Mécanismes et effets psychologiques et cognitifs d'une intervention basée sur la pleine conscience chez des adultes âgés présentant un trouble cognitif léger amnésique
|Advisor:||Goulet, Sonia; Hudon, Carol|
|Abstract:||Mindfulness meditation allows to develop a stable and non-judgmental consciousness of the present moment experience. This meditation is taught using brief and structured programs, namely mindfulness-based interventions (MBI). MBI’s benefits on psychological health are allowed by acceptation and monitoring capacity training and have been widely supported. Their effects on cognitive health are more equivocal, but some potential has been shown for cognitive remediation in populations at risk for future decline, including the military about to be deployed and healthy older adults. Amnestic mild cognitive impairment (aMCI), a probable Alzheimer’s disease (AD) prodromal phase, is characterized by cognitive decline and psychological symptoms, which worsen prognosis. It is suggested that MBI could benefit aMCI by promoting both brain health (hence reducing AD risk factors) and cognitive health (through attention training). This thesis aimed at determining to what extent an MBI can improve the psychocognitive profile of older adults with aMCI and to deepen the understanding of the underlying mechanisms of action. To do so, a first article has collated the available literature on changeable adverse factors and cognitive decline associated with AD, with the objective of identifying MBI’s potential mechanisms of action on AD pathology. A schematic model was then developed to illustrate the course of aMCI and AD neurodegeneration, and the MBI possible preventive effects through stress, depression, and metabolic syndrome remediation. This review showed evidence that MBI’s main effects on aMCI and AD development happened through stress, depressive symptoms, and inflammation reduction. Next, a clinical study published in two separate articles tested MBI’s effects on psychological and cognitive variables. The efficacy and specific mechanisms of action of the administered MBI were compared to those of a psychoeducation-based intervention (PBI). In the second article of the thesis, both interventions led to improved anxio-depressive symptoms and aging-related quality of life. General quality of life and memory remained stable after the two interventions. MBI’s efficacy was explained by improvement of acceptation and reductions of ruminations, but not by monitoring changes. The third article, which investigated more deeply the interventions’ effects on cognitive variables, showed no specific benefits on memory or attention following the MBI. The only attentional and subjective cognitive changes reported were similar for both interventions, while MBI-specific effects were expected. The hypothesis regarding an attentional control contribution to memory changes was also denied by the study results. Overall, the thesis supports the relevance of a MBI as a psychological therapeutic option for older adults with aMCI. While its potential to improve cognition was not demonstrated in the thesis, it is suggested that it might instead modify an expected cognitive decline. Further clinical studies in aMCI populations based on the reflections of the last chapter of the thesis are needed to deepen the understanding of mindfulness’ effects and mechanisms of action on psycho-cognitive symptomatology. This thesis contributes to research efforts in AD prevention by backing the relevance of a new non-pharmacological approach for a highly vulnerable population. Its contributions also refine knowledge of MBI effects and mechanisms and confirm the need for early intervention in older adults with aMCI.|
|Document Type:||Thèse de doctorat|
|Open Access Date:||15 October 2019|
|Collection:||Thèses et mémoires|
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