Keeper: One House, Three Generations, and a Journey Into Alzheimer's by Andrea Gillies

as prime minister in 1976 because he’d become aware of his own mild cognitive impairment (MCI), and foresaw accurately that dementia was on its way. Not all politicians have the insight to abdicate so early in the disease. It’s alleged that Woodrow Wilson had dementia in office, and that the resulting capriciousness of his decision making culminated in his failure to get Congress to approve the Versailles Treaty that ended World War I. It is also suggested that Stalin was a dementia sufferer, his failing intellect combining suggestively with increasing levels of aggression and paranoia. Roosevelt was evidently quite ill and possibly suffering symptoms of dementia when he had to negotiate with Stalin at Yalta in 1945 (he died two months later of a cerebral hemorrhage). The Labour prime minister Ramsay MacDonald is said to have struggled with dementia in office. Lenin died of dementia, which, as in the case of Stalin, was most likely brought on by syphilis. There seems little doubt that Urho Kekkonen, the president of Finland from 1956 to 1981, had Alzheimer’s while in office, a fact actively covered up from about 1978 onward. Ronald Reagan showed early signs of the disease during his presidency.
    Dementia is fast becoming the condition that’s cited by the young and healthy as the disease that is most feared. It’s not curable, unlike cancer. It’s not able to be tackled with drastic measures, unlike heart disease and its bypasses and transplants. It’s more fundamental than that. We don’t have brains; we are our brains. You can lose a leg or an arm, or accept the gift of another person’s heart and lungs, and still be yourself. The brain is where the self lives. Lose the use of your brain by degrees and the self is stripped away, layer by layer. In the early stages, the middle stages, even in the early part of the late stage this may well be something you are conscious of, the lights going out one by one.
    The dementia numbers are ascribed to our soaring life expectancy rates. It’s only an epidemic, so the orthodoxy goes, because we are living long enough to develop it. In 1910, when very little dementia was recorded, only 15 percent of people lived longer than the age of fifty. Life expectancy then was around forty-eight for men and fifty-two for women. We live, on average, around thirty years longer than we did a hundred years ago. Add to this another salient statistic: namely, the number of people over sixty-five worldwide is expected to double in the next twenty years. There’s the engine of the epidemic on a plate.
    Vascular dementia, the artery-furring sort, is the second biggest dementia disease group by numbers of sufferers. Around 20 percent of dementia victims have this one, and another 20 percent may have a vascular/Alzheimer’s combination. It’s the dementia that’s most equivalent to heart disease. Vein damage prevents blood from getting to parts of the brain; neurons are starved and die. Vascular dementia can be caused by stroke: single-infarct dementia, if it’s a single serious stroke; multi-infarct dementia, if it’s lots of little strokes, some so tiny as barely to register symptoms, and this is the most common sort. A rare variant called Binswanger’s disease begins in blood vessels deep in the brain and may start to show itself with walking problems.
    King Lear has been diagnosed, from the verbal evidence of the play, to have suffered from vascular dementia. There’s no doubt he suffered from one kind or another of dementing illness. “Methinks I should know you, and know this man,” he says in act 4. “Yet I am doubtful; for I am mainly ignorant / What place this is; and all the skill I have / Remembers not these garments; nor I know not / Where I did lodge last night. Do not laugh at me.”
    The third most common sort is dementia with Lewy bodies (DLB); in fact, some studies claim it’s the second most common. Notoriously difficult to diagnose, it overlaps with other dementias.