This extract from Susan Sontag’s seminal book suggests a state of potential disease, illness and death that sits in parallel to health and wellness. Our increasing preoccupation with health risk gives new significance to Sontag’s metaphor of dual citizenship, which now seems particularly apt at describing our relationship to health and illness in contemporary western societies. The expansion of biomedical explanations for memory loss, and other forms of cognitive decline, calls upon older people to check their entry status into the kingdom of the sick, being held, as Beard and Neary (Making sense of nonsense: Experiences of mild cognitive impairment. Sociology of Health and Illness, 35(1), 130–146, 2013) describe it, on the precipice of a dementia diagnosis. What this precipice represents, the risks it encompasses, reflects the shifting understandings of what dementia is, how it expresses itself and what it means for people’s present and future lives. If dementia’s pathological roots extend decades into the past, roots that have grown, at least in part, due to the actions and choices of the person in which they reside, then the risks of falling from this precipice are not only to a person’s mind or to the possibilities for them to live a valued life but also, potentially, to their moral character.