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One of the most significant developments in dementia care has been the introduction of pharmacological interventions to slow mild to moderate cognitive decline in Alzheimer's disease. The majority of these drugs are designed to interfere with the process by which the Alzheimer pathology breaks down acetylcholine, a neurotransmitter essential for optimal brain functioning. The introduction of drug treatment coincided with an interest in studying dementia in its earliest manifestations, when cognitive loss deviates from normal functioning but at levels insufficient to meet criteria for a diagnosis of dementia. This phenomenon, described almost half a century ago as "benign senescent forgetfulness," has in the past decade received a surge of interest, with nearly 20 new diagnostic categories characterizing more or less the same type of impairment.

The attraction in detecting dementia at an early stage lies in the possibility of introducing pharmacological intervention to retard decline into full-blown disease. With an increasingly aging population, early detection represents a potentially lucrative market for pharmaceutical companies that have invested in the development of dementia treatments. However, a key challenge has been to develop neuropsychological tests that are sufficiently accurate to distinguish the types of impairment that convert to dementia from those associated with normal aging. Inaccurate diagnosis could lead to the unwarranted use of potentially harmful drugs and cause psychological distress to those mistakenly identified as being at risk for dementia and their families. The stigma of being labeled as "dementing" early in life also has repercussions in terms of employment and access to adequate health insurance coverage. Rising public awareness of these new diagnostic categories could also potentially cause healthy older individuals to needlessly worry about their memory function.

The definition of dementia remains contested as biomedicine continues in its quest to categorize cognitive decline into increasingly specific disorders. Social scientists have drawn attention to the social and moral dimensions associated with the diagnosis, genetic testing, and treatment of dementia disorders, with particular emphasis on Alzheimer's disease. Epidemiological findings about the prevalence of dementia disorders in an increasingly older population raise concerns about the allocation of health care resources worldwide.

Bibliography:

1) Ballenger, Jesse F. 2006. Self, Senility, and Alzheimer's Disease in Modern America: A History. Baltimore: Johns Hopkins University Press.

2) Gubrium, Jaber F. 1986. Old Timers and Alzheimer's: The Descriptive Organization of Senility. Greenwich, CT: JAI.

3) Kitwood, Tom. 1997. Dementia Reconsidered: The Person Comes First. Buckingham, England: Open University Press.

4) Leibing, Annette and Lawrence Cohen, eds. 2006. Thinking about Dementia: Culture, Loss, and the Anthropology of Senility. New Brunswick, NJ: Rutgers University Press.

5) Sabat, Steven R. 2001. The Experience of Alzheimer's Disease: Life through a Tangled Veil. New York: Blackwell.

6) Traphagan, John W. 2000. Taming Oblivion: Aging Bodies and the Fear of Senility in Japan. Albany, NY: StateUniversity of New York Press.

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