09/14/2012 06:57 pm ET Updated Nov 14, 2012

All Gone : Alex Witchel on Her Mother's Dementia

Do we need another memoir about a loved one with dementia? Not really. If one goes to and enters the words "memoir" and "Alzheimer," dozens of books appear.

But there is an interesting fact about these memoirs: the vast majority of them have an average customer rating of five stars, Amazon's highest. Something about these books, despite their similarity, makes them compelling.

And so it is with Alex Witchel's All Gone. Witchel has written the story of her mother's dementia, which began around 2000 and continues today. And she has done it through the prism of what she calls "refreshments," exploring the connection of herself, her mother and the food they have shared.

An added bonus of All Gone is learning more about Witchel, a writer at The New York Times and the wife of the journalist and writer Frank Rich. The book is as much an autobiography as a biography of her mother. Witchel grew up in Passaic, New Jersey and then Scarsdale, New York, the second oldest of four children. Her father, with whom she has had a rocky relationship, worked in public relations.

But it was her mother who was such a distinctive presence in the suburbs of the 1960s. Barbara was unfailingly polite and honest, a private person who declined to gossip with the other mothers and went back to school to earn her doctorate in education. Witchel describes her as fierce, loving and prickly.

Barbara was also a terrific cook, not of fancy food but of postwar staples such as meat loaf, roast chicken, chicken with prunes and spaghetti with meat sauce. All Gone includes several recipes for the ambitious reader. Watching her mother cook, and eating what she prepared, were essential parts of Witchel's childhood -- and adulthood. "That's what home cooking is about," she writes. "Shared tastes, mutual passions."[1]

Subtle mistakes in cooking were one of the early clues that something was wrong with Barbara. Here Witchel's story is all too familiar. Her mother started forgetting names of people and plots of movies. She started to dress sloppily after a lifetime of being fastidious. More alarmingly, she apparently gave the same lecture twice to a college class.

It is always easy in retrospect to make medical diagnoses. We read about these symptoms now and immediately think dementia -- perhaps Alzheimer's. But people with dementia are often good at minimizing or denying their problems. Barbara went about her business for over a year before her family insisted that she get help. Witchel, in many ways her mother's best friend, finally took charge. The diagnosis: a series of silent strokes had damaged her brain causing vascular dementia, the second most common cause of dementia in the elderly.

The diagnosis was, in one sense, a relief. This condition, in contrast to Alzheimer's, may not have a progressively downhill course. But despite a series of medications, including antidepressants, Barbara never got better. Meanwhile, Witchel's sister, Phoebe, was diagnosed with breast cancer.

So why do we continue to find these stories so compelling, even if we know the plot and the ending? Perhaps it has to do with the ways in which each story of dementia within a specific family has its own unique characteristics, depending on who the players are. It is hard not to be moved.

What was especially hard for Barbara, for example, was having to retire after teaching for 52 years. At one point, she had to mourn the loss of her job. Because of either anger or fear of the unknown, she also rejected numerous efforts by Witchel and her doctors to increase her social interactions, such as volunteering at the Bronx Botanical Gardens.

Witchel herself went through numerous stages of engagement and withdrawal, pushing her mother at times and then easing up. For a while, she even distanced herself from her mother's cooking. Later, she embraced it as a way to stay connected to her old, healthy mother. "There was no healing, no salvation," Witchel disappointingly discovered. "My sister still had cancer and my mother still had dementia."[2]

Ultimately, Witchel concludes that there is no one way to care for someone with dementia. Caring and loving are crucial, of course, but they should not take over a caretaker's life.

Barbara understood this as well as anyone. "You're here with me now," she would tell her daughter. "That's enough."[3]

[1] Alex Witchel, All Gone: A Memoir of My Mother's Dementia, with Refreshments, p. 154.

[2] Witchel, All Gone, p. 156.

[3] Witchel, All Gone, p. 203.