It is a wicked disease that robs its victims of their memories, their ability to think clearly, and ultimately their lives. For centuries, those afflicted by Alzheimer's disease have suffered its debilitating effects while family members sit by, watching their loved ones disappear a little more each day until the person they used to know is gone forever. The disease was first described by German psychologist and neurologist Alois Alzheimer in 1906. One hundred years and a great deal of scientific effort later, much more is known about Alzheimer's, but it still affects millions around the world, and there is no cure in sight.
In The End of Memory, award-winning science author Jay Ingram writes a biography of this disease that attacks the brains of patients. He charts the history of the disease from before it was noted by Alois Alzheimer through to the twenty-first century, explains the fascinating science of plaques and tangles, recounts the efforts to understand and combat the disease, and introduces us to the passionate researchers who are working to find a cure.
An illuminating biography of "the plague of the twenty-first century" and scientists' efforts to understand and, they hope, prevent it, The End of Memory is a book for those who want to find out the true story behind an affliction that courses through families and wreaks havoc on the lives of millions.
|Publisher:||St. Martin's Press|
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The End of Memory
A Natural History of Aging and Alzheimer's
By Jay Ingram
St. Martin's PressCopyright © 2014 Jay Ingram
All rights reserved.
Facing, or Fearing, Aging
You cannot think about aging today without the shadow of Alzheimer's disease intruding. Many of us — most of us — are afraid of it: James Watson, co-discoverer of the structure of DNA, had a set of Alzheimer's gene locations redacted from his genome because he didn't want to know whether he was prone to the disease. He was seventy-nine at the time.
The amounts of money being spent on combating the disease or caring for patients suffering from it are already astronomical, but overwhelming increases threaten our future. Even with extensive global research going on, Alzheimer's is still mysterious and complex. So dependable treatment, let alone a cure, might be distant.
These are things we already know, and this is what aging in the twenty-first century is all about, particularly in the Western world. But in the "time before Alzheimer's" — before dementia became an issue for all of us — what people thought about aging was very different. Beginning hundreds of years ago, thoughts and proclamations about sin, vitality, God's will and the stages of life all fought for the public's attention. A complicated mix, but the one main difference between then and now is this: when people in centuries past grappled with the inevitability of aging and death, religion was the place to turn. Religion has a weaker hold on us now, but we still place faith, or at least hope, in medical science. We want research to allow us to enjoy a happy and extended life.
But it hasn't been like that for very long. Once you get a glimpse of how different the experience of aging was centuries ago, it's easier to stand back and assess how overwhelming Alzheimer's is. The disease demands an outsider's vantage point, and oddly enough, it is our ancestors who can furnish this persepctive.
In the fourteenth and fifteenth centuries, most people didn't even know exactly how old they were but measured life, if they did at all, in terms of ages or stages. These might be four (childhood, youth, maturity and old age, sometimes linked to the four seasons) or seven, made famous by the lines in Shakespeare's As You Like It:
All the world's a stage,
And all the men and women merely players;
They have their exits and their entrances,
And one man in his time plays many parts,
His acts being seven ages.
The seven stages originated centuries before with the astronomer Ptolemy, in his astrological work, Tetrabiblos, based on the influences of the sun, the moon and the five known planets. The Ptolemaic influences were precise: the moon was responsible for guiding the first four years of life, Mercury the next ten, Venus the following eight, the Sun the nineteen years of "young manhood" and Mars, Jupiter and finally Saturn the later years. A planet's qualities were evident in their influence: the moon, so changeable as seen from earth, governs the first four years of life, when brain and body develop dramatically. But near the end of a person's years, the slow-moving Saturn presides over the deceleration of life: "the movements both of body and soul are cooled and impeded in their impulses, enjoyments, desires, and speed; for the natural decline supervenes upon life, which has become worn down with age...."
The idea of stages of life dominated thinking about aging for centuries, though the numbers of stages expanded beyond the original four and/or seven. One of the most persistent elaborations, making appearances in one form or another from the fifteen hundreds to the eighteen hundreds, arrayed people on a pyramidal set of stairs, infants on the first step on the left, fifty-year-olds at the top and greater and greater ages descending the stairs on the right. In some versions, centenarians weren't even accorded their own step but lay horizontal beside the last, the ninety-year-old, step on the right. The American printing company Currier and Ives distributed scores of such images as late as the mid-eighteen hundreds.
Variations on the central theme were abundant: for the longest time, the pyramid featured only men; women first appeared as faithful wives and only as themselves in the nineteenth century. Each stage or step on the pyramid was accompanied by the appropriate symbols: the grim reaper holding an hourglass, saplings on the left mirrored by dead trees on the right, an aged cat dozing beside the fire. These were the nineteenth-century equivalent of the popular graphic of human evolution, with our hominid ancestors on the left transitioning to upright-walking Homo sapiens on the right.
