Psychological factors in retrograde amnesia: self-deception and a broken heart

We explored potential contributing psychological factors in a patient (‘XF’) with focal retrograde amnesia, within the framework proposed by Kopelman (2000). In particular, we investigated the psychological trait of self-enhancement. We constructed a self-report questionnaire measure of self-enhancement and compared XF’s score on this measure with the scores of 61 control participants. XF was found to have a significantly greater level of self-enhancement than the entire control group, and also than a smaller sample of age- and sex-matched controls. We propose that heightened self-enhancement may reflect a premorbid tendency that potentially predisposes individuals to develop retrograde amnesia

A reflection on the complexity of the self in severe dementia

What is the impact of dementia on your sense of self? This is a complex question given the various definitions of the self and difficulties in measuring it, particularly in this population. It has been argued that the gradual decline in memory (in particular autobiographical recall) abilities that is associated with Alzheimer’s Dementia coincides with a diminishing and eventual “loss” of self. These “memory centric” theories, however, fail to consider other aspects of self that can be relatively preserved in the face of dementia, such as the “interpersonal” and “moral” self. This paper describes the case of David, a surgeon with severe Alzheimer’s Dementia, and reflects on the relative sparing and impairment of different aspects of his self, based on his wife’s account and the author’s interaction with him during a neuropsychological assessment. Drawing on the model of 5 selves proposed by Neisser in 1988, and current literature on the self in dementia, this case demonstrates that our “selves” are not entirely dependent on autobiographical memory, and are not simultaneously “lost” in the severe stage of dementia

Commentary on "Rebuilding identity after brain injury : standard cognitive and music-evoked autobiographical memory training"

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Music and dementia

There is an increasing incidence of dementia in our aging population, and consequently an urgent need to develop treatments and activities that may alleviate the symptoms of dementia. Accumulating evidence shows that persons with dementia enjoy music, and their ability to respond to music is potentially preserved even in the late or severe stages of dementia when verbal communication may have ceased. Media interest in this topic has contributed to the public perception that music abilities are an “island of preservation” in an otherwise cognitively impaired person with dementia. In this chapter, we review the current literature on music cognition in dementia and show that there has been very scarce rigorous scientific investigation of this issue, and that various types of music memory exist and are differentially impaired in the different types of dementia. Furthermore, we discuss the recent development of music activities as a nonpharmacological treatment for dementia and highlight the methodological limitations of the current literature on this topic. While it has been reported that music activities can improve behavior, (particularly agitation), mood, and cognition in persons with dementia, recent large-scale randomized control studies have questioned the specificity of the effect of music and found that it is no more beneficial than other pleasant activities. Nevertheless, music is unique in its powerful ability to elicit both memories and emotions. This can provide an important link to individual's past and a means of nonverbal communication with carers, which make it an ideal stimulus for persons with dementia.29 page(s

When Music Compensates Language: A Case Study of Severe Aphasia in Dementia and the Use of Music by a Spousal Caregiver

Background: There is accumulating evidence of the preservation of music skills in people with Alzheimer’s dementia (AD), including spared memory for familiar music and the ability to produce music by singing or playing an instrument. Music can also be used to alleviate symptoms of dementia, leading to reduced agitation, improved positive mood, memory, and expressive language functions. Aims: We evaluated the rate of decline of expressive language and music skills in TC, a 77 year old woman with aphasia in the context of severe AD, and her husband’s use of music in caregiving. Neither TC nor her husband had any formal music training. We also explored whether the preservation of music skills had implications for treating a symptom of her dementia, specifically her misidentification delusion. Methods & Procedures: A retrospective comparison of the progressive decline in TC’s expressive music and language skills was obtained through interviews with her husband. He also completed a purposefully developed questionnaire regarding his use of music during caregiving. Assessment of TC’s language skills was attempted using the Sydney Language Battery, and her music engagement skills were evaluated with the Music Engagement Questionnaire (MusEQ, informant version). Her behaviour and verbal communication was observed during four different conditions, presented by her husband; (1) reading a newspaper article, (2) reading familiar song lyrics, (3) singing familiar song lyrics, and (4) listening to the original version of the familiar song. Outcomes & Results: TC exhibited a gradual deterioration of her expressive language abilities, whereas her music skills (singing and music engagement), were relatively preserved. Her overall score on the MusEQ was in keeping with age matched healthy controls (50–55 percentile) and she had a high average (80–85 percentile) score on the \u27emotion\u27 subscale. The impact of preserved music engagement was powerfully demonstrated when TC developed a transient misidentification delusion and believed that her husband was an intruder. Her delusion was only resolved after her husband repeatedly sang a significant song that they had shared as a couple for close to 60 years. By singing this special song (\u27Unchained Melody\u27), TC eventually \u27came back\u27 and recognised him. During behavioural observations under different language and music conditions, TC’s verbal communication did not appear to change. Conclusions: This case study illustrates that when language skills deteriorate in AD, music functions may persist, providing a vital tool in coping with the symptoms of severe dementia. (PsycInfo Database Record (c) 2020 APA, all rights reserved

