Psychosocial impact of communication changes

 Breakdown of communication is perhaps the most devastating consequence of

dementia
 Train of thought difficult to follow
 Misunderstanding speech of other people
 Ability of speech can be lost altogether
 1996 studies very negative and pessimistic in terms of views of communication in
individuals with dementia
 Language deficits
o Understanding of abstract concepts
o Prone to repetition and digression
o In early stages, people are aware and can become frustrated by their
forgetting
 Mid stage dementia
o People can withdraw from social situations
o Appear to be unaware of communication deficits
o Use of stock phrases
 Used as a face saving technique
o Late stage dementia
 Look at form of communication
 Methodology
o Low ecological validity
o Communicating with researchers is different to communicating with families
etc.
 People will make fewer attempts to communicate
 Reduces self-esteem and leads to social withdrawal
 Fewer attempts by carers to communicate
 Iris Murdoch
o Face saving phrases
o Stock phrases are not a deficit
 Bayles paper for practical examples and suggestions
 Imitation reduces cognitive load
 Maintaining conversation is valuable
 Echolalia
 The Self in Dementia
o What is the self?
o Think about the self as an ontologically subjective experience
o What conditions required to think about the concept of the self?
o Mind and body separation?
o Descartes  rationality and cognition as the constituting principles for
selfhood
o Locke  conscious remembering enables diachronic persistence
 Thinking we are the same across time on a very deep level. We can
change in many ways but the deep level stays the same
o The self and cognition, especially memory, are inseparably linked
 o Tulving’s framework of the episodic memory (1972)
o The cognitive approaches reflect the notion that memory has the significant
evidential role in providing the basis of our sense of self
o That memory and self are linked suggests that without memory there is no
self
o People with dementia disintegrate until there is ‘nothing left’?
o The self should be viewed as a multi-dimensional construct
o Assumption that we communicate selfhood verbally
o Autobiographical (episodic) memories are a key component of human
interaction
o The self is also communicated in implicit ways
o The self is not only communicated verbally
o Inner perceptual world
o The self may not be a unitary construct, but rather be considered as a set of
closely connected yet substantive manifestations
o Diverse aspects of the self have a hierarchical relationship
 Self processes develop earlier
 Sense of having a life narrative
o Understand the pattern of self-alterations in dementia
o Caddell and Clare in 2010
 Only focused on a single manifestation at the time
o Scoping review
 NOT a systematic review
 Identify and map the available evidence, determining the scope of a
body of literature on a given topic and give a clear indication of the
volume of literature on a given topic and give a clear indication of the
volume of literature and studies available as well as an overview of its
focus
 Research question is exploratory
 2009-2021
 Grey literature = literature not published in peer reviewed journals
 Interest only in the psychological self
 Not socially constructed aspects of the self, such as marital
identity and group belonging and gender identity
 High order manifestations
o Autobiographical memory
 Findings suggest that there is a diminished capacity to recall and
produce specific past episodes, but, the use of naturalistic and
sensory cues provides promising results in successfully eliciting
autobiographical recall
o Self-knowledge
 Varied results
 Some show accuracy of self-traits but some not
o Future self-thinking
  People with dementia produce fewer autobiographical events with
notable similarities as they seem to imagine a future based on often
fragmented autobiographical information
o Perceived change
 Some people do not feel disconnected from their past self, but some
explicitly feel like they are not the same person they used to be
 Foundational manifestations
o Self-continuity
 Preserved or slightly altered self-continuity, despite alterations in
autobiographical recall and future self-knowledge
o Embodiment
 Embodied elements of the self, as expressed by personally significant
objects, household chores, inside jokes, and gestures are preserved in
dementia
 Maintain a sense of personal style
 Will show objects to a researcher
o Agency
 Preserved agentic experiences and feelings of control over one’s
actions
 Functional aspects of the self (cognitive biases for self-related information)
o Self-reference effect
 Enactment effect
o Memory benefitted from enactment but without a self-specific advantage
 Pronoun use
o Use first-person pronouns in answers
 Conceptual frameworks of self as a multifaceted construct