Excerpt from Keeper by Andrea Gillies, plus links to reviews, author biography & more

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Keeper

One House, Three Generations, and a Journey into Alzheimer's

By Andrea Gillies

Keeper
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  • Hardcover: Aug 2010,
    336 pages.
    Paperback: Oct 2011,
    336 pages.

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This might also be the moment to tell you that names in the account that follows have been changed. Nancy is beyond minding or even registering the fact that she's the subject of what you might call an unauthorized biography, and changing names provides only a tissue- paper- thin layer of anonymity, but it feels right, nonetheless.

A lot of what follows is taken from unedited diaries, which accounts for the use of the present tense and also for the emotional rawness of some passages. While filling the diaries, I used some of the entries in a newspaper piece I wrote about Nancy. It was straightforward and at moments graphic about her problems (and ours), and this didn't go down well with online commentators. Their chief complaint had to do with my having written intrusively about my mother- in- law without her consent. Even by then Nancy was long past the point of being able to consent to anything; she found the choice of Weetabix or cornflakes baffling enough. Intellectual competence aside, the argument remains that what ever the truth about rights, it's in bad taste to write in such unsparing detail about another's decline. The daughter of former British prime minister Margaret Thatcher has been pelted with rebukes since disclosing her mother's dementia. Her critics insist that the disease should be "kept in the family," which is only a short hop from suggesting that it's stigmatizing and shameful. Tony Robinson, the actor who played Baldrick on the popular BBC show Blackadder, was accused of something similar when he let UK Channel 4 make a documentary about his mother's last weeks. His response was robust: no, quite the opposite; he was proud of the program. There's a public ser vice element to allowing media access, even if it might appear to the viewer to be cloaked in voyeurism. Those of us who have loved ones embarked on the dementia journey - and it is a journey, with clearly defined stages - publicize the details of their decline not despite our love, but in large part because of it. In some cases, the love is shared with the nation at large. In the case of Ronald Reagan, the announcement of his Alzheimer's disease by means of an open letter in 1994 (a poignant and brave last message that marked the end of his public life) prompted a whole new national surge of affection for the former U.S. president.


Science still isn't sure precisely what triggers Alzheimer's, though things are moving so fast that the mystery may be solved by the time you get to read this. (In fact, the pattern in the last few years has been that they move fast and get nowhere much.) What's uncontroversial is that Alzheimer's brains show the presence of two weird and provocative things: (1) a wild overproduction of beta-amyloid, a naturally produced and usually soluble protein, contributing to sticky blobs called plaques and (2) the knotting and snagging of the tau protein that forms the "rungs" in the communication ladders within brain cells into tangles. The race is still on to determine what the definitive cause is.

An adult brain has about 100,000 million nerve cells, individual neurons that each look rather like the branching root of a tuber pulled out of the ground - tubers of different shapes according to flavor. A good analogy, put forward by the Oxford professor Susan Greenfield, is to think of the brain as the Amazon rain forest inside your head. In the Amazon rain forest's 2.7 million square miles, she says, there are about 100,000 million trees. Imagine all that foliage condensed into the size of a cauliflower within your skull: 100,000 million tiny trees, making a dense neuron forest. Our memories and our thoughts travel through the forest as encoded electrical signals. The "roots" of the neuron are called dendrites (from the Greek for treelike), and its stalk (trunk) is called an axon. The information comes in to the neuron via the dendrites, into the soma (cell body) - that's the front door - and then goes out the back door, travels up the axon, along parallel lines of communication called microtubules, and out the other end at branches called synaptic terminals. This information moves, in tiny leaps, from axon to dendrite, from one neuron to the next. How does it do that? For a while there were two camps of conjecture, spark versus soup. The sparkers, who believed in an electrical leap, lost out in the end to the soupers, who thought that the constituency of the soup was key. The spaces at which the crossing is made are called synapses, though they're more like ports than spaces - ports at which clusters of neurotransmitters are waiting as a chemical transport system. Subsequent research has shown that there are indeed electrical as well as chemical synapses in the brain, though the electrical ones are heavily outnumbered. The number of dendrites and synapses varies hugely according to the neuron's function, but on average a neuron is thought to have around 7,000 synaptic terminals. Multiply that by 100,000 million and the mind begins to boggle.

Copyright © 2010 by Andrea Gillies
From the book Keeper by Andrea Gillies, published by Broadway Books, a division of Random House, Inc. Reprinted with permission.

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