Narrative accounts of illness in schizophrenia: association of different forms of awareness with neurocognition and social function over time

Awareness of illness in schizophrenia reflects complex storied understanding of the impact of the disorder upon one’s life. Individuals may be aware of their illness in different ways and this may be related to their functioning. A total of 76 adults with schizophrenia were assessed for their awareness of illness, neurocognition, social cognition, and social function concurrently and social function was also assessed at three later time points. A cluster analysis revealed 3 groups: generally full awareness, generally limited awareness, and superficial awareness. Comparisons between these profiles revealed the superficial group had poorer executive function, emotion recognition ability, and capacity for social relationships than the full awareness group, yet had better verbal memory and more social contacts than the limited awareness group. These results suggest assessing the narrative qualities of awareness of illness may reveal unique links with cognition and function, and this may have implications for interventions.     

Self-awareness and self-monitoring of cognitive and behavioral deficits in behavioral variant frontotemporal dementia, primary progressive aphasia and probable Alzheimer's disease

Lack of insight is a core diagnostic criterion for behavioral variant frontotemporal dementia (bvFTD), and is believed to be intact in the early stages of primary progressive aphasia (PPA). In other neurological conditions, symptom-specific insight has been noted, with behavioral symptoms appearing especially vulnerable to reduced insight. Different components of insight, self-awareness and self-monitoring, are also often considered separate phenomena. The current study compared insight in patients with PPA, bvFTD, and probable Alzheimer's disease (PrAD) and a group of cognitively intact control subjects. Additionally, differences in insight for the domains primarily affected by the three types of dementia, namely, Behavior, Naming, and Memory, were assessed, and self-awareness and self-monitoring were compared. A total of 55 participants were enrolled. Participants were asked to complete self-estimate scales demonstrating their perceived ability immediately prior to, and immediately following a test in each domain of interest. Results indicated that PPA and normal control groups performed very similarly on control (Weight and Eyesight) and cognitive domains, whereas bvFTD and PrAD patients were unable to accurately assess Memory. All three diagnostic groups failed to accurately assess their behavioral symptoms, suggesting that this domain is vulnerable to loss of insight across diagnoses. Naming ability, in contrast, was either accurately assessed or underestimated in all groups. Finally, there were no notable differences between self-awareness and self-monitoring, potential explanations for this are examined.     

Loss of emotional insight in behavioral variant frontotemporal dementia or "frontal anosodiaphoria"

Loss of insight is a prominent clinical manifestation of behavioral variant frontotemporal dementia (bvFTD), but its characteristics are poorly understood. Twelve bvFTD patients were compared with 12 Alzheimer’s disease (AD) patients on a structured insight interview of cognitive insight (awareness of having a disorder) and emotional insight (concern over having a disorder). Compared to the AD patients, the bvFTD patients were less aware and less concerned about their disorder, and they had less appreciation of its effects on themselves and on others. After corrective feedback (“updating”), the bvFTD patients were just as aware of their disorder as the AD patients but remained unconcerned and unappreciative of its effects. These findings suggest that lack of insight in bvFTD is not due to “anosognosia,” or impaired cognitive and executive awareness of disease, but to “frontal anosodiaphoria,” or lack of emotional concern over having bvFTD and its impact on themselves and others.     

Public awareness and knowledge of stuttering in Rio de Janeiro

This study reports the results of an investigation of public awareness and knowledge of stuttering in Rio de Janeiro, Brazil. A total number of 606 street recruited respondents answered questions on various aspects of stuttering, including prevalence, onset, gender distribution, occurrence in different cultures, cause, treatment, intelligence, and hereditariness. The questionnaire used was a Portuguese version of the one by [Van Borsel, J., Verniers, I. & Bouvry, S. (1999). Public awareness of stuttering. Folia Phoniatrica et Logopaedica, 51, 124–132]. Although, stuttering is a disorder which is known to a majority of the participants, knowledge appears to be limited for certain aspects. Knowledge also differs among subgroups of participants according to gender, age and educational level. Comparison of the results of the current study with similar studies conducted in Belgium and in Shanghai, China shows several similarities but also some differences.

Educational objectives: The reader will be able to: (1) discuss public awareness and knowledge of stuttering in Rio de Janeiro, Brazil; (2) discuss the differences in knowledge according to gender, age and educational level and; (3) discuss similarities and differences with comparable studies run in Belgium and Shanghai, China.     

