Culture, Medicine, and Psychiatry

, Volume 38, Issue 2, pp 217–236 | Cite as

The Earlier the Better: Alzheimer’s Prevention, Early Detection, and the Quest for Pharmacological Interventions

Original Paper

Abstract

Although the risk factors, biomarkers, and medications for Alzheimer’s disease appear to be almost identical in 1993 and 2013, profound changes can de detected throughout this time period. This article maps these recent changes in the conceptualization of Alzheimer’s disease, especially the emerging trend toward prevention. While some preventive practices (e.g., brain training) and the search for early signs and biomarkers (such as APOEε4) have existed for a long time, the recent broadening of scope to include cardiovascular risk factors and their prevention, paired with pre-symptomatic detection of disease-specific biomarkers, has considerably impacted the conventional understanding of this syndrome and the possibilities for pharmacological and non-pharmacological interventions. The rationale for emphasizing multiple logics when explaining these changes is to avoid simplified argumentative pathways that exist among some scientists.

Keywords

Alzheimer’s disease Prevention Cardiovascular risk factors Biomarkers Early detection Embeddedness Multiple logics Pharmacological interventions 

References

  1. ADI (Alzheimer’s Disease International) 2013 About dementia, www.alz.co.uk/about-dementia, accessed October 2013.
  2. Alzheimer’s Association 2013 New Diagnostic Criteria, http://www.alz.org/research/diagnostic_criteria/, accessed October 2013.
  3. American Heart Association 2013 New heart disease and stroke prevention guidelines released, http://blog.heart.org/new-heart-disease-and-stroke-prevention-guidelines-released/, accessed November 2013.
  4. Angells, M. - The Truth about Drug Companies: How They Deceive us and what to do about it. New York: Random House, 2004.Google Scholar
  5. Applbaum, K. 2009 Is Marketing the Enemy of Pharmaceutical Innovation? Hastings Center Report 39(4): 13–17, 2009.Google Scholar
  6. Applbaum, K. 2012 see three articles on the pharmaceutical industry, http://somatosphere.net/author/kalman-applbaum.
  7. Applby, B.S., et al. 2013 A review: Treatment of Alzheimer’s Disease Discovered in Repurposed Agents. Dementia and Geriatric Cognitive Disorders 35(1–2): 1–22.Google Scholar
  8. Arai, H. (1996) Biological markers for the clinical diagnosis of Alzheimer’s disease (abstract).Tohoku J Exp Med. 179(2): 65–79.CrossRefGoogle Scholar
  9. Barnett, J.H., Hachinski, V., and A.D. Blackwell (2013) Cognitive health begins at conception: Adressing dementia as a lifelong and preventable condition. BMC Med. 11(1): 246.CrossRefGoogle Scholar
  10. Battistin, L., and A. Cagnin 2010 Vascular Cognitive Disorder. A Biological and Clinical Overview. Neurochemical Research 35(12): 1933–1938.Google Scholar
  11. Bell, K. (2010) Cancer Survivorship, Mor(t)ality and Lifestyle Discourses on Cancer Prevention, Sociology of Health and Illness 32(3): 349-364CrossRefGoogle Scholar
  12. Berchtold, N.C. and C.W. Cotman 1998 Evolution in the conceptualization of dementia and Alzheimer’s disease: Greco-Roman period to the 1960s. Neurobiology of Aging 19(3): 173-189CrossRefGoogle Scholar
  13. Berrios G.E. - Alzheimer’s disease: a conceptual history. International Journal of Geriatric Psychiatry 5: 355-365, 1990.CrossRefGoogle Scholar
  14. Biehl, J. - Pharmaceutical Governance. In A. Petryna, A. Lakoff, and A. Kleinman (eds.), Global Pharmaceuticals: Ethics, Markets, Practices. Durham, NC: Duke University Press, 2006.Google Scholar
