The general aim of any social contract theory is to generate the terms of an agreement which the parties to the contract will accept and respect. In order to identify what terms are likely to be acceptable, the theorist needs to specify the character of the parties and the conditions in which they are making the agreement. A prior step is also needed. The theorist needs to show that the characteristics and conditions chosen are appropriate to the task of generating (...) an agreement. The theorist must have a defensible methodological framework for his or her project. ;In this dissertation I examine the different frameworks adopted by two contemporary political philosophers: John Rawls and David Gauthier. I argue that the neo-Hobbesian project undertaken by Gauthier in Morals by Agreement is flawed. His attempt to derive a general moral theory almost exclusively from a relatively uncontroversial conception of instrumental rationality is marred by his commitment to a description of the political subject as a discrete entity having an identity independent of its social relationships. ;I then argue that John Rawls, in A Theory of Justice and more explicitly in some more recent articles, supplies a more promising framework. He takes the considered judgements of socially situated individuals to be the base from which a theory of justice can be extracted. The connected ideas of "overlapping consensus" and "reflective equilibrium" are central to his project, and allow him to treat social agreements as flexible instruments which can accommodate and even facilitate political change. ;I defend Rawls against the charge that his theory cannot account for political stability, and also against the communitarian claim that his conception of justice undermines the crucial role that community membership plays in human life. I conclude by noting that the Rawlsian conception of justice does face certain limitations because it presupposes a particular definition of the political domain. I then consider how Rawls's framework might address this issue, and attempt to sketch a preliminary possibility. (shrink)

This volume contains ten chapters, each of which takes up a different question in contemporary moral or political philosophy. The volume has three parts: meta-ethics, issues in freedom and autonomy, and contemporary political philosophy. In the meta-ethical section, the chapters address issues concerning acts and their value, the plausibility of aggregation and counting with respect to the value of human lives, and the role of moral character in causing and explaining moral behavior. In the second section, the chapters take up (...) questions about the connection between moral imagination and a plausible account of integrity, the connection between autonomy and rights to property, and the difficulties facing internalist accounts of autonomy. In the final section, the chapters address issues concerning feminist critiques of Rawlsian liberalism, the limits of liberalism and communitarianism, the importance of understanding Rawls's social contract as a contract for institutions, and the morality of nationalist movements. These chapters reflect a cross-section of the issues concerning value that are of contemporary scholarly interest in Canada and the United States. (shrink)

Shiner has produced a valuable contribution to the field of analytical jurisprudence. He remains faithful to the investigative and exploratory task that he set for himself. Legal Institutions and the Sources of Lawcan be usefully consulted by anyone interested in the idea of a “source of law”. And it can certainly be used as an authoritative reference by those legal and political theorists who wish to pursue a fuller normative approach to law or politics.

The world's first permanent international criminal tribunal for the prosecution and punishment of the world's most serious crimes was created in 2002. In Bringing Power to Justice? legal scholars, political scientists, and political philosophers respond to fundamental questions about the future of this court and international criminal justice. For instance, will the ICC be undermined by political constraints, given the opposition of major powers, including the United States? What are the implications of holding heads of state responsible for international crimes? (...) Are trials the best response to state crime or would other devices (such as truth commissions) be more suitable? Is retributive justice an appropriate response? The contributors offer indispensable and thoughtful assessment of the future of international criminal justice. (shrink)

In this contribution I aim at developing some critical considerations about the possibility of establishing a dialogue between Husserlian phenomenology and embodied cognitive science to which both partners can participate with equal dignity, apart from any concession to radical forms of naturalism. Phenomenology and cognitive science are different theoretical enterprises, each of which relies autonomously on its own methods and categorial apparatus. This does not prevent of course that both disciplines can influence each other by exerting some kind of constraints. (...) Phenomenology alone cannot provide a full explanation of our conscious experiences as regards their sub-personal mechanisms and needs therefore to be integrated in a unitary framework which allows for its communication with the empirical sciences of mind, without any need to distort phenomenology’s transcendental features. On the other side, cognitive science should seriously take into account phenomenological and eidetic descriptions of first-person experience and avoid superimposing on it its own ontological and methodological assumptions. In the first part of the paper, I try first of all to highlight how Husserl’s phenomenology amounts to a theory of experience which keeps itself equidistant from both extremes of scientism and idealism and then to illustrate the necessity of downplaying Husserl’s transcendental philosophy through a critical assessment on its attitude toward natural sciences and by highlighting at the same time its right to conduct its inquiries autonomously. In the second part I explore the mediating role of psychological phenomenology in allowing a mutual exchange between phenomenology and embodied cognitive sciences, as far as it falls on the side of naturalistic attitude. In the third part I proceed to a critical evaluation of the encounter between embodied phenomenology and embodied cognitive sciences by underlining some ontological and methodological shortcomings in which some of their representatives incur. In the fourth part, I argue for a mild naturalization of phenomenology by confronting it with some forms of non-reductionist naturalism (e.g. liberal and enactive naturalism) for the purpose of safeguarding its fundamental tenets. In the fifth and final part I discuss the topic of lived body and embodiment as the turning point which allows for the mutual transition from the transcendental to the empirical level. To this aim, I try to focus on the intrinsic belongingness of lived body to the essential features of transcendental subject to the extent that it plays a major role in disclosing an oriented worldly space through its kinaesthetic powers. (shrink)

