Concepts of Alzheimer Disease: Biological, Clinical, and Cultural Perspectives (review)

Peter J. Whitehouse, Konrad Maurer, and Jesse F. Ballenger, eds. Concepts of Alzheimer Disease: Biological, Clinical, and Cultural Perspectives. Baltimore: Johns Hopkins University Press, 2000. xx + 321 pp. Ill. $55.00.

The majority of essays that make up this extremely useful and informative collection are the result of a 1997 symposium held in Alois Alzheimer's birthplace in Marktbreit, Germany. Although parts of this book trace material familiar to specialists in each area examined, the volume as a whole provides a comprehensive overview of Alzheimer disease (AD) that is valuable for generalists as well as for historians of medicine. The book is divided into five sections, each focusing on a different methodological approach to AD. The first examines the cases of Alzheimer's original two patients. Based on recently discovered clinical records and examination of the first patient's brain, Konrad Meyer and his colleagues conclude that the tangles and plaques, with an absence of vascular lesions, make this a model for AD. In contrast Hans-Jurgen Möller and Manuel B. Graeber find that Alzheimer's second patient, Johann F. (1911), reveals "numerous plaques but no neurofibrillary tangles" (p. 44). This history opens the wider historical, clinical, and cultural questions discussed in the chapters that follow: Are there separate categories of AD that can be classified through histology? Should AD be seen as separate from senile dementia? Is the neuropathology and sign/symptom complex associated with senile dementia a separate disease when it occurs in relatively younger patients? Can a common condition of aging be classified as a disease?

The second section reviews the evolution of AD as a clinicopathologic entity. Heiko and Eva Braak's excellent discussion of neurofibrillary changes in AD provides a useful historical overview of the way that neuropathology has been understood in AD. Hans Förstl argues that the correlation between deficits and pathology in AD patients provides "a powerful argument for a spectrum of clinical and anatomical findings between pathology and normalcy," which "does not support a simplistic categorical distinction between separate clinicopathologic disease entities, which would have to be based on qualitative rather than quantitative markers" (p. 78). Jesse F. Ballenger, on the other hand, demonstrates the extent to which social and cultural assumptions have framed the way clinicopathologic findings have been interpreted and have influenced treatment over the past century. Informative essays by Robert Katzman and Katherine L. Bick on the rediscovery of AD in the postwar decades and by Daniel A. Pollen on genetics round out this section.

The third part consists of three essays on AD as a social and cultural entity. Rob J. M. Dillman takes on the debate over whether AD is an inevitable feature of aging. Reminding readers that "the demarcation of diseased biological processes does not have a clear ontological basis," he insists that "since AD is a reality claim, it is impossible to tell what AD really is" because "aging is not a mechanism; it is a way of comparing people" (p. 150). Thus, it is circular to describe as changes features that are seen as inevitable processes of aging. Similar issues are explored by Martha Holstein, who argues that "transitions in the concept of AD graphically illustrate how negotiation processes establish that certain physical and/or mental conditions deserve the disease label--a decision that often cannot be singularly explained by scientific discovery" (p. 159). Examining the narratives of AD patients and caregivers, Jaber F. Gubrium separates the affliction from its diverse meanings. He finds that "AD only becomes a widely shared framework for assigning personal meaning to the cognitive experiences of later life in the 1970s" (p. 200).

The fourth section focuses on the politics of AD, especially the influence of voluntary associations on legislation and medical care. Patrick J. Fox's essay on the development of the Alzheimer's Association is informative, but is not placed in the context of...