Self-Reported Cognitive Inconsistency in Older Adults

ABSTRACT

Insight into one's own cognitive abilities, or metacognition, has been widely studied in developmental psychology. Relevance to the clinician is high, as memory complaints in older adults show an association with impending dementia, even after controlling for likely confounds. Another candidate marker of impending dementia under study is inconsistency in cognitive performance over short time intervals. Although there has been a recent proliferation of studies of cognitive inconsistency in older adults, to date, no one has examined adults' self-perceptions of cognitive inconsistency. Ninety-four community-dwelling older adults (aged 70–91) were randomly selected from a parent longitudinal study of short-term inconsistency and long-term cognitive change in aging. Participants completed a novel 40-item self-report measure of everyday cognitive inconsistency, including parallel scales indexing perceived inconsistency 5 years ago and at present, yielding measures of past, present, and 5-year change in inconsistency. The questionnaire showed acceptable psychometric characteristics. The sample reported an increase in perceived inconsistency over time. Higher reported present inconsistency and greater 5-year increase in inconsistency were associated with noncognitive (e.g., older age, poorer ADLs, poorer health, higher depression), metacognitive (e.g., poorer self-rated memory) and neuropsychological (e.g., poorer performance and greater 5-year decline in global cognitive status, vocabulary, and memory) measures. Correlations between self-reported inconsistency and neuropsychological performance were attenuated, but largely persisted when self-rated memory and age were controlled. Observed relationships between self-reported inconsistency and measures of neuropsychological (including memory) status and decline suggest that self-perceived inconsistency may be an area of relevance in evaluating older adults for memory disorders.     

Inducing cognitive development and learning: A review of short-term training experiments I. The organismic developmental approach

The author reviewed and interpreted the literature of experimental studies whose purposes were to determine rules of generation that transform a child's cognitive organization at one stage of development into that of the next, more advanced stage. The categories of the research methodology were consistent with the organismic-developmental approach, and the findings of the studies tended to support most of the hypotheses generated from this approach. Some unresolved theoretical and methodological issues were presented, and research strategies to shed light on these issues were proposed.     

From pilot fish to analyst: Finding a path between symbiotic and autistic defences

This paper presents the clinical case of a patient with autistic features. One of the main difficulties in his treatment was the particular rapid rhythm of his projections, introjections and re‐projections that constrained the analyst's capacity for reverie and hindered the use of effective projective identification processes. These alternating defensive constellations lead either to an expelling autistic barrier or to an engulfing symbiotic fusion. Their combination can be seen as the expression of a defence against an unintegrated and undifferentiated early experience of self that was in this way kept at bay to prevent it from invading his whole personality. Maintaining the symbiotic link, in which I kept included by staying partially fused to what was being projected and using my analytic function in a reduced way, helped to relate to what was in the patient's inside. Leaving this symbiotic link let my interpretations appear to ‘force’ their way through the autistic barrier. Yet as the process developed they allowed to show the patient how he ejected me and what was happening in his inside, behind his autistic barrier. So I found myself on the one hand accepting the symbiotic immobilization and on the other hand interpreting in a way that seemed forced to the patient, because it implied a breaking of the symbiotic position. The inordinate speed of projections and introjections could thus be interrupted, creating a space for awareness, reflection and transformation, and allowed the emergence of a connection between the patient's inside and outside. In the course of treatment I realized that this kind of dual defence system has been described by the late Argentinian analyst José Bleger. He assumes the existence of an early “agglutinated nucleus” that is held together by a psychic structure he calls the “glischro‐caric” position, in which projective identification cannot take place because there is no self/object differentiation. I have considered the rapid and fugitive use of projection and re‐introjection I met in my patient to be a manifestation of the dual defence system Bleger describes. Although he does not specifically mention this particular vicissitude of operative defences he does give hints about a rhythm in the patients’ projections and introjections.     

Relations Between the Development of Teaching and Theory of Mind in Early Childhood

The relations among children’s theory of mind (ToM), their understanding of the intentionality of teaching, and their own peer teaching strategies were tested. Seventy-five 3-, 4-, and 5-year-olds completed 11 ToM and understanding-of-teaching tasks. Subsequently, 30 of the children were randomly chosen to teach a peer how to play a board game, and their teaching strategies and levels of contingent teaching were recorded. There were developmental changes in the children’s understanding of teaching as an intentional activity. When teaching their peers, 3-year-olds used demonstration, whereas 4- and 5-year-olds added verbal explanations and began to adapt contingently to the learners’ changing knowledge level. Relations among ToM, understanding of teaching, and teaching level were found. The results suggest that the development of children’s teaching strategies and their contingency are closely tied to the development of ToM.     

Emotion Regulation Strategies in Cognitive Behavioral Therapy for Panic Disorder

Emotion regulation (ER) has been incorporated into many models of psychopathology, but it has not been examined directly in cognitive behavioral therapy (CBT) for panic disorder with agoraphobia (PD/A). In this study, a preliminary model of ER in CBT for PD/A is proposed based on existing theories, and several propositions of the model are tested. We hypothesized that increases in cognitive reappraisal would precede decreases in biased cognitions, decreases in expressive suppression would follow decreases in biased cognitions, and a reduction in symptom severity would follow decreases in expressive suppression. Twenty-nine patients who received CBT for PD/A completed weekly self-report measures of symptom severity, anxiety sensitivity, reappraisal and expressive suppression. In addition, patients were compared to a matched normal sample. Cross-lagged analyses partially supported the hypotheses. Reappraisal did not change until late stages of therapy and was generally not associated with treatment outcome. Suppression decreased significantly and exhibited a reciprocal relationship with biased cognitions. Symptom reduction followed decreases in suppression as hypothesized. However, patients did not differ in ER from matched controls at either pre- or posttreatment. Results suggest the important distinction between reappraisal and appraisal, and stress the role of session-by-session decreases in suppression as a predictor of symptom reduction.     

工作记忆成分的年龄相关差异对算术策略运用的预测效应

采用选择/无选范式,借助工作记忆成套测验,在两位数乘法估算问题中探讨了工作记忆系统各成分对不同年龄段个体算术策略运用的预测效应。结果显示:(1)工作记忆的不同成分与年龄之间存在明显的相关。表现为,除视空模板成分外,其他各成分得分随着年龄增长而呈现上升趋势;(2)估算策略运用中,年龄与策略选择显著相关,表现为随着年龄增长,策略选择表现明显提高;(3)估算策略运用中,不同年龄个体的工作记忆不同成分和策略选择表现出不同的联系,中央执行均显示出显著的预测效应,语音环路和视空模板的预测效应均不显著。不同年龄个体的工作记忆不同成分对策略执行的预测效应均不显著。上述发现对于深刻理解工作记忆系统在算术认知策略运用中的作用机制具有重要理论含义。     

主动脉夹层患者手术前心理危机的危害及其干预对策

主动脉夹层患者手术前的心理危机对其治疗有极大的负影响.本文作者首先列举了主动脉夹层患者手术前心理危机的主要危害,并详细分析了其心理危机的产生原因.然后针对性地提出了该类患者手术前心理危机可能的干预对策,同时列举一些采取了这些心理干预取得显著疗效的医院,充分证明心理干预在该类患者治疗中的重要性,最后面对目前该类患者手术前医疗状况的不足,进行了深刻的思考.