Persistence of self in advanced Alzheimer's disease.
Persistence of self in advanced Alzheimer's disease.
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DOI：
10.1111/j.1547-5069.1999.tb00445.x
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发表时间：
1999-06
期刊：
影响因子：
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通讯作者：
Ruth M. Tappen;Christine Williams;Sarah Fishman;T. Touhy
中科院分区：
文献类型：
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作者：
Ruth M. Tappen;Christine Williams;Sarah Fishman;T. Touhy
目的：确定阿尔茨海默病中晚期患者是否存在自我意识或个人认同感的证据。关于阿尔茨海默病的流行和专业文献中都充斥着自我弱化的主题。设计：使用对话分析进行定性分析。有目的的样本是美国东南部两家城市养老院的23名老年痴呆症中晚期患者。他们的平均精神状态考试分数为10.65分。在1993-1997年的研究中，19名研究对象是女性，4名是男性。方法分析与诊断为可能阿尔茨海默病的养老院居民进行的45次持续30分钟的谈话。在会话分析中寻求使用第一人称索引和其他证据，例如对发生的变化的认识和反应，来支持和反对自我持久性的概念。调查结果：受访者频繁、自由、连贯地使用第一人称索引。也有证据表明，参与者意识到自己的认知变化。许多人努力给出解释，但没有人提到阿尔茨海默病。结论有证据表明，阿尔茨海默病中晚期仍存在自我意识。在中后期阶段未能认识到持续的自我意识和人的人类经验可能导致以任务为导向的护理和对治疗干预的低期望。受访者指出的困惑表明，人们应该被告知他们的诊断结果，并解释这一诊断的含义。
PURPOSE To determine if evidence of the persistence of a sense of self or personal identity could be found in people in the middle and late stages of Alzheimer's disease. The theme of diminishing self pervades both the popular and professional literature on Alzheimer's disease. DESIGN Qualitative using conversational analysis. The purposive sample was 23 residents of two urban nursing homes in the southeastern United States who were in the middle and late stages of Alzheimer's disease. Their mean Mini-Mental State examination score was 10.65. Nineteen subjects were women, four were men in this 1993-1997 study. METHODS Analysis of 45 conversations lasting 30 minutes with nursing home residents with a diagnosis of probable Alzheimer's disease. Use of the first person indexical and other evidence, such as awareness and reactions to the changes that had taken place, in support of and counter to the notion of persistence of self, were sought in conversational analysis. FINDINGS Respondents used the first person indexical frequently, freely, and coherently. Evidence was also present that participants were aware of their cognitive changes. Many struggled to provide an explanation, but none mentioned Alzheimer's disease. CONCLUSIONS Evidence suggests the persistence of awareness of self into the middle and late stages of Alzheimer's disease. Failure to recognize the continuing awareness of self and the human experience of the person in the middle and late stages can lead to task-oriented care and low expectations for therapeutic interventions. The bafflement noted in respondents suggests that people should be told their diagnosis and offered an explanation of what this diagnosis means.