Personal Identity, Neuroprosthetics, and Alzheimer’s Disease

Author(s):  
Fabrice Jotterand

This chapter examines the implications of the use of neuroprosthetics such as artificial hippocampi or neurostimulation techniques for the understanding of personal identity in patients with Alzheimer’s disease (AD): first, regarding a conceptualization of personal identity based on psychological continuity (memory), and second, according to a conceptualization of personal identity based on psychological continuity (memory) and embodiment. This chapter provides an overview of the various stages of AD, including how the disorder impacts people’s memory capabilities and personality and generates behavioral changes. It focuses on neuroprosthetics as a technique to help patients in the early stages of AD to compensate for lost neural functionality and cognitive abilities. It also critically examines the concept of personal identity through the work of John Locke and Derek Parfit and provide an alternative account called bio-psycho-somatic unity. Finally, the chapter offers an ethical framework for the care of patients with AD who experience identity loss that includes the preservation or restoration of psychological continuity, the acknowledgment of an embodied identity, and the necessity of a relational narrative.

2014 ◽  
Author(s):  
Joseph P. Barsuglia ◽  
Michelle J. Mather ◽  
Hemali V. Panchal ◽  
Aditi Joshi ◽  
Elvira Jimenez ◽  
...  

2021 ◽  
Vol 80 (2) ◽  
pp. 749-759
Author(s):  
Albert Lladó ◽  
Lutz Froelich ◽  
Rezaul K. Khandker ◽  
Montserrat Roset ◽  
Christopher M. Black ◽  
...  

Background: There exists considerable variation in disease progression rates among patients with Alzheimer’s disease (AD). Objective: The primary objective of this observational study is to assess the progression of AD by characterizing cognitive, functional, and behavioral changes during the follow-up period between 6 and 24 months. Methods: A longitudinal prospective study with community-dwelling patients with an established clinical diagnosis of AD of mild to moderate severity was conducted in Germany, Spain and the UK. A sample of 616 patients from 69 sites was included. Results: Patients had a mean of 1.9 years (SD = 1.9) since AD diagnosis at study inclusion. Cognitive symptoms were reported to have first occurred a mean of 1.1 years (SD = 1.7) prior to AD diagnosis and 1.4 (SD = 1.8) years prior to AD treatment. Patients initially diagnosed with mild and moderate AD spent a median (95%CI) of 3.7 (2.8; 4.4) and 11.1 (6.1, ‘not reached’) years until progression to moderate and severe AD, respectively, according to the Mini-Mental State Examination (MMSE) scores. A mixed model developed for cognitive, functional, and neuropsychiatric scores, obtained from study patients at baseline and during follow-up period, showed progressive deterioration of AD patients over time. Conclusion: The study showed a deterioration of cognitive, functional, and neuropsychiatric functions during the follow-up period. Cognitive deterioration was slightly faster in patients with moderate AD compared to mild AD. The duration of moderate AD can be overestimated due to the use of retrospective data, lack of availability of MMSE scores in clinical charts and exclusion of patients at time of institutionalization.


2013 ◽  
Vol 7 (2) ◽  
pp. 197-205 ◽  
Author(s):  
Corina Satler ◽  
Carlos Tomaz

ABSTRACT Anosognosia, impairment insight and unawareness of deficits are used as equivalent terms in this study. Objective: To investigate the relationship between the presence of anosognosia symptoms and cognitive domains, functional abilities, and neuropsychiatric symptoms in patients with probable Alzheimer's disease (pAD) and elderly controls (EC). Methods: Twenty-one pAD (14 women) and twenty-two EC (16 women) were submitted to a neuropsychological battery of tests assessing global cognitive status, and specific cognitive functions: memory, executive and attention functions, verbal fluency and visuoconstructive abilities. Additionally, functional abilities (FAQ) and neuropsychiatric symptoms (NPI) were measured. Results: The linear regression statistical test found general anosognosia to be associated with subjective memory complaints, age and Arithmetic-DRS in the EC group. On the other hand, cognitive and functional abilities scores (Arithmetic- DRS, IQCODE and FAQ) were the best predictors in pAD patients, particularly for behavioral awareness. Conclusion: These results indicated that different variables are associated with self-awareness for pAD patients and EC, but for both groups executive functions appear to play an important role, contributing particularly to awareness of behavioral changes.


