As the world's population of older people rapidly grows in the coming years, Alzheimer's and other forms of dementia will become a health-care disaster.

Stephen S. Hall

Friday, October 5, 2012

William UtermohlenBlue Skies (detail), 1995 Galerie Beckel Odille Bocos

Evelyn C. Granieri is that rarest of 21st-century doctors: she still makes house calls. On a warm Thursday morning toward the end of August, the New Yorkbased geriatrician, outfitted in a tailored white suit and high heels, rang a doorbell at a seven-story red-brick apartment building in the Riverdale section of the Bronx and was buzzed in.

"You look gorgeous!" the doctor exclaimed when she greeted her patient, a 99-year-old woman with white hair and a wry smile, in the dining room of her apartment. In an hourlong conversation, Mrs. K (as we'll call her) recalled, in moving and sometimes mischievous detail, growing up in Poland, where soldiers on horseback took her brother away; coming to America on a ship and working in her parents' grocery story in Queens; and dealing with male colleagues in the real-estate business when they got "fresh." But when Granieri asked how old Mrs. K was when she got married, she looked puzzled.

WHY IT MATTERS We have no effective treatments for dementia, a huge health crisis facing the world. The annual cost of care in the United States alone could reach $1 trillion by 2050.

"I can't remember," she said after a pause. A cloud passed over her face. "Was I married? To whom?" A framed photograph on a nearby table memorialized her 50th wedding anniversary.

Spirited and funny, her personality intact even as her memory deteriorates, Mrs. K is one of more than five million Americans with dementia. Far from the gleaming research centers where scientists parse the subtle biochemical changes associated with Alzheimer's disease and other forms of the condition, clinicians like Granieri, chief of the Division of Geriatric Medicine and Aging at Columbia University Medical Center, confront its devastating reality every day. And, often, they talk to relatives of patients. As Granieri and two interns probed Mrs. K's memory with small talk and measured her blood pressure, a niece called from Manhattan to see how her aunt was doing.

Almost every dementia patient has worried family members huddled in the background, and almost every story about dementia includes a moment when loved ones plead with the doctor for somethingany medicine, any intervention, anythingto forestall a relentless process that strips away identity, personality, and ultimately the basic ability to think. Unfortunately, Evelyn Granieri is the wrong person to ask. In 2010 she served on a high-level panel of experts that assessed every possible dementia intervention, from expensive cholinesterase-inhibiting drugs to cognitive exercises like crossword puzzles, for the National Institutes of Health; it found no evidence that any of the interventions could prevent the onslaught of Alzheimer's. She canwith immense compassion, but equally immense convictionexplain the reality for now and the immediate future: "There really is nothing." Dementia is a chronic, progressive, terminal disease, she says. "You don't get better, ever."

More here:
The Dementia Plague