Summary: Researchers provide a statistical analysis of ‘saving appearance responses’ in patients with dementia. The study reveals the SAR responses are particularly common in those with Alzheimer’s disease.
Source: Kumamoto University.
Dementia, in any form, is a heartbreaking disease that can take away one’s thinking and judgement abilities before they pass. To save face, people with dementia often pretend to know answers to questions, even if they really don’t. This often hides the severity of the disease and exasperates the fears and frustrations of the people who care for them. The act of pretending to know answers to keep up appearances is referred to as “saving appearance responses” (SARs), and a research group from Kumamoto University in Japan has performed the first statistical analysis of SARs in patients with various forms of dementia. Their findings revealed that those face-saving responses are particularly common in people with Alzheimer’s disease (AD), leading the researchers to recommend that doctors and caregivers should develop a more respectful attitude toward dementia patients who exhibit SARs because SARs imply conflicted feelings about questions that patients cannot answer correctly.
People with dementia, despite experiencing various problems in their social life caused by memory impairment, often make conversation as if they remember what they forgot. This communication style (using SARs) is well-known among those who treat and care for people with dementia. Many reports on SARs have been made in Japan, but most are based on the experiences and impressions of doctors, nurses, and clinical psychologists, and do not include enough numerical data.
Kumamoto University researchers compared the appearance frequency of SARs observed during cognitive function examinations using definitions from preceding research for four pathological conditions that cause dementia, AD (107 patients), AD with cerebrovascular disease (16), Lewy body dementia (30), and mild cognitive impairment (55). More than half of the AD patients were found to have SARs and it quickly became clear that face-saving reactions and attitudes in these patients occurred much more frequently compared to those Lewy body dementia and mild cognitive dysfunction. The examination was statistically adjusted for sex, estimated duration of disease, cognitive function, and frontal lobe function. Researchers found that AD was 4.24 times more likely than Lewy body dementia to produce SARs, and 3.48 times more likely than mild cognitive impairment.
“SARs are a patient’s effort to show that they have no cognitive problems, but it seems that there are various psychological conflicts involved,” said Kumamoto University’s Dr. Masateru Matsushita of the Center for Medical Education and Research, leader of the study. “The reason more SARs are seen in AD may be because even though the memory function of the brain is in decline, thinking and judgment abilities are barely compromised. Attention to SARs might be helpful for more accurate dementia diagnosis. We expect that a better understanding of the characteristics of SARs, particularly in AD, will lead to earlier detection and better medical care for people suffering from dementia.”
Funding: Funding provided by Japan Society for the Promotion of Science: KAKENHI.
Source: J. Sanderson & N. Fukuda – Kumamoto University
Publisher: Organized by NeuroscienceNews.com.
Image Source: NeuroscienceNews.com image is in the public domain.
Original Research: Open access research for “Are saving appearance responses typical communication patterns in Alzheimer’s disease?” by Masateru Matsushita, Yusuke Yatabe, Asuka Koyama, Akiko Katsuya, Daisuke Ijichi, Yusuke Miyagawa, Hiroto Ikezaki, Noboru Furukawa, Manabu Ikeda, Mamoru Hashimoto in PLOS ONE. Published May 23 2018.
Are saving appearance responses typical communication patterns in Alzheimer’s disease?
To keep up appearances, people with dementia sometimes pretend to know the correct answer, as seen during administration of neuropsychological tests such as the Mini-Mental State Examination (MMSE). These saving appearance responses (SARs) of people with dementia often lead to caregivers and/or medical staff underestimating the severity of dementia and impede proper early initiation of treatment. However, most descriptions of SARs are based on empirical knowledge of clinicians. In this study, we investigated whether SARs are typical communication patterns in people with Alzheimer’s disease (AD), compared with mild cognitive impairment (MCI) or dementia with Lewy bodies (DLB).
The participants were 107 outpatients with AD, 16 with mixed AD with cerebrovascular dementia, 55 with MCI, and 30 with DLB. We assessed the occurrence of SARs during the MMSE. The relationships between the SARs and AD were examined by the χ2 test and logistic regression analysis.
People with AD who showed SARs were 57.9%, whereas those with MCI were 18.2% and DLB were 20.0% (P with Bonferroni correction < 0.05). Although there were significant differences in some variables in each group of diagnosis, logistic regression analysis showed that people with AD were more likely to show SARs than those with MCI (Odds ratio = 3.48, 95% Confidential Interval = 1.18–10.28) and DLB (Odds ratio = 4.24, 95% Confidential Interval = 1.50–12.01), even after controlling for sex, estimated disease duration, MMSE, and frontal assessment battery scores.
The occurrence of SARs could be found most frequently in people with AD. Clinicians should develop a respectful attitude toward dementia patients with SARs because SARs imply conflicted feelings about questions that patients cannot answer correctly.