Author(s):  
Hanna Maria Elonheimo ◽  
Helle Raun Andersen ◽  
Andromachi Katsonouri ◽  
Hanna Tolonen

Alzheimer’s disease (AD) is the most common form of dementia, prevalent in approximately 50–70% of the dementia cases. AD affects memory, and it is a progressive disease interfering with cognitive abilities, behaviour and functioning of the person affected. In 2015, there were 47 million people affected by dementia worldwide, and the figure was estimated to increase to 75 million in 2030 and to 132 million by 2050. In the framework of European Human Biomonitoring Initiative (HBM4EU), 18 substances or substance groups were prioritized for investigation. For each of the priority substances, a scoping document was prepared. Based on these scoping documents and complementary review of the recent literature, a scoping review of HBM4EU-priority substances which might be associated with AD was conducted. A possible association between risk of AD and pesticides was detected. For mercury (Hg), association is possible but inconsistent. Regarding cadmium (Cd) and arsenic (As), the results are inconsistent but inclined towards possible associations between the substances and the risk of disease. The evidence regarding lead (Pb) was weaker than for the other substances; however, possible associations exist. Although there is evidence of adverse neurological effects of environmental substances, more research is needed. Environmental chemical exposure and the related hazards are essential concerns for public health, and they could be preventable.


Antioxidants ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 1664
Author(s):  
Marika Cordaro ◽  
Angela Trovato Salinaro ◽  
Rosalba Siracusa ◽  
Ramona D’Amico ◽  
Daniela Impellizzeri ◽  
...  

Alzheimer’s disease (AD) is the principal cause of dementia, and its incidence increases with age. Altered antioxidant systems and inflammation have an important role in the etiology of neurodegenerative disorders. In this study, we evaluated the effects of Hericium erinaceus, a nutritional mushroom with important antioxidant effects, in a rat model of AD. Animals were injected with 70 mg/Kg of AlCl3 daily for 6 weeks, and Hericium erinaceus was administered daily by gavage. Before the experiment’s end date, behavioral test training was performed. At the end of the study, behavioral changes were assessed, and the animals were euthanized. Brain tissues were harvested for further analysis. AlCl3 mainly accumulates in the hippocampus, the principal region of the brain involved in memory functions and learning. Hericium erinaceus administration reduced behavioral changes and hippocampal neuronal degeneration. Additionally, it reduced phosphorylated Tau levels, aberrant APP overexpression, and β-amyloid accumulation. Moreover, Hericium erinaceus decreased the pro-oxidative and pro-inflammatory hippocampal alterations induced by AD. In particular, it reduced the activation of the NLRP3 inflammasome components, usually activated by increased oxidative stress during AD. Collectively, our results showed that Hericium erinaceus has protective effects on behavioral alteration and histological modification associated with AD due to the modulation of the oxidative and inflammatory pathways, as well as regulating cellular brain stress.


2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Davide Quaranta ◽  
Camillo Marra ◽  
Concettina Rossi ◽  
Guido Gainotti ◽  
Carlo Masullo

Apathy is one of the most common behavioral symptoms of dementia; it is one of the salient features of behavioral variant of frontotemporal dementia (bvFTD) but is also very frequent in Alzheimer's disease. This preliminary investigation was aimed at assessing the type of apathy-related symptoms in a population of bvFTD and AD subjects showing comparable apathy severity. Each patient underwent a comprehensive neuropsychological assessment; behavioral changes were investigated by the neuropsychiatric inventory (NPI), using the NPI-apathy subscale to detect apathetic symptoms. At univariate analysis, bvFTD subjects showed lack of initiation (χ2=4.602,p=0.032), reduced emotional output (χ2=6.493,p=0.008), and reduced interest toward friends and family members (χ2=4.898,p=0.027), more frequently than AD subjects. BvFTD displayed higher scores than AD on NPI total score (p=0.005) and on subscales assessing agitation (p=0.004), disinhibition (p=0.007) and sleep disturbances (p=0.025); conversely, AD subjects were more impaired on memory, constructional abilities, and attention. On multivariate logistic regression, reduced emotional output was highly predictive of bvFTD (OR=18.266;p=0.008). Our preliminary findings support the hypothesis that apathy is a complex phenomenon, whose clinical expression is conditioned by the site of anatomical damage. Furthermore, apathy profile may help in differentiating bvFTD from AD.


Author(s):  
Lovingly Quitania Park ◽  
Britt Busson

The loss of independence is a quintessential feature of dementia and important to the clinical diagnosis of Alzheimer's disease (AD). However, changes in memory and other cognitive abilities can significantly influence the rate and the trajectory of decline in everyday life. The goal of this chapter is to provide the reader with a picture of how the cognitive and emotional changes associated with AD can alter daily living in the early-to-moderate stages and the subsequent psychosocial impacts. Practical suggestions with regard to management of AD by the affected individual and supporters are offered, as are some suggestions for addressing completion of daily tasks, such as finances, medications, appointments, and transportation.


