End-of-life decision-making in patients with dementia is a complex topic. Belgium and the Netherlands have been at the forefront of legislative advancement and progressive societal changes concerning the perspectives toward physician-assisted death (PAD). Careful consideration of clinical and social aspects is essential during the end-of-life decision-making process in patients with dementia. Geriatric assent provides the physician, the patient and his family the opportunity to end life with dignity. Unbearable suffering, decisional competence, and awareness of memory deficits are among the clinical (...) considerations that physicians should incorporate during the end-of-life decision-making process. However, as other societies introduce legislature granting the right of PAD, new social determinants should be considered; Mexico City is an example. Current perspectives regarding advance euthanasia directives (AED) and PAD in patients with dementia are evolving. A new perspective that hinges on the role of the family and geriatric assent should help culturally heterogeneous societies in the transition of their public health care policies regarding end-of-life choices. (shrink)

The main current application of placebo is in clinical research. The term placebo effect refers to diverse non-specific, desired or non-desired effects of substances or procedures and interactions between patient and therapist. Unpredictability of the placebo effect necessitates placebo-controlled designs for most trials. Therapeutic and diagnostic use of placebo is ethically acceptable only in few well-defined cases. While "therapeutic" application of placebo almost invariably implies deception, this is not the case for its use in research. Conflicts may exist between the (...) therapist's Hippocratic and scientific obligations. The authors provide examples in neuropsychiatry, illustrating that objective scientific data and well-considered guidelines may solve the ethical dilemma. Placebo control might even be considered an ethical obligation but some provisos should be kept in mind: (a) no adequate therapy for the disease should exist and/or (presumed) active therapy should have serious side-effects; (b) placebo treatment should not last too long; (c) placebo treatment should not inflict unacceptable risks, and (d) the experimental subject should be adequately informed and informed consent given. (shrink)

One of the main limitations of natural language‐based approaches to meaning is that they do not incorporate multimodal representations the way humans do. In this study, we evaluate how well different kinds of models account for people's representations of both concrete and abstract concepts. The models we compare include unimodal distributional linguistic models as well as multimodal models which combine linguistic with perceptual or affective information. There are two types of linguistic models: those based on text corpora and those derived (...) from word association data. We present two new studies and a reanalysis of a series of previous studies. The studies demonstrate that both visual and affective multimodal models better capture behavior that reflects human representations than unimodal linguistic models. The size of the multimodal advantage depends on the nature of semantic representations involved, and it is especially pronounced for basic‐level concepts that belong to the same superordinate category. Additional visual and affective features improve the accuracy of linguistic models based on text corpora more than those based on word associations; this suggests systematic qualitative differences between what information is encoded in natural language versus what information is reflected in word associations. Altogether, our work presents new evidence that multimodal information is important for capturing both abstract and concrete words and that fully representing word meaning requires more than purely linguistic information. Implications for both embodied and distributional views of semantic representation are discussed. (shrink)

People undergo many idiosyncratic experiences throughout their lives that may contribute to individual differences in the size and structure of their knowledge representations. Ultimately, these can have important implications for individuals' cognitive performance. We review evidence that suggests a relationship between individual experiences, the size and structure of semantic representations, as well as individual and age differences in cognitive performance. We conclude that the extent to which experience-dependent changes in semantic representations contribute to individual differences in cognitive aging remains unclear. (...) To help fill this gap, we outline an empirical agenda that utilizes network analysis and involves the concurrent assessment of large-scale semantic networks and cognitive performance in younger and older adults. We present preliminary data to establish the feasibility and limitations of such empirical, network-analytical approaches. (shrink)

This article reviews the Dutch societal debate on euthanasia/assisted suicide in dementia cases, specifically Alzheimer's disease. It discusses the ethical and practical dilemmas created by euthanasia requests in advance directives and the related inconsistencies in the Dutch legal regulations regarding euthanasia/assisted suicide. After an initial focus on euthanasia in advanced dementia, the actual debate concentrates on making euthanasia/assisted suicide possible in the very early stages of dementia. A review of the few known cases of assisted suicide of people with so-called (...) early dementia raises the question why requests for euthanasia/assisted suicide from patients in the early stage of Alzheimer's disease are virtually non-existent. In response to this question two explanations are offered. It is concluded that, in addition to a moral discussion on the limits of anticipatory choices, there is an urgent need to develop research into the patient's perspective with regard to medical treatment and care-giving in dementia, including end-of-life care. (shrink)