Negative effects of institutionalization on the sense of self in Alzheimer's Disease.

In this longitudinal study, we investigated the effects of institutionalization on the sense-of-self in individuals with Alzheimer's Disease (AD). We recruited two groups of participants: one living in care facilities (i.e., institutionalized-group) and another group living in their own home (i.e., non-institutionalized-group). In the two groups, we assessed the "Who-am-I" task on which participants were invited to provide statements beginning with the phrase "I am" that they felt were essential in defining who they are. We assessed this task, in the two groups, at a baseline (approximately one-month before-institutionalization) and at a follow-up (approximately six months after institutionalization). We analyzed whether responses on the "Who-am-I" task reflected physical-, social-, or psychological-self. Unlike at the baseline, fewer statements describing physical-, social-, and psychological-self were observed in the institutionalization than in the non-institutionalized group at the follow up. These findings demonstrate negative effects of institutionalization on the sense of self in AD.

"I Remember the Fall": Memory of Falls in Older Adults.

OBJECTIVES: While there is a large body of research on falls and their consequences in older adults, little is known about how older adults remember them. We addressed this gap by inviting older adults to remember falls and control memories. METHODS: We analyzed specificity of memories and invited participants to rate emotional valence, mental time travel, visual imagery, importance, and rehearsal, as experienced during retrieval. RESULTS: Although analysis demonstrated no significant differences between memories of falls and control memories regarding specificity, participants rated memories of falls as more negative than control memories. Furthermore, they rated memories of falls as triggering higher mental time travel, higher visual imagery, higher importance, and higher rehearsal than control memories. CONCLUSIONS: The negative emotional valence of memories of falls, as well as their ability to trigger significant levels of mental time travel, visual imagery, importance, and rehearsal, demonstrate how these memories are different from other memories in older adults. CLINICAL IMPLICATIONS: The findings demonstrate how falls can modulate memory of personal events in older adults.

The "Sickness" Memory: Can Patients With Alzheimer Disease Remember the Diagnosis Announcement?

BACKGROUND: Diagnosis of Alzheimer disease (AD) can cause substantial psychological distress in patients. We thus assessed how patients with AD remember the announcement of diagnosis. METHODS: We recruited 47 participants with mild AD (26 women; M age=68.89 y, SD=7.37; M years of formal education=9.74, SD=3.00). We invited the participants to remember the moment when their clinicians announced their diagnosis, within 6 months of the event, as well as a control memory, over the same period. We analyzed memory retrieval regarding specificity, as well as the subjective experience of retrieval (ie, regarding mental time travel, visual imagery, emotion and importance). RESULTS: No significant differences were observed between memory of diagnosis and control memory regarding specificity, mental time travel and visual imagery. However, memory of diagnosis triggered a more intense emotional experience and feeling of importance than control memory. DISCUSSION: Retrieval of the diagnosis announcement can activate a strong emotional and personally important experience in patients with AD. When remembering the diagnosis announcement, patients with AD may re-experience some features of that turning point in which they shift from "person" to "patient."

Emotional exhaustion and fear of COVID-19 in geriatric facilities during the COVID-19 pandemic.

OBJECTIVE: Since the onset of the COVID-19 pandemic, healthcare workers, especially those employed in hospital settings, have been exposed to a variety of stressors in the workplace. The aim of this study was to explore the Emotional Exhaustion (EE) of workers in geriatric facilities during the COVID-19 crisis. We accordingly sought to investigate the short-term impact of the COVID-19 pandemic in terms of the EE experienced by workers in geriatric facilities, and to examine the manner in which psychosocial conditions and fear of COVID-19 in the workplace have affected EE. METHODS: Surveys were administered in the midst of the COVID-19 crisis (October to December 2020). The study included 118 French healthcare workers with a mean age of 35.61 ± 0.73 recruited in geriatric facilities. We assessed EE, psychosocial conditions (e.g., demands at work, health and well-being, etc.) and fear of COVID-19 in the workplace. RESULTS: The analysis yielded two main outcomes. First, 34.75% workers (41) reported severe levels of EE. Second, demands at work and the fear of COVD-19 increased EE. Health and well-being were, however, demonstrated to protect against EE. DISCUSSION: Furthermore, fear of COVID-19 was shown to contribute significantly to EE healthcare workers in geriatric facilities. It is likely that Covid-19 indirectly contributes to EE by influencing demands at work.

