Dementia is an illness that raises important questions about our own attitudes to illness and aging. It also raises very important issues beyond the bounds of dementia to do with how we think of ourselves as people--fundamental questions about personal identity. Is the person with dementia the same person he or she was before? Is the individual with dementia a person at all? In a striking way, dementia seems to threaten the very existence of the self.LThis book brings together philosophers (...) and practitioners to explore the conceptual issues that arise in connection with this increasingly common illness. Drawing on a variety of philosophers such as Descartes, Lock, Hume, Wittgenstein, the authors explore the nature of personal identity in dementia. They also show how the lives and selfhood of people with dementia can be enhanced by attention to their psychological and spiritual environment. Throughout, the book conveys a strong ethical message, arguing in favor of treating people with dementia with all the dignity they deserve as human beings. The book covers a range of topics, stretching from talk of basic biology to talk of a spiritual understanding of people with dementia. Accessibly written by leading figures in psychiatry and philosophy, the book presents a unique and long overdue examination of an illness that features in so many of our lives. (shrink)

In this article, I explore how methods of investigation can allow us either to appreciate the intact cognitive and social abilities of people with Alzheimer’s disease or unwittingly obscure those same abilities. Specifically, I shall assert that (1) the biomedical- quantitative approach, while being generally appropriate for drug efficacy studies, does not allow us to appreciate the many significant strengths possessed by people diagnosed with dementia, (2) qualitative/narrative approaches do so admirably, and (3) understanding the cognitive and social strengths of (...) people diagnosed is of paramount importance for developing optimal care giving approaches and reveals strikingly the shared humanity of those diagnosed with dementia and those deemed healthy. (shrink)

This article presents a critique of an article previously featured in Nursing Philosophy (10: 26–33) by Ursula Naue and Thilo Kroll, who suggested that people living with dementia are assigned a negative status upon receipt of a diagnosis, holding the identity of the ‘demented other’. Specifically, in this critique, we suggest that unwitting use of the adjective ‘demented’ to define a person living with the condition is ill-informed and runs a risk of defining people through negative (self-)attributes, which has a (...) deleterious impact upon that person's social and relational personae. Moreover, use of the locution ‘demented’ reinforces a divide between the ‘demented’ (them) and the ‘healthy others’ (us). Social constructionist theory, malignant positioning and viewing people with dementia as semiotic subjects are the philosophical pillars through which we construct the main arguments of the critique. The article concludes with the voice of one of the authors, a younger person with dementia, asking for language in dementia care to be carefully reconsidered and reframed and for the recognition of the diagnosed person's agency in the conduct of their day-to-day lives. (shrink)

Grant Gillett's (2009) welcome and extremely thought-provoking target article addresses many complex issues of such far-ranging consequence that it seems impossible to provide a commentary worthy o...

In lieu of an abstract, here is a brief excerpt of the content:Mild Cognitive Impairment:What's in a Name?Steven R. Sabat (bio)Keywordslabeling, mild cognitive impairment, recall memory, selfhood, stereotype threatCorner and Bond (2006) raise a number of important conceptual issues related to the problems involved in defining mild cognitive impairment (MCI), differentiating it from normal aging, the definition of normal aging itself, and ethical issues surrounding the possible adverse effects of a diagnosis of MCI on the individuals thus described. It would (...) seem that portentous ramifications are involved and that clarifying the conceptual issues would be of great value, not only to researchers but also to the ever-growing population of elderly people. In what follows, I address some of these issues further.Problems of Definition and MeasurementOne of the problems that the authors discuss at the outset of their article concerns what methods are appropriate for detecting those with MCI: "Neuropsychological tests alone do not discriminate between normal aged-related memory loss and MCI or dementia and clinical judgment remains central to diagnosis" (Corner and Bond 2006, 5). Of course, to be able to discriminate between normal aged-related memory problems and MCI, we must first be able to define the former. What exactly is normal? As the authors correctly point out, the term has different meanings, one being normative (usual), another being nonpathologic. Is it normal (usual) for some sort of breakdown to occur in brain systems as a function of increased age? If so, is there a threshold age below which the very same physiologic breakdown is unusual? Would such a threshold age, if one existed, be the same for everyone, regardless of genotype and the cumulative interactive effects of nutrition, health, and stress-related factors over a period of decades? In effect, is some sort of memory impairment part of the natural (usual) process of aging for some people at particular ages rather than for others? And exactly what does it mean to be mildly impaired in the cognitive domain?Hogan and McKeith (2001) presented a working group's definition characterizing MCI such that people who complain about memory problems and who also provide objective evidence of such problems, yet who simultaneously display "normal general cognitive function and intact activities of daily living" (Hogan and McKeith 2001, 1131), should be identified and followed. Here again, however, we confront the problem of defining "normal general cognitive function" as well as "normal activities of daily living." Can one have normal general cognitive function without normal memory function? If so, what exactly constitutes [End Page 13] general cognitive function and on what conceptual or theoretical basis is such a definition valid? Furthermore, what sort of memory function are we talking about? Memory can be said to involve a number of stages: encoding, storage, and retrieval. Retrieval can be of the explicit type (conscious recall or recognition of specific information) with which people with Alzheimer's disease (AD) often reveal deficits or of the implicit type (a change in behavior as a result of previous experience of which the person may have no conscious recollection) as demonstrated in people with AD (Knopman and Nissen 1987). That is, people with AD can display deficits in explicit memory functions without similar deficits simultaneously in implicit memory functions.A partial answer to the question about memory loss in MCI may be found in the use of the Mini-Mental State Examination (MMSE; Folstein, Folstein, and McHugh 1975), originally intended to be used as a screening device, but employed more and more frequently as an outcome measure to assess cognitive decline as well as the efficacy of drug treatments. Although the examination purports to test orientation, registration, attention, calculation, recall, language (naming, repeating, reading, writing, three-stage command), and construction, a task analysis reveals that the test is not quite as "global" in the cognitive domain as it is purported to be. For example, ten of the maximum thirty points on the examination are earned for "orientation" in time and place. Yet, all of the questions in this section of the test require intact recall of the relevant information. For example, if a person is asked, "What day of the week is this?" and replies "I don't know," the... (shrink)