We are the sum of our memories. Everything we know, everything
we perceive, every movement we make is shaped by them. "The
truth is," Friedrich Nietzsche wrote, "that, in the process
by which the human being, in thinking, reflecting, comparing, separating,
and combining . . . inside that surrounding misty cloud a bright
gleaming beam of light arises, only then, through the power of using
the past for living and making history out of what has happened,
does a person first become a person."
The Austrian psychiatrist Viktor Frankl made much the same point
in Mans Search for Meaning, his memoir of experiences as a
concentration camp inmate. Frankl recalled trying to lift the spirits
of his fellow camp inmates on an especially awful day in Dachau:
"I did not only talk of the future and the veil which was drawn
over it. I also mentioned the past; all its joys, and how its light
shone even in the present darkness. [I quoted] a poet . . . who
had written, Was Du erlebst, kann keine Macht der Welt Dir rauben.
(What you have experienced, no power on earth can take from you.)
Not only our experiences, but all we have done, whatever great thoughts
we may have had and all we have suffered, all this is not lost,
though it is past; we have brought it into being. Having been is
a kind of being, and perhaps the surest kind."
Emerson was also fascinated by memoryhow it worked, why it
failed, the ways it shaped human consciousness. Memory, he offered
about a decade or so before his own troubles first appeared, is
"the cement, the bitumen, the matrix in which the other faculties
are embedded . . . without it all life and thought were an unrelated
succession." While he constructed an elaborate external memory
system in topical notebooks, filling thousands of pages of facts
and observations that were intricately cross-referenced and indexed,
Emerson was also known for his own keen internal memory. He could
recite by heart all of Miltons "Lycidas" and much
of Wordsworth, and made it a regular practice to recite poetry to
his children on their walks. His journal entries depict an enchantment
with the memory feats of others.
He kept a list:
Frederic the Great knew every bottle in his cellar.
Magliabecchi wrote off his book from memory.
Seneca could say 2,000 words in one hearing.
L. Scipio knew the name of every man in Rome.
Judge Parsons knew all his dockets next year.
Themistocles knew the names of all the Athenians.
"We estimate a man by how much he remembers," Emerson
Ronald Reagan was never particularly admired for his memory. But
in the late 1980s and early 90s, he slowly began to lose his
grasp on ordinary function. In 1992, three years after leaving the
White House, Reagans forgetting became impossible to ignore.
He was eighty-one.
Both his mother and older brother had experienced senility, and
he had demonstrated a mild forgetfulness in the late years of his
presidency. Like many people who eventually suffer from the disease,
Reagan may have had an inkling for some time of what was to come.
In his stable of disarming jokes were several about memory troubles
afflicting the elderly. He shared one at a 1985 dinner honoring
Senator Russell Long.
An elderly couple was getting ready for bed one night, Reagan told
the crowd. The wife turned to her husband and said, "Im
just so hungry for ice cream and there isnt any in the house."
"Ill get you some," her husband offered.
"Youre a dear," she said. "Vanilla with chocolate
sauce. Write it downyoull forget."
"I wont forget," he said.
"With whipped cream on top."
"Vanilla with chocolate sauce and whipped cream on top,"
"And a cherry," she said.
"And a cherry on top."
"Please write it down," she said. "I know youll
"I wont forget," he insisted. "Vanilla with
chocolate sauce, whipped cream, and a cherry on top."
The husband went off and returned after a while with a paper bag,
which he handed to his wife in bed. She opened up the bag, and pulled
out a ham sandwich.
"I told you to write it down," she said. "You forgot
It seems clear enough that Reagan was increasingly bothered by
personal memory lapses. In a regular White House checkup late in
his second term, the President began by joking to his doctor, "I
have three things that I want to tell you today. The first is that
I seem to be having a little problem with my memory. I cannot remember
the other two."
Did Reagan have Alzheimers disease in office? Yes and no.
Without a doubt, he was on his way to getting the disease, which
develops over many years. But it is equally clear that there was
not yet nearly enough decline in function to support even a tentative
diagnosis. Reagans mind was well within the realm of normal
functioning. Even if his doctors had been looking intently for Alzheimers,
it is still likely that they would not have been able to detect
the disease-in-progress. A slight deterioration of memory is so
common among the elderly that even today it is considered to be
a natural (if unwelcome) consequence of aging. About a third to
a half of all human beings experience some mild decline in memory
as they get older, taking longer to learn directions, for example,
or having some difficulty recalling names or numbers.
Alzheimers disease overtakes a person very gradually, and
for a while can be indistinguishable from such mild memory loss.
But eventually the forgetting reaches the stage where it is quite
distinct from an absentminded loss of ones glasses or keys.
Fleeting moments of almost total confusion seize a person who is
otherwise entirely healthy and lucid. Suddenly, on a routine drive
home from work, an intersection he has seen a thousand times is
now totally unfamiliar. Or he is asking about when his son is coming
back from his European vacation, and his wife says: "What do
you mean? We both spoke to him last night." Or he is paying
the check after a perfectly pleasant night out and its the
strangest thing, but he just cannot calculate the 20 percent tip.