Daniel Dennett (1991) has advanced a mild realism in which beliefs are described as patterns “discernible in agents' (observable) behavior” (p. 30). I clarify the conflict between this otherwise attractive theory and the strong realist view that beliefs are internal states that cause actions. Support for strong realism is sometimes derived from the assumption that the everyday psychology of the folk is committed to it. My main thesis here is that we have sufficient reason neither for strong realism nor (...) for the supporting assumption about the commitments of folk psychology. Several generally implicit arguments in support of the latter assumption are considered. Explicit arguments for it by Ramsey et al. (1990) and Wellman (1990) are examined and judged unsuccessful. An explicit argument for strong realism by Cummins (in conversation) is also found inadequate. Consideration of this latter argument helps to explain why we cannot be satisfied with Dennett's own very brief discussion of causation by beliefs. (shrink)

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)

This paper explores the relationship between mania, or pathologically elevated mood, and philosophical theories of well-being. A patient, Mr. M., is described who oscillated between periods when he refused medication and periods when he was willing to accept it, and whose desires and life objectives were radically different in his medicated and unmedicated states. The practical dilemmas this raised are explored in terms of the three principal philosophical theories of well-being: hedonism, the desire fulfillment theory, and objectivism. None of these (...) adequately accounted for Mr. M.'s case: hedonism, because pleasure is increased in mildly manic states; desire fulfillment theories, because these suggest that an unending cycle of treatment and nontreatment would be in Mr. M.'s best interests; and objectivism, because, in a form that would be applicable to Mr. M., that theory brings with it substantial risks of paternalism. Four further philosophical approaches are explored briefly—approaches focusing on autonomy, rationality, personal identity, and illness, respectively—but these also provide no straightforward resolution of the clinical dilemmas. It is concluded that philosophical analysis, even if it does not resolve cases like Mr. M.'s, can deepen our understanding of the issues involved in clinical decision making in psychiatry, especially the importance of sensitivity to the patient's wishes and values; and conversely, that mild mania is an important "real life" case against which philosophical theories of well-being can be tested. (shrink)

Isaac Levi's new book develops further his pioneering work in formal epistemology, focusing on the problem of belief contraction, or how rationally to relinquish old beliefs. Levi offers the most penetrating analysis to date of this key question in epistemology, offering a completely new solution and explaining its relation to his earlier proposals. He mounts an argument in favor of the thesis that contracting a state of belief by giving up specific beliefs is to be evaluated in terms of the (...) value of the information lost by doing so. The rationale aims to be thoroughly decision theoretic. Levi spells out his goals and shows that certain types of recommendations are obtained if one seeks to promote these goals. He compares his approach to his earlier account of inductive expansion. The recommendations are for "mild contractions." These are formally the same as the "severe withdrawals" considered by Pagnucco and Rott. The rationale, however, is different. A critical part of the book concerns the elaboration of these differences. The results are relevant to accounts of the conditions under which it is legitimate to cease believing and to accounts of conditionals. Mild Contraction will be of great interest to all specialists in belief revision theory and to many students of formal epistemology, philosophy of science, and pragmatism. (shrink)

Although VL30 retrotransposable elements have been associated with certain cancers for nearly twenty years, because of their expression in rodent malignancies and recombination into murine sarcoma viruses, their causative role, if any, in cancer has been uncertain and enigmatic. Recent findings suggest loss of normal transcriptional control of specific VL30 element expression may make a critical contribution to tumor progression at a step associated with malignant conversion, by bringing into play a cellular program normally involved in wound healing. This program, (...) the fibroblast anoxic response system, includes an adaptation to glycolytic metabolism, secretion of metalloproteinases, and activation of an endonuclease. While appropriate for facilitating debris removal during wound healing, loss of control of this program in a cell which has already progressed to the benign neoplastic state has the potential to simultaneously produce the invasiveness and genomic instability charateristic of malignancy. Examination of tumors and tumor derived cell lines has confirmed that key aspects of this system are in fact activated in cancer. (shrink)

This paper argues that, while the existence of strong moral dilemmas is notoriously controversial, a case can be made for the existence of mild dilemmas. It is common for people to feel that they are caught in some type of moral dilemma. If mild dilemmas are a genuine feature of the moral terrain, perceptions by ordinary people that they are caught in a moral dilemma are to some extent vindicated.

