the impact of temporality in alzheimer's dementia

329 Pages·2009·1.63 MB·English

by  J Glonek

THE IMPACT OF TEMPORALITY IN ALZHEIMER'S DEMENTIA:
AN EXISTENTIAL PHILOSOPHICAL INTERPRETATION.

A Thesis presented for the degree of

Doctor of Philosophy

by

Judith A. Glonek (M Geront. B. Spec Ed. Dip T)

in the

School of Occupational Therapy

University of South Australia

October, 2000
TABLE OF CONTENTS
THE IMPACT OF TEMPORALITY IN ALZHEIMER'S 1
DEMENTIA:
AN EXISTENTIAL PHILOSOPHICAL
INTERPRETATION.
Abstract. Page vi
Statement of Originality Page vii
Acknowledgements Page viii
CHAPTER I Page 1
INTRODUCTION AND METHODOLOGY
Background Page 1
Rationale Page 3
Conceptualisation Page 5
The Method Page 8
The structure. Page 10
Definitions. Page 10
Alzheimer's dementia. Page 11
Functioning. Page 11
Cognition. Page 11
Human being. Page 11
Temporality. Page 12
PART A Page 14
LIFE AND TIMES OF LIVING WITH ALZHEIMER'S
DEMENTIA.
Introduction Page 14
CHAPTER II Page 16
ALZHEIMER'S DEMENTIA: PATIENT, SUBJECT, CLIENT OR
PERSON?
Introduction. Page 16
The Bad Old Days Page 16
Laboratory and Clinic Page 20
The Care Enterprise Page 24
The Person with Alzheimer’s Disease Page 41
PART B Page 46
EXISTENCE IN PHILOSOPHICAL TEMPORALITY
Introduction Page 46
CHAPTER III Page 48
REVIEW OF SOME PHILOSOPHICAL TIME CONCEPTS
Introduction Page 48
Aristotle Page 50
Motion and change Page 50
Kant Page 51
Hegel Page 52
Guyau Page 52
Bergson Page 53
Alexander Page 54
Heidegger Page 56
Sartre Page 58
Binswanger Page 59
Page ii
Hawking Page 62
Summary Page 65
CHAPTER IV Page 67
TEMPORALITY IN KNOWING
Introduction Page 67
Some early thoughts on learning. Page 69
The sources of learning Page 69
The means and rationale of learning Page 71
Some methods and techniques Page 74
Outcomes Page 77
Implications of Temporality for Learning Page 79
Macro temporalities Page 79
Micro temporalities Page 82
Summary Page 84
CHAPTER V Page 86
TEMPORALITY IN PERSONAL IDENTITY
Introduction. Page 86
Why an identity? Page 88
C’est moi Page 90
The self, body or mind? Page 95
The spatiality of the body Page 97
The mind’s ‘I’ Page 102
First abstract thoughts Page 103
Language Page 105
Memory Page 107
Consciousness Page 110
Continuity and change Page 112
Discussion Page 114
Summary Page 116
CHAPTER VI Page 119
TEMPORALITY IN INTERACTIONS WITH THE WORLD
Introduction Page 119
External realities Page 120
The world of material objects and the 'I' Page 121
Temporal orientation of objects Page 122
Spatiality of objects Page 124
Objects as future referents Page 126
Objects as past referents Page 128
Relationship with others Page 131
The subjective internal world Page 137
Biological times of the 'I' Page 138
Psychological time zones of the 'I' Page 139
Conclusion Page 142
SUMMARY OF PART B Page 145
Endwords Page 149
PART C Page 152
THE IMPACT OF TEMPORALITY ON THE
EXISTENTIAL FUNCTIONING OF PERSONS WITH
ALZHEIMER'S DEMENTIA.
Page iii
Introduction Page 152
CHAPTER VIIA Page 154
DISTORTIONS OF TIME
Everyday time distortions Page 155
Pathological time distortions Page 157
Distorted physical rhythm. Page 158
Insomnia. Page 158
Mood disorders. Page 158
Disorganised cognition. Page 159
Learning disabilities. Page 159
Altered realities. Page 161
Dissociative disorders and amnesia. Page 161
Hallucination. Page 162
Personal dysfunction. Page 165
Schizophrenia. Page 165
Delirium Page 168
Summary Page 169
CHAPTER VIIB Page 171
DISTORTIONS OF TIME IN ALZHEIMER'S DEMENTIA
Introduction Page 171
Time distorting psychiatric states and Alzheimer's dementia Page 171
Insomnia Page 172
Amnesia Page 176
Depression. Page 178
Delusions and hallucinations. Page 180
Delirium Page 183
Interconnectedness of psychiatric states Page 185
Summary Page 186
CHAPTER VIII Page 188
TEMPORALITY IN ALZHEIMER'S DEMENTIA RESEARCH.
Introduction Page 188
The professional view Page 188
Summary Page 195
CHAPTER IX Page 196
THE TEMPORALITY OF KNOWING IN ALZHEIMER'S
DEMENTIA
Introduction Page 196
Cognition Page 196
Space, time and cognition Page 198
Cognitive neuropsychology Page 201
Cognition in Alzheimer's dementia Page 203
Memory Page 204
Perceptual motor Page 206
The language arts Page 207
Some visual spatial processes Page 209
Some consequences of cognitive impairment Page 210
Therapies and treatments Page 213
Cognitive impairment and the person with Alzheimer's Page 216
CHAPTER X Page 218
THE TEMPORALITY OF PERSONAL IDENTITY IN ALZHEIMER'S
Page iv
DEMENTIA
Introduction Page 218
The everyday self Page 218
Views of self and personhood in Alzheimer's dementia Page 220
Some signs of the disorienting self Page 224
A conceptual discourse Page 226
Cognitive processes and the self Page 227
Cognition and the dynamics of self Page 230
Existence in atemporality Page 231
A new temporality model Page 232
Model and concepts of the Space-Time Light Cone. Page 233
The Glonek Personal Space-Time Zone. Page 235
Human life as a major event. Page 236
Minor events in Personal Space-Time Page 238
Multiple minor events Page 239
The Personal Space-Time of the person with Alzheimer's dementia Page 240
Theoretical implications Page 242
Summary Page 244
CHAPTER XI Page 247
THE TEMPORALITY OF INTERACTIONS WITH THE WORLD IN
ALZHEIMER'S DEMENTIA.
Introduction. Page 247
The world of material objects and the 'I'. Page 247
Alzheimer's dementia and objects. Page 249
The spatial temporal aspects of objects and dementia Page 254
Non interaction with objects Page 256
Objects and the disordered self Page 258
Relationship with others in Alzheimer's dementia Page 261
The subjective internal world Page 266
The biological times of 'I' Page 268
The psychological times of 'I' Page 269
Conclusions Page 275
THESIS SUMMARY Page 279
CONCLUDING REMARKS AND ENDWORDS. Page 289
LIST OF FIGURES Page 297
REFERENCES Page 298

