Making sense of self in Alzheimer's disease: reflective function and memory

ABSTRACT

Objective: The current investigation examined the relationship between cognitive impairment and sense of self in Alzheimer's disease (AD).

Method: Forty-nine participants with dementia associated with AD were recruited through memory clinics in Victoria, Australia. The 26 participants of the healthy control sample were recruited from a retirement village. Self was measured via the Reflective Self-Function Scale – a theory of mind indicator that provides personal and social self-reflection scores. Cognitive assessment included measures of new learning, executive function, and speed of information processing.

Results: A reduction in sense of self in mild AD was demonstrated in both personal and social domains, as compared to healthy adults of a similar age. With a focus on specific cognitive impairment relationships, new learning was found to predict personal self-reflection, whereas speed of information processing predicted social self-reflection capacity.

Conclusion: Findings suggest that deficits in new learning ability contribute to a reduced ability of people with early AD to understand their mental world and interpret thoughts, feelings, and beliefs about themselves. This impaired capacity to self-reflect will be intrusive in daily activities that require monitoring of current self-performance. Furthermore, with reduced speed of information processing found to impact on ability to reflect on social relations, individuals with AD are placed at risk of reduced ability to understand their social world, including communicating and interacting with others. Notwithstanding the overall group findings, individual variability was evident which reinforces the need for person-centred care in dementia.

KEYWORDS:

• Dementia
• Alzheimer's disease
• self
• cognitive impairment
• reflective function

Acknowledgments

We would like to thank the participants and their families for their generous time. It was a privilege to meet the participants and hear their stories. Thanks to the staff at the Bendigo and Ballarat Cognitive Dementia and Memory Services (CDAMS) and the Bendigo Retirement Village, who assisted with recruitment. We are also grateful for the research assistance provided by Ms Kris Ellery, Ms Neroli McConachy, and Ms Lynette Johnson.

Disclosure Statement

There is no financial interest or financial benefit arising from the research or direct application of the research for any of the authors.

Additional information

Funding

This work was supported by the Jack Brockhoff Foundation Australia and the La Trobe University Bendigo Postgraduate Award.