‘Still Alice’: An Accurate Portrayal of Alzheimer’s Disease?

 Yashvi Jain

‘Still Alice’ is a heartfelt film which highlights Dr Alice Howland’s arduous struggle with Alzheimer’s disease, and sheds light on the harsh reality of its physical, mental and emotional effects. In order to dramatise a film and keep it in sync with the current trends, directors often tend to sacrifice scientific accuracy. This makes it crucial to scrutinise the film and discern its authenticity. In this blog post, I aim to unravel the intricacies of Alzheimer’s disease in ‘Still Alice’ and evaluate its accuracy, or lack thereof.  

Alzheimer’s disease falls under the purview of dementia and is the most common type of neurocognitive disorder. It is “a progressive neurodegenerative disease characterised by cortical atrophy, neuronal death, synapse loss, and accumulation of amyloid plaques and neurofibrillary tangles, causing dementia and a significant decline in functioning” (American Psychological Association, 2022). Only approximately 5-6% of individuals susceptible to Alzheimer’s disease develop symptoms before 65 (Mayo Clinic, 2020). The protagonist, Alice Howland, a renowned and highly acclaimed professor of linguistics at Columbia University, was one such individual. Initially, she and her husband mistook her slight forgetfulness as characteristic of old age. However, when she got lost on a campus she was highly familiar with, she decided to see a neurologist and was diagnosed with Early-Onset Alzheimer’s disease at the mere age of 50. 

DSM-5 describes several symptoms associated with Alzheimer’s disease. Firstly, to classify it as a major neurocognitive disorder, “evidence of a causative Alzheimer’s disease genetic mutation from family history” (American Psychiatric Association, 2013, p. 611) is required. Early-onset Alzheimer’s disease is “inherited in an autosomal dominant pattern, which means one copy of an altered gene in each cell is sufficient to cause the disorder” (MedlinePlus, 2021). Alice possibly inherited the altered gene from her father, who was a victim himself. After her diagnosis, she informed her children so they may get tested and grow cognizant of their potential future, since there is a 50% chance of incidence. Thus, genetic history was present. 

Secondly, there should be definitive indications of deterioration in one’s memory, learning, and other cognitive domains. For Alice, her memory lapses were originally mild and began with an inability to recall small bits and pieces of information. For example, during her UCLA speech, she suddenly forgot a word. In another instance, when her son’s girlfriend came by for dinner, she reintroduced herself after forgetting their previous interaction. She also forgot an important dinner with her husband and his superior colleague. Thus, Alice began forgetting, feeling disoriented and confused (Hepburn, 2015). During these early stages, she employed creative techniques wherein she filled a set questionnaire with basic questions such as her children’s names, to maintain a high level of functioning. 

Moreover, these symptoms slowly stripped Alice of her intellectual capabilities as the disease started plaguing her cognitive functions. She was an eminent educator, published author and lecturer. However, she started facing difficulties with her respectable career as a professor. For example, when she met the head of her department, he read out complaints from students claiming that “the course was erratic”, “the content was muddled, and delivered with little focus or care” (Glatzer et al., 2014). Alice confessed that she was suffering from a mild cognitive impairment, promised that she would do better, and would like to continue working for as long as everyone deemed fit. Eventually, her cognitive functions started plummeting, and she had to stop working. 

Over time, these symptoms grew more acute and there was a “gradual decline in cognition, without extended plateaus” (American Psychiatric Association, 2013, p. 611). In this stage, a victim may forget facts of their past and even be confused about the time and place (Kindlycare, 2020). For example, Alice had to wear a bracelet tagged ‘memory impaired’ because she had a tendency to wander. She felt befuddled and disoriented in her family home while trying to locate a bathroom and she praised her youngest daughter (Lydia) for her acting performance, thinking it was a stranger. Additionally, her response time to questions in her daily questionnaire also increased, but she still tried to cling on to her sense of self. 

The severity of the disorder intensified. Eventually, there was a heightened loss of function as Alice required help with basic routine tasks like getting dressed. She forgot that her daughter, Anna, was pregnant and started confusing Anna with her sister –Anne – who died years before. Alice’s mental and physical capabilities crumbled as she lost track of time and started forgetting where she was, what was happening around her, or who her caretaker was (Kindlycare, 2020). When she was unable to answer basic questions on her self-made questionnaire, she tried to inflict self-harm, but was unsuccessful. Thus, she reached the vulnerable leg of Alzheimer’s, wherein she had to be supervised 24x7. Towards the end of the film, the formerly distinguished linguist was reduced to a shadow of herself and she lost her ability to communicate. This is strikingly displayed in the scene where she barely chirped a single word in response to her daughter.

Thirdly, in Alice’s condition, there was no indication of mixed etiology (American Psychiatric Association, 2013) or interference of other disorders. Thus, she meets all the diagnostic criteria of symptoms for Major neurocognitive disorder due to Alzheimer’s disease mentioned in DSM-5. 

In conclusion, ‘Still Alice’ is a reasonably accurate representation of the symptoms and struggles of Alzheimer’s disease. The societal and familial responses to the disease are also portrayed with good veracity. As is typical, her family has a difficult time initially, but deals with it well eventually. The movie also captures how difficult it is for an individual with Alzheimer’s to adjust in society. This is because society usually only empathises with illnesses that have physical manifestations (Burge et al., 2016). However, there are certain inaccuracies. The deterioration of Alice’s disease is portrayed far too rapidly (Dabak, 2020). It reaches the point where she can barely utter words within a year after her diagnosis. According to DSM-5, the average survival duration post diagnosis is approximately 10 years (American Psychiatric Association, 2013). In light of this, the rate of decline is too fast, unrealistic and even abnormal. Additionally, the film does not show “the full range of physical deterioration that can accompany Alzheimer’s” (Kindlycare, 2020). Overall, ‘Still Alice’ is undeniably a fairly accurate depiction of Alzheimer’s disease; nonetheless, it is important to acknowledge its inaccuracies. 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.978089042559

American Psychological Association. (2022). Neurocognitive Disorders. American Psychological Association. Retrieved April 17, 2022, from https://dictionary.apa.org/alzheimers-disease 

Burge, K & A Riesselman. (2016). Movies in the Classroom: Still Alice. Sullivan University College of Pharmacy. Louisville, KY. Retrieved April 17, 2022, from

https://cpnp.org/perspective/2017/03/334298

Dabak, S. (2020). To Educate or to not Educate: A Look into Scientific Accuracy of Films. Lake Forest College. Retrieved April 17, 2022, from

https://www.lakeforest.edu/news/to-educate-or-to-not-educate-a-look-into-scientific-accuracy-of-films#:~:text=While%20Still%20Alice%20showed%20accurate,to%20be%20warped%20for%20entertainment.

Glatzer, R & W. Westmoreland. (Director). (2014). Still Alice [Film]. Sony Pictures Classics. 

Hepburn, K. (2015). Still Alice. Retrieved April 17, 2022, from https://academic.oup.com/gerontologist/article/55/2/328/659613

Kindlycare. (2020). Still Alice (Movie): A Scene-by-Scene Portrait of Alzheimer’s. Retrieved April 17, 2022, from https://www.kindlycare.com/still-alice-portrait-of-a-disease/

Mayo Clinic. (2020). Young-onset Alzheimer's: When symptoms begin before age 65.  Retrieved April 17, 2022, from https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers/art-20048356#:~:text=About%205%25%20to%206%25%20of,onset%20form%20of%20the%20disease. 

MedlinePlus. (2021). Alzheimer Disease. Retrieved April 17, 2022, from https://medlineplus.gov/genetics/condition/alzheimer-disease/#inheritance