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The Alzheimer Conundrum

The Alzheimer Conundrum: Entanglements of Dementia and Aging

Margaret Lock
Copyright Date: 2013
Pages: 304
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  • Book Info
    The Alzheimer Conundrum
    Book Description:

    Because of rapidly aging populations, the number of people worldwide experiencing dementia is increasing and the projections are grim. Despite hundreds of millions of dollars invested in medical research, no effective treatment has been discovered for Alzheimer's disease, the most common form of dementia. The Alzheimer Conundrum exposes the predicaments embedded in current efforts to slow down or halt Alzheimer's disease through early detection of presymptomatic biological changes in healthy individuals.

    Based on a careful study of the history of Alzheimer's disease and extensive in-depth interviews with clinicians, scientists, epidemiologists, geneticists, and others, Margaret Lock highlights the limitations and the dissent implicated in this approach. She stresses that one major difficulty is the well-documented absence of behavioral signs of Alzheimer's disease in a significant proportion of elderly individuals, even when Alzheimer neuropathology is present in their brains. This incongruity makes it difficult to distinguish between what counts as normal versus pathological and, further, makes it evident that social and biological processes contribute inseparably to aging. Lock argues that basic research must continue, but it should be complemented by a realistic public health approach available everywhere that will be more effective and more humane than one focused almost exclusively on an increasingly frenzied search for a cure.

    eISBN: 978-1-4008-4846-1
    Subjects: Anthropology, History of Science & Technology, Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Acknowledgments
    (pp. ix-xii)
  4. Orientations
    (pp. 1-25)

    We live with a plethora of “epidemics”—obesity, diabetes, autism, prostate cancer, breast cancer, HIV/AIDS, child abuse, crime, and terrorism, to name a few. Among this multiplication of catastrophes, reports about a proliferating epidemic of Alzheimer disease are increasingly conspicuous in the media.

    In his book The Longevity Revolution Robert Butler, gerontologist, psychiatrist, and Pulitzer Prize winner, argues that one of the triumphs of the 20th century has been the dramatic increase in the numbers of people who live to old age, but he quickly adds that this has brought about an increase in the number of individuals suffering from...

  5. Chapter 1 Making And Remaking Alzheimer Disease
    (pp. 26-50)

    In January 2011 I attended a lecture delivered in an engaging manner in a Montréal hospital about pathbreaking basic science research in connection with amyloid plaques and neurofibrillary tangles, long thought to be diagnostic of Alzheimer disease. The lecture was given by an invited guest from Harvard University, Bradley Hyman, and took place in a room packed with young molecular biologists from diverse countries of origin, interspersed here and there with a few clinicians. In striking contrast to the majority of basic science lecturers who launch immediately into their specialized subject making use of the obligatory PowerPoint presentation, Dr. Hyman...

  6. Chapter 2 Striving to Standardize Alzheimer Disease
    (pp. 51-75)

    The historian of medicine Charles Rosenberg writes, “[T]he modern history of diagnosis is inextricably related to disease specificity, to the notion that diseases can and should be thought of as entities existing outside the unique manifestations of illness in particular men and women.”² Rosenberg adds, “Diagnosis labels, defines, and predicts and, in doing so, helps constitute and legitimate the reality that it discerns.”³ In elaborating on this “specificity revolution,” Rosenberg highlights, as have many other researchers writing about changes since the late 19th century, the way in which the medical world has with ever-increasing acceleration developed an array of technologies...

  7. Chapter 3 Paths to Alzheimer Prevention
    (pp. 76-99)

    The idea of being “predisposed” to an illness stems from the early 18th century, when discussion among medical practitioners and lay people alike about the “constitution” of individuals and its relation to disease vulnerability began to take place.² However, François Ewald, a political scientist, argues that the “philosophy of risk” as we understand it today is very much a product of contemporary society—a radical epistemological transformation involving a “mutation” in attitudes toward justice, responsibility, time, causality, and destiny.³ This transformation was part of a shift toward a secularized approach to life where “the ills that befall us lose their...

