Free Still Alice by Lisa Genova Page B

Recall—were familiar to her. They were designed to tease out any subtle weakness in the integrity of language fluency, recent memory, and reasoning processes. She had, in fact, taken many of them before, serving as a negative control in the cognition studies of various graduate students. But today, she wasn’t a control. She was the subject being tested.
    The copying, recalling, arranging, and naming took almost two hours to complete. Like the students she imagined, she felt relieved to be done and fairly confident in her performance. Escorted by the neuropsychologist, Alice entered Dr. Davis’s office and sat in one of the two chairs arranged side by side, facing him. He acknowledged the empty chair next to her with a disappointed sigh. Even before he spoke, she knew she was in trouble.
    “Alice, didn’t we talk about you coming here with someone last time?”
    “We did.”
    “Okay, it’s a requirement of this unit that every patient comes in with someone who knows them. I won’t be able totreat you properly unless I have an accurate picture of what’s going on, and I can’t be sure I have that information without this person present. Next time, Alice, no excuses. Do you agree to this?”
    “Yes.”
    Next time. Any solid relief and confidence generated from her self-evaluated competence in the neuropsychological exams evaporated.
    “I have the results of all of your tests now, so we can go over everything. I don’t see anything abnormal in your MRI. No cerebral vascular disease, no evidence of any small, silent strokes, no hydrocephalus or masses. Everything there looks fine. And your blood work and lumbar puncture all came back negative as well. I was as aggressive here as we can be and looked for every condition that could sensibly account for the kinds of symptoms you’re experiencing. So we know you don’t have HIV, cancer, a vitamin deficiency, mitochondrial disease, or a number of other rare conditions.”
    His speech was well constructed, obviously not his first delivery of its kind. The “what she did have” would come at the end. She nodded, letting him know that she followed him and that he should continue.
    “You scored in the ninety-ninth percentile in your ability to attend, in things like abstract reasoning, spatial skills, and language fluency. But unfortunately, here’s what I do see. You have a recent memory impairment that is out of proportion to your age and is a significant decline in your previous level of functioning. I know this from your own account of the problems you’ve been having and from your description of the degree to which they’ve been interfering with your professional life. I also personally witnessed it when you couldn’t retrieve the address I’d asked you to remember the last time you werehere. And although you were perfect in most of the cognitive domains today, you showed a lot of variability in two of the tasks that were related to recent memory. In fact, you were down to the sixtieth percentile in one.
    “When I put all of this information together, Alice, what it tells me is that you fit the criteria of having probable Alzheimer’s disease.”
    Alzheimer’s disease.
    The words knocked the wind out of her. What exactly did he just tell her? She repeated his words in her head. Probable. It gave her the will to inhale, the ability to speak.
    “So ‘probable’ means that I might not fit the criteria.”
    “No, we use the word ‘probable’ because the only definitive diagnosis for Alzheimer’s right now is by examining the histology of the brain tissue, which requires either an autopsy or a biopsy, neither of which is a good option for you. It’s a clinical diagnosis. There’s no dementia protein in your blood that can tell us you have it, and we wouldn’t expect to see any brain atrophy on an MRI until much later stages in the disease.”
    Brain atrophy.
    “But this can’t be possible, I’m only fifty.”
    “You have early-onset Alzheimer’s.