The eyes of the past: larger pupil size for autobiographical memories retrieved from field perspective.

BACKGROUND: Visual perspective during memory retrieval has mainly been evaluated with methodologies based on introspection and subjective reports. The current study investigates whether visual perspective can be evaluated with a physiological measurement: pupil dilation. METHODS: While their pupil diameter was measured with an eye-tracker, forty-five participants retrieved one memory from a field perspective (i.e., as viewed through our own eyes) and one memory from an observer perspective (i.e., as viewed from a spectator's standpoint). After retrieval, participants rated the emotional intensity of the memories. RESULTS: Analysis demonstrated larger pupils during the retrieval of memories from a field perspective and higher emotional intensity for memories retrieved from a field perspective. DISCUSSION: The larger pupils for memories recalled from a field perspective could, however, not be attributed to their higher emotional intensity. These findings suggest that pupil dilation could be used as a physiological assessment of visual perspective during memory retrieval.

"My sympathetic clinician": perception of sympathy by patients with Alzheimer's disease increases when asked to provide autobiographical memories.

BACKGROUND AND AIMS: Autobiographical memory serves to recall past personal experiences and share them with others, promoting social bonding and communication. In this study, we investigated whether encouraging patients with Alzheimer's disease (AD) to share autobiographical memories during formal neuropsychological testing may boost the patient-clinician relationship, and more specifically, the neuropsychologist's level of sympathy as perceived by patients. METHODS: We invited patients with mild AD to perform neuropsychological testing in two conditions. In one condition, we invited patients to retrieve and share two autobiographical memories after testing, while in a control condition, the testing session ended without asking patients to retrieve and share any autobiographical memories. After the two conditions, patients were invited to rate the neuropsychologist's level of sympathy towards them. RESULTS: Analysis demonstrated that patients perceived a higher level of sympathy when their neuropsychologist invited them to retrieve and share past personal experiences. DISCUSSION: By inviting patients with AD to retrieve past personal experiences, clinicians can promote a sense of sharing, create a social bond and, consequently, enhance the therapeutic relationship. In other words, by inviting patients with AD to share autobiographical memories, clinicians can promote a "social glue" with their patients, boosting mutual sympathy and patients' well-being.

Memories of Falls: Resolved or Unresolved Memories?

BACKGROUND: There is bourgeoning interest in how older adults remember their falls and research in this area has demonstrated how falls can reshape memory retrieval in older adults. We pursued this line of research by assessing whether older adults succeed in integrating memories of falls into their life story. METHODS: We invited older adults to remember their falls and analyzed whether these memories were integrated or non-integrated. RESULTS: Analysis demonstrated no significant differences between the number of integrated and non-integrated memories. Critically, however, higher anxiety and depression was observed in participants who produced non-integrated memories than in those who produced integrated ones. DISCUSSION: The ability to integrate memories of falls in older adults is likely associated with anxiety and depression. Anxiety may result in avoidance of processing of the meaning of falls, and depression may hamper the ability to extract meaning from them, resulting in difficulties for older adults to integrate falls into their life story. Non-integrated memories of falls in older adults may be seen as unresolved memories and deserve special clinical attention.

"Who will I be?": The future of the self as described by Alzheimer's disease (AD) patients.

We assessed how Alzheimer's disease (AD) patients would imagine their self in the future. AD patients and healthy controls were asked to generate statements beginning with "I-will-be" to describe how they saw themselves or how they wished to be in the future. These statements were analyzed in terms of four self-dimensions, i.e., physical self, social self, psychological self and self-cessation. The latter was investigated to assess how AD patients processed the idea of their own mortality. Findings demonstrated fewer total "I-will-be" statements in AD participants than in controls, suggesting that the construction of future self-concepts becomes weaker in the disease. Our results also demonstrated fewer statements related to the physical-self, the social-self and the psychological-self, and more statements related to self-cessation in AD participants than in controls. These findings suggest that AD patients are highly preoccupied by the idea of death when thinking about the future of their self.

Hallucinations and Covid-19: Increased Occurrence of Hallucinations in Patients with Alzheimer's Disease During Lockdown.

