In lieu of an abstract, here is a brief excerpt of the content:Reifying Relevance in Mild Cognitive Impairment:An Appeal for Care and CautionJanice E. Graham (bio) and Karen Ritchie (bio)KeywordsAlzheimer’s disease, construction, dementia, market forces, mild cognitive impairmentWe thank the reviewers for their thoughtful comments that probe shadowy areas in our argument, and we welcome this opportunity to elucidate our position. First, we are not repudiating the natural and social facts of pathologic brain degeneration and the physical and cognitive (...) impairments that manifest in people affected by dementia disorders. We are, however, questioning the epistemology, politics, and persistence by some to harden the construct of mild cognitive impairment (MCI) prematurely as a "natural" precursor to dementia. We suggested insufficiencies in viewing MCI as prodromal to Alzheimer's disease (AD; Graham and Ritchie 2006, 36), and pointed to evidence for the prognostic irrelevance of some MCI subcategories (35). The commentators have read our manuscript as suggesting that AD and MCI are different kinds, and that a diagnosis of AD is more "real" than that of MCI. But AD is also fraught with classification issues, as we describe in the section of our paper that deals with consensus committees, published practice guidelines, and the determination of treatment efficacy. Like MCI, AD is a heterogeneous condition, but unlike MCI, AD is a constructed practical kind that does some "work" beyond essentialist (neural degeneration, brain atrophy) claims. Its criteria identify people with well-defined dementia symptoms and multiple cognitive and functional impairments who are in need of, and benefit from, support. Even with these criteria, however, there have been great attempts to achieve definitional accuracy in dementia diagnoses. Practical refinements to the differential diagnosis of dementia based on solid research evidence have made way for more specific recognitions of vascular dementias, dementia of the Lewy body type, and other subtypes beyond AD. So AD too has been subject to more careful, more cautious operationalization in recent years, with research supporting multiple factors and the comorbidity of several types (kinds) of dementia in any one individual.Our paper takes up concerns that are not resolved for dementia and suggests that the nascent category of MCI is still so insufficiently defined as to be ambiguous, and as such, is in danger of identifying individuals with what will be, and has [End Page 57] already been, linked to a debilitating and deeply stigmatizing and fatal disorder (AD). We are not contesting the reality that some people begin to display early signs of cognitive loss, nor are we suggesting that symptoms be ignored; as researchers, we stand behind the careful tracking of symptoms and signs in patients and research participants as an essential clinical and research practice. In a era where the public has been made wary of the potentially fatal effects of new treatments whose more careful scrutiny in specific populations would have saved lives (e.g., Fontanarosa, Rennie, and DeAngelis 2004; Psaty and Furberg 2005), and made all the more popular by what Kramer coined "diagnostic bracket creep" (1993, 15), we are questioning the drivers and value of a premature diagnostic classification whose definitional accuracy is neither sufficient nor effective for specific identification of individuals.That matters of fact are constructed does not take away from their natural fact. Some people have subjective reports or show objective evidence of cognitive decline while having preserved activities of daily living—the construction of this evidence indicates they are not normal and they are not demented. Based on such evidence, where then does the balance of probability for MCI lie? A multidisciplinary international group of experts gathered in Stockholm in 2003 to discuss MCI concepts (Winblad et al. 2004). They acknowledged that the heterogeneous etiology of MCI contributes to "some confusion concerning the specific boundaries of the condition", stating that this "not normal, not demented" condition is nonetheless "useful both clinically and as a research entity" (p. 241). Importantly, they concluded that MCI needs "better definition" (p. 246). It was at this stage that we first wrote our manuscript, and in the subsequent two years we have eagerly awaited new studies, and the recognition of flexible, practical subtypes to evolve.We state "that MCI cannot be considered to be a separate clinical entity" (Graham and... (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)

Social groups—like teams, committees, gender groups, and racial groups—play a central role in our lives and in philosophical inquiry. Here I develop and motivate a structuralist ontology of social groups centered on social structures (i.e., networks of relations that are constitutively dependent on social factors). The view delivers a picture that encompasses a diverse range of social groups, while maintaining important metaphysical and normative distinctions between groups of different kinds. It also meets the constraint that not every arbitrary collection of (...) people is a social group. In addition, the framework provides resources for developing a broader structuralist view in social ontology. (shrink)

Predicate nominals (e.g., “is a female”) seem to label or categorize their subjects, while their adjectival correlates (e.g., “is female”) merely attribute a property. Predicate nominals also elicit essentializing inferential judgments about inductive potential and stable explanatory membership. Data from psychology and semantics support that this distinction is robust and productive. I argue that while the difference between predicate nominals and predicate adjectives is elided by standard semantic theories, it ought not be. I then develop and defend a psychologically motivated (...) semantic account on which predicate nominals attribute kind membership and trigger a presupposition that underpins our essentialist judgments. (shrink)

We start with an observation about implicit quantifier domain restriction: certain implicit restrictions (e.g., restricting objects by location and time) appear to be more natural and widely available than others (e.g., restricting objects by color, aesthetic, or historical properties). Our aim is to explain why this is. That is, we aim to explain why some implicit domain restriction possibilities are available by default. We argue that, regardless of their other explanatory virtues, extant pragmatic and metasemantic frameworks leave this question unanswered. (...) We then motivate a partially nativist account of domain restriction that involves a minimal view of joint planning around broad shared goals about navigating and influencing our environments augmented with cognitive heuristics that facilitate these. Finally, we sketch how the view can be extended to account for the ways non-default restriction possibilities become available when conversationalists have shared idiosyncratic goals. (shrink)

Polysemy is a phenomenon involving single lexical items with multiple related senses. Much theorizing about it has focused on developing linguistic accounts that are responsive to various compositional and representational challenges in semantics and psychology. We focus on an underexplored question: Why does systematic polysemy cluster in the ways it does? That is, why do we see certain regular patterns of sense multiplicity, but not others? Drawing on an independently motivated view of kind cognition – i.e. the formal structures for (...) different classes of kind representations – we argue for an answer centered on conceptual individuation. Specifically, we argue that classes of kind concepts vary in what they individuate (i.e. counting as one and specifying what makes it the same or different from others). By elucidating these differences, we can explain why a range of patterns of systematic polysemy are found cross-linguistically and why other patterns are not attested. Overall, our account provides an explanatory framework addressing an important question at the interface between language and mind and opens new avenues for future theoretical and empirical research. (shrink)

Conceptual integration theory (Fauconnier & Turner, 1998, 2002) is re-examined in the light of recent criticisms (e.g., Gibbs, 2000, 2001). It is argued that the assumption of four independent "cognitive spaces" enters the model primarily as an entailment of the "space," "blending," and "construction" metaphors, leads to unnecessary ambiguity, and works against statement of the theory in a form that supports derivation of testable hypotheses. Several examples from Fauconnier and Turner (2002) are analyzed to show that they can be interpreted (...) more simply, without need of four separate "spaces." Suggestions are made for reformulating conceptual integration theory without the problematic metaphors. (shrink)

Introduction: All is trash that reason cannot reach : unenlightened writers and the postmodern world -- Learning to read, learning to listen in Robinson Crusoe -- The hymns of Isaac Watts and postmodern worship : aesthetic knowledge as a response to the Enlightenment critique of religion -- Jonathan Swift's information machine and the critique of technology -- Christopher Smart's poetry and the dialogue between science and theology -- Festival and discipline in revolutionary France and postmodern times -- Remembering things past (...) : tradition as a way of knowing in Edmund Burke and Hans-Georg Gadamer -- Reconciling the heart with the head : the poetry of William Cowper and the thought of Michael Polanyi. (shrink)