Prospective Evaluation of Predictive DNA Testing for Huntington’s Disease in a Large German Center

We present a prospective study of counselees seeking predictive testing for Huntington’s disease at the Huntington Center North Rhine-Westphalia (Bochum, Germany) between 2010 and 2012. The aim was to observe the decision-making process of at-risk individuals and explore their experiences following the decision as well as the impacts of positive and negative mutation results. Data were collected using two standardized questionnaires as well as via a semi-standardized telephone interview one year after the initial counseling session. Seventy-two  individuals participated in at least one of the three phases of the survey, including 31 individuals in the telephone interview. Sociodemographic data were in accordance with previous reports. The process of predictive testing was generally perceived in a positive manner, with almost all interviewees reporting a balanced emotional state one year after initial counseling, regardless of the decision for or against the test. The most important reasons named in favor of or against testing were assembled as well as different aspects regarding the satisfaction with the reached decision. In line with and expanding previous observations on gender-related differences in decision-making, our results suggest that gender-related aspects should be more strongly taken into account in genetic counseling during the predictive testing and counseling processes.     

Parkinson’s Disease: Patients’ Knowledge,Attitudes, and Interest in Genetic Counseling

The objective of this study was to assess the genetics knowledge of patients with Parkinson’s disease (PD), and to explore their attitudes on genetic testing and interest in genetic counseling. We surveyed 158 patients from the University of Maryland Parkinson’s Disease and Movement Disorders Center. Patients averaged a score of 63% on general genetics knowledge and 73% on PD genetics knowledge. Participants had an overall positive attitude toward genetic testing: 80% believed that the use of genetic tests among people should be promoted, and 83% would undertake genetic test for PD if it was available. Patients reported a high interest to discuss the benefits, risks, and impacts of genetic testing for PD (mean sum score?=?26, range?=?9–35), and 43% patients expressed interest in meeting with a genetic counselor. Multivariate regression analysis showed that patients who had more positive attitudes toward genetic testing for PD were more interested in meeting with a genetic counselor (β?=?0.6, p?<?0.001). This study is the first to demonstrate an interest in genetic counseling among patients with PD. Our findings demonstrate a new niche for genetic counselors to support patients in clarifying gaps or misconceptions in knowledge about PD genetics as well as the possible risks, benefits, and limitations of genetic testing.     

Couples’ Attributions for Work Function Changes in Prodromal Huntington Disease

People who have tested positive for the expanded Huntington disease (HD) gene who are not yet diagnosed (pre-HD) and their companions report subtle changes in ability of people with pre-HD to do their jobs. However, it is not known whether they attribute these changes to HD. Semi-structured telephone interviews were analyzed from seven persons with pre-HD at different estimated points from diagnosis and six companions. Data were analyzed using qualitative analysis methods. Participants made attributions related to health, work, and temperament. Only one participant attributed a change to HD. The process of forming attributions was demonstrated through symptom monitoring and comparison of participants with pre-HD to others with and without HD. Participants also expressed uncertainty regarding how to make attributions. Attributions influence coping procedures, including whether to seek and accept medical treatment. In persons with prodromal HD the relationship between attributions and use of coping strategies for symptoms that interfere with job functioning is unknown.     

Beyond Theory: Martin Buber’s I and Thou and the Role of Contemplation in Integrated Relational Counseling

The current paradigm in mental health practice does not completely protect practitioners from theory-induced blindness. Many clinicians continue to rely on stable theoretical frameworks, which, although helpful, can become a hindrance to integrated relational practice. Overreliance on a particular theory or set of techniques can prevent clinicians from adopting a genuinely relational orientation. This article describes the nature of the contemplative-relational orientation using concepts from Martin Buber’s I and Thou and proposes that clinicians wishing to build competency in integrated relational counseling may benefit from contemplative prayer, meditation, and other mindfulness practices. A clinical vignette is provided and illustrates general features of an integrated relational approach, and empirical evidence is advanced to support the benefits of contemplative practice for mental health practitioners.     

Eye-Hand Coordination in Aging and in Parkinson’s Disease

Aiming movements to defined target positions were performed as fast and as accurately as possible by younger and older subjects and by patients in the early stages of Parkinson's disease (PD). Movement time and accuracy were tested in two conditions: with and without a centre cue. Older subjects exhibited slower movement time relative to the younger subjects only when the centre cue was present suggesting inefficient feedback processing. The performance of patients with PD was found to be as precise as that of older subjects. The movements of PD subjects, however, were slower in both conditions. Finally, the performance of subjects improved over trials. The data suggest that there is no difference in the nature of the control processes used by older and early-stage PD subjects, but that there is a reduction in the speed of these processes in PD.     

