"Where has Yesterday Gone"

Memory loss, like old age is a condition which mankind has always reluctantly re
cognized and always - with resignation. Memory loses are sometimes trivial and m
eaningless and go unrecognized. However, when these loses are so great that a pe
rson does not know who or where they are the concerns are quite grave. Although
it is realize that Alzheimer's disease destroys the brain memory function, many
do not realize precisely how the memory is destroyed once one is aware of the pr
ocess, it becomes faster to work forward to alleviate the destruction.
"Without memory there is no knowledge to recreate or reproduce past perc
eptions, emotions, thoughts and actions that are so vital to live a full and fun
ctioning life. Memory is the key that unlocks doors that keep us functioning, no
t only mentally but physically (Corrick 32)."
"Memory loss is not a sign of decay (Freedman 10)." As we get older, the
re is some mild impairment in our recollection of recent events, such as forgett
ing why one went into a room or misplacing a person's eye glasses, which even yo
ung are guilty of doing. As reported by Larry Squire, "forgetting is quite norma
l and usually develops in the third decade of life, and by one estimate 85 perce
nt of the healthy elderly - those over 65-suffer some memory impairment (59)."
According to Dr. Seligmann, "forgetting is the process through which inf
ormation in memory becomes inaccessible, either because it is stored but is not
at that time retrievable (51)." This is one of the most important factors in for
getting. Memory loss is rapid at first and then gradually levels off. There are
many types of "dismembering" enemies that hamper ones recall and retrieval syst
em. "Forgetting may be increased by interference from proactive inhibition, that
is material learned beforehand, like trying to remember a soup recipe (51)."
In remembering stories or events there is a tendency for distortions to
occur. Cutler explains that studies made by Elizabeth Loftus reveal, "what you l
earn today may actually distort your memory of what happened to you yesterday. .
. (62)." People tend to remember the events that they regard as the most import
ant. They attempt to reconstruct the event, usually what knowledge they have, wi
th the result being what would have been expected rather than what actually happ
ened.
Dr. Siegfried reports that "Neural decay is another enemy to the memory.
Sensory receptors, such as visual, auditory and smell, provide you with sharply
etched neural impressions or the world around you. But this pattern of neural f
iring is quickly destroyed in one of two ways; the receptor neurons adapt to the
input (10- 11)." The brain can register only one item at a time. If two events
are occurring at the same time the storage of the information will depend on the
importance of information to the individual. "Neural decay is perhaps the simpl
est types of forgetting (Seligmann 51)."
As explained by Dick Gilling, "the short-term memory 'holds' items until
a person decides how important they are and if they need to be transferred to t
he long-term memory for permanent storage (15)." According to the experience, th
e brain has made a mental index card for each category experience. "These index
categories are used when someone wants to retrieve an item from memory storage b
anks. Sometimes these 'mental index cards' get catalogued in the wrong way, that
is misfiled, or even lost (14)."
When someone has learned too many things at once, cataloging errors freq
uently occur (Hamdy 93). For example, if a person is introduced to a dozen unfam
iliar people at a party, mistakes will be made trying to attach the right names
to proper faces. If a person were to meet one new individual a day for a dozen d
ays, the chances will be greater of getting the file cards filed out correctly.
"Misfiling also occurs, and people have trouble locating items in their
memory banks. The more similar two items are, the more likely it is that one of
them will be filed in the place supposedly reserved for the other (Gilling 14)."
All the changes of aging that occur in the brain should not interfere wi
th everyday living, "as there is ample organ function left to go on to ripe old
age as long as there is no disease to accelerate the aging process (Gold 12)." W
e lose some brain cells as we age, but "there are millions of healthy ones left
for our intellectual endeavors. . . However, a disease such as Alzheimer's can t
ake away a person's memory, leaving them with no past, present, or future of any
type (Gold 12- 13)." A person becomes nothing but an empty body with no mind in
side.
Until recently, explains James A. Corrick, "it was accepted that with th
e aging process along with senility. Some people will revert back to childhood a
nd remembering things well and thinking clearly will no longer happen. What we c
all senile dementia is really Alzheimer's disease (26)." It can strike people in
their middle forties. Alzheimer's disease is incurable and irreversible for now
, but neuroscientists are hoping to develop a vaccine against the disease. "Ever
yone would be vaccinated at birth. . . (27)," and as neurosurgeon Dr. J. Eric Ho
lmes notes, "almost nobody would suffer a decline in intellect and personality a
s they got older. We would all be bright as a tack as we got to be eighty or nin
ety. . . (28)." The only thing that would kill us is if our system gave out.
