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It used to be called "senility" -- the mental deterioration that older people underwent -- as though all old people suffered from it. But that changed. It changed for the realistic reason that elderly people differed greatly in how disoriented they became as they aged. And it changed for the pragmatic reason that, with the graying of America, older Americans didn't want to believe they were destined to lose their ability to function.
And, so, what was called senility, a function simply of growing old, was redefined as a disease--dementia. Then it was further refined as Alzheimer's Disease. At first, Alzheimer's was regarded as a subcategory of dementia. But, more and more, the label came to apply to ALL older people who "lost their wits," as the experience used to be described. And, with the greater diseasification, came the hope--the belief--that senility was on the verge of being cured.
Which brings me to the unusual article in the current AARP Bulletin, listed as "Alzheimer's Dilemma: To Test or Not to Test" on the cover, and as "Diagnosing Alzheimer's" inside. Well, can they diagnose Alzheimer's or can't they? Actually, that's not the question the article tackles, which is: "Is there a definitive--even a viable--medical test for Alzheimer's?" The article provides four answers: 1) no, 2) Americans think there is one, 3) don't worry, there will be one soon, 4) don't worry about the whole matter, just live a good life.
Here are the relevant quotes from the article:
In a recent international survey, nearly nine in 10 Americans said if they were experiencing memory loss and confusion, they'd go to the doctor to find out if the cause was Alzheimer's.
They would go because most Americans "believe there's a reliable medical test" to detect Alzheimer's, and then an "effective treatment" for the disease.
The AARP article chides people for their optimism: "Unfortunately, neither of these things is true--at least not yet." So why do Americans believe it?
The public's apparent misconception may stem from a flurry of publicity about Alzheimer's diagnosis, as researchers announce exciting strides toward a reliable test and drug companies vie to bring the first diagnostic test to market.
Well, that sounds like what Americans believe to be true, but which is not, will soon be realized! And the article presents these optimistic hopes:
In April the Alzheimer's Association and the National Institute for Aging announced new guidelines for diagnosing the disease. These include recommendations for how to use the new "biomarkers" tests that measure two proteins, beta-amyloid and tau, which make up brain "plaques" and "tangles," the signature features of Alzheimer's.
That makes it seem like we're there! Not so fast: "[S]cientists don't yet understand exactly what various results of biomarker tests mean for each patient or how they can be used to predict a patient's future." Translation: "Some people with some markers develop dementia, and others with the same profiles don't." Thus, the article declares: "No medical test for Alzheimer's is widely available." And, on top of that, "the few drugs used to treat it can temporarily help with some symptoms but don't halt the disease itself."
Right now, you find out if you have Alzheimer's-- well, by seeing if you have Alzheimer's. The diagnosis "rests on talking with the patient and family(!), administering memory and other mental function tests, and running blood tests and basic brain scans designed mainly to rule out other conditions such as stroke or tumor" (emphasis added).
During such diagnostic procedures, "the standard evaluation might instead (instead of what?) find a treatable cause of mental confusion--such as depression. . ." Boy, that's long way from getting to the roots of the disease called Alzheimer's.
Let's consider another possibility. What was called dementia is a complex result of a person's mental acuity to start with; overall health--particularly that connected with carrying blood to the brain; overall mental and life condition--life, work, and family engagement; and just a sense of themselves and their worlds--along with a variety of potential disease factors.
Thus, we can search for this or that specific cause of Alzheimer's--like we do for addiction--without definitive results (which are impossible to find), but with unmitigated--indeed, with ever-quickening-- anticipation that we are on the verge of a Eureka discovery.
The AARP article itself strongly intimates that this imminent revelation is near, so that it's not surprising that a large majority of Americans are misinformed about the state of knowledge about, and our ability to solve, senility.
Which brings us to PT blogger Allen Frances' wise conclusion to the article, which seems to run counter to much of what the article says:
It will likely be many years before any test can predict precisely who really will get the disease, and when. In the meantime, there will be lots of continued hype about progress in testing (do tell!). The best thing most people can do is simply ignore it. Instead of worrying about Alzheimer's, you should make sure to exercise your mind and body, eat well, don't drink too much (but, I might add, drink moderately), and enjoy life. (emphasis added)
Except for the standard one-sided recommendation on drinking, amen, Dr. Frances!
P.S. Of course, the article is illustrated with a picture of the brain--how do you get a picture of a person's life?
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