The Role of Instruments for Screening Cognitive Function and Alzheimer's disease: A Sociological Exploration

This qualitative ethnographic study examines how cognitive screening tools are used in clinical practice in the process of articulating a classification of Alzheimer’s disease (AD). An exploration of how these low-technological tools constitute AD is important because of their central role in detecting initial cognitive decline in the ‘ageing population’. The study draws upon fieldwork undertaken across a secondary healthcare memory service and a major teaching hospital in the UK. Focusing on the everyday practices and interactions between clinicians, patients and these technologies, the study shows how these tools were made provisional, and yet emerged as central mediators for producing knowledge about AD. I explore the uncertainties associated with measures of cognitive decline and consider how these were navigated and managed through the making of the tools as provisional devices. I continue by showing how the tools emerged as central mediators for negotiating how classification proceeded in medical practice: producing and reproducing professional hierarchies and identities. I also investigate how uncertainty was mobilised by clinicians to constitute the boundaries of classification; fuelled by the possibility that patients may go on to develop AD. Finally, I demonstrate how the adoption of the tools in the wider policy terrain translated into everyday clinical practice; increased efforts to quantify cognitive decline at earlier stages, produced uncertainty around patient futures. I reflect on how the making of these tools as provisional devices, relied upon and resulted in the portability of these devices and, in turn, constituted AD. Portability highlights the temporal and spatial aspects of classification processes involved in diagnosis/prognosis, as well as patient and professional identities and autonomy. I conclude by considering the implications of these findings for the diagnosis and management of patients with cognitive decline and AD locally in the clinic, and with respect to managing the ‘ageing population’.