David Shenk

Harper Collins, £15.99, pp 301 

ISBN 0 00 257174 9

Rating:

Journalist David Shenk has produced an insightful account of the experience, science, history, and potential future of Alzheimer's disease. He has also constructed a powerful challenge to our existing attitudes towards life, disease, and the direction of medical "progress." All this is achieved with intelligence and objectivity in measured, yet compelling, prose.

Shenk contends that "a sharp unravelling of memory and mind" has been associated with old age throughout history. Only with Kraeplin's description in 1910 of "Morbus Alzheimer" did senility become defined as a disease. The construction of Alzheimer's as disease and cultural demon has stimulated a search for a medical cure, but it has also reduced the condition to "a plain horror, an utterly unhuman circumstance." Shenk posits the opposite, claiming that the condition is emphatically human and that, in fact, it emphasises our humanity. He points, for example, to the "beautiful, sensual, and exuberant" artwork of slowly dementing abstract painter Willem de Kooning. More persuasive is the voice of a person with Alzheimer's describing how the impairment of memory brings a more dramatic involvement in the present: "Everything seems richer . . . we can appreciate clouds, leaves, flowers as we never did before."

For those of us with memories more or less intact, Shenk asserts that we might recognise in Alzheimer's "perhaps the most poignant of all reminders of why and how human life is so extraordinary." It allows us to perceive life's meaning as we witness its gradual loss, he suggests.

While those with Alzheimer's descend in physicality and faculty, they and their caregivers may spiritually transcend their condition and circumstances by finding a renewed humanity. The author's hope is not that that will overcome the limitations of our humanity, but that we will "find comfort" in them. He consequently values rehabilitation programmes for people with Alzheimer's and carers over a cure for the disease.

Shenk has risen above the alarmist account of Alzheimer's that we might expect a journalist to write for a lay audience. He offers more than a tale of the devastation wrought by dementia and the desperate need for a cure.

Andrew Moscrop, final year medical student. 

Edinburgh University