Katie Aubrecht shares her thoughts on Alzheimer’s, dementia, and aging as these intersect with The Alzheimer Conundrum: Entanglements of Dementia and Aging.

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The World Health Organization and Alzheimer Disease International published Dementia: A Public Health Priority (2012) that highlights the global prevalence of Alzheimer’s disease and other dementias. The report projects that the number of people living with dementia worldwide will triple by the year 2050. It also calls on governments to recognize dementia as “an increasing threat to global health” – a threat that requires a global response. As well, the report explains why dementia is such a problem – because it is a burden that will only get worse over time. Who is dementia a threat to? And, who is it a burden for? The answer seems to be “everyone”: individuals living with dementia, their families, friends and communities, entire countries, and even the world.

Two years before this report was published, the Alzheimer Society of Canada published Rising Tide: The Impact of Dementia on Canadian Society. This report called on Canadians to challenge governments to take action and redirect investments to where they could have the greatest impact. To this day, there is no national dementia care strategy in Canada. Meanwhile, dementia care remains an issue of importance to Canadians and health researchers, policy makers, and practitioners. This was evident in the focus on dementia at the 2015 Canadian Academy of Health Sciences forum, The Rising Tide of Dementia in Canada: Facing the Critical Challenge by 2025. Meanwhile, in June 2015 Nova Scotia introduced a dementia care strategy, Towards Understanding.

Population aging is now a reality for many industrialized countries. According to Statistics Canada there are now more persons aged 65 years and older than there are children aged 0-14 years, and the highest ratio of older adults to children is in Nova Scotia. Within public policy and popular media, the realities of population aging and increases in the prevalence of Alzheimer’s and other dementias are often represented as two sides of the same coin.

But what does population aging have to do with Alzheimer’s and dementia?

In The Alzheimer Conundrum: Entanglements of Dementia and Aging, Margaret Lock (2013) addresses the relationship between Alzheimer’s, dementia, and aging. Lock shares a social history of the knowledge, assumptions, and practices involved in recognizing and treating Alzheimer’s and dementia. Her book concludes that within the medical sciences, the difference between ‘normal aging’ and dementia is still not fully understood.

Lock informs her reader that, “The idea of a national initiative to prevent Alzheimer’s disease has been on the table since 1987, but despite ongoing efforts to reduce its incidence and standardize diagnosis, relatively little progress was made…” (p. 124). Despite the statistics that support the urgent call to action in the reports, prevalence is based on projections and the actual incidence is not well understood as a result of diagnostic difficulties.

Further, a lack of standardization in diagnosis has led Alzheimer’s specialists to doubt the current reports of incidence as very likely the result of under, over, or misdiagnosis. According to Lock, “… national and global estimates of [Alzheimer Disease] cases cannot possibly provide an accurate estimate of the number of individuals at increased risk because statistically reliable databases do not exist”; even when data is reliable, the findings are not necessarily generalizable.

The Oxford Dictionary defines conundrum as a confusing or difficult problem or question; as well as a question asked for amusement, a riddle. Lock describes the different possible ways of knowing and responding to Alzheimer’s and dementia. She illustrates how many approaches at once amplify and relieve anxieties related to uncertainty about what Alzheimer’s and dementia are, and what truths they can tell us about the world in which we live. Lock traces the limits of current scientific knowledge of Alzheimer’s and dementia, and the failure of science to definitively answer the question of why, everything else being equal, some people develop Alzheimer’s and others do not. The book also suggests that the failure of science to find a cure for Alzheimer’s and dementia could be viewed as a space of possibility. Which is to say that we could know things differently, and do better.

Lock provides us with a rich analysis of the relationship between Alzheimer’s and the medicalization of aging. She opens the book by identifying what she understands as three “entangled tensions” in “the Alzheimer’s world” which animate current interest in re-conceptualizing Alzheimer’s. There is tension between the mind and body. There is tension between the ways in which mind, persons, life events, aging, and environment interact. And finally, there is tension between genetic variation, molecular differences, and biological adaptation as explanations for Alzheimer’s.

In examining these tensions, Lock raises critical questions about the socio-political, cultural, and economic contexts that have shaped the current emphasis on prevention and cure. In our efforts to make sense of the truth of Alzheimer’s, it is undisputable that, “The concept of Alzheimer’s is an artifact of value, one which has taken on a life of its own among medical practitioners, the public, and advocacy groups alike.”

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Katie Aubrecht is a CIHR Postdoctoral Fellow at Mount Saint Vincent University and Research Coordinator at the Nova Scotia Centre on Aging.