Preliminary evidence for an increased likelihood of a stable trajectory in mild cognitive impairment in individuals with higher motivational abilities.

BACKGROUND: Motivational abilities (MA), that describe skills in relation to goal-oriented behavior, have recently been found to be associated with neuropathological aging. Here we examine the impact of MA on the long-term course of mild cognitive impairment (MCI). METHODS: We followed-up N = 64 individuals diagnosed with MCI (Mage = 73 years, 44% female) for 3 years. MA were assessed by long-term informants of the participants using two scales: motivation and decision regulation [Volitional Components Questionnaires, VCQ, (Kuhl and Fuhrmann, Decomposing self-regulation and self-control: the volitional components inventory, 1998)]. Cognitive abilities were assessed with the Mini Mental State Examination (J Psychiatr Res 12:189-98, 1975). Survival analyses and multilevel modeling (MLM) were applied to determine the predicting effect of informant-rated MA at baseline on the likelihood of MCI stability and on the trajectory of cognitive abilities. RESULTS: Fifty percent (n = 32) of the MCI participants remained stable, while 32.8% (n = 21) and 17.2% (n = 11) converted to Alzheimer's disease (AD) or dropped-out, respectively. Survival analyses revealed that MCI cases with higher-rated MA at baseline were more likely to exert a stable course in MCI over 3 years (p = 0.036) when controlling for demographic characteristics and executive function. MLM analyses indicated that higher informant-rated MA at baseline were significantly related to higher cognitive abilities, even when controlling for MCI subtype (p = 0.030). CONCLUSIONS: This study provides preliminary longitudinal evidence for a lower risk of conversion to AD and higher cognitive abilities by higher rated MA at an early stage of MCI.

Disclosure of Diagnosis in Early Recognition of Psychosis.

There is a debate concerning risks and benefits of early intervention in psychosis, especially concerning diagnosis disclosure. The present study reports preliminary findings on self-reported locus of control and psychological distress after the disclosure of diagnosis in an early recognition center. We compared the ratings of the locus of control and psychological distress before and after communication of diagnosis. The study included individuals with an at-risk mental state (ARMS) (n = 10), schizophrenia (n = 9), and other psychiatric disorders (n = 11). Results indicate greater endorsement of the internal locus of control in individuals with ARMS after communication of diagnosis in contrast to the other groups. Our results suggest that disclosure of diagnosis in an early recognition center leads to a reduction of psychological distress and increased feelings of control over one's health. Persons with ARMS seem to particularly benefit from disclosure of diagnosis as part of early intervention.

[Recommendations for the diagnostic and therapy of behavioural and psychological symptoms of dementia (BPSD)].

INTRODUCTION: The «Recommendations for the Diagnosis and Treatment of Behavioral and Psychological Symptoms of Dementia (BPSD)¼ were developed in parallel with the Swiss National Dementia Strategy 2014-2019 under the auspices of the Swiss Society for Geriatric Psychiatry and Psychotherapy (SGAP) and mark the beginning of a series of recommendations for geriatric psychiatric disorders. They depict the evidence-based state of knowledge about diagnostics and therapy, based on the clinical experience of the experts, and are designed for interprofessional and interdisciplinary use. The non-pharmacological intervention options and pharmacotherapy are discussed in detail. This paper is the revised version of the 2014 publication and compiles the development in this area for everyday clinical practice.

Acquisition of affective dispositions in dementia patients.

In this study, we investigated the acquisition of affective dispositions towards neutral faces in patients with Alzheimer's disease and mixed dementia. Participants viewed four affectively neutral male faces from the International Affective Picture System. Biographical information about the depicted persons was presented, which described them in terms of positive or negative traits varying in intensity. Participants were asked to rate the pictures with respect to emotional valence, arousal, and preference prior to and after the presentation of the biographical information. Following a retention interval of 180 min, pictures were rated again and the biographical information was presented once more. Final ratings were obtained after another interval of 1300 min. As expected, healthy control participants identified the faces and recalled parts of the information in the delayed recall test. They showed pronounced changes in affective ratings. Patients did not recognize the faces in a recognition test after the retention intervals, but valence, arousal, and preference ratings were systematically altered by the affective content of biographies. The results suggest that acquisition and maintenance of implicit affective dispositions are preserved in dementia even when explicit memory is impaired.

Evaluative Conditioning with Facial Stimuli in Dementia Patients.

We present results of a study investigating evaluative learning in dementia patients with a classic evaluative conditioning paradigm. Picture pairs of three unfamiliar faces with liked, disliked, or neutral faces, that were rated prior to the presentation, were presented 10 times each to a group of dementia patients (N = 15) and healthy controls (N = 14) in random order. Valence ratings of all faces were assessed before and after presentation. In contrast to controls, dementia patients changed their valence ratings of unfamiliar faces according to their pairing with either a liked or disliked face, although they were not able to explicitly assign the picture pairs after the presentation. Our finding suggests preserved evaluative conditioning in dementia patients. However, the result has to be considered preliminary, as it is unclear which factors prevented the predicted rating changes in the expected direction in the control group.

Affective learning and psychophysiological reactivity in dementia patients.

We examined the association of faces with biographical information that varied in emotional content in patients with Alzheimer's disease and a healthy control group. During two experimental sessions, participants rated neutral male faces on dimensions of hedonic valence and emotional arousal, later paired with fictitious biographical information. Both groups changed their ratings of the faces according to the biographical content. Free recall and recognition were tested in the second session. Patients neither recalled the biographical information nor recognized the faces, whereas the controls did. In addition, psychophysiological measures were taken in response to the face stimuli. Patients showed significant heart rate modulation as a function of their emotion ratings, whereas the controls did not. No correlation of rating changes with skin conductance was found in any group. Results suggest that psychophysiological reactions such as heart rate changes may indicate preserved affective associative learning in dementia patients despite impaired explicit memory.

Implicit learning of affective responses in dementia patients: a face-emotion-association paradigm.

The aim of the present study was to develop and evaluate an ecologically valid approach to assess implicit learning of affective responses in dementia patients. We designed a Face-Emotion-Association paradigm (FEA) that allows to quantify the influence of stimuli with positive and negative valence on affective responses. Two pictures of neutral male faces are rated on the dimensions of valence and arousal before and after aversive versus pleasant fictitious biographical information is paired with each of the pictures. At the second measurement time point, memory for pictures and biographical content is tested. The FEA was tested in 21 patients with dementia and 13 healthy controls. Despite severely impaired explicit memory, patients changed valence and arousal ratings according to the biographical content and did not differ in their ratings from the control group. The results demonstrate that our FEA paradigm is a valid instrument to investigate learning of affective responses in dementia patients.