destroy theel along withhe loss of cells is a reduction of certa neurotransmitters that aid in mmunication throughout the brain. as well to potentially participate reatment trials for progressiv memory disorders. the fact that thisrocess happs iffused areas in bra helps to expin why thsymptomsan be so vie nancy earl is a neurologist and clinical psychologist at the duke university alzheimer's disease research center. there are a variety of changes that can be seen. wh i see most frequently is a social withdrawal and isolation, to some extent. frequently, early on, you y e withdrawal from activiti-- nding to staho, not t wanting to speak outrch or hobbias frequently.t thgs,

people becommoepdent on their spouse or on their chilen, and ople that may have bee very indepdent will sta to defer more toth people's jume, allow other ople e e choices. i s acd to larry's intellinc and his sensofor. those werehe two firsthgs to go here was a man who s well-iormed. can't read a newspaper. if he watches tevision, he recognis a few conservatis th he esn't age with, but for mostt, he doesn't recogni what is on. he hasn't driv wo or three years. he w qteillingo quit, whics a biadvanttoe. i pick clothes, put out in the morning. i sibeside him as he ts dssed, and heooks at his sock, and he thinks, put the sock omy foot orn my shoe?"

everytng difficu fohim. we're in go over meuestions like we usualldo when you come toee us. i'd like you to tr and answhese best yocan. t alalzheimer's patients present in the same way as lar gorrell. there are otr disees that can causeimilar mental impairments, making alzheimer's difficult to diagnose. testinfor larry gorrels ecic deficits reveals thextent of his illness provn indicaon of areas othbrain atre bted. at seasoit ithe--19--wha of theeaer, mean, . what seasois it? as? 's i u.. 19--season. .. ancy e 'll do a matxa siy,hat's a systemat y ere

differenars function in the bra. you test memory, involving the tempor les you test language, involving the left tempol lobe. llest eomotor axis, or using hands in tasks, writing and manipulating objects, basicallought to be rietal. you'll elore aariety of cognitive questions in testing the mental status. i'd likeou to take a look at this dring antrand draw i again fome. yr time on that. ose particar tests that he had are al specicay signed toax are, to testreas that we know are impaired in alzimer's disease. people can appear very uniaired, and when you are put in aonfrontational setting, it taxes you such that you don't perfo as well.

that's pretty good. in alzheimer's, there is a second patient involved-- e spouse or faly membe who is the day-to-day ca provider. lisa gwyer is dire of the duke family suprt program. a pers with zheimer's sease setheir memory, d y n't learn infoation or learn from experience or dw on their experienc the caregiver, on the other hand, has vid memoriesf the person as they were d as thewereheth loved them or knewhem and can learn neinformation, can draw fm exrience, and can get better. they c be he to ustand why the ent behaves the y they do and how to be a more eective caregiver while still reducing the negati consequens of providing that on tmselve itay be 2o years

betweethe onset of memory problems and the end age the disease, en it is ternal. the ti between dinosis and ath is marked by slow intellectual, emotional, and psical decline, placing extraordinary stress on both the patient d the caregiver. sometimes he says, "lifist worth living this way." sometimes heays, "i'd likto die," d i can't say him, "o no, larry, you don't want to " as wwere dring over here this morning, he sai "you ow, i really think i'm a t better." he's n constt about it. he's unhappy. he's fstrated. he isearful. you think just minute-- how would u feel if, when you get up in t morning, th is strange, you n'recogne anything? u wonderho the woman next to you is. if you go to the bathroom, you don't really know where the commode is

everythi is strange. his reflection in the mirror-- i have a tableclh taped over our bathroom mirror. herwise, tnks that's an enemy. he thinks his feet are chdren apparently, th're no lovinghildren becausi can hear him go... apparent[smack]re no lovinghildren ey must be teenagers, i've deced. they're ry aggravating to him. i alry and gethem to underand the role of fear ts are fghnedgravating to him. if ty n't unrstandwhat's gn. to underand the role of fear th're oking foresura ey're looking toake nse of tir eonment, so their gaps in memy sometimes they fill in by making up stories-- confabuling. if they cat find sething that they' misplaced, d it must have bee whoever is in the house. if they're frightene of b left in a world that dsn'take see, thenhereore like t cuse t spouse of infidelity

or of leaving em so that if people understand a reappraise the bevior and personality chans and say, "she w not hno behaved in this way, "and this bon hewill oher ntrol, and it is also beyond my control to change that." it m be another 1o-15 years forearorrereaches the termae alzheeris and dies. ri tme, his tellecal, otional, and phical losse will cone.d dies. yet mrs. gorrell, like many caregivers, is committed to providing e support rry needs. pe do this because th bieve iss what a family should do for each o or a spouse or parent. sometis op say, he w a gd mother," or"she was a gd wife and she would have done the me thi for me."

