The Alzheimer's Conundrum provides an important reminder for researchers to ensure that their work is appropriately multifaceted and contextualised. The book is the result of Margaret Lock's ethnographic study into the world of Alzheimer's disease research. Lock views ethnography as a practice that reconstructs the recent past in order to help shape future action: a role that after reading this book I hope it can achieve. She illustrates that the complexity and uncertainty inherent in Alzheimer's disease research is not always recognised by those involved and that this can have potentially limiting results on the usefulness of the research itself.

Lock outlines how the emphasis on medicalising dementia has led to a situation where social explanations have been marginalised: ‘We would do well … to consider the approaching pandemic of aging as a matter of public health and local politics and not merely a medical matter, with its individualized approach to the detection of bodily ills’ (p. 18). In making this argument she begins by highlighting ontological critiques of scientific objects: ‘Exactly what is drawn on to constitute and verify named diseases changes over time, usually due to technological innovations that permit new ways of “seeing” and thinking about the “object” in question’ (p. 6). To consolidate her argument, Lock provides a detailed analysis of existing Alzheimer's research. She begins with a discussion of how even the work that led to the initial ‘discovery’ of Alzheimer's is not as clear-cut as we are often led to believe. In highlighting how this complexity continues in research today, Lock identifies three tensions that she feels obscure Alzheimer's disease. The first is the tendency to separate mind and body, which she argues has meant that the role of the mind does not appear in discussions of dementia despite being the mediator between the brain and external stimuli.

The second tension relates to the pressure to divorce Alzheimer's from natural ageing, when many scientists acknowledge age as the biggest risk factor. Moreover, she adds that the ongoing emphasis on the role of amyloid plaques and tangles in the brain continues despite the extent to which their presence correlates with symptoms of dementia not being straightforward. Many people can have plaques and tangles present in their brain without any symptoms. Lock argues that ‘the reality is there will be no silver bullet for Alzheimer disease’ (p. 241). She suggests that the big question should be: what protects individuals from dementia? Nevertheless, she adds that the recent preventative shift is also problematic because there are so many unknowns to Alzheimer's aetiology and to who is at risk. Lock recognises that the prioritising of the language of ‘cure’ and of discourses about the certainty of detection are in part due to the need to raise money to fund research and to provide people affected by dementia with access to much needed support. She is also clear that they are in part the result of media over-simplification. However, she suggests that the reification of Alzheimer's has also helped obscure the complexity of what lies beneath the symptoms.

The third tension concerns the tendency to try to understand biology out of context; in particular, she refers to the search for Alzheimer's genes when it is clear that genes and environment are intricately entangled. She highlights how some such ‘epigenomic’ research already exists but that it is currently peripheral. Lock concludes that public health programmes are also needed to engage with the reality of ageing while attempting to reduce dementia prevalence, or at least slow its progression, … largely through the agency of family and communities that receive governmental support’ and that this ‘would also reduce the stigma’ (p. 242). She adds that such public health initiatives would only have a limited effect and that there is also a need to reduce poverty and inequality.

The strength of this book is the in-depth detailing of the limitations of the existing science of Alzheimer's. At the same time, this level of detail is perhaps not necessary to convince social scientists that science is socially constructed, or that our bodies are intricately interconnected with our environments. The main limitation of the book, however, is that although it argues for a public health approach it does not detail any existing studies and therefore it is not clear what a public health approach could offer. Had Lock included even just a couple of paragraphs outlining some of the major developments in understanding how the experience of living with dementia can be improved this would have made her argument more convincing.

This book is particularly relevant for researchers in the field of dementia: for those coming from a bio-medical perspective it may help them to be more reflexive about the choices they make in their studies, and for social scientists it may help to further understandings of and potential links with more medically focused research.