In this response to "Mild Mania and Well-Being" I propose a different analytic strategy and scrutinize the presented case of mild mania within the framework of a holistic theory of health. I distinguish between the following fundamental questions: (1) is mild mania a disease or illness? (2) does the mild mania of Mr. M. reduce his health significantly? and (3) should Mr. M. be recommended treatment with lithium or not? I answer the first question in the (...) affirmative. I propose some theoretical tools for resolving the second one. A complete resolution of it, however, requires a deeper analysis of Mr. M.'s state of mind and general situation. Finally, I hold that an affirmative answer to the first two questions does not imply an affirmative answer to the third, namely that Mr. M. should be recommended treatment with lithium. Other considerations, in particular ethical ones, should play a r. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mild Cognitive Impairment Is RelevantRonald C. Petersen (bio)Keywordsaging, Alzheimer’s disease, dementia, mild cognitive impairment, pharmaceutical industryGraham and Ritchie (2006) have contributed a scholarly document that implores us to reexamine nosological categories and certain diagnostic outcomes. They have chosen mild cognitive impairment (MCI) as the target of their scrutiny and have raised several interesting issues. I would like to comment on their approach and suggest that MCI (...) is a useful clinical entity that does serve a practical function and hopefully will lead to a better quality of life for aging persons.There are several clarifications concerning the construct of MCI that need to be emphasized. Graham and Ritchie have asserted that all persons with MCI eventually evolve to Alzheimer's disease (AD) and have claimed that this is the inevitable outcome of the disorder. Although it is true that many of the early studies on MCI focused on the amnestic subtype as a precursor to AD (Bennett et al. 2002; Ganguli, Dodge, Shen, and DeKosky 2004; Lopez et al. 2003; Petersen et al. 1999), subsequent work has expanded the construct to include prodromal forms of other disorders (Petersen 2004; Winblad et al. 2004). As such, the construct of MCI has become flexible in recent years to account for alternative types of intermediate cognitive impairment.The authors state that MCI addresses those individuals speculated to have an inevitable dementia. Certainly, we do not presume that dementia is inevitable in the aging process; rather, we posit that if certain criteria are fulfilled in persons who are aging, the likelihood of a person progressing to a certain type of dementia is quite high. As such, this is an important precondition about which to learn, because interventional strategies may be available.Graham and Ritchie argue that some cognitive changes with aging are "normal" and trying to classify these individuals as "abnormal" is performing a disservice to much of the aging population. We draw an important distinction between the cognitive changes of normal aging, as they are recognized to exist, and what we feel constitutes the pathologic changes of MCI. We believe that the abnormal cognitive function found in MCI has a high probability of progressing to a greater degree of cognitive dysfunction in a relatively short period of time and these behavioral changes are accompanied by pathologic brain changes that are manifested on magnetic resonance imaging scans, positron emission tomography scans, cerebrospinal fluid biomarkers, and autopsy studies (Hampel et al. 2004; Jack et al. 1999; Markesbery et al. [End Page 45] 2006; Petersen et al. 2006). This type of progression is in contradistinction to other individuals who are experiencing cognitive changes of normal aging. These individuals do not progress rapidly to greater degrees of impairment and autopsy studies reveal that their brains do not harbor the pathologic changes found in the MCI population (Knopman et al. 2003).The cognitive and behavioral changes accompanying persons with MCI are devastating and cannot be ascribed to "senility" or "He is just getting old." It is a mistake to imply that by labeling people with a condition such as MCI we are doing them a disservice. Most of these individuals are seeking medical attention for their perceived difficulties. Consequently, addressing these concerns and educating the individuals on the implications of their symptoms are important services. Although we may not have adequate therapies at present, this does not imply that we should ignore the symptoms.We cannot treat many conditions at present, yet we do not avoid the opportunity to characterize the condition and make a diagnosis. Even if this were part of the aging process, this does not mean that we should ignore the disability and refuse to treat it. Most individuals develop an inflexibility of their optical lenses as they age, yet corrective lenses of one type or another are believed to be extremely beneficial at alleviating this disability associated with the aging phenomenon. No one would argue that it is inappropriate to treat this condition because it is "just a part of aging."It should be noted that I have stressed the situation in which individuals are seeking medical attention for their cognitive concerns. It is quite a different situation if an... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mild Cognitive Impairment:Kinds, Ethics, and Market ForcesStephen Ticehurst (bio)KeywordsAlzheimer’s disease, dementia, human kinds, mild cognitive impairment, natural kindsIn their article, Graham and Ritchie (2006) robustly confront the term mild cognitive impairment (MCI). They contrast a "real" diagnosis of Alzheimer's disease (AD) with a potentially spurious human invention called MCI. They argue we should not push MCI and AD too close together, lest MCI catch too much (...) of the reflected reality it does not deserve. I agree with their purpose, but suspect their argument is not as clear cut as we might hope.Classification is fundamental to the human activity called science. It is reflected also in the way we allocate and refine words. Classification allows us to determine the usefulness of terms, to share meaning, and hopefully to predict. MCI is an attempt at classification in this manner.The first problem is the clarity of definition. Graham and Ritchie imply that others see MCI as a precursor to dementia. At times they fall prey to this belief themselves. But is this what MCI claims? This link to AD and its recursive coloring of MCI is central to their argument. It seems that many hope that MCI is a term for "at risk of dementia." This confusion hampers much of the debate. The current operationally defined nosological criteria specify MCI is not dementia. This means that MCI can not be dementia without changing the criteria for one or both. At present, the evidence does not support this. Those people with MCI who will go on to develop dementia cannot reliably be distinguished from those who have a defective memory for other reasons. In the meantime, the link between MCI and dementia of various types is a valid area for investigation. Graham and Ritchie should have more confidence that usefulness can be determined by science and that this will triumph in the end.Modern psychiatry is very keen to believe it is naturalistic. Everything can be measured and will soon be explained by physical laws. However, Graham and Ritchie point to the intrusion of human concepts and values that may be shaping the way we measure the natural world. They invoke the term human kind to differentiate this activity from natural kinds. Psychiatry has always struggled to connect its diagnoses to naturalistic ideas of pathology and etiology. It could be argued that psychiatric nosology has always been susceptible to the creations of humans. Another modern invention—early psychosis—has parallels with the MCI story. But as the Rorschach test shows, most of us continue to see shapes in what really [End Page 53] is only an inkblot. If the shape is something we really want to see, expect, or have been trained to look for, so much the better. A definable precursor state to dementia (or schizophrenia) would make us all happy, not just those insatiable shareholders. However, the earlier in the unfolding of degenerative dementia we go, the less reliable and valid are our clinical diagnoses.Graham and Ritchie say MCI is a human kind, unlike Alzheimer's disease, which is an essential natural kind. The authors argue that the purported relationship between MCI and AD feed back in a loop to give MCI a natural kind standing that it does not yet deserve. They examine the underlying social processes that support this firming of an as yet insubstantial concept. These include the desire for patients and their doctors to have hope and pharmaceutical companies to have markets and profits. They invoke a mythical authorized person who can determine a diagnosis as a newly formed kind after a common act of recognition. Using kind in this context appears to refer to a thing rather than a term. But it is the term that is being socially validated, not the thing. AD is a more socially validated term than MCI, but its relationship with reality remains humanly constructed.Does the invocation of kinds aid this argument? A kind is not really what it appears. A kind is a term to describe a concept that humans hold about the world. Therefore, dividing kinds into various types, such as natural, human, and practical, betrays the inevitable human... (shrink)