We investigated the effects of lockdown, as implemented by retirement homes to cope with the spread of Covid-19, on hallucinatory experiences in patients with Alzheimer's disease (AD). The study included 47 patients with AD living in retirement homes and who were already experiencing hallucinations prior to the lockdown. We invited caregivers to rate hallucinatory experiences in these patients during the lockdown, and compared this rating with that provided by the same caregivers prior to the lockdown. Results demonstrated increased hallucinatory experiences in patients with AD during the lockdown, compared with before the lockdown. The decrease in social and physical activities during the lockdown, and especially, the physical separation of residents from family members, might have led to decreased sensory stimulation and increased loneliness, and consequently, to the hallucinatory experiences in patients with AD living in retirement homes during the lockdown. While the restrictive measures were necessary to cope with the spread of Covid-19, these measures have increased hallucinations in patients with AD living in retirement homes, at least in those who were already experiencing hallucinations prior to the lockdown.

The Past as Seen by Women and Men With Alzheimer Disease: Sex Differences in Autobiographical Memory.

BACKGROUND: Although there is a large body of research demonstrating the negative effects of Alzheimer disease (AD) on autobiographical memory (ie, memory of personal information), little is known about sex differences in autobiographical retrieval in AD. METHODS: We addressed this issue by inviting patients with AD and healthy control participants to retrieve autobiographical memories and analyzed them with regard to specificity, subjective experience (ie, time travel, emotion, and visual imagery), and retrieval time. RESULTS: Analyses demonstrated no significant differences between women and men with AD with regard to autobiographical specificity, time travel, visual imagery, or retrieval time. However, the higher emotional value was attributed to memories by women with AD than by men with AD. DISCUSSION: AD seems to equally affect the ability of women and men with AD to construct specific autobiographical memories, to mentally travel in time to relive these memories, to construct mental visual images during memory retrieval, and to organize and monitor search processes, as the latter are mirrored by retrieval time. However, women with AD seem to attribute greater emotional value to autobiographical memories than men with AD.

The subjective experience of mind wandering in Alzheimer's disease.

Introduction: Little is known about mind wandering in Alzheimer's disease (AD). In this study, we evaluated the subjective experience of mind wandering in AD.Methods: We invited AD patients and control participants to rate the occurrence, intentionality, emotionality, visual imagery, specificity, self-relatedness and temporal orientation of mind wandering.Results: Analysis showed that AD patients rated their mind wandering as more frequent, negative, and more oriented toward the past, but less vivid and specific than that of control participants. No significant differences were observed between AD patients and control participants regarding the intentionality or self-relatedness of mind wandering.Conclusions: These findings demonstrate the negative content in AD. Regarding the reduction of visual imagery and specificity during mind wandering, this reduction may mirror a diminished subjective experience of mind wandering in AD. Regarding temporality, our results may reflect a tendency of AD patients to reminisce over past experiences. Finally, mind wandering in AD seems to trigger significant self-related content.

Visual imagery: The past and future as seen by patients with Alzheimer's disease.

We investigated visual imagery for past and future thinking in Alzheimer's Disease (AD). We invited AD patients and controls to retrieve past events and to imagine future events. Participants also provided a "Field" response if they see the event through their own eyes, or an "Observer" response if they see themselves in the scene as a spectator would. Less "Field" and more "Observer" responses were observed in AD participants than in controls during past and future thinking, suggesting a diminished ability to mentally visualize past and future events in AD. Results also demonstrated significant positive correlations between the production of "Field" responses and specificity during past and future thinking, suggesting a relationship between the ability to mentally visualize past and future events and autobiographical overgenerality in AD.

A look into hallucinations: the relationship between visual imagery and hallucinations in Alzheimer's disease.

Introduction: We investigated the relationship between visual hallucinations and vividness of visual imagery in patients with Alzheimer's disease (AD). Method: We recruited 28 patients with AD and 30 healthy control participants, matched for age and education. We evaluated proneness towards hallucinations with the Launay-Slade Hallucinations Scale, which includes items assessing visual and auditory hallucinations. We also evaluated vividness of visual imagery with the Vividness of Visual Imagery Questionnaire on which participants had to imagine four images (i.e., imagining the face of a friend, the rising sun, a familiar shop-front, and a country scene) and report the vividness of the images they generated. Results: Analysis demonstrated significant positive correlations between visual hallucinations and vividness of visual imagery in AD patients, however, no significant correlations were observed between auditory hallucinations and vividness of visual imagery in these participants. No significant correlations were observed between hallucinations and vividness of visual imagery in healthy control participants, probably due to the lack of hallucinations in these participants. Discussion: These results demonstrate a selective relationship between the occurrence of visual (but not auditory) hallucinations and the ability to generate vivid visual images in AD.

