Sunday, May 10, 2009

Maria Shriver's "The Alzheimer's Project" began Mother's Day on HBO

Maria Shriver’s multi-part documentary “The Alzheimer’s Project” began Sunday, May 10, 2009 on HBO. The first episode, 90 minutes, is called “The Memory Loss Tapes”. The episodes are listed at HBO’s site, here Future episodes Monday and Tuesday reportedly will cover Alzheimer’s research. Another episode will be called “Caregivers”. Apparently all of the episodes are available for streaming from the HBO website now.

Maria Shriver is the host, and John Hoffman is the series producer. Maria is the daughter of Sargent Shriver, who developed Alzheimer’s rapidly around 2003. She has described her relationship with her dad in many television appearances.

The first episode presents seven people talking about their experience. Both men and women appear. One of the men runs a blog, "Living with Alzheimer's", with URL here.

The film shows patients being given memory tests, including recalling from lists of words. One person is given a driving test. In one case a patient is ask to recall former President Clinton’s name, and in another (in an informal setting) to identify the game of baseball.

The doctors make the point that the short term memory loss with which the disease often begins does not mean the loss of basic intelligence or even self-awareness. But eventually patients lose awareness of their symptoms and develop agnosia, which is well documented in Wikipedia,

The National Institutes of Health has a page on Alzheimer’s, with links to the HBO documentary, here. The actual agency is called "The Alzheimer's Disease Education and Referral (ADEAR) Center" of "The National Institute on Aging." The page lists NIH studies and sometimes it is possible to be selected for research and treatment at NIH Clinical Center hospital (in Bethesda MD).

The Centers for Disease Control has a page here with some startling statistics about the rapid increase in the disease. It may become the largest public health problem ever.

One female caregiver says she never had children but almost feels she has “gained motherhood” and is called “mom” sometimes by her own mother. In another case, however, an elderly wife (past a golden anniversary) recalls the whole life with her husband while giving care, and he only intermittently recognizes her as his spouse. Soon he is in a hospice.

The film episode is difficult to watch in many places. The music in the background often consists of Bach played on the piano by Glenn Gould, a leading Bach interpreter from the 1960s (Columbia Records).

The Journal of the Alzheimer’s Association is called “Alzheimer’s and Dementia”, link here. It is important to remember that some elderly dementia occurs from other causes (like heart failure and circulation problems) and technically is not Alzheimer’s. The progression and symptoms may be milder. NIH has a page on “Multi-Infarct Dementia” here. There are many other causes, such as Huntington’s (genetic) prion-related diseases (CDC page) including Creutzfeldt-Jakob Disease (CJD).

"Grandpa, Do You Know Who I Am?" aired Monday night May 11, and was a 30-minute segment. Maria described how she came never to "correct" her father. The other scenes with children portrayed emotion that was difficult for me to watch.

Monday night that was followed by the first part of the clinical report, "Momentum in Science," itself in many parts, starting with "Plaques and Tangles." The role beta-amyloid was discussed, and then the film moved on to genetics. The film made the startling prediction that someone born today has a 10% chance of developing Alzheimer's Disease during lifetime, which goes up to 20% with a family history. The next physician talked about insulin resistance as contributing factor, and even described a Morgan Spurlock "Superfried" experiment where too much fat caused increased beta-amyloid to form in the spinal fluid, alone with insulin that remains high because the body's cells have become immune to insulin (leading to Type II diabetes). Amyloid was described as a "splinter" in the brain leading to destructive inflammation. Later, the film says that high blood pressure, heart failure, and related problems could contribute to Alzheimer's in that inflamed brain capillaries can't flush out beta amyloid (which is very insoluble) as it forms. Genetics is part of the problem, but not all of it. Medications and lifestyle changes could prevent development of disease.

The second part of the medical film aired Tuesday night and ran 68 minutes. The film started with the "Pittsburgh compound" invented in 2004, enabling one to see a living brain. One family had several siblings with one woman not carrying the gene for b-amyloid, concerned about how all her siblings would be respected. Later the film went into the topic of "cognitive reserve", which indicates that some people with a large amount of plaque still have no symptoms, if they have been intellectually and particularly socially active -- so already the disease seems to have a behavioral influence. Finally, the film went into a vaccine trial, where the vaccine stimulates the body into making antibodies against its own amyloid. There was a safety trial, and the efficacy trial was left incomplete when about 5% of vaccinated patients got a form of encephalitis. Still, the trial leads to hope for full prevention. Furthermore, there is a new drug in trial based on antibodies already made. It seems to have worked in some patients, judging from autopsies looking for clearing of plaques.

On Tuesday, May 12 HBO aired the 50-minute "Caregivers" portion. Several situations were presented, including a few married couples. It seems that the complete dedication (one husband does duty at the nursing home after his wife finally has to move in) develops as part of the marriage vow. But another man, without his own children but six siblings (it's not mentioned whether he has a spouse or partner), takes care of his father, and he says "I have an 82 year old son; I know what parents go through" after he moves his dad into his house. He says, "I didn't choose this, it just fell into my lap." That's a much tougher situation to handle, where one is expected to offer the intimacy and commitment that would come from a marriage without ever having made one voluntarily. I suppose that this sounds like a place for a Rick Warren sermon ("it's not about you"). In the end, "you" are the sum of yourself as an individual and yourself as a member of the community, and sometimes the community makes more demands of "you" than other, and sometimes less. When you go to your maker, you have to see if the end result is good enough. It is difficult to accept becoming only a caregiver, and not having the rest of one's life.

The film does show other sessions that you would expect, such as support groups.

Picture (mine): Clinical Center, National Institutes of Health, Bethesda, MD

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