Introduction All experiences are preceded by mind, having mind as their master, created by the mind. —Lord Buddha When I first met Mrs. Lisa Wolfe, she was well into her eighties. As she rolled into my room in a wheelchair, followed by what seemed to be the entire Wolfe dynasty, extending from sons and daughters to great-grandchildren, I was instantly taken by her buoyant presence, in spite of her stiff countenance. Her fragile eyelashes framed razor-sharp eyes that virtually spoke on their own. Her skin was surprisingly wrinkle-free and flawless. She broke into a sweeping smile the moment she entered. 'Pleasure meeting you, Mrs. Wolfe,' I said, surprised by my own animated spirit, considering that she was my last scheduled patient after a long arduous day in my clinic and at the hospital. Instead of replying, she questioned back, obviously referring to her last name. 'When was the last time you so graciously welcomed a two-legged animal?' she said, laughing out loud. It turned out this was more of a social visit. Mrs. Wolfe was in a rush to leave, as she had a baseball game to watch that evening. Apparently, her previous primary care facility had closed. Mrs. Wolfe wanted someone closer to her home who 'wouldn't retire or die' before her 'own end comes.' She had no major complaints, save for a nagging fatigue she attributed to her growing years. Considering her age, the physical examination was outstanding. Her heart and lungs were clear, and her belly was benign. Realizing that fatigue could be a manifestation of one or more of many hidden mishaps, I ordered a preliminary work-up and let her go. She winked at me as she was being wheeled out. 'If you can get rid of the darn fatigue,' she said, 'I will rewrite my will.' Her blood reports came back reasonably steady, and I had little reason to ask for a revisit within the next three months. Two months down the road, however, I got a call from Janice, Mrs. Wolfe's granddaughter. 'I want to relay to you a strange happening concerning Grandma.' Janice's voice had an undertone of panic. 'If it's an emergency, Janice,' I said, 'you should call 911 and bring her to my hospital.' Sensing her urgency, I did not want to waste any time. 'Nothing physical. It's just that last night she forgot where the switch of her ceiling fan was, and instead she was using her walking stick to move the fan. I thought that was very peculiar and wanted to let you know.' 'Did you notice any forgetfulness on her part?' 'Not really. But she has been forgetting familiar names and objects.' 'Since when?' 'For quite some time.' 'I wish you had told me that at her last visit.' I was disappointed, to say the least. 'Could you bring her back? I would like to perform some additional tests.' When Mrs. Wolfe returned to my office, I performed the Mini Mental Status examination, an initial assessment of cognition and mental status that can be brief or more extensive, depending on the setting and level of concern. Systematically going through the various cognitive spheres, including attention and concentration, memory, language, visual-spatial perception, calculations, executive functioning, mood, and thought content, the test reaches a maximum score of 30. Mrs. Wolfe failed with a score of 15. Not convinced, I pursued the Montreal Cognitive Assessment (MoCA) that has emerged as a preferred brief assessment tool, owing to its superior sensitivity in detecting mild cognitive impairment, as well as executive and language dysfunction. She failed that, too, with a score of 22. Eventually diagnosed with Alzheimer's disease, Mrs. Wolfe continued to deteriorate, despite her run with psychiatrists, neurologists, half a dozen imaging studies, and more blood work. She was prescribed both of the major drugs available in the market for the treatment of Alzheimer's—tacrine and memantine. Neither drug touched her dwindling mind. The tipping point came when she struggled to recall my name on one of her return visits. 'You have brown skin, Doctor,' she said. 