Understanding Alzheimer’s Disease from the Psychological Perspective in the Notebook

The 2004 romantic drama movie, The Notebook, directed by Nick Cassavetes is the story about a young heiress, Allie, and poor country boy, Noah, who are desperately in love with each other. Allie's parents disapprove of Noah because he does not come from a wealthy family and they move her away. Noah departs to serve in World War ll, but when he returns so does Allie and their love is rekindled. In the movie, this story is being read by Noah as an old man in a nursing home to his aging companion, Allie, who has Alzheimer's disease (AD). Alzheimer's disease is a progressive, devastating brain illness that causes cognitive decline, including memory, language, and thinking problems (Licht, Hull, & Ballantyne, 2017, p.271). This disease destroys the brain cells and once they die it effects how the brain works.

Relevant Parts of the Brain

Alzheimer's disease effects various areas of the brain. Initially, the damage causes problems with memory. There are many different areas in the brain that deal with memory such as the temporal lobe, the hippocampus, the amygdala, the cerebral cortex, the cerebrum, and the left hemisphere of the brain (Licht, Hull, & Ballantyne, 2017). The temporal lobe is responsible for spatial memory storage, and when damaged, it is difficult to recognize familiar faces and objects. The hippocampus is the area of the brain responsible for the formation of explicit memories. This is typically the first part of the brain damaged making it harder to form new memories and learn new things (Functions of the Brain, 2018). The amygdala forms implicit memories and emotional memories. When this area is affected, often times people are able to make connections due to an association with certain emotions, but they are unable to remember actual facts. In the movie, Allie felt emotional about the story that was being read to her but she was not able to remember it was her love story that she had written out and told her husband to read to her. The cerebral cortex serves as memory storage distributed throughout the brain and the cerebrum is also responsible for memory. There is also the left hemisphere of the brain which controls semantic memory as well as language control. Language production is another difficulty people with Alzheimer's face which is due to it being controlled in part by the temporal lobe and the cerebrum. Lastly, people with Alzheimer's disease have difficulties with thinking. The part of the brain that is affected is the frontal lobe which controls decision-making and the ability to reason.

Impact and Prevalence

Millions of people are affected yearly by this brain illness. A study from 2002 estimated that there were 2.3 million people in the United States who were affected by Alzheimer's disease (Wilson, Weir, Leurgans, Evans, Hebert, Langa, & Bennett, 2011). The study showed that there was a higher prevalence of this disease for individuals who were 71 years old or older. That being said, there are also a number of people who have early-onset Alzheimer's and symptoms can become evident as early as 30. According to the Mayo Clinic, Women seem to be more likely than are men to develop Alzheimer's disease, in part because they live longer (Alzheimer's Disease, 2017, para. 26). Due to the many different ethnic groups in the United States, investigators have been able to compile studies to see which ethnic groups are affected by Alzheimer's disease the most. The most frequent findings in reviewing this literature are that African Americans and Hispanics have higher prevalence and incidence of dementia and AD than whites (Manly & Mayeux, 2004, para. 6).

Nature Versus Nurture

Genetics contribute more to the manifestation of Alzheimer's disease than environmental factors. The gene, APOEe4, is what has been found to make people susceptible to getting Alzheimer's (Licht, Hull, & Ballantyne, 2017, p.271). Also according to the Psychology textbook, people who have an immediate family member with the disease have a higher risk of developing it as well. Some suggest that environmental factors can lessen the chances one has of getting the disease but environmental factors can only help slow the progression of it. In a study that was performed to determine the effect that the APOEe4 gene had on memory, results showed that carriers of that gene showed worse cognitive performance as time went by (Oltra-Cucarella, Sanchez-SanSegundo, & Ferrer-Cascales, 2018). There still isn't a concrete cause of this brain illness and even though environmental factors might influence, inheritance plays a bigger role.