Page v
Abstract.
This thesis represents a work of basic research into dimensions of time and space, referred to as
temporality, in the condition Alzheimer's dementia. In this theoretical, text-based study,
temporality was explored as a dual exposition, in ordinary functioning and in impaired
functioning. As expected, the influence of time and space, was found to enter each experience
and was observable in every facet of human endeavour and behaviour. Significantly, however,
fundamental new interpretations were developed regarding the role of temporality in human life
and functioning. Temporality was identified as an essential, common component of both
cognitive functions and cohesive identity construction in a unified view of body and mind. As an
illustration and clarification of this concept of temporality as a subjective, psychological clock, an
innovative framework, the Personal Space-Time model was developed. The study also introduces
the consideration of atypical temporality. Investigation of impaired functioning has shown that,
in some pathological states, cognitive disorders, and personality disturbances, marked
temporality distortions occur for various durations. In the current original exploration, through
the notion of temporality, the condition of Alzheimer's dementia was discovered to be an
extreme and enduring form of personal time and space distortion. It was believed to be a
permanent state of un-synchronised, disturbed personal temporality organisation, named in the
study as asynchronia. This brings to attention the first-time introduction of the concept of
complex time in human life, a combination of real time and imaginary time, without defined
directions of present, past or future. In Alzheimer's dementia, the progressive, irreversible
severity of the temporality-linked deficiencies is evidenced in the wide range of symptoms of the
disease, and in the irrecoverably diminishing ability to function cognitively and existentially. The
major impact of temporality in the life of a person with Alzheimer's dementia is to be found in
the misrepresentation of the present, the suppression of cognitive functions, and the de-
structuring of the personal self.