At-Risk Marriages after Compulsory Premarital Testing and Counseling for β-Thalassemia and Sickle Cell Disease in Saudi Arabia, 2005–2006

Results from a screening program for sickle cell disease and β-thalassemia suggest about 90% of couples in Saudi Arabia at risk of having affected children still decide to marry. This study determined the rate of at-risk marriages and identified several factors that may prevent at risk couples from marrying. The marriage status of 934 at-risk couples was determined from original screening program records in the Ministry of Health. Of 934 couples, 824 married (88.2%) and 110 (11.8%) did not. A case–controlled study was conducted on 104 couples who did not marry (cases) and 478 couples who did marry (controls) in order to assess relationships between various cultural and social factors and marriage decisions. In the case-controled study, 28.8% of couples (30/104) who did not marry (cases) knew their disease or carrier status before screening compared to 18% (86/478) of those who married (controls). Reasons couples gave for proceeding with marriage included: wedding plans could not be canceled, and fear of social stigma. Couples who did not marry reported being influenced by prior knowledge of their disease or carrier status and whether they or family members were affected. Approximately half of the cases and controls (n = 270, 46.4%) thought it best to undergo screening before proceeding with the engagement and wedding plans. Most couples received no advice to participate in genetic counseling services. Marriage decisions for the small number who received genetic counseling (n = 168, 27.6%) did not differ significantly from those that received no counseling. Recommendations are made for improving the effectiveness of this screening program.     

Cognitive Theory and Phenomenology in Arendt’s and Nussbaum’s Work on Narrative

In this essay I compare Nussbaum’s and Arendt’s approach to narrativity. The point of the comparison is to find out which approach is more adequate for practical philosophy: the approach influenced by cognitive theory (Nussbaum) or the one influenced by hermeneutic phenomenology (Arendt). I conclude that Nussbaum’s approach is flawed by methodological solipsism, which is due to her application of cognitive theory.

Differences Between African American and White Research Volunteers in Their Attitudes,Beliefs and Knowledge Regarding Genetic Testing for Alzheimer’s Disease

Genetic susceptibility testing for common diseases is expanding, but little is known about race group differences in test perceptions. The purpose of this study was to examine differences between African Americans and Whites in knowledge, attitudes, and motivations regarding genetic susceptibility testing for Alzheimer’s disease (AD). Before enrolling in an AD genetic testing research trial, 313 first-degree relatives of AD patients (20% African American; 71% female; mean age = 58 years) were surveyed regarding: (1) knowledge about genetics and AD risk; (2) concerns about developing AD; and (3) reasons for seeking testing. In comparison to Whites, African Americans were less knowledgeable about genetics and AD risk (p < .01) and less concerned about developing AD (p < .05), with lower levels of perceived disease risk (p = .04). The results suggest that African Americans and Whites differ notably in their knowledge, beliefs, and attitudes regarding genetic testing for AD. Additional research with more representative samples is needed to better understand these differences.     

Working Memory and Learning in Early Alzheimer’s Disease

Cognitive deficits associated with early Alzheimers disease (AD) have been recently operationalised in terms of an acquisition deficit and the research supporting this view is presented. However, there is still debate concerning the nature of this deficit and how underlying cognitive processes may be detrimentally affecting the ability to acquire new information in early AD. This review argues that the pattern of cognitive deficits contributing to the acquisition impairment in early AD patients may be readily interpreted within the context of a working memory model. Isolating the component processes of working memory that underlie the acquisition deficit in early AD patients will aid in the design of clinical applications that are focussed at enhancing the ability to acquire new information in everyday life.     

Testing Shneidman’s model of suicidality in incarcerated offenders and in undergraduates

Suicidality constitutes a major health issue for society in general and incarcerated populations in particular. Shneidman’s model of suicide proposes that psychache (i.e., intense psychological pain) is the pre-eminent psychological cause of suicidality and mediates the influence of all other psychological correlates such as depression or hopelessness. The current research evaluates Shneidman’s model for samples of 73 male federal offenders, 80 male undergraduates, and 80 female undergraduates. Consistent with Shneidman’s theory, psychache was both a significant and a more important statistical predictor of reported self-harming ideation and action than was either depression or hopelessness. Further, this relatively greater importance of psychache for the statistical prediction of suicidality was not moderated either by offender status or by sex. Overall, findings support the applicability of Shneidman’s model of suicidality to incarcerated individuals and indicate the model’s generalizability across sex and offender status.     

