P3–234: Qualitative assessment of self‐identity in advanced dementia
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.018 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.010 | 0.010 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.002 | 0.008 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".