P3–234: Qualitative assessment of self‐identity in advanced dementia
Notice bibliographique
Résumé
Alzheimer's disease is popularly characterized as leading to a 'loss of self.' However, Sabat and Harre (1992) posited that “the primary cause of the loss of self is the ways in which others view and treat the Alzheimer's sufferer.” Importantly, people with dementia continue to refer to themselves as “I” and frequently do not recognize the cognitive deficits ascribed to them. Definitions of what constitutes the self vary widely across disciplines. Although neurological lesions can lead to loss of deficit awareness, self-identity appears not to be a neurologically localizable phenomenon. We conducted semi-structured interviews designed to explore self-identity through discourse. Residents diagnosed with dementia who lived in a locked dementia-specialty residential care facility were referred for study. Deficits were severe enough to require institutional care, but prospective subjects were able to understand conversation and provide coherent responses to questions. Informed consent was provided by legally authorized representatives; interviewees provided assent. To confirm the diagnosis, separate clinical interviews with a family member and the subject were undertaken by a neurologist (DSG) experienced in criterion-based diagnosis and staging of dementia. Control subjects lived independently in a residential facility. All interviews were recorded, transcribed, and analyzed for emerging themes and patterns of word use related to the concept of self. Cognitive deficits, including severe episodic memory loss, were prominent among participants with dementia. These were especially notable in understanding time frames and reference points in response to questions. However, participants with dementia consistently used the first person in self-references. They readily recounted information unique to their past life experiences and their roles in those experiences. They identified clear preferences and attachments. Similar elements of self-identity were observed in control participants. People with advanced dementia and significant episodic memory loss present a coherent and continuous sense of self in discourse, very similar to nondemented age peers. Our findings suggest that, even in advanced dementia, cognitive deficits do not inevitably lead to a loss of “self.” Alternative formulations of the impact of dementia on self-identity are needed, as is a re-examination of deficit unawareness as a form of self-identity loss.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,015 | 0,018 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,010 | 0,010 |
| Communication savante | 0,004 | 0,003 |
| Science ouverte | 0,002 | 0,008 |
| Intégrité de la recherche | 0,002 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».