“In the home computers.” He took another sip of wine. “Next.”
“Clara Devine is a seventy-six-year-old AD patient who mysteriously eloped from a locked unit and ended up the next morning three miles away in a CVS where she killed a guy. None of that is supposed to happen.”
“Do you know how she got out?”
She could not betray Alice. “Pardon me?”
His gaze hardened. “Do you know how she got out, how she eloped?”
Yes. “No.”
“Then how do you know she eloped and wasn’t let out?”
Shit! “I don’t. That’s probably what the police are wondering.”
“I know you saw the security videos.”
Her chest tightened. “Security videos?”
“It’s okay. In fact, we were eventually going to show them to you.” He leaned forward and lowered his voice. “Tell me exactly what you saw on those videos.”
René wondered if this was a trick to get the nurses in trouble. “I saw an elderly woman with Alzheimer’s tap a security code and let herself out, then emerge in disguise at the front of the building and disappear.”
“Yes. And how do you explain that? What are the possibilities?”
“That she’d been misdiagnosed. Or that somebody had instructed her how to do it. Or that it wasn’t Clara Devine.”
“And what does your gut tell you the most likely explanation is?”
“My gut tells me nothing.”
“Exactly.” Then he ticked them off on his fingers. “One, you know she was not misdiagnosed since you saw her admission profile: a seventyish woman with moderate AD. Two, she was too far gone to be trained to escape or recall the code. And, three, it was Clara Devine because that was her face on camera, correct?”
René’s heart kicked up a beat. Then out of some half-glimpsed premonition she heard him say, “What you witnessed was a medical miracle.”
“A medical miracle,” she said, as if taking an oath.
“Yes. For the last six months Clara Devine and other dementia patients have been part of a large clinical trial of a new compound for the treatment of Alzheimer’s disease. As I am sure you’re aware, the brains of patients with Alzheimer’s on autopsy and on MRI have been observed to have deposits of beta-amyloid protein, or plaques, which do not form on the brains of people without Alzheimer’s. So we know that these plaques are a major cause of dementia, though we’re learning there are other factors as well—a loss of key brain neurotransmitters such as acetylcholine, which is important in learning and memory functions.
“This new compound has been shown not only to dissolve the plaques but also to stimulate neuronal growth, all but reversing the degenerative effects of the disease. In short, patients are getting their memory and functionality back. And what you saw in that video is the result of that reversal.”
It was as if the speech centers of René’s brain had tilted out.
“The woman’s elopement was an unfortunate consequence of a recovered ability to function. My guess is that she overheard a staffer tell someone else the code, which she memorized. Then she escaped, put on a disguise, and walked out of the building. What you witnessed was a woman in the process of being cured of Alzheimer’s disease.” His face was beaming.
For a long moment René tried to process his words, running through her head the crude black-and-white video, trying to find cracks in his explanation against those images of the woman purposefully making good her elopement.
“Like I said, a miracle.”
René felt a fist grip her organs and it had nothing to do with protocol. “I’m having difficulty digesting all this. A cure for Alzheimer’s disease?”
“Exactly. And keep in mind that until a few years ago nobody thought it was possible for nerve cells to reproduce. Now we’ve learned that they divide even in adults, that we’re not born with all the brain cells we’ll ever have. And that’s what this stuff does—stimulates new cell growth in the hippocampus and with it memory functions.”
“But that’s impossible.”
“Only because you’re thinking of meds currently on the market—Aricept, Exelon, Reminyl—which, at best, only slow the progress of the disease. I am sure you know the pharmacology of those as well as I do, right? Why they only slow the progress of the dementia without curing the disease?”
René tried to concentrate on his question around the fist tightening on her internal organs. He was testing her, she told herself. Suddenly this was classroom. So she decided to humor him. “Aricept and the others are cholinesterase inhibitors. Cholinesterase is an enzyme that destroys the neurotransmitter acetylcholine, which, as you said, is crucial in learning and forming memory. By inhibiting the action of cholinesterase, acetylcholine is not destroyed as quickly. Yet the amount of new acetylcholine produced in the brain continues to decline. And these drugs keep the acetylcholine that’s produced around longer, but they don’t stop the continuing decline of acetylcholine production. So the dementia continues, but at a slower rate than without these medications.”
Carr’s eyes lit up. “Very good!”
Yeah, because I researched the pharmacology of every damn drug on the market to save my father.
“And, of course,” Carr continued, “the other reason is that the loss of acetylcholine isn’t the only cause of dementia. The big problem is the plaque deposits that spread throughout the brain, causing changes in the levels of other important neurotransmitters. And that may explain the different rates of disease progression seen in different patients—or why some dementia patients slowly become mute, docile, and isolative, while others become very agitated, combative, and aggressive. We don’t understand all the reasons for this, but so far we only have the cholinesterase inhibitors to help deal with the disease.”
She took a deep breath against the conflicting sensations. “So you’re saying you’ve developed a new approach.”
“More than that, a cure.”
And at the core of her body the fist tightened.
“And it’s a completely new drug entity. A proteolytic compound that actually degrades the beta-amyloid protein plaques that cause the dementia. I’m telling you it’s amazing: We’ve seen the plaques recede on MRI in these trials while patients regain functioning and memory. The stuff actually reverses previous damage, not simply slowing the progression. There’s also a mysterious secondary effect—the regeneration of nerve cells. Whatever, the compound’s been in the GEM Tech pipeline for years. And its trade name is Memorine.”
“Memorine.” All those fancy people under the tent yesterday. “GEM Tech.”
A cure.
“Yes, GEM Neurobiological Technologies. As in Gavin Edward Moy.”
The waiter arrived for their orders. René’s appetite had suddenly died, so she ordered an appetizer.
“That’s all you’re going to eat?”
“I’m not very hungry.”
Carr ordered a steak. “You don’t seem very impressed,” he said when the waiter left.
“I’m still trying to process it all.”
“Of course,” he smiled. “It is mind-boggling. But maybe this will help.” From his coat pocket he removed a Palm Pilot. He hit a few buttons, then turned the device for her to see. “You recognize Clara there in the blue sweatshirt.”
“Yes.” On the small screen was an interior shot of patients at a table.
“That was taken seven months ago.” The camera zoomed in on the Manchester Union Leader to confirm the date. Clara was at a table doing a picture puzzle of a puppy. She randomly picked up pieces and tried to fit them together, clearly having difficulty.