BackgroundThe cognitive outcomes induced by subthalamic nucleus deep brain stimulation (STN-DBS) remain unclear, especially in PD patients with mild cognitive impairment (MCI). This study explored the cognitive effects of STN-DBS in PD patients with MCI.MethodsThis was a retrospective cohort study that included 126 PD patients who underwent STN-DBS; all patients completed cognitive and motor assessments before and at least 6 months after surgery. Cognitive changes were mainly evaluated by the Montreal cognitive assessment (MoCA) scale and the seven specific MoCA (...) domains, including visuospatial/executive function, naming, attention, language, abstract, delayed recall, and orientation. Motor improvement was evaluated by the UPDRS-III. Cognitive changes and motor improvements were compared between PD-MCI and normal cognitive (NC) patients. Logistic regression analyses were performed to explore predictors of post-operative cognitive change.ResultsAt the time of surgery, 61.90% of the included PD patients had MCI. Compared with the PD-MCI group, the PD-NC group had a significantly higher proportion of cases with post-operative cognitive decline during follow-up of up to 36 months (mean 17.34 ± 10.61 months), mainly including in global cognitive function, visuospatial/executive function and attention. Covariate-adjusted binary logistic regression analyses showed that pre-operative global cognitive status was an independent variable for post-operative cognitive decline. We also found that pre-operative cognitive specific function could predict its own decline after STN-DBS, except for the naming and orientation domains.ConclusionPD-MCI patients are at a lower risk of cognitive decline after STN-DBS compared with PD-NC patients. (shrink)

The evolution of a relevant nosological concept reflects changes in the distinction between what is recognized and defined as normal and pathologic. Attention is directed to the rationale and value of detecting subclinical aging-related modifications in cognitive performance. The position that different kinds of dementias may have precedents in etiological-specific kinds of early or mild cognitive impairments (MCI) supports targeting people earlier for study of these subclinical symptoms. Because heterogeneous disorders can be expected to have multiple patterns of cognitive (...) and behavioral changes, useful conceptual nosologies should be flexible. Yet clinical research primarily restricts its focus to a single pathway where MCI leads to Alzheimer's disease (AD), and uses selective recruitment, washout screenings, repeated trialing of similar compounds, and other methods that bank the published evidence in favor of the existing therapies and their modest efficacy. This focus on AD recursively colors MCI, not as a flexible "human kind" in need of more careful research, but like AD, as an essential "natural kind." Early determination of MCI targets a potential pharmaceutical market of a quarter to a half of the population over sixty-five and the individual experiencing cognitive decline in its early stages is aware and sensitive to their surroundings, to a linked sociodegeneration with neurodegeneration. This paper examines how classifying people changes both the classifier and the subject of classification. The potential for conflict of interest is raised regarding what new causal knowledge and techniques for ascertainment are selected. Reading evidence from epidemiology, neurology, and clinical studies through science studies and bioethics lenses, we explore the possibility of a pluralistic model of cognitive impairment nosology where biological/pathologic processes respond and interrelate with a normal healthy state. (shrink)

Jim Joyce argues for two amendments to probabilism. The first is the doctrine that credences are rational, or not, in virtue of their accuracy or “closeness to the truth” (1998). The second is a shift from a numerically precise model of belief to an imprecise model represented by a set of probability functions (2010). We argue that both amendments cannot be satisfied simultaneously. To do so, we employ a (slightly-generalized) impossibility theorem of Seidenfeld, Schervish, and Kadane (2012), who show that (...) there is no strictly proper scoring rule for imprecise probabilities. -/- The question then is what should give way. Joyce, who is well aware of this no-go result, thinks that a quantifiability constraint on epistemic accuracy should be relaxed to accommodate imprecision. We argue instead that another Joycean assumption — called strict immodesty— should be rejected, and we prove a representation theorem that characterizes all “mildly” immodest measures of inaccuracy. (shrink)

Mild Cognitive Impairment (MCI) is a diagnostic category indicating cognitive impairment which does not meet diagnostic criteria for dementia such as Alzheimer’s disease. There are public health concerns about Alzheimer’s disease (AD) prompting intervention strategies to respond to predictions about the impacts of ageing populations and cognitive decline. This relationship between MCI and AD rests on three interrelated principles, namely, that a relationship exists between AD and MCI, that MCI progresses to AD, and that there is a reliable system (...) of classification of MCI. However, there are also several ethical issues and problems arising in the AD/MCI relationship. These include early diagnosis and interventions, the effects on people with MCI, and the newer neuroimaging and neuropharmacological approaches used in diagnosis and treatment. All these issues pose questions about the principles of MCI in relation to AD, with implications for how MCI is understood, diagnosed, treated, and experienced by patients. This article analyses four challenging areas for neuroethics: the definition and diagnosis of MCI; MCI in relation to AD; clinical implications of MCI for ethical disclosure, diagnosis, and treatment; and the research implications of MCI. The significant connections between these areas are often overlooked, together with uncertainties overall. Patients, healthcare systems and society are best served by informed clinicians, academics and researchers. After 35 years, the store of MCI knowledge is expanding and evolving. (shrink)

