The Forgetting
David Shenk
Trade Paperback
ISBN 978-0-385-49838-8
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Alzheimer's, a degenerative brain disease, is the leading cause of dementia in older people. Over an average of eight years, Alzheimer's shuts down the functions of the brain, beginning with short-term memory, then shifting to language and basic thinking skills, and finally impairing mobility and basic life functions like swallowing and breathing. For those who do not die of an unrelated condition in the interim, Alzheimer's is always fatal.

No one is immune to Alzheimer's, and there is no known preventative measure. The cause is still not known, but risk increases dramatically with age. It is almost unheard of in people aged 20-39, and very uncommon (about 1 in 2,500) for people aged 40-59. In the 60s, the odds begin to get more worrisome. An estimated one percent of 65 year olds have Alzheimer's or a closely-related dementia,
    - two percent of 68 year-olds
    - three percent of 70 year-olds
    - six percent of 73 year-olds
    - nine percent of 75 year-olds
    - thirteen percent of 77 year-olds
And so on. The risk accelerates with age, to the point where dementia affects nearly half of those 85 and over.

Senile dementia is as old as humanity. "Worse than any loss in body," wrote the Roman poet Juvenal in the first century A.D., "is the failing mind which forgets the names of slaves, and cannot recognize the face of the old friend who dined with him last night, nor those of the children whom he has begotten and brought up."

In a 1906 autopsy, Dr. Alois Alzheimer identified plaques and tangles, the two signature markers of the disease. But because relatively few people lived to old age before the 20th century -- the average life expectancy in 1900 was in the 40s -- senility has never been a major social concern. Now, with life expectancy climbing toward 80 and ninety percent of today's babies expected to live past 65, senile dementia is fast reaching epidemic levels. Just in the last twenty five years, the number of afflicted Americans has grown from 500,000 to nearly 5 million.

There have been astounding advances in recent years, leading many researchers to be hopeful that effective treatments will become available over the next five-fifteen years. Several potential breakthrough drugs, including an Alzheimer's vaccine, are already in human trials. But it's extremely unlikely that anyone already diagnosed with Alzheimer's will benefit from these drugs; any breakthrough drugs won't be available at least several years.

There are a few drugs available right now that are sometimes helpful in treating the symptoms of Alzheimer's for a limited time. Patients and caregivers should consult a doctor about whether the available drugs might be suited to them.

Short of a medical rescue, Alzheimer's must be forcefully addressed as a humanitarian issue. Families need financial, emotional, legal and physical support as they care for their loved ones 24 hours a day for many years. Communities and nations will have to devote increasing resources to Alzheimer's, and individuals can help by gaining a more nuanced understanding of this devastating illness.

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