Dementia has never had a higher profile and governments are falling over themselves to commit funds, though dementia research is still grossly underfunded in comparison with less common and less costly conditions. Despite this, concerns have been expressed about a narrowness of focus, the majority of dementia research focusing on the hypothesis that amyloid is the key to Alzheimer’s disease.
Thank goodness for anthropologist Margaret Lock and her intelligent, comprehensive survey of the state-of-the-art in dementia research. Professor Lock’s book begins and ends by examining three tensions in Alzheimer’s disease research. First, do brain changes directly cause dementia or is there a complex ‘entanglement’ between mind, body and environment throughout the life course? Second, can dementia be disentangled from normal ageing or is it inevitable if one lives long enough? Finally, how much of the disease can be ascribed to genetics alone and how much to changes in gene expression due to gene–gene and gene–environment interactions – ‘a revitalized and reformulated nature/nurture debate’ (p. 6)?
The intervening chapters provide a robust and accessible overview of current dementia research, the fruit of over a decade’s study, including attending numerous conferences and interviewing many of the leading researchers (albeit, understandably, with a North American bias). The book considers attempts to standardise the diagnosis of dementia, although noting that it may represent a ‘moving target’, a term coined by the philosopher–historian–mathematician Ian Hacking. Lock refuses to accept that the recent impetus to drive diagnosis earlier and earlier through the use of biomarkers truly represents a paradigm shift, though hints that there may be one in the offing. Her detailed work examining the long-term effects of being given one’s APOE status – a genetic risk factor for Alzheimer’s disease – as part of a research project is fascinating. Many participants merely assimilated this genetic risk information alongside everything else, including assessments of risk based on similarity to family members who developed dementia, and few made major changes to their lifestyle.
This is an extremely important book and one which I am very grateful to have read. There is much here for the interested general reader but the rich endnotes provide guidance to those wanting to explore the area in more detail. It is wonderfully refreshing to read such a clear survey of dementia research and some interesting speculation of the way things may develop in the future.
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