Abstract
Despite severe amnesia, some studies showed that Alzheimer Disease (AD) patients with moderate to severe dementia keep a consistent, but impoverished representation of themselves, showing preservation of the sense of identity even at severe stages of the illness. Some studies suggest that listening to music can facilitate the reminiscence of autobiographical memories and that stimulating autobiographical memory would be relevant to support the self of these patients. Consequently, we hypothesized that repeated participation to reminiscence workshops, using excerpts of familiar songs as prompts would participate to the enrichment of autobiographical memories, self-representation and sense of identity. We included a group of 20 AD patients with severe dementia residing in nursing homes. Their performances were compared to a control group of 20 matched (age, education, mood) healthy residents living in the same institutions. The experiment was conducted in three phases over a 2-week period. On phase 1, an individual assessment of sense of identity was proposed to each participant. On phase 2, participants joined musical reminiscence workshops (six sessions over 2 weeks for AD patients and 3 sessions over a week for controls). During the third phase (12 days after the first assessment), individual evaluation of autobiographical memory and a second assessment of sense of identity were proposed. Our results showed that, despite their massive amnesia syndrome, autobiographical memories of AD reached at the end of the 2 weeks the number and quality of those of matched controls. Moreover, we confirmed a continuity of self-representation in AD patients with a stable profile of the answers between the first and second individual assessments of sense of identity. However, the increase in number and episodic quality of autobiographical memories was not accompanied by an enrichment of the sense of identity. In a complementary study, new patients participated in the same paradigm, but using movie extracts as prompts, and showed very similar effects. We discuss all of these results with regard to the literature showing the significant impact of repetition on the reactivation of memory traces even in very amnestic AD patients at severe stages of the disease.
Highlights
In psychology, the self is viewed as a complex multi-dimensional construct with a structural level of self-representation in memory (Kihlstrom et al, 2002) and a set of self-related functional processes required to evoke self-representations (Stuss et al, 2001; Morin, 2006)
The main objective of this work was to study the relevance of repeated reminiscence workshops with musical cues on the recall of autobiographical memories in Alzheimer’s disease (AD) patients at moderate to severe stages of illness
We observed a spectacular increase of the number of memories produced by the AD participants, considering their massive amnesia, while Matched Control (MC) participants produced less memories at the end of the workshop sessions
Summary
The self is viewed as a complex multi-dimensional construct with a structural level of self-representation in memory (Kihlstrom et al, 2002) and a set of self-related functional processes required to evoke self-representations (Stuss et al, 2001; Morin, 2006). Our previous study (Eustache et al, 2013) aimed at showing preservation of the sense of identity in AD patients at a moderate to severe stage of the illness: assessing twice their sense of identity within a 15 days interval, patients were able to introduce themselves in a very similar way, while they did not recall any circumstance and context of these assessments. In this latter study, we found a consistent self-representation among AD patients at moderate to severe stages of the disease. AD patients, despite severe amnesia and cognitive disturbances, seem to keep a consistent, but impoverished, representation of themselves and stimulating their autobiographical memory seems relevant to support their self (El Haj et al, 2019; Rathbone et al, 2019)
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