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The Father

Nor Azlieza Binti Nor Azhar

Created on April 20, 2026

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Transcript

The Father

sometimes the treatment is worse than the disease

START

Experiencing Alzheimer’s in The Father

The film The Father presents Alzheimer’s disease from the patient’s perspective, rather than from the viewpoint of caregivers. This unique storytelling approach allows viewers to experience the confusion directly, rather than simply observing it.

What symptoms are highlighted?

How would you feel if your surroundings suddenly changed without explanation?

Ask Yourself

The Science Behind Alzheimer’s Disease

Recognising Alzheimer’s Symptoms in Film

The Small Blue Pill

Medication inAlzheimer’s Treatment

In one scene, Anthony is given a small blue pill to manage his condition. Although the drug is not named in the film, it most closely resembles:

💊 Donepezil

How Do Alzheimer’s Medications Work?

Most medications used to treat Alzheimer’s disease belong to a group called:

Acetylcholinesterase inhibitors

how it works

what it hepls

This raises an important question:

Who benefits morefrom these treatments?

the patient

the carer

both equally

How does the treatment is the worse?

Current treatments for AD primarily aim to increase acetylcholine (ACh) levels as this neurotransmitter is essential for memory and cognitive function. Acetylcholinesterase (AChE) inhibitors work by inhibiting AChE, the enzyme responsible for hydrolysis of ACh. Therefore, the inhibitors could reduce the symptoms of AD through increased availability of ACh in the brain. In addition, N-methyl-D-aspartate (NMDA) receptor antagonists are used to regulate glutamate activity by preventing overstimulation of the receptor. Excessive glutamate can lead excitotoxicity that causes neuronal damage and further cognitive decline.

Drugs affect Alzheimer’s Disease's patient the most

However, these treatments do not prevent the disease progression. They only provide temporary symptomatic relief and may slow the cognitive decline for a limited time. Although the film The Father does not explicitly focus on medication, it may reflect on how treatment may interact with symptoms of AD. This raises the question of whether pharmacological intervention always benefits the patient or sometimes can worsen their condition.

Hallucinations

After taking medication, a man said to Anthony “How much longer do you intend to hang around getting on everybody’s tits?”

Info

elevated confusion

Before taking medication, Catherine said Anne will visit him during the weekend. After taking the pills, Anthony gets confused and thought his mother will visit him instead.’

Info

Implications

carer

patient

+ INFO

+ INFO

The next step of therapy

It seems Anthony forgets about you

Remind him

Monoclonal antibodies..?

The most significant modern alternative involves antibodies targeting amyloid-beta (A𝛽) plaques

Lecanemab

Dunanemab

Older drugs

Lucanemab

Dunanemab

Antipsychotics or some jazz?

In The Father, Anthony’s distress often stems from losing his sense of "home." And now he's aggressive... choose

Risperidone

Risperidone increases stroke risk by 28%

Sedation may ease the care burden but physically endangers Anthony.

Music and Reminiscene Therapy

Music/Reminiscence reduces agitation and improves mood

Addressing Anthony’s sense of home through non-drug means avoids iatrogenic (treatment-caused) harm.

Precision Medicine & Early Diagnostics

p-tau217 blood tests
able identify the disease years before the confusion seen in the film begins

Finishing words

For patients in late-stage dementia, drug treatment is often still "worse" because the brain’s natural resilience is exhausted. At this point, there are too few healthy connections left for the drugs to act upon, leaving only the side effects.

Ultimately, the "better" alternative is found in proportionality. For a patient like Anthony, this means using DMTs only in the early stages when they can truly help, while shifting to Person-Centered Care later on.

Thus,

By prioritizing a patient's mental comfort over the habit of using sedatives, we ensure our medical choices support the person’s remaining strengths rather than causing more harm than the disease itself.

