Subjective Time in Dementia: A Critical Review

Abstract

The capacity for subjective time in humans encompasses the perception of time’s unfolding from moment to moment, as well as the ability to traverse larger temporal expanses of past- and future-oriented thought via mental time travel. Disruption in time perception can result in maladaptive outcomes—from the innocuous lapse in timing that leads to a burnt piece of toast, to the grievous miscalculation that produces a traffic accident—while disruption to mental time travel can impact core functions from planning appointments to making long-term decisions. Mounting evidence suggests that disturbances to both time perception and mental time travel are prominent in dementia syndromes. Given that such disruptions can have severe consequences for independent functioning in everyday life, here we aim to provide a comprehensive exposition of subjective timing dysfunction in dementia, with a view to informing the management of such disturbances. We consider the neurocognitive mechanisms underpinning changes to both time perception and mental time travel across different dementia disorders. Moreover, we explicate the functional implications of altered subjective timing by reference to two key and representative adaptive capacities: prospective memory and intertemporal decision-making. Overall, our review sheds light on the transdiagnostic implications of subjective timing disturbances in dementia and highlights the high variability in performance across clinical syndromes and functional domains.