The onset of dementia caregiving and its longitudinal implications

This study examined patterns of entry into the caregiving role and how onset influences outcomes pertinent to the caregiving process. Using 3-year longitudinal data, the present analysis classified dementia caregivers into 1 of 4 onset sequences: those whose entry into caregiving was defined by diagnosis, those who first recognized symptoms and then obtained a diagnosis, those caregivers who first recognized symptoms and then provided care, and those who provided care prior to diagnosis or recognition. Analyses revealed that respondents who experienced a less abrupt entry into caregiving were less likely to institutionalize their relatives and reported greater decreases in well-being. The findings point to the dynamic process that defines entry into caregiving and emphasize that how individuals assume caregiving roles have implications long after onset.     

Aversive conditioning under conditions of restricted awareness: Effects on spatial cueing

In the literature on aversive conditioning there is still debate on the role of awareness. According to some authors, affective learning can occur with or without contingency learning (dual-process model), whereas others argue that a single process produces both affective responses and contingency knowledge. Although many studies have investigated these models, the results to date are inconclusive. Based on a review of the literature, a new series of experiments was designed to examine aversive conditioning in the absence of contingency awareness. In the present study we examined the effects of subliminal aversive conditioning on a spatial cueing task. Awareness was stringently tested after conditioning. Three kinds of awareness were distinguished: contingency awareness (awareness of the CS?US contingencies, where CS is the conditioned stimulus, and US is the unconditioned stimulus), perceptual awareness (awareness of the perceptual differences between the CSs), and US expectancy (awareness of a threat feeling when confronted with the CS+, but not when confronted with the CS?). The results of three experiments demonstrated that responses on the spatial cueing task were modulated by subliminal aversive conditioning. Importantly, none of the participants was contingency aware or able to perceptually discriminate between the conditioned stimuli. However, in Experiment 3, only those participants showing some level of postconditioning expectancy awareness exhibited conditioning effects. These experiments suggest that subliminal aversive conditioning produces small but significant effects, which may be modulated by expectancy awareness.     

Measuring consciousness: task accuracy and awareness as sigmoid functions of stimulus duration

When consciousness is examined using subjective ratings, the extent to which processing is conscious or unconscious is often estimated by calculating task performance at the subjective threshold or by calculating the correlation between accuracy and awareness. However, both these methods have certain limitations. In the present article, we propose describing task accuracy and awareness as functions of stimulus intensity (thus obtaining an accuracy and an awareness curve) as suggested by Koch and Preuschoff (2007). The estimated lag between the curves describes how much stimulus intensity must increase for awareness to change proportionally as much as accuracy and the slopes of the curves are used to assess how fast accuracy and awareness increases and whether awareness is dichotomous. The method is successfully employed to assess consciousness characteristics on data from four different awareness scales.     

Turning back the hands of time: Autobiographical memories in dementia cued by a museum setting

The current study examined the effects of cuing autobiographical memory retrieval in 12 older participants with dementia through immersion into a historically authentic environment that recreated the material and cultural context of the participants’ youth. Participants conversed in either an everyday setting (control condition) or a museum setting furnished in early twentieth century style (experimental condition) while being presented with condition matched cues. Conversations were coded for memory content based on an adapted version of Levine, Svoboda, Hay, Winocur, and Moscovitch (2002) coding scheme. More autobiographical memories were recalled in the museum setting, and these memories were more elaborated, more spontaneous and included especially more internal (episodic) details compared to memories in the control condition. The findings have theoretical and practical implications by showing that the memories retrieved in the museum setting were both quantitatively and qualitatively different from memories retrieved during a control condition.     

Auditory awareness negativity is an electrophysiological correlate of awareness in an auditory threshold task

One theory of visual awareness proposes that electrophysiological activity related to awareness occurs in primary visual areas approximately 200 ms after stimulus onset (visual awareness negativity: VAN) and in fronto-parietal areas about 300 ms after stimulus onset (late positivity: LP). Although similar processes might be involved in auditory awareness, only sparse evidence exists for this idea. In the present study, we recorded electrophysiological activity while subjects listened to tones that were presented at their own awareness threshold. The difference in electrophysiological activity elicited by tones that subjects reported being aware of versus unaware of showed an early negativity about 200 ms and a late positivity about 300 ms after stimulus onset. These results closely match those found in vision and provide convincing evidence for an early negativity (auditory awareness negativity: AAN), as well as an LP. These findings suggest that theories of visual awareness are also applicable to auditory awareness.     

