Making sense of self in Alzheimer’s disease: reflective function and cognitive status

Submission note: A thesis submitted in total fulfilment of the requirements for the degree of Doctor of Philosophy to the School of Psychological Science, Faculty of Science, Technology & Engineering, La Trobe University, Bundoora.

The purpose of the current investigation is to examine the relationship between cognitive impairment and self‐evaluation in AD. Research is divided regarding the maintenance of self in AD, which may reflect the diversity in the conceptualisation and measurement of self (Caddell and Clare, 2010). William James’ (1890/1950) me‐self (the empirical, material being that is the object of experience) and I‐self (subject or agent of experience – the thinker and the feeler that is aware of the me‐self) provide the structure of self in the current study, while a biopsychosocial framework (Clare, 2003; Kitwood, 1988) ensures that both personal and social aspects of self are acknowledged, along with the neurocognitive. Me‐self (measured via self‐concept) was found to remain unaffected in mild AD, although the reliability of the approach to self‐evaluation was questionable. I‐self (measured via reflective function - a theory of mind scale) deteriorated in mild AD (Study One). A high correlation was also found between I‐self and general cognitive impairment in AD. In Study Two, the reduction in I‐self in mild AD was demonstrated in both personal and social domains of I‐self; and with a focus on specific cognitive impairment relationships, episodic‐related new learning was found to predict personal I‐self, and speed of information processing to predict social I‐self. Study Three supported the overall downward trend in self over time for the AD group, particularly for personal I‐self. Surprisingly, despite the reduction in I‐self and cognitive status, subjective quality of life appeared to remain unaffected in participants with AD. The final study also highlighted that despite group differences identified throughout the three studies, the AD journey - inclusive of the relationship between I‐self and cognitive impairment - is individually variable.