References

  • Barthélemy, N.R., Salvadó, G., Schindler, S.E., He, Y., Janelidze, S., Collij, L.E., Saef, B., Henson, R.L., Chen, C.D., Gordon, B.A., Li, Y., La Joie, R., Benzinger, T.L.S., Morris, J.C., Mattsson-Carlgren, N., Palmqvist, S., Ossenkoppele, R., Rabinovici, G.D., Stomrud, E., Bateman, R.J. and Hansson, O. (2024) ‘Highly accurate blood test for Alzheimer’s disease is similar or superior to clinical cerebrospinal fluid tests’, Nature Medicine, 30, pp. 1111–1120. doi: 10.1038/s41591-024-02869-z.
  • Choma J, Griffiths A, Henley W, Mueller C, Williams N, Ballard C, Hopkins R, Young KG, Dennis JM, Creese B. Risk of stroke associated with risperidone in dementia with and without comorbid cardiovascular disease: population-based matched cohort study. Br J Psychiatry. 2025 Oct 9:1-7. doi: 10.1192/bjp.2025.10419. Epub ahead of print. PMID: 41063545.
  • Marucci, G., Buccioni, M., Ben, D.D., Lambertucci, C., Volpini, R. and Amenta, F. (2021). Efficacy of acetylcholinesterase inhibitors in Alzheimer’s disease. Neuropharmacology, [online] 190, p.108352. doi:10.1016/j.neuropharm.2020.108352.
  • National Center for Biotechnology Information (2026a) PubChem Compound Summary for CID 3152, Donepezil, PubChem. Available at: https://pubchem.ncbi.nlm.nih.gov/compound/Donepezil (Accessed: 8 April 2026).
  • National Center for Biotechnology Information (2026b) PubChem Compound Summary for CID 4054, Memantine, PubChem. Available at: https://pubchem.ncbi.nlm.nih.gov/compound/4054 (Accessed: 8 April 2026).
  • National Center for Biotechnology Information (2026c) PubChem Compound Summary for CID 9651, (-)-Galantamine, PubChem. Available at: https://pubchem.ncbi.nlm.nih.gov/compound/Galantamine (Accessed: 8 April 2026).
  • National Center for Biotechnology Information (2026d) PubChem Compound Summary for CID 77991, Rivastigmine, PubChem. Available at: https://pubchem.ncbi.nlm.nih.gov/compound/Rivastigmine (Accessed: 8 April 2026).
  • NICE (2011) Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease. TA217. Available at: https://www.nice.org.uk/guidance/ta217 (Accessed: 8 April 2026).
  • NIHAging (2022). What Are the Signs of Alzheimer’s Disease? [online] National Institute on Aging. Available at: https://www.nia.nih.gov/health/alzheimers-symptoms-and-diagnosis/what-are-signs-alzheimers-disease [Accessed 22 Apr. 2026].
  • Van der Steen, J.T., Smaling, H.J., van der Wouden, J.C., Bruinsma, M.S., Scholten, R.J. and Vink, A.C. (2018) ‘Music-based therapeutic interventions for people with dementia’, Cochrane Database of Systematic Reviews, 7(7), CD003477. doi: 10.1002/14651858.CD003477.pub4.
  • Van der Flier, W.M. and Heneka, M.T. (2025). Zooming in on brain inflammation in Alzheimer’s disease. Brain, [online] 148(1), pp.1–2. doi:https://doi.org/10.1093/brain/awae394.
  • Van Dyck, C.H., Swanson, C.J., Aisen, P., Bateman, R.J., Chen, C., Gee, M., Kanekiyo, M., Li, D., Reyderman, L., Cohen, S., Froelich, L., Katayama, S., Sabbagh, M., Vellas, B., Watson, D., Dhadda, S., Irizarry, M., Kramer, L.D. and Iwatsubo, T. (2023) ‘Lecanemab in Early Alzheimer’s Disease’, The New England Journal of Medicine, 388(1), pp. 9–21. doi: 10.1056/NEJMoa2212948.‌
  • Woods, B., O'Philbin, L., Farrell, E.M., Spector, A.E. and Orrell, M. (2018) ‘Reminiscence therapy for dementia’, Cochrane Database of Systematic Reviews, 3(3), CD001120. doi: 10.1002/14651858.CD001120.pub3.
  • Zimmer, J.A., Ardayfio, P., Wang, H., Khanna, R., Evans, C.D., Lu, M., Sparks, J., Andersen, S., Lauzon, S., Nery, E.S.M., Battioui, C., Engle, S.E., Biffi, A., Svaldi, D., Salloway, S., Greenberg, S.M., Sperling, R.A., Mintun, M., Brooks, D.A. and Sims, J.R. (2025) ‘Amyloid-Related Imaging Abnormalities With Donanemab in Early Symptomatic Alzheimer Disease: Secondary Analysis of the TRAILBLAZER-ALZ and ALZ 2 Randomized Clinical Trials’, JAMA Neurology, 82(5), pp. 461–469. doi: 10.1001/jamaneurol.2025.0461.

Thank you!

Watch

Created by: Nor Nor Azhar, Fatin Muhammad Hasri and Muhammad Abdul Halim

Unlike older drugs that simply boost brain chemicals, these monoclonal antibodies aim to clear the disease's physical roots, potentially slowing decline by 27-35% in early-stage patients.