Dr. Siegfried states that Dr. Lewis Thomas, the former Dean of the Yale
School of Medicine and now Chancellor of Memorial Kettering Center, has describe
d Alzheimer's disease as the "disease of the century: . . .the worst of all dise
ases, not just for what it does to the victim, but for its devastating effects o
n families and friends (13). It begins with the loss of learned skills progresse
s inexorably to a total shutting down of the mind. "It is, unmercifully, not let
hal. Patients go on and on living, essentially brainless but otherwise healthy,
into advanced age, unless luckily enough to be saved by pneumonia (14)."
There are three important changes that occur in the brains of Alzheimer'
s patients. "These changes include senile plaques, neurofibrillary tangles and g
ranulovaculoar degeneration (Frank 15)."
Lawrence Galton describes "senile plaques as a development in the nerves
of the brain. This is actually a scar, a mark resulting from degeneration, rath
er than a cause of it. Senile plaques are multiple small islands of dead materia
ls containing specific compounds,. . . (8)." Their origin is unknown. These pla
ques consists of a chronic infection. "It has been estimated that 80 percent of
patients over the age of sixty- five have senile plaques (9)." However, "Alzheim
er's brains have a very heavy concentrated amount of senile plaques in the hippo
campus are of the brain where the normal does not (10)."
Another change that takes place in the brain is the abnormal neurofibril
lary tangles in the nerve cells. A normal nerve cell looks like a small plant wi
th branches, stem and many roots. "As aging occurs, the roots, which are called
dendrites, begin to shorten and lose some of their structure. Eventually, the en
ds of the roots of these dendrites begin to accumulate into a sort of halio that
resembles a small starfish (Cutler 14)." They become thick and intertwined. Alt
hough plaques and tangles appear in normal brains and gradually increase with th
e age Alzheimer's patient seems to have highly concentrated amount in the. . . "
hippocampus portion of the brain, that the seat of memory, the short- term memor
y (Cutler 24).
The third characteristic that changes in the brain of the Alzheimer's pa
tient is the "granulovaculor degeneration (Gilling 13)." According to Gold, cert
ain changes inside the cells themselves are taking place. The interior of the ce
ll is undergoing changes and become crowed with fluid filled "vacuoles" as well
as granular material. An increased concentration of granulovaculoar degeneration
is also found in the hippocampus area of the brain (82).
The changes in the brain found in Alzheimer's patients are concentrated
in the hippocampus are which also appears to be the "primary anatomic locus of s
hort- term memory (Gilling 14)." Short- term memory loss may, however, be the ea
rliest sign of a more catastrophic event occurring in the brain, especially if f
orgetfulness is severe and progressive (14).
According to Dr. Siegfried, "The following seven stages are adopted from
the scale measuring Alzheimer's disease that was developed by Drs. Barry Reisbe
rg, Steven H. Ferris, Mony J. de Leon, and Thomas Crook (22)." Stage one is "a
state of clinical normality (24)." The second stage is the "forgetfulness stage
(24)." This phase is common and usually occurs over the age of forty- five. One
might forget names of well known friends, however, this does not create a seriou
s handicap for a person working ability. Sometimes the patient is not aware of w
hat is happening. "In stage three, a mild cognitive decline or an early conditio
nal state happens (24)." In this stage a person's ability to remember someone's
name after being introduced to them is hampered, also, a person begins to mispla
ce items and concentration declines." In this stage, denial symptoms, as well as
anxieties, occur. If a person was tested at this stage it would be impossible t
o diagnose Alzheimer's disease, especially if someone was sixty years or older (
26)." However, the testing would conclude that there may be evidence of memory d
eficiency.
"During the fourth stage, there is an increased cognitive decline ( Cohe
n 32)." Abnormalities are definitely found during testing. For example, there mi
ght be an inability to continue serial subtraction, to travel, handle personal f
inances, and an overwhelming decrease in knowledge of current and recent events.
However, a person will be able to recognize familiar faces and friends, and the
re will be no disorientation about where the person is. "In this stage denial is
very strong and complex tasks. . . (32)," which were easy to perform in the pas
t cannot be done at all. "In stage five the patient cannot survive without some
assistance (32)." People cannot recall their phone numbers or their addresses. I
n some cases a person cannot, recall family members' names or names of schools t
hey attended. There may also be some confusion as to what day, time or season it
is. However, major facts are still retained. Usually, a patient will know their
spouse and sometimes their children and still attend to their personal needs. "
There might be some difficulty in choosing clothes and shoes (32)." "In stage si
x there is severe cognitive decline. . . (32)." Assistance for daily activities
is required. The
patient may not remember their spouse's name and has complete unawareness of rec
ent events and experiences. Past knowledge will be vague
in this stage. Night and day become confusing and the patient may become inconti
nent. "Amazingly, the patient does remember their own name and simple daily clea
ning activities may take place (Siegfried 28)." Unfortunately, at this stage del
usional and sometimes violent behavior along with anxiety symptoms and agitation
occur due to the inability to carry on a thought pattern. Stage seven, the most
severe stage, the patient may lose their speech and walking ability. Assistance
with feeding is required and bladder control is lost. "The brain is totally sep
arated from the body. . . (Siegfried 29)." "The patient may survive for a long t
ime in this stage, but will eventually die from either respiratory arrest or som
e other organ failure (Siegfried 30)."
