All four of my grandparents had died before I was born. Seventy-five years later, I enjoy lucid physical interactions with my eighteen grandchildren, and hope to continue similarly at some point with great-grandchildren. Knock on wood.

The Big Three medical problems have historically involved external invasions (infectious disease), internal insurrections (malignancies), and the inevitability of death. The medical profession has done quite well with invasions, seems to be progressing effectively with insurrections, and has increased our lifespan.

Unfortunately, this increase in lifespan has led to a greater incidence of age-related degenerative cognitive and motor maladies (such as Alzheimer’s and Parkinson’s Diseases), long popularly viewed as an unfortunate inevitable result of aging. The cost of caring for those who suffer serious cognitive and/or motor decline is enormous, however, and the impact on the family is typically devastating. We don’t want our children and grandchildren to recall us as being incompetent at the end of a vibrant lifetime.

Death is inevitable, but it’s in the public interest for scientists to seek solutions to cognitive/motor degeneration—at least to delay the onset and slow the progression. The goal is for folks to live as qualitative a life as possible until death finally looms.

What had seemed a hopeless quest a few years ago suddenly shows promise. The former belief of a static non-renewable brain has given way to the concept of life-long neuronal regeneration and plasticity. Further, very recent stem cell discoveries materially increase hopes that dysfunctional brain systems can be repaired and replaced through neuronal transplant, and dramatic developments are also occurring on a number of other neuroscience research fronts.

Last month’s column suggested that much of our cognitive activity focuses on movement—determining and predicting our movements and the movements of objects and others. Movement results from the expenditure of energy in space and time. Effective movements require efficient memory systems that encompass relevant factual knowledge (commonly called declarative memories) about our environment and personal experiences, and motor skills (procedural memories) that execute complex motor programs. Alzheimer’s and Parkinson’s Diseases result from a deterioration of the cognitive systems that allow us to easily navigate our time/space environment.

Two excellent recent readily available resources for general readers describe these optimistic research developments.

  1. The 29 page cover story of the June 24 Newsweek Magazine, “Fixing Your Brain”, describes several emerging high tech advances that should enhance the quality of life, but the six pages devoted to Alzheimer’s Disease are especially informative.
  2. Ira Black’s excellent The Dying of Enoch Wallace: Life, Death, and the Changing Brain(2001, McGraw-Hill) uses parallel narrative formats to explain both cognitive and motor degeneration.

The initial narrative focus of the book is a composite case study. Ira Wallace is a 62-year-old investment banker with Alzheimer’s Disease. The book describes and explains his decline, and also that of several others who suffer from related (principally motor) disorders.

The book’s second (and probably principal) narrative focus is a fascinating account of how neuroscientists approached their seemingly insurmountable tasks: to determine the cause of late life cognitive/motor degeneration, and to solve the problem.

The book is thus a useful optimistic resource for readers faced with such decline in family and/or friends—and beset with worries about their own future. Black wisely humanizes the neuroscientists in his often humorous characterizations of researchers he obviously knows personally. The neuroscientists thus become human beings as well as committed participants in an increasingly successful world wide research enterprise. Putting human faces on both patients and researchers thus adds a humane touch to a book about a terrible human problem.

Research on cognitive/motor degeneration originally focused on the brain systems that regulate the processes. Recent dramatic developments in research technology now allow scientists to also explore the minute molecular world of synapses (the connecting link between two neurons), and this has led to the increased scientific optimism.

Such current research focuses on the roles of signal molecules (neurotransmitter systems, and especially glutamate), growth molecules (and especially Nerve Growth Factor, a hormone that helps direct the establishment of neural networks), and trophic molecules (that provide the nutrition necessary to maintain the systems).

The optimism that Black communicates results from advances in these fields that enhance our understanding of the diseases and that also suggest solutions. Readers who have a family history of late life cognitive/motor degeneration will feel reinsured by Black’s optimism. The information may not affect a current loved one’s longevity or quality of life—but it’s very helpful to understand what’s occurring within a patient’s brain, and it’s reassuring to know that such cognitive/motor deterioration isn’t inevitable, and will probably become treatable.

The book makes some demands on readers who have a limited understanding of biology, but technical details necessary to the explanation don’t get in the way of the parallel narratives that make this an excellent positive book on a subject that’s quite negative.

Two fine resources on normal cognitive/motor problems associated with aging are: Richard Restak’s Older and Wiser: How to Maintain Peak Mental Ability for as Long as You Live (1997, Simon and Schuster), and Daniel Schacter’s The Seven Sins of Memory: How the Mind Forgets and Remembers (2001, Houghton Mifflin).