Time,Perception and the Aging Mind: The National Alzheimer's Project Act 2011 Enacted–Is This the Beginning of a New Era in Health Care Research?

“For there is nothing either good nor bad, but thinking makes it so.”

—W. Shakespeare (in Hamlet, Act 2, Scene 2) ¹

I t is 2011 —a New Year is underway. It is a moment perhaps to reflect on time, that remarkable entity of ultimate relativity, inexorably passing, relentlessly progressing, forever present if the mind is set in linear sequential perception. Perception, however, can operate in different modes— linearity is but one setting. Time can appear to stand still, or it can appear that the clock whirrs into action and suddenly it seems to accelerate, as if frenzied with nothing seemingly able to slow it down. The symptoms and signs that accompany each of these are clear: In the former, when time stands still, there is relaxation, clarity, and sometimes extraordinary sensitivity to space and atmospheres, to light, or to the minutiae of the given moment, and the brain is quiet, as if suspended from the incessant chatter that ordinarily proceeds, perceiving as if in a Gestalt state as a whole. In the latter, it is as though the horizon and boundary of one's inner world reduces, as if everything is pressured within and without, as if there is no time to complete anything—too much to do and think and know and be on top of, too many lists to complete and hold in the head—no time for thinking or feeling—just pressure, pressure, pressure!

Each of these states are but modes of perception. The significance is that each is accompanied by and gives rise to biomolecular consequences, metabolic phenomena, and physiologic sequelae that can lengthen or shorten life, bring life to cells and molecules, or cause them to explode in abbreviated episodes of metabolic mayhem. Each of these states, these metabolic phenomena, can be changed, controlled, acted upon and transformed. Each affects the brain, the mind, and the body. Never has this reality been more significant. Never has the opportunity to work with the brain been so great—behaviorally, psychologically, and emotionally.

On January 5, 2011, The National Alzheimer's Project Act was signed into law in the United States of America by none other than President Barack Obama (D). This is no mean feat—indeed it represents the results of the efforts of many, many people worldwide, especially within the United States of America. More than 50,000 e-mails, nearly 10,000 phone calls, and more than 1000 meetings by the Alzheimer's Association and its advocates led to this historic legislative victory for the Alzheimer's community. So why is this so important and why editorialize it in the context of the opening paragraphs?

The reason lies in the impact of each of the different brain states on the very structure and function of the brain. The National Alzheimer's Project Act will create a coordinated national plan to overcome the Alzheimer's crisis and will ensure the coordination and evaluation of all national efforts in Alzheimer's research, clinical care, institutional, and home- and community-based programs and their outcomes. This is a very significant agenda and it is evident that the Alzheimer's Association of America has a vision to match, boldly stating that its mission is “to eliminate Alzheimer's disease through the advancement of research”; to provide and enhance care and support for all affected; and to reduce the risk of dementia through the promotion of brain health. This is a very significant moment—everything now will rest on the directions that research and evaluation take.

If we return to the opening analogy of our experience of time and thus of aging we will begin to “taste” something of life-changing significance. Is it really possible to envisage a time when the world is rid of Alzheimer's disease? In reality, I very much doubt it. However, if it is to be possible, we must envisage it, and the question, then, of course has to be “how?” And the answer to that question depends upon understanding the etiology and pathogenesis of Alzheimer's disease and all the dementias. Currently, there is no one definitive answer to that question: How could there be for a disease state affecting an organ of such gargantuan cellular and physiologic complexity? However, there is, in the phenomena of the experience of time, of the states of rapidly passing time, and that of time standing still, something remarkable that comes to the fore if one observes attentively.

When “time stands still,” the experience is of “no rush,” there is nowhere to go. There is, in the experience, a unique and immediately recognizable state of alertness, of presence, and of well-being, a perception of being in the present moment. In that state of perception, linearity gives way to Gestalt, particle and antiparticle meet and cohere, perception is fundamentally changed, and thinking in the ordinary sense is changed. Thinking is linear, embedded in duality. When time stands still, when polarization is collapsed in harmony, duality becomes unity, perception becomes a Gestalt, and nothing has changed except perception, and, yet, in that moment, one's entire life has changed. From the physiologic, pathologic, and cellular perspectives the significance of this is that each perceptual state is accompanied by a unique set of biochemical and physiologic states, and, when time stands still, we can see the entire central and autonomic nervous systems become receptive, as they are called to attention.

For the person in whom this is happening, the experience is of participating more fully in life, with an awareness of co-creation—in every experience, every sensation, every thought, and every feeling—of the truth of Hamlet's philosophy cited at the beginning of this Editorial. Everything is affected by this state. Metabolism is responsive, digestion changes, circulation responds, the endocrine system responds, the stress response is altered, respiration responds, oxygen flows, and cellular function proceeds along pathways encoded at the moment of conception in ways that minimize aging. This is a state of health, of poise, of equilibrium—a metabolic, and physiologic reality unique to each person in each moment.

Alternatively the brain–mind can be strained, anxious, continuously caught in linear time, planning, reacting, stressed, metabolically oxidative and reactive, fixated on achievement, performance, and pressure. This is a metabolic, physiologic, endocrine and biochemical concert of activity, of stress and tension involving the entire nervous system, affecting every cell in the organism and determining molecular and metabolic processes that cause oxidation and decay, and that accelerate aging, inflammation, and apoptosis.

Can we then explore, seriously, the determinants of these states and so inform the national agenda with questions that go to the heart of the functioning of the human organism, both in terms of disease and of health? The technology exists now to explore the finest nuances of cellular function in real time, to image and record, in minute quanta of time the processes that accompany and give rise to thought and feeling, to the metabolic and biomolecular reactions that sustain longevity, or, by contrast, wear down and retard cellular integrity eroding the processes of attention and presence. For this to be understood these pathways must be documented and monitored—the researching mind must open to the enormity of the cellular universe and the ways in which it not only generates but is affected by thoughts and feelings, and by interpretation and exploration. No longer is the model of pharmaceutical intervention sufficient.

Can the National Project be driven by such an enlightened research agenda that seeks to understand the human experience and the determinants of cellular integrity and well-being in this way? If it can, then the new law enshrining the National Project will affect much, much more than the epidemiology of Alzheimer's disease and dementia; this Project will become part of a whole new approach to science and healing, to the evolution of health and well-being on individual, societal, community, national, and even a planetary basis. It will be part of a radical transformation in health care. This will bring in to being technologies that utilize the very latest developments in biophysics, in the understanding of the functioning of the brain and nervous system, the extraordinarily complex interplay of mind, body, and spirit.

Minerals, vitamins, trace elements, proteins, carbohydrates, fats, and complex glycoproteins are all involved. Perhaps most remarkable of all, however, is that at the core of the evolution of the metabolic matrix is meaning. It is meaning, conscious or unconscious that drives every process in the human organism. It is meaning that is at the heart of the perception and motivation of each human life. In and of itself, meaning can determine the rate of metabolism, the pathways utilized and the ways in which the organism interacts with both inner and outer environments. One word, one gesture, one moment of touch, of understanding, of context, can totally transform a life. That is true of carer just as much as patient. If this depth of understanding is at the heart of The National Project, then Alzheimer's disease, one of the most tragic of all human afflictions, will be at the heart of a remembering what leads to well-being and a rennaisance in science and healing. This act could mark the beginning of a new era in health care research in which the United States could lead the world. It is my hope that this Journal will be able to assist in the process as a vehicle for the communication of ideas to generate pathways of research and integration in human healing and care.