A likely case of progression from mild cognitive impairment to dementia in Yasunari Kawabata's The Sound of the Mountain

ABSTRACT Ageing has always been a prominent theme for many authors, who wrote about the physical and cognitive changes that accompany it. Japanese literature, in particular, is rich in examples, especially from the pen of Yasunari Kawabata. In The Sound of the Mountain, Kawabata narrates the old age of Shingo Ogata, who begins the book manifesting only lapses in episodic memory, in a manner compatible with what we would call mild cognitive impairment. After detailed descriptions of other ailments of old age, Shingo comes to realise that a new deficit has appeared: apraxia. Unable to tie his own tie, he realises his own decline to what we could call an initial form of dementia, with this added cognitive deficit impacting his daily life. In short, Kawabata elegantly delineates a disease progression familiar to all neurologists, in a way that leads us to consider with new lenses the neurological challenges of ageing.摘要：衰老是诸多作家笔下经久不衰的核心主题，他们常以文字描摹衰老伴随的生理与认知变化。日本文学中此类创作尤为丰沛，尤以川端康成（Yasunari Kawabata）的作品为代表。在其小说《山音》（The Sound of the Mountain）中，川端讲述了尾形新宫的晚年历程：小说开篇，他仅表现出情景记忆（episodic memory）减退，症状与轻度认知障碍（mild cognitive impairment）相符。在细致铺陈了其他老年病症后，新宫终于意识到新的认知缺陷已然出现——失用症（apraxia）。当他连自身领带都无法系好时，便清晰意识到自己已进展至痴呆的早期阶段，这种新增的认知缺陷正持续影响其日常生活。简言之，川端以优雅的笔触描绘了所有神经科医师都熟知的疾病进展轨迹，令我们得以以全新视角审视衰老带来的神经学挑战。