Has the diagnosis of Alzheimer’s disease outlived its usefulness? I have felt for some time that the diagnosis of Alzheimer’s disease has no clinical utility. First, one can have Alzheimer’s disease and never become forgetful. Second, one can have Alzheimer’s disease with memory loss but not become demented. Third, one can become demented and not have Alzheimer’s disease. Fourth, we do not know the cause of Alzheimer’s disease as evidenced by the massive failure of amyloid treatments to date. Fifth, there is no pure case of Alzheimer’s disease in the elderly. Finally, there is no specific treatment unique to Alzheimer’s disease.

The real life problem is not that someone has Alzheimer’s disease but rather the practical issue is whether one can be competent to handle the tasks of independent living: self-care, toileting, dressing, doing the checkbook, getting around, learn, being in relationships, etc. Some are more proficient at any of these tasks than others. But the clinical problem develops when one becomes disabled, unable to carry out independent activities in the real world. Dementia is a form of disability. Dementia is by definition irreversible. Dementia may come on suddenly from such things as head injuries or strokes. Dementia may develop over time from such things as Alzheimer’s disease, Lewy Body disease, or Huntington’s chorea.

Based on autopsy findings very few elderly that become demented have pure Alzheimer’s disease. For example, as we age, the brain is affected by strokes. Most of the strokes are “silent” that is without symptoms. There are small strokes that can be seen upon imaging techniques such as the MRI but we are not aware of events marking them. There are strokes so small that they cannot be seen via imaging like the MRI but can be seen under the microscope during autopsy. These silent strokes alone may double the rate of dementia. It may not be the pathology of Alzheimer’s disease alone that causes one to become demented but rather the added burden of a second pathology that overwhelms the ability to compensate.

So rather than use a term like Alzheimer’s disease wouldn’t we be better off just using labels like Mild Cognitive Impairment (still independent) and dementia (no longer independent)? If we made this change it would allow us to focus our attention on practical skills like doing a checkbook, driving, being able to express oneself, preparing meals, etc. This removes all of the connotations that a label like Alzheimer’s disease has. Rather we could then assess functional skills and develop treatments plans to address them.

We could also become more proactive. For example, we can address issues like cardiovascular disease to reduce (not prevent) the likelihood of ever becoming demented, even if we are unlucky enough to have the pathology that is Alzheimer’s disease. Aggressively treating such factors as blood pressure may reduce the odds of becoming demented by 50%. We can further protect ourselves by not smoking, limiting consumption of alcohol, managing diabetes, exercising, and eating a heart healthy diet.

It is time to redirect our thinking. The label “Alzheimer’s disease” limits our thinking and has outlived its usefulness. It reduces our options. It creates a hopelessness that may be unnecessary. Alzheimer’s disease is a label not an explanation for certain ways the brain becomes less competent with advancing age in some but not all.