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Paddy's Lament, Ireland 1846-1847: Prelude to Hatred
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Vision and Art: The Biology of Seeing
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The Forgetting: Alzheimer's: Portrait of an Epidemic

The Forgetting: Alzheimer's: Portrait of an Epidemic - David Shenk This one is a little different -- more focused on the impact on society as a whole with the coming wave of elderly growing, but also interwoven with some very moving personal narratives. Family (voluntary) caregiving -- not compensated monetarily, and "depending on the patient's health insurance and the size of her estate, the illness can actually cost the caregiver tens of thousands of dollars every year. Neither Medicare nor private health insurance covers the type of long-term care most patients need. The average out-of-pocket costs for Alzheimer's patients are $12,500 per year. Nursing home care averages more than $40,000 annually." p.88"What researchers realized in delving further into this comparison was that Alzheimer's degeneration followed the opposite pattern of brain myelinization -- the insulation of nerve axons with a white myelin sheath in order to boost the strength of the signals. ...As neurons in various regions of the brain become insulated during child development, generating the famous "white matter" of the brain, these regions are brought online, made effective. ...What [Dr. Conel, a Boston neuropathologist working in the 1930-40s] discovered comported with every parent's experience of their growing child: the first neurons to gain myelin insulation are in the primary motor area, enabling gross movements of the hands, arms, upper trunk and legs. Next come the primary sensory area neurons in the parietal lobe, bringing gross touch sensations online. After that comes some development of the occipital lobe for visual acuity, followed by the temporal lobe for auditory processing.Gradually, the association areas are then formed, allowing the brain to make more and more sense of the perceptions being registered. Symbolic processing areas then begin to develop slowly, enabling language. Eventually the frontal cortex matures, enabling concentration, abstract thought, and the ability to plan. One of the very last structures in the brain to be covered in protective myelin is the hippocampus, making it one of the last places to work effectively. This is why children generally don't have any permanent memories prior to age 3 (although the amygdala can store some very early emotional memories). The reverse myelinization process of Alzheimer's begins with the most recent and least-myelinated brain region -- the hippocampus. From there it moves to the next least-myelinated, and so on. In this one respect, at least, the disease process makes sense." p.124-125Experiences of the middle stage. "Another imp. consideration is the impairment of so-called executive function skills, including goal-setting and self-evaluation. A person's introspection begins to wither away from the beginning of Alzheimer's -- the constant "how-am-I-doing?" inner dialogue that people with functioning brains take for granted. When introspection begins to break down, so does willfulness -- "here's-what-I-should-do-next." AS the plaques and tangles proliferate and the brain begins to shrink, a psychic barrier arises between the victim and the outside world. The Alzheimer's sufferer becomes an island." p.204"Why shouldn't Alzheimer's patients get as much conditioning as stroke victims, for example? The disease's ultimate mortality should not automatically annul patients' expectations of living the fullest possible life for the longest possible time. Alzheimer's is a very slow disease, and there was no particular reason to settle for a passive approach of managing loss -- which was often tantamount to hospice in slow motion. If drugs like Aricept could lead to marginal improvements, it was tantalizing to imagine what a professional rehabilitation program could do. Intensive rehab, in the spirit of what knee and hip surgery patients go through routinely, had just never been considered before in Alzheimer's disease. In the era of people discovering their disease very early on, the idea made abundant sense." p.250"I realized that, in a peculiar way, Morris had rehabilitated me -- and my understanding of Alzheimer's. When I started my research, I conceived of a book that might, on the one hand, catalogue the horrors of Alzheimer's, and on the other, relay the hopeful story of the race to cure the disease.I still respected that dichotomy, still feared the disease, and still hoped for a cure, of course -- as did Morris. But I also now realized that the story of Alzheimer's is in some ways exactly the opposite of my original premise: it is a condition specific to humans and as old as humanity that, like nothing else, acquaints us with life's richness by ever so gradually drawing down the curtains. ...It wouldn't be fair to say that I had transcended the disease in the same way that Morris obviously had, or in the way that Emerson and de Kooning admirably had. After all, I was still only an observer. But it's worth noting that, personally, I migrated over several years' time from morbid fascination and dread of Alzheimer's to a new kind of peace and reconciliation." p.251-252