For a couple of years now, the professional researchers are trying to determine how and when the brain starts to deteriorate. Alzheimer’s disease is one of the most wide-spread forms of dementia, a persistent or chronic disorder of the mental processes which is caused by brain injury or disease and marked by various memory disorders, impaired reasoning, and personality changes. Most of the patients across the whole world who suffer from this powerful disease are usually over 65 years old (Crystal, n.d.).
The late age of patients with Alzheimer’s disease astonishes scientists very much. A research conducted by a group of professionals shed some light on this mystery. With age, certain changes occur in our brain which can easily harm neurons and add up greatly to the development of the disease. The most serious of these alterations are considered to be atrophy, that is shrinking of certain brain parts, a decrease in cell energy production is called mitochondrial dysfunction, and the increase in free radicals production causes inflammation (Alzheimer’s Disease Fact Sheet, 2012).
Very rarely the illness can hit people aging 30-60 years old. Only 5 percent of people are succumbed to the Alzheimer’s disease in the age under 60. Most of the cases happen to the genetics, when certain changes occur in one of three genes that are inherited from a parent (Alzheimer’s Disease Fact Sheet, 2012).
In the movie “The Notebook” Allie, one of the main characters, has the Alzheimer’s disease that is why she does not realize that the story which Noah, her husband, retells her is the story of her own life. The movie shows us life in a kind of retrospection: Beginning with the scene in the nursing home where Noah reads a book to Allie. The book opens for us the life of two quite young people being passionately in love with each other, however, life circumstances make their paths go apart, destroying in such a way their hopes and dreams.
However, the day comes when both of them can be together again. Despite the fact that many years have elapsed and that a lot of things in their lives have changed, their love continues to be as strong as in the years of their adolescence.
The movie does not tell us about their life together much, however, we can see their children and grandchildren, loving and supportive family. Allie gets Alzheimer’s disease and Noah is reading the book of their own life to her each day in order to remind her who she is. Despite the doctor’s inconsolable prognosis that Allie cannot become who she was before the disease hit her, Noah does not lose his hope that their strong love will help her to find herself one day. And this day comes.
When talking about the medical side of the Alzheimer’s disease and its appearance in the movie, I would like to state that we cannot observe all the real symptoms that usually are faced by the patients who suffer from Alzheimer’s. Allie does not have strong word misuses or she does not forget words which she wants to say (Belluck, n.d.).
Concerning the possible discrimination which the patients frequently face in the treating institutions for people with mental disorders, the movie does not show us these horrors. On the contrary, we see a beautiful area which reminds more of the private closed unit, like a sanatorium or special resort for older people, which is a little bit differs from what often can be observed in the reality.
However, once when Allie loses her memory again, she becomes anxious and the doctors take her away in a little bit harsh manner. Still, not as harsh as we know frequently happens in the daily life of such people which suffer from poor treatment sometimes more than from the effects of their diseases. But let us have a closer look at the real signs and symptoms, including possible treatment of the Alzheimer’s disease.
We can usually observe both Axis 1 (primary clinical diagnosis) and Axis II (personality disorder) of people who suffer from Alzheimer’s disease. Axis 1 includes learning disorders, major mental disorders, and substance use disorders. Axis II comprises of intellectual disabilities and personality disorders which include Autism, the developmental disorders.
The main symptoms of Alzheimer's disease are as follows (Alzheimer’s Disease Signs and Symptoms, n.d.):
- Disorientation - people can get lost in the street where they live, forget how they got where they are have no idea how to get back home.
- People can lose the skill of solving problems and drawing the conclusions. For these group of people it is extremely difficult, for example, to understand how to use the credit card because the patient forgets what to do with the numbers at all.
- Succumbed to Alzheimer’s disease may frequently become without enthusiasm to do anything, sleep a lot or star at one and the same spot hours long. They cannot do the everyday chores either. People lose the initiative.
- A very serious problem is that people frequently forget simple words and can even substitute words with some inappropriate ones. A patient who cannot find her or his toothbrush can ask for "that thing for my mouth." (Alzheimer’s Disease Signs and Symptoms, n.d.).
- The mood alters so fast that family usually cannot understand neither the causes for it nor what the person feels: Weeping with no reason, shouting suddenly, complete inability to control the emotions.
- Despite the fact that all of us are prone to misplace such items as a wallet or key occasionally, but a person with Alzheimer's puts things in unusual places, for example, as an iron in the freezer and a wristwatch in the soup bowl almost all the time.
- Poor Judgment is a common symptom. Patients can dress without thinking about weather outside, wearing several blouses or shirts on a warm day or, on the contrary, very little clothes in cold weather. Some others can give away large amounts of money to people in the streets or pay for home repairs and buy products they do not need.
- People ill with Alzheimer are subdued to the change of character, for example, becoming extremely confused, scared, suspicious or unable to make decisions on their own, as happened with Allie in the movie.
Scientists define the following stages in the progression of the Alzheimer’s disease (Alzheimer’s Disease Fact Sheet, 2012).
Mild Alzheimer’s disease is characterized by the worsening of memory loss and the alterations of the cognitive abilities become evident. For example, the problem can include trouble with paying bills and handling money in general, getting lost all the time, repeating questions, needing more time to complete daily easy tasks, have often changes of mood, and using inadequate, poor judgment. Looking at these endemic features of illness, we can clearly see that Allie must experience final phase of this stage as she still does not have problems with language, however, her memory loss is very severe despite all those flashes of clarity that come to her from time to time.
