still-alice1Still Alice, starring  Julianne Moore (2014)

Still Alice—the film with Oscar-winner Julianne Moore in the role of a brilliant professor who has a perfect life until she develops frightening cognitive changes—humanized Alzheimer’s disease in a remarkable and profound way. In our ongoing series on dementia, Women’s Voices has addressed the risk factors for Alzheimer’s dementia and the research initiatives into strategies for prevention of the disease. Recently, Dr. Cecilia Ford focused on the broader emotional impact of the disease on Alice’s family and on the character’s response as she lives through the uncertainty of early symptoms, the diagnosis of the disease, and the inexorable course of this form of dementia.

Dementia is a term used to describe the impairment of someone’s abilities to function independently due to dysfunction in memory, judgment, thinking (executive function), language processing, and social abilities. In general, dementia progresses over many years, although the exact speed varies significantly, depending on the underlying cause and on the individual affected. It is not caused by a single disease but by a large number of processes that progressively destroy brain cells. Alzheimer’s disease is the most common of these, affecting roughly 500,000 Americans a year, followed by vascular dementia (roughly 300,000), Parkinson’s and Lewy body dementia (roughly 60,000), and several other less common disorders.

Approximately two thirds of the people suffering from Alzheimer’s disease in America are women. Women in their 60s have a 1 in 6 risk of developing Alzheimer’s disease over the course of their lives; their risk of developing breast cancer is 1 in 11. (cancer.gov and alz.org) Still Alice highlights a much less common form of the disease—early-onset familial Alzheimer’s. Accounting for about 3 percent of total Alzheimer’s cases, this familial disease usually affects people between age 50 and 65, although it can start much earlier. It is passed from one generation to the next in an autosomal dominant fashion. This genetic term means that if a parent has the gene and the disease, then his or her offspring each has a 50 percent chance of inheriting the disease. It has been linked to 3 different genes at this time: Presenilin 1, Presenilin 2, and amyloid beta precursor protein. The genetic aspect of this form of Alzheimer’s was only a small theme in this film, which highlighted the ethical issues involved in the testing of these sorts of inevitable diseases.

The most important information the film provides—illustrated beautifully by Julianne Moore, who plays the title character, Alice—was what happens when cognitive symptoms begin to be obvious. While some minor memory changes do occur as people age, it is important to talk with your doctor if you notice a progression of minor memory change occurring  in a family member or yourself. The key to diagnosing dementias starts with a thorough history: What part of the patient’s life has been most affected—memory, language, executive functioning, or social abilities? Are there other signs of disease, such as tremor or difficulty initiating movement (this problem is seen more often in Parkinson’s and Lewy body dementias) that would point to one cause of dementia over another? Are there structural abnormalities of the brain (stroke or a tumor, for example)? Are there metabolic abnormalities that can cause symptoms of dementia such as significant thyroid abnormalities, vitamin deficiencies, or chronic drug or alcohol use?

Next page: Handling the devastating diagnosis

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