Alzheimer’s disease (AD) is the leading cause of progressive dementia in the United States accounting for 95% of all dementias. It is believed that approximately 5 million Americans suffer AD and that this number will nearly triple in the next 40 years. AD is also on the increase worldwide.
AD is a progressive dementia that affects functions of memory, language, spatial skill, personality and functional ability. The disease continues to erode these functions rendering the patient completely dependent. It is generally believed that patients with more advanced AD are not aware of their condition and do not have an awareness of the people or places around them.
New research on awareness in those with vegetative state suggests this may not be true. Communication may also be possible for those in vegetative state. One case of a 29 year-old patient in a vegetative state was able to answer yes no questions by visualizing specific scenes the doctors asked him to imagine. The brain yielded different activity when different scenes were viewed. This particular patient was in a vegetative state for five years.
This new study published in the online version of the New England Journal of Medicine supports previous cases of awareness in those with vegetative state and raises significant issues concerning understanding of brain function and ethical matters dealing with end of life decisions.
Another suspicion this raises for me is whether a patient with advanced Alzheimer’s disease maintains some awareness of his surroundings. Perhaps the patient’s smile or blink to a family member has more meaning than we previously believed. It is not unreasonable to believe that the complexity of the human brain will not permit complete disconnect from those persons or things that are most important to that brain. We may simply not yet have the ability to measure such activity.
The new study reported in the online New England Journal of Medicine will help to spur research into this and other questions. We are on the frontier of an entirely new understanding of the human brain and we will be very surprised by how we have underestimated its ability and power. I refer to this new exploration of human brain potential as “neural energies.”