Page vi
Statement of Originality
I certify that this thesis does not incorporate without acknowledgement any material previously
submitted for a degree or diploma in any University, and that to the best of my knowledge and
belief it does not contain any material previously published or written by another person except
where due reference is made in the text.

Judith A. Glonek.

Page vii
Acknowledgements
I wish to thank my Supervisors, Dr. Esther May and Ms. Sue Gilbert-Hunt, and Ms. Trish
McLaine of the University of South Australia. I would like to express my sincere gratitude for
their support, encouragement and generosity in spending many hours of their own Personal
Space-Time with me and this project.

I would like to acknowledge the financial support kindly granted by the scholarship of the
University of South Australia Research Award.

Gratitude is also expressed for the patience and forbearance shown by the small and tall of my
family, through the many years of study.

Above all, I would like this research to be a dedication and homage to the three remarkable,
most important women in my life. Without their love, inspiration and influence, this work would
not have been possible.

To my three Mashas

Margaret Steiner, Amanda Glonek and just Jasmine.

Page viii
THE IMPACT OF TEMPORALITY IN ALZHEIMER'S DEMENTIA:
AN EXISTENTIAL PHILOSOPHICAL INTERPRETATION.

A Thesis presented for the degree of

Doctor of Philosophy

by

Judith A. Glonek (M Geront. B. Spec Ed. Dip T)

in the

School of Occupational Therapy

University of South Australia

October, 2000
TABLE OF CONTENTS
THE IMPACT OF TEMPORALITY IN ALZHEIMER'S 1
DEMENTIA:
AN EXISTENTIAL PHILOSOPHICAL
INTERPRETATION.
Abstract. Page vi
Statement of Originality Page vii
Acknowledgements Page viii
CHAPTER I Page 1
INTRODUCTION AND METHODOLOGY
Background Page 1
Rationale Page 3
Conceptualisation Page 5
The Method Page 8
The structure. Page 10
Definitions. Page 10
Alzheimer's dementia. Page 11
Functioning. Page 11
Cognition. Page 11
Human being. Page 11
Temporality. Page 12
PART A Page 14
LIFE AND TIMES OF LIVING WITH ALZHEIMER'S
DEMENTIA.
Introduction Page 14
CHAPTER II Page 16
ALZHEIMER'S DEMENTIA: PATIENT, SUBJECT, CLIENT OR
PERSON?
Introduction. Page 16
The Bad Old Days Page 16
Laboratory and Clinic Page 20
The Care Enterprise Page 24
The Person with Alzheimer’s Disease Page 41
PART B Page 46
EXISTENCE IN PHILOSOPHICAL TEMPORALITY
Introduction Page 46
CHAPTER III Page 48
REVIEW OF SOME PHILOSOPHICAL TIME CONCEPTS
Introduction Page 48
Aristotle Page 50
Motion and change Page 50
Kant Page 51
Hegel Page 52
Guyau Page 52
Bergson Page 53
Alexander Page 54
Heidegger Page 56
Sartre Page 58
Binswanger Page 59
Page ii