Cognitive Aging and Community: A Newview

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DEMENTIA IN EVERYDAY LIFE: CHALLENGES, CHOICES AND SOLUTIONS

The Alzheimer's Association estimates that more than 5 million people in the United States are living with Alzheimer's disease, and the challenges are significant and varied for individuals and their families coping with Alzheimer's disease and dementia. This 'In Focus ' section highlights five experts' approaches to patient care and to the promotion of wellbeing for those living with Alzheimer's and other forms of dementia. The strategies, research findings, programs and activities are aimed at helping people with dementia lead safe and supported lives, with a fuller sense of engagement and purpose.

- Alison Hood, Editor

Aging Today

Fear is the predominant emotion evoked by our cultural understanding of so-called Alzheimer's disease. This fear limits healthier approaches to cognitive aging. Alzheimer's is claimed to be both a single condition and a padiology unrelat- ed to aging by the Alzheimer's establishment, but is neither. Alzheimer's disease is a catch-all phrase that represents a collection of brain aging processes that affect us all variously as we age. When we reframe Alzheimer's as brain aging and reject a diseaseoriented approach, we enable greater individual and social choice. Healdicare professionals play an important role in guiding individuals and families, not by offering the promise of a quixotic biological fix, but by providing holistic, community-based approaches that focus on prevention and improve quality of life.

Alzheimer's disease can influence change in how we see ourselves as human beings, and in how we conceptualize our community spaces and relationships to the natural environment. When we focus on the strengths and capacities of people with brain aging, rather than on their frailties and debilities, we transform our Uves and our communities. The dominant disease model must be challenged because of its economic and psychological costs. If we do so, we gain a more integrated perspective.

CREATING HEALTHIER COMMUNITIES

Uncertainty over the concept of Alzheimer's disease arose 100 years ago with Dr. Alois Alzheimer who questioned whedier the symptoms he observed in his patients represented a disease process or an accelerated process of brain aging. Research over time has reinforced our knowledge that so-called Alzheimer's is a heterogeneous set of conditions involving neuronal loss, plaques, tangles and other biological features. Variability exists at the genetic level and, critically, in the clinical presentation and evolution of our elders' cognitive challenges.

Today, our population has a larger segment of older individuals, and the impact of billions of human beings on the planet's ecosystems and societies is far greater.

A wise response to these challenges involves a reinvention of local community. …