'You must be an Indian.' That was all she could muster when I quizzed her. She was still smiling radiantly, refusing to surrender to a disease rampant in its ascent. Grounded with a relentless dementia and frequent mood disorders that fluctuated from deep depression to virile temper, Mrs. Wolfe soon sank into a whirl of nameless emotions, becoming a functional ruin behind her seemingly intact structural framework. I sometimes wonder whether we physicians have missed the boat. In the deluge of endless CAT scans, MRIs, and PET scans, have we stopped using the primordial organs with which we started our practice of medicine—our eyes and ears, with a finger on the pulse? In our rush for a diagnosis, do we circumvent the very beholders of the disease? Does our maddening desire to know the brain make us overlook the impossible width and depth of the human mind? In a tragic twist of fate, despite medicine's incredible advances, competent, conscientious, and compassionate doctors have become an endangered species. Nowhere is the cry for answers more poignant than with Alzheimer's disease. A terrifying spectacle sinks mind after mind, unbridled and untouched by any type of resistance thrown at it. This disease springs from an organ that is the least understood and felt in our body, one that robs a person of emotion and identity, transforming all humane faculties into an expressionless stare. In Alzheimer's disease, the medical world is facing its hardest hour. Of all the diseases that continue to harass humanity, Alzheimer's holds hostage the very fulcrum of human existence: its mind. Far more surreptitious than a stroke or tumor that grows, flares, or strikes with characteristic visibility and grandiosity, by turning the brain into a bloody battlefield, Alzheimer's is that serpent in the grass that doesn't give a hint of its existence in the air. Its deceptive presence evokes virtually no resistance as it spews its venom virtually unchallenged. When the serpent finally decides to announce itself, the human brain has already turned into jelly, helpless as it yields to the serpent's sinking teeth. Scientists and physicians have tried to defy it the way they always have—with imaging studies, molecular genetics, and the pharmaceutical industry. But we also realize that unlike other disorders that harp on certain organic traits, Alzheimer's deals with memory, the finest and the flimsiest of our faculties. For an entity as integral, infinite, and invisible as memory, a drug or procedure is as futile and redundant as a group of ants trying to grapple with a giant pizza. So while stress can be managed, mood can be elevated, growth can be arrested, blood can be stalled, and a clot can be busted, memory cannot be revived with a single magic bullet. The chatty familiarity of care, love, and affection do little to dent the fact that when it comes to cut-and-dry disease prevention, today's practice of medicine is still scratching the surface. Unlike any other organ, the brain remains the only one that has little control of the boundless possibilities of its own existence. Moving from consciousness, awareness, cognition, and metacognition to motivation, intention, insight, and free will, the brain and mind arc seamlessly back and forth, exchanging each other's position as cause and effect. Like the classical Achilles tendon of modern medicine, Alzheimer's disease highlights the shortcomings and incredible challenges of a branch of science that, despite its bludgeoning advances, thrives on external discoveries while completely ignoring the treasures from its own internal resources. The understanding that this disease is much more than a rusty brain that has been dwarfed due to disuse makes one cringe at the limitless possibilities that might be leading to this tragic state of inertia. The overwhelming fact remains that unless we have a deeper understanding of how the mortal mind works beyond the configuration of the brain's anatomical landmarks, we will find it hard to tame a beast that revels in random invasions. In other words, unless we comprehend how we remember and relate, we cannot comprehend how we forget. Making matters more ominous are the rapidly emerging concepts that Alzheimer's is not just about loss of memory; nor does it involve only the sufferer. Almost like an infectious disease, it trespasses from the patient to the caregiver. A singular disease turns into a family affair that is at once vicious and aggressive. As a result, depression, agitation, personality changes, stress, and allied cognitive disorders become inevitable ingredients of a complete package for both the patient and those caring for the patient. To put it succinctly, this is one fiend whose taming calls out for not just neuroscientists but masters of philosophy, sociology, physics, and, I dare add, spirituality. ©2017 Shuvendu Sen, MD. All rights reserved. Reprinted from Why Buddha Never Had Alzheimer's: A Holistic Treatment Approach Through Meditation, Yoga, & the Arts. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, without the written permission of the publisher. Publisher: Health Communications, Inc., 3201 SW 15th Street, Deerfield Beach, FL 33442. |