  15. Birks, J. 2005 Cholinesterase Inhibitors for Alzheimer’s disease. Cochrane Database of Systematic Reviews 2006. doi:10.1002/14651858.CD005593.
  16. Blessed G., Tomlinson B.E., Roth M 1968. The association between quantitative measures of dementia and senile change in the cerebral grey matter of elderly subjects. Br J Psychiatry 114: 797–811.CrossRefGoogle Scholar
  17. Campbell NL et al 2013 Risk Factors for the Progression of Mild Cognitive Impairment to Dementia. Clinical Geriatric Medicine 29(4): 873-893.CrossRefGoogle Scholar
  18. Carrillo, M.C. et al. – Can we prevent Alzheimer’s disease? Secondary “prevention” trials in Alzheimer’s disease. Alzheimers Dement. 9(2): 123-131, 2013.CrossRefGoogle Scholar
  19. Chételat, G. et al. 2013 Amyloid imaging in cognitively normal individuals, at-risk populations and preclinical Alzheimer’s disease. Neuroimage Clin. 2: 356-365.CrossRefGoogle Scholar
  20. Consumer Reports 2013 Evaluating Prescription Drugs Used to Treat: Alzheimer’s Disease; Comparing Effectiveness, Safety, and Price, http://www.consumerreports.org/health/resources/pdf/best-buy-drugs/AlzheimersFINAL.pdf, accessed October 2013.
  21. Daston, L. (ed.) - Biographies of Scientific Objects. Chicago: University of Chicago Press, 2000.Google Scholar
  22. Dehnel, T. – The European Dementia Prevention Initiative. Lancet Neurology 12(3): 227-228, 2013.CrossRefGoogle Scholar
  23. Dubois B. et al. - Research Criteria for the Diagnosis of Alzheimer’s Disease. Lancet Neurol. 6(8): 734-46, 2007.CrossRefGoogle Scholar
  24. Dubois, B. et al. - Revising the Definition of Alzheimer’s Disease: A New Lexicon. Lancet Neurol. 9(11): 1118-27, 2010.CrossRefGoogle Scholar
  25. Ermini-Fünfschilling D, Stähelin HB 1993 Is Prevention of Dementia Possible (article in German). Zeitschrift für Gerontologie 26(6): 446-452.Google Scholar
  26. Fagan, T., and G. Strobel 2013 Background Text, http://www.alzforum.org/res/for/journal/detail.asp?liveID=192, accessed August 2013.
  27. Feldman, H et al. - Efficacy of donepezil on maintenance of activities of daily living in patients with moderate to severe Alzheimer’sdisease and the effect on caregiver burden.J Am Geriatr Soc.51(6):737-44, 2003.CrossRefGoogle Scholar
  28. Ferenczi, E.A. et al. - Can a Statin Neutralize the Cardiovascular Risk of Unhealthy Dietary Choices? The American Journal of Cardiology 106(4): 587-592, 2010.CrossRefGoogle Scholar
  29. Friedland, R.P. 2001 Should Dietary Modifications be Recommended to Lower the Risk of Alzheimer’s Disease? In 53rd Annual Meeting, American Academy of Neurology, Philadelphia, May 6, 2001.Google Scholar
  30. Gauthier, S. et al. - Commentary on “Recommendations from the National Institute on Aging-Alzheimer’s Association Workgroups on Diagnostic Guidelines for Alzheimer’s Disease.” A Canadian Perspective, Alzheimer’s & Dementia 7: 330–332, 2011.CrossRefGoogle Scholar
  31. Gellerstedt, N. – ZurKenntnis der Hirnveränderungenbei der normalenAltersinvolution. UpsalaLäkareföreningsFörhandlingar 38: 193-408,1933. And JAMA 103(2): 131, 1934.Google Scholar
  32. Granovetter, M. 1985 Economic Action and Social Structure: The Problem of Embeddedness. American Journal of Sociology 91(November): 481–510.Google Scholar
  33. Greene JA 2007 Prescribing by Numbers: Drugs and the Definition of Disease. Baltimore, MD: Johns Hopkins University Press.Google Scholar
  34. Harvard Mental Health Letter 2004 Alzheimer’s Drugs: Are They Worth it? November issue. http://www.health.harvard.edu, accessed March 2009.
