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Título: SELF-AWARENESS AND EMOTIONAL PROCESSING IN ALZHEIMER S DISEASE
Autor: ANNA FISCHER
Colaborador(es): DANIEL CORREA MOGRABI - Orientador
Catalogação: 23/JUN/2020 Língua(s): ENGLISH - UNITED STATES
Tipo: TEXT Subtipo: THESIS
Notas: [pt] Todos os dados constantes dos documentos são de inteira responsabilidade de seus autores. Os dados utilizados nas descrições dos documentos estão em conformidade com os sistemas da administração da PUC-Rio.
[en] All data contained in the documents are the sole responsibility of the authors. The data used in the descriptions of the documents are in conformity with the systems of the administration of PUC-Rio.
Referência(s): [pt] https://www.maxwell.vrac.puc-rio.br/projetosEspeciais/ETDs/consultas/conteudo.php?strSecao=resultado&nrSeq=48746&idi=1
[en] https://www.maxwell.vrac.puc-rio.br/projetosEspeciais/ETDs/consultas/conteudo.php?strSecao=resultado&nrSeq=48746&idi=2
DOI: https://doi.org/10.17771/PUCRio.acad.48746
Resumo:
Lack of awareness of condition, also termed anosognosia, is a common symptom in Alzheimer s disease (AD). However, its functional structure and underlying mechanisms are not fully understood. Level of awareness has great relevance for treatment success and caregiver burden. Another factor that has considerable impact on interpersonal relationships and thus on well-being of patients and caregivers is emotional processing. The current thesis explores these topics through four articles. In Article 1, structural equation modeling (SEM) was used in a large sample of people with AD (PwAD) to investigate the nature of the relationship between cognitive function, mood state, and functionality in predicting awareness. Results showed that lower cognitive function and higher level of depressive mood state negatively influenced PwAD s ability to perform daily living activities, which in turn were associated with better awareness. Article 2 investigated executive and mnemonic origins of anosognosia in AD, with a reaction time task being applied to examine awareness of task performance. The findings demonstrated that online monitoring was preserved, while medium- and long-term monitoring were impaired. This was supported by results from electrophysiological data. The results strengthen the evidence for a mnemonic rather than executive nature of anosognosia in PwAD in accordance with the Cognitive Awareness Model (CAM). Article 3 investigated emotional reactivity to negative, self-relevant, and neutral pictures using ratings of arousal and valence, facial expression recordings and electrophysiological data. Emotional reactivity of PwAD was similar to young adults, but electrophysiological responses were elevated compared to healthy older adults, which might be explained by a lack of cognitive control mechanisms. Apathy was associated with reduced electrophysiological responses for negative pictures, and awareness of social impairments was linked to higher arousal ratings of self-relevant pictures. Article 4 discussed how higher emotional abilities are affected by AD, through a review of the literature on empathy in this clinical group. PwAD showed a pattern of relatively preserved affective aspects and impairments in cognitive components of empathy, whereby impairments in affective components can mainly be attributed to a general cognitive decline. Our findings highlight that different factors influence awareness in AD, emphasizing the role of neuropsychiatric symptoms (NPS), cognitive functioning and activities of daily living. Moreover, executive processes seem to be preserved, whereas impairments in updating and consolidation of this knowledge seem to be a possible cause for anosognosia in AD. Furthermore, we suggested that emotional abilities are largely preserved in PwAD. Our results have great significance for clinical practice. Translational research is needed to implement research findings into specific therapeutic approaches.
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