There were even board games that played on the idea of life as a series of stages. In 1860 American entrepreneur Milton Bradley (whose eponymous company was eventually acquired by Hasbro in 1984) launched The Checkered Game of Life, which ran the course from Infancy to Happy Old Age. Only the odd lucky roll allowed players to avoid Ruin or Poverty, but there was no square labelled Death — though notably, there was a risk of Suicide. Bradley sold tens of thousands of copies of his game.
I dug around in my cupboards and found the 2002 version of Bradley's invention. It bears scant resemblance to the original and has none of the darkness of the one produced in 1860: no squares labelled Crime, Idleness, Disgrace or Poverty. Instead, we have Join Health Club, Buy Sport Utility Vehicle and Have Cosmetic Surgery. That's The Game of Life today.
Much art has been devoted to the subject of life's stages: among the most important is a set of four huge canvases called The Voyage of Life by American painter Thomas Cole.
I first saw these works in the National Gallery in Washington, DC, years ago, long before I had any interest in the subject, but for a few minutes, I was entranced. The four paintings show a trip down a river, beginning with an infant in a boat emerging from a cave and ending with an old man, still in the boat, setting out on the open ocean. It is all religion: a guardian angel accompanies the man throughout his life (though for the most part, without his knowledge); a shiny white castle hovers in the sky; companion angels flit here and there. Exactly what you might expect from a religious, mid-nineteenth-century artist's rendering of "life as a voyage."
It wasn't just Cole, of course: for centuries, religion had been the only significant influence on thinking about the passage of life. Yes, people thought of aging as a series of steps or stages, but that was just the calculation and anticipation part. Religion provided motivation: for instance, to counter the view that aging simply draws one further and further from usefulness and closer and closer to death, the Puritans argued that old age actually had an important purpose. It brought one nearer to salvation, something that no forty-year-old could experience. Therefore, there was an incentive, and a powerful one, to live every last day of one's life in a moral way.
Actually, it seemed to be a good idea to get an early start on that moral modus vivendi. One widely held belief was that a full, healthy and enjoyable life to the end was possible only through consistent purity of mind and faithfulness to God; those who either died earlier than they should have or, worse, suffered through their last years were seen as the deserving victims of their own immoral lives. They had only themselves to blame, not Providence. So if you were a sinner, old age would inevitably be miserable. Unfortunately, even if you weren't, there were no guarantees.
So the prominence given to angels and heaven in Cole's paintings was no surprise. But there is much more to these canvases: the boat passes through absolutely fantastical landscapes. The carefree youth gliding on calm waters gives way to a troubled middle-aged man deep in prayer as he is tossed about by the waves. There is no doubt that in the end, nature subdues man, but still, the skies toward which the old voyager drifts are heavenly lit.
An abrupt change occurs between the first two and the last two canvases. For the most part, the first and second paintings represent the dreams and hopes of the young (although even in the second canvas, where the youth sails confidently on smooth waters toward a shining castle in the skies ahead, a glance at the extreme right of the painting reveals an upcoming curve in the river, where the waters are choppy, promising a much rougher voyage). The last two canvases are completely grim and dark, the autumn and winter of life, a period that Cole himself described as characterized by trouble.
The Voyage of Life does not even allow for the possibility of choice; the river ensured that there was only one path, a helpless drift toward the sea, albeit watched over by celestial beings. Whether ensured by them or not, the voyage seems to turn out well, with heaven beckoning in the distance.
I have read other accounts by people who were captivated at first sight by The Voyage of Life, but it's still not clear to me why this happens. Maybe the paintings force us to address the "threat" of getting old instead of pretending the phenomenon doesn't exist. Or it might be something as pedestrian as the sheer size of the canvases: each is about one and a half metres by two metres (five feet by six feet). Regardless, ever since the four canvases of The Voyage of Life were first exhibited publicly in 1840, they have attracted crowds. A decade later, engraved reproductions were hung in homes just as the steps of life had been decades before. Even today, thousands view The Voyage of Life, even though the twenty-first-century attitude toward aging has been thoroughly secularized since the paintings were executed about 175 years ago.
Note that these varied visual treatments of life's stages, despite putting wildly different interpretations on what happened to people as the years passed (and how much responsibility they bore for their fate), all bumped up against the same ceiling: no one could escape the inevitability of it all. You climbed the pyramid, then descended step by step. The passenger on Cole's Voyage through a landscape apparently unaffected by the presence of humans was propelled by currents and buffeted by the weather; he had no role other than to hang on and pray for his salvation. Even as you moved through The Checkered Game of Life, you had to be passive: you might escape the worst or you might not, but you had no control.
The best expression of this helplessness in the face of inevitable old age and death (and the pre-eminent role of religion) was provided by the theologian and preacher Nathanael Emmons. He sermonized in New England for more than sixty years, dying in 1840 at the impressive age of ninety-five. According to his theology, people could influence to some degree whether or not they might ascend to heaven, but above all, they were dependent on God, and God had absolute authority over who died and when. In the timing of death, human behaviour would not influence Him.
