Progress in the history of Alzheimer's disease: The importance of context

Abstract

The history of Alzheimer's disease (AD) is typically formulated as the history of great doctors and scientists in the past making great discoveries that are in turn taken up by great doctors and scientists in the present -all sharing the aim of unraveling the mysteries of the disease and discovering how it can be prevented or cured. While it can certainly be edifying to study the "great men" and how their contributions laid the foundation for current work, there are problems with this approach to history. First, it oversimplifies the actual historical development of science. Second, using history to legitimate the present can keep us from asking critical questions about the aims and limits of contemporary research. This chapter urges a broader view of the history of AD, one that recognizes that context is as important as the great doctors to the historical development of the concept of AD. Thought of this way, I argue that it is useful to divide of the history of AD into three periods. First there was the period in which Alzheimer and Kraepelin laid the clinical and pathological foundations of the disease concept. Then there is our own period, which began in the late 1970s and has emphasized the biological mechanisms of dementia. In between, there is the period -almost completely ignored in most histories of AD -that conceptualized dementia in psychodynamic terms. It is true that the psychodynamic model of dementia did not directly contribute to the concepts and theories that dominate AD research today. But it did change the context of aging and dementia in important ways, without which AD could not have emerged as a major disease worthy of a massive, publicly supported research initiative.

Dementia As a Cultural Metaphor

“…However, today dementia, which in popular discourse is used interchangeably with "AD," is predominantly associated with older people (although associations between AD and dementia were outlined in the late 1950s and 1960s [Corsellis & Brierley, 1959;Roth, Tomilinson, & Blessed, 1966], historians have demonstrated that the current sociocultural construction of AD and dementia first emerged in the late 70s and 80s [Ballenger, 2006;Herskovits, 1995]). The words dementia or AD evoke strong feelings: they have become heavily value-laden terms.…”

“…The drive to see AD and dementia as specific disease entities and to link age-related dementia with AD has been connected to the evolution of geriatric psychiatry, societal forces, as well as the work of clinical neurologists, neuropathologists, and others (D'Alton & George, 2011;George, Whitehouse, & Ballenger, 2011). Classifying AD and other agerelated dementias as a unified entity has also been politically powerful (Ballenger, 2006;Gubrium, 1986). It has facilitated funding and research into diseases for which it is implied that there will eventually be a cure.…”

Alzheimer’s disease: Recent advances in diagnosis and overview of clinical research in newer treatments

“…In the period since the issuance of the Alzheimer's initial report in 1906 and the 1960s, the primary focus was on the epistemology of the disease and struggle for consensus on the clinical definitions. Lack of validated standardized clinical assessment tools and uncertainity in the definition of clinical phenomenon led to relatively slow progress in understanding the relationship between the behavioral expression and pathological phenotypes of dementia (3).…”

Framing Confusion: Dementia, Society, and History

“…From mid-1930s through the 1950s, a number of American psychiatrists led by David Rothschild responded to the challenge of dementia in the state hospitals by framing dementia as a psychosocial problem rather than a brain disease [8,9]. Rothschild and his followers argued that the observation of inconsistent correlations between clinical manifestations of dementia and pathological findings could best be accounted for by people's differing ability to compensate for brain damage.…”