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Implicit Behavioral Change in Response to Cognitive Tasks in Alzheimer Disease

Bomilcar, Iris, MD*; Morris, Robin, G., PhD†,‡; Brown, Richard, G., PhD‡,§; Mograbi, Daniel, C., PhD*,§,∥

Cognitive And Behavioral Neurology: March 2018 - Volume 31 - Issue 1 - p 2–12
doi: 10.1097/WNN.0000000000000145
Original Study

Background and Objective: Lack of awareness about impairments is commonly found in Alzheimer disease (AD), but recent evidence suggests that patients may respond to the experience of illness despite limited awareness. In this study, we explored whether implicit emotional responses to experiences of failure in cognitive tasks would result in longer-term change in behavior.

Methods: Twenty-two patients with AD were seen 1 week after a previous session in which they performed computer tasks that had been manipulated to be either too difficult (failure condition) or very easy (success condition) for them. At the second session, both types of tasks were set to have medium difficulty and were administered so that the participants decided how long to persist on each task. Task persistence was determined by relative time spent doing the tasks, considering that participants would be more likely to stop performing tasks in which they had experienced failure during the first session.

Results: Task persistence in the second session was not affected by performance in the first session. However, when participants’ awareness of performance in the first session was taken into account, differences were found in persistence between tasks in the second session. During the second session, participants stopped performing tasks after a sequence of errors. There were no self-reported changes in motivation or enjoyment in response to task failure.

Conclusions: These findings suggest that implicit learning of task valence may be compromised in AD, but that initial moments of awareness of performance may influence long-term adaptation in unaware patients.

*Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

King’s College Hospital, London, United Kingdom

South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Kent, United Kingdom

§Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom

Department of Psychology, Pontifícia Universidade Católica–Rio, Rio de Janeiro, Brazil

Supported in part by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley National Health Service (NHS) Foundation Trust, King’s College London, and the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES Foundation). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.

The authors declare no conflicts of interest.

Correspondence: Daniel C. Mograbi, PhD, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London SE5 8AF, United Kingdom (e-mail:

Received September 6, 2017

Accepted January 2, 2018

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