THE VANISHING FAMILY

An unfortunate family falls victim to a mysterious—and highly destructive—hereditary illness.

As Kolker’s narrative opens, a 41-year-old woman named Barb fears she may have the same form of dementia that her mother and five of her nine siblings had. “The symptoms were subtle at first—­missed appointments, an uncharacteristic aloofness, an end to deep conversations,” writes Kolker (Hidden Valley Road, 2020). “Slowly, impulse control and emotional depth became things of the past.” Some of Barb’s family simply tuned out, while others began drinking heavily and running into trouble with the law. The culprit was a rare malady called frontotemporal dementia, or FTD, which, Kolker explains, resembles Alzheimer’s disease but has more troubling dimensions. “Unlike Alzheimer’s,” he writes, “FTD emerges in the prime of life—as early as one’s forties—and relentlessly attacks the part of the brain responsible for planning, organizing, expressing language, understanding social cues, and exercising judgment.” The author delivers a searching discussion of the loss of executive function and the etiology of dementia. One leading school held (and still has a few advocates) that amyloid proteins are to blame, while the prevalent view today is that so-called tau proteins entangle brain cells, populating the neurons themselves. Just as central to Kolker’s narrative alongside this clear exposition of neuroscience is his portrait of Barb and her family, some of whom considered FTD a kind of depression that followed divorce, job loss, and other traumas. Barb instead elected to understand the disease and chart its effects on her, keeping a journal and “making a check mark each time she experienced a symptom,” such as forgetting someone’s name or neglecting to pay a bill. Sadly, Kolker notes, FTD is unlikely to be high on a list of medical and pharmaceutical priorities since it’s too uncommon to generate a profit: “In this landscape, most rare diseases are out of luck.”

A compelling view of dementia and its devastating effect on victims and family alike.