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Title: The role of social & psychological factors in unawareness of current functioning in dementia
Author: Seiffer, Anna
Awarding Body: University of London
Current Institution: University College London (University of London)
Date of Award: 2001
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A person-centred, social psychological model of dementia was used as a framework for considering the role of psychological and social factors in unawareness of current functioning in dementia. Historically, unawareness has been considered to arise from neuropsychological impairment. Neuropsychological theories, however, cannot account for all aspects of unawareness (e.g. the observed variability in awareness). The study's central aim was to investigate the role of psychological factors such as patients' pre-morbid personality and coping strategies and social factors such as style of communication with significant others in unawareness in dementia. The study also re-investigated the association between unawareness and increased carer burden. A cross-sectional correlational design was used to study unawareness in a sample of 49 individuals with a 'non-frontal' dementia. All participants and their partners completed a number of standardised self-report questionnaires relating to patients' awareness of current functioning, pre-morbid personality, coping strategies, style of communication between patient and partner, and carer burden. The relationship between these variables and awareness was explored, while controlling for pre-morbid marital satisfaction, patients' and partners' level of depression and anxiety, and disease severity and duration. Patients' awareness was significantly better for language ftinction than for memory and general cognitive and executive function. Greater awareness was associated with self- reported depressive symptoms, and there was a non-significant trend for increased awareness to be associated with self-reported anxiety symptoms. Reduced awareness was related to increased age of the patient, and there was a non-significant trend for unawareness to be associated with longer duration of disease. No significant relationship was found between unawareness and disease severity. It was suggested that this pattern of relationships is not wholly consistent with an exclusive neuropsychological model of unawareness in dementia, and the need to consider additional non-biological factors was highlighted. Pre-morbid personality factors, in particular negative attitudes towards emotional expression were related to patients' use of avoidant coping strategies in managing the experience of dementia. However, neither negative attitudes towards emotional expression nor avoidant behavioural coping related to unawareness. The study did detect an overall relationship between patients' pre-morbid conscientiousness and unawareness, but this was not significant in a regression analysis after disease-related variables and emotional factors were controlled for. The study's finding were interpreted with reference to the literature on denial and denial-like processes. It was suggested that a distinction should be made between the processes of conscious behavioural avoidance and unconscious defensive denial and that these two processes have different implications for the assessment of unawareness and for clinical practice. The study also replicated the finding that unawareness was related to higher carer burden, but this effect was not independent of spouses' depression and anxiety.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available