e one thing atpens inaregivin is thathe's this talhange in the normal gi-a-tak of rathips. aacutillns, you know if your husband is hostalized for suery that you'll mobili, llive it your and eval hel get well, and if that happenedo you, he'd probably do the same. in proessive chronic lns, u're giving re and more, and that person is ner gointo pay you b think that people mit benterested what are t emotions that t caregiver feels? first yofe a great deal of grief. yosee, day after d, a person die. somebodyust rently told me her mother had a sensef humor. you can't ha a sense of humor if you don't see relationships. the funny paper's not nny unless you understand .

larrphysic health has oken a great deal. healks like a much older man. it reminds me little-- as if a rgeon says, e're going tdo a major surger "but we won't make aeep t. we'll just cut a little each day." every day, you cut a little bit more. that's gef. that goes on and on. one of the most enduring tales in english literure is alice in wonderland lew cll. onof carro's most extraordinary characts was e volatile and quite irtional mad hatter. thisharacter s acallyased on a very real d well-known fact of 19th-century life-- that many long-term workers in hat-making frequently exhibited erratic personality traits. these behavioral problems came about after years of exposure to tox mercury

us inn the making of felt. this behavior was so common that the expressn "mad as a hatter" earned a permanent place in the english language. like the experience of hatworkers 1oo years ag expoconsueeic materialinanoe of cteorarli there arnumeus potent substances found not only the workplace, al in the nment at can produce many physical and psychological effects. substances that have an impact cells of e ain and a resulting pshological impairment are called neurotoxins. traumatic hd injury alzhr's see, oticance caafct several diffent areas ofherain ing a spec of cognitive anbevioral disorders. one rece and amat exale he eec of neurotoxic exposure occurred in michigan in 1973. thousands of pple were accidentally expose to toxic polybromat bhels,

or pbb in theummer of 197 in the process of mixing imal feed inhe state of michig, somee made aista. as a result of this miup in the places they mix cattleeed and chicken feed, they m a firretardt, fire master, with the cattle feed. w,obody knhat, and ma month after the, uh, the fire retardant was in, was left in the food chain, people wernoticing very intesng changes. the cattleere just... we experiencing very severe weight ls. the anals would e for no apparent reason, and people would experience usual illnesses. the peleremers, are very harworking. the people are gting up 4:oo in the morning.

you would find sries of versuccessful farmers that wouldn't get up ti1o:oo in morning. in additn to oversleep farms reported dion, an inability to coentrate, ansevere memory loss. in a few months, the pbbs spad through the food chain, these me symptoms began to show up in the population at large. because of the concern that we did not ow the extent of the contamination, wetudied a cross secti of the entire michigan state for the prevalence, and we found thaalmost all of the micgan residents d demotrable levels of eos in the blood. the psychological effects of toxic substce are frequent present even in e absence of physical mptoms. thimplicion is that higher awaress is reqred of the pubc and the clinicwhmight sethe.

thidea is that u have tbe alert that there are rtaielements-- animal, plants, chemical compounds-- that, through the improper handling or the improper absorption or accidental absorption, will cause a behavioral change which you might not be noticing with the clinical approach. that is the most tragic consequence and where the psychologists could make the mt portant contribution. the is no grs effects that will kill you. in lead, you have to really take extraordinary amounts to kill. but it will, by minute dose, it will produce subtle effects that you only notice wh you challenge your brain to do certain tasks. this is a message at is clear. for some sociainrso leterious cts of alcohol

e mir and ansit. for others, these effects can be deay. long-term alcohol abus can cause otr prlems inuding peanent changes in persolity and meal ability if someone is a chronic alholic d isrinking a pint or a quart owhkey day and he ds it over manyears, he develops a ss ofertain cognitive abilities. the most string of these arconceptual abilities, oblem-solving abilities, perceptual abiliti. memory remains relavely intact. nelson bters is chief of the psychology service at the veterans administration medical center in san diego. the fects tend to range from mild to mode in severity and te to be related to how long an indidual has been driing. wyt ingram is good with hisands. a former supervir for an aircraft nufacturer,

he keeps his skills sharp by working around the house he builto years ago. he can easily recall the y he bought the land. whate cannot rememr is what day it is to he doesn't rememr anythi that happened for more thaa few seconds. wyatt ingram literally lives from men moment. is difficul he wea himse out because he has to continlly do the same thing over agai like put uthe mini-blinds in the kitch, th normally would haveaken m a halfou he worked on for four days cause he had the mi-blinds lying ou and he wld measure them. then he'd in e kitche and forget the msurements has two shardd remeasur to g anything ne.

att ingram hakorsakoff syndme rare neurological impairment causy long-term hakoalcohol abusee and a deciency of the b-colex vitamin thiamine. ne specic part isnaaus of the brain. koakofsyndrome has been aociated mo wi thealnutrion that alcoholics invariably suffer and more specifically withhiame deficien. so that if somne is thiamine-deficient foa given period of time, this will lead to an ute episode of beding or hemorrhaging in a particular part ofhe brain, namely the thalamus. wl ubleft a t l.lly amnesic state he will be unable to rall the past. this will be chronic. , in moscases, will remain permanently for threst of the patient's le.