This paper classifies a family of grammar formalisms that extendcontext-free grammar by talking about tuples of terminal strings, ratherthan independently combining single terminal words into larger singlephrases. These include a number of well-known formalisms, such as headgrammar and linear context-free rewriting systems, but also a new formalism,(simple) literal movement grammar, which strictly extends the previouslyknown formalisms, while preserving polynomial time recognizability.The descriptive capacity of simple literal movement grammars isillustrated both formally through a weak generative capacity argument and ina more practical (...) sense by the description of conjunctive cross-serialrelative clauses in Dutch. After sketching a complexity result and drawing anumber of conclusions from the illustrations, it is then suggested that thenotion of mild context-sensitivity currently in use, that depends on therather loosely defined concept of constant growth, needs a modification toapply sensibly to the illustrated facts; an attempt at such a revision isproposed. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Alzheimer's Disease, Mild Cognitive Impairment, and the Biology of Intrinsic AgingThomas B. L. Kirkwood (bio)Keywordsaging, Alzheimer’s disease, genetic mutation, mild cognitive impairment, telomereThe article by Gaines and Whitehouse (2006) raises key questions about the uncertain relationship between (i) the intrinsic, "normal" aging process, and (ii) the clinicopathologic states represented by the labels of Alzheimer's disease (AD) and mild cognitive impairment (MCI). This short commentary offers a (...) perspective on this debate that is drawn from a consideration of underlying biological mechanisms.Because age is unquestionably the greatest single risk factor associated with AD and MCI, I begin by asking what we know about the intrinsic processes of aging. The central feature of current understanding of intrinsic aging is that it consists of the gradual, lifelong accumulation of a wide variety of molecular and cellular faults that begins very early in life and eventually leads to overt functional impairments resulting in age-related frailty, disability, and disease (Kirkwood 2005). This is an essentially bottom-up process. A strong consensus has emerged in recent years that there is no active program for aging and that there are no genetic factors that have evolved specifically to cause aging or age-related diseases. Unquestionably, there are genes that influence susceptibility to disease and even length of life, but these genes are genes for maintenance and repair functions, not for aging. It is the limitation in the past evolutionary pressure to invest in greater longevity than was required, within an environment where life was usually truncated by hazards such as starvation, injury, or infection, that means that our maintenance systems—good as they are—are insufficient to keep us going indefinitely. Added to this is the idea that there are probably also genes that program processes that are good for the young organism, but which may in later life have harmful effects. Processes like inflammation and apoptosis, which are seen to occur extensively in aged tissues, including brain, surely evolved to help cope with infection and cellular damage arising earlier in life. That they are called into play in aged tissues is a direct, but secondary, consequence of accumulated damage.With this general framework to understand the intrinsic biology of aging, let us now ask what we might expect a priori for the aging of an organ such [End Page 79] as the brain. Although we cannot pretend complete ignorance of how the brain actually does age, our enquiry can be based entirely on data from other organ systems, so we can develop our predictions about brain aging without prejudice.Aging begins very early during human development, faults accumulating from the first stages of embryonic development. Each time a cell divides, each of the daughter cells is likely to acquire a few new mutations. We know this from the estimates for the error rate in DNA replication and the size of the human genome. It is confirmed by direct evidence that at individual gene loci where mutations have been measured, mutation frequency increases with age (Morley 1998; Vijg 2000). In addition to replication errors, DNA is damaged on a daily basis to a very considerable degree by agents such as reactive oxygen species (free radicals), which are formed as byproducts of normal cellular metabolism. Although most of this damage is corrected by repair, the repair mechanisms themselves are not error free and additional mutations accumulate through this route. If a mutation is lethal to the cell, the cell dies and thus the mutation is eliminated. However, the majority of mutations are nonlethal, either because the mutation is recessive and the cell carries an intact gene copy on the other chromosome, because the gene is not currently required, or because the mutation produces only a delayed deleterious effect. Examples of genes that produce delayed deleterious effects include the genes responsible for familial AD. It is interesting to reflect that on statistical grounds alone, it is almost certain that each of us carries a randomly determined fraction of cells in our brains that bear amyloid precursor protein or presenilin mutations associated with AD. We also carry a heterogeneous array of random mutations that compromise essential cell maintenance functions. How many such... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mild Cognitive Impairment:Which Kind Is It?Andy Hamilton (bio)Keywordshuman kinds, mild cognitive impairment, multiple personality disorder, practical kinds, social constructionThere is much stimulating material in the Graham and Ritchie's paper (2006), concerning not just disease-classification but also the ethics of diagnosis. My concern is with the way in which they adduce Ian Hacking's views in the philosophy of science in support of their own. The authors quote with (...) approval his "dynamic nominalism" and its influence on Zachar's concept of "practical kinds." Hacking's view, as the authors quote it, is that "People classified in a certain way tend to conform to or grow into the ways that they are described; but they also evolve in their own ways, so that the classifications and descriptions have to be constantly revised" (1995, 21). The act of classifying changes both the classifier and the subject of classification, resulting in facts and categories that are both socially created and real. Hacking calls this "the looping effect of human kinds," and comments that "Multiple personality [disorder] is an almost too perfect illustration of this feedback effect" (1995, 21). The authors comment that Zachar (2000) builds on Hacking's position, discarding essentialist notions of classification that are limited to inherent biological properties, and turning instead to "practical kinds—nonarbitrary cultural artifacts intended to meet pragmatic needs (e.g. therapeutic, predictive prognostic, labeling effects, and physiology)" (Graham and Ritchie 2006, 36). Practical kinds, they believe, offer a way out of the clinical approach focused on mild cognitive impairment (MCI) as a precursor to, or mild form of, Alzheimer's disease. The inclination of the authors, as I read them, is to treat MCI as a practical or human kind, and not, like Alzheimer's disease, as a natural kind.My concern is whether the "looping effect of human kinds" can be transferred to the case of MCI from Hacking's original case study in Rewriting the Soul, multiple personality disorder (MPD). Hacking wished there to undermine the traditional debate over whether MPD is a "social or psychiatric artifact." He claims, correctly I think, that the presupposition behind the question "Is MPD a real disorder as opposed to a product of social circumstances?" should be rejected. The fact that a disorder is a product of social circumstances does not make it less real (1995, 12). On the looping of human kinds, Hacking comments that "The concept of child abuse [implicated in MPD] may itself be so made and molded by attempts at knowledge and intervention, and social reaction to these studies, that there is no stable object, child abuse, to have knowledge about." This is a "no fact of the matter" response, and it [End Page 51] is based on the recognition of conceptual change. He later adds that child abuse "is a real evil, and it was so before the concept was constructed. It was nevertheless constructed. Neither reality nor construction should be in question" (1995, 61, 68). However, Hacking's conclusions about the reality of MPD express only a muted skepticism. Utilitarian skeptics approach this question by asking, "What is the most effective treatment?" Hacking writes that "in their hearts [such skeptics] suspect that the outcome of multiple therapy [therapy that condones or even encourages the development of multiples in the patient] is a type of false consciousness" (1995, 267). The skeptics about MPD are making a moral judgment, he believes; but on whether that moral judgment is correct, he is silent, although the suspicion must be that he agrees with it.How do these considerations apply to the case of MCI? Graham and Ritchie rightly note that classifying a subject as suffering from MCI, and informing them of the diagnosis, will affect them adversely—it will cause suffering not least because there is at present no cure. However, it must surely be conceded that any disease at all—physical or mental—is a social entity insofar as it involves behavioral ascriptions to the subject concerning their incapacity. The authors also note the vested interests—especially from the pharmaceutical industry—in developing a diagnostic category of MCI. These interests are present in the development of any significant diagnostic... (shrink)

