In Preventing Dementia? Editors Annette Leibing and Silke Schicktanz take what they call the ‘new dementia’, and the emergent prevention paradigm surrounding it, as the focus for a collection of critical contributions from across the social sciences. What's striking about the book is the way its empirical case pushes social scientists to think beyond familiar arguments about medicalisation, brain-centeredness, reductionism and tech-solutionism. What might at first seem like a straightforward reflection on what is considered novel in public health and biomedicine, in fact unsettles our associations between newness and the high-tech. The book opens with a rundown of the recent ‘turn towards prevention’ in the field of dementia: a story of expanding notions of risk factors and possible interventions. Drawing from a Lancet Commission on Dementia Prevention, Intervention and Care (Livingston et al., 2017), they outline key modifiable risk factors that are now associated with lifestyle in early and mid-life as well as older age. This marks a departure from existing approaches to dementia prevention, which were ‘restricted to rather uncertain ideas around “brain training”’ in older age (p.1), and a renewed focus on the whole body and life course.

Rather than taking the ‘newness’ of dementia prevention for granted, the editors and contributors play with what is new and what is ‘not so new’ throughout the book. We learn, for example that this prevention paradigm links the brain, the body and the social environment in ways that far precede the Alzheimer's disease model (page 3). I was compelled by the anthropological notion of ‘brain becoming body’ (ibid.), particularly as it enters mainstream public health approaches. Indeed, the introduction suggests a cautious optimism that challenges the neuro-reductionist picture that social scientists have painted of the dementia field thus far. However, the chapters that follow show the dangers and pitfalls of the prevention paradigm as the contributors encounter it empirically. I read in this a strong ‘be careful what you wish for’ message, revealing how prevention ideals can be transformed, co-opted or seen to be inherently flawed, as they take on a life of their own in practice: a recognition of poverty-related risk leading to ‘blaming the poor for poor health’ (Chapter 2), an emergent, more ‘holistic’ approach that may also over-extend the medical gaze (Chapter 5), and the critique of medical expertise that ends up shifting responsibility from health-care providers to individual citizens (Chapter 10), to name a few throughout the book.

Part One focuses on specific case studies of the discursive and social practices of dementia prevention. As the longest section of the book, it brings together five chapters that situate these practices in their historical and epistemic context (Chapters 1 and 5) and in three distinct national contexts (Brazil, Chapter 2; Germany, Chapter 3; Switzerland, Chapter 4). For example, Leanza's observations of the role of the state and other collectives in producing the ‘preventative self’ in the Swiss context offers a ‘different take’ on the neoliberal critique, which lends itself to describing how individuals are encouraged to take responsibility for their health instead of relying on state-led interventions. Whilst narratives of individual responsibility are important throughout the book, the chapters raise questions about the extent to which people incorporate lifestyle ideals into their habits and practices: under what conditions? Amongst which groups? Why? I would have been interested to see the global-local interaction (or the ‘glocal’ as Leibing calls it, p.50) pushed yet further to address such questions; perhaps through attention to smaller scales than these national comparators – micro interactions, spaces or locales, which might reveal different, perhaps messier, sets of connections to the global discourses and dynamics of the ‘new dementia’.

Part Two focuses on the early detection of dementia and the long-debated diagnostic category of mild cognitive impairment (MCI). Whilst Chapter 7 focuses on the persistent uncertainties that the label carries, the other contribution, from Tiago Moreira, charts empirical shifts since the early 2000s that have seen MCI lose its status as an enabler of promising therapeutics. In doing so, he brings us back to the interrogation of ‘the new’ in dementia prevention, with the astute observation that people with memory problems are increasingly configured as ‘consumers’ of diagnostic information and distinctly non-technical lifestyle advice.

Part Three focuses on prevention itself, in relation to chronicity, responsibility, and governmentality. At this point, I wondered if the cautious optimism outlined in the introduction bears out in this broader frame of chronic illness that has come to emphasise lifestyle as the core problem confronting public health (Bell, Chapter 8). Overall, the book seems to imply a kind of ambivalent optimism towards the "contested space" of prevention (p.245). This optimism is very different to that associated with current discourse around ‘active’ or ‘successful’ ageing where assumptions of individual autonomy, empowerment, and inner resources abound. Leibing, in particular, insists that we recognise the unevenness and undemocratic nature of dementia and how it affects lives. Like the early responses to COVID-19 that suggested we were all ‘in it together’, it is clear that models of dementia as a mysterious and indiscriminate brain disease are fast becoming untenable. What is less clear is how the editors’ cautious optimism might take hold; how might prevention models based on the ‘brain becoming body’ move beyond the ‘responsible individual’ to the social worlds, structures, and ecologies of these ageing bodies?

In provoking such questions, this collection provides a highly informative but also political take on the changing face of dementia prevention internationally. This will be illuminating to social science and bioethics scholars, as well as policymakers and public health practitioners engaged in dementia prevention, chronic illness, and ageing throughout the life course.

