英美报刊选读10.docx

英美报刊选读10.docx

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英美报刊选读10

Little-knownbraindiseaseripsapartlivesofvictim,lovedones

FromtheLosAngelesTimesofFebruary11,2012

WhenStuBryantbeganactingrudeandimpulsive,hisfamilywasbaffled.Thentheylearnedhehadfrontotemporaldisease,whichstripsawayself-restraintandtheabilitytodeciphersocialsituations.

∙

Morethanayearafterthediagnosis,MaureenBryanthadgrownaccustomedtomakingexcusesforherhusband.

WhenStustoodbehindatattooedwomaninlineatPandaExpress,andsaidloudly,"Wow,that'salotoftattoos,"Moesteppedbetweenhimandthewomanandapologized.

Whenherepeatedlywanderedintothehousethatwasbeingbuiltdownthestreet—despitethe"NoTrespassing"signandthefence—sheexplainedtotheownerthathewasjustcurious.

Possiblythemostembarrassingepisodeoccurredwhentheywerecominghomefromdinner,andshedashedintoamini-martatamarinainOxnardtobuymilk.

"Doyouknowthatman?

"theownersaid,seeingStuinthecar."He'sbeenstealingfromme."

Moeremembersbeingbaffled.

Muffinsandcheesecake,theownersaid,showingherphotosfromthestore'svideocamera."ButIcan'tcatchhim.Hedrivesawayinthegolfcarttoofast."

MoeofferedtopayforwhatStuhadtaken."Hehasnocontroloverwhathedoes,"shesaidtopolicewhentheyarrived.

Sometimesshewillsaythathehasabraintumor.It'seasierthansayingfrontotemporaldementiaandhavingtodescribehowthediseasehasstrippedawayhisself-restraint.Stuisnolongerawareofhowtobehaveinthecompanyofothers,andlikeanunknowingchild,willblurtoutthefirstthingthatcomestomindorwillactwithoutconsideringtheconsequences.

Moerealizesthatthisisdifficulttounderstand.Beingrudeordisrespectfulseemslikeadeliberatechoice,andStu,60,hasaquicksmileandaneasylaugh.It'seasyforpeopletowritehimoffasinconsiderateandself-centered.

ThisiswhatMoeandherdaughters,KatyandJessica,didbeforetheydiscoveredhowsickhewas.

OncecalledPick'sdiseaseandnowFTD,frontotemporaldementiahidesitssymptomswell.LikeAlzheimer's,itistheresultofthedegenerationofneuronscausedbyanabnormalaccumulationofproteinsinthebrain.

Inearlystages,Alzheimer'saffectspredominantlythehippocampusintheinnerpartofthebrain,wherememoriesareformed,andFTDaffectsthefrontalandtemporallobes,aboveandbehindtheeyes,wheresocialemotionsareformed.Alzheimer'spatientssenseafuzzinessintheirthinking—awordmisplaced,aconfusionbetweenthepastandpresent—andrealizetheirerrors.MostpatientswithFTDhavenosuchinsightintotheirdisease.

Jessica,22,firstnoticedherfatherbecomingmoreselfishandtemperamentalwhentheylivedinSacramento.Hedoteduponhisdaughtersandwoulddoanythingforthem,butthenthatseemedtostop.WhereonceheletJessicachoosewhattowatchonTV,nowheheldontotheremoteandgotangryifshechangedthechannel.

ThetragedyofFTD,accordingtoMarioMendez,theUCLAneurologisttreatingStu,isitselusivediagnosis.Thepresenceofthediseasecanbeconfirmedonlythroughanautopsy,andMendezreachedhisconclusionaboutStubasedonspecificbehaviorsandbrainscans.

Thediseasebeginswithachangeinpersonalitythat'softenseenasvolitional.Introvertsbecomeextroverts.Once-agreeableemployeesactrude.Formerlyfaithfulspouseshaveaffairs,andwhiletheyacknowledgetheirtransgressions,theyareunabletoappreciatetheimplications.

Someendupinstitutionalizedbecausetheirbehaviorlookslikementalillness.Someareincarceratedwhentheybreakthelaw.AdiagnosisofFTDledtoreducedchargesagainstaNewYorkCityphysicianwhocuthisinitialsintothestomachofapatient,andwhatcouldhavebeenasmanyas25yearsinprisonendedupasfiveyears'probation.

Researchersbelievethatbetween30,000and50,000peopleintheUnitedStateshaveFTD.Thereisnocure,andthediseaseleadstodeath,oftenwithineightyears,eitherfromaccidentsorsecondaryinfections.

WhenStubeganactingdifferentlyin2007,bickeringwithJessica,Moedidn'tthinkanythingofit.SheandStuhadbeenmarriedmorethan25years.Shefiguredrelationshipschange.

Hewasthedreamer,shethepragmaticone.Shewasaconsultantforahealthcarecompany,andhewasaprivategolfcoachandacarsalesman.Buthisrealpassionwascoachingbaseball.AccordingtoJerryWeinstein—whowasheadcoachintheearly1980satSacramentoCityCollege,whereStuworked—Stuwasknownforhiscausticwitanddemandingpractices.Theplayerstrustedhim,Weinsteinsaid.

MoeandStuhadmovedtoSacramentofromLosAngelesin1992.Hisfatherhadjustdied,andhethoughtheshouldbenearhismother.Butadecadelater,whenshewasinher80s,hesuddenlystoppedwantingtoseeher.

