The Long Search: Preface to the Volume (1997)

Alzheimer's disease is a convoluted puzzle wrapped in layers of mystery. Peeling away one of those layers was the object of an international conference held in the Meadowlands of New Jersey on November 13–15, 1996. The proceedings in this volume of the Annals represent the presentations made at that conference. The prevailing theme of the conference, the first of its kind ever held, centered on the role of the cerebral vasculature on the pathologic evolution of Alzheimer's disease. Presenters and guest scientists from many different disciplines came together from all over the globe for a brief but intensive three days in an attempt to make sense of the anatomic, physiologic, and metabolic changes associated with the cerebral vasculature in normal and Alzheimer brains. The contributions contained in this volume reaffirm the concept that cerebral perfusion and metabolic function in the brain of Alzheimer victims are critically linked in a manner that may provide fundamental information as to the pathophysiologic basis and possible management of this disorder. Why, then, was this conference not held before? The answer to this question might be found in the writings of the noted science historian Thomas Kuhn, who wrote in his book The Structure of Scientific Revolutions, the following: No part of the aim of normal science is to call forth new sorts of phenomena; indeed those that do not fit the box (containing the prevailing paradigm) are often not seen at all. Nor do scientists normally aim to invent new theories and they are often intolerant of those invented by others. This statement is a fair assessment of the way many leading scientists have entrenched their research efforts for the past 90 years into a spinning and largely unproductive paradigm. This stubborn attitude has affected major research funding in the United States at the expense of other potentially useful investigations since it has generally ignored contributions that might have made a difference in the management of this dementia. Kuhn's observation may also help explain why, after 90 years and thousands of studies performed since Alzheimer's disease was first clinically described in 1907, no real clue as to the cause or cure of this disorder has been found. It is therefore appropriate that new ideas and suggestions for nonarchetypal lines of research are presented by investigators contributing to this volume not so much for the sake of shaking the old paradigm, but more as a realization that substantial and compelling evidence seems to indicate a major role for cerebrovascular elements in dementing disorders, particularly Alzheimer's disease. The classic scientific approach of asking “what if…” remains a powerful technique in identifying the problem and designing a strategy that will lead to a reasonable clinical treatment. Time and further research will determine the ultimate merit of this conference in the long search for a solution to this devastating illness. The editors of this volume would like to thank all the sponsors of this conference for their financial assistance, particularly Hoechst Marion Roussel and the National Institute of Aging, without whose major support this meeting would not have been held. We wish to thank the New York Academy of Sciences and Dr. Rashid Shaikh, Director of Science and Technology Meetings, and his able staff, who worked tirelessly and professionally to assure the success of this conference. We are also thankful to the members of the editorial department at the Academy, and particularly Justine Cullinan, the managing editor, for their skill and grace in seeing this volume through the press.