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The setting was a conference on dementia at the American Psychiatric Association annual meeting in Chicago. The speaker, Dr. Jacobo Mintzer of the University of South Carolina, had just asked the audience a question: "How many of you think that the spirit is gone from an individual with Alzheimer's disease?" The audience was silent and still, contemplating a question most of us had never been asked or had asked ourselves. A second question followed: "How many believe the spirit remains?"
As I joined colleagues, researchers, and clinicians from around the country in raising my hand, I reflected on another meeting fifteen years earlier at the University of Iowa Hospitals. As a third year medical student, I had just participated in a daylong evaluation of a pleasant, humorous eighty-eight-yearold gentleman. His family had brought this World War I veteran and retired personnel manager to Iowa City because of concerns about increasingly severe memory lapses, and I had signed up to assist with the evaluation and "walk him through" the exhausting evaluation process. He was my grandfather.
At that time there was little to be offered Alzheimer's sufferers but "supportive care" during a progressive and inevitable decline. I sat with him and my mother as the faculty neurologist gently corifirmed what we already suspected. My grandfather, undaunted, got the ever-present notebook out of his jacket pocket and, after fumbling for a pencil, wrote the words "Alzheimer's disease" on the first page. He didn't want to forget.
The spirit is indeed seen in people who, like my grandfather, do battle with this disease. One sees it in their struggle for place and meaning even as memory fades. One finds it in the tenderness and dedication with which caregivers bring their energy and creativity to bear in providing for the needs of their loved ones. The spirit is present in the dedication of those researchers who have devoted their lives to finding a cure.
Alzheimer's disease is the most common of a group of illnesses called the dementias, which by definition involve a progressive loss of memory as well as the other intellectual gifts—language, problem-solving, social judgment—we rely on to make our way in the world. It affects 4 million Americans and will closely touch the lives of nearly every one of us in some way. In providing a broad perspective on this disease, I hope to address the realities we all face as more and more of us enter the high-risk years.
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