Digging Deeper: What Can We Really Learn about Dementia from History?

In response to Finch and Burstein's provocative argument that the advanced dementias may result from environmental toxins and lifestyle factors associated with post-industrial societies, we call for a more rigorous historical approach, emphasizing the importance of situating ancient texts more fully in their historical and cultural context. Such an approach would also entail consideration of the declining relative rates of dementia in Western countries, which have been linked to population health-level factors and policies that appear to have reduced the risk of dementia by directly and indirectly influencing the social determinants of brain health.

Framing Confusion: Dementia, Society, and History.

This essay will briefly sketch historical changes in the framing of dementia since the late nineteenth century. In broad terms, this period has seen a shift from viewing dementia as a pathological variant of normal aging to viewing it as a distinct disease. Although this broad reframing of dementia was clearly positive in raising awareness and funding for research, it had some negative aspects that should be considered. Caregiving came to seem less important than research aimed at a cure, and the stigma surrounding dementia has, if anything, increased.

Before it is too late: professional responsibilities in late-onset Alzheimer's research and pre-symptomatic prediction.

The development of a wide array of molecular and neuroscientific biomarkers can provide the possibility to visualize the course of Alzheimer's disease (AD) at early stages. Many of these biomarkers are aimed at detecting not only a preclinical, but also a pre-symptomatic state. They are supposed to facilitate clinical trials aiming at treatments that attack the disease at its earliest stage or even prevent it. The increasing number of such biomarkers currently tested and now partly proposed for clinical implementation calls for critical reflection on their aims, social benefits, and risks. This position paper summarizes major challenges and responsibilities. Its focus is on the ethical and social problems involved in the organization and application of dementia research, as well as in healthcare provision from a cross-national point of view. The paper is based on a discussion of leading dementia experts from neuroscience, neurology, social sciences, and bioethics in the United States and Europe. It thus reflects a notable consensus across various disciplines and national backgrounds. We intend to initiate a debate on the need for actions within the researchers' national and international communities.

Isotopic paleoecology of Clovis mammoths from Arizona.

The causes of megafaunal extinctions in North America have been widely debated but remain poorly understood. Mammoths (Mammuthus spp.) in the American Southwest were hunted by Clovis people during a period of rapid climate change, just before the regional onset of Younger Dryas cooling and mammoth extirpation. Thus, these mammoths may provide key insights into late Pleistocene extinction processes. Here we reconstruct the seasonal diet and climatic conditions experienced by mammoths in the San Pedro Valley of Arizona, using the carbon ((13)C/(12)C) and oxygen ((18)O/(16)O) isotope compositions of tooth enamel. These records suggest that Clovis mammoths experienced a warm, dry climate with sufficient summer rainfall to support seasonal C(4) plant growth. Monsoon intensity may have been reduced relative to the preceding time period, but there is no isotopic evidence for severe drought. However, it is possible that the "Clovis drought", inferred from stratigraphic evidence, occurred suddenly at the end of the animals' lives and thus was not recorded in the enamel isotopic compositions. Unlike mammoths that lived before the Last Glacial Maximum, Clovis mammoths regularly increased C(4) grass consumption during summer, probably seeking seasonally green grasslands farther from the river valley. This predictable seasonal behavior may have made mammoths easier to locate by Clovis hunters. Furthermore, Clovis mammoths probably had no previous experience of such sudden climatic change as is believed to have occurred at the time of their extinction.

The evolving classification of dementia: placing the DSM-V in a meaningful historical and cultural context and pondering the future of "Alzheimer's".

Alzheimer's disease is a 100-year-old concept. As a diagnostic label, it has evolved over the 20th and 21st centuries from a rare diagnosis in younger patients to a worldwide epidemic common in the elderly, said to affect over 35 million people worldwide. In this opinion piece, we use a constructivist approach to review the early history of the terms "Alzheimer's disease" and related concepts such as dementia, as well as the more recent nosological changes that have occurred in the four major editions of the Diagnostic and Statistical Manual since 1952. A critical engagement of the history of Alzheimer's disease and dementia, specifically the evolution of those concepts in the DSM over the past 100 years, raises a number of questions about how those labels and emergent diagnoses, such as Neurocognitive Disorders and Mild Cognitive Impairment, might continue to evolve in the DSM-V, due for release in 2013.

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

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 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.