• Mechanism: Selectively and reversibly inhibit the AChE – may be the “little blue pill” mentioned in the film • Application: Mild to moderate AD (NICE, 2011)

Donepezil

  1. Blocking acetylcholinesterase, an enzyme that breaks down acetylcholine
  2. Slowing the breakdown of acetylcholine
  3. Increasing acetylcholine levels in the brain
  4. Improving communication between neurons
  • Does improved cognition increase patient independence?
  • Does symptom control reduce carer burden?
  • How might emotional stress differ between both groups?

Consider:

Carer

Anne struggles emotionally as the film portrays her frustration, exhaustion and distress while taking care of his father. The treatment does not appear to reduce her burden. Instead, Anthony’s worsening confusion and behavioural changes increase the difficulty of caregiving. This ultimately forced her to place her father in a care institution.

  • Improve memory function
  • Support thinking and communication
  • Slow the worsening of symptoms

Confusion

Confusion occurs when Anthony struggles to understand what is happening around him. He becomes unsure about people, conversations, and events, showing how Alzheimer’s disrupts normal thinking processes.

Elevated confusion

According to NICE (2011), rivastigmine may cause side effects such as confusion. This scene suggests that the treatment may intensify his inability to distinguish reality from imagination, leading to more confusion.

Amyloid Beta Plaques

Amyloid beta proteins clump together between brain cells, forming plaques. These plaques:

  • Disrupt communication between neurons
  • Trigger inflammation
  • Damage surrounding brain cells

However, is it "worse" than the disease? This progress comes with the risk of ARIA (Amyloid-Related Imaging Abnormalities) as side effects including brain swelling or small bleeds. Van Dyck et al. (2023) reported these in 12.6% of Lecanemab patients.

Hallucinations

This moment may reflect Anthony’s internal thoughts of ruining his daughter’s life and he portrayed them as a character that only him can see it. Drugs such as donepezil and galantamine are known to cause agitation and hallucinations, according to NICE (2011).

Emotional Frustration

Anthony frequently shows frustration, anger, and anxiety when he cannot understand his surroundings. These emotional responses are common in Alzheimer’s patients, especially when memory failure causes distress.

Looking for answer for...

Are Modern Alternatives Better?

While current drugs offer modest benefits, the new frontier of neuropharmacology is shifting toward Disease-Modifying Therapies (DMTs) and non-drug interventions

Loss of Neurotransmitters

There is a major reduction in acetylcholine (ACh) — a neurotransmitter essential for:

  • Memory
  • Learning
  • Communication between neurons

Low acetylcholine levels lead directly to:

  • Memory impairment
  • Cognitive decline

• Mechanism: Precise mechanism has not been fully determined, but suggested it binds reversibly to inhibit AChE - also inhibit butyrylcholinesterase • Application: Mild to moderate AD (NICE, 2011)

Rivastigmine

• Mechanism: A competitive AChE inhibitor – also binds to nAChRs allosterically to increase ACh release and activity of neighbouring glutaminergic and serotoninergic neurons • Application: mild to moderate AD (NICE, 2011)

Galantamine

  • Does improved cognition increase patient independence?
  • Does symptom control reduce carer burden?
  • How might emotional stress differ between both groups?

Consider:

Important note:

These medications do not cure Alzheimer’s disease.

Instead, they:

  • Slow symptom progression
  • Provide temporary improvement
  • Become less effective as the disease advances

Donepezil

This medication is commonly prescribed for: Taking this pill becomes a daily routine for many patients.

  • Mild Alzheimer’s disease
  • Moderate Alzheimer’s disease

Disorientation

Disorientation is shown when Anthony becomes confused about time and place. He often believes he is in a different home or location, reflecting how Alzheimer’s affects spatial awareness and navigation.

Brain Shrinkage

Over time, the brain shrinks, particularly in the: Hippocampus — the region responsible for memory formation.

  • Does improved cognition increase patient independence?
  • Does symptom control reduce carer burden?
  • How might emotional stress differ between both groups?

Consider:

Memory Distortion

Memory distortion occurs when Anthony mixes past and present events or recalls memories inaccurately. He sometimes believes old memories are current events, making it difficult to distinguish reality from imagination..

Patient

This scene capture Anthony’s devastation of both the disease and its treatment. The patient can no longer tell which one is the reality as he still felt confused with the time and space even though he had taken his medications.

Tau Protein Tangles

Inside brain cells, a protein called tau becomes misfolded. Misfolded tau:

  • Forms neurofibrillary tangles
  • Blocks internal transport systems
  • Prevents normal cell function
  • Leads to cell death

• Mechanism: low affinity, uncompetitive NMDA receptor antagonist – combined with AChE inhibitors for further beneficial effects on other symptoms of dementia. • Application: moderate to severe AD (NICE, 2011)

Memantine