Loss of insight is a prominent clinical manifestation of behavioral variant frontotemporal dementia , but its characteristics are poorly understood. Twelve bvFTD patients were compared with 12 Alzheimer’s disease patients on a structured insight interview of cognitive insight and emotional insight . Compared to the AD patients, the bvFTD patients were less aware and less concerned about their disorder, and they had less appreciation of its effects on themselves and on others. After corrective feedback , the bvFTD patients were just (...) as aware of their disorder as the AD patients but remained unconcerned and unappreciative of its effects. These findings suggest that lack of insight in bvFTD is not due to “anosognosia,” or impaired cognitive and executive awareness of disease, but to “frontal anosodiaphoria,” or lack of emotional concern over having bvFTD and its impact on themselves and others. (shrink)

As patient autonomy expands, a highly controversial issue has emerged. Should the advance directives of refusing life-saving treatments or requesting euthanasia of persons with dementia who express changed minds or are often in a happy state be fulfilled? There are two autonomy-related positions. The mainstream position in philosophical discussions supports the priority of ADs based on precedent autonomy. Buchanan and Brock, and Dworkin represent this view. The other position supports the priority of PWDs’ current wishes based on minimal autonomy represented (...) by Jaworska. By rethinking the theoretical and practical challenges of the two positions and their arguments respectively, the paper concludes that in such a scenario, the priority of ADs is morally indefensible, and it is also challenging to establish minimal autonomy defend the moral priority of PWDs’ current wishes. For PWDs whose past values, beliefs, and preferences fade away but who retain apparent intrinsic sentience of well-being, a modified defined quality-of-life approach serves as another reasonable basis in their medical decision-making, and the ADs and the QoL should be further merged to reduce the uncertainty of the grey zone. (shrink)

This paper reviews the literature concerning the neural correlates of the self, the relationship between self and memory and the profile of memory impairments in Alzheimer’s disease and explores the relationship between the preservation of the self and anosognosia in this condition. It concludes that a potential explanation for anosognosia in AD is a lack of updating of personal information due to the memory impairments characteristic of this disease. We put forward the hypothesis that anosognosia is due in part to (...) the “petrified self.”. (shrink)

In some neuropsychological disorders memory distortions seemingly fill gaps in people’s knowledge about their past, where people’s self-image, history, and prospects are often enhanced. False beliefs about the past compromise both people’s capacity to construct a reliable autobiography and their trustworthiness as communicators. However, such beliefs contribute to people’s sense of competence and self-confidence, increasing psychological wellbeing. Here we consider both psychological benefits and epistemic costs, and argue that distorting the past is likely to also have epistemic benefits that cannot (...) be obtained otherwise, such as enabling people to exchange information, receive feedback, and retain key beliefs about themselves. (shrink)

The Two Selves takes the position that the self is not a "thing" easily reduced to an object of scientific analysis. Rather, the self consists in a multiplicity of aspects, some of which have a neuro-cognitive basis (and thus are amenable to scientific inquiry) while other aspects are best construed as first-person subjectivity, lacking material instantiation. As a consequence of their potential immateriality, the subjective aspect of self cannot be taken as an object and therefore is not easily amenable to (...) treatment by current scientific methods. -/- Klein argues that to fully appreciate the self, its two aspects must be acknowledged, since it is only in virtue of their interaction that the self of everyday experience becomes a phenomenological reality. However, given their different metaphysical commitments (i.e., material and immaterial aspects of reality), a number of issues must be addressed. These include, but are not limited to, the possibility of interaction between metaphysically distinct aspects of reality, questions of causal closure under the physical, the principle of energy conservation. -/- After addressing these concerns, Klein presents evidence based on self-reports from case studies of individuals who suffer from a chronic or temporary loss of their sense of personal ownership of their mental states. Drawing on this evidence, he argues that personal ownership may be the factor that closes the metaphysical gap between the material and immaterial selves, linking these two disparate aspects of reality, thereby enabling us to experience a unified sense of self despite its underlying multiplicity. -/- . (shrink)