Understanding and awareness of dementia in the Sikh community

Previous literature confirms that older black minority ethnic populations are less likely than white populations to contact dementia services in the UK. However, it is unknown whether this is due to a higher or lower prevalence of dementia or due to different needs or coping strategies within these communities. The aim of this study was to explore the understanding and perceptions of dementia amongst Sikhs living in the UK. Six focus groups were involved with 28 Sikh participants who were recruited from Gurdware (Sikh places of worship). Data were analysed using constant comparative methodology. The themes reported in this paper include “awareness and interpretation of the characteristics of dementia”, “multiple perspectives of the same symptoms” and “causes of dementia”. The findings have been discussed in the context of existing research and provide an introductory insight into informing culturally appropriate interventions.     

Neuropsychological and neurophysiological effects of strengthening exercise for early dementia: A pilot study

ABSTRACT

Research demonstrates a positive effect of aerobic exercise on cognitive functioning in older adults. Unfortunately, aerobic exercise is often contraindicated for older adults due to cardiovascular and functional limitations. Low-intensity strengthening exercise may offer a practical alternative, but the neuropsychological benefits and potential neurophysiological mechanisms are less well understood. The current study evaluated the effects of a 10-week strengthening exercise intervention on cognitive functioning and EEG in a sample of 13 older adults with early dementia, and 9 normative controls. Results revealed beneficial effects of strengthening exercise on verbal memory coupled with frontal beta and delta power asymmetries and N200 amplitude asymmetry. Results point to increased cognitive efficiency following 10 weeks of strengthening exercise. The findings suggest it is feasible to conduct a strengthening intervention with early dementia patients, and to gather neuropsychological and neurophysiological data to evaluate outcomes. Strengthening exercise may serve as a useful alternative to aerobic exercise.     

Global shape integration and illusory form perception in the absence of awareness

Previous research on perceptual organization operations still provides contradictory evidence on whether the integration of sparse local elements into coherently unified shapes and the construction of the illusory form are accomplished without the need of awareness. In the present study, three experiments were conducted in which participants were presented with masked (Experiment 1, SOA = 27 ms; Experiment 2; SOA = 53 ms) and unmasked (Experiment 3) primes consisting of geometric shapes (a square or a diamond) that could be congruent or incongruent with subsequent probe stimuli (square vs. diamond). Furthermore, the primes were divided into: a grouping condition (where local elements may group together into global shapes), an illusory condition (where the arrangement of local elements produced illusory shapes) and a hybrid condition (where both operations were presented simultaneously). While no priming effects were found for the shortest SOA (27 ms), both grouping and illusory primes produced significant priming effects in the longer SOA (53 ms). On the other hand, results in Experiment 3 (unmasked) showed strong priming effects for the grouping of the inducers in both the grouping and the hybrid conditions, and also a significant but weaker priming effect for the illusory condition. Overall, our results support the possibility of the integration of local visual features into a global shape in the absence of awareness and, likewise, they suggest an early –subliminal– construction of the illusory shape, implying that feedback projections from higher to lower visual areas are not crucial in the construction of the illusory form.     

Perceptual awareness and categorical representation of faces: evidence from masked priming

How internal categories influence how we perceive the world is a fundamental question in cognitive sciences. Yet, the relation between perceptual awareness and perceptual categorization has remained largely uncovered so far. Here, we addressed this question by focusing on face perception during subliminal and conscious perception. We used morphed continua between two face identities and we assessed, through a masked priming paradigm, the perceptual processing of these morphed faces under subliminal and supraliminal conditions. We found that priming from subliminal faces followed linearly the information present in the primes, while priming from visible faces revealed a non-linear profile, indicating a categorical processing of face identities. Our results thus point to a special relation between perceptual awareness and categorical processing of faces, and support the dissociation between two modes of information processing: a subliminal mode involving analog treatment of stimuli information, and a supraliminal mode relying on discrete representation.     

Stories of family caregivers of people with dementia in Greece: Implications for counselling

A substantial body of literature has identified high rates of burden, psychological morbidity, social isolation, health and financial difficulties among dementia caregivers. The present qualitative study adopted an Interpretive Phenomenological Analysis approach in order to explore the lived experiences of dementia family caregivers within the Greek sociocultural context. The sample was purposive and consisted of 10 women dementia family caregivers from Athens and Thessaloniki. Individual in-depth interviews were conducted and analysed according to IPA. The participants’ personal accounts included themes related to ethical/existential and cultural aspects of family caregiving; changes in family relationships; impact of the caregiving experiences; sources of support and help seeking; positive and meaningful aspects of the care experience. The research findings are discussed in the context of Gilligan’s moral psychological theory, and cultural dimensions of family caregivers. Implications for counselling interventions aiming at supporting caregivers are presented.     

