A life-course and multifactorial approach to Alzheimer's disease: Implications for research, clinical assessment and intervention practices.

According to the dominant biomedical view, Alzheimer's disease (AD) has a precise, necessary and unifying neurobiological cause, which distinguishes it from other neurodegenerative diseases and normal ageing. However, different types of evidence specifically lead to questioning the foundations of this essentialist and category-based approach to AD. It seems more and more evident that AD represents a heterogeneous state, determined by multiple factors and mechanisms that interact and intervene throughout life. This other way of conceiving AD not only requires a change of research objectives, but also a profound modification of clinical assessment and intervention practices. It also appeals to follow the path of prevention.

A daily-life-oriented intervention to improve prospective memory and goal-directed behaviour in ageing: a pilot study.

Difficulties in the execution of goal-directed behaviours, and particularly their prospective memory component, can arise in ageing and have important consequences for autonomy. The first objective of this article is to present an intervention that trained older individuals who reported prospective memory or goal-directed behaviour problems to use "implementation intentions". This technique, which has been shown to improve different aspects of goal-directed behaviour enactment, consists of establishing a mental (verbal and/or visual) link between the action that must be performed and the situation in which it must be performed. Our programme proposes exercises of progressively increasing difficulty that are targeted at daily life situations. Our second objective was to test the programme in small groups of older adults. Preliminary data regarding the programme's feasibility and its initial efficacy show a significant improvement in the main outcome measure, a questionnaire assessing goal-directed behaviours in everyday life. The participants also reported being significantly less bothered by their difficulties, although there were no significant changes in quality of life, self-esteem, anxiety or depression. Two participants with different psychological profiles, who benefited differently from the intervention, are then presented in more detail.

Apathy in aging: are lack of interest and lack of initiative dissociable?

Apathy is common in aging and generally defined on the basis of three dimensions: lack of initiative, lack of interest and emotional blunting. Curiously, no study until now has examined the associations and dissociations between these dimensions in elderly people (with or without dementia). These questions were addressed in two studies. In the first study, we explored the distribution of scores and the relationships between the three dimensions of apathy in 56 patients with dementia, focusing mainly on lack of initiative and lack of interest. Apathy was hetero-evaluated with the Apathy Inventory (AI), a scale widely used to assess the apathy dimensions in aging. In the second study, given the AI's limitations, we investigated in more detail the relationship between lack of initiative and interest in 115 elderly people using a new questionnaire specifically designed to assess these two dimensions. Results showed that lack of initiative was closely related to lack of interest (Study 1). Although we used a more specific questionnaire, these facets of apathy did not constitute two separable dimensions, but reflected a common main factor of apathy in aging (Study 2). Thus, the distinction between lack of initiative and lack of interest seems questionable. Only a multifactorial approach that includes the various psychological factors involved in apathy would enable one to gain a better understanding of the different manifestations of apathy and to highlight possible dissociations between them.

A multidimensional approach to impulsivity changes in mild Alzheimer's disease and control participants: cognitive correlates.

INTRODUCTION: Impulsive behaviors are frequently described in brain-damaged patients, including patients with Alzheimer's disease (AD). However, few studies have examined impulsivity changes and associated cognitive impairments in AD and healthy controls. Consequently, the first aim of this study was to compare patients with mild AD and matched controls on four dimensions of impulsivity (urgency, lack of premeditation, lack of perseverance, and sensation seeking) recently highlighted in the literature. The second objective was to examine the association between impulsivity changes and cognitive performances on executive/attentional tasks in mild AD and healthy controls. METHODS: Thirty patients with mild AD and 30 matched controls were administered a battery of tests that assessed executive and attention processes. In addition, informants of each patient and control completed a short questionnaire designed to assess the changes on the four dimensions of impulsivity (Rochat et al., 2008). RESULTS: Patients with mild AD had higher scores than controls on lack of premeditation and lack of perseverance dimensions of impulsivity, whereas the two groups did not differ on urgency and sensation seeking. Furthermore, patients showed significant decreased performances on measures of inhibition of prepotent responses, set-shifting, and working memory, as well as higher variability of reaction times (RTs) than matched controls. Regression analyses computed on the whole sample emphasized that difficulties in inhibition of prepotent responses significantly predicted higher lack of premeditation, and larger variability of RTs and set-shifting difficulties significantly predicted higher lack of perseverance, even when global cognitive functioning, general processing speed, working memory, and age were controlled for. Urgency and sensation seeking were not associated with any variables. CONCLUSIONS: These results provide valuable insight into the nature of brain systems and cognitive processes underlying impulsive behaviors. In addition, they open up interesting prospects for better comprehension of behavioral and psychological symptoms of AD.

Apathy and prospective memory in aging.

BACKGROUND: Apathy is common in aging, but the processes underlying its different components are still unclear. The aim of this study was to examine the relationships between apathy and prospective memory (PM), a process involved in the execution of delayed intentions. METHODS: Fifty elderly participants completed a PM task and a working memory task. Close relatives of the participants were given the Apathy Inventory, which assesses three dimensions of apathy (lack of initiative, lack of interest, emotional blunting), and a negative mood scale. RESULTS: Correlation analyses showed strong relationships between PM and lack of initiative and interest. These relations remain significant even after controlling for global cognitive functioning, working memory, processing speed and negative mood. CONCLUSION: This study sheds new light on the cognitive mechanisms associated with apathy in aging and opens up interesting prospects for psychological intervention.