Understanding the history and cultural variations in the concepts of Alzheimer disease (AD) and related labels such Mild Cognitive Impairment (MCI) can help us understand current diagnostic trends and create ways to enhance quality of life of those challenged now and in the future by age-related cognitive changes. Alzheimer himself had questions about his own disease so labeled by his chairman Emile Kraepelin and by now a world wide and sometimes terrifying eponym. The elimination of the early distinction between pre-senile forms and senile dementia combined with the demographics of aging created an epidemic of AD. Yet most of the world still sees age-related cognitive decline as a part of expected aging for many and, in fact, most as people live longer. As a result of medicalization forces (particularly Nobel-seeking, genetic reductionistic and profit making forms) and scientism in the wealthy countries, the world’s elderly and their doctors are the subject of a campaign to find the “cure” for this dreaded disease. Certainly a clear mind is a gift at any age and biological therapies have helped people with memory and attention problems and may even help those without severe diagnosable problems. Science is powerful and new cognitive enhancers may be a blessing to society. However attempts to recognize early dementia have created a new world of people perplexed by their cognitive aging. Is MCI early AD, not AD or premorbid AD? How can we understand the formation of an international organization advocating and supporting persons with dementia founded and run by people with AD and some with frontal lobe, executive dysfunction forms of dementia? Can we imagine people labeled with AD teaching reading to youngsters in an Intergenerational School? Should we translate (as Chinese experts are suggesting) the term MCI into ideographs meaning “loss of wisdom?” Will we finally have the wisdom amongst experts to recognize that we must be careful trying to have our cake and eat it to? AD is related to aging. Curing it may require a kind of neural fountain of youth. Many will die with cognitive impairment whatever we do, as our brains are our most fragile organs. Let’s try to find biological answers but let’s not forget the wisdom of asking the right questions and accepting that science is not limitless. In a world of pestilence and war where many of our future selves are not being given the chance to enjoy even brief healthy lives, let alone have the opportunities to gain the wisdoms of age, can we not put relationship-based care first? Can we not put the survival of human and other species on our priority list? Evolution gave us the curiosity that drives science; let’s hope it also gave us the biological and cultural tools to create the collective wisdom to put science and cognitive aging in perspective.
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