Any one of the stages may continue on for years. There is no certain tim
e limit on any of the stages, making a hardship on the family unbearable. It is
not known if a person will stay in one stage or progress to another. This thief
of the mind robs a person of their mind little by little, leaving them with no d
ignity or identity. A person with no memory can create or reproduce items that m
ake a full and functioning life as we know it.
I was fortunate enough to have the privilege an experience of interviewi
ng a good friend of my mom's, Mary, whose mother is a victim of Alzheimer's dise
ase. She shared with me, some very private and emotional feelings that her mothe
r, sister, and she experienced and are still experiencing while confronting Alzh
eimer's disease. Mary was able to explain, from her point of view, what it was l
ike caring for a person with Alzheimer's disease.
Mary began by stating, her mother was a fifty- four year old, mother of
two daughters that was losing her mind by the handfuls. It took just six months
time for her mother to go from a vital, radiant and full functioning person to s
omeone recognizable only in physical form.
The first signs that developed were forgetting phone numbers and unledga
ble handwriting. Missing appointments occurred regularly and items began to get
misplaced. Mary's mother would be gone all day and then not remember where she h
ad gone. The three and four day disappearances were the convincing data needed t
o realize something was wrong with her mother.
 Her and her sister took their mother to the best neurologist in the stat
e. She was diagnosed as having Alzheimer's disease. The doctor told Mary and her
sister that in order to understand their mother's behavior, each of them would
have to imagine a woman contemplating losing her mind. The mind will not tolerat
e this conclusion, and the result is denial, the question, the constant question
, which are an appeal for some confirming sign that she is not losing her mind.
She cannot retain the answers, and she cannot remember that she had just asked a
question. Basically, Dr. Ruben told the two daughters that their mother was los
ing her short- term memory.
Mary's mother continued to change everyday for the worse. She had to hav
e full time nursing care. The daughters would visit their mother every day, hopi
ng to spark some kind of response from their mother, however, Mary's mother just
sat and stared at the window.
Finally a good friend of the family talked the daughters into putting th
eir mother in a home, where people could take care of their mother and give her
some stimulation, which she needed desperately. It was the hardest and most pain
ful decision the girls had to ever make, but deep down they knew it was the best
decision for all concerned. This horrible disease had robbed their mother of he
r self identity and is suffering from the humiliation of having her dignity wren
ched from her.
As our conversation came to a close, I asked Mary if she knew of Dr. Kev
orkian and of his work with the suicide machine. Mary was well aware of Dr. Kevo
rkian and his work. She was in full agreement that he did the right thing by hel
ping Jane Adkins end her life before Alzheimer's did. With tears in her eyes, Ma
ry stated, I know if my mother would have had the choice like Jane Adkins did to
end her life with dignity, she would have taken the choice (Personal Interview)
."
The treatment for Alzheimer's disease is unknown. Through the efforts of
researchers, worldwide, some of the mysteries of this disease have begun to unf
old. At times tranquilizers can lessen agitation, anxiety, and reduce incidence
of undesirable behavior. "It is a degenerative disease of the brain (Parke- Davi
s 6)." "Deficiency of cortical acetylcholine is believed to account for clinical
manifestation of mild to moderate dementia (Cognex 3)."
Cognex is the only drug of choice presently used for treatment of Alzhei
mer's patients. "Cognex presumably acts by elevating acetylcholine concentration
in cerebral cortex by slowing the degradation which is released by enact chelin
ergic neurons (Cognex 3)."
Approximately "5,600 patients were on clinical trails about 17% were imp
roved with memories. . ." and " 40% stayed the same no change and about 20% had
been "withdrawn" with adverse reaction (Cognex 4)."
In conclusion, when is memory loss, whether it is great or small, it tak
es away the ability to recreate or reproduce to some extent our emotions, past e
xperiences, thoughts and actions that we take for granted. It gives us far more
then we give it. The mind needs knowledge to keep us functioning and in return w
ill perform amazing feats for us. Although the cause of Alzheimer's diseases unk
nown care, research is ongoing, worldwide. "There is no evidence that Cognex alt
ers the course of the underlying demeaning process (Cognex 3)."