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On the reconceptualization of Alzheimer's disease

机译：论阿尔茨海默病的侦查

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In the hope of future treatments to prevent or slow down the disease, there is a strong movement towards an ever-earlier detection of Alzheimer's disease (AD). In conjunction with scientific developments, this has prompted a reconceptualization of AD, as a slowly progressive pathological process with a long asymptomatic phase. New concepts such as 'preclinical' and 'prodromal' AD have been introduced, raising a number of conceptual and ethical questions. We evaluate whether these new concepts are theoretically defensible, in light of theories of health and disease, and whether they should be understood as disease or as an at-risk state. We introduce a pragmatic view on disease concepts and argue that an evaluation of the reconceptualization of AD should also take its aims and effects into account, and assess their ethical acceptability. The reconceptualization of AD is useful to coordinate research into preventive strategies, and may potentially benefit future patients. However, in the short term, early detection and labelling of 'preclinical AD' can potentially harm people. Since there is no treatment available and the predictive value is unclear, it may only create a group of 'patients-in-waiting' who may suffer from anxiety, uncertainty and stigmatization, but will never actually develop dementia. We conclude that only if the promise of preventive medication materializes, will the reconceptualization of AD turn out unequivocally to be for the better. Otherwise, the reconceptualization may do more harm than good.
机译：在未来治疗的希望中预防或减缓疾病，朝着阿尔茨海默病（广告）的较早检测有很大的运动。与科学发展的发展相结合，这促使广告的康复，作为具有较长无症状的逐步渐进的病理过程。引入了“临床前”和“前驱”广告等新概念，提高了许多概念和道德问题。根据健康和疾病的理论，我们评估这些新概念是否是理论上可取的，以及它们是否应理解为疾病或以风险状态。我们介绍了疾病概念的务实看法，并争辩说，评估广告的康复化应考虑到其目标和效果，并评估其道德可接受性。广告的康复化可用于协调预防策略的研究，可能会使未来的患者受益。但是，在短期内，早期检测和标记“临床前广告”可能会危害人。由于没有可用的治疗，并且预测值尚不清楚，因此它可能只会为可能患有焦虑，不确定性和侮辱的人创建一组“候车患者”，但实际上不会产生痴呆症。我们得出结论，只有在预防性药物的承诺实现的情况下，广告的康复会毫不含糊地变得更好。否则，侦察化可能比良好更弊。

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