The Forgetting: Alzheimer's -- Portrait
of an Epidemic by David Shenk,
Doubleday, $24.95, 290 pages.
The News & Observer
September 23, 2001
A history of Alzheimer's disease
By Phillip Manning
When he was 63 years old, Ralph Waldo Emerson was still vigorous
in body, but his mind was beginning to fail. Unlike most of us,
he did not flinch from that reality. Instead, he wrote a poem
called "Terminus," which began: "It is time to
be old/To take in sail." A few years later, Emerson attended
the funeral of his longtime friend Henry Wadsworth Longfellow.
"The gentleman who lies here," Emerson reportedly said,
"was a beautiful soul, but I have forgotten his name."
Emerson died in 1882, 15 years after he wrote "Terminus"
and 25 years before Alois Alzheimer examined the brain of a deceased,
deranged woman and lent his name to her condition. Consequently,
we have no definitive diagnosis of Emerson's dementia, but it
is almost certain that he was suffering from Alzheimer's disease,
a horrific affliction that steals the mind.
In "The Forgetting: Alzheimer's: Portrait of an Epidemic,"
David Shenk offers a comprehensive look at the disease. He recounts
its history and provides poignant tales of its sufferers -- including
Emerson, Ronald Reagan and Jonathan Swift -- and of their caregivers,
who tend loved ones who no longer recognize them. The author notes
that Alzheimer's is becoming epidemic in America as life spans
increase, and he recounts the stories of the scientists who are
searching for a cure for the disease. The result of trying to
cover so much ground is an ambitious but jumpy book that flits
from topic to topic. Nevertheless, it is worthwhile reading for
the millions of Americans whose lives have been scarred by Alzheimer's
and for those who want to learn more about the disease. It also
offers hope for the future.
One can find hope in the intensive research under way to find
a cure for Alzheimer's. To develop remedies for most diseases,
scientists must test experimental drugs on infected animals. Problem
is, only humans suffer from Alzheimer's. Because the animals of
choice for most medical experiments are mice -- which are small,
easy to study and have short life spans -- scientists had to build
a mouse that could get Alzheimer's.
This is a complex process, but Shenk explains it clearly. Researchers
can build new strains of mice through a process called transgenics.
Essentially, they "knock out" a snippet of DNA from
one species and insert it into another. In 1996, Karen Hsiao at
the University of Minnesota spliced a human gene into a mouse.
Although normal at birth, the mouse developed amyloid plaques
in its brain as it aged, similar to those found in humans with
Alzheimer's. Memory problems ensued; the mouse forgot the path
through mazes it had previously mastered. Now, the hunt was on
to find a drug that would slow the growth of the deadly plaques
in the knock-out mouse.
According to Shenk, the most promising treatment was developed
by Dale Schenk at Elan Pharmaceuticals. Surprisingly, the breakthrough
drug was a vaccine. Vaccines, such as those used for polio or
mumps, work by injecting a weakened virus into the body. The virus
stimulates the immune system, which then recognizes and attacks
the real virus if it comes along. Researchers injected bits of
a synthetic plaque-causing amyloid into the bloodstreams of knock-out
mice. When the brains of the vaccinated mice were examined, scientists
found fewer plaques than in unvaccinated mice. Even more remarkably,
they found a substantial reduction in the plaques of elderly transgenic
mice who were given the vaccine after the plaques had developed.
The vaccine, Shenk writes, was "not just a shield but also
an antidote."
Do we have a cure for Alzheimer's? Not yet. Many questions remain.
The two big ones are: Will the vaccine prevent the formation of
amyloid plaques in humans? And do the plaques themselves actually
cause Alzheimer's, or are they merely a byproduct of the disease?
Despite these questions, the vaccine has raised the hopes of victims,
caregivers and researchers.
As our knowledge of Alzheimer's has grown, so have our methods
of coping with it. Both caregivers and victims know better what
to expect, and new drugs are on the way that may slow or stop
its mind-killing progression. However, until effective treatments
are available, the most pressing question facing sufferers, especially
those in the early stages of the disease, is how best to face
their fate. Shenk movingly explores this issue through the stories
of Jonathan Swift and Emerson, two great intellects and writers
who coped with the disease in entirely different ways.
Swift railed against the illness that was destroying his mind.
He became withdrawn and hostile, alienating friends and family.
As the disease progressed, Swift mourned the death of his intellect,
and his last words were, "I am a fool."
Emerson, on the other hand, accepted what was happening to him.
"He suffered very little," wrote his son Edward, "took
nourishment well. ... He went to his study and tried to work,
accomplished less and less, but did not notice it." Two weeks
before he died, Emerson could still muster a smile, although he
could not remember how to spell "Concord," the town
where he had spent most of his life. By accepting his illness,
Emerson avoided many of its terrible side effects, such as the
loneliness and bitterness that consumed Swift.
The Emersonian approach of accepting the disease has modern disciples.
Morris Friedell, a college professor from Santa Barbara whom Shenk
interviewed, has Alzheimer's and is trying to transcend it. Friedell
believes rehabilitation from Alzheimer's is possible. Get rid
of mental and physical clutter, he advises. " 'Simplify,
simplify, simplify,' -- just like Thoreau." Although Friedell
hopes desperately that scientists will find a cure for the disease
that is wasting his mind, he has managed to maintain his dignity
in the face of its encroachments. And that, too, is reason for
hope.
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