The distinctiveness and utility of a measure of trait emotional awareness

There has been a proliferation of new measures of individual differences in emotional processing, but too little research that evaluates the distinctiveness and utility of such measures. We critically evaluated the Level of Emotional Awareness Scale (LEAS), which is a measure of people's awareness of emotions in both the self and others. Across two studies, university students (N=124 and 107 for study 1 and 2, respectively) completed the LEAS, as well as a battery of personality measures and ability tests, and a mood-induction task. The LEAS was statistically distinct from a wide variety of personality measures, emotional intelligence tests, and self-report ability measures. In addition, both studies demonstrated that people high in emotional awareness were less likely than others to show mood congruent biases in their judgments (e.g. when bad moods lead to negative judgments and good moods to good judgments). The LEAS appears to be both distinctive and useful in understanding mood-relevant processes.     

Supporting the spiritual needs of people with dementia in residential aged care

ABSTRACT

Objective: To describe how an Australian age care provider, BaptistCare NSW & ACT, has embraced the National Guidelines for Spiritual Care in Aged Care for people with dementia.

Method: A 12-month study was conducted in 19 Baptistcare residential homes, including 14 dementia units. Data were obtained from selected items of the Person-Centred Environment and Care Assessment Tool using interviews, observation, and document review.

Results: The person-centred approach was instituted in adhering to the Guidelines for people with dementia. Conclusion: The person-centred approach assists in actioning the Guidelines for people with dementia.     

Selective attention for masked and unmasked threatening words in anxiety: Effects of trait anxiety, state anxiety and awareness

We investigated the effects of awareness on selective attention for masked and unmasked verbal threat material using a computerised version of the emotional Stroop. Participants were assigned to the high trait anxious (HTA) and low trait anxious (LTA) groups on the basis of questionnaire scores, and state anxiety was manipulated within participants through the threat of electric shock. To investigate the effects of awareness on responses to threat, the mode of exposure was blocked such that half the participants received masked trials before the unmasked trials, whereas the other half received the reverse order. The results revealed that there was no difference between the HTA and LTA groups in responses to threat for those who received the masked trials before the unmasked trials. However, when unmasked trials were presented before the masked trials HTA individuals were significantly slower to respond to both masked and unmasked threat words compared to the LTA group, and these effects were not further modified by participants' state anxiety status. The results are discussed in terms of the automatic nature of threat processing in anxiety.     

Awareness of memory task impairment versus everyday memory difficulties in dementia

The study investigated different types of awareness of memory dysfunction in dementia, specifically judgements concerning memory task performance or appraisal of everyday memory functioning and also exploring the neuropsychological correlates of such awareness. This was investigated in 76 people with dementia, comprising 46 patients with Alzheimer's disease (AD) and 30 patients with vascular dementia (VaD). The Memory Awareness Rating Scale (Clare et al., 2002, Neuropsychol Rehabil, 12, 341–362) was used, which includes an Objective‐Judgement Discrepancy (OJD) technique involving comparison of subjective evaluation of performance on specific memory tasks with actual performance, and a Subjective Rating Discrepancy (SRD) technique, which compares self versus informant judgement of everyday memory function. The AD and VaD groups showed lower awareness than a normal control group for both types of measures, the AD group showing less awareness than the VaD group on the OJD measure. Regression analyses supported associations for both groups between memory impairment and the OJD measure and between naming impairment and the SRD measure. The findings are discussed in terms of neurocognitive theories accounting for loss of awareness in dementia.     

Nonjudgment as a moderator of the relationship between present-centered awareness and borderline features: Synergistic interactions in mindfulness assessment

The symptoms of borderline personality disorder (BPD) have been characterized as deficits in mindfulness. Mindfulness can be defined as nonjudgmental, present-centered awareness. The present study investigates the theory that, consistent with this conceptualization, the extent to which acting with awareness predicts reduced BPD features and related dysfunction depends upon levels of nonjudgment. In a sample of 223 undergraduates, we calculated the interaction between awareness-based and nonjudging-based mindfulness skills using subscales of the Five Facet Mindfulness Questionnaire. Regression analyses demonstrated a significant effect of the interaction on several difficulties that are common in BPD: problems with relationships, emotion-related impulsivity, and anger rumination. For acting with awareness to benefit individuals with these difficulties, a less judgmental stance toward internal experiences may be necessary. These findings have significant treatment implications and demonstrate the importance of assessing mindfulness as a multifaceted, synergistic construct.