Dementia profoundly impacts an individual's sense of self, a concept described as the "vanishing self" where various components of identity are progressively eroded. Researchers categorize these components into seven "selves": the embodied, agentic, implicit, critical, surrogate, extended, and emergent selves. Understanding how dementia affects these aspects is crucial for developing humanizing care practices that focus on preserved abilities and promote personhood, rather than diminishing it through "malignant social psychology" which can lead to disempowerment and increased disability.
Separately, studies are exploring innovative methods to combat cognitive decline. A karaoke-based digital therapeutic (DTx) called CogniSong, for instance, has shown promise in improving cognitive function in individuals with mild cognitive impairment (MCI). In a 12-week randomized controlled trial, the CogniSong group demonstrated a significant improvement of +5.9 points in the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) total score, compared to a decline of -0.2 points in the standard treatment group (p=0.041). This represents a medium-large effect size (Cohen's d=0.71).
While the karaoke intervention significantly boosted overall cognitive performance in MCI patients, it did not show significant differences in specific RBANS subdomain scores like visuoconstruction or attention, nor in secondary outcomes such as daily functioning, mood, or neuropsychiatric symptoms. The study, however, highlights the potential of engaging, music-oriented digital therapies as a complementary approach to cognitive rehabilitation, offering a novel and enjoyable way to improve cognitive function in those at risk of dementia.
Furthermore, conditions like frontotemporal lobar degeneration (FTLD) are associated with a diminished sense of self, particularly in self-conscious emotional responding. Patients with FTLD show reduced behavioral and physiological responses to self-conscious emotions like embarrassment. This impairment in self-monitoring and self-reflection contributes to the severe social difficulties experienced by FTLD patients, underscoring the critical link between brain health and the intricate workings of the self.
