Alzheimer’s disease: remembering and forgetting

TO GROW old, many people think nowadays, is to become forgetful. We speak of “senior moments” as lapses of memory, and we are all too familiar with old people being ulyanin and having Alzheimer’s disease. According to one study, almost 40 percent of people over the age of 65 experience some form of memory loss.

Doctors make a distinction among various types of dementia, which may be confusing in real life as they often overlap. These include vascular dementia, the loss of memory and cognition that comes after a stroke. More commonly, there’s Alzheimer’s disease, a progressive degeneration of brain cells that runs its course through several years. Moreover, dementia is not to be confused with “age-associated memory impairment,” which is part of the normal aging process. All these diagnoses associate old age with forgetfulness.

But in many Philippine societies, to grow old is also to be full of memories. Among the Badjao, anthropologist Bruno Bottignolo writes, the people have no concept of chronological age, and do not even know how old their children are. For the Badjao, “what counts are the significant moments.” We can also see this in our own culture. The Tagalog term for old is luma, but for old persons it is matanda, a cognate of tanda, which means “to remember.” Indeed, we can take this to mean that our forebears marked age not by number of years but by the number of memories.

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I became mindful of these things when my grandaunt, Lola Tarcila, died at the age of 88. For more than a decade, she had suffered from Alzheimer’s disease. As a medical student, and then as the only doctor in our family, I followed the course of her illness, from the time she began to lose track of our birthdays to the time she could no longer recognize herself in the mirror.

A public schoolteacher responsible for the meeting of my grandfather (her brother) and my grandmother (her coteacher), she never married, and instead became a mother to everyone in our family, supporting the education of many of her nephews and nieces. The sweetheart of her youth was always her refrain, even as all else had faded: “We would have been together … but I just did not want to elope with him,” she would always say, even to strangers, with an air of nostalgia.

That something was wrong with her dawned on us when she began to misplace items. Keys would disappear, only to be found in the most obscure drawers. Then she began to forget birthdays and anniversaries. And every day she would ask whether it will be Sunday tomorrow. Slowly but steadily, her memory began to fade.

Then the day came when she could no longer recognize me, conflating me with my father or my brother. But in rare moments of lucidity that gave me joy, she would tell others that one of her grandnephews would soon be a doctor. One day we saw her talking to herself in the mirror, thinking that it was another lady in front of her. But even then, her graciousness never left: She politely asked her own image whether she would like to have dinner with us.

Her relatives kept visiting, but as they grew and spread further apart, the visits dwindled in number. Gradually, her friends faded away. While everyone she knew kept their high regard for her, they treated her differently, as she could no longer take part in conversations. It was if the Tarcila they knew no longer existed. Looking back, I realize that the tragedy of Alzheimer’s disease is not just that you forget people, but also that people forget about you.

In August 2013 she died peacefully in her sleep, after 15 years of Alzheimer’s. Gone from us is is my dear grandaunt who cooked the best bulalo and the best leche flan. Her industriousness and generosity were life-changing for many of her loved ones. But, alas, the intervening years have blunted the impact of her loss. How could I forget the voice that lulled me to sleep when the world was yet bright and new? Yet, even as I race to remember those times, I know that my efforts are bound to fail, for the details have faded.

Can it be that Alzheimer’s disease is a metaphor for the human condition? We grow up as parents and children, brothers and sisters, lovers and friends, and together, we face life: its ups and downs, joys and sorrows, triumphs and defeats, loves and heartaches. But even as we etch these things in our memories, and convince ourselves that there they will remain forever, they begin to fade at the moment of their inception. And when the time comes to recover them, we realize, sometimes with tears, sometimes with indifference, that very little has remained.

To hold on to these memories and to never let them go: This then is humanity’s only resort. It is not in the inevitability of forgetting but in the struggle of remembering that we are able to rise above the illness of corruptible memories that afflict all of us, some in dramatic fashion, others in far subtler ways. Just as Lola Tarcila, even in her amnesiac state, never forgot her sweetheart though several decades had passed, so, too, will I try to never let go of the elders who have touched my life. To look at them as matanda—full of memories—and to fill ourselves with memories of them: This is what will allow us to cherish them in life and treasure them in death and beyond. Indeed, we should strive to carry them in our hearts until our own capacity for memory and life has gone.

When all remedies have failed, there is still remembrance.

Gideon Lasco is a physician and medical anthropologist. Visit his website on health, culture and society at www.gideonlasco.com.