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Book Reviewed by:Neuroscientist Lisa Genova's first novel, Still Alice, has been endorsed
by the National Alzheimer's Association with good reason: It's one of the few
books that addresses what it's like to live with the disease from the patient's
point of view.
Genova's work with Alzheimer's patients has given her a deep understanding of
the disorder and its impact not only on the afflicted, but on their friends and
family as well. She does a remarkable job of sharing that perspective with her
readers. Most of us have a sketchy familiarity with Alzheimer's and its primary
symptom: a gradual loss of memory. Genova moves her readers beyond their
superficial knowledge to a more profound grasp of the illness, illuminating
consequences of it that most haven't considered (for example, the eventual loss
of the ability to read a novel, as Alzheimer's patients lose the capacity to
keep track of a plot line).
The novel follows Alice Howland's life from her first suspicions of the illness
through its conclusive diagnoses to how Alice and her family learn to cope as
her condition worsens. Although the story's progression is somewhat predictable,
the scenes Genova relates are generally unexpected. Like Alice, the reader never
knows when the disease will impact a situation or simply lie dormant in the
background. When Alice does exhibit symptoms, they seem to come when she, and
the reader, least expect them.
Genova also explores the difficult decisions faced by Alzheimer's patients and
their families. She delves into such subjects as treatment options, care
facilities, coping mechanisms, genetic implications, and even suicide. The text
occasionally gets a bit wordy and artificial during some of these discussions,
but for the most part they add to the sense of realism the novel projects.
The book does lack a certain emotional depth. The narrator reports Alice's
actions, but doesn't explore her feelings to any great extent; it's a bit
clinical. This distance does, however, allow readers to develop a greater
understanding of Alzheimer's while at the same time keeping them from becoming
mired in the tragedy of the situation. There are two or three touching scenes
between Alice and her daughters, but the author largely avoids melodrama.
Readers will leave the book in a contemplative state of mind, eager to tell
others what they've learned, as opposed to feeling they've been witnesses to a
poignant family drama; we never really learn enough about Alice to mourn her
ultimate fate.
Still Alice seems designed specifically with book clubs in mind. Not only
does the subject matter lend itself to in-depth discussion, but the novel
features both a reader's guide and an extensive author Q&A. Beyond the book club
circuit, those curious about this insidious disease will find this an
enlightening and enjoyable read.
This review is from the April 1, 2009 issue of BookBrowse Recommends.
Click here to go to this issue.
First described by German psychiatrist Alois Alzheimer in 1906, Alzheimer's Disease (AD) is the most common form of dementia. It is a progressive brain disorder in which the nerve cells in the brain gradually die off. It afflicts an estimated 26 million people world-wide, and of those, approximately 4.5 million live in the United States. It is the seventh leading cause of death in the country and the fifth leading cause of death for those over age 65. 17% of women and 10% of men age 55 and older can expect to develop AD in their remaining lifetime (the difference between the genders is thought by most to be because of greater female longevity rather than an increased risk for women).
People may show early signs of the ailment for years, but if the symptoms are noticed at all they're most often attributed to old-age or stress. The most common indicator is short-term memory loss. As the illness progresses, Alzheimer's patients may experience confusion, irritability, inability to do familiar tasks or navigate familiar surroundings, an inability to use language effectively, long-term memory loss, and loss of bodily functions.
The cause of the disease isn't well understood but appears to be associated with plaques (deposits of amyloid, a fibrous protein, in the gray matter of the brain), neurofibrillary tangles (proteins found within the neurons of the brain), and a loss of the connections between the nerve cells in the brain. All three lead to diminished cell function and cell death.
Early-onset Alzheimer's, as experienced by the protagonist of Still Alice, is perhaps the most insidious form of the disease. While Alzheimer's isn't generally diagnosed until the patient is over 65, the early-onset variety generally afflicts individuals in their 50s or early 60s (although it can appear in those as young as 16). This type accounts for only 5% to 10% of all Alzheimer's sufferers, but those impacted are often at the peak of their careers, not to mention their lives, and thus they and their families tend to be more impacted by the effects of the disease, both emotionally and financially.
Half of all early-onset Alzheimer's cases are the result of genetic predisposition. There are three types, each related to a specific gene mutation: Presenilin 1 (PS1), Presenilin 2 (PS2) and Amyloid beta precursor protein (APP). All three forms are passed from parent to child; the chance of a child inheriting the mutation from an affected parent is approximately 50%.
There is no cure or known treatment for Alzheimer's disease, although in 2008 there were more than 500 clinical trials in process.
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This review is from the April 1, 2009 issue of BookBrowse Recommends.
Click here to go to this issue.
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