Early Alzheimer's: A View From Within

EARLY ALZHEIMER'S: A VIEW FROM WTTHIN/Spencer Nadler 1FIRST ENCOUNTERED ALZHEIMER'S disease (AD) at the tender age of ten. WhUe sleeping over at the home of my maternal grandparents , in their den, I was suddenly awakened by an apparition. Bolting from my bed, I came face to face with my grandmother. Her missing teeth—she soaked them in a glass on her bedside table while she slept—left her lips devoid of a supporting structure, and as she screamed at me, her mouth imploded. "TeU me who your Zayde is running around with. I know he's seeing another woman." As she stood by the large window that opened onto Sherbrooke Street, the chiffon curtains blew in around her luce gossamer wings, and I saw, in the faint reflected Ught of street lamps, the madness in her eyes. The fierce irony of her mistrust was not lost on me, for I knew then how my grandfather doted on her. "Zayde has no girlfriends," I said. "I promise." My words did not comfort her, and as I moved to help her back to bed she was out the door. So ephemeral was our nighttime encounter that I awoke in the morning convinced that it had been a bad dream. But the delusions and paranoia of my grandmother's illness were real. Alzheimer's disease was slowly claiming her mind. As an adult, I had always thought of AD in this way—as a progressive mind loss of obscure origin with characteristic clinical and pathologic features. True, there are variations in the patterns and progressions of this illness, but they always seemed to me of Utile consequence. IfAD mind loss had a beginning, an early stage, I beUeved it was but a shortlived step in a progressive mental incapacitation that jarred the victim from his Ufe. It was not until I met Morris FriedeU that I came to see the flaw in my conception of AD. He showed me how a regressing mind, Uke a deteriorating body, can crystallize the Ufe that remains and devise ways to enhance it. I had taken the mind to be an aU-or-none entity; I was unaware ofthe possible magnitude of man's mental capacity in the face of significant neuron losses. 180 · The Missouri Review "My short-term memory has always been unreUable. I didn't find myself losing keys when I developed AD because ever since my chUdhood of losing keys, pens and mittens, I've coped by using procedural memory," Morris says. He is a smaU and gentle man with a copious, frizzled beard, a sociologist retired from the University of California at Santa Barbara who looks younger than his sixty years and has a professorial feUcity with words. "When AD made me more forgetful, it was easy to expand my ingrained habit of relying on rules, and I shifted the burden to my procedural memory, with its alarm watch and notebook prostheses." Having Uved with his AD diagnosis since September of 1998, Morris was brought to my attention by a nurse-practitioner friend, who, intrigued by his high-minded approach to his illness and aware of my interest in AD, suggested that I meet him. Morris' description of his pre-AD vulnerabUities gives me pause. Are there specific traits in some of us that are predictors ofAD, traits that are discernible, yet whose import goes unrecognized? Epidemiologist David Snowdon studies nuns. He and his coUeagues have analyzed nun's autobiographies written in their subjects' twenties— prior to taking their vows—for idea density (the number of ideas in every ten words ofwriting). They reevaluate the nuns in old age. Those whose autobiographies have the lowest idea densities are the most likely to develop AD. This study, still too smaU to be conclusive, is nearly 90 percent accurate in predicting AD. Despite the singularity of Snowdon's population, he strongly suspects that any youthful writer of simple sentences, ones that lack a complexity of interrelated ideas, is demonstrating a cognitive handicap predictive of AD. The Nun Study is startling to me. I cannot help wondering about the idea density in the early correspondence of our fortieth president, Reagan. Can we...