A reflection on the complexity of the self in severe dementia

What is the impact of dementia on your sense of self? This is a complex question given the various definitions of the self and difficulties in measuring it, particularly in this population. It has been argued that the gradual decline in memory (in particular autobiographical recall) abilities that is associated with Alzheimer’s Dementia coincides with a diminishing and eventual “loss” of self. These “memory centric” theories, however, fail to consider other aspects of self that can be relatively preserved in the face of dementia, such as the “interpersonal” and “moral” self. This paper describes the case of David, a surgeon with severe Alzheimer’s Dementia, and reflects on the relative sparing and impairment of different aspects of his self, based on his wife’s account and the author’s interaction with him during a neuropsychological assessment. Drawing on the model of 5 selves proposed by Neisser in 1988, and current literature on the self in dementia, this case demonstrates that our “selves” are not entirely dependent on autobiographical memory, and are not simultaneously “lost” in the severe stage of dementia.