Problem of Alzheimer's : How Science, Culture, and Politics Turned a Rare Disease into a Crisis and What We Can Do About It
by Karlawish, Jason







Introduction: The Disease of the Century1(8)
PART 1 ALZHEIMER'S UNBOUND
1 A Peculiar Disease of the Cerebral Cortex
9(14)
2 No One Says No to Len Kurland
23(9)
3 Accurate but Not Presumptuous
32(8)
4 The Olympics of Pharmacokinetics
40(15)
5 The Republic of Alzheimer's Disease
55(9)
6 A Young Man in a Hurry
64(6)
7 How Do You Cast a Broken Brain?
70(15)
PART 2 THE BIRTH OF ALZHEIMER'S DISEASE
8 The Old Woman in the Tower
85(7)
9 Alois Alzheimer: An Unwitting Revolutionary
92(9)
10 Oblivion, or War and Madness
101(9)
11 The Essay Heard Round the World
110(9)
12 A Self-Help Group for the Self-Made Man
119(9)
13 A Crisis in the Family
128(8)
14 The Last Casualties of the Cold War
136(12)
15 Hope in a Pill
148(13)
PART 3 LIVING WELL IN THE HOUSE OF ALZHEIMER'S
16 The Extraordinary Ordinary
161(11)
17 A Correction
172(9)
18 Discernment
181(11)
19 Some Things to Watch Over Us
192(6)
20 Not (Legally) Dead Yet
198(9)
21 Targeting Amyloid
207(7)
22 Hope in a Plan
214(19)
PART 4 A HUMANITARIAN PROBLEM
23 Something Must Be Working
233(10)
24 Existential Dread
243(6)
25 Caring for Each Other
249(11)
26 The Worlds We Create
260(18)
27 The Worlds We End
278(13)
Acknowledgments291(2)
Notes293(14)
Glossary307(2)
Selected Bibliography309(6)
Index315


Traces Alzheimer's from its beginnings to its recognition as a crisis and discusses biomedical breakthroughs that may be used to prevent and treat the disease so that people with dementia and caregivers alike can reclaim their autonomy. 50,000 first printing.





JASON KARLAWISH is a physician and writer. He researches and writes about issues at the intersections of bioethics, aging, and the neurosciences. He is the author of the novel Open Wound: The Tragic Obsession of Dr. William Beaumont and his essays have appeared in The New York Times, The Washington Post, Forbes and the Philadelphia Inquirer. He is a Professor of Medicine, Medical Ethics and Health Policy, and Neurology at the University of Pennsylvania and Co-Director of the Penn Memory Center, where he cares for patients. He lives in Philadelphia.





Today about 5.8-million Americans live with Alzheimer's, which can cause dementia and problems with such day-to-day activities as venturing outside the home or being able to use the bathroom on one's own. Karlawish, a professor of medicine at the University of Pennsylvania and codirector of the Penn Memory Center, covers the history of diagnosis and treatment and shares his own experiences. During the "clock-draw test," he asks a patient to fill in the face and show the time as 12:55. A 71-year-old retired art teacher creates a jumble of misplaced numbers and lines. Patients exhibit confounding changes in behavior and mood and forget all kinds of things. Often, it's the caregiver who is sad and in despair. One laments that it's all "pills and bills." Americans who reach their eighties enter the age of dementia. and it can strike anyone, from U.S. presidents (Ronald Reagan) to the spouses of Supreme Court justices (that of Sandra Day O'Connor). There's no cure for Alzheimer's, but Karlawish reassures readers that it's possible to help patients preserve their comfort and dignity. Copyright 2021 Booklist Reviews.





A professor of medicine at the University of Pennsylvania delivers a lucid, opinionated history of the science, politics, and care involved in the fight against this century's most problematic disease. The first symptom of Alzheimer's is usually difficulty with memory, often recognized by a spouse, friend, or caregiver. Over years, memory deteriorates, and victims can no longer perform simple tasks such as paying bills or taking medicine. As the disease worsens, they become apathetic or delusional; lose the ability to dress, feed, and clean themselves; become bedridden and depressed; and often die from complications. Caring for an affected spouse or parent is a crushing experience, often bankrupting all but the wealthy because medical insurance and Medicare pay for medicine and doctor visits but not "custodial care," which is estimated at as many as 170 hours per month. As Karlawish shows, Alzheimer's usually causes more suffering for the caregiver than the patient. Until the 1970s, most doctors explained that this was "senility," a consequence of aging beyond the scope of medical science. Eventually, researchers realized they were dealing with an epidemic of brain disease. At the same time, patient advocacy groups formed to lobby Congress, which was amenable to providing funding. Formerly, doctors diagnosed Alzheimer's by examining the brain after death. Observing and testing living patients was a major advance. In 2012, the FDA approved an ingenious brain scan that illuminates the areas damaged by Alzheimer's. Sadly, Medicare won't pay for the $3,000 test, which doesn't directly help patients because no good treatment exists (several drugs purport to slow its progress, but many experts believe they're worthless). A medical expert with a page-turning style, Karlawish is mostly successful in conveying optimism. Hopeful drugs are in the research pipeline, but even better news is that physicians, institutions, and advocacy organizations are adopting more imaginative and humane programs to care for victims both before and after their disease becomes crippling. An outstanding primer that readers should put into the hands of their doctors. Copyright Kirkus 2020 Kirkus/BPI Communications. All rights reserved.






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