An emotional Stroop test is a variation of theclassic Stroop taskthat measures interference in reaction times when color-naming emotionally salient words.
Implicit and explicit awareness
Implicit awareness refers to an unconscious, automatic form of knowledge that exists below the surface of deliberate conscious understanding.
People may retain implicit awareness of deficits even after explicit, self-reported awareness of their condition fades.
In contrast, explicit awareness represents conscious, declarative knowledge of one’s status.
Key Points
Rationale
Prior research shows that many people with dementia retain some functional abilities despite reduced explicit awareness, suggesting an unconscious or implicit understanding of their condition (Weinstein, 1991).
Cognitive models propose mechanisms that allowimplicit awarenessto separate from explicit awareness in dementia (Geurten et al., 2021; Lenzoni et al., 2020; Morris & Mograbi, 2013).
Emotional Stroop tasks elicit responses at an automatic, pre-attentive level (Mogg et al., 1993; Ohman et al., 2001), providing a way to gauge implicit awareness.
A prior cross-sectional study found an emotional Stroop effect for dementia-relevant words, indicating implicit awareness even in subgroups with limited explicit awareness (Martyr et al., 2011).
Changes over time in implicit awareness of dementia have not been examined longitudinally. Emotional Stroop effects occur in caregivers (Martyr et al., 2011), but it is unknown if healthy older adults show similar emotional interference.
Method
Insight
Findings suggest that implicit awareness is present in early dementia but appears to fade over the course of the disease, independently of overall cognitive decline.
Explicit awareness remains stable, indicating a dissociation and lack of association between implicit and explicit awareness in dementia.
Healthy older adults also show emotional responses to dementia-related content, possibly reflecting fears about developing dementia.
Further research could explore reasons for declining implicit awareness in dementia using neuroimaging or test interventions aimed at supporting awareness.
Strengths
Limitations
Implications
References
Alexander, C. M., Martyr, A., & Clare, L. (2022). Changes in awareness of condition in people with mild-to-moderate dementia: Longitudinal findings from the IDEAL cohort.International Journal of Geriatric Psychiatry, 37(4).https://doi.org/10.1002/gps.5702
Clare, L., Nelis, S. M., Martyr, A., Whitaker, C. J., Markova, I. S., Roth, I., Woods, R. T., & Morris, R. G. (2012). Longitudinal trajectories of awareness in early-stage dementia.Alzheimer Disease & Associated Disorders, 26(2), 140–147.https://doi.org/10.1097/WAD.0b013e31822c55c4
Doninger, N. A., & Bylsma, F. W. (2007). Inhibitory control and affective valence processing in dementia of the Alzheimer type.Journal of Neuropsychology, 1(1), 65–83.https://doi.org/10.1348/174866407X180828
Dudley, R., O’Brien, J., Barnett, N., McGuckin, L., & Britton, P. (2002). Distinguishing depression from dementia in later life: A pilot study employing the emotional Stroop task.International Journal of Geriatric Psychiatry, 17(1), 48–53.https://doi.org/10.1002/gps.514
Farina, F. R., Bennett, M., Griffith, J. W., & Lenaert, B. (2022). Fear of memory loss predicts increased memory failures and lower quality of life in older adults: Preliminary findings from a fear-avoidance of memory loss (FAM) scale.Aging & Mental Health, 26(3), 486–492.https://doi.org/10.1080/13607863.2020.1856780
Fleischman, D. A., Wilson, R. S., Gabrieli, J. D., Schneider, J. A., Bienias, J. L., & Bennett, D. A. (2005). Implicit memory and Alzheimer’s disease neuropathology.Brain, 128(9), 2006–2015.https://doi.org/10.1093/brain/awh559
Geurten, M., Salmon, E., & Bastin, C. (2021). Impaired explicit self-awareness but preserved behavioral regulation in patients with Alzheimer disease.Aging & Mental Health, 25(1), 142–148.https://doi.org/10.1080/13607863.2019.167514
Geurten, M., Salmon, E., Willems, S., & Bastin, C. (2021). Boosting familiarity-based memory decisions in Alzheimer’s disease: The importance of metacognition.Journal of the International Neuropsychological Society, 27(3), 239–248.https://doi.org/10.1017/s1355617720000910
Harrison, B. E., Son, G. R., Kim, J., & Whall, A. L. (2007). Preserved implicit memory in dementia: A potential model for care.American Journal of Alzheimer’s Disease and Other Dementias, 22(4), 286–293.https://doi.org/10.1177/1533317507303761
Kessler, E. M., Bowen, C. E., Baer, M., Froelich, L., & Wahl, H. W. (2012). Dementia worry: A psychological examination of an unexplored phenomenon.European Journal of Ageing, 9(4), 275–284.https://doi.org/10.1007/s10433-012-0242-8
Lenzoni, S., Morris, R. G., & Mograbi, D. C. (2020). The petrified self 10 years after: Current evidence for mnemonic anosognosia.Frontiers in Psychology, 11(1), 465.https://doi.org/10.3389/fpsyg.2020.00465
Martyr, A., Clare, L., Nelis, S. M., Marková, I. S., Roth, I., Woods, R. T., Whitaker, C. J., & Morris, R. G. (2012). Verbal fluency and awareness of functional deficits in early-stage dementia.The Clinical Neuropsychologist, 26(3), 501–519.https://doi.org/10.1080/13854046.2012.665482
Martyr, A., & Clare, L. (2018). Awareness of functional ability in people with early-stage dementia.International Journal of Geriatric Psychiatry, 33(1), 31–38.https://doi.org/10.1002/gps.4664
Mogg, K., Kentish, J., & Bradley, B. P. (1993). Effects of anxiety and awareness on colour identification latencies for emotional words.Behaviour Research and Therapy, 31(6), 559–567.https://doi.org/10.1016/0005-7967(93)90107-6
Mograbi, D. C., & Morris, R. G. (2013). Implicit awareness in anosognosia: Clinical observations, experimental evidence, and theoretical implications.Cognitive Neuroscience, 4(3–4), 181–197.https://doi.org/10.1080/17588928.2013.833899
Morris, R. G., & Mograbi, D. C. (2013). Anosognosia, autobiographical memory and self knowledge in Alzheimer’s disease.Cortex, 49(6), 1553–1565.https://doi.org/10.1016/j.cortex.2012.09.006
Ohman, A., Flykt, A., & Esteves, F. (2001). Emotion drives attention: Detecting the snake in the grass.Journal of Experimental Psychology: General, 130(3), 466–478.https://doi.org/10.1037/AXJ96-3445.130.3.466
Sevush, S. (1999). Relationship between denial of memory deficit and dementia severity in Alzheimer disease.Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 12(2), 88–94.
Stroop, J. R. (1935). Studies of interference in serial verbal reactions.Journal of Experimental Psychology, 18(6), 643–662.https://doi.org/10.1037/h0054651
Weinstein, E. A. (1991). Anosognosia and denial of illness. In G. P. Prigatano & D. L. Schacter (Eds.),Awareness of deficit after brain injury: Clinical and theoretical issues(pp. 240–257). Oxford University Press.
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Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
