The Alzheimer’s project: HBO Documentary Films and the National Institute on Aging at the NIH. 2009.

John Hoffman, Sheila Nevins, and Maria Shriver. Running time: 4 hours 43 minutes.

When Julie Christie, as Fiona Anderson in the 2006 film Away from Her, began her battle with Alzheimer disease, I knew that the disease had hit the mainstream cinema world. Trying to imagine Christie, a model of idealized beauty during my youth, as a patient with this devastating disease was painful. The Notebook, the 2004 film based on the Nicholas Sparks novel of the same name, covered much of the same ground, showing a loving spouse trying to hold on to his significant other as she slipped away into mental oblivion. The 2001 film Iris depicted the gradual onset of Alzheimer disease in Iris Murdoch, the acclaimed British novelist whose descent into the disease and the unconditional love of her partner is the kind of tale Hollywood loves to portray. Of course these types of films tear at our hearts, but only for a short while, then we go on hoping and believing that this could not possibly happen to us or anyone we know.

The four-part HBO Documentary Films series The Alzheimer’s Project is not Hollywood. There are no famous movie stars playing the part of patients with the disease. There are only the real stories of patients, their spouses and family members, and of course many scientists and physicians trying to ease the pain and solve the enigma of Alzheimer disease. The discomfort one feels watching these brave souls tell their stories or being told about their disease is matched only by the enormous respect one has for their willingness to confront the disease head on. The scenes of patients in their homes with their children, at the nursing facility with other patients, and at the funeral of their loved ones depict the true-to-life experience of these people and their families. The toll is palpable and real.

On balance, the science is discussed in terms easy for a lay audience to understand. The remarkable improvement in early diagnosis and the development of treatments are handled well. While some claimed discoveries might be debatable among some of the scientists interviewed, the discussion of the disease-related amyloid and tau proteins were thorough and the illustrations remarkably clear. As someone who works in the field, I was pleased with the depth of discussion in most areas. However, some statements were unsubstantiated. I found the comment that we are “on the verge of controlling one of the major diseases affecting world health” a little too optimistic for my taste. Other topics, such as insulin, are given much more attention than is probably warranted; insulin has not been established as a key factor in the cause of the disease. Seizures frequently accompany Alzheimer disease, but it is not the most debilitating aspect of this illness. Nonetheless, it seems that the producers wanted to provide the audience with the widest possible range of information available today. In that, I think they succeeded.

The series and 15 related supplemental vignettes, streaming free online at http://www.hbo.com/alzheimers/index.html and also available in DVD and in book format, are wonderful for patients and families struggling with the disease, if for no other reason than to point out that they are not alone. For that reason, and to that audience, I strongly recommend them. The series will also almost certainly help to draw even more attention to the disease, and hopefully more federal funding for research. The battle against Alzheimer disease is at a critical juncture. Just when progress in understanding the pathogenesis was being made, federal support for research decreased to a low point. The federal economic stimulus package may help, but only for a short while.

Alzheimer disease is the most frequent cause of dementia in Western societies. It is estimated that approximately 5 million people in the United States, and 17 million worldwide, suffer from the disease (1, 2). By age 85 years and older 15%–30% are affected, and the incidence rate increases from approximately 1% among people aged 65–70 years to approximately 6%–8% for people aged 85 years and older (1–3). It is expected that these numbers will quadruple by the year 2040, by which time 1 of 45 Americans will be affected, leading to a considerable public health burden (4). As there is no curative treatment available, extensive efforts for the prevention of dementia in persons at risk are needed. Delaying the onset, by modifying risk or lifestyles, could significantly decrease the prevalence and subsequent public health burden.

The Alzheimer’s Project is a welcome addition to the knowledge base — a series worth seeing whether you are a patient, family member, or caregiver or are simply interested. It will be helpful to many. The epidemic of Alzheimer disease is now upon us, and without preventive measures or treatments, society will needlessly pay the high price for neglecting this major illness of the elderly. To paraphrase Philip Roth from the novel Everyman, getting old is not a battle, it’s a massacre.

References

1. Fratiglioni, L., De Ronchi, D., Aguero-Torres, H. 1999. Worldwide prevalence and incidence of dementia. Drugs Aging. 15:365-375.
2. Llibre Rodriguez, J.J., et al. 2008. Prevalence of dementia in Latin America, India, and China: a population-based cross-sectional survey. Lancet. 372:464-474.
3. Jorm, A.F., Jolley, D. 1998. The incidence of dementia: a meta-analysis. Neurology. 51:728-733.
4. Brookmeyer, R., Gray, S., Kawas, C. 1998. Projections of Alzheimer’s disease in the United States and the public health impact of delaying disease onset. Am. J. Public Health. 88:1337-1342.