No description available.

Background: Unawareness of memory functioning is a key symptom of Alzheimer’s disease and dementia that has been demonstrated to be related to a number of important factors for the person with dementia (PwD) and their family caregivers including quality of life and depression. Understanding more about how awareness relates to these factors will help inform how PwD and their caregivers are best supported. Objective: A meta-analysis was conducted in order to examine the relationship between Awareness and depression in dementia. An empirical study was conducted to examine the contribution awareness provides to explaining PWDs’ Quality of Life (QoL). PwD have been found to be aware of factors that affect their caregiver and so caregiver wellbeing and quality of life and the quality of the caregiving relationship were also investigated as well as more established predictors of quality of life for PwD. Both PwD self-ratings and caregiver ratings of the PwD they care for of QoL were examined as they have been shown to be affected by different factors. Method: Meta-analysis: A search of electronic databases Psycinfo, Embase and Medline was conducted. A meta-analysis of correlations was undertaken examining the relationship between awareness and depression in dementia. Empirical study: 27 PwD and their caregivers were recruited. In order to assess the research aims the PwD completed measures of: Quality of life (Quality Of Life-Alzheimer’s Disease scale), awareness of memory functioning (Memory Awareness Rating Scale-Adjusted), cognitive functioning (Addenbrooke’s Cognitive Exam-R), depression and anxiety (Hospital Anxiety and Depression Scale). The caregiver completed measures of: PwD Quality of life (Quality Of Life-Alzheimer’s Disease scale proxy), Memory Functioning Scale (from MARSA), self-ratings of depression and anxiety (Hospital Anxiety and Depression Scale), activities of daily living (Disability Assessment in Dementia), Neuropsychiatric symptoms (Neuropsychiatric symptoms inventory-Questionnaire), caregiver burden (Zarit Burden Inventory), and rating of relationship quality with PwD (Burns Relationship Satisfaction Scale). Results: Meta-analysis: Thirty-one studies were identified. A small association was found between awareness and depression with substantial amount of heterogeneity (- 0.23). Analysing the studies that excluded major depression demonstrated that mild depression had a moderate negative relationship with awareness (-0.42). Subgroup analysis showed that the different measures of awareness used seemed to suggest different effects with depression for different measures. Empirical study: Awareness was not found to predict PwD rated or caregiver rated QoL. No caregiver variables predicted PwD QoL. Depression and neuropsychiatric symptoms predicted PwD QoL. Caregiver rated QoL was predicted by activities of daily living and caregiver rated quality of caregiving relationship. Conclusions: Meta-analysis: The effect between mild depression and lack of awareness but not major depression supports the assertion that unawareness is a psychological response to decline in memory functioning in dementia. Neither depression nor awareness appear to be unitary constructs in PwD. Empirical study: Awareness not related to PwD QoL. The quality of caregiving relationship is important to QoL in a dementia context. PwD and their caregivers rate the QoL of PwD differently.

Thesis Abstract The present thesis investigates correlations between a selection of metafictional texts and narrative theory. The selection consists in two sets of self-reflexive texts. The first one explores metafictional tendencies in the 17th and 18th century novels. To achieve this, the selection largely ignores their provenience. In addition to Henry Fielding's Tom Jones and Laurence Sterne's Tristram Shandy, it also examines Cervantes's Don Quixote. The latter set of texts focuses on post-War American metafictions (John Barth's Lost in the Funhouse, Donald Barthelme's Snow White, Kurt Vonnegut's Slaughterhouse-Five). These represent a coherent body of works from a particular period. Metafiction is generally understood as fiction about fiction. The present thesis challenges those assumptions and suggests interpreting metafiction within the framework of Michel Foucault's epistemes. Metafiction is not conceived of as a separate genre of literature but in the context of broader cultural tendencies in the understanding of representation. Representation is a key concept in metafiction and the increasing degree of narrative self-awareness is viewed in this light. The thesis emphasizes this contrastive and interdisciplinary approach. The text is divided into five chapters. Chapter one is a theoretical...