Calculable People? Standardising Assessment Guidelines for Alzheimer's Disease in 1980s Britain.

Duncan Wilson

doi:10.1017/mdh.2017.56

Abstract

This article shows how funding research on Alzheimer’s disease became a priority for the British Medical Research Council (MRC) in the late 1970s and 1980s, thanks to work that isolated new pathological and biochemical markers and showed that the disease affected a significant proportion of the elderly population. In contrast to histories that focus on the emergence of new and competing theories of disease causation in this period, I argue that concerns over the use of different assessment methods ensured the MRC’s immediate priority was standardising the ways in which researchers identified and recorded symptoms of Alzheimer’s disease in potential research subjects. I detail how the rationale behind the development of standard assessment guidelines was less about arriving at a firm diagnosis and more about facilitating research by generating data that could be easily compared across the disciplines and sites that constitute modern biomedicine. Drawing on criticism of specific tests in the MRC’s guidelines, which some psychiatrists argued were ‘middle class biased’, I also show that debates over standardisation did not simply reflect concerns specific to the fields or areas of research that the MRC sought to govern. Questions about the validity of standard assessment guidelines for Alzheimer’s disease embodied broader concerns about education and social class, which ensured that distinguishing normal from pathological in old age remained a contested and historically contingent process.

Highlights

Recent decades have witnessed a striking reappraisal of the nature, prevalence and consequences of Alzheimer’s disease
This article shows how funding research on Alzheimer’s disease became a priority for the British Medical Research Council (MRC) in the late 1970s and 1980s, thanks to work that isolated new pathological and biochemical markers and showed that the disease affected a significant proportion of the elderly population
In contrast to histories that focus on the emergence of new and competing theories of disease causation in this period, I argue that concerns over the use of different assessment methods ensured the MRC’s immediate priority was standardising the ways in which researchers identified and recorded symptoms of Alzheimer’s disease in potential research subjects

Summary

Introduction

Recent decades have witnessed a striking reappraisal of the nature, prevalence and consequences of Alzheimer’s disease. Several historians and social scientists have detailed the linked factors that underpinned this shift, including: the development of electron microscopy, which facilitated work on the protein structure of senile plaques in the 1960s;6 research by British psychiatrists that linked the severity of cognitive impairment to the numbers of senile plaques found during post-mortems, which allowed them to reposition Alzheimer’s disease as a discrete clinical entity and the leading cause of dementia in the 1970s;7 the finding that brains of patients contained low levels of the neurotransmitter acetylcholine in the late 1970s, which raised hopes for treatments and led governments across the western world to prioritise research into Alzheimer’s disease;[8] and the establishment of advocacy groups and media coverage of notable patients, such as former United States President Ronald Reagan, which increased awareness of the social, economic and personal costs of an increasingly ageing population.[9]. Self, Senility and Alzheimer’s Disease in Modern America: A History (Baltimore, MD: Baltimore University Press, 2006), 91–3. Ballenger (eds), Concepts of Alzheimer’s Disease: Biological, Clinical and Historical Perspectives (Baltimore and London: Johns Hopkins University Press, 2000), 209–33

Duncan Wilson

Conclusions