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

At least 20 percent of Americans with dementia are thought to have DLB, and among the elderly demented the percentage is much higher. Dr. Frederich Lewy identified this variant in 1912, having spotted tiny foreign bodies (proteins again) in the neurons in the brain. Parkinson’s disease also has these bodies, though in the case of Parkinson’s they’re confined to one brain area, the substantia nigra. Symptoms can mimic Alzheimer’s, though DLB victims may have more specific problems, with near-normal memory and language skills but trouble with abstract thinking. Hallucinations are so common as to be diagnostic, much more so than in Alzheimer’s. Sufferers may also have Parkinson’s-like symptoms, trouble with movement and tremors. It’s a very up-and-down disease with good days and bad days, good hours and bad hours.
    The best known of the frontotemporal dementias is Pick’s disease, named after a Czech neurologist, Arnold Pick (1851 – 1924). Pick’s was isolated and named in 1892. Specks known as Pick’s bodies are found in the frontal and temporal lobes, to which this variant is confined. Pick’s can be nasty: It comes on early, can instigate massive personality change, and sufferers exhibit an unfortunate tendency toward lechery.
    Frontotemporal dementia (FTD) also includes particular niche dementias, like aphasia dementia (loss of language) and semantic dementia, in which the connections between words and meanings are lost. Frontotemporal dementia sufferers have specific problems with language, behavior, and emotional response. In research results, FTD has been more strongly linked with tau proteins than with plaques. No drugs are available: Alzheimer’s medications seem only to make things worse.
    Other conditions can lead to dementia. Parkinson’s has already been mentioned. Variant CJD is another. AIDS can lead to dementia. People with Down syndrome or Huntington’s disease are at risk. Damage caused by long-term alcoholism can mimic dementia (Korsakoff’s syndrome), as can B vitamin deficiency, diabetes, kidney failure, thyroid problems, liver dysfunction, anemia, or electrolyte imbalance, though these are only apparent dementias from which people can recover.

Chapter 7
Our business in this world is not to succeed, but to continue to fail in good spirits .
    —R OBERT L OUIS S TEVENSON
    I T’S AUTUMN ON THE PENINSULA, AND M ORRIS IS RUSHED into hospital. He gets up out of his chair to go to bed, puts his foot forward awkwardly, and goes down hard, breaking his leg at the top by the hip. Nancy doesn’t know this, although she was with him when he fell, and held his hand until the ambulance came, and has visited him every afternoon. We keep it from her—or so she accuses, when it occurs to her to ask where he has gone, two or three dozen times a day. She doesn’t take the news very well. Her face puckers up pinkly.
    “Why didn’t anyone tell me he was in hospital? That’s just ridiculous.” She sweeps out of the room in a huff, or tries to, her shuffling waddle a little faster than usual, her hands outstretched to grasp the door handle, like a great outsize wrinkled toddler.
    There are days when the toddler similarity is persuasive and bizarre. Days when I feel like a babysitter, a new and inexperienced one, given care of a reluctant and stroppy child, having to make it up as I go along, trying more and more desperately to mollify and distract, and feeling that dark needle of fear when nothing I do makes any difference. She shakes her head and stamps her foot and has tantrums. She asks for her father and gets agitated when he can’t be produced, looks horrified when I confess that he and her mother are dead. Then, shocked by my own bluntness, I add, “But that’s because you are an old lady now.” She looks baffled. “You see, you’re almost eighty. You don’t have parents any longer, but you have children, and grandchildren. Six grandchildren. Three of them are in Canada, and three of