Roger Gil

Gil R, Arroyo-Anllo EM, Ingrand P, Gil M, Neau JP, Ornon C, Bonnaud V. Self-consciousness and Alzheimer’s disease. Acta Neurol Scand 2001: 104: 296–300. # Munksgaard 2001. Objectives – To propose a neuropsychological study of the various aspects of self-consciousness (SC) in Alzheimer’s disease. Methods – Forty-five patients with probable mild or moderate AD were included in the study. Severity of their dementia was assessed by the Mini Mental State (MMS). Fourteen questions were prepared to evaluate SC. Results – No significant correlations were found between SC score and educational level, age, and duration of disease. A significant correlation was found between SC score and the severity of dementia, whereas frontal disturbances were just short of the significance threshold. The various aspects of SC were not impaired to the same degree. The most disturbed ones were awareness of cognitive deficiencies, moral judgements and prospective memory. The least disturbed aspects were awareness of identity and of mental representation of the body. Items relating to anosognosia and moral judgements were significantly correlated with the MMS score, whereas affective state, body representation disorders, prospective memory, and capacities for introspection were not related to the severity of the dementia. Consciousness of identity was sound, regardless of MMS score. Conclusions – AD clearly induces an heterogeneous impairment of SC. SC requires a convergence of many neural networks. In AD, neuronal alterations involve many cortical areas and information sent to the associative frontal cortex from memory, language and visuospatial areas is lacking or disturbed. Thus, the sequential order of successive stimuli cannot be maintained by the heteromodal associative cortex (dorsal convexity of the prefrontal cortex), and the supramodal associative cortex (located rostrally in the frontal lobes) is unable to provide reliable monitoring and assessment of simultaneous neural cognitive networks carrying insufficient and inadequate input. The core deficiency in AD patients might be impaired SC equated with the disability to maintain sequential and simultaneous ‘‘attention to life’’. The Self-Consciousness Questionnaire, a clinical scale providing multidimensional measurement, indicates that different aspects of consciousness are not correlated with overall cognitive deficiency as determined by the MMSE.

Impairment of the Self has been described in frontal–temporal dementia but little research has been carried out in patients with Alzheimer’s disease. Objective. The aim of this study was to explore changes in the self in patients with AD. Method. Forty-seven patients with mild to moderate AD were examined using a semi-structured scale designed to assess the self-concept along three dimensions, namely, the Material Self, the Social Self and the Spiritual Self. Results. The majority of patients presented impairment of at least one dimension of the Self. When only one dimension was affected, it was always the Social Self. The severity of impairment of the Self was correlated to the impairment of the semantic autobiographical memory and apathy. The Self is impaired in AD and the Social Self dimension appears to be more vulnerable in AD than other dimensions

L’épître aux Corinthiens, écrite vraisemblablement vers 96, est une clé de lecture et d’interprétation de la construction identitaire de l’Eglise. Dire que Clément intervient dans un contexte d’identité naissante ne doit cependant pas faire oublier qu’une identité n’est jamais figée. Mais comment déterminer ce qui relève d’adaptations ou ce qui menace l’identité ? L’épître de Clément mérite d’être relue en utilisant les concepts proposés par Paul Ricoeur. Les évènements qui agitaient « l’Eglise de Corinthe » furent considérés comme graves car ils relevaient, selon « l’Eglise de Dieu en séjour à Rome », non de « l’identité-mêmeté » mais de « l’identité-ipséité ». Et c’est pourquoi ils portaient atteinte à la construction et à la configuration identitaires de « l’Eglise de Dieu ». Ainsi l’épître est une exhortation qui permet de repérer ce qui commençait à se construire comme « identité-ipséité » d’un « protocatholicisme » succédant au catholicisme primitif.