The first few slips get chalked up to anxiety or a lousy nights
sleep or a bad cold. But how to consider these incidents of disorientation
and confusion when they begin to occur with some frequency? What
begin as isolated incidents start to mount and soon become impossible
to ignore. In fact, they are not incidents; collectively, they are
signs of a degenerative condition. Your brain is under attack. Months
and years go by. Now you are losing your balance. Now you can no
longer make sense of an analog clock. Now you cannot find the words
to complain about your food. Now your handsome young husband has
disappeared and a strange elderly man has taken his place. Why is
someone taking your clothes off and pouring warm water over you?
How long have you been lying in this strange bed?
By 1992, the signs of Reagans illness were impossible to
ignore. At the conclusion of a medical exam in September, as the
New York Times would later report, Reagan looked up at his doctor
of many years with an utterly blank face and said, "What am
I supposed to do next?" This time, the doctor knew that something
was very wrong.
Sixteen months later, in February 1994, Reagan flew back to Washington,
D.C., from his retirement home in Bel Air, California, for what
would turn out to be his final visit. The occasion was a dinner
celebrating his own eighty-third birthday, attended by Margaret
Thatcher and twenty-five hundred other friends and supporters.
Before the gala began, the former President had trouble recognizing
a former Secret Service agent whom he had known well in the White
House. This didnt come as a total shock to his wife, Nancy,
and other close friends, but it did cause them to worry that Reagan
might have problems with his speech that night.
The show went on as planned. After an introduction by Thatcher,
Reagan strolled to the podium. He began to speak, then stumbled,
and paused. His doctor, John Hutton, feared that Reagan was about
to humiliate himself. "I was holding my breath, wondering how
he would get started," Hutton later recalled, "when suddenly
something switched on, his voice resounded, he paused at the right
places, and he was his old self."
Back at his hotel after the dinner, Reagan again slipped into his
unsettling new self, turning to Nancy and saying, "Well, Ive
got to wait a minute. Im not quite sure where I am."
Though the diagnosis and public announcement were both months away,
Reagan was already well along the sad path already trod by his mother,
his brother, and by Auguste D.
The doctors who diagnosed Reagan in 1994 knew with some specificity
what was happening to his brain. Portions of his cerebral cortex,
the thin layer of gray matter coating the outside of his brain,
were becoming steadily clouded with two separate forms of cellular
debris: clumpy brown spherical plaques floating between the neurons,
and long black stringy tangles choking neurons from inside their
cell membranes. As those plaques and tangles spread, some neurons
were losing the ability to transmit messages to one another. Levels
of glucose, the brains sole energy source, were falling precipitously,
weakening cell function; neurotransmitters, the chemicals that facilitate
messages between the neurons, were becoming obstructed. The tangles
in some areas of the brain were getting to be so thick it was like
trying to kick a soccer ball through a chain-link fence.
Ultimately, many of the neurons would die, and the brain would
begin to shrink. Because the brain is highly specialized, the strangulation
of each clump of neurons would restrict a very specific functionthe
ability to convert recent events into reliable memories, for example,
or the ability to recall specific words, or to consider basic math
problems. Or, eventually, to speak at all, or recognize a loved
one. Or to walk or swallow or breathe.
We know about plaques and tangles because of Auguste D. and Alois
Alzheimer. After four and a half years in the hospital, Frau D.
died on April 8, 1906. Her file listed the cause as "septicaemia
due to decubitis"acute blood poisoning resulting from
infectious bed sores. In her last days, she had pneumonia, inflammation
of the kidneys, excessive fluid in the brain, and a high fever.
On the day of her death, doctors understood no more than they had
on the first day she was admitted. They could say only this about
Auguste D.: that a psychic disturbance had developed in the absence
of epileptic fits, that the disturbance had progressed, and that
death had finally intervened.
Alois Alzheimer wanted to learn more. He wanted to look at her
Standing apart from most doctors at the time, Alzheimer was equally
interested in both clinical and laboratory work. He was known for
his tireless schedule, his devoted teaching, and his own brand of
forgetfulness. An inveterate cigar smoker, he would put a half-smoked
cigar down on the table before leaning into a students microscope
for a consultation. A few minutes later, while shuffling to the
next microscope, hed light a fresh cigar, having forgotten
about the smoke already in progress. At the end of each day, twenty
microscopes later, students recalled, twenty cigar stumps would
be left smoldering throughout the room.
But Alzheimer did not forget about the woman who had lost herself
in Frankfurt. Though he had since moved to the Royal Psychiatric
Clinic, in Munich, to work for the renowned psychiatrist Emil Kraepelin,
he sent for Frau D.s central nervous system as soon as she
died. Her brain, brainstem, and spinal cord were gently removed
from the elaborate bone casing, that flexible yet durable wrapper
that allows us all to crouch, twist, and bump into things without
much concern. The exposed contents were then likely wrapped in formalin-soaked
towels, packed carefully in a wooden crate, and shipped by locomotive
190 miles southeast to Munich.
