Alzheimer’s: Lost in the Night of Thought
It is a cold winter’s night. The dark of the eve has set in over the snow-encrusted ground. Bursts of bone-chilling wind lift flirtatious mists of powdered snow into the air that swirl and scoff at any soul brave enough to wander into the cold. Individual fluttering crystals scatter the light of a single distant street lamp, creating a dazzling array of glittering sparkles that slowly come to rest upon the rising drifts of snow. Meanwhile, I gaze longingly through the window’s sodden pane that has frosted around the edges. An elderly man now, I rest my palm against the glass and wince only slightly as the warmth of my home retreats from my fingers. I try to recall days of Christmas celebrations from my youth, but the memories have long since faded. I wonder how close the day must be.
The fleeting thought of mother’s hot chocolate with little marshmallows after an exciting day of ice skating on the small pond in the park passes through my thoughts, but it quickly escapes and drifts off into the deep unbounded darkness just outside. Where the time and memories go once they leave my mind, I cannot quite say. Wherever they might go, I hope that they might find solitude; a peaceful place to reside for eternity. But in the passing of the moment, an uncontrollable urge drives my thoughts to a new idea. My father should be coming home soon to eat dinner with his family. I am certain he will be tired after downing great pines of the forest that will crackle in the fireplace over the long winter night. I lean to my right and gently place the last piece of wood in the hearth. Eager to greet my father, I open the door and wander outward. My goal seems temporarily clear, but it will fade like my thoughts of Christmas, and I too will find myself helplessly lost in the night.
It is hard to admit to myself that my mind is degenerating. To be a once great researcher in the field of aging and memory is an ironic reality that I know must embrace that I have Alzheimer’s disease. At one point in the past, I would have been able to recognize and accept that this process of losing my cognitive function was happening. But I digress; I have reached a new stage in my life where I no longer am aware that I am struggling with the disease, and I am free to live as if I am no different than I was when I was a child. For now, I can remember the names of my closest family: Charlie, my father, and my loving mother Janet. My sister, Sarah visits me nearly every day, and even though my parents have long since passed, I will always walk into the night to great my father when he comes home from work.
I am scared that this too will fade. There will assuredly come a day when the most treasured highways of memories in my brain will succumb to the destructive nature of the disease, and I can only pray that I will not live long enough to reach this point. Before the darkness closes completely on my weary soul, I must share some remaining thoughts that I have come to appreciate during my days as a researcher.
Let me begin by saying that the mind is incredibly complex. Humans, in their quest for knowledge will work tirelessly to understand this amazing puzzle that God has placed within our own bodies. While nearly everyone has a relative like me that experiences the conscious terror of struggling with Alzheimer’s, I must admit that there is a peaceful bliss that comes with ignorance of the strains and problems in the world around us. Some of these people might even know that two characteristics of the disease include amyloid-β plaques and fibrous tangles that develop in the brain, but the general knowledge of the public does not often reach much further.
I recall learning about the role of insulin in the disease. Insulin! Is that not for use in diabetes? Yes, most certainly it is, but insulin resistance also plays a significant role in Alzheimer’s disease. Insulin is not only responsible for regulating one’s blood sugar levels, the characteristic trait that diabetics deal with on a daily basis, but in the brain, insulin is responsible for activating a convoluted pathway called the PI3/Akt/mTOR pathway, and what a TERRIBLE name this is! How can researchers ever expect the general public to understand when they use a language that is completely different than our own? More appropriately, they should call it, “The Memory Loss” pathway.
Normally, this pathway involves a series of modifications and actions your body uses to regulate survival, metabolism, and growth. In moderation, the pathway works in your favor, but over time, it begins to become dysfunctional and indirectly causes the buildup of the amyloid-β plaques and fibrous tangles that are characteristic of Alzheimer’s disease. Although we are uncertain exactly why these things happen, the buildup of these plaques and tangles between the neurons in our brain seem to causes the neurons to slowly break down and eventually die. These neurons are critically important to the normal function of the brain in controlling body function and even recalling and forming memories. Over time, the situation worsens, and this is well observed in our loved ones that suffer with the disease.
When our bodies process insulin normally, the “Memory Loss” pathway functions at its normal level, and we do not experience any problems. But as we age, many of us build up insulin resistance. With insulin no longer able to process the “Memory Loss” pathway in a normal way, our body loses control, and the pathway becomes hyperactive. It is this unregulated hyperactivity of the PI3/Akt/mTOR pathway that shortens our lifespan and causes the degeneration of our neurons.
Obviously, there is much more to this incredibly complex problem, and there is still much to learn about the disease. The small amount that we do know perhaps gives us cause to ask more questions than it actually tells us about how the disease works. And in my old age, I cannot remember every fact that was once relevant. These are the basics, the “take home message” if you will, that are truly important to understanding the disease. Long after I have gone, I hope that future scientists will remain as passionate about Alzheimer’s disease as I am and continue to unravel its mysteries. Treatments are improving constantly, and one day we might even have a “cure.”
But until then, I have appreciated that you have taken your time to listen to the thoughts of an elderly man like me. I am sure that it will not be long until I will not be able to recount the same stories I have shared here, but I will cherish the time that I have. Regardless of how I may be in the future, just remember that I am a son, a grandson. I have family and friends that love me, and I love my children. Regardless of if I can remember your name on Earth, my soul lives on, and I will call you by name when I reach the Heavens.
Final thoughts on Alzheimer’s disease written by Steven Dotzler
