School of Psychology, Bangor University, Bangor, Gwynedd LL57 2AS, UK.
Aging Ment Health. 2010 Jan;14(1):20-32. doi: 10.1080/13607860903421029.
Although awareness has been extensively researched in relation to people with dementia, studies have focussed mainly on people who have dementia of mild to moderate severity. Consequently, relatively little is known about awareness in people with severe dementia, and there is no clear conceptual framework to indicate how this should be understood or investigated.
This review presents a conceptual framework for considering awareness in people with moderate to severe dementia which distinguishes fundamental awareness of sensory and perceptual stimuli and three levels of awareness involving more complex cognitive operations, termed 'on-line monitoring', 'evaluative judgement' and 'meta-representation', and provides an integration of the available evidence regarding each level.
Findings indicate that sensory and perceptual awareness can be detected even in people with very severe or end-stage dementia, while some aspects of complex awareness may be retained into the severe stages.
The environmental context and the nature of caregiving interactions influence the extent to which awareness is expressed. There may be scope for enhancing the expression of some aspects of awareness in people with moderate to severe dementia, but this should only be undertaken where it is likely to improve quality of life. Understanding more about awareness is an important element in the provision of high-quality care for people with moderate to severe dementia.
尽管已经广泛研究了痴呆症患者的意识，但研究主要集中在轻度至中度痴呆症患者上。因此，对于重度痴呆症患者的意识，人们知之甚少，也没有明确的概念框架来表明应该如何理解或研究这种意识。
本综述提出了一个用于考虑中度至重度痴呆症患者意识的概念框架，该框架区分了对感官和知觉刺激的基本意识，以及涉及更复杂认知操作的三个意识水平，分别称为“在线监测”、“评价判断”和“元代表”，并对每个水平的可用证据进行了整合。
研究结果表明，即使是患有非常严重或终末期痴呆症的患者，也可以检测到感官和知觉意识，而复杂意识的某些方面可能会保留到重度阶段。
环境背景和护理交互的性质影响了意识表达的程度。在中度至重度痴呆症患者中，可能有一定的空间可以增强某些方面的意识表达，但这只能在提高生活质量的情况下进行。更多地了解意识是为中度至重度痴呆症患者提供高质量护理的重要组成部分。