WhenMoeaskedwhy,hecouldn'tsay,andafterhismotherdied,hebecamemorewithdrawnandstubborn.TheysawacounseloranddecidedthatleavingSacramentomighthelpthemgetovertheirproblems.

MoefoundarentalinOxnardonthestrandbetweentheharborandtheocean.Withsomanygolfcoursesinthearea,shethought,Stuwouldbeabletofindajobandplayasmuchasheliked.Heworkedforafewmonthsandthenstopped.Theyfought,andoneday,almostayearaftermovingtothebeach,shecamehometofindhimpackingaU-Haul.

HesaidhewasmovingbacktoSacramentoandhadnoexplanationotherthan"becausethisiswhatI'mdoing."Moe,52,stillremembershowemptyhisexpressionwasthatMayafternoonin2010.Familymembersthoughthewashavinganaffair.

Herentedaone-bedroomapartment.Afamilyfriend,EdModeste,visitedhimandfoundtheplacenearlyempty:

aTV,achair,notmuchmore.Sturarelycontactedthefamily.

Divorceseemedinevitable.ThenonenightKaty,26,calledMoeintears.

ShewaslivingintheMontereyareaandhadinvitedherfatherfortheweekend.SheandStuwentonabikerideinthehillsaboveFt.Ord,andhedisappeared,showinguptwohourslater,hardlyconcernedthattheyhadbecomeseparated.ThenextdayattheU.S.OpenatPebbleBeach—herFather'sDaytreatforhim—hecouldn'tstandstillorbequiet,andshethoughtthey'dbekickedout.

Sheinsistedthathermothertakehimtothefamilydoctor;shehadneverseenherfatheractthisway.MoeflewtoSacramento,andafterStuunderwentanMRI,shefeltherlifeshiftingagain.

Stu,thedoctortoldher,isinnopositiontolivebyhimself.Youcaneitherproceedwiththeseparationoryoucansetyourfeelingsasideandtreatthislikeamedicaldisease.

Moewasn'treadytoforgiveStuanymorethanshewaspreparedtobehiscaretakerorhiswidow.Butshecouldn'tleavehimonhisown.

Studidn'tknowthathehadhurthisfamily;hehadlosthiscapacitytocare.Moehadtoexplaintofriendsandfamilywhyshetookhimbackafterhisthree-monthabsence.MosthadneverheardofFTD;somethoughtitaweakexcuseforamid-lifecrisis.

Undertheswayofthedisease,impulsesinStu'sbrainwentunchecked.Helogged30milesonhisbikeinthecourseofthreedailyridesandhebecameagitatedifhedidnotgettothegolfcourseeachday.Hewasinconstantmotion,snappinghisfingersandtappinghistoes.Hesnackedcompulsively,especiallywhenMoewasn'taroundtostophim.

Readingaboutthedisease,MoecameacrossthenameofMarioMendez,aprofessorofneurologyandpsychiatryatUCLAandthedirectoroftheneurobehaviorunitattheWestLosAngelesVeteransAffairshospital.

MendezandJillShapira,anursepractitioner,seeFTDpatientsonWednesdays,andMoemadetheirfirstappointmentforSept.8,2010.MendezandShapirareassuredMoethatwithmedicationsandguidance,Stu'smoreuninhibited,repetitivebehaviorscouldbesuppressed.

MoeandStualsoagreedtotakepartinastudyofthedisease.BecauseFTDmakesempathy,embarrassment,guiltandshameallthemoreconspicuousfortheirabsence,Mendezisinvestigatinghowsocialemotionsariseoutofthephysiologyofthebrain.

MendezandShapirarananumberoftestsonStudesignedtoisolatedifferentpartsofthefrontalandtemporallobes.Somewerewritten;somewereconductedinconversation,andinoneinstance,Stulookedatphotographsofflowers,mountains,roadkillandstarvingchildrenasmonitorscapturedhisskintemperatureandheartrate.

"Whatdoesitmeanthatpeoplewholiveinglasshousesshouldn'tthrowstones?

"MendezaskedStuduringafollow-upappointment.

"You'dbreaktheglass,"Stusaid.

Justasheisincapableofinterpretingthissayingorengaginginabstractthinking,heissimilarlyunabletodeciphersocialsituationsandknowwhyinsultingastrangerwithtattoos,trespassingonprivatepropertyorstealingiswrong.

InNovember,MoeandStuarrivedatUCLAforanotherMRI.Moehopedtoseehowfarthediseasehadprogressed.Stulaydowninsidethehugemachine.Whenthetechnicianaskedifhewantedtolistentomusic,heaskedfortheRollingStones,oneofhisfavoritebands.

"LetItBleed"begantoplay.

TheBryants'livingroomfrontsthedunes.TheChannelIslandsfloatonthehorizon,andabovethegaragehangsasignthatreads"LazyDays."

MoegivesStudailytasks—walkingthedogs,cleaningwindows,feedingthetortoise,vacuuming—tokeephimoccupiedsohewon'twanderinandoutofthehouseorsearchforfoodthatshe'shidden.Shefeignsforgetfulnesswhentheytalk,sohewillexercisehismemory.Sheplansspecialoutings,likeawhale-watchingtripafewweeksago.

TherecentMRI,accordingtoMendez,showedonlyminutechangesinStu'sbrainoverthelastyear,butMoeishardlyreassure