gms | German Medical Science

Background and current state of (inter)national research: Since dementia is a result of cognitive rather than physical impairment, cognitive aspects should also be considered when estimating the care of older people.

Research questions and objectives: Therefore, this study aims to understand how the loss of cognitive functioning affects mental representations of daily activities.. A mixed-model study was conducted to study specifically how the content of the mental representations differs between stages of dementia.

Methods or hypothesis: A total of 25 people (age (mean: 67.64; SD: 23.625), sex (f: 14 (56%); m: 17 (68%)) participated in the study. A mixed-method design was used to assess mental representations of daily activities. This included the script generation task of daily activities (grocery shopping, dentist appointment, doing laundry, leaving the house, car accident) as well as a qualitative semi-structured interview. Cognitive status (healthy: n=6; mild demented: n=7; severe demented: n=12) was assessed via the Montreal Cognitive Assessment (MoCa). The qualitative analysis was based on the Grounded Theory.

Results: Overall, we found evidence that mental representations of daily activities loose in content and get inaccurate throughout the course of the disease (number of actions, abstractions, unemotional content) in three (grocery shopping, doing laundry, leaving the house) of five scripts, with a steady transition by cognitive status. The number of problem solving techniques to manage daily life, that the participants reported, also decreased with dementia severity. In contrast, mild demented participants report the most strategies and extend their mental representation by including strategies to circumvent experienced problems. However, mental representations of daily activities seem to be largely intact throughout the course of dementia (no difference in terms of sequencing, personalizations, intrustions, examples, emotional content).

Discussion: This study outlines that even though the content of mental representations, especially in terms of abstractions and unemotional content, decreases with dementia, the mental representations themselves remain largely in good order. Performance of daily activities throughout dementia may be hampered by the specific loss of content of the generated actions.

Practical implications: Further research is needed to gain a detailed understanding in how the content of script generation gets affected along decreasing cognitive status in order to compensate this action loss by offering specific solutions to enhance the autonomy of a dementia patient.