That was the title of a Raymond Chandler book published in 1953 and 20 years later became a classic movie. The term today is associated with something far removed from entertainment. It was the title of a book by Patti Davis, the daughter of President Reagan, chronicling his slow decline into Alzheimer’s disease.
Although dementia of many types has been known for centuries, in 1901 Alois Alzheimer, a German psychiatrist, described the dementia that bears his name. It was originally called pre-senile dementia since the index case appeared in a woman 50 years old and was distinguished from senile dementia which was thought to be the inevitable mental decline associated with advanced age.
Currently it is thought that 60-70 percent of diagnosed dementia cases are of the Alzheimer’s type but are recognized as occurring at a later stage of life than the original descriptions. Refined diagnostic techniques are showing differentiating characteristics for the other causes of dementia.
Doubtless we are on the cusp of much more sophisticated tests that will separate out the multiple causes of this terrible affliction. Of more importance will be the development of treatments for Alzheimer’s disease that will significantly alter, if not cure it. We can hope that day is not in the too distant future.
As everyone is aware the prognosis for those who are suffering from Alzheimer’s disease is grim. While some types advance more rapidly than others, the outlook for having to face the long good-bye is depressing for all.
So widespread is the problem that it must be a concern to the majority of the aged. Most of us in that period of life wonder when appointments are forgotten, the names of old friends become foggy, if not lost, confusion about when important events occurred, and similar annoyances of everyday living. . . are those a cause for concern?
Forgetfulness is certainly among the vagaries of getting old and in most cases is not the harbinger of dementia. Not knowing where you left your keys or confusion about the location of your car in the mall parking lot is not a cause of concern. Not knowing what to do with the keys when you find your car or getting significantly lost in driving home that is quite another matter.
The important message here is we should not obsess over the minor problems, but not be oblivious to the potentially more alarming ones.
Even in the absence of meaningful treatment good things are happening relative to this disease. The families that have a member in such a decline can find support. Day care centers and instructions for family members who become caregivers will provide help to both the patient and the families. The widespread publicity given the problem has accelerated research and will lead to better understanding for both the patients affected and the catastrophic costs to the family, not only financially but emotionally.
It is not an overstatement that virtually every family will have a member or friends who are going through the “long good-bye.” The frustration and emotional exhaustion of the being involved in such a situation is beyond calculation. The feeling of helplessness in being a bystander to the process is hard to imagine until you have actually been involved in it.
When the victim is a beloved spouse, a parent who has disappeared into an unknown and unknowing stranger, when a sibling who has known you longer than anyone else on earth is wandering off into a sandy delta of senility, then the feeling of helplessness becomes an ever present companion.
When we find ourselves in such a situation it is important to remember that loving concern of all involved can ameliorate but not eliminate the pain of these difficult last years. For those of us who are coping with this scourge such support is a blessing not to be taken for granted.
When facing Alzheimer’s and similar problems, living each day with a positive attitude can be a blessing and help as we all walk into an uncertain future.