When Martin, a talented and famous composer in his late-fifties, meets Barbara, the beautiful first violinist ten years his junior, it is love at first sight. All is bliss for the newlyweds, until five years later when Martin suddenly starts to experience small memory slips, which aggressively progress. Rapidly, Barbara finds herself helplessly watching her once brilliant and loving spouse turn into someone who does not even know who she is. A Song for Martin dives deep into the denial, sadness, and struggle experienced by the person with Alzheimer’s disease, and the grief, depression, and desperation experienced by their caregiver.
Neuropsychological Review Alzheimer’s Disease: Ruling Out Other Options
Mallory Sykes, Kristen Focht, and Reed Vennel
En Sang for Martin (A Song for Martin) is a film that presents a compelling, but tragic story of how painful and far-reaching Alzheimer’s disease can be….
A few years into their marriage, Martin, who is well known for his intelligence and musical talent, starts to exhibit signs of Alzheimer’s disease in isolated incidences. At first, the slip-ups are small and could be chalked up to reasons much less serious. For example, Martin forgets his manager and best friend’s name (22:30) and calls Barbara his ex-wife’s name (23:00). Soon though, these memory lapses escalate to much more dramatic incidents, such as when he suddenly does not recognize his bedroom (25:00) to no longer remembering the days of the week (1:02:00). Although the disease progresses probably more quickly than it would in real life, and there are some overdramatic instances, such as when Martin urinates into a potted plant at his birthday party (1:25:30), A Song for Martin portrays Alzheimer’s disease reasonably accurately. The movie especially shows how, despite the person remaining alive and relatively healthy, Alzheimer’s disease still causes a tremendous amount of grief for family and caregivers.
Dementia is the general term used for when a loss of brain function occurs due to certain diseases or conditions. It affects memory, thinking, language, judgment and behavior (Karatzoulis & Galvin, 2011). Alzheimer’s disease (AD) is the most common neurodegenerative type of dementia, as well as the most commonly diagnosed (Zillmer, Spiers, & Culbertson, 2008). AD is classified as a progressive cortical dementia, due to the fact that it primarily affects the cortex of the brain and gets worse over time. The main neuroanatomic area that is progressively affected by AD is the hippocampus. However, deterioration is also likely to occur in the temporal cortex, and can even spread to the parietal, frontal, and occipital lobes (Karatzoulis & Galvin, 2011). The neurotransmitter most associated with AD is Acetylcholine. It is highly involved in attention and arousal within the central nervous system and muscle activation in the peripheral nervous system. AD has a typical onset age of about sixty-five years old, and an average between eight and ten years from diagnosis until death (Zillmer et al., 2008).
At first, it was not clear what Martin was suffering from, so ruling out other options was necessary. When Martin first visited the doctor, he initially told Martin that his symptoms were due to overexertion and stress, and all he needed was rest to return back to his normal self. However, when Martin’s symptoms progressed, it became clear that more was involved. Given his age when Martin began having substantial memory issues, we immediately considered different forms of dementia. Dementia can have many different causes, such as toxic or infectious agents, traumatic brain injury, endocrine disorders, or tumors (Zillmer et al., 2008). From the information provided in the movie, it appeared that Martin was a relative healthy individual, who did not have a history of abusing drugs or alcohol. He did not suffer from any particularly significant traumatic injuries, which could have caused traumatic brain damage. In the movie, Martin also had imaging done on his brain (36:00), so it is safe to assume that a tumor would have been detected if that was the cause of his dementia.
Other forms of dementia besides AD include Frontotemporal Dementia, Vascular Dementia, Huntington’s Disease, and Parkinson’s Disease. Frontotemporal Dementia was ruled out because even though progressive changes in personality, behavior, and cognition are typically the first symptoms observed, memory is more intact until later stages of this illness (Karatzoulis & Galvin, 2011). However, memory loss was the very first symptom Martin experienced. Vascular Dementia seemed unlikely as well because it is usually accompanied by a stroke and motor control issues (Zillmer et al., 2008). Martin did not show any signs of either throughout the movie. Huntington’s Disease was also ruled out because of its association with a history of psychiatric disturbance and presence of involuntary and unpredictable movements involving specific parts of the body, known as chorea. Parkinson’s Disease is also characterized by tremors, loss of coordinated movement, and stiffness (Turner, Moran, & Kopelman, 2002). None of this appeared to be evident in Martin. Lastly, a stroke initially seemed possible because of how sudden the onset of Martin’s confusion and trouble speaking was (24:30), however no other symptoms such as numbness, weakness or pain on one side of the body, vision problems, or severe headache were experienced, so that was ruled out as well (NINDS, 2004).
To help support the diagnosis of Alzheimer’s disease, we compared Martin’s behavior to the early signs and symptoms of AD according to a 2009 publication from the Alzheimer’s Association. Firstly, Martin displayed challenges in planning or solving daily problems, such as when he threw away very important papers that were part of the score he was writing (43:00). It also became difficult for him to complete simple, familiar, daily tasks, such as when he forgot how to get under the covers (1:01:30). Martin experienced confusion with time or place, like when he had to ask Barbara several times what day it was (1:02:00). He frequently misplaced things and ideas, such as when he suddenly stopped conducting during a concert, and insisted that there was “something I’ve got to do” (34:30). He also lost the ability to retrace his steps, revisiting the same restaurant twice in a single day (40:30). He displayed increasingly poor judgment, such as when he urinated in public (1:25:30). Martin also became withdrawn from social activities, no longer going out with his wife to events or for dates. Lastly, Martin experienced an overall mood and personality change from the beginning of the movie to the end, morphing from a patient and loving person to a withdrawn and angry man.
In conclusion, although we found some scenes to be slightly overdramatized and the time span a bit too fast, we agreed with A Song for Martin’s portrayal of Alzheimer’s disease. The course of Alzheimer’s disease varies between individual, so Martin’s symptoms and actions throughout the movie could have been very possible and accurate for a person suffering from this disease. Overall, we would highly recommend it as an accurate portrayal of both progressive AD and its effects on both the diagnosed and their main caregiver.
Alzheimer's Association. (2009). 10 Early signs and symptoms of Alzheimer’s disease.
Retrieved from http://www.alz.org/alzheimers_disease_10_signs_of_alzheimers.asp
August, B. (Producer), & August, B. & Isaksson, U. (Writer/Director). (2001). En sang for
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Retrieved from http://www.ninds.nih.gov/disorders/stroke/stroke.htm
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