In the moderate stage of Alzheimer’s disease, the damage in those areas of the brain occurs, which are responsible for the proper language use, sensory processing, reasoning, and conscious thinking. Confusion and memory loss grow worse with each coming day. At this stage people start experiencing serious problems with recognizing friends and even family members. Usually, they stop being able to learn new material, perform daily chores, especially those which consist of small routine tasks (for example, to get dressed or cook dinner) and coping with unusual states of affairs becomes extremely troublesome.
The final stage is severe Alzheimer’s disease which causes very serious damage to the brain. The brain tissue gets shrunk very much. People who suffer from this illness cannot communicate anymore. They completely depend on other people. With the last days of life the person can stay all the time or almost all the time in bed as the body stops functioning properly (Alzheimer’s Disease Fact Sheet, 2012).
To make a good diagnosis of Alzheimer’s disease the doctor should take into consideration a range of factors. First of all, a physician should study well the detailed medical history of the patient. The next step is the conduct of neurological and physical examinations. Laboratory examinations, including urine tests, magnetic resonance imaging, a computer axial tomography, or a positron emission tomography have to be applied to find out the availability of structural anomalies of the brain and also head. The physician should also make an assessment test of mental and functional statuses. The final step will be a complete list of all medications that patient is currently taking (Alzheimer’s Disease, n.d.).
Unfortunately, nowadays there is no a cure that can heal from the Alzheimer’s disease fully. However, there is a plenty of methods which allow to alleviate and slow down the negative effects of the illness on the body of a human being. The most common are next approaches that are applied widely in modern medicine. The first one helps to relieve behavioral symptoms which are associated with the disease, like agitation, depression, and psychosis. Such medications as cholinesterase inhibitors enhance the effective work of acetylcholine slowing its breakdown. However, these medications just temporally improve the symptoms. Often, the effects of the medications fade with the progress of deterioration of brain cells. Doctors can also prescribe antipsychotics, antidepressants, beta blockers, anticonvulsants, benzodiazepines, and such drugs as BuSpar, Desyrel, and Eldepryl which help to control the psychosis, agitation, depressive features, disturbances, apathy and anxious features in appetite and sleep (Alzheimer’s Disease, n.d.).
Cholinesterase inhibitors, precursors and cholinergic receptor agents are prescribed to relieve cognitive dysfunction and improve memory, attention, language, and orientation in space. Doctors apply those medications which help to slow the rate of progression of the illness, therefore, preserve the quality of life (Alzheimer’s Disease, n.d.)..
Methods to impede the onset of illness are used. Therapies and drugs to stop such problems are still under development. Researchers are trying to develop methods which can enhance cerebral metabolism, promote neuronal sprouting, stabilize membranes, neurotoxins, decrease inflammation, and excite amino acids, including the alteration of key proteins in metabolism (Alzheimer’s Disease, n.d.).
In addition to these methods, the conservation approaches can help to alleviate the negative impact of the disease. It is very important to eat a proper diet and get daily exercise. The implementation of memory aids, namely, a prominent calendar and the list of things-to-do during the day can help a lot in compensating for confusion and memory loss. Patients should be provided with a motivating and cozy environment. People around them should try to use very simple language giving clearly formulated tasks to the patients. A very popular method nowadays is visiting special support groups where come people with the same problems (Alzheimer’s Disease, n.d.).
When talking about ethical issues of the Alzheimer’s disease, I would like to point out that it is quite a burden for many families whose member suffers from this illness. Even professional caregivers can become demoralized and exhausted from all the tasks they have to perform to help the poor people to go through the day. Family members usually lose their freedom, too, having to care for the ill all the time. Unfortunately, they never usually receive any acknowledgment or at least gratitude. The resentment which they can possibly develop with time can be increased by the fear to inherit this terrible disease. The personal remorse of having to deny patient’s desires all the time, and having to tell small lies to the ill only add up to the problem (Alzheimer’s Disease, n.d.).
“The Noteboook”, however, shows us that the closest Allie’s family helps her with all their love, especially her husband who spends all days and nights near her.
Unfortunately, we do not know from the movie what the cause of Allie’s mental disorder was. We cannot also say when exactly it happened. However, we see all the care and support that she gets from the skillful nurses and doctors and her loving family.
Frequently one can observe how caregivers look more depressed than the patients. Such situation happens due to the fact that people find it difficult to be responsible to take the decisions all the time. Those small tasks they perform each day, like washing, eating, dressing, etc., are conducted without much of a thought. However, when you need to make these choices for another person, it can become a very heavy burden. The caregivers usually do not have time for their personal lives and gradually anger and resentment reach such a point that the level of care can sharply decrease leading to the progression of the patient’s disease (Alzheimer’s Disease, n.d.).
The best solution in such cases is to submit an ill person to the special institutions where professional people will care for them. Frequently, family members do not even know enough about this illness and they cannot choose the best methods of treatment. In the United States, most of citizens with Alzheimer’s disease end up in the nursing houses almost at once.
Recently, researchers have predicted that the amount of people who will enter nursing institutions aging over 65 would make 40 percent. 25 percent would stay at home for about a year, and about 10 percent would last there for about five years or maybe more before being submitted to the nursing house. If to count the average age of the people in the nursing homes, we will receive the figure 86. Unfortunately, but over two-thirds of the ill are females (Alzheimer’s Disease, n.d.)
Continuing this sad statistics, I would like to mention that the overwhelming majority of patients die in the nursing houses just during three years, mostly due to the fact that family members take this step only when all possible means are finished and the unlucky person is on the edge of death (Alzheimer’s Disease, n.d.). Due to the lack of the knowledge, families often procrastinate the actual submitting of the ill people to the professional institutions.
To conclude I would like to add that the best cure to any disease is prophylaxis: Preventive measures must be a good choice to alleviate the possible effects or even avoid the progression of the disease for older people or those who are prone to Alzheimer’s.