Relationships Between Confabulations and Mental Time Travel in Alzheimer's Disease.

The authors assessed the relationship between confabulations in Alzheimer's disease and the ability to mentally travel in time to reexperience memories. Twenty-seven patients with Alzheimer's disease were administered evaluations of provoked confabulations, spontaneous confabulations, and mental time travel. Provoked and spontaneous confabulations were evaluated with questions probing personal and general knowledge and with a scale rated by nursing and medical staff. Mental time travel was assessed by asking patients to retrieve personal memories. After each memory, participants had to provide a "remember" response if they were able to retrieve the event with their encoding context or a "know" response if they knew that the event had occurred but were unable to recall any contextual details. Results showed significant negative correlations between confabulations and "remember" responses. These findings reflect a relationship between the occurrence of confabulations in patients with Alzheimer's disease and impairments in their ability to mentally project themselves in time when retrieving the context in which confabulated memories were originally encoded.

The shifting self in aging.

BACKGROUND AND AIMS: This study investigated the ability of older adults to shift between self-images. METHODS: We designed a shifting-self task in which older adults and younger adults were invited to produce statements describing their physical self (e.g., "I am tall") and psychological self (e.g., "I am cheerful"). Participants were invited to shift between physical-self statements and psychological-self statements and, on a control task, to produce two blocks of physical-self statements and psychological-self statements. They also performed a typical shifting task (i.e., the plus-minus task). RESULTS: Analysis showed slower completion time on the shifting-self task in older adults than in younger adults. Time to complete the shifting-self task was longer than that for the control task in both older and younger adults. Performances on the shifting-self task were significantly correlated with performances on the plus-minus task. DISCUSSION: We hypothesized that older adults take more time to shift between self-images because they enjoy self-stability. In other words, the tendency of older adults to shift between self-images more slowly than younger adults might be because they have more consistent or stable self-concepts, and are therefore less inclined to "change" their self-images.

Hallucinations in Alzheimer's disease: failure to suppress irrelevant memories.

INTRODUCTION: Research with patients with schizophrenia suggests that inhibitory dysfunction leads to the emergence of redundant or irrelevant information from long-term memory into awareness, and that this process may be involved in generating hallucinations. We investigated whether inhibitory dysfunction in Alzheimer's disease (AD) leads to hallucinations. METHOD: AD participants and healthy matched controls were assessed with a hallucinations scale and a directed forgetting task. On the directed forgetting task, they were asked to retain a list of 10 words (i.e., List 1). Thereafter, half of the participants were asked to forget this list whereas the other half were asked to retain the list in memory. After the List 1 presentation, all participants were asked to retain another list of 10 words and, successively, were asked to remember all of the words from both lists, regardless of the previous forget or remember instruction. RESULTS: Relative to healthy matched controls, AD participants showed difficulties in suppressing the words from List 1. AD participants also showed more hallucinatory experiences than healthy matched controls. Interestingly, a significant correlation was observed between the score on the hallucinations measure and difficulties in suppressing List 1 in AD participants. DISCUSSION: Hallucinations in AD may, at least in part, be related to difficulties in suppressing memory representations, such that unwanted or repetitive thoughts intrude into consciousness.

From Nose to Memory: The Involuntary Nature of Odor-evoked Autobiographical Memories in Alzheimer's Disease.

Research suggests that odors may serve as a potent cue for autobiographical retrieval. We tested this hypothesis in Alzheimer's disease (AD) and investigated whether odor-evoked autobiographical memory is an involuntary process that shares similarities with music-evoked autobiographical memory. Participants with mild AD and controls were asked to retrieve 2 personal memories after odor exposure, after music exposure, and in an odor-and music-free condition. AD participants showed better specificity, emotional experience, mental time travel, and retrieval time after odor and music exposure than in the control condition. Similar beneficial effects of odor and music exposure were observed for autobiographical characteristics (i.e., specificity, emotional experience, and mental time travel), except for retrieval time which was more improved after odor than after music exposure. Interestingly, regression analyses suggested executive involvement in memories evoked in the control condition but not in those evoked after music or odor exposure. These findings suggest the involuntary nature of odor-evoked autobiographical memory in AD. They also suggest that olfactory cuing could serve as a useful and ecologically valid tool to stimulate autobiographical memory, at least in the mild stage of the disease.

