Manual The Alzheimer Conundrum: Entanglements of Dementia and Aging

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She begins with the discovery of the disease by Alois Alzheimer and its creation as a disease category chapter 1 and then describes efforts to standardize AD given the continuous anomalies between neuropathology and symptoms chapter 2. Lock analyses the shift towards the assessment of risk, especially through the identification of mild cognitive impairment MCI, chapter 3 , prodromal AD chapter 4 , genetic biomarkers chapter 5 , and genome-wide associations chapter 6.

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She examines the effects of this focus on risk assessment on offspring of Alzheimer patients chapter 7 and its role in the current interest in epigenetics chapter 8. When is something pathological?

The Alzheimer conundrum : entanglements of dementia and aging (eBook, ) [cesssuwildlessnal.ml]

The later chapters describe a somewhat hesitant shift towards prevention. In her analysis Lock focuses on the role of uncertainty and high-tech biomedical reductionism in AD research.

In particular, she examines the dominant and enduring position of localization theory, which tries to locate AD in changes in the brain and relate the disease to specific neuropathology. Investigators, consciously or unconsciously, embed this localization theory in their research.

Lock shows that although attention has now shifted to twenty years prior to first symptoms, with research on MCI, genetic and epigenetic processes, and the hunt for biomarkers to identify disease onset , this research is still based on the amyloid cascade hypothesis. In the tracing of research she demonstrates that AD research is primarily conducted in the United States, and addresses the precarious balance with research subjects in developing countries, especially when it comes to experimental pharmaceutical interventions. One such example is a randomized controlled trial of a pharmaceutical intervention involving families in Antioquia, Colombia.

The Alzheimer Conundrum

This group of families carries a specific gene mutation that results in about one third among them developing early onset AD manifest around the age of forty-five. In these trials it is often unclear whether participants will benefit from the developments that they co-create. In the case of the Colombian trial, participants were asked to sign up for information and attend extensive information sessions, and the pharmaceutical company agreed that if a medicine would be developed the Colombian families would receive it.

Some frame the hesitant move toward prevention as a Kuhnian paradigm shift, but Lock convincingly shows that research efforts in fact are a continuation of thinking within the framework of the amyloid cascade hypothesis; such a paradigm shift is actually nonexistent.

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Furthermore, uncertainty still pervades the research field. In the sidelines of The Alzheimer Conundrum lingers a critique of localization theory, the effects of a genetic focus on patients and family members, and the sometimes somewhat limited self-reflection of the researchers. She hints at a dogmatic following of localization theory and an unrelenting belief in the amyloid cascade hypothesis, almost as an implicit rationale within the AD community. However, Lock does this with utmost respect; she sees the vigorous activity, the efforts, and the well-hearted attempts, but at the same time raises ethical and philosophical questions.

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Disentangling Alzheimer’s, Dementia, and Aging

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