An analytic framework for conceptualisations of disease: nine structuring questions and how some conceptualisations of A
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SCIENTIFIC CONTRIBUTION
An analytic framework for conceptualisations of disease: nine structuring questions and how some conceptualisations of Alzheimer’s disease can lead to ‘diseasisation’ Kristin Zeiler1
© The Author(s) 2020
Abstract According to the US National Institute on Aging and the Alzheimer’s Association (NIA-AA), Alzheimer’s disease (AD) should be understood as a biological construct. It can be diagnosed based on AD-characteristic biomarkers only, even if AD biomarkers can be present many years before a person experiences any symptoms of AD. The NIA-AA’s conceptualisation of AD radically challenges past AD conceptualisations. This article offers an analytic framework for the clarification and analysis of meanings and effects of conceptualisations of diseases such as that of AD. This framework consists of nine questions that allows us to determine how the conceptualisations of diseases, such as that of AD, link or decouple the following terms to/from each other: screening, diagnosis, pathology, disease (along the lines of what have been labelled as “biologicalphysiological” or “normative” conceptions of disease in philosophy of medicine), symptoms, and illness. It also includes questions regarding how specific decouplings open up for new categories through which people can understand themselves in new ways, and what spaces of possibilities specific conceptualisations (and their decouplings and linkages) open to. The article shows how specific decouplings/linkages can open up not only for the phenomena of pathologisation but also for a distinct, but related phenomenon here termed as diseasisation. Keywords Alzheimer’s disease · Concept · Performativity · Diagnosis · Pathology · Disease · Diseasisation
Introduction Dementia has been described as one of the major challenges facing health care systems (cf. the UK Department of Health 2012). Calls have been made for the early testing for dementia and interventions to increase dementia diagnosis have been carried out (see for example Burn et al. 2019; Krohne et al. 2011). Alzheimer’s disease (hereafter referred to as AD) dementia has been estimated to account for 70% of all cases of dementia (Kamentani and Hasegawa 2018), and much socio-political and scientific work specifically target AD. New conceptualisations and diagnostic criteria for AD have been recommended (Dubois et al. 2007, 2010, 2014, 2016; Cummings et al. 2013; Jack et al. 2011, 2018; Sperling * Kristin Zeiler [email protected] 1
et al. 2011; McKhann et al. 2011) that challenge past conceptions. A workgroup convened by the US National Institute on Aging and the Alzheimer’s Association (NIA-AA), for example, has argued that AD should be understood as a “biological construct”, and that the diagnosis of AD be based on AD-characteristic biomarkers, irrespective of whether clinical symptoms are present (Jack et al. 2018, p. 536). This would allow a diagnosis of AD several years before a person has any symptoms. Concerns have been raised as to whether such an early diagnosis is more benefi
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