在预防痴呆症？编辑 Annette Leibing 和 Silke Schicktanz 将他们所谓的“新痴呆症”以及围绕它的紧急预防范式作为跨社会科学的重要贡献集合的焦点。这本书的惊人之处在于它的实证案例促使社会科学家超越关于医学化、以大脑为中心、还原论和技术解决主义的常见论点进行思考。乍一看似乎是对公共卫生和生物医学中被认为是新事物的直接反映，但实际上扰乱了我们在新事物和高科技之间的联系。这本书首先概述了痴呆症领域最近的“转向预防”：一个关于风险因素和可能干预措施的扩展概念的故事。摘自柳叶刀痴呆症预防委员会，2017 年），他们概述了现在与早年和中年以及老年生活方式相关的关键可改变风险因素。这标志着与现有的痴呆症预防方法的背离，这些方法在老年时“仅限于围绕“大脑训练”的相当不确定的想法（第 1 页），并重新关注整个身体和生命历程。

编辑和撰稿人并没有将预防痴呆症的“新事物”视为理所当然，而是在整本书中探讨新事物和“不那么新”的事物。例如，我们了解到，这种预防范式以远早于阿尔茨海默病模型的方式将大脑、身体和社会环境联系起来（第 3 页）。我被“大脑变成身体”（同上）的人类学概念所吸引，特别是当它进入主流公共卫生方法时。事实上，引言表明了一种谨慎的乐观主义，它挑战了社会科学家迄今为止对痴呆症领域所描绘的神经还原论图景。然而，随后的章节展示了预防范式的危险和陷阱，因为贡献者在经验上遇到了它。我在这篇文章中读到了一个强烈的“小心你想要的”信息，

第一部分侧重于预防痴呆症的话语和社会实践的具体案例研究。作为本书最长的部分，它汇集了五章，将这些实践置于其历史和认知语境（第 1 章和第 5 章）以及三个不同的国家语境（巴西，第 2 章；德国，第 3 章；瑞士，第 4 章）中）。例如，Leanza 对瑞士背景下国家和其他集体在产生“预防性自我”方面的作用的观察提供了对新自由主义批评的“不同看法”，这有助于描述个人如何被鼓励为他们的行为承担责任。卫生，而不是依赖国家主导的干预措施。虽然个人责任的叙述在整本书中都很重要，这些章节提出了人们将生活方式理想融入他们的习惯和实践的程度的问题：在什么条件下？在哪些群体中？为什么？我很想看到全球与本地的互动（或雷冰所说的“全球本地”，第 50 页）进一步推动解决这些问题；也许是通过关注比这些国家比较对象更小的尺度——微观互动、空间或场所，这可能会揭示与“新痴呆症”的全球话语和动态的不同的、也许是更混乱的联系。

第二部分重点介绍痴呆症的早期检测和长期争论不休的轻度认知障碍 (MCI) 诊断类别。虽然第 7 章侧重于标签所带来的持续不确定性，但来自 Tiago Moreira 的另一项贡献描绘了自 2000 年代初以来的经验变化，这些变化已经看到 MCI 失去了作为有希望的疗法的推动者的地位。在这样做的过程中，他将我们带回了对痴呆症预防“新事物”的质疑，他敏锐地观察到，有记忆问题的人越来越多地被配置为诊断信息和明显非技术性生活方式建议的“消费者” 。

第三部分侧重于预防本身，与长期性、责任和管理性有关。在这一点上，我想知道引言中概述的谨慎乐观主义是否在这个更广泛的慢性病框架中得到证实，该框架已经开始强调生活方式是公共卫生面临的核心问题（贝尔，第 8 章）。总的来说，这本书似乎暗示了一种矛盾的乐观主义迈向预防的“竞争空间”（第 245 页）。这种乐观情绪与当前围绕“积极”或“成功”老龄化的讨论非常不同，后者对个人自主权、赋权和内在资源的假设比比皆是。尤其是雷兵坚持认为，我们认识到痴呆症的不平衡性和不民主性质以及它如何影响生活。就像对 COVID-19 的早期反应表明我们都“在一起”一样，很明显，痴呆症作为一种神秘且不分青红皂白的脑部疾病的模型正在迅速变得站不住脚。不太清楚的是，编辑们的谨慎乐观情绪可能会如何站稳脚跟；基于“大脑成为身体”的预防模型如何超越“负责任的个人”，进入这些衰老身体的社会世界、结构和生态？

在引发此类问题时，该系列提供了对国际上痴呆症预防不断变化的面貌的高度信息化但也具有政治意义。这将对社会科学和生物伦理学学者以及从事痴呆症预防、慢性疾病和整个生命过程中衰老的决策者和公共卫生从业者具有启发意义。