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Personality Traits, Behavioral and Psychological Symptoms and Cognitive Decline in Patients at an Early Stage of Alzheimer’S Disease

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Personality Traits, Behavioral and Psychological Symptoms and Cognitive Decline in Patients at an Early Stage of Alzheimer’S Disease Unicentre CH-1015 Lausanne http://serval.unil.ch Year : 2013 Personality traits, behavioral and psychological symptoms and cognitive decline in patients at an early stage of Alzheimer’s disease POCNET CORNELIA POCNET CORNELIA, 2013, Personality traits, behavioral and psychological symptoms and cognitive decline in patients at an early stage of Alzheimer’s disease Originally published at : Thesis, University of Lausanne Posted at the University of Lausanne Open Archive. http://serval.unil.ch Droits d’auteur L'Université de Lausanne attire expressément l'attention des utilisateurs sur le fait que tous les documents publiés dans l'Archive SERVAL sont protégés par le droit d'auteur, conformément à la loi fédérale sur le droit d'auteur et les droits voisins (LDA). A ce titre, il est indispensable d'obtenir le consentement préalable de l'auteur et/ou de l’éditeur avant toute utilisation d'une oeuvre ou d'une partie d'une oeuvre ne relevant pas d'une utilisation à des fins personnelles au sens de la LDA (art. 19, al. 1 lettre a). A défaut, tout contrevenant s'expose aux sanctions prévues par cette loi. Nous déclinons toute responsabilité en la matière. Copyright The University of Lausanne expressly draws the attention of users to the fact that all documents published in the SERVAL Archive are protected by copyright in accordance with federal law on copyright and similar rights (LDA). Accordingly it is indispensable to obtain prior consent from the author and/or publisher before any use of a work or part of a work for purposes other than personal use within the meaning of LDA (art. 19, para. 1 letter a). Failure to do so will expose offenders to the sanctions laid down by this law. We accept no liability in this respect. Personality traits, behavioral and psychological symptoms and cognitive decline in patients at an early stage of Alzheimer’s disease THÈSE DE DOCTORAT Présentée à la FACULTÉ DE SCIENCES SOCIALES ET POLITIQUES De l'Université de Lausanne Pour l’obtention du grade de Docteur en Psychologie Par CORNELIA POCNET Co-directeurs de thèse Professeur JERÔME ROSSIER, Institut de Psychologie, Université de Lausanne Professeur ARMIN VON GUNTEN, Service Universitaire de Psychiatrie Age Avancé, CHUV et Faculté de Biologie et Médecine, Université de Lausanne Jury Professeur David Giauque, Président et vice-doyan de la Faculté Professeur Dario Spini, Université de Lausanne, Rapporteur Docteur Mathias Allemand, Université de Zürich, Expert LAUSANNE, 2013 !!! Personality traits, behavioral and psychological symptoms and cognitive decline in patients at an early stage of Alzheimer’s disease THÈSE DE DOCTORAT Présentée à la FACULTÉ DE SCIENCES SOCIALES ET POLITIQUES De l'Université de Lausanne Pour l’obtention du grade de Docteur en Psychologie Par CORNELIA POCNET Co-directeurs de thèse Professeur JERÔME ROSSIER, Institut de Psychologie, Université de Lausanne Professeur ARMIN VON GUNTEN, Service Universitaire de Psychiatrie Age Avancé, CHUV et Faculté de Biologie et Médecine, Université de Lausanne Jury Professeur David Giauque, Président et vice-doyan de la Faculté Professeur Dario Spini, Université de Lausanne, Rapporteur Docteur Mathias Allemand, Université de Zürich, Expert LAUSANNE, 2013 i ii Summary The aim of this doctoral thesis was to study personality characteristics of patients at an early stage of Alzheimer’s disease (AD), and more specifically to describe personality and its changes over time, and to explore its possible links with psychological and symptoms (BPS) and cognitive level. The results were compared to those of a group of participants without cognitive disorder through three empirical studies. In the first study, the findings showed significant personality changes that follow a specific trend in the clinical group. The profil of personality changes showed an increase in Neuroticism and a decrease in Extraversion, Openess to experiences, and Conscientiousness over time. The second study highlighted that personality and BPS occur early in the cours of AD. Recognizing them as possible precoce signs of neurodegeneration may prove to be a key factor for early detection and intervention. In the third study, a significant association between personality changes and cognitive status was observed in the patients with incipient AD. Thus, changes in Neuroticism and Conscientiousness were linked with cognitive deterioration, whereas decreased Openness to experiences and Conscientiousness over time predicted loss of independence in daily functioning. Other well-known factors such as age, education level or civil status were taken into account to predict cognitive