Imagine, now, that lifeless brain on a passenger train. A coconut-sized
clump of grooved gelatinous flesh; an intricate network of prewired
and self-adapting mechanisms perfected over more than a billion
years of natural selection; powered by dual chemical and electrical
systems, a machine as vulnerable as it is complex, designed to sacrifice
durability for maximal function, to burn brightlya human brain
is 2 percent of the bodys weight but requires 20 percent of
its energy consumptionat the cost of impermanence. Enormously
powerful and potato-chip fragile at the same time, the brain is
able to collect and retain a universe of knowledge and understanding,
even wisdom, but cannot hold on to so much as a phone number once
the glucose stops flowing. The train, an elementary device by comparison,
can, with proper maintenance, be sustained forever. The brain, which
conceived of the train and all of its mechanical cousins, cannot.
It is ephemeral by design.
But there was nothing in the brains blueprint about this
sort of thing, as far as Alzheimer could infer. This was a flaw
in the design, a molecular glitch, a disease process, he suspected,
and it was important to see what that process looked like up close.
It was also now actually possible to do this for the first time,
thanks to a whirl of European innovation. Ernst Leitz and Carl Zeiss
had just invented the first distortion-free microscopes, setting
a standard in optics that survives today. Franz Nissl had revolutionized
tissue-staining, making various cell constituents stand out, opening
up what was characterized as "a new era" in the study
of brain cells and tissues. (The "Nissl method" is still
in use. Nissl, a close collaborator and friend of Alois Alzheimer,
became a medical school legend with his instructions on how to time
the staining process. "Take the brain out," he advised.
"Put it on the desk. Spit on the floor. When the spit is dry,
put the brain in alcohol.")
Dr. Alzheimers assistants prepared for microscopic examination
more than 250 slides from slivers of the outer lining (the meninges)
of Frau D.s brain; from the large cerebral vessels; from the
frontal, parietal, and occipital areas of the cerebral cortex (locus
of conscious thought); from the cerebellum (regulator of balance,
coordination, gait) and the brainstem (breathing and other basic
life functions); and from the spinal cord, all chemically preserved
in a cocktail of 90 percent alcohol/10 percent formalin, and stained
according to a half-dozen recipes of Alzheimers contemporaries.
Having fixed, frozen, sliced, stained, and pressed the tissue between
two thin pieces of glass, Alzheimer put down his cigar and removed
his pince-nez spectacles, leaned into his state-of-the-art Zeiss
microscope, and peered downward. Then, at a magnification of several
hundred times, he finally saw her disease.
It looked like measles, or chicken pox, of the brain. The cortex
was speckled with crusty brown clumpsplaquestoo many
to count. They varied in size, shape, and texture and seemed to
be a hodgepodge of granules and short, crooked threads, as if they
were sticky magnets for microscopic trash.
The plaques were nestled in amongst the neurons, in a space normally
occupied by supporting tissue known as glial cells. They were so
prominent that Alzheimer could see them without any stain at all,
but they showed up best in a blend of magenta red, indigo carmine,
and picric acid. Alzheimer had squinted at thousands of brain slides,
but he found these clumps "peculiar" and had no idea what
they could be.
A different stain, invented just four years earlier, revealed the
other strange invasion of Auguste D.s brain. In the second
and third layers of the cortex, nearly a third of the neurons had
been obliterated internally, overrun with what Alzheimer called
"a tangled bundle of fibrils"weedy, menacing strands
of rope bundled densely together.
The tangles were just as foreign to Alzheimer as the plaques, but
at least the ingredients looked familiar. They seemed to be composed
of fibrils, an ordinary component of every neuron. It was as if
these mild-mannered, or "Jekyll," fibrils had swallowed
some sort of steroidal toxin and been transformed into "Hyde"
fibrils, growing well out of proportion and destroying everything
within their reach. Many affected neurons were missing a nucleus
completely, and most of the rest of their cell contents. A good
portion of the neurons in the upper cell layers of the cortex had
disappeared. They just werent there. Alzheimers assistant
Gaetano Perusini wrote of the neurofibrillary tangles in Frau D.s
It is impossible to give a description of all the possible pictures:
there are present all the variable and twisted formations that one
can imagine; at times large fibrils seem to lie only on the periphery
of the cell. But on focusing untangled fibrillar agglomerations
are found. Changing the focus again one has the impression that
the single dark-coloured fibrils unwind into an infinite number
of thinner fibrils . . . arranged as balls of twine or half-moons
Connecting a camera lucida to the top of the microscope, Alzheimer
and Perusini both drew pictures of the tangles.
The menacing drawings perfectly convey the ghastly significance
of their discovery. Here was the evidence that Auguste D. had not
lost herself. Rather, her "self" was taken from her. Cell
by cell by cell, she had been strangled by unwelcome, malignant
What were they, exactly, and where did they come from?