Clarifying Dementia

By Julian Fisher, MD

"Clarifying" and "dementia" may seem to be terms in conflict, but they allow me to shed some light on my last post -- and a response to those who wrote in with valid comments and concerns.

In general and from a public health/health economics standpoint, it is unreasonable to undertake mass screenings for a disease that has no effective treatments.  Early diagnosis cannot initiate early treatment, prevention or anything...with one important exception that I neglected to mention, and for which I apologize.

Patients beginning the deterioration of a disease like Alzheimer's are still often active in life and business, in social activities and philanthropic activities, all of which may suffer as the neurodegeneration proceeds.  These patients are part of families and communities, with multiple interdependencies.

If there is some concern that someone is suffering an evolving mild cognitive impairment, an early step toward a potentially diagnosable dementia like Alzheimer's, and that person's loss of function and judgment may adversely affect others by bad personal or business decisions (family social or financial issue, business investments, charitable donations), there may well be justification for an attempt at early diagnosis.

One does have to be cautious, though, at this early stage, since the newly reliable tests are new and their reliability has only been proven in relatively small studies.  Sitting on a three-legged stool is comforting -- as long as all three legs are solid.

Julian Fisher, MD is a Boston-based neurologist and medical information entrepreneur.

James Fallows is a national correspondent for The Atlantic and has written for the magazine since the late 1970s. He has reported extensively from outside the United States and once worked as President Carter's chief speechwriter. His latest book is China Airborne. More

James Fallows is based in Washington as a national correspondent for The Atlantic. He has worked for the magazine for nearly 30 years and in that time has also lived in Seattle, Berkeley, Austin, Tokyo, Kuala Lumpur, Shanghai, and Beijing. He was raised in Redlands, California, received his undergraduate degree in American history and literature from Harvard, and received a graduate degree in economics from Oxford as a Rhodes scholar. In addition to working for The Atlantic, he has spent two years as chief White House speechwriter for Jimmy Carter, two years as the editor of US News & World Report, and six months as a program designer at Microsoft. He is an instrument-rated private pilot. He is also now the chair in U.S. media at the U.S. Studies Centre at the University of Sydney, in Australia.

Fallows has been a finalist for the National Magazine Award five times and has won once; he has also won the American Book Award for nonfiction and a N.Y. Emmy award for the documentary series Doing Business in China. He was the founding chairman of the New America Foundation. His recent books Blind Into Baghdad (2006) and Postcards From Tomorrow Square (2009) are based on his writings for The Atlantic. His latest book is China Airborne. He is married to Deborah Fallows, author of the recent book Dreaming in Chinese. They have two married sons.

Fallows welcomes and frequently quotes from reader mail sent via the "Email" button below. Unless you specify otherwise, we consider any incoming mail available for possible quotation -- but not with the sender's real name unless you explicitly state that it may be used. If you are wondering why Fallows does not use a "Comments" field below his posts, please see previous explanations here and here.


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