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David Balota is currently a Professor Emeritus at Washington University in St. Louis, where he was a professor of Psychological and Brain Sciences since 1985. His work focuses on cognitive changes in healthy aging and the early stages of Alzheimer’s disease in hopes of better understanding the cognitive changes that occur with healthy aging and those which are disease-related. This work has led his group to focus on breakdowns in attention and reaction time variability along with the influence of personality differences in influencing the trajectory of age- and disease-related changes. He has published over 100 peer-reviewed papers and has been consistently funded by the National Institute of Aging.
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TMYS: Would there be any personal incident/s or observation that provoked your interest in Psychology, Neurology and Brain Sciences? Tell Me Your Story.
Dr. Balota:
My mother had early-stage dementia and spent a few years in a very nice home with individuals who also had dementia. Most of the individuals had more severe dementia than my mother. However, seeing the differences in how individuals responded to their cognitive decline was eye-opening. For example, some individuals seemed relatively “ok” with their situation, whereas others were much more upset and agitated. Of course, this may reflect different neural bases of dementia (e.g., frontal temporal lobe vs sporadic Alzheimer’s disease) and many other differences, such as their pre-existing personalities.
TMYS: With reference to your paper, The Power of Personality in Discriminating Between Healthy Aging and Early-Stage Alzheimer's Disease, do personality changes, such as increased neuroticism and decreased conscientiousness, have any impact on the formation of false memories in early-stage Alzheimer's Disease?
Dr. Balota:
We have not tested this hypothesis directly, but one might think that individuals who are high in conscientiousness might also be more careful with their memories, i.e., internally checking their memories from multiple pathways to increase the likelihood of the memories being valid, instead of assuming the first thing that comes to mind is a valid memory. But, of course, this is speculative at this point.
TMYS: With relation to your paper, The Power of Personality in Discriminating Between Healthy Aging and Early-Stage Alzheimer's Disease, what findings were you able to explore that highlight the significance of personality traits in identifying early-stage Alzheimer's Disease compared to traditional neuropsychological tests?
Dr. Balota:
This was one of the first studies showing that personality differences (in particular neuroticism and conscientiousness) were very sensitive to early-stage Alzheimer’s disease. At the time, most research focused on cognitive changes, particularly memory loss. However, our study indicated that changes in personality were just as great as changes in cognition. More recently, we (and others) have shown that personality can even be sensitive to ad-related biomarkers building up in individuals before they are clinically impaired.
TMYS: Does the progression of dementia impact life expectancy and lead to death? Please elucidate.
Dr. Balota:
Yes, dementia has a clear influence on life expectancy. Much of this influence is indirect, e.g., individuals who are cognitively impaired are more likely to fall, possibly due to changes in attention and psychomotor ability. Poor decision-making due to cognitive changes can also lead to poor health maintenance. At more advanced stages, individuals who are demented are more likely to be bed-ridden, and so are more susceptible to life threatening events such as pneumonia. These are just a few of the ways in which dementia influences life expectancy.
TMYS: How do social interactions and mental stimulation influence cognitive health in older adults, and what strategies can help prevent or slow down the progression of dementia?
Dr. Balota:
There is still some controversy regarding the direct benefits of social and mental stimulation in older adults. It is difficult to make strong inferences because it would be virtually impossible to randomly assign some individuals to a high mental (or social) stimulation condition and others to a low mental (or social) stimulation condition. Random assignment is important in making strong inferences, since there are so many other variables that differ between pre-existing groups (e.g., those individuals who have more mental stimulation are also those individuals who are more likely to follow medical advice and/or have the higher cognitive ability, to begin with). This does not mean that mental and/or social stimulation are unimportant and indeed they clearly have benefits (e.g., in measures of fulfilment and happiness), even if these benefits may not involve slowing down the disease process.
TMYS: What are the most common misconceptions about Alzheimer's disease and other dementias, and how can we combat these misconceptions to improve public understanding and support?
Dr. Balota:
One of the most common misconceptions is that Alzheimer’s disease is simply one type of disease that attacks everyone in a similar way. As I mentioned in my response to the first question, there are many individual differences in the disease process and how individuals react to their situations. Although there is no doubt that memory will decline (since this is part of the diagnosis), other cognitive, social and personality factors will come into play which likely modulate an individual’s trajectory.
TMYS: How does caring for someone with dementia impact the mental health of caregivers, and what resources or support systems are essential for caregiver’s well-being?
Dr. Balota:
This question is a bit beyond my expertise. However, I have personally seen that the drain on caregivers is enormous. It is also unfortunate that the cost of assisted living and long-term care for our loved ones who are experiencing cognitive decline is exorbitant. Of course, respite for caregivers is very helpful when possible. Again, some individuals with dementia become very agitated and hence are more difficult to care for than others. This is again why understanding individual differences is so important.
TMYS: What are the key areas that you personally think need better understanding for memory-related issues & dementia among the general public?
Dr. Balota:
Dementia is a multi-faceted behavioural syndrome that can be caused by multiple underlying neuropathological processes. There is currently an enormous research effort to better understand the biological mechanisms underlying Alzheimer’s disease which is the most common cause of dementia. Because of the complexity of this age-related phenomenon, it is unclear if there is going to be a silver bullet in the near future, above and beyond curtailing its progressive decline in cognition. Indeed, there has been some relatively recent success on this front. However, at this point, one must be a cautious consumer of media overselling the benefits of x, y and/or z in curing the disease. This is why discussing specific concerns with one’s physician or neurologist is critical in understanding the current evidence.
TMYS: How are cases of early-onset dementia in children diagnosed and treated? How does this challenge the common misconception that dementia only affects older adults?
Dr. Balota:
When I think of early-onset dementia, I think of individuals developing dementia in their 40s and 50s. These individuals often have genetic mutations that cause the dementia, and indeed, are the focus of considerable research, because their trajectory in cognitive decline is very similar to older individuals who develop dementia that do not have the genetic disposition (also called sporadic dementia). Hence, this affords a targeted group to study for intervention because one may have a better understanding of the biological cascade that produces the dementing behaviour. Childhood dementia is very rare, and also has been shown to have genetic influences.
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Interview conducted by Sarah Rahaman Shaikh.
This interview is a part of the book compiled under the theme -
Echoes & Whispers: Voices from Another World