Treatments

There is currently no cure for Alzheimer's disease but there are ways to delay the progression of symptoms. Some things that were helpful for Allie were repeating old memories to her and the use of medication. At the end of the movie, it shows that Allie wrote in the notebook telling Noah to read the book to her and that she would come back to him. This is significant because as Noah reads Allie the story, she feels an emotion in response to it. Throughout the film, Allie does not understand why she feels this way, but at the end she remembers it is her love story with Noah. In another scene of the movie, a nurse's tells Allie she loves to play the piano and Allie is able to remember a piece of music. There is also another time Allie becomes lucid and is able to remember things when she is having dinner with Noah. Sadly, these moments of clarity do not last and she becomes frightened and agitated. The nursing staff came running in and they injected Allie with some medication to calm her. This is a common response for those in similar conditions to Allie.

Current treatments for Alzheimer's focus only on reducing the severity of symptoms. Two drugs being used today are Cholinesterase inhibitors and Memantine (Namenda). According to the Mayo Clinic, Cholinesterase is a drug that provides acetylcholine which boosts cell-to-cell communication and can improve neuropsychiatric symptoms. Similarly, Memantine slows the progression of symptoms. (Alzheimer's Disease, 2017). There are many other factors that contribute to a treatment plan for someone suffering from this illness such as creating a safe and supportive environment, exercise, and nutrition. Due to the drastic effects this disease has on memory, taking precautionary measures such as removing excess furniture, using a calendar to mark things, or setting up a phone tracking system can ensure the safety of the individual suffering from Alzheimer's (Alzheimer's Disease, 2017). Regular exercise is also important because it maintains health and can help improve mood. Lastly, it is important to make sure people affected by AD have proper nutrition because they might forget to eat or drink.

Psychological Perspectives

The cognitive perspective focuses on processes such as thinking, memory, and language to determine how it effects behavior (Licht, Hull, & Ballantyne, 2017, p.14). Alzheimer's effects all three of these processes, memory playing the major role. From a cognitive perspective, memory would be what influences behavior the most. People with Alzheimer's are incapable of remembering anything short-term or long-term; therefore, this can make them very afraid. They may not know where they are or who the people around them are. This fear and confusion is what causes people with Alzheimer's to become agitated and lash out. Also when their language starts to be affected they will not be able to express how they are feeling or what they want and it can be difficult for them.

The biological perspective uses knowledge about hormones and genes in order to determine how it effects behavior (Licht, Hull, & Ballantyne, 2017, p.14). As mentioned earlier people with the gene APOEe4 have an increased risk of getting Alzheimer's disease. Therefore, if an immediate family member has Alzheimer's then it is likely that they passed the gene on. People who carry this gene might begin to experience symptoms of AD. These genes can affect behavior because it is effecting cognitive function. The effects it has on the brain are clear and when all those areas of the brain are damaged an individual will start to forget who they are and that they have an illness. Once they become forgetful it becomes frightening and behavior begins to decline.

The Portrayal: Accurate or Not

The movie did an incredible job portraying the effects of Alzheimer's disease. The movie shows the short-term and long-term memory loss Allie experiences. Throughout the film you can tell Allie's disease is progressing because she has difficulties forming her thoughts and understanding those around her. Alzheimer's also effects behavior and the movie depicts that when Allie has a brief moment of clarity then she forgets again and becomes agitated. The movie also did a great job of showing the effect Alzheimer's has on family and the caregivers. There is a scene where Noah and Allie's children and grandchildren come to visit and she has no idea who they are. Their children try to get Noah to leave and he tells them that where Allie is, is where his home is. This is important because in real life it is hard to have to put your loved ones in a nursing home, but sometimes that is the best option. Also, in the scene where Allie is getting sedated you can see how hard it is for Noah to see her going through that and this is an accurate representation of what it is actually like for families dealing with a loved one affected by Alzheimer's disease.

Conclusion

In conclusion, Alzheimer's disease effects many people of different genders and ethnicities in the geriatric population. There is no cure for this disease yet but there are different treatments that can help slow the progression of it. The most surprising thing I learned while researching this disease is how much of the brain is actually affected by it. I previously knew Alzheimer's affected memory but it also effects other things such as language and behavior and all these things are controlled by different areas of the brain. Therefore, after figuring out the exact parts of the brain that are impacted, I was surprised because it was almost every part of the brain. Due to the movie's great portrayal of Alzheimer's disease and how it not only showed the effects it had on the patient but on the family and caregivers as well, I give The Notebook 5 out of 5 stars.

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