Tappen R M, Williams C, Fishman S, Touhy T
Florida Atlantic University, Boca Raton, USA.
Image J Nurs Sch. 1999;31(2):121-5. doi: 10.1111/j.1547-5069.1999.tb00445.x.
To determine if evidence of the persistence of a sense of self or personal identity could be found in people in the middle and late stages of Alzheimer's disease. The theme of diminishing self pervades both the popular and professional literature on Alzheimer's disease.
Qualitative using conversational analysis. The purposive sample was 23 residents of two urban nursing homes in the southeastern United States who were in the middle and late stages of Alzheimer's disease. Their mean Mini-Mental State examination score was 10.65. Nineteen subjects were women, four were men in this 1993-1997 study.
Analysis of 45 conversations lasting 30 minutes with nursing home residents with a diagnosis of probable Alzheimer's disease. Use of the first person indexical and other evidence, such as awareness and reactions to the changes that had taken place, in support of and counter to the notion of persistence of self, were sought in conversational analysis.
Respondents used the first person indexical frequently, freely, and coherently. Evidence was also present that participants were aware of their cognitive changes. Many struggled to provide an explanation, but none mentioned Alzheimer's disease.
Evidence suggests the persistence of awareness of self into the middle and late stages of Alzheimer's disease. Failure to recognize the continuing awareness of self and the human experience of the person in the middle and late stages can lead to task-oriented care and low expectations for therapeutic interventions. The bafflement noted in respondents suggests that people should be told their diagnosis and offered an explanation of what this diagnosis means.
确定在阿尔茨海默病中晚期患者身上是否能找到自我意识或个人身份持续存在的证据。自我意识逐渐衰退这一主题贯穿于有关阿尔茨海默病的大众文献和专业文献之中。
采用对话分析的定性研究。目标样本是美国东南部两家城市养老院中处于阿尔茨海默病中晚期的23名居民。他们的简易精神状态检查表平均得分为10.65分。在这项1993 - 1997年的研究中，19名受试者为女性，4名受试者为男性。
对45段与诊断为可能患有阿尔茨海默病的养老院居民进行的时长30分钟的对话进行分析。在对话分析中，寻找第一人称指示词的使用以及其他证据，如对已发生变化的认知和反应，以支持或反驳自我持续存在的观点。
受访者频繁、自由且连贯地使用第一人称指示词。也有证据表明参与者意识到了自己的认知变化。许多人努力给出解释，但没有人提到阿尔茨海默病。
有证据表明在阿尔茨海默病中晚期仍存在自我意识。未能认识到中晚期患者持续存在的自我意识和人类体验可能导致以任务为导向的护理以及对治疗干预的低期望。受访者表现出的困惑表明应该告知人们他们的诊断结果，并对该诊断的意义作出解释。