This book draws on transpersonal anthropology and psychology in order to explore mild altered states of consciousness (ASCs) experienced in everyday life. While research into consciousness and particularly ASCs is growing, this book focuses on a neglected area: ‘everyday’ experiences of ASCs. Opening with an up-to-date overview of the development of the study of ASCs, the author presents an in-depth empirical exploration and mapping of mild ASCs. Dr Sheppard examines original research conducted in a range of religious and (...) secular contexts with participants who were engaged in activities including prayer, sport, nature conservation, music and musical instrument making, and TV viewing. The author takes a novel phenomenological approach to the analysis of ASCs, emphasising the subjective experience. The book explores the healing potential of such mild ASCs; the everyday fantasy reality of the interior landscape; and discusses the problem of validity, and belief in the study of ASCs. It will appeal to students and scholars of transpersonal psychology, consciousness studies, social anthropology, and the philosophy of mind. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mild Cognitive Impairment:Where Does It Go From Here?John Bond (bio) and Lynne Corner (bio)Keywordsbiomedicalization, dementia, mild cognitive impairment, subjectivityThe joy of formal interdisciplinary discussion of this kind is the way that ideas presented through the gaze of social scientists stimulate such exciting thoughts and responses from other disciplines such as philosophy and psychology. We would like to thank Sabat and Thornton for their supportive and provocative reactions (...) to our paper. In the spirit of their responses, it is not our intention to respond to their thoughts directly; rather, we take the opportunity to theorize sociologically about this new category of psychiatry that has come to be known simply as mild cognitive impairment (MCI). In reviewing the responses of Sabat and Thornton, three thoughts emerged. First, together we have covered ontologic, epistemologic, methodologic, and theoretical questions about MCI, but none of us has posed basic political questions, such as: Why has MCI emerged as a new psychiatric label at this particular time? Second, this discussion brings together social scientists with a psychologist and a philosopher, but important constituents are missing. Consequently we are missing "insider" views on the importance of MCI to clinical practice. Third, this discussion highlights for us even more acutely the central question: Is MCI a real entity? In the following, we reflect on the first of these because our response also addresses the third. We first revisit the "evidence" about the importance of MCI for clinical practice.The notion of MCI as the transitional state between normal aging and Alzheimer's disease and other dementias has existed in a number of guises for many years, with benign senescent forgetfulness (Kral 1962) being the forerunner of a number of other terms, including questionable dementia, incipient dementia, isolated memory impairment, mild neurocognitive decline, age-associated memory impairment, age-associated cognitive decline, and cognitive-impairment-not-demented (Geda et al. 2004). Given that psychiatric labels implying the existence of MCI have been part of the practice landscape for over forty years, it is perhaps not surprising that its reinvention in the form of MCI has not, it appears, raised much attention outside specialist centers in North America and Europe. The reaction from grassroots clinical practice has been similar in intensity to their subdued reaction to the antipsychiatry movement in the 1960s. But for specialist clinics like the Mayo Clinic in Rochester, Minnesota, it has been an expanding [End Page 29] industry with numerous published papers, international conference presentations, and research funding opportunities.MCI can be distinguished from similar diagnostic categories that preceded its appearance in 1991. A key diagnostic criteria is the requirement for a subjective memory complaint by the person subsequently diagnosed as having MCI. Other diagnostic criteria include normal general cognitive function, normal activities of daily living, and memory being impaired for age, but not being demented (Petersen et al. 1999; Petersen and Morris 2003). To our knowledge, the idea of subjectivity being an important diagnostic criterion, as opposed to a means of identifying signs and symptoms, is a first in medical science. We know of no other medical category or diagnosis where subjectivity plays such a significant role, other than perhaps severe health phobias. Broadly speaking, two kinds of clinical evidence for MCI exist: first, that originating from studies (some quite small) applying the diagnostic criteria in specialist clinic populations; and, second, that found in large population studies. The main distinction between these two sets of evidence is that one is based on selected clinic populations and the other on unselected community populations. Most studies conclude that people whose memory is impaired for their age, as measured by similar cognitive tests such as the Mini-Mental State Examination, show decline in cognition that often leads to Alzheimer's disease and other kinds of dementia in the future. This finding is not remarkable given that it has long been known that age is a predictor of cognitive impairment. However, the population studies suggest a lower conversion rate than those for specialist clinics (Ritchie, Artero, and Touchon 2001).Petersen (2005) provides a robust defense as to why MCI might be a useful category in research and also indicates the potential benefits of treating MCI... (shrink)

The enjoyment of beauty has a peculiar, mildly intoxicating quality of feeling The science of aesthetics investigates the conditions under which things are felt as beautiful, but it has been unable to give any explanation of the nature and origin of beauty Psychoanalysis, unfortunately, has scarcely anything to say about beauty either.1 Freud.