the thalamus is sometimes describ the brain's cerelay ation. it is a the thalus that n informaon is stored memory in other parts of the brain. well hea ke an. her th tha i'm ne, ry u want tspk to hri? it'sherr haret i'm ne, ry solengcan reca tsf years ago witharit whapne ot ec ago. [intervier] coulyotee who just cal who lled me onhe phone? soone wanha do you remember who it was? it was her sisr. [harriet] it was sherry, honey, r hter i made a good gus, anyway. becausof his pfod learng dity, wyatt ingram n alzheient.nod

that, unlike the typical aleimer's paen many other cognive ills, ch as his express hself, toomte math lems, anpeorm tor skills, give me wos you can think were int that start with theetter "f". fight, fry, fist, first, funn. i did assess aspects of hiseneralntelligee-- vocabula, his languageunctions. i had him do some fluency tests. those were all dig to get at his sioverall ntal status or intelligenc you'll remember that he did quite ll. where failed is when i got to tests of memory what'dike too again with you is to see if you caremember the date. could you tell me, uh, what the date is tod?

no. right off, i couldn't tell yo but i k it's abouthe 18th. the 18th owhat? uhh... what month is it? well, we are about july. au. ly or august. no. this is seember 11th. september 11th. 199o. 199o. ok. how old are yonow? umm... 7o... 77 or 78. 77. that's right. very good.has the date today? the 19. the 19th of what september. no. 's septemb 11th.

what year it? uh... ? . 's 199o. 9o. it was very clear th he cod stor practically nothinnew. that is, i kt on telling him e date. he coun't remember the date. i was unable in the course of thatol interview really teach him the date. he couldn't learn it. in fact, you'll note inartsf at interview, he had forgotten that infmation within 1o seconds. i would tell him the information, distract him basking him mae my nam for a few secos, theno back and say, "what's e date?" he'd go back to saying it was 1984. in 1o conds, the information had been los what we're seeing there is thenability

to consolidate any new information or to transfer it from short-term memory into long-term memory. do you rememr johnennedy at all? uhsothing of, ye was he.. was he a pnt of the united states, or what d he do? yes, he was, if i rall correctly. john kne. he ever president of the uted ates? well, kennedy was, but m notoo re at the john was. endy esident of the united states. he was. do you remember wh happeneto him or wt happened during his presidency? if ialcorrectly, somebody took ot at hi yes, and wha happened? it seemed toe though he was hpitalid for quite a little while and i lieve he fullyover.

he did fully recover, huh? actually, heied. he was assassinated. he was actually assassinated yes, he was. a man ofis anment ine, thatohn kennedy shouwas assassinated. at is, the are manthings that he forgot or could notecall at thitime that he once knew. you'll alsnote that there is kindf a temporal gradient to that loss as you go back in time, his memoryets better. his memories for the 19s is bter than his memories for the 196os and 7os. as you go back in time, his memory tends to get better. that is typical of a korsakoff patient, typical of any amnesic patient. how was your game? not bad. the inability to remember events in your life

for the past 3o years is a significant hp. what enables wya ingram to cope with h difculties hlstruured vi eir where life rai fiasibl anyone that lives with a person with the type amnesia that he s has to ble to stay calm and live with it because they are uble to do anhing about , ally. anbeing very independe. about improvising he needs a little help remeg at he did fi minutes ago, an hour, oyestery.emember he h aurdewith me, t because i'm physical unable to do many things.

he does the physal part. all i have to is remind m keep doing it because if he lees it-- like, he was washi winds yestday, and he forgo what he was doing. so iave to remind m to continue washg the window 'soi to trim the hedge. i remind him to dohat. don't owhat i'doitho him. he doesn't know what he'd do withoume. the human brai is complex, but it inot beyond understanding dical anchnical va itwrg assumeiout ner workin that scientists will find urological reasons r evy ychologil problem. how d en, environment, and interaction with oth people is too complicated a process to be determined solely by damaged or defective brain cells.

nick crane suffered a traumatic head injury. larry gol has alzheimer's disease. wyin korsakoff syndme of r lis haen ndamy fected tamagethbraiavsuer. undetandthat canchas pred abt their problems is significant, buknowdge of how tse problems affect eir lives wi continue to b provided by ychology, science of human behavior. it's difficult to believe that wre going to nd a pill or anything els alonthe way that's going to suddenly cause new neurons to sprout. that ialmost inncvae me. hence, in many cases perhaps mostases-- of organic brain damage, have no realistic hope of achieving a cure of the problem.

on the other hand, there is this whole array ofsychological problems at are visited upon the individual with snificant brain mage, many of whh- for example, combativeness are not, again, the cessary oduct of brain damage, but rather of the psychological situation which the individual finds himself herself. now, that can worked with psychologilly. and as a matter of fact, there is a fair amot data-- increasily so in recent yes-- thatemonstrates that people who are getting on in age and ginning to he alzheimer-type demtia problems can be very sutantially helped psychosocially. their life bdens cabe much lessen virtue of appropriate psychosocial meares suchs, for emple, setting up the eironment in such a way

that thendividuais sll making his or her own oices. iong pfoed by the national captioning institute,nc.

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