Author(s):  
Marya Schechtman

While many areas of philosophy are concerned with issues of personal identity, the investigation most usually referred to as ‘the problem of personal identity’ within analytic philosophy centers on the question of what makes individuals at different times the same person. This is a complex and difficult question because we change a great deal over the course of our lives. A woman of 50, for instance, is made up of largely different matter from her ten-year-old self, and looks quite different. Her beliefs, desires, and values have probably changed a great deal; she has a host of memories and relationships that her ten-year-old self did not have, and she fills quite different social roles. Despite all of this we might unequivocally judge that the woman before us is the same person as the ten-year-old. Philosophers of personal identity seek to describe what it is that constitutes the identity of the fifty-year-old and the ten-year-old (if they are indeed identical). As it is usually conceived, the question of personal identity is a metaphysical question and not an epistemological question. Rather than asking how we know when someone at one time is identical to someone at another time, it asks what it is that actually makes it the case that they are the same. This question is also a question of numerical identity rather than qualitative or psychological identity; it is about the relation that makes something the self-same entity over time rather than about what makes entities indistinguishably similar to one another (see Identity). This last distinction is important to make because in everyday speech talk of personal identity is often connected to questions about what someone truly believes or desires, or what is fundamentally important to them, and not about what makes them a single entity. Everyday talk of identity is thus connected to judgments about similarity of character or personality. Historically, there have been three main approaches to addressing the metaphysical question about the numerical identity of persons over time. One defines identity in terms of the continuation of a single immaterial substance or soul; one in terms of psychological continuity; and one in terms of bodily or biological continuity, although there have been several other approaches offered as well. All of these accounts have had their adherents, and all have their difficulties. The bulk of philosophical discussion of personal identity during the late twentieth and early twenty-first centuries has focused on the relative merits of psychological and biological approaches. For most of this period psychological accounts were dominant. These views, inspired by John Locke, hold that a person at time t2 is the same as a person at earlier time t1 just in case there is an overlapping chain of psychological connections (memories, beliefs, desires, etc.) between the person at t2 and the person at t1. They have a great deal of intuitive appeal, capturing the widely held sense that if biological and psychological continuity were to diverge, the person would go where the psychological life goes, but they have also been subject to some important objections. Many of these are related to the fact that psychological continuity does not have the same logical form as identity. For instance, a person existing now could in principle be psychologically continuous with two people in the future, but cannot be identical to both of them since they are not identical to each other. Toward the end of the twentieth century, biological accounts of identity re-emerged with new vigour, mounting a serious challenge to the dominance of psychological accounts. Defenders of the biological approach say that we are, most fundamentally, human animals who persist as long as a single human organism does. The biological approach allows that psychological continuity may be of tremendous importance to us, and that we may identify with our psychological states, but insists this continuity is no part of what determines our literal persistence as single entities. Biological theorists point out that if we think of persons as entities distinct from human animals we will be left with a number of awkward questions about the relation between persons and animals, making psychological continuity theories deeply implausible. In response, defenders of the psychological approach have argued that biological accounts suffer from many of the same deficits with which they charge psychological theories. A metaphysical view in which persons are constituted by human animals has also been offered to show a way in which a psychological account of identity can avoid the difficulties with explaining the relation of persons to human animals uncovered by animalists. As the debate between animalists and psychological theorists has continued, a variety of other views have been put forward, including narrative accounts of identity and minimalist accounts which place identity in the continuation of bare sentience. Over time a number of interesting general questions.


2010 ◽  
Vol 23 (2) ◽  
pp. 333-334
Author(s):  
V M Aziz ◽  
J. Yagoub ◽  
K. Saba ◽  
M. Asaad

Alzheimer's disease (AD) manifests clinically with an insidious onset and slow but progressive cognitive impairment. The clinical picture of AD can be classified into cognitive and behavioral changes. The initial deficit usually manifests as an amnesic syndrome which may progress very gradually for several years before impairment in other cognitive domains, such as language, semantic memory and visuospatial function, becomes apparent (Hodges and Patterson, 1995).


2020 ◽  
Vol 26 (10) ◽  
pp. 963-977
Author(s):  
Olivia P. Demichelis ◽  
Sarah P. Coundouris ◽  
Sarah A. Grainger ◽  
Julie D. Henry

AbstractObjective:A large literature now shows that Alzheimer’s disease (AD) disrupts a number of social cognitive abilities, including social perceptual function and theory of mind (ToM). However, less well understood is how the specific subcomponents of ToM as well as both the broader and specific subcomponents of empathic processing are affected.Method:The current study provides the first meta-analytic review of AD that focuses on both empathy and ToM as broad constructs, as well as their overlapping (cognitive empathy and affective ToM) and distinct (affective empathy and cognitive ToM) subcomponents.Results:Aggregated across 31 studies, the results revealed that, relative to controls, AD is associated with large-sized deficits in both cognitive ToM (g = 1.09) and affective ToM/cognitive empathy (g = 0.76). However, no statistical differences were found between the AD participants and controls on affective empathic abilities (g = 0.36).Conclusions:These data point to a potentially important disconnect between core aspects of social cognitive processing in people with AD. The practical and theoretical implications of these findings are discussed.


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