TY - JOUR T1 - Dementia: is the biopsychosocial model vindicated? JF - British Journal of General Practice JO - Br J Gen Pract SP - 344 LP - 345 DO - 10.3399/bjgp17X691781 VL - 67 IS - 661 AU - Steve Iliffe AU - Jill Manthorpe Y1 - 2017/08/01 UR - http://bjgp.org/content/67/661/344.abstract N2 - We know so much more about dementia syndrome than we did 20 years ago, but we can do little more for it medically. A BMJ editorial of 1 October 1983 entitled ‘Dementia: biological solution still a long way off’ still holds good. The pathological model built around a neurone-centric, linear cascade initiated by amyloid and leading to the dominant subtype of dementia, Alzheimer’s disease (AD), is wrong. This direct causality is incompatible with clinical observations,1 and has failed to produce any significant pharmacological therapies. Not only are there no disease-modifying drugs but also the symptom modifiers, cholinesterase inhibitors and memantine, yield clinical benefits that are negligible at a population level.2 The research community acknowledges that a single cure for AD is unlikely to be found and that the approach to drug development for this disorder needs to be reconsidered.3This is a pessimistic picture, but only if all research is focused on cellular mechanisms. We can be more optimistic if we frame dementia syndrome as a disability (the gap between environmental … ER -