From Margot De Vergie, Amandine Longeau and Carla Vantighem
When you see : *, it’s a “word we learned”
As the world population ages, dementia, and especially Alzheimer’s disease*, has become a major health concern. Consequently, there exists an increased public awareness of cognitive aging and neurodegenerative diseases. However, persons with Alzheimer’s disease are considered incompetent. These stereotypes also concern elederly people in a normal aging. Therefore, many studies have take into account the influence of negative age-related stereotypes (e.g. “older people have a bad memory”) and have shown that these can deteriorate cognitive performance in older adults. Nevertheless, only three studies (Barber et al., 2015 ; Haslam et al., 2012 ; Mazerolle et al., 2016) have actually investigated the impact of stereotypes on the cognitive performance of older people during a cognitive assessment*. In addition, it has been shown that the fear of contracting Alzheimer’s disease also leads to a decrease in cognitive performance (Kessler et al., 2012). So, Fresson and al. (2017) carried this research with the aim of studying more exactly the impact of age-related stereotypes on older people’s overall cognitive functioning and the moderating effect of the fear of developing Alzheimer’s disease.
To do this, 72 participants aged between 59 and 70 years old were recruited for this research and performed a set of neuropsychological tasks. They were cognitive and neurologically healthy, with MMSE (Mini Mental State Examination; Folstein & McHugh, 1975) scores ranging from 27 to 30. Participants were divided into two groups: a half was confronted with negative age-related stereotypes (negative condition) while the other half had received positive stereotypes (positive condition).
The results showed that participants in negative condition had lower cognitive performance than participants in positive condition. This result is moderated by the fear of contracting Alzheimer’s disease: the negative effect of stereotype threat* is greater for adults expressing moderate to high fear of developing Alzheimer’s disease. The results also showed that the performance of older people in threat situations and expressing high levels of worry about the disease would be so poor that they could be classified as concerning in a cognitive assessment.
The conclusion of the Fresson and al. (2017) study led us to question our own practice. Indeed, all three of us have or are going to undertake an internship* in memory clinics*. In this context, we are going to participate in diagnostic assessments of neurodegenerative diseases such as Alzheimer’s disease. However, Fresson et al. (2017) showed that stereotype threat and the fear of developing Alzheimer’s disease has a negative impact on the executive performance of older adults. Yet, patients who consult us usually do it because they suspect a neurodegenerative disease, which can create apprehension. Thus, the neuropsychological assessment situation is likely to be threatening to the patients and to have an impact on their performance. Indeed, the fear of confirming stereotypes about aging could mobilize additional cognitive resources during the evaluation. These cognitive resources would not be totally available for the task requested but rather focused on the emotional processing of these stereotypes. These stereotypes, by fear of being confirmed, could create additional stress for the cognitive evaluation, which by its characteristics can be stressful. Indeed, according to a study of Sindi et al. (2013), the place of the test, the age of the experimenter and the time of the day when the test is conducted are contextual variables that can be stressful. In addition, the memorization instruction, which is present in certain tasks, may also be an experimental factor to be careful of, as by causing ego threat (Régner et al., 2016). In fact, older adults may mobilize their resources to process the emotions produced by potential stereotype threat and thus underperform.
Something essential is highlighted in these articles. It is important in our practice to step back and take a critical look at the performance of older adults. Indeed, the results obtained at the neuropsychological tasks may be biased by the impact of stereotypes and the fear of developing Alzheimer’s disease. It seems important to us to take into account the psychological state of our patients and to be aware that the evaluation situation is a source of apprehension and stereotype threat. If parasitic variables are preoccupying the adult’s cognition, one must ask what is really being assessed. So we asked ourselves what we could do to reduce this threat.
Firstly, it is important to have initial contact with patients at the beginning of consultation. It is also essential to get to know the patient in order to inquire about their potential worries and to reassure them on certain points. Establishing a good alliance by taking the time to talk, explaining the reasons for the consultation and how it will be carried out can help us to make the patient feel comfortable. During the cognitive assessment, it is also important to have a reassuring posture, to smile and to answer all their questions so that the patient doesn’t leave with questions and fears that came to them during the session. It is essential to pay attention to the rhythm of the session and to not hesitate to offer breaks if the patient feels tired and to reassure them. It is also important to take into account qualitative elements when scoring tests and writing reports.
To conclude, it is therefore essential to set up more favorable conditions to reduce the anxiety caused by the environment and negative beliefs in order to measure cognitive functions that are closer to reality.
WORDS WE LEARNED
- Stereotype threat (menace du stéréotype)
- (Alzheimer’s) disease (maladie (d’Alzheimer))
- Cognitive assessment (évaluation cognitive)
- Memory clinic (consultation mémoire)
- Internship (stage)
BIBLIOGRAPHY
Barber, S. J., Mather, M., & Gatz, M. (2015). How stereotype threat affects healthy older adults’ performance on clinical assessments of cognitive decline: The key role of regulatory fit. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 70, 891–900. doi:10.1093/geronb/gbv009.
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). Mini-mental state: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189–198. https://doi.org/10.1016/0022-3956(75)90026-6.
Fresson, M., Dardenne, B., Geurten, M., & Meulemans, T. (2017). The effect of stereotype threat on older people’s clinical cognitive outcomes: investigating the moderating role of dementia worry. The Clinical Neuropsychologist, 31(8), 1306-1328. DOI: 10.1080/13854046.2017.1307456.
Haslam, C., Morton, T. A., Haslam, S. A., Varnes, L., Graham, R., & Gamaz, L. (2012). “When the age is in, the wit is out”: Age-related self-categorization and deficit expectations reduce performance on clinical tests used in dementia assessment. Psychology and Aging, 27, 778–784. doi:10.1037/a0027754.
Kessler, E.-M., Bowen, C. E., Baer, M., Froelich, L., & Wahl, H.-W. (2012). Dementia worry: A psychological examination of an unexplored phenomenon. European Journal of Ageing, 9, 275–284. doi:10.1007/ s10433-012-0242-8.
Mazerolle, M., Régner, I., Barber, S., Paccalin, M., Miazola, A.-C., Huguet, P., & Rigalleau, F. (2016). Negative aging stereotypes impair performance on brief cognitive tests used to screen for predementia. Journal of Gerontology Series B: Psychological Sciences. doi:10.1093/geronb/gbw083.
Régner, I., Mazerolle, M., Alescio-Lautier, B., Clarys, D., Michel, B., Paccalin, M., Piolino, P., Rigalleau, F., Sambuchi, N., & Huguet, P. (2016). Aging Stereotypes Must be Taken Into Account for the Diagnosis of Prodromal and Early Alzheimer Disease. Alzheimer Disease & Associated Disorders, 30(1), 77-79. https://doi.org/10.1097/wad.0000000000000129.
Sindi, S., Fiocco, A. J., Juster, R. P., Pruessner, J., & Lupien, S. J. (2013). When we test, do we stress ? Impact of the testing environment on cortisol secretion and memory performance in older adults. Psychoneuroendocrinology, 38(8), 1388-1396. https://doi.org/10.1016/j.psyneuen.2012.12.004.