L’effet de menace du stéréotype en situation d’évaluation neuropsychologique : enjeux cliniques

Abstract

Due to longer life expectancy, many people are concerned about the effects of aging on their mental faculties (e.g., decline in memory) and the possibility of developing Alzheimer's disease, and they are therefore more likely to undergo neuropsychological testing. If their cognitive complaint is confirmed by a performance below the level of healthy older adults, these people are diagnosed as having mild cognitive impairment (MCI), a syndrome that sometimes progresses to Alzheimer's disease. The number of older people diagnosed with MCI after a memory assessment continues to increase. However, not all MCI patients develop Alzheimer's disease, with some remaining stable and others even reverting back to normal. A possible explanation could be that stereotype threat permeates the clinical testing situation and lowers patients’ performance, resulting in a false-positive detection of MCI. Several laboratory studies have shown that negative stereotypes of aging (beliefs that aging inevitably causes cognitive decline) can disrupt normal cognitive functioning in healthy older adults, leading them to perform below their true abilities. This deleterious effect of stereotypes on performance is known as the “stereotype threat effect.” Only a few studies have examined, in a laboratory setting, age-based stereotype threat effects on neuropsychological testing, and none of them were conducted in a real clinical setting. The present article reviews these studies and presents the protocol of an ongoing experiment examining, for the first time, stereotype threat effects during real neuropsychological testing among patients coming for their first memory assessment. The protocol is composed of either a standard test-administration condition, which is assumed to implicitly activate negative stereotypes of aging, or a threat-reduction condition, with instructions designed to alleviate anxiety related to these stereotypes. This innovative protocol is likely to offer new recommendations to improve the assessment conditions and accuracy of the early diagnosis of Alzheimer's disease, with positive consequences for the well-being of patients and their caregivers.