Elsevier

Biochemical Pharmacology

Volume 88, Issue 4, 15 April 2014, Pages 677-681
Biochemical Pharmacology

Review - Part of the Special Issue: Alzheimer's Disease – Amyloid, Tau and Beyond
The end of Alzheimer's disease—From biochemical pharmacology to ecopsychosociology: A personal perspective

https://doi.org/10.1016/j.bcp.2013.11.017Get rights and content

Abstract

The future of the Alzheimer's disease (AD) field involves a more complete understanding not only the state of current scientific approaches, but also the linguistic and cultural context of preclinical and clinical research and policy activities. The challenges surrounding dementia are large and growing but are only part of broader social and health concerns. In this latter context, the current state of research in the AD area is reviewed together with necessary priorities in moving forward. Creating a more optimistic future will depend less on genetic and reductionist approaches and more on environmental and intergenerative approaches that will aid in recalibrating the study of AD from an almost exclusive focus on biochemical, molecular and genetic aspects to better encompass “real world” ecological and psychosocial models of health.

Introduction

Identifying future directions by which to travel on the complex map of what has become called the Alzheimer's field involves understanding not only the state of the art in current day science, but also the language that is used to characterize the challenges and the cultural context in which basic and clinical research and policy making activities occur. The future of this key area of human endeavor is critically dependent on what happens to human beings in general and while the social concerns surrounding dementia, including Alzheimer's disease (AD), are huge by no means do they represent the only social, economic, and health challenges. A more hopeful future can – and must – be created but this depends on learning the lessons from the last few decades of AD research. The principal lesson for this quarter century veteran basic and clinical scientist researcher is that we need less genetic and reductionist science and more environmental and intergenerative approaches to move from biochemical/molecular pharmacology to ecopsychosociology [1], [2]. For those committed to applying scientific approaches to dementia, as I am, appreciating the bigger social picture is critical.

Words and stories matter greatly in this process of change. Intergenerative is a new word that focuses attention on innovation via the exploration of the spaces between concepts like disciplines and professions. Thus the future poses intergenerational ethical issues that the relative distribution of resources to children and elders and to those with dementia now and those threatened by it in the future. Ecopsychosocial is another new term designed to extend the biopsychosocial model of health by making explicit the need to view ecology as a dominant form of biological thinking in relationship to disease [1]. Ultimately evolutionary anthropological approaches in medicine are needed that look at changes in genes and environment over time in relationship to each other and to culture.

In this review I will explore the larger context of work in dementia focusing on aging, health, the environment, economics and ethics and will then examine the state of the science in relationship to these broader perspectives. Finally I will end with a brief discussion of priority setting and next steps that should be considered (Fig. 1).

Section snippets

Context

Aging demographics are often repeated like a mantra in the field of AD to emphasize the growing number of elders at risk for dementia. Statistics are used to calculate that someone is newly affected (diagnosed or labeled?) by AD every minute and that in the future that rate will accelerate. Moreover we are driven to believe that early diagnosis will improve outcomes, although how early and of what and for what purpose are questions that are only rarely asked. Moreover, language such as the

State of the science

During the past 25 years we have seen two hypotheses dominate the AD research field, the arguably true but limited so-called cholinergic hypothesis [19], [20] and the currently fashionable but weakening amyloid hypothesis [21], [22]. Both can be framed more narrowly in clinical and scientific terms but as general claims to importance they reflect more the current practices, politics, and fads of the Alzheimer field and science in general. The cholinergic hypothesis was based on a systems focus

Priorities for the future

We must essentially reverse priorities for the treatment of AD. Care must be viewed as more important than cure rather than the current message from the Alzheimer's Association and others that cure (“ending” Alzheimer's) is the answer. Even if effective drugs are developed, they might improve mortality (i.e. by keeping people out of nursing homes longer) and hence might not in the long term diminish the number of older people with cognitive impairment. If such drugs prolong life, they might

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