To me, going back to “A Piano for Mrs. Cimino,” the scenario keeps getting revived again and again, especially in the relationship between professional caregivers and the families whom they are trying to help.

Right now Alzheimer’s professional caregivers are a various lot.  Neurologists, geriatricians, psychiatrists, psychotherapists, speech therapists, physical therapists, pharmacists, directors of retirement living facilities — the list could go on and on as a celebration of both American scientific expertise and the range of disagreement among professional caregivers regarding what Alzheimer’s dementia means and how an Alzheimer’s patient should be treated. 

Since the best way for a family to build its confidence in outside experts is to discuss matters with them directly, I’m appending four short statements, each of which can be responded to via agreement on a 10-point scale.  In the interests of fact-based discussion, the four statements are as a group followed by four short background notes.

S1:  Alzheimer’s dementia is a uniquely “American” disease. . . . S2:  American Alzheimer’s dementia is a language disease. . . . S3: The language symptoms of Alzheimer’s dementia are measurable. . . . S4:  Treatment for Alzheimer’s dementia should emphasize therapies that measurably alleviate its language symptoms.

Background Notes. . . . S1: Alzheimer’s dementia is a uniquely “American” disease. . . . According to the World Health Organization, America’s 5.2 million cases of AD comprise one seventh of the world’s total of 35 million.  Our proportion would be even higher if our longevity rate were not so low, ranking 23 (below Cuba) and only 77.9 years. According to the Harris Poll, over 50% of Americans worry about AD — more so than about heart disease and diabetes.

S2: American Alzheimer’s dementia is uniquely a language disease Formally and informally, a diagnosis of AD is customarily based upon language behavior, especially going blank on proper names and ordinary words, along loss of concentration (e.g., “what were we just talking about?”  The fact that 80% of the American English vocabulary has been borrowed from non-English sources, along with its size and inconsistent pronunciation-spelling structure, ensures that a higher proportion of Americans will exhibit AD symptoms in their early fifties.

S3: The language symptoms of Alzheimer’s dementia are measurable. . . .

The vocabulary and pronunciation symptoms of American AD lend themselves to scientific measurement as practiced by the National Institute for Standards and Technology far more easily than non-language symptoms.  This includes an authoritative standard of measurement, e.g., an American college-size dictionary and the capacity to calibrate difference levels of difficulty. 

S4:  Treatment for Alzheimer’s dementia should emphasize therapies that measurably alleviate its language symptoms.  From 1950 on,  the Reality Orientation programs of our Veterans Administration hospitals successfully treated thousands of WWI veterans suffering from AD.  This long range program included the compilation of data on the correlation between dementia symptoms and the traditional plaques and tangles associated with the Alzheimer’s diagnosis via autopsy after death. 

As noted by the late Arthur Cherkin (UCLA) and others, that correlation is only .6.  In layman’s terms this means that approximately half of the plaques-and-angles patients did NOT exhibit dementia-language symptoms, while approximately half of the patients with dementia-language symptoms did NOT exhibit plaques-and-tangles symptoms. 

Lacking refutation of the VA findings, Alzheimer dementia can fairly be described as an American language disease whose symptoms are measurable enough to justify behavior modification programs, as opposed to drugs.  This does not mean that Alzheimer’s caregivers should promise more than they can deliver.  But it certainly justifies a higher level of hope than is now the case, especially during the emergency settings that bring families and caregivers together.

As an instance of a productive emergency, recent obituaries for the actress Patricia Neal, age 83, certainly indicate that the complete loss of language and memory caused by a massive stroke can be successfully attacked by common sense word games and crossword puzzle concentration.  At a time when the Harris Poll tells us that after half of all Americans fear Alzheimer’s dementia more than cardiac disease or diabetes, an American language perspective surely demands consideration in the interaction between families and professional caregivers — especially when confidence building is called for.

Oliphant, an emeritus professor of English at Cal State Northridge, lives in Thousand Oaks.