The Problem of Alzheimer's

December 1, 2020
A professor of medicine at the University of Pennsylvania delivers a lucid, opinionated history of the science, politics, and care involved in the fight against this century's most problematic disease. The first symptom of Alzheimer's is usually difficulty with memory, often recognized by a spouse, friend, or caregiver. Over years, memory deteriorates, and victims can no longer perform simple tasks such as paying bills or taking medicine. As the disease worsens, they become apathetic or delusional; lose the ability to dress, feed, and clean themselves; become bedridden and depressed; and often die from complications. Caring for an affected spouse or parent is a crushing experience, often bankrupting all but the wealthy because medical insurance and Medicare pay for medicine and doctor visits but not "custodial care," which is estimated at as many as 170 hours per month. As Karlawish shows, Alzheimer's usually causes more suffering for the caregiver than the patient. Until the 1970s, most doctors explained that this was "senility," a consequence of aging beyond the scope of medical science. Eventually, researchers realized they were dealing with an epidemic of brain disease. At the same time, patient advocacy groups formed to lobby Congress, which was amenable to providing funding. Formerly, doctors diagnosed Alzheimer's by examining the brain after death. Observing and testing living patients was a major advance. In 2012, the FDA approved an ingenious brain scan that illuminates the areas damaged by Alzheimer's. Sadly, Medicare won't pay for the $3,000 test, which doesn't directly help patients because no good treatment exists (several drugs purport to slow its progress, but many experts believe they're worthless). A medical expert with a page-turning style, Karlawish is mostly successful in conveying optimism. Hopeful drugs are in the research pipeline, but even better news is that physicians, institutions, and advocacy organizations are adopting more imaginative and humane programs to care for victims both before and after their disease becomes crippling. An outstanding primer that readers should put into the hands of their doctors.

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Starred review from February 1, 2021

As the number of older people in the United States grows, so does Alzheimer's disease. In 2020, around 5.8 million Americans lived with it, and it is estimated that by 2025, around 13.8 million will. It is often devastating to those who suffer from it, their families (many of whom become their caregivers and may also end up paying for their care), as well as to the society and economy. In this careful and caring new look at the issue, physician Karlawish (Co-Director, Penn Memory Center) explores the history of the disease and its treatments; contemporary efforts to determine its multitudinous causes and manifestations and how to treat them, either pharmaceutically or therapeutically; and how governmental and other health programs can better respond. Ever since Alois Alzheimer conducted his revolutionary studies of the disease over 100 years ago, no cures have been found, current treatment and medications are often ineffective and inadequate, and even exact causes have been hard to pin down. VERDICT As science and medicine continue to study Alzheimer's, Karlawish suggests, advances in technology, assisted living arrangements, and other lifestyle changes can be used to help people live well with the disease. A must-read on an important subject.--Marcia G. Welsh, formerly with Dartmouth Coll. Lib., Hanover, NH

Copyright 2021 Library Journal, LLC Used with permission.

February 15, 2021
Today about 5.8-million Americans live with Alzheimer's, which can cause dementia and problems with such day-to-day activities as venturing outside the home or being able to use the bathroom on one's own. Karlawish, a professor of medicine at the University of Pennsylvania and codirector of the Penn Memory Center, covers the history of diagnosis and treatment and shares his own experiences. During the "clock-draw test," he asks a patient to fill in the face and show the time as 12:55. A 71-year-old retired art teacher creates a jumble of misplaced numbers and lines. Patients exhibit confounding changes in behavior and mood and forget all kinds of things. Often, it's the caregiver who is sad and in despair. One laments that it's all "pills and bills." Americans who reach their eighties enter the age of dementia. and it can strike anyone, from U.S. presidents (Ronald Reagan) to the spouses of Supreme Court justices (that of Sandra Day O'Connor). There's no cure for Alzheimer's, but Karlawish reassures readers that it's possible to help patients preserve their comfort and dignity.

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