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P4‐156: COGNITIVE DEBT AND ALZHEIMER'S DISEASE: A THEORETICAL JOURNEY FROM THOUGHTS TO SYMPTOMS
Author(s) -
Marchant Natalie
Publication year - 2014
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2014.05.1673
Subject(s) - worry , rumination , psychology , anxiety , cognition , neuroticism , cognitive decline , mechanism (biology) , depression (economics) , clinical psychology , disease , personality , psychiatry , medicine , dementia , psychoanalysis , philosophy , epistemology , economics , macroeconomics
Background: Clinical disorders, personality, and life events have been independently associated with increased risk for Alzheimer’s disease (AD). Thus far they have been reported as isolated associations, however in this presentation we explore whether a universal principle links them together.Methods: In an extension of Yaakov Stern’s concept of Cognitive Reserve, we propose a theory of Cognitive Debt that encapsulates behaviors that increase vulnerability to symptomatic AD. Taking a life-course approach, we describe how depression, anxiety, post-traumatic stress disorder, sleep disturbance, neuroticism, and life stress increase Cognitive Debt. We further isolate a behaviorally measurable process common to these factors through which Cogntive Debt is manifested. Results: Repetitive Negative Thinking (RNT) transcends disorder-specific definition, encompasses rumination and worry, and is defined by perseverative, negative thought tendencies. Biological evidence of dysregulated stress responses supports both the theory of Cogntive Debt, of RNT as its driving mechanism, and of their interaction with the APOE genotype to increase risk of symptomatic AD. Conclusions: We hope that understanding the psychological mechanisms that might increase vulnerability to symptomatic AD will allow researchers to develop a more specific risk profile. Interventions could be targeted earlier and more precisely at individuals at greatest risk for AD (ie APOE e4 carriers and/or those with Cognitive Debt). Behavioural therapies to reduce RNT could also be explored as an option to prevent or delay onset of symptomatic AD.