Heart of Darkness

When David Shenk set out to write his intelligent and unusually circumspect book The Forgetting, he had, he said, two ambitions: to write a “biography” of Alzheimer’s disease, and to chronicle the race for its cure. A biography of a disease is a strange nomenclature. It suggests, at the start, that Alzheimer’s has a life of its own, one that is distinct from its victims’. Alzheimer’s doesn’t have its own life, except in this: it is animated by fear. A nationwide poll conducted this spring for the Alzheimer’s Association by Peter D. Hart Research Associates found 95 percent of all respondents saying that Alzheimer’s was a “serious problem facing the nation,” and well more than half—64 percent—of those between 35 and 49 years of age reporting that they were concerned about getting the disease themselves. Four million Americans already have Alzheimer’s, a number that is expected to grow to fourteen million by midcentury. As Gary Small, the director of UCLA’s Center on Aging, says in his bullish manual for beating the odds, The Memory Bible: An Innovative Strategy for Keeping Your Brain Young, “we are all one day closer to Alzheimer’s disease.”

By the same logic, then, we are all one day closer to the cure for Alzheimer’s, too. “Ten years to a cure,” a Japanese researcher said to David Shenk in March 1999 at the biannual “Molecular Mechanisms in Alzheimer’s Disease” conference. He, like other researchers Shenk encountered there, was “giddy” at the prospect. Giddiest of all, it seems, was Ivan Lieberburg, the head of research and development for Elan Pharmaceuticals. “We’re really on the threshold of a new age,” Shenk reports him saying. “I think we’re coming very close to the goal line now….”

When Lieberburg said this, it had been nearly a century since a German physician, Alois Alzheimer, first admitted a disoriented, volatile, yet seemingly healthy, fifty-one-year-old woman to his clinic. Unable to remember her own name, she nonetheless accurately described her condition. “I have lost myself,” she told the doctor.

Over the next four and a half years the woman continued to decline, losing the ability to speak, to feed herself, to walk, or to know her own incapacity. Alzheimer was at a loss to diagnose her condition, which did not fit any known model. It was only when she died, and he was able to view slides of her brain, that the doctor found what appeared to be the cause of her premature senility. As Shenk describes it,

…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 clumps—plaques—too 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.

And that wasn’t all:

In the second and third layers of the cortex, nearly a third of the neurons had…

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