The Forgetting by David Shenk

The long goodbye of Alzheimer's

My mother died soon after I had finished reading this book. She died of what David Shenk calls "the forgetting" and of a common cold. Before she took to the bed where sleep engulfed her, she had forgotten most of her languages as well as her beloved granddaughter and me. What recognition there was existed only on a bodily level. She knew someone was in front of her. She seemed to be made comfortable if that someone had a lilt in her voice and warmth in her face. The present was her only tense.

My mother was 86 – an age above which, American statistics predict, 50 per cent of people will suffer from a variety of dementia. The condition is hardly new. What is new is that in the West more of us live long enough to suffer from it. Which is why some of us – occasionally Shenk – aren't sure that, despite the promises of scientific medicine and the desire of baby-boomers for old age with none of the traces, Alzheimer's may be less a curable disease than a common, if slow, form of that process called dying.

King Lear had it, complete with faulty judgement, confusion and hallucinations, though his soliloquies were rather better than my mum's. So did the American transcendentalist Ralph Waldo Emerson. Shenk vividly narrates the great man's decline. Emerson continued to lecture to packed houses but would lose his place in the text or repeat sections. Sought out by an autograph-hunter just before the end, he had to ask for the name the youth wanted him to sign, then dutifully did so once – and since he had no memory of the first accomplished action, all over again.

Jonathan Swift, who invented the Struldbruggs, those frightening senile creatures who have immortality without youth, was another sufferer. A deep fear that his mind would fade took on the force of a prediction. At 73 he developed symptoms akin to those of Iris Murdoch: language began to leave him, as did memory, so that his writing became a series of blots. Just before his death, he struck the local rector, who urged him out and got him drunk – an event Swift forgot but which earned him charges of lunacy from detractors.

Accounts such as those lace Shenk's lucid and often moving book, with an excellent preface from Adam Phillips. At a time when we understand memory as constitutive of identity, the disease of forgetting looms menacingly on the horizon. Shenk grapples with science, the sufferers and the carers.

The condition takes its name from Alois Alzheimer, the German doctor, who in 1906 presented a case of early senility. His paper describes what remain the salient features – the plaques and tangles in the brain, visible only in autopsies, which are the cause (or perhaps the accompaniment) of the neural deterioration which makes the sufferer forget anything from names to faces.

There was not much interest among scientists until the late Sixties, when the proportion of people living to 85 had increased three times since 1900. In America, the grey vote grew vocal. Medicare came into being, designed to protect every citizen "against the ravages of illness in his old age."

In the early Seventies, Congress established a National Institute on Aging. By 1985, there were 10 Alzheimer's research centres across the US. The race to find a cure was on, merging with and propelling the growing interest in the neuroscience of memory. Now, with pharmaceutical companies in on the act, budgets have exploded; every week brings news of miracle pills or vaccines, none of which has done more than infinitesimally slow the progress of the condition.

Shenk is a wonderful writer on science. His prose zings along with apt metaphors. He has an eye for the social and financial forces that shape scientific interests, and he brings key players, whether proteins or people, to dramatic life. What irks me about The Forgetting is its American-ness. It is not only that Shenk's patients, support groups and most scientists are American. Even the science world, with its competitive fervour, may no longer be so very different. What does seem different is the culture of dying.

The need to wrest something positive even from this, the sticky glue of sentiment, can leave one wishing for Shakespeare's terse implacability about that last age: "mere oblivion,/ Sans teeth, sans eyes, sans taste, sans everything."