  35. Healy, D 2012 Pharmageddon. Berkeley: University of California PressGoogle Scholar
  36. Jonsson, T et al. – A mutation in APP protects against Alzheimer’s disease and age-related cognitive decline. Nature 488:96-99, August 2012.CrossRefGoogle Scholar
  37. Kalaria, R.N. - Vascular Basis for Brain Degeneration: Faltering Controls and Risk Factors for Dementia. Nutr. Review 68 (suppl 2): S74-87, 2010.CrossRefGoogle Scholar
  38. Katzman, R. - The prevalence and malignancy of Alzheimer disease. A major killer. Archives of Neurology 33: 217–218, 1976.CrossRefGoogle Scholar
  39. Kaufman, S.H. 2000 Senescence, decline, and the quest for a good death: Contemporary dilemmas and historical antecedents. J Aging Studies 14(1): 1-23CrossRefGoogle Scholar
  40. Khachaturian ZS 2011 Revised criteria for diagnosis of Alzheimer’s disease: National Institute on Aging-Alzheimer’s Association diagnostic guidelines for Alzheimer’s disease. Alzheimer’s & Dementia 7(3): 253–256CrossRefGoogle Scholar
  41. Kolata, G. 2013 Experts Reshape Treatment Guide for Cholesterol. The New York Times, November 12, 2013. http://www.nytimes.com/2013/11/13/health/new-guidelines-redefine-use-of-statins.html?_r=0.
  42. Kraepelin, E. 1910 Psychiatrie. Ein Lehrbuch für Studierende und Ärzte (2nd edn). Leipzig: Barth Verlag.Google Scholar
  43. Kral, V.A. - Senescent Forgetfulness: Benign and Malignant. Can Med Assoc J 86: 257–260, 1962.Google Scholar
  44. Latour, B. - On the Partial Existence of Existing and Nonexisting Objects. in: Daston, L. (ed.) Biographies of Scientific Objects. Chicago: The University of Chicago Press, pp. 247-269, 2000.Google Scholar
  45. Leibing, A. 2006 Divided Gazes: Alzheimer’s Disease, the Person Within, and Death in Life. In Thinking About Dementia—Culture, Loss, and the Anthropology of Senility. A. Leibing and L. Cohen, eds., pp. 240–268. New Brunswick, NJ: Rutgers University Press.Google Scholar
  46. Leibing, A. - Tense prescriptions? Alzheimer medications and the anthropology of uncertainty. Transcultural Psychiatry 46(1): 180-206, 2009a.CrossRefGoogle Scholar
  47. Leibing, A. 2009b From the Periphery to the Center: Treating Noncognitive, Especially Behavioral and Psychological, Symptoms of Dementia. In Do We Have a Pill for That? Treating Dementia. J. Ballenger, P. Whitehouse, C. Lyketsos, P. Rabins, and J. Karlawish, eds., pp. 74–97. Baltimore: The Johns Hopkins University Press.Google Scholar
  48. Leibing, A. 2014 The Earlier the Better—Alzheimer’s Prevention, Early Detection, and the Quest for Pharmacological Interventions. Invited Conference: Colloque “Responsible Innovation in a Multiple World—The Case of Alzheimer Diagnostics”, 20–21 February 2014. Holland: University of Twente.Google Scholar
  49. Leibing, A. and A. Kampf 2013 Neither body nor brain: Comparing attitudes to prostate cancer and Alzheimer’s disease. Body & Society 19(4): 61-91.CrossRefGoogle Scholar
  50. LeMoyne, EL, Curnier, D, St-Jacques, S, and D Ellemberg - The effects of exercise during pregnancy on the newborn’s brain: study protocol for a randomized controlled trial. Trials 13: 68, 2012.CrossRefGoogle Scholar
  51. Levine, R.A. - Defying Dementia, Understanding and Preventing Alzheimer’s and Related Disorders. Lanham: Rowman and Littlfield, 2010.Google Scholar
  52. Levy, R. – Are drugs targeted at Alzheimer’s disease useful? BMJ 300: 1121-1132, 1990.CrossRefGoogle Scholar
  53. Lieberman, J.A., et al. 2005 Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia. New England Journal of Medicine 353(12): 1209–1223.Google Scholar
