What ‘The Father’ film teaches us about dementia and Alzheimer’s
Anthony Hopkins and Olivia Colman in The Father (2020). Les Films du Cru, Film4
One of the greatest feature films (I think) depicting dementia was released last year, 2021.
The Father, directed and co-written by Florian Zeller, tells Anthony’s story (played by Anthony Hopkins). A retired engineer who lives on his own in West London and begins to show symptoms of dementia (theories suggest it is Alzheimer’s). The plot is inspired by Zeller’s own experience of his grandmother’s illness. And what is extremely scary about ‘The Father’ is that, for almost one and a half hours, we live inside Anthony’s head as we see the world through his own perception.
We experience with him, step by step, the overwhelming symptoms of dementia and him, trying to make sense of his ever-changing circumstances. As his illness progresses, we see him begin to doubt himself, his loved ones and the fabric of his reality.
So … Is dementia a disease?
Dementia is an umbrella term for several diseases that affect memory, cognitive abilities and behaviour, which interferes significantly with someone’s ability to maintain the activities of daily living.
Major forms of dementia are; Vascular dementia, dementia with Lewy bodies, and a group of diseases that contribute to Frontotemporal dementia. Alzheimer’s disease is the most common form of dementia, and according to WHO, it contributes to 60–70% of cases.
In 2015, dementia affected 47 million people worldwide (roughly 5% of the world’s elderly population), which is expected to rise to 75 million in 2030 and 132 million by 2050.
Recent studies estimate that globally nearly 9.9 million people develop dementia each year; That is one new case every three seconds!
Although age is the strongest known risk factor for the onset of dementia, it is not an inevitable result of ageing. Dementia does not only affect older people. In fact, Up to 9% of cases affect people before the age of 65 years.
What is Alzheimer’s disease (AD)?
Alzheimer’s disease (AD) is a progressive disease that affects brain cell function. The leading theory is that abnormal residues of proteins, called plaques and tangles, build up in the brain, causing brain cell dysfunction and, ultimately, cell death.
Is Alzheimer’s genetic?
A family history of Alzheimer’s doesn’t mean someone will develop the disease. However, research indicates that people with a first-degree relative with Alzheimer’s are more likely to develop the disease than those without. In addition, having more than one first-degree relative with Alzheimer’s means a higher risk of developing the disease.
Early-Onset of Alzheimer’s disease:
The early onset of Alzheimer’s is rare. However, it accounts for 5% to 10% of all cases. Early onset of Alzheimer’s is typically between someone’s 30s to mid-60s and is linked to mutations in 3 genes:
- Amyloid precursor protein (AAP) gene on chromosome 21
- Presenilin1 (PSEN1) on chromosome 14
- Presenilin 2 (PSEN2) on chromosome 1.
Mutations in these three genes may lead to increased generation and accumulation of the plaques. In addition, someone whose both biological parents carry a mutation for one of these three genes has a 50% chance of inheriting that mutation, which can increase the probability of developing Alzheimer’s disease. However, other risk factors for the early onset of Alzheimer’s are being investigated. For example, Having Down syndrome can increase the risk of Alzheimer’s disease, which is believed to happen because individuals with Down syndrome have an extra copy of chromosome 21, which carries the APP gene.
Late-Onset of Alzheimer’s disease
Not much is understood about the genetics of Alzheimer’s at a late onset, which typically happens after the age of 65. However, the APOE gene is associated with increased disease risk.
APOE gene on chromosome 19 produces Apolipoprotein E, a multifunctional protein and genetic marker associated with neurodegenerative diseases and increased risk of Alzheimer’s disease.
APOE gene has three variants or (alleles): APOE e2, APOE e3, and APOE e4.
Everyone inherits two alleles of the APOE gene, one from each biological parent.
Although the presence of the APOE e4 allele is a significant risk factor for Alzheimer’s disease, having one APOEe4 allele does not always lead to Alzheimer’s disease. Among 50% of persons carrying one APOE e4 allele develop Alzheimer’s disease, and 90% of those have two alleles.
How does it feel to live with dementia? Living with dementia at an older age is not just forgetting your loved ones’ names …
In real life, people with dementia are often denied their human rights in both the community and care homes. They are not always involved in decision-making processes, and their wishes and care preferences are often not respected.
Frequently, dementia is viewed as a natural part of ageing, the inevitable price we have to pay for living much longer than in the past. And since the symptoms are considered unavoidable in old age, the disease is described in much less threatening and catastrophic terms in those who are older. On the other hand, rare cases of young dementia receive more attention from the media, presenting them as more shocking and tragic. In addition, there is this general perception that there is no distinction between healthy seniors and people with dementia. They are all placed in the same group as older people, who will develop dementia at some point.
Dementia depiction in films
In film, dementia narratives often centre on heroic carers or portray the illness as a memory problem while neglecting other medical aspects that affect other cognitive functions, such as perception, executive functions, speech and spatial orientation. And in many cases, the term dementia or Alzheimer’s disease are used interchangeably.
The story is often created for entertainment purposes, with actions and characters made to fulfil the requirements of a plot. Therefore, in most cases, stories are less complicated and less likely to be used for educational purposes.
However, I’d argue that the above is not a rule and is not always the case, especially for ‘The Father’. Seeing the world through Anthony’s eyes is an overwhelming experience, as we, the viewers, are not quite sure what is “real”. At the beginning of the film, you wonder if Anthony is being manipulated or gaslighted as we are drawn into his perceptions; but later, you realise that what we see is Anthony’s chaotic world, which is undoubtedly a scary reality to him.
Conclusion
The film concludes with a scene that blends mystery and psychodrama to depict the “leaves falling apart” when Anthony’s life falls apart as people, reality, environment, and time become confusing and tricky. And the only comfort to the progression of his condition is, undoubtedly, human care. Such a powerful message I leave you with …
Lama Swas is a creative science communicator and educational & commercial medical writer, thriving to share accessible knowledge about genetics and neuroscience.