DEMENTIA REIMAGINED

A patient-focused perspective on two highly complex and stigmatized brain diseases.

In this effective demystification of dementia and Alzheimer’s disease, physician and bioethicist Powell (Psychiatry and Bioethics/Albert Einstein Coll. of Medicine) reframes two debilitating cognitive disorders. She recounts her medical school years studying brain pathology, a field that has been drastically revised and improved over the decades, though definitive disease cures remain elusive. Her illuminating history of Alzheimer’s disease and its legacy of treatments and policies features the German psychiatrist who identified the malady and Solomon Fuller, a black pathologist who contributed groundbreaking brain-mapping dementia studies in the early 20th century. Deinstitutionalization and assisted living facility costs refocused government attention back onto mental illness and the elderly, rebranding it as a priority just as Ronald Reagan was diagnosed with Alzheimer’s in 1994. Powell smoothly moves through the advent of palliative drugs and the much-argued hypotheses of amyloid plaque accumulation as well as the debate over preventative PET scans. There is progress being made, she observes, and optimistic statistics show the numbers of older people with dementia decreasing, yet the stakes and costs remain high to find a cure. Powell profiles a geriatrician who discusses the ethical, emotional, and financial dilemmas facing loved ones of dementia patients, and she looks at the caregiving decisions that plague families. As someone who regularly participates in research studies, the author holds a great personal (and congenital) stake in her subject matter. Her “medical training,” she writes, “never prepared me to address the challenges of dementia that I faced as a daughter and granddaughter,” and her warm advice to readers on effective dementia care is useful and proactively delivered. In a touching conclusion, Powell discusses her imagined requests at the final stages of her life when feeding tubes and emergency room visits are forbidden in favor of daily pain management. Throughout this insightful book, the author addresses the issues facing dementia victims and their caregivers with the kind of compassion and dignity everyone deserves at the end of life.

A potent hybrid of medical history/journal and memoir.