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Mind Over Matter

THE FORGETTING: Alzheimer's: Portrait of an Epidemic, By David Shenk, Doubleday: 290 pp., $24.95 * LOSING MY MIND: An Intimate Look at Life With Alzheimer's, By Thomas DeBaggio, The Free Press: 208 pp., $24

June 16, 2002|ROBERT LEE HOTZ | Robert Lee Hotz is a science writer for The Times.

At age 76, Ralph Waldo Emerson, that serene titan of 19th century American letters, was invited by a friend at the Harvard Divinity School to lecture at his home. To the gathered admirers, Emerson delivered an essay on memory he had written some 22 years before.

"As gravity holds matter from flying into space, so memory gives stability to knowledge," Emerson read aloud. "Memory performs the impossible for man by the strength of his divine arms; holds together past and present, beholding both, existing in both, abides in the flowing, and gives continuity and dignity to human life. It holds us to our family, to our friends. Hereby home is possible; hereby only a new fact has value."

How poignant then that, as Emerson spoke those words, his own memory was failing. He could no longer recognize his own text. In his dotage, he had lost his place in time and was no longer able to form new memories or to retrieve the old. He was pinned to the moment, like a place in the essay text that he marked with his moving finger as he read. Almost certainly, Emerson had Alzheimer's disease, and it robbed him of the asset he prized most: an organized mind.

For David Shenk, Emerson's descent into oblivion perfectly embodies the horror of a disease that destroys memory and self-awareness. In "The Forgetting," Shenk has drawn together threads of neurobiology, art history and psychology into a literary portrait of Alzheimer's disease perfectly balanced between sorrow and wonder, devastation and awe. "The Forgetting" is a remarkable addition to the literature of the science of the mind.

An estimated 4 million Americans suffer from Alzheimer's disease; as many as 80 million worldwide are expected to be in its grips by 2050. For every one brain Alzheimer's infects, it also ravages several other people: those who are driven into exhaustion, depression and sometimes bankruptcy caring for people with the disease. Given its ubiquity, Shenk relates, it is all the more remarkable that it took so long to recognize that the absent-mindedness of old age was often a disease. The first acknowledged Alzheimer's patient was admitted to a hospital in Frankfurt, Germany, in 1901. "I have lost myself,'' she complained. The 51-year-old hausfrau was diagnosed by Dr. Alois Alzheimer, the neuropathologist who eventually gave the condition its name.

But not until the 1970s did Alzheimer's disease truly become part of the medical lexicon as a progressive dementia that always begins in the same place: a tiny part of the brain shaped like a cashew called the hippocampus. This structure is crucial in the creation of long-term memories. In Alzheimer's disease, the neural cells of the cerebral cortex become choked with brown spherical plaques and swollen with tangled filaments. The neurons die, and as the disease spreads, it claims other mental faculties. An Alzheimer's patient dies twice. He loses first his memory of life, then life itself. No one knows its cause, an effective treatment or its cure.

Every disease holds its particular terror. Alzheimer's is so unsettling because it is aimed so pointedly at what makes us human. In "Losing My Mind," Thomas DeBaggio vividly articulates the profound shock and despair of one person in the early stages of Alzheimer's disease. It is a story made all the more compelling because that person is himself. He writes himself on to the page as he is deconstructed by disease. "There are hints every day now that it will not be long before I look but am not able to unscramble what I see, seek the simple word but be unable to write it correctly on the page. Am I anything without my memory and the simple skills of reading and writing that I learned in childhood?" DeBaggio asks. "I will soon be stripped of language and memory, existing in a shy and unsteady forbearance of nature." There is illumination in the dying of his light.

These books haunt my memory. I carry them encoded in a lattice of electrical potentials across interlaced neurons and synapses. My memories link to other memories: to that of a lawyer I know whose mother no longer can recognize him, to a woman I once met whose husband is drained of the mind that animated their marriage, to a psychologist I visited who studies the chemistry of these damaged brains. These thoughts link in turn to a poem by Hart Crane, to a melody I cannot place, and on through the corridors in the palace of memory.

So fickle are the ways of the brain, science now teaches us, that much of what we remember most accurately may not be even true. How much of us is a fiction? We trail a thread of recollection behind us as we navigate life's labyrinth. When this tether breaks, we lose our way in the world and in ourselves. "Forgetfulness is like a song / That, freed from beat and measure, wanders," Crane wrote.

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