In this paper I argue that much of the confusion and mystery surrounding the concept of "self" can be traced to a failure to appreciate the distinction between the self as a collection of diverse neural components that provide us with our beliefs, memories, desires, personality, emotions, etc (the epistemological self) and the self that is best conceived as subjective, unified awareness, a point of view in the first person (ontological self). While the former can, and indeed has, been extensively (...) studied by researchers of various disciplines in the human sciences, the latter most often has been ignored -- treated more as a place holder attached to a particular predicate of interest (e.g., concept, reference, deception, esteem, image, regulation, etc). These two aspects of the self, I contend, are not reducible -- one being an object (the epistemological self) and the other a subject (the ontological self). Until we appreciate the difficulties of applying scientific methods and analysis to what cannot be reduced to an object of inquiry without stripping it of its essential aspect (its status as subject), progress on the "self", taken as a pluralistic construct, will continue to address only one part of the problems we face in understanding this most fundamental aspect of human experience. (shrink)

Patients suffering from the behavioral variant of Frontotemporal Dementia (FTD-b) often exaggerate their abilities. Are those errors in judgment limited to domains in which patients under-perform, or do FTD-b patients overestimate their abilities in other domains? Is overconfidence in FTD-b patients domain-specific or domain-general? To address this question, we asked patients at early stages of FTD-b to judge their performance in two domains (attention, perception) in which they exhibit relatively spared abilities. In both domains, FTD-b patients overestimated their performance relative (...) to patients with Dementia of Alzheimer Type (DAT) and healthy elderly subjects. Results are consistent with a domaingeneral deficit in metacognitive judgment. We discuss these findings in relation to “regression to the mean” accounts of overconfidence and the role of emotions in metacognitive judgments. (shrink)

Objective: Identifying the sources of personality development across the adult life span is a key issue of current personality research. The present dissertation investigates the long-term, mutual inter-relationships of personality traits with life satisfaction, constructs of health and different cognitive abilities. Guiding questions where: Can personality and its development be predicted by these different domains? Are these predictions sensitive to aging, namely the change from middle adulthood to old age? Method: Analyzes were based on data from the “Interdisciplinary Longitudinal Study (...) on Adult Development and Aging ”, a prospective German cohort study of mid adulthood and old age, longitudinally spanning across 12 years. Participants were recruited stratified by cohort, sex and region of residence. After 12 years the overall response rate was 76.7%. Personality traits were measured by the 60-item NEO-FFI inventory. Life satisfaction was assessed by a single-item measurement and health variables by an individual’s self-rating and an extensive physician-rating. Cognitive abilities were measured by a comprehensive test-battery of various well-established cognitive tests of different cognitive domains. Furthermore, gender, education and depression were used as control variables. In publication 1 and 2 multi-group cross-lagged panel analyses were used and in publication 3 multi-group dual latent change regression models were conducted. Results: The results of publication 1 suggest that there is only limited evidence of life satisfaction predicting the personality traits extraversion and neuroticism in later life. The path coefficients were small and only significant in the old cohort. Integrating health into the models weakened the inter-relationships. The results of publication 2 show that physician-rated health is an important predictor for the personality traits neuroticism, extraversion and agreeableness at later life. Self-rated health demonstrated to be more of an outcome measure of earlier personality in adulthood. There were no considerable cohort differences regarding the cross-lagged predictor paths. The results of publication 3 illustrate the important role of cognitive abilities as a predictor for 12-year personality changes in the personality traits neuroticism, extraversion and openness. Cohort differences, again, were limited. Conclusions: All in all, health and cognitive abilities are demonstrated to be important driving forces for following personality development in adulthood for all of the Big-Five personality traits, except conscientiousness. Physician-rated health was a particularly important predictor for later life neuroticism and agreeableness, while cognitive abilities proved to be important predictors for following personality changes in neuroticism, extraversion and openness. Life satisfaction is demonstrated to be more of an outcome than a predictor of later personality. Moreover, there were no effects of aging on the cross-relationships, highlighting the non-transient importance of the predictor domains across life span. Lastly, a differential perspective is highly recommended for future research, as the results appeared to depend highly on the personality trait and predictor considered. (shrink)