The Forgetting

David Shenk. The Forgetting. Alzheimer's: Portrait of an Epidemic . New York, N.Y.: Anchor Books, 2002. 294 pages.

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Alzheimer's is a progressive and ultimately fatal neurological affliction that interferes with and extinguishes brain cells. It kills nearly 100,000 Americans a year, and nearly half of those 85 and older have Alzheimer's or a related dementia.

In The Forgetting, journalist David Shenk explains in layperson's terms the history and biology of this insidious disease. With a storyteller's flair, Shenk presents a detailed explanation of Alzheimer's causes and effects and movingly captures the disease's impact on its victims, from Ralph Waldo Emerson to Willem de Kooning to Ronald Reagan.

The biological hallmarks of Alzheimer's are "plaques" and "tangles," two unwelcome substances that deliver a one-two punch to the brain's cellular structure. Alzheimer's always begins in the hippocampus, the part of the brain that helps form new memories. As the disease slowly spreads, patients develop problems with speech, reasoning, problem solving, and eventually long-term memory. They begin to lose power over their emotional balance, as well, although it is not until the middle stages that there is any compromise of motor skills. If the patient has not succumbed to another disease first, in the final stage the brain simply forgets to tell the body how to breathe and to tell the heart how to beat.

Shenk describes his work as the life story of a biological outlaw that sends victims "on a slow but certain trajectory toward forgetting and death." Readers of this multilayered and compassionate book will learn not just about Alzheimer's but about how memories form, how man's thinking about memory and its "gorgeous fragility" has evolved over the centuries, and why Alzheimer's is, ultimately, "one of our best lenses on life and the meaning of loss."