alzheimers disease (AD). We investigated various phenomenological features of autobiographical memory to determine their relative vulnerability in AD. To this aim, participants with early AD and cognitively normal older adult controls were asked to retrieve an autobiographical event and rate on a five-point scale metacognitive judgments (i.e., reliving, back in time, remembering, and realness), component processes (i.e., visual imagery, auditory imagery, language, and emotion), narrative properties (i.e., rehearsal and importance), and spatiotemporal specificity (i.e., spatial details and temporal details). AD participants showed lower general autobiographical recall than controls, and poorer reliving, travel in time, remembering, realness, visual imagery, auditory imagery, language, rehearsal, and spatial detail-a decrease that was especially pronounced for visual imagery. Yet, AD participants showed high rating for emotion and importance. Early AD seems to compromise many phenomenological features, especially visual imagery, but also seems to preserve some other features.

Apolipoprotein E (APOE) ε4 and episodic memory decline in Alzheimer’s disease: A review

A growing body of research has examined the relationship between episodic memory decline, the cognitive hallmark of Alzheimers disease (AD), and the presence of Apolipoprotein E ε4 (APOE ε4) allele, a major genetic risk factor for the disease. Our review attempts to summarize and critically evaluate this literature. We performed a systematic search for studies assessing episodic memory in AD patients who were genotyped for APOE ε4 and identified fourteen papers. Although most of these papers reported significant relationships between APOE ε4 and episodic memory decline in AD, some papers did not confirm this relationship. Our review links this controversy to the conflicting literature about the effects of APOE ε4 on general cognitive functioning in AD. We identify several shortcoming and limitations of the research on the relationship between APOE ε4 and episodic memory in AD, such as small sample sizes, non-representative populations, lack of comparison of early-onset vs. late-onset disease, and lack of comparison among different genotypes that include APOE ε4 (i.e., zero, one, or two ε4 alleles). Another major shortcoming of the reviewed literature was the lack of comprehensive evaluation of episodic memory decline, since episodic memory was solely evaluated with regard to encoding and retrieval, omitting evaluation of core episodic features that decline in AD, such as context recall (e.g., how, where, and when an episodic event has occurred) and subjective experience of remembering (e.g., reliving, emotion and feeling during episodic recollection). Future research taking these limitations into consideration could illuminate the nature of the relationship between APOE ε4 and episodic memory decline in AD.

Couples' experiences with early-onset dementia: An interpretative phenomenological analysis of dyadic dynamics

Objective The growing interest in early-onset dementia has attracted attention to the situation and experiences of the caregiver, most often the spouse. Several qualitative studies on caregiving spouses have underlined the importance of the feeling of loss, the change of role reported by the caregiving spouses, and the strategies used to protect the person with dementia, all of which raise the question of the relational dynamics at play in these dyads. The present study on 16 couples examines the experiences of each partner, as well as the kinds of interactions taking place within the dyad and how they have evolved since the disease began. Design An interpretative phenomenological analysis was conducted on dyadic semi-structured interviews. Results Seven axes emerged from the analyses, showing that control over symptoms gradually leads to deterioration of marital interactions and to the components of marital dissolution.

Hallucinations, loneliness, and social isolation in Alzheimer's disease.

ABSTRACT Introduction: Cognitive and functional compromise, as frequently observed in Alzheimers disease (AD), hinders communication and social interactions. One consequence of this hindrance may be a feeling of loneliness. Moreover, emptiness and boredom, as observed in social isolation and loneliness, may thus be compensated for by creating imagined stimuli. Conditions of loneliness may be viewed as potentially generating hallucinatory experiences. To assess this assumption, the present study explored the relationship between social isolation, loneliness, and hallucinations in a sample of 22 mild AD participants and 24 elderly, healthy controls. Methods: Participants were assessed using the Launay–Slade Hallucination Scale, the UCLA Loneliness Scale, and a scale exploring contact with others and social participation. Results: More hallucinatory experiences, social isolation, and loneliness were found in the AD group than in the healthy control group. Moreover, significant correlations were observed between hallucinations and loneliness and between hallucinations and social isolation in both groups. Finally, hallucinations were predicted by social isolation. Discussion: Hallucinations may constitute a compensatory mechanism that aims to fulfil communication needs in lonely, elderly participants. Hallucinations may also be regarded as experiences that allow certain participants to escape the cycle of boredom, emptiness, and affective deprivation caused by social isolation.

“Forget to Whom You Have Told This Proverb”: Directed Forgetting of Destination Memory in Alzheimer’s Disease

Destination memory is the ability to remember the receiver of transmitted information. By means of a destination memory directed forgetting task, we investigated whether participants with Alzheimers Disease (AD) were able to suppress irrelevant information in destination memory. Twenty-six AD participants and 30 healthy elderly subjects were asked to tell 10 different proverbs to 10 different celebrities (List 1). Afterwards, half of the participants were instructed to forget the destinations (i.e., the celebrities) whereas the other half were asked to keep them in mind. After telling 10 other proverbs to 10 other celebrities (List 2), participants were asked to read numbers aloud. Subsequently, all the participants were asked to remember the destinations of List 1 and List 2, regardless of the forget or remember instructions. The results show similar destination memory in AD participants who were asked to forget the destinations of List 1 and those who were asked to retain them. These findings are attributed to inhibitory deficits, by which AD participants have difficulties to suppress irrelevant information in destination memory.

Young couples' experiences of breast cancer during hormone therapy: an interpretative phenomenological dyadic analysis.

Background: Young women are confronted with the same consequences of cancer as older women are. In addition, they face problems specifically related to their age, such as their children’s education and their family responsibilities, marital relationships, and career issues. Objective: The objective was to identify the functioning profiles of young couples confronted with hormone therapy. Methods: This study was both qualitative and dyadic. Interviews with 11 couples revealed 5 themes. Results: Initially, the partners reported increased intimacy and mutual support; however, during hormone therapy, a divergence developed between the patients and their partners. The partners wished for the couple to resume a normal life. The patients’ loved ones, also helpful in the beginning, were tempted to promote this resumption of normalcy, with the risk that the patients’ suffering would no longer be acknowledged. The risk of cancer recurrence appeared to immobilize the patients, who were unable to adopt a long-term perspective. Finally, the experience of the disease led the participants to reorganize their priorities and promoted self-centering. Conclusions: Breast cancer affects both the patient and her loved ones. Future research should focus on qualitative extensions to other stages of cancer treatment and quantitative studies to measure the phenomena revealed in the current work. Implications for Practice: Cancer and its treatment have impacts on the patient and her marriage; therefore, the focus for the clinical care should be on the couple rather than just the patient. Additionally, our findings suggest new areas of psychological dyadic counseling for cancer patients and their partners.