decline. The three studies suggested five important implications: (1) cost-effective screening should take into account premorbid and specific personality changes; (2) psycho-educative interventions should provide information on the possible personality changes and BPS that may occur at the beginning of the disease; (3) using personality traits alongside other variables in the future studies on prevention might help to better understand AD’s etiology; (4) individual treatment plans (psychotherapeutic, social, and pharmacological) might be adapted to the specific changes in personality profiles; (5) more researches are needed to study the impact of social-cultural and lifestyle variables on the development of AD. iii Résumé L'objectif de cette thèse a été d'investiguer la personnalité chez des patients avec une maladie d'Alzheimer (MA) légére. Nous avons comparé, à travers trois études, ce groupe clinique à des participants sans troubles cognitifs, concernant l'évolution de la personnalité, son impact sur les symptômes comportementaux et psychologiques (SCP) ainsi que sur le niveau cognitif. Dans la première étude, d'importants changements de personnalité, suivant une tendance spécifique, ont été observés uniquement dans le groupe clinique. Le profil de ces changements montre une augmentation du Névrosisme et une diminution de l'Extraversion, de l'Ouverture et de la Conscience au fil du temps. La deuxième étude souligne que les changements de la personnalité et les SCP surviennent tôt dans la MA. Les reconnaître comme des signes avant-coureurs de la maladie peut s'avèrer un facteur clé pour la détection et l'intervention precoce. Dans la troisième étude, une association significative entre l'évolution de la personnalité et le niveau cognitif a été observée chez les mêmes patients. Ainsi, les changements du Névrosisme et de la Conscience sont liés à la détérioration cognitive, tandis que la diminution de l'Ouverture et de la Conscience dans le temps prédit la perte d'autonomie quotidienne. Facteurs tels que l'âge, le genre, l'éducation et l'état civil ont été pris en compte pour prédire le déclin cognitif. Ces études suggèrent cinq implications pratiques importantes: (1) un dépistage rentable de la MA devrait prendre en compte les traits premorbides et les changements spécifiques de la personnalité; (2) les interventions psycho-éducatives pourraient fournir des informations sur les changements de personnalité et SCP qui peuvent surgir tôt dans la MA; (3) des études sur la prévention sont nécessaires pour mieux comprendre l'étiologie de la MA; (4) le traitement individuel (psychologique, social, pharmacologique) pourrait être adapté aux changements spécifiques de la personnalité; (5) amples recherches sont requises afin d'étudier l'impact des variables socioculturelles et des styles de vie sur le développement de la MA. iv Acknowledgements There are many people who have contributed to this thesis in various ways and I would like to express them my deepest gratitude. First of all, I would like to thank all the participants (mentally healthy people and patients with Alzheimer’s disease) for the time they gave me as volunteers. Without them, this work would not have been possible. Every interview and meeting was a lesson for me. I would like to give warm thanks to my supervisors, Prof. Jérôme Rossier and Prof. Armin von Gunten, for making this project possible, challenging and exciting, and for guiding me throughout this work. I thank them for everything they have taught me, scientifically and personally. Thank you for believing in me and supporting me in good and difficult times. It made me confront my strengths, my weaknesses, and helped me move forward. I would like to thank Dr. Jean-Philippe Antonietti for sharing his knowledge in statistics with me, but also for our exchange of ideas, questions, and doubts. Thank you for your availability. This research was financed partially through a grant from the Swiss Alzheimer Association and a grant from the Swiss National Research Foundation (Grant No. 3200BO-122263) to Armin von Gunten and Jérôme Rossier. I also thank my family, friends, and colleagues for their encouragement and valuable advices. I would also like to thank the members of my thesis committee for agreeing to be part of the jury, for the time they spent reading the manuscript and for their valuable input. Thanks to all those I have not mentioned here but who helped me to enrich and complete my thesis. v Table of Contents General Objectives…………………………………………………………….………….1 Chapter 1. Personality Psychology……………………………...……………………….5 1.1. Personality and characteristic adaptations………………………………………….5 1.1.1. Psychoanalytic and neo-analitic perspectives…………………………………5 1.1.2. Learning perspective.…………………………………………………….........9 1.1.3. Humanistic perspective ……………………………………………………...11 1.1.4. Cognitive perspective………………………………………………………...13 1.1.5. Psychobiological approach…………………………………………..……….14
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