Memory for Music in Alzheimer’s Disease: Unforgettable?

The notion that memory for music can be preserved in patients with Alzheimer’s Disease (AD) has been raised by a number of case studies. In this paper, we review the current research examining musical memory in patients with AD. In keeping with models of memory described in the non-musical domain, we propose that various forms of musical memory exist, and may be differentially impaired in AD, reflecting the pattern of neuropathological changes associated with the condition. Our synthesis of this literature reveals a dissociation between explicit and implicit musical memory functions. Implicit, specifically procedural musical memory, or the ability to play a musical instrument, can be spared in musicians with AD. In contrast, explicit musical memory, or the recognition of familiar or unfamiliar melodies, is typically impaired. Thus, the notion that music is unforgettable in AD is not wholly supported. Rather, it appears that the ability to play a musical instrument may be unforgettable in some musicians with AD.     

Theory of mind and joint action in Parkinson’s disease

It has been suggested that the Theory of Mind (ToM) may rely on more basic processes of social cognition, such as action control (e.g., joint action), even if little is known about this relationship. The relationship between ToM and joint action can be studied in patients with Parkinson’s disease (PD), because they are characterized not only by a deficit in ToM (and in its cognitive and affective subcomponents) but also by a deficit in the inhibition of competing responses. Sixty PD patients and 60 matched healthy controls (HCs) performed a go/no-go Flanker task in both joint and individual conditions. Cognitive (Advanced Test or AT) and affective (Emotion Attribution Task or EAT) ToM also were measured. Thirty-five PD patients and matched HCs also performed the standard Flanker task, as a control measure. In patients, only individuals with high AT scores exhibited a joint Flanker effect, whereas in HCs the joint effect was found irrespectively of AT score. Patients with low EAT scores showed a greater interference effect than patients with high scores, whereas the opposite pattern was found for HCs. In regression analysis AT and EAT scores predicted the Flanker effect in the joint condition only. In the standard task, both groups showed a Flanker effect. The role of different fronto-striatal circuits, especially in PD patients, could explain the different involvement of cognitive and affective ToM in joint tasks. The Flanker effect is discussed considering the referential coding account and the attention-focus account as possible candidates to explain joint action effects.     

Political Theory and Linguistic Criteria in Han Feizi’s Philosophy

Han Feizi’s 韓非子 thought, I argue, contains a political theory that justifies principled, law-governed government. A key element of his theory is a solution to the problem of rectifying names. He recognized that the same word can have varying criteria of application depending on the purpose of the practice that requires a criterion. Some criteria for a practice are good and some bad. A wise ruler knows which criteria are good and appropriate to ruling. His view is illuminated by considering the phenomenon of paradiastole and a contemporary view about the relationship between meaning and criteria of application.     

Quasi-Realism and Inductive Scepticism in Hume’s Theory of Causation

Interpreters of Hume on causation consider that an advantage of the ‘quasi-realist’ reading is that it does not commit him to scepticism or to an error theory about causal reasoning. It is unique to quasi-realism that it maintains this positive epistemic result together with a rejection of metaphysical realism about causation: the quasi-realist supplies an appropriate semantic theory in order to justify the practice of talking ‘as if’ there were causal powers in the world. In this paper, I problematise the quasi-realist reading of Hume on causation by showing how quasi-realism does not speak to inductive scepticism. I also offer evidence that Hume takes inductive scepticism to result from his theory of causation, and that his scepticism is tied to his rejection of metaphysical causal realism.     

Very Early Decline in Recognition Memory for Odors in Alzheimer’s Disease

When in the progression of Alzheimer’s disease (AD) a decline in detection sensitivity and recognition memory for odors begins, and whether a fast progression in dementia is related to a fast loss in odor sensitivity, was determined by studying 78 patients with probable AD, categorized as very mild, mild, or moderate in degree of dementia, and 78 controls. Taste and vision were studied for comparison. Whereas the earliest decline in odor sensitivity and visual memory was found in mild patients, a decline in odor memory was found in the very mild patients. Similar taste thresholds in the four groups suggest that the poor odor detectability in AD was not related to task demands in threshold testing. A fast progression in dementia was also found to be related to a fast loss in odor sensitivity. The findings imply that memory-based olfactory tests may contribute to early diagnosis of AD.