Burden of family caregivers in Alzheimer's disease: The role of caregivers' perception of cognitive impairment.

OBJECTIVES: This study examined the role of caregivers' perception of cognitive impairment in burden of family caregivers in Alzheimer's disease (AD). We hypothesized that the evaluation of cognitive impairment by family caregivers plays a pivotal role in burden. METHODS: The study included 110 dyads (person with AD and their caregiver) recruited from a Memory Unit in France. The cognitive impairment and depressive symptoms of person with AD were evaluated by a geriatrician using the Mini Mental State Examination (MMSE) and the Geriatric Depression Scale (GDS-15). Caregivers provided self-reports on the perception of cognitive impairment (IQCODE) of the care recipient, the caregiving burden (ZBI), depressive symptoms (GDS-15), and self-esteem (RSE). Descriptive analyses, comparison of different caregiver burden groups, and multinomial logistic regression analyses to understand correlates of caregiver burden were conducted with SPSS®, version 20. RESULTS: The findings show that the caregivers are on average 60 years old and the majority are women. They care for persons with AD, who are on average 82 years old and most of whom are women. Our results show that the duration of caregiving, depression of the caregiver, and caregivers' perception of cognitive impairment contribute significantly to burden of caregiver. DISCUSSION: This study shows that it is necessary to adopt the caregiver-centered approach to support the dyad. The role of the caregivers' perception of cognitive impairment in AD should be developed when supporting caregivers in suffering.

ChatGPT as a Diagnostic Aid in Alzheimer's Disease: An Exploratory Study.

Background: The potential of ChatGPT in medical diagnosis has been explored in various medical conditions. Objective: We assessed whether ChatGPT can contribute to the diagnosis of Alzheimer's disease (AD). Methods: We provided ChatGPT with four generated cases (mild, moderate, or advanced stage AD dementia, or mild cognitive impairment), including descriptions of their complaints, physical examinations, as well as biomarker, neuroimaging, and neuropsychological data. Results: ChatGPT accurately diagnosed the test cases similarly to two blinded specialists. Conclusions: While the use of generated cases can be a limitation to our study, our findings demonstrate that ChatGPT can be a useful tool for symptom assessment and the diagnosis of AD. However, while the use of ChatGPT in AD diagnosis is promising, it should be seen as an adjunct to clinical judgment rather than a replacement.

Anti-dementia drugs and changes in gait: a pre-post quasi-experimental pilot study.

BACKGROUND: Anti-dementia drugs may improve gait performance. No comparison between acetylcholinesterase inhibitors (CEIs) and memantine-related changes in gait variability has been reported. The objectives of this study were to 1) quantify and compare the mean values and coefficients of variation (CoV) of stride time in demented patients with Alzheimer's disease and related disorders (ADRD) before and after the use of CEIs or memantine, and in age- and gender-matched controls patients with ADRD using no anti-dementia drugs; and 2) to determine whether changes in CoV of stride time differed between CEIs or memantine. METHODS: A total of 120 demented patients with mild-to-moderate ADRD were prospectively included in this pre-post quasi-experimental study with two intervention groups (43 patients taking CEIs, and 41 taking memantine) and a control group (36 age- and gender matched patients without any anti-dementia drugs). CoV of stride time and walking speed were measured with GAITRite® system while usual walking at steady state. Age, gender, number of drugs daily taken, use of psychoactive drugs, body mass index and time between the two visits were also recorded. RESULTS: There was no difference between groups for the time between baseline and follow-up assessments (232.9 ± 103.7 days for patients without anti-dementia drugs, 220.0 ± 67.5 days for patients with CEIs, 186.7 ± 96.2 days for patients with memantine, P = 0.062). Patients with memantine had a lower (i.e., better) CoV of stride time at follow-up assessment compared to those with CEIs (4.2 ± 2.4% versus 5.8 ± 4.2%, P = 0.010). Patients with memantine had a greater decrease in CoV of stride time compared to those with CEIs (-1.90% versus 0.93%, P = 0.010) and mixed-effects linear regressions showed that this decrease was specifically explained by memantine (P = 0.028). CONCLUSIONS: Our results showed that patients with ADRD and treated with memantine, but not those with CEIs, decreased their gait variability, and thus improved their gait safety (Trial registration number: NCT01315704).