  54. Maesako, M et al - Exercise is more effective than diet control in preventing high fat diet-induced β-amyloid deposition and memory deficit in amyloid precursor protein transgenic mice. J Biol Chem. 287(27): 23024-23033, 2012.CrossRefGoogle Scholar
  55. Mcilroy, A. 2010 New Tools Allow for Early Detection of Alzheimer’s,’ Globe and Mail September 22, http://www.theglobeandmail.com/life/health/dementia/new-tools-allow-for-early-detection-of-alzheimers-but-theres-a-catch/article1717718/, accessed February 2010.
  56. Mehlman, M.J. 2004 Cognition-Enhancing Drugs. Milbank Q. 82(3): 483–506CrossRefGoogle Scholar
  57. Mount, C., and C. Downton 2006 Alzheimer’s Disease: Progress or Profit? Nature Medicine 12(7): 780–784. Google Scholar
  58. No Author 2013 How Science Goes Wrong, October 19th–25th. The Economist 26–30.Google Scholar
  59. Noel-Storr AH, Flicker L, Ritchie CW, Nguyen GH et al. - Systematic review of the body of evidence for the use of biomarkers in the diagnosis of dementia. Alzheimer’s & Dementia 9(3): e96-e105, 2013.CrossRefGoogle Scholar
  60. Oldani, M. (2009). Uncanny scripts: Understanding Pharmaceutical Emplotment in the Aboriginal Context. Transcultural Psychiatry 46(1): 131-156.CrossRefGoogle Scholar
  61. Ornish, D, Scherwitz, LW, Billings, JH, Gould, KL, Merritt, TA, et al. – Intensive lifestyle changes for reversal of coronary heart disease. JAMA 280: 2001–2007, 1998.CrossRefGoogle Scholar
  62. Pedersen, N. 2010 Reaching the Limits of Genome-Wide Significance in Alzheimer Disease. JAMA 303: 1864–1865.Google Scholar
  63. Petersen, R.C. 2004 Mild Cognitive Impairment as a Diagnostic Entity. Journal of Internal Medicine 52(3): 183–194.Google Scholar
  64. Petryna, A. 2006 Globalizing Human Subjects Research. In Global Pharmaceuticals, Ethics, Markets, Practices. A. Petryne, A. Lakoff, and A. Kleinman, eds., pp. 33–60. Durham, NC: Duke University Press.Google Scholar
  65. Rabin, R.C. 2010 Good’ Cholesterol May Lower Alzheimer’s Risk. New York Times, (Dec 16), http://well.blogs.nytimes.com/2010/12/16/good-cholesterol-may-lower-alzheimers-risk/?emc=eta1, accessed December 2010.
  66. Ranii, D. 2011 Chapel Hill Firm to Lead Alzheimer’s Trials. NewsObserver, www.newsobserver.com/2011, August 23, 2011.
  67. Rapoport, M., and B.H. Mulsant 2010 Pathway to Prevention: Great Progress has been Made But We are not yet There. International Psychogeriatrics 22: 1193–1195.Google Scholar
  68. Rocca, W.A. 1994 Frequency, Distribution, and Risk Factors for Alzheimer's Disease. Nursing Clinics of North America 29(1): 101–111.Google Scholar
  69. Roe C.M., et al. Amyloid imaging and CSF biomarkers in predicting cognitive impairment up to 7.5 years later.Neurology 80(19):1784-1791, 2013.CrossRefGoogle Scholar
  70. Roses, A.D. - On the Discovery of the Genetic Association of Apolipoprotein E Genotypes and Common Late-onset Alzheimer Disease. Journal of Alzheimers Dis. 9(3): 361-366, 2006.Google Scholar
  71. Royall, D. R. - The emperor has no clothes: Dementia treatment on the eve of the aging era. Journal of the American Geriatric Society 53(1): 163–164, 2005.CrossRefGoogle Scholar
  72. Russ, T.C., and J.R. Morling 2012 Anti-dementia drugs for people with memory problems but without dementia (Cochrane study), http://summaries.cochrane.org/CD009132/anti-dementia-drugs-for-people-with-memory-problems-but-without-dementia, accessed April 2013.
  73. Selkoe D, Mandelkow E and D Hotzman – Deciphering Alzheimer Disease. Cold Spring Harb Perspect Med 2:a011460, 2012.CrossRefGoogle Scholar
