The Neuropsychology of Degenerative Brain Diseases

By Robert G. Knight | Go to book overview

Chapter 4
ALZHEMER'S DISEASE

A former high school mathematics teacher, Ada looks a lot younger than her 72 years. She sits, whitehaired and erect by her husband John. When spoken to, however, it is clear something is very wrong. She responds to questions with a confused half answer that conveys little. Most of the time, her husband John replies for her. He tells how just over three years ago he noticed Ada was having difficulty setting the table before dinner. It was only a trivial incident and he made no comment. But some weeks later Ada herself commented on her forgetfulness. She lost the ability to do even simple arithmetic calculations and her memory loss and disorientation increased. Bothered by her repetitive questioning and tendency to become lost and confused even in familiar surroundings, John consulted his doctor. A diagnosis of Alzheimer's disease was made. Over the past two years Ada has deteriorated still further. Now she cannot remember her husband's name or any of their life together. Despite the fact that she needs almost constant supervision, John has continued to look after her at home. Much of the experience of caring for her he finds rewarding; certainly he does not resent her increasing incapacity and almost complete dependence. Nearly 78 himself, John acknowledges that soon he will have to arrange for her to enter a nursing home. He conveys his sadness that the witty and bright person he knew has now almost completely gone.


Background

Remarkable changes in the neurofibrils appeared. In the interior of a cell that otherwise appeared normal, one or several fibrils stood out due to their extraordinary thickness and impregnability. At a later stage, many fibrils appeared, situated side by side and altered in the same way. Then they emerged into dense bundles and gradually reached the surface of the cell. Finally the nucleus and the cell disintegrated, and only a dense bundle of fibrils indicated the site where a ganglion cell had been ( Alzheimer, 1977).

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