_Introduction:_ Clinically relevant information can go uncaptured in the conventional scoring of a verbal fluency test. We hypothesize that characterizing the temporal aspects of the response through a set of time related measures will be useful in distinguishing those with MCI from cognitively intact controls. _Methods:_ Audio recordings of an animal fluency test administered to 70 demographically matched older adults (mean age 90.4 years), 28 with mild cognitive impairment (MCI) and 42 cognitively intact (CI) were professionally transcribed and fed (...) into an automatic speech recognition (ASR) system to estimate the start time of each recalled word in the response. Next, we semantically cluster participant generated animal names and through a novel set of time-based measures, we characterize the semantic search strategy of subjects in retrieving words from animal name clusters. This set of time-based features along with standard count-based features (e.g., number of correctly retrieved animal names) were then used in a machine learning algorithm trained for distinguishing those with MCI from CI controls. _Results:_ The combination of both count-based and time-based features, automatically derived from the test response, achieved 77% on AUC-ROC of the support vector machine (SVM) classifier, outperforming the model trained only on the raw test score (AUC, 65%), and well above the chance model (AUC, 50%). _Conclusion:_ This approach supports the value of introducing time-based measures to the assessment of verbal fluency in the context of this generative task differentiating subjects with MCI from those with intact cognition. (shrink)

Background: In the present study, we aimed to better investigate attention system profile of Parkinson's disease-Mild Cognitive Impairment patients and to determine if specific attentional deficits are associated with 123I-FP-CIT SPECT.Methods: A total of 44 de novo drug-naïve PD patients [ with normal cognition and 17 with MCI ], 23 MCI patients and 23 individuals with subjective cognitive impairment were recruited at the Clinical Neurology Unit of Santa Chiara hospital. They were assessed by a wide neuropsychological battery, including Visual (...) Search Test measuring selective attention. Performances among groups were compared by non-parametric tests. Further, Spearman's rank correlations were performed to explore the association between neuropsychological variables and 123I-FP-CIT SPECT data in PD subgroup.Results: PD-MCI patients performed worse on VST than patients with PD-NC, patients with MCI and individuals with SCI. The performance of PD-MCI patients on VST significantly correlated with caudate nucleus 123I-FP-CIT SPECT uptake, whereas a negative correlation between such test and 123I-FP-CIT SPECT uptake in the left putamen was found in PD-NC patients.Conclusions: We suggest that selective attention deficit might be a trigger of cognitive decay in de novo PD-MCI patients. The VST should be routinely used to detect attentional deficits in hospital clinical practice, in the light of its closely association with dopamine depletion of basal ganglia in mildly impaired PD patients. (shrink)

Auch und gerade in der modernen Moral gibt es viele Verpflichtungen oder Pflichten, die keine Korrelate moralischer, auch rein moralischer Rechte anderer sind. Beispiele sind Verpflichtungen zu Hilfeleistung unter Risiko und zu Dankbarkeit, Verzeihung, Freundlichkeit und Treue. Diese Verpflichtungen kann man durch einen Typ von affektiven Sanktionen gegenüber anderen und sich selbst explizieren, der nicht-aggressiv und auch intentional zwangsfrei ist. Alternative Theorien werden kritisiert.

In lieu of an abstract, here is a brief excerpt of the content:The Ambiguities of Mild Cognitive ImpairmentTim Thornton (bio)Keywordsclassification, disease, mild cognitive impairment, normative, valuesCorner and Bond's paper (2006) raises some key ethical questions about the classification and diagnosis of mild cognitive impairment (MCI). In this commentary, I wish to revise some of the general issues about the classification of mental disorder raised by this particular classificatory concept. The central issue raised is the connection between the (...) pathologic status of a condition and what I term the plain facts about the frequency and nature of its symptoms.There are a number of ethical questions raised by applying the label of MCI. Centrally, perhaps, is the concern, illustrated by the case vignettes, that a diagnosis carries negative repercussions that might outweigh the more narrowly medical advantages of an early diagnosis. But although that concern may be appropriate, such ethical complications are a danger of any psychiatric classification or diagnosis, even the most well grounded. Any psychiatric diagnosis can carry a danger of stigma, for example.What seems to make such ethical concerns more serious in this case—at least to a philosopher outsider—is the implicit further concern that MCI is not a real, objective, or, to use a more medical term, valid category or classification. If it is not valid, then any negative connotations of the diagnosis will not be outweighed by medical technological achievements. In other words, the further ethical issues are given much greater weight if the question of validity is not satisfactorily resolved.The question of the reality, objectivity, or validity of MCI can be divided into two issues:1. Is MCI a real, objective, or valid feature of psychological phenomenology?2. Is MCI a real, objective, or valid psychological illness, disease, or pathology?A condition might be a real, objective, or valid feature of psychological phenomenology without being a real illness. It might be some other aspect of human living. Szasz (1960) suggests that this is the case with mental illness (he might more properly say "so-called mental illness") as a whole. But, less controversially, the unusual ability to calculate, mentally and in a flash, the date of future Easter Sundays is a genuine feature of human living—some people possess the ability even if most do not—without either it, or its lack, being an illness. Being real as an illness is a very specific kind of being. It is this, I suggest, that raises difficulties in the case of MCI by contrast with the easier question of whether something is a genuine feature of human living in some other way. [End Page 21]From "normal" and "normative" to "correct" and "incorrect"Corner and Bond (2006) usefully suggest that the question of whether MCI is real is made more difficult by an ambiguity in the sense of the word normal. They suggest that although "physiologic and cognitive decline is assumed to be a normal experience" this still leaves "boundary problems" about "distinguishing normal aging from disease" (Corner and Bond 2006, 3–4). Thus, if the symptoms of MCI are continuous with the ordinary phenomena of physiologic and cognitive decline, then they might also be merely normal. But this does not settle the status of MCI because normal can mean either "normative, that is, usual; or it can mean nonpathologic" (Corner and Bond 2006, 4).On the assumption that MCI is at least continuous with phenomena that are normal, then its symptoms might be normal in the sense of usual but nevertheless pathologic: an inevitable illness. Or they might be usual and nonpathologic, that is, merely a feature of aging that, although regrettable, lacks the connotations of illness (e.g., the appropriateness, if not the possibility, of treatment). (In principle on the assumption in play—that the symptoms of MCI are normal—they might be unusual but nonpathologic akin, for example, to an improved ability to solve crosswords with age that might affect a small lucky proportion of the population. Perhaps such a crossword puzzler might be reassured by their doctor: "Well that is very unusual but there is no need to worry: it is not a symptom of any illness. You are perfectly normal.")Thus the question "Is MCI normal... (shrink)

