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Shefali Patel, PharmD Student
Notre Dame of Maryland University, School of Pharmacy

Caitlin M. Hughes, PharmD
Clinical Assistant Professor, Psychiatry/Neurology
Notre Dame of Maryland University School of Pharmacy

The Notebook is a novel by the best-selling author Nicholas Sparks. It was adapted into a film in 2004 and stars Ryan Gosling and Rachel McAdams. The plot is a magnificent story of the unconditional love of a man for his wife, despite her memory being taken away by dementia. The movie is centered around an elderly man named Noah who reads aloud to the love of his life, confident to bring her faded memory back. He has full belief that his words will give his wife, Allie, the chance to relive their turbulent, youthful relationship and the unforgettable love they shared. He spends day after day reading sections to her from his old journal while she simply treats him as a nice but mystifying stranger.

Dementia is an unforgiving disease that takes away memory and impacts a patient's independence. Allie's type of dementia is never defined in the movie, however the majority of the audience likely identifies with Alzheimer's dementia. Alzheimer's disease is the most common form of dementia which gradually worsens over time. The Notebook depicts Allie as having complete memory loss of her past. She is unable to recognize her husband, children and grandchildren. Allie's entire reality is erased and she is living the life of a stranger among her loved ones. While there is no cure for Alzheimer’s disease, there are strategies to delay progression, maximize function and maintain independence. In the movie, a nurse tries to remind Allie that she loves to play the piano and she is able to remember a piece of music from memory. Tasks once enjoyable to Allie like painting became next to impossible after a while. As time progressed, Allie’s world became more nonsensical. Throughout the film, it is apparent that it is difficult for her to form complete thoughts and understand those around her. As Allie's disease progresses, Noah continues to remain optimistic that he can bring her memory back if only for a moment. He persists with reading his journal to Allie and invites her to a romantic dinner coordinated by the staff members. During dinner, Allie has a moment of clarity where she recognizes Noah, but her memory quickly lapses. She becomes confused, scared, agitated and begins yelling out. The staff comes in and attempts to restrain Allie with an injection of an unknown medication. Noah is distraught over the incident, however he never loses faith that his Allie will come back to him.

The Notebook is a story of unwavering love that has gathered a following of fans. Additionally, this film depicts the effects of dementia on patients as well as their caregivers. This movie conveys its message through a love story, yet highlights more grave issues related to dementia through subtler means. Allie is portrayed as having difficulty with long term memory as well as short term memory loss. Alzheimer's dementia often starts as a loss in short term memories. Long term memories of patient's past typically remain intact until later stages of the disease. In the later stages, it is also common for patient's to lose their ability to perform activities of daily living and have difficulty communicating. Other dementia-related behaviors, such as agitation, may ensue. While patient's with dementia have good days with regards to clarity of thought, they often do not return completely to baseline as the movie depicts. 

This film is beneficial for pharmacy students as it accurately portrays the struggles of caregiver burden. Allie's family must make difficult decisions about her care and have to be sensitive to not upset her in her confused state. When Allie becomes agitated and requires sedation, this is extremely difficult for the patient but likely more so for her husband. The film also depicts the emotional decision families must make to place their loved one in a nursing facility to ensure adequate care is given to the patient. This movie may serve as a platform to facilitate a discussion around the healthcare provider's role in prolonging independence and the importance of slowing disease progression. Students may also benefit from discussing how to ensure caregiver health. Overall, The Notebook is an enthralling story of a resilient couple whose loves withstands illness and hardships.

References

  1. Epinions. Alzheimer’s Disease and lasting romonance. http://www.epinions.com/review/the_notebook_dvd_2010_with_valentine_s_day_movie_cash/content_173292293764?sb=1 (accessed 2013 Sep 28)
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