An Intergenerational View: Shifting Perceptions of Human Brain Aging Can Bring Generations Together
George, Daniel R., Whitehouse, Peter J., Aging Today
Our conventional understanding of Alzheimer's disease as an "Old Timer's disease" has too often kept us from seeing brain aging as an intergenerational issue- but the landscape of perception is changing.
For decades, late-life dementia has been understood as a disease event afflicting elders, and the public has relied on an exaggerated hope that science would produce a pharmacological compound to prevent our brains from deteriorating. Yet since 2000, more than 20 Alzheimer's drugs have failed, and scientists are rethinking the fundamental theories of causation that have dominated for a generation. Billions of dollars spent on research have essentially taught us that Alzheimer's disease is not one thing: it is a heterogeneous syndrome rather than a specific disease, and is invariably age-related. This has greatly complicated the pathway to a cure.
Alzheimer's researchers are now looking upstream, conceding that the variegated brain changes we call Alzheimer's likely begin decades before symptoms appear. New diagnostic and research categories are being constructed to define mild and even pre-symptomatic stages, and therapies will be tested earlier in the hope they might intercede in neurodegeneration before symptoms appear.
A Change of Viewpoint
Viewing Alzheimer's as a lifespan condition rather than an end-of-life disease event is a favorable development that can build solidarity between generations. Emancipated from expectations of a downstream pharmacological fix, our multi-age communities can grow more reflective about myriad modifiable risk factors- diet, exercise, stress levels, environmental exposures, healthcare access, head injuries, lifelong learning and others present in our shared environmentsthat affect brain aging processes from in utero through the end stage of life.
Then we can take action: eat more fruits and vegetables and less red meat, wear bike helmets, reduce pollution and toxins, and volunteer in the communitysteps that protect all of us. Healthier and more tightly knit communities will produce healthier brains.
There is also reason to hope that our basic cultural story about brain aging can become more inclusive and life-affirming as the disease model crumbles. One of the most distressing consequences of viewing brain aging as a disease event is that it has produced a cultural horror story, with exclusionary labels and language patterns that separate normal functioning people from those with dementia and justify solitary confinement in assisted living homes.
Rather than finding affinity with those more severely affected by brain aging, we have labeled them mentally ill. These stigmatizing labels are freighted with ominous cultural meanings; for instance, we consider those with Alzheimer's to be disease victims, lost selves- even zombies-treating them as the living dead, beings to be both pitied and feared, despite their obvious signs of life.
Challenging the Cultural Stigma of Dementia
Within the context of increasingly aging populations, it is urgent to de-dramatize Alzheimer's. Realizing we are all susceptible to the same aging processes throughout life (who among us doesn't fall into the new proposed research category of "pre-symptomatic Alzheimer's disease"!) can replace stigma against persons affected by dementia with solidarity, and open opportunities for interaction between generations. …