The potential impact of aging stereotypes in the assessment of memory deficits and screening for prodromal state of Alzheimer’s disease – AGING

Our objectives will be addressed through experimental studies distributed in three tasks.
-Task #1 will examine in the clinical setting whether older adults at risk coming to the hospital for first cognitive evaluation (N=250) perform better on neuropsychological tests (the same for all patients) under reduced stereotype threat compared with standard (self-threatening) testing conditions, and whether these performance differences are exacerbated by some vulnerability factors. The effects will be measured on cognitive performances and physiological stress (Heart rate variability, Salivary stress biomarkers). Biomarkers of neurodegeneration (hippocampal atrophy, ß-amyloid peptide, Tau and Phospho-Tau) will be used to confirm the diagnosis among 60 of the patients identified aMCI after the neuropsychological tests.
-Task #2 will replicate Task 1 in the lab setting (except for biomarkers of neurodegeneration) in order to determine the size of stereotype threat effect in the overdiagnosis of aMCI, outside the potential effect of the specific stress associated with the hospital setting. It will involve 120 older adults at risk because of subjective memory complaints who will be recruited from advertising.
-Task #3 will rely on an fMRI experimental design to examine whether ST effects lead to changes in functional brain regional responses and connectivity during encoding and retrieval of episodic memory in 20 healthy older adults and 20 aMCI patients.

in progress

in progress

in progress

Because of the lengthening of life expectancy, more and more people are concerned with the effects of aging on their mental faculties (e.g., memory decline) and with the possibility of getting Alzheimer’s Disease (AD) or other forms of dementia. This increasing awareness of AD has already resulted in a growing demand for neuropsychological testing. AD’s research also emphasizes the need for early screening to improve the prediction of the disease progression and the efficacy of any future therapy. Such a drive to screen for pre-dementia raises the challenging issue of frontline identification of individuals in the preclinical or early clinical stages of AD. Mild Cognitive Impairment (MCI) is typically considered to be the prodromal state of AD, and is therefore at the core of the drive for early screening. Moreover, Pre-MCI so called SCI (Subjective Cognitive Impairment) can precede AD for 15 years. However, many individuals diagnosed with MCI do not convert to AD, some remaining stable and others even reversing back to normal (with rates of reversion to normal varying from 4.5% to as high as 53%). This over-diagnosis bias, which has been largely overlooked, is at the core of the present project at the interface of human and life sciences. Here, we argue that an important source of overdiagnosis in the prodromal state of AD comes from negative aging stereotypes (e.g., the culturally shared beliefs that aging inescapably causes severe cognitive decline and diseases such as AD) that permeate neuropsychological screening. There is ample evidence in the laboratory that such stereotypes contribute to the differences observed in the healthy population between younger and older adults in explicit memory tasks. Additionally, three pilot (lab) studies specifically conducted for the present ANR project (Psychol Science, 2012; Exp Psychol, 2015; J. of Gerontology: Psychol Sciences, under revision) showed that the threat of being judged stereotypically undermines the controlled use of memory of healthy older adults and simultaneously intensifies their automatic response tendencies, resulting in impaired memory performance. The present proposal goes several steps further by examining for the first time whether aging stereotypes are powerful enough to implicitly permeate the clinical neuropsychological testing and thus inflate memory deficits in older adults judged “at risk” (based on either epidemiological criteria or memory complaints), resulting in false-positive detection of SCI and MCI. This provocative hypothesis will be tested while 1) using biomarkers of neurodegeneration to distinguish false-positives from true MCI, 2) using biomarkers of stress to examine whether and how aging stereotypes can lead to accute physiological stress during neuropsychological testing, and 3) examining the brain mechanisms underlying the effects of this threat on performance.
This ambitious and interdisciplinary project (social and cognitive psychology, neurology, neuropsychology, integrative neurosciences, geriatrics medicine) involves researchers from 6 research units associated with 5 French universities (Aix-Marseille, Caen, Clermont-Fr, Paris Descartes, Poitiers) and 2 major research institutions (CNRS, INSERM), as well as neurologists and neuropsychologists from 4 public hospitals. It has both theoretical and practical implications for improving neuropsychological testing to the benefit of many people who otherwise may be wrongly classified as MCI (the supposed precursor of AD). Without denying that aging may be associated with cognitive decline and neurodegenerative diseases such as MCI or AD for many people, our proposal yet suggests to pay special attention to the influence of psychosocial factors largely overlooked regarding neuropsychogical performances. This innovative project has the potential to offer new recommandations to improve the diagnosis accuracy of prodromal state of AD, with positive consequences for older people’s wellbeing.