Memoir Some researchers hold that we are all pre-Alzheimer's, that given a long enough life, even the low-risk among us would succumb.
There's a perverse fascination in pondering this, the Sword of Damocles that is dementia, because dementia itself is perversely fascinating. Alzheimer's victims, with their obsessions and delusions and discomfiting utterances - "I wish I had a daughter just like you," my grandmother told my mother after a particularly pleasant exchange - suggest to us that beneath the logical grid of our own thinking, chaos bides its time.
There are currently about four million cases of Alzheimer's Disease (AD) in the US. By 2050, that number is set to reach 14 million (the number of 80-year-olds having tripled by then). One result of such statistics is that there are now more new drugs in clinical trials for the treatment of AD than for all other neurological conditions combined. Another result is that Alzheimer's has become a rather hot literary topic. Fictional characters with AD and the memoirs of real-life care-givers are both proliferating. The latest offering in the memoir genre is from bestselling American writer Sue Miller, author of such novels as The Good Mother.
Miller tells the story of her father, an ordained minister and professor of theology, and a victim of AD. She traces the disease's progress from her father's first subtle symptoms to his death. No one actually dies of AD, but rather of complications brought on by it, and Miller's father likely died of a cancer that went undiagnosed. She describes the eruptions of violence in this previously imperturbable man, the proverbial wandering that goes with AD ("a need to get going . . . but disconnected utterly from the notion of destination"), the onset of delusions - her father constructed an elaborate belief system in which his care facility was a university - and her dilemma in deciding whether or not to collude in these delusions.
Before the disease struck, Miller writes, her father was "a painstakingly thorough but not startlingly original scholar . . . a generous and attentive teacher, but not a dynamic or exciting one . . . a loyal, faithful, hard- working colleague, but not a charming or easy-going one . . . incapable of falsity, his truthfulness was dispassionate . . ." (Her mother, by contrast, was an eccentric and hard-drinking attention-seeker who dropped dead of a heart attack at a party when she was 60.) Miller doesn't quite render the father of her youth interesting, but, at the risk of sounding ghoulish, both her book and her father become more absorbing as his dementia progresses. Certainly one gets the feeling that Miller's own engagement with him - despite his fragmenting identity - assumed an intensity that had previously been absent from their relationship. This is not to suggest, of course, that Miller took pleasure from the situation, but rather that she - being a writer, perhaps - could not but find his increasingly bizarre turns of mind fascinating as well as heart-rending.
When the (probable) cancer was diagnosed in 1986, her father already drifting into unconsciousness, Miller signed a Do Not Resuscitate order, according to the instructions in his will. She compares his 10-day dying to a long labour, "the work mostly his, but the experience for me as profound, as isolating, as the labor of birth".
In the years that followed, she worked on successive drafts of the memoir, her motives for writing it changing with time. Ultimately, she concludes, the book was driven by her need to revisit and slay her "childhood fear of abandonment", which her father's AD had reawakened. Her "lifelong feeling of loss" hadn't arisen in response to anything like fecklessness or drink or adultery (none of which her father indulged in), but rather to his faith. He loved Jesus more than any worldly thing, including his family: "\ took away my father, yes. But it reminded me that my father had long since been taken . . . gone, claimed elsewhere - by his beliefs."
The primary cause of AD is not known, but its hallmarks are the plaques and tangles which accumulate on the brain and destroy neurons but which are visible only upon autopsy, making definitive diagnoses of AD difficult in the living, at least in its early stages. Plaques are deposits of aggregated proteins - principally beta-amyloid, which is normally benign but in the case of AD over- produced and altered in form. Tangles are long threads of transport proteins which have grown snarled. The fibrous nature of plaques and tangles means that brain activity in the affected areas simply ceases, as signals are unable to pass through.
At present, the primary drug treatment for AD - cholinesterase inhibitors - delays the symptoms of cognitive decline but doesn't arrest the disease's progression. And early drug intervention is unlikely; apart from the diagnostic complications, the initial progress of the disease is slow and much damage may occur before any symptoms are detectable.
Miller's tale offers little comfort in the face of these facts. AD isn't one of those diseases that opens up new possibilities for connection between people; quite the opposite. She makes much of the fact that her father recognised her, more or less, right up to the end, and acknowledges the desperate pride she took in what AD's idiosyncratic assault in this case deigned to leave intact.
The Story of My Father breaks no new ground in the memoir genre, but those who have seen a loved one reduced to what Miller calls "a needier and needier husk" will find much to identify with here. And the shifting dynamic played out between the author and her father has a particularly poignant twist. There was a brief spell, after her mother's death and just before the disease became apparent, when her father opened up to her in a "momentary dwelling of introspection", expressing regret over the lifelong distance he'd kept from his family. But the illness quickly set in, obscuring whatever insights he seemed on the verge of and leaving his daughter with only the merest glimpse of him as he wavered, fleetingly, between his two long spells of dispassion.
Molly McCloskey is a writer and critic
The Story of My Father By Sue Miller Bloomsbury, 171 pp. £ 12.99