Emmons even argued that God could deliberately end a person's life to underline the fact that He was in total control — the vengeful God. This belief led Emmons to argue, surprisingly, that because God therefore ruled over even the laws of nature, it was impossible to know the "natural" life span of a human. That idea allowed for the possibility that human lives, if God weren't tempted to tamper with them, might be much longer than anyone had ever known:
As we are not perfectly acquainted with the laws of nature, we cannot absolutely determine that any of those who are dead did actually reach the natural bounds of life. We may, however, form some conjecture upon this subject, by the very few instances of those who have lived an [sic] hundred and twenty, or thirty, or forty, or fifty years. ... Hence we have great reason to conclude that God has most commonly deprived mankind of the residue of their years. And never allowed one in a thousand or one in a million of the human race to reach the bounds of life which nature has set.
Despite Emmons's assertion that many more years of human life might be possible, the fact that God held them in his hand didn't offer much hope of ever obtaining them. And anyway, there had never been much talk of 150-year-olds; immortality had been forfeited in the Garden of Eden. Centenarians, if they were portrayed at all, were virtually comatose. The limits on human life were all too obvious.
By the mid-eighteen hundreds, though, religion's grip on thoughts of aging and death was, at least in some quarters, beginning to loosen. Practitioners of something called "health reform" argued that while God was definitely still in the picture, it made perfect sense for people to live in responsible and healthy ways in order to maximize the years available to them. In fact, living to extreme old age would merely be a return to those fantastic life spans uncritically recorded in the Bible (Methuselah, for example), so this approach was anything but a rebuff to God. People were advised to avoid tobacco, alcohol, coffee and tea (or at least to moderate their indulgence in these things), and they were told not to engage in excessive sex. On the other hand, they were encouraged to bathe and change their clothes more often and to increase their consumption of vegetables.
Many of the health reform movement's recommendations don't sound out of place today, but some of its most enthusiastic champions didn't know when to stop: they foresaw lives of two or three hundred years or more, based, again, on those biblical claims. Indeed, religion was slow to loosen its grip entirely. In his 1857 book, Laws of Health, William Alcott wrote: "It is assumed finally that old age must necessarily be wretched. But old age, whenever it is wretched, is made so by sin. Suffering has no necessary connection with old age, any more than with youth or manhood."
In the mishmash of thinking, emoting, rationalizing and sermonizing about death that characterized the nineteenth century, there was one unique, bizarre, not-sure-whether-to-laugh-or-cry strand of thought that emerged in the late eighteen hundreds. Enunciated by none other than the great Canadian-born physician William Osler, the idea had its roots in Anthony Trollope's 1882 novel, The Fixed Period. Everywhere described as "dystopian," The Fixed Period describes the country Brittanula, which has established a fixed period for a life: sixty-seven years. At that point, people are sent to a place called "the college" in the town of Necropolis, where, within a year, they are euthanized and then cremated. Trollope is said to have derived inspiration for the book from a seventeenth-century play, The Old Law, which he had apparently read shortly before writing his novel. But in doing so, he overlooked a much more recent and forcefully argued version of the same idea in George Miller Beard's 1874 publication, Legal Responsibility in Old Age.
Trollope was being satirical; Beard, not really. A doctor, Beard based his book on an address he gave to the Medico-Legal Society of the City of New York in March 1873. At the beginning of this talk, he announced he would speak about the impact of aging on the "mental faculties" and indicate whether that impact impaired the elderly to the point where the legal system would be forced to take notice: "The method by which I sought to learn the law of the relation of age to work was to study in detail the biographies of distinguished men and women of every age."
"All the greatest names of history" were included in Beard's analysis. He collated the ages at which each performed his or her most important work: statesmen their legislation, architects their monuments, philosophers their systems. Here are Beard's key conclusions:
Eighty per cent of the "work of the world" is accomplished before the age of fifty.
The most productive fifteen-year period is between thirty and forty-five.
A large number of Beard's subjects lived to be over seventy, but on average their final twenty years, across the board, were unproductive.
Beard, wanting to ensure that his message hit home, attached precious metals and other materials to the decades, beginning with twenty to thirty as brazen, thirty to forty as gold, then silver, iron and tin. The final decade (between seventy and eighty) was "wooden." To give some heft to his research, Beard pointed out that this principle was universal: horses' best years, according to him, were between eight and fourteen, and hunting dogs were most effective from two to six. Hens hit their egg-laying peak at the age of three, though they might produce eggs for several more years.
Excerpted from The End of Memory by Jay Ingram. Copyright © 2014 Jay Ingram. Excerpted by permission of St. Martin's Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents
1. Facing, or Fearing, Aging
2. "I have, so to say, lost myself"
3. Has Alzheimer's Always Been with Us?
4. The Case of Jonathan Swift
5. The Biology of Aging
6. A Natural Life
7. The Aging Brain
8. Plaques and Tangles
9. "I only retire at night"
10. A Deadly Progression
11. The Brain Fights Back
12. Is the Epidemic Slowing?
13. Am I going to get it? And if so, when?
14. Treatment: Candidates But No Champions
15. Men, Women and Alzheimer's
16. Was It Really the Aluminum?
17. The Many Faces of Dementia
18. Where You Live, What You Eat
19. What's Next?