Archive for June, 2011

Alzheimer’s Disease

Wednesday, June 29th, 2011

I recently heard an interview with Dr. Peter Whitehouse, who has authored a book called The Myth of Alzheimer’s Disease. Provocative title, but he has some very good things to say. He notes that there are problems with the way the diagnosis of Alzheimer’s Disease (AD) has evolved over the years, and why. Essentially, his argument is that cognitive changes are a normal part of aging, and that we have done ourselves a disservice by casting them as an irreversible, terminal illness. By doing so we effectively tell people that once cognitive decline has started, their life is basically over and they no longer have a place in the human community. Thenceforward they are treated with diminished respect and dignity, and everyone is effectively just waiting for them to die, or for the unlikely event that a “treatment” will be discovered that can “cure” the problem. In the meantime, they aren’t encouraged to make use of the resources that would help them cope with the decline.

Whitehouse notes that the patients that Alzheimer originally described were not old, but were cases of premature dementia occurring in the fifth or sixth decades of life, rather than the eighth or ninth. In addition, Whitehouse points out that the diagnosis of AD is really a residual one; i.e., if signs of dementia are not accounted for by the presence of some other disease, the diagnosis of “probable” AD is made. Finally, he writes that the brain pathology (plaques and neurofibrillary tangles) originally identified with the presence of AD doesn’t actually correlate that well with symptoms of dementia. Specifically, many people who showed no signs of dementia while alive are found to have the pathology in their brains after death, which calls into question the role of the pathology in producing the cognitive decline.

Whitehouse argues that it was in the interest of certain groups (he identifies the National Institute of Aging and, not surprisingly, the pharmaceutical industry) to turn age-related cognitive decline into a “disease” as a way of attracting funding to their cause.

I agree that it’s easy to take the limitations, weaknesses, and ultimately the brevity of human life and sell the idea that they are illnesses or diseases, that need to be treated by experts — who, by the way, need lots of money to fund their research and pay for their time. This isn’t just the case in the area of cognitive decline and aging, it’s also a perennial pull in the world of psychiatry, with its ever-expanding list of diagnoses and ever-increasing claims of jurisdiction over what we used to consider the ordinary storms and strains of life. There is a great deal we can do to keep ourselves vital and sharp — that’s really what Choratech is all about — but we must never succumb to the dangerous illusion that we can use technology to bring an end to all human weaknesses, limitation, and pain.