Building a Mystery: Alzheimer's Disease, Mild Cognitive Impairment, and Beyond

Abstract

In this paper, we suggest some of the dimensions of the problematic concept of Alzheimer Disease (AD) as a natural disease discerned by increasingly sophisticated medical scientific progress. Taking a page from Max Weber concerning unique events, we show some of the conceptual building blocks and social processes that have coalesced into the perception of certain phenomena as abnormalities that are seen as implicated in the development of a degenerative disease distinct from the process of normal, but variable, brain aging. We note some of the decisions and social forces pushing for particular conceptualizations, interpretations, and reifications of brain alterations. In so doing, we do not argue that there is no "there" there. Rather, we suggest that the mystery of the "there" (i.e., AD, mild cognitive impairment) may not be much different (if at all) from, and probably is, the mystery of the "everywhere" (i.e., aging).

Ethical implications of the perception and portrayal of dementia

“…When regarding dementia as a biomedical condition focussing on neuropathology (Cummings, 2007;Gaines & Whitehouse, 2006), people may be motivated to seek diagnosis.…”

What explains variations in the clinical use of mild cognitive impairment (MCI) as a diagnostic category?

“…MCI characterizes individuals who have a clinical presentation of a memory complaint, accompanied by an objective memory impairment (assessed by clinical interviews and psychological and brain imaging tests), but who have no other cognitive impairment, preserve most activities of daily living and do not have dementia. While MCI has had a significant impact in the field of dementia research and is consistent with current scientific understanding of the progressive etiology of neurodegenerative diseases, its use as a diagnostic category in clinical practice remains controversial (Gauthier and Touchon, 2005;Whitehouse and Juengst, 2005;Gaines and Whitehouse, 2006;Gauthier et al, 2006;Whitehouse and Brodaty, 2006).…”

Assessment meetings between care managers and persons living with dementia : Citizenship as practice

“…The relationship between neuropathology and dementia has been explored in dementia research with the main objective of finding a treatment, reducing symptoms, or stopping the development of dementia (Beard, 2004;Gaines & Whitehouse, 2006). Criticism has been raised that persons with dementia have been treated and viewed as objects, as hollow shells (Kitwood, 1997), or as living dead (Behuniak, 2011), rather than as persons.…”