THE PROBLEM OF ALZHEIMER'S is off for copy editing....

THE PROBLEM OF ALZHEIMER'S is off for copy editing....

 

 

July 2020 -- I'm thrilled that the manuscript has taken shape quite nicely. My colleagues at Macmillan/St. Martins are hard at work moving into final edits and production. Publication is February 2021.

Here's what's inside "The Problem of Alzheimer's: How Science, Culture and Politics Turned a Rare Disease into a Crisis and What We Can Do About It" (the prior title was "The Disease of the Century: How Alzheimer's Became a Crisis and What We Can Do About It" a title I still like, but my editor and I felt 'The Problem..." better conveys the messages of the book).

A Prologue ("The Disease of the Century") sets the tone and frames the key themes. The title is a line from a 1980 essay the physician, essayist and researcher Lewis Thomas ("The Problem of Dementia"). We meet the Harrisons at their new patient visit at the Penn Memory Center. There's is the usual sad story of years trying to find clear answers to explain her cognitive problems and help to care for her and for him.

Edith and Ed's sad story leads me to some questions. This disease was once rare, and then it was common and soon it became a crisis. Why? What do we need to do? 

Part I ("Alzheimer's Unbound") explains the changing meanings of what is Alzheimer’s disease and the enduring challenges of translating this complicated and nuanced diagnosis to patients, their families and health care systems. The histories of MCI (mild cognitive impairment) and amyloid imaging (PIB, or Pittsburgh Compound B) are especially fascinating.

Part II ("The Birth of Alzheimer's Disease") looks back over the course of the 20th century to show a tragedy of science and medicine colliding with politics and culture in ways that kept the disease largely hidden and untreated and then, once recognized as common, underdiagnosed and patients and families neglected. The story walks through events such as the battlefields of world war I, the dark and ugly events that led to the collapse of Germany's Weimar Republic, Dr. Will in the USA, Operation Coffee Cup, the Contract With America, and the Reagan Revolution.

This was a lot of fun to research. 

Part III ("Living Well in the House of Alzheimer's") shows the opportunities to address the crisis. Scientists have discovered ways to improve care in the physician’s office, home and community, hospital and nursing home. There are also astonishingly promising advances in the ability to diagnose and treat the disease before a person has dementia.

I tell these pioneers' stories. They include Sharon Inouye's groundbreaking work to discover and treat delirium, the team at Highland Hospital, a failing commnity hospital in upstate New York, who revolutionized hip fracture care, Dr. Peggy Noel of Ashville, North Carolina's and her passionate determination to create a memory center despite the lack of any business model, Dr. Jeff Kaye's "mandalas of function," Dr. Reisa Sperling and one of the first biomarker-based "prevention studies," Dale Schenk's revolutionary approach to therapautics. Dr. Paul Appelbaum's groundbreaking work in capacity assessment. And the clever politics that finally gave America an "Alzheimer's Plan."

The problem isn’t science.

Part IV ("A Humanitarian Problem") explains why and what we have to do. The stories of Dr. Lisa Barnes and London cab drivers and the residents of Framingham, Massachusetts show how our brains our caught up in the ways we treat or mistreat them. We learn how people who have learned their Alzheimer's biomarker test resutls cope with their existential dread. I explore the promise of technologies to monitor and alert, such a whealthcare, and how robots might care for us. Robots as caregivers?

The closing chapters are "The World's We Create" and "The World's We End."

Alzheimer’s disease starts out in individuals. Soon it spreads to other people, men and women who become caregivers. Together, millions of patients and caregivers experience physical, psychological, financial and moral sufferings. Their awesome tally adds up. The solution isn’t simply better medical care. We must mobilize our cultural, civic and social systems to address this humanitarian problem.

Publication is February 23rd, 2021.