  8. Chapter 4 Embodied Risk Made Visible
    (pp. 100-131)

    At the 2010 Honolulu meeting of ICAD (International Conference on Alzheimer’s Disease), a news briefing was held on July 13 in which information that had previously been embargoed from release was first made public. The briefing stated that by 2009 a broad consensus had become apparent among experts working on dementia that the criteria for an AD diagnosis needed to be revised on the basis of scientific advances made in the field over the past quarter century. With this in mind, the National Institute on Aging (NIA) and the Alzheimer’s Association set up advisory meetings composed of individuals from both...

  9. Chapter 5 Alzheimer Genes: Biomarkers of Prediction and Prevention
    (pp. 132-155)

    In a 1997 article titled “Plundered Memories,” Zaven Khachaturian, then the director of the Ronald and Nancy Reagan Research Institute of the Alzheimer’s Association, and later director of the Office of Alzheimer Disease Research Center at NIH, wrote,

    Some critics ask whether genetic research is worth the resources it consumes and the anguish it will bring to those who test positive for a harmful gene—when a cure still seems so far away. In my view, however, the genetic approach is on the right track, and I think the continuing research on Alzheimer disease may soon confirm that belief. Those...

  10. Chapter 6 Genome-Wide Association Studies: Back to the Future
    (pp. 156-173)

    Polymorphisms—variations at a single DNA site or locus—are common in nature, and much more frequent in the human genome than had been anticipated prior to its mapping. They constitute the genetic basis for human variation and diversity.² The APOE polymorphic variation, the alleles ε2, ε3, and ε4, are clinally distributed, that is, they occur universally, but they do not everywhere have the same prevalence. And, as we have seen, it is well established that individuals with an 4 allele are at increased risk for AD under circumstances that are as yet poorly understood. Given that APOEε4 is neither...

  11. Chapter 7 Living with Embodied Omens
    (pp. 174-206)

    From time immemorial divination has been an integral part of the everyday lives of humankind. Whether its practice involves an examination of the entrails of sacrificed birds and animals, consultation with oracles in trance-like states, or sessions with one of any number of kinds of fortune-tellers, divination produces knowledge not readily available to ordinary people—knowledge that has the potential to incite action. Historical and anthropological research suggests that one objective of divinatory proceedings is to provide explanations for what has already taken place, for it is in the reconstruction of past events that causes of misfortune are uncovered and...

  12. Chapter 8 Chance Untamed and the Return of Fate
    (pp. 207-228)

    A two-day meeting titled “Alzheimer’s Disease Research Summit 2012: Path to Treatment and Prevention” was held at the National Institutes of Health in Washington in May of that year. The stated goal of the summit was to find effective prevention and treatment approaches for Alzheimer’s disease by 2025, and leading Alzheimer’s researchers from around the world were present to give presentations and discuss how this could effectively be carried out.² On the first day of the gathering Kathleen Sebelius, the secretary for Health and Human Services, emphasized that 16 million people (in the United States) will be affected with Alzheimer’s...

  13. Chapter 9 Transcending Entrenched Tensions
    (pp. 229-242)

    The preceding chapters have made clear that the interrelated tensions highlighted in the opening Orientations revolve to a greater or lesser degree around matters relating to ideas about AD causation. Is Alzheimer’s best modeled as though this condition is purely a “material” matter? In other words, does AD take hold and evolve entirely in the brain as a fully localized phenomenon? If yes, then efforts to treat this condition should be focused on the presumed molecular pathologies associated with the final common pathway(s) that result from the amyloid cascade hypothesis, or some modified version of it. This localized approach is...

  14. Afterword: Portraits from the Mind
    (pp. 243-246)

    I noted toward the end of the Orientations that opened this book that I would not be able, for reasons of space, to give more than minimal consideration to the actual experience of Alzheimer’s as it affects individuals and their families. I am acutely aware that what is missing almost entirely from this treatise is the ultimate, undeniable reason for the existence of the Alzheimer enterprise—the anguish and suffering that this condition brings to millions of individuals and their families. In closing I want to draw readers’ attention to a remarkable set of paintings by the artist William Utermohlen...

  15. Notes
    (pp. 247-276)
  16. Bibliography
    (pp. 277-300)
  17. Index
    (pp. 301-310)