Novel cognitive insights from the first year after bi-thalamic infarct

Neuropsychological consequences of bi-thalamic damage are scarcely known. This case study documents cognitive (in particular memory and executive) functioning in a man with a medial bi-thalamic infarct in the first year (8 and 12\ua0months) post injury. NG showed persistent memory (including autobiographical) impairment, but improved executive functions at one year post injury. On a response inhibition task his speed of response improved but his ability to inhibit a "prepotent" automatic response declined, corresponding to an increase in behavioral disinhibition. Despite this, he showed intact performances on several social cognition tasks. This case contributes to our understanding of the role of the thalamus in mediating retrograde memory, executive, and social cognition functions

A ‘Music, Mind and Movement’ Program for People With Dementia: Initial Evidence of Improved Cognition

Background: Music is being increasingly used as a therapeutic tool for people with dementia. Research has uncovered several qualities of music that are responsible for its beneficial effects. Based on the identification of seven therapeutic capacities of music, we devised the Music, Mind, and Movement (MMM) program and evaluated whether it had therapeutic benefit for people with dementia (various types) in the areas of cognition, mood, identity, and motor fluency. Methods: The MMM program involved seven 45-min weekly group sessions, and individual 15-min \u27booster\u27 sessions. Twenty people with mild to moderate dementia participated. Group 1 (n = 10) completed the MMM program first and Group 2 (n = 10) acted as a wait list control for 7 weeks, receiving standard care and completing the MMM program after the first group. Assessments of global cognition (Addenbrooke’s Cognitive Examination, ACE-III), mood (Geriatric Depression Scale short form), identity (‘I am’ task), and fine motor skills (9-Hole peg task) were conducted at baseline (T1), time 2 (T2, post treatment), and time 3 (T3, 1 month post MMM program). Results: Within group comparisons were conducted with 12 participants from the MMM program and 10 participants receiving standard care. Global cognition (total ACE-III score) improved in 8/12 participants after the MMM program, whilst it decreased in 8/10 participants after the period of standard care. MMM participants showed increases in ACE-III subdomain scores of attention (p = 0.007) and verbal fluency (p = 0.056). Conclusion: Our preliminary findings suggest that the MMM program may improve cognition, particularly verbal fluency and attention, in people with dementia. (PsycInfo Database Record (c) 2020 APA, all rights reserved

Music and Dementia: From Cognition to Therapy

Dementia is the most significant health issue facing our aging population. With no cure to date, there is an urgent need for the development of interventions that can alleviate symptoms of dementia and ensure optimal well-being for people with dementia and their caregivers. There is accumulating evidence that music is a highly effective, non-pharmacological treatment for various symptoms of dementia at all stages of disease progression. In its various forms, music (as a medium for formal therapy or an informal activity) engages widespread brain regions, and in doing so, can promote numerous benefits, including triggering memories, enhancing relationships, affirming a sense of self, facilitating communication, reducing agitation, and alleviating depression and anxiety. This book outlines the current research and understanding of the use of music for people with dementia, from internationally renowned experts in music therapy, music psychology, and clinical neuropsychology

Does music training facilitate the mnemonic effect of song? An exploration of musicians and nonmusicians with and without Alzheimer's dementia

Introduction: The efficacy of using sung words as a mnemonic device for verbal memory has been documented in persons with probable Alzheimer’s dementia (AD), but it is not yet known whether this effect is related to music training. Given that music training can enhance cognitive functioning, we explored the effects of music training and modality (sung vs. spoken) on verbal memory in persons with and without AD. Method: We used a mixed factorial design to compare learning (5 trials), delayed recall (30-min and, 24-hour), and recognition of sung versus spoken information in 22 healthy elderly (15 musicians), and 11 people with AD (5 musicians). Results: Musicians with AD showed better total learning (over 5 trials) of sung information than nonmusicians with AD. There were no significant differences in delayed recall and recognition accuracy (of either modality) between musicians with and without AD, suggesting that music training may facilitate memory function in AD. Analysis of individual performances showed that two of the five musicians with AD were able to recall some information on delayed recall, whereas the nonmusicians with AD recalled no information on delay. The only significant finding in regard to modality (sung vs. spoken) was that total learning was significantly worse for sung than spoken information for nonmusicians with AD. This may be due to the need to recode information presented in song into spoken recall, which may be more cognitively demanding for this group. Conclusions: This is the first study to demonstrate that music training modulates memory of sung and spoken information in AD. The mechanism underlying these results is unclear, but may be due to music training, higher cognitive abilities, or both. Our findings highlight the need for further research into the potentially protective effect of music training on cognitive abilities in our aging population.13 page(s