  74. Sismondo, S. 2008 How Pharmaceutical Industry Funding Affects Trial Outcomes: Causal Structures and Responses. Social Science & Medicine 66: 1909-1914.CrossRefGoogle Scholar
  75. Slooter, A.J., et al. 1997 Apolipoprotein E epsilon4 and the Risk of Dementia with Stroke. A Population-Based Investigation. JAMA 277(10): 818–821. Google Scholar
  76. Smith, A., Kobayashi, K., Chappell, N. and D. Hoxsey- The controversial promises of cholinesterase inhibitors for Alzheimer’s disease and related dementias: A qualitative study of caregivers’ experiences.Journal of Aging Studies 25(4):397-406, 2011.CrossRefGoogle Scholar
  77. Sparks DL et al. 2010 Cholesterol and cognitive performance in normal controls and the influence of elective statin use after conversion to mild cognitive impairment. Neurodegenerative Disease 7: 183–186.CrossRefGoogle Scholar
  78. Sperling, R.A. et al. - Toward Defining the Preclinical Stages of Alzheimer’s Disease. Alzheimer’s & Dementia 7(3): 280-292, 2011.CrossRefGoogle Scholar
  79. Sperling, RA and KA Johnson 2012 Dementia: New Criteria but no New Treatments. JAMA 11: 4-5.Google Scholar
  80. Tanzi, RE and AB Parsson 2000 Decoding Darkness, The Search for the Genetic Causes of Alzheimer’s Disease. Cambridge, MA: PerseusGoogle Scholar
  81. Tariot, PN et al. (for the Memantine Study Group) – Memantine treatment in patients with moderate to severe Alzheimer Disease already receiving donepezil. JAMA 291(3): 317-324, 2004.CrossRefGoogle Scholar
  82. The Lancet 2011 Editorial: Lessons from Lipitor. doi:10.1016/S0140-6736(11)61858-8.
  83. Thomas, K. 2013 Questions for a New Class of Cholesterol Drugs. The New York Times, November 14, 2013, ‘Business day’ section.Google Scholar
  84. Timmermann, C. 2011 Appropriating Risk Factors: The Reception of An American Approach to Chronic Disease in the Two Generations, ca. 1950–1990. Social History Medicine. doi:10.1093/Shm/hkr051.
  85. Trinh, N.H., J. Hoblyn, S. Mohanty, and K. Yaffe 2003 Efficacy of Cholinesterase Inhibitors in the Treatment of Neuropsychiatric Symptoms and Functional Impairment in Alzheimer Disease: A Meta-analysis. Journal of the American Medical Association 289(2): 210–216.Google Scholar
  86. Van Dujn, C.M., et al. 1994 Interaction Between Genetic and Environmental Risk Factors for Alzheimer's Disease: A Reanalysis of Case-control Studies. EURODEM Risk Factors Research Group. Genetic Epidemiology 11(6): 539–551Google Scholar
  87. Van Melick, E.J. 2004 Atypical Antipsychotics in the Elderly. Tijdschrift Voor Gerontologie En Geriatrie 35(6): 240–245.Google Scholar
  88. Visser, PJ, Vos, S, van Rossum, I. and P. Scheltens 2012 Comparison of International Working Group criteria and National Institute on Aging–Alzheimer’s Association criteria for Alzheimer’s disease. Alzheimer’s & Dementia 8: 560–563. CrossRefGoogle Scholar
  89. Whitehouse, P. and D. George 2008 The Myth of Alzheimer’s: What You Aren’t Being Told About Today’s Most Dreaded Diagnosis. New York: St. Martins Press.Google Scholar
  90. Wilson, D. 2010 Risks Seen in Cholesterol Drug Use in Healthy People. New York Times, March 30, online issue.Google Scholar
  91. Wirth, M. 2013 Associations between Alzheimer Disease Biomarkers, Neurodegeneration, and Cognition in Cognitively Normal Older People. JAMA Neurology 70(12): 1512–1519.Google Scholar
  92. Yamamura, T., et al. 1984 New Mutants of Apolipoprotein E Associated with Atherosclerotic Diseases but not to Type III Hyperlipoproteinemia. Journal of Clinical Investigation 74(4): 1229–1237.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.University of MontrealMontrealCanada

Personalised recommendations