We use a result due to Rolin, Speissegger, and Wilkie to show that definable sets in certain o-minimal structures admit definable parameterizations by mild maps. We then use this parameterization to prove a result on the density of rational points on curves defined by restricted Pfaffian functions.

Introduction Limited treatments for Mild Cognitive Impairment (MCI) highlight the need to explore innovations including Deep Brain Stimulation (DBS), with patient perspectives key to ethical protocol development.Methods Seven MCI patients and four care partners were interviewed (Feb 2023–Jan 2024) about daily MCI challenges, desired treatment outcomes, and views on DBS. Thematic analysis following COREQ guidelines identified key themes.Results DBS was a novel concept for all (7/7), and most expressed interest (6/7) despite concerns about invasiveness (6/7) and preference to exhaust (...) medications first (4/7). Care partners (4/4) shared concerns about invasiveness and emphasized proven efficacy. Key deciding factors included the involved procedural risk (6/7), desired significant outcomes (6/7), and prior testing for MCI (7/7). Most participants (6/7) were hesitant to be the first to try DBS, while one was willing.Conclusion Patient and care partner insights on DBS for MCI are crucial for balancing innovation with ethical, patient-centered research. (shrink)

Music-based interventions (MBI) have become increasingly widely adopted for dementia and related disorders. Previous research shows that music engages reward-related regions through functional connectivity with the auditory system, but evidence for the effectiveness of MBI is mixed in older adults with mild cognitive impairment (MCI) and Alzheimer’s disease (AD). This underscores the need for a unified mechanistic understanding to motivate MBIs. The main objective of the present study is to characterize the intrinsic connectivity of the auditory and reward systems (...) in healthy aging individuals with MCI, and those with AD. Using resting-state fMRI data from the Alzheimer’s Database Neuroimaging Initiative, we tested resting-state functional connectivity within and between auditory and reward systems in older adults with MCI, AD, and age-matched healthy controls (N = 105). Seed-based correlations were assessed from regions of interest (ROIs) in the auditory network (i.e., anterior superior temporal gyrus, posterior superior temporal gyrus, Heschl’s Gyrus), and the reward network (i.e., nucleus accumbens, caudate, putamen, and orbitofrontal cortex). AD individuals were lower in both within-network and between-network functional connectivity in the auditory network and reward networks compared to MCI and controls. Furthermore, graph theory analyses showed that the MCI group had higher clustering and local efficiency than both AD and control groups, whereas AD individuals had lo... (shrink)

Background: Mild traumatic brain injury results from an external force to the head or body causing neurophysiological changes within the brain. The number and severity of symptoms can vary, with some individuals experiencing rapid recovery, and others having persistent symptoms for months to years, impacting their quality of life. Current rehabilitation is limited in its ability to treat persistent symptoms and novel approaches are being sought to improve outcomes following mTBI. Neuromodulation is one technique used to encourage adaptive neuroplasticity (...) within the brain.Objective: To systematically review the literature on the efficacy of neuromodulation in the mTBI population.Method: A systematic review was conducted using Medline, Embase, PsycINFO, PsycARTICLES and EBM Review. Preferred Reporting Items for Systematic Reviews and the Synthesis Without Meta-analysis reporting guidelines were used and a narrative review of the selected studies was completed. Fourteen articles fulfilled the inclusion criteria which were published in English, investigating an adult sample and using a pre- and post-intervention design. Studies were excluded if they included non-mild TBI severities, pediatric or older adult populations.Results: Thirteen of fourteen studies reported positive reductions in mTBI symptomatology following neuromodulation. Specifically, improvements were reported in post-concussion symptom ratings, headaches, dizziness, depression, anxiety, sleep disturbance, general disability, cognition, return to work and quality of life. Normalization of working memory activation patterns, vestibular field potentials, hemodynamics of the dorsolateral prefrontal cortex and excessive delta wave activity were also seen. The studies reviewed had several methodological limitations including small, heterogenous samples and varied intervention protocols, limiting generalisability. Further research is required to understand the context in which neuromodulation may be beneficial.Conclusions: While these positive effects are observed, limitations included unequal representation of neuromodulation modalities in the literature, and lack of literature describing the efficacy of neuromodulation on the development or duration of persistent mTBI symptoms. Better clarity regarding neuromodulation efficacy could have a significant impact on mTBI patients, researchers, clinicians, and policy makers, facilitating a more productive post-mTBI population. Despite the limitations, the literature indicates that neuromodulation warrants further investigation. PROSPERO registration number: CRD42020161279. (shrink)