Dr. Alice Howland is a distinguished tenured professor of psycholinguistics at Harvard University. Her husband, John, is also a tenured professor at Harvard and frequently spends long hours at his biology lab conducting research and working with his graduate students. Together they have three kids, Anna (who is trying to conceive her first child with her husband, Charlie), Tom (a third-year medical student at Harvard), and Anna (who is pursuing acting in Los Angeles). Both Alice and John are very ambitious people and the demands of their careers have forced them to spend a lot of time apart over the course of their marriage, but they are still happy with one another and the life they’ve created together.
Alice has been away from home a lot over the summer and is preparing for a final presentation at Stanford University before the start of the school year. During her trip, she will also visit Lydia in Los Angeles, and John warns Alice not to argue with her too much. Alice and Lydia struggle to get along because Alice wants her to go to college, but Lydia refuses to give up acting for school. While giving her presentation at Stanford, Alice suddenly forgets a word she uses frequently. Unable to recall it, she moves on, but is embarrassed. Later, Alice goes to Lydia’s home before taking her out to dinner. During dinner, Alice and Lydia have a minor argument over what Lydia’s plans for her life, but they are unable to see eye to eye. As they leave the restaurant, the waiter runs after them to tell Alice that she forgot her BlackBerry. Lydia looks suspicious but doesn’t say anything.
Returning to Cambridge, Alice is upset to see that John is not home even though she got in late and had told him she wanted him to be there when she arrived. Irritated, Alice decides to go for a run, something she usually does every day and always along the same route. When she reaches the end of it, however, Alice is suddenly disoriented and unable to figure out how to get back to her house. She panics, but after a few minutes remembers the way and goes home. John is there but tells her he’s about to leave. Alice is still shaken up and tells him she wants him to stay, but he refuses and calls her “needy” before leaving. Once he’s gone, Alice is overwhelmed by her earlier experience. The more she thinks about it, however, the more she wonders if it is just menopause. After looking up the symptoms, which match her own, she feels better and goes to bed.
Despite having convinced herself that her symptoms were just due to menopause, Alice becomes increasingly worried that there is something more serious going on. At her 50th birthday party, she has a small emotional breakdown in the bathroom because she is worried about what might be wrong with her. She makes and appointment with Dr. Tamara Moyer, her primary care physician of 22 years. Dr. Moyer asks her some questions about her symptoms and lifestyle, which leads her to tell Alice that she is very likely in the early stages of menopause. However, she does not believe that Alice’s memory problems are due to menopause and wants to run some tests.
While she waits for her next appointment, Alice spends more time thinking over her career while she looks out of her office window. Her success did not come easy, and she doubts that John would have been able to do as much as she did: juggling children, work, research, and traveling for conferences. One day Alice receives an email telling her she’s forgotten to send some important slides, then she forgets what lecture to deliver to her class despite having spent an hour going over the material. When she gets home John reminds her that she was supposed to fly out to Chicago that afternoon. Shortly thereafter, Alice returns to Dr. Moyer’s office and is told that her tests came back clean. Alice requests a referral to a neurologist.
In December, Alice and John attend Eric Wellman’s annual holiday party with the Harvard Psychology Department. While there, Alice’s graduate student, Dan, introduces her to his new wife, Beth, and they chat for a while before Alice excuses herself. When she returns moments later, she fails to recognize Beth and reintroduces herself, causing those around her to raise their eyebrows. They believe Alice has had too much to drink, so John walks her out and they return home. Shortly before Christmas, Alice meets with a neurologist, Dr. Davis, who has her take some cognitive tests. At the end of the tests, he tells her he thinks her memory problems might have a serious underlying cause and he orders some bloodwork and other tests done. That Christmas, before Alice has received answers, she obsesses over what might be wrong with her. She devises a test for herself in which she randomly selects words from the dictionary, writes them down, and then sets a timer. When the timer goes off, she must remember the words. She does this all through the evening, never missing a word until later when her family has all gathered in the house and is making a lot of noise. Alice uncharacteristically snaps at both of her daughters and then pulls out the ingredients for the bread pudding she makes every year. To her horror, she can no longer remember anything about the recipe, even though she’s made it every year since she was a child.
Alice returns to Dr. Davis’s office the next month for her test results and he is upset that she hasn’t brought a family member with her even though he had asked her to. He tells Alice that he believes she has early-onset Alzheimer’s, which has a “strong genetic linkage.” The progression can be slowed somewhat with medication, though the condition is degenerative and incurable. Alice is stunned and worried about her kids inheriting the disease. Dr. Davis gives her some paperwork and a booklet to bring home, and urges her to tell John. After a brief period of anger and depression, Alice does tell John about her symptoms and diagnosis. At first, John does not believe it, but soon accepts that something might be wrong and leaves her to go do research on possible treatments, causes, and clinical trials. John and Alice soon go to a genetic counsellor to have a test done on Alice that will definitively tell them if she has a PS1 gene mutation that could have been passed down to their children. The counsellor confirms that Alice does have this mutation. It takes some time, but eventually Alice and John get Anna, Tom, and Lydia to come for a visit and tell them about Alice’s diagnosis and the possibility that they will face the same thing one day. Anna and Tom decide to get tested to see if they carry the mutation, but Lydia decides not to. The results of Anna and Tom’s tests come back and show that Tom has not inherited the mutation, but Anna has. As a result, Anna (who is undergoing in vitro fertilization) decides to have her and Charlie’s embryos tested before implantation to make sure they do not carry the same mutation.
One day Alice secretly visits a care facility for dementia patients. She wears her mother’s butterfly necklace. This necklace was once saved for special occasions, but Alice now frequently wears it since her diagnosis. Alice is horrified by what she sees at the facility and soon leaves. She gets ice cream and sits down by herself to consider what her future will be like. She wants more time to see her kids reach important milestones and to take another sabbatical year with John. However, she also devises a plan to commit suicide when the symptoms of her disease make her a burden on her family. This plan ultimately fails when she is unable to find the medication.
Alice’s condition rapidly declines. She struggles to function without assistance from technology, John, and their children. John struggles to cope with all the help Alice needs, which causes some friction in their marriage. On the other hand, Alice determines to get closer to Lydia and soon they can talk to each other about plays and Lydia’s acting without arguing. Lydia develops a knack for reading Alice and determining her needs and mood before anyone else can, which also helps bring them closer together. Alice tells Eric about her Alzheimer’s when he calls her into his office to discuss the poor student reviews she received the last semester. Alice hadn’t realized how much her work was being affected by her symptoms, so she steps down from her teaching and speaking duties. However, she keeps her office in order to help Dan finish his dissertation. Soon, Alice’s colleagues start avoiding her and she spends less time at her office. To make up for the loss of her friendships at work, Alice forms a support group for herself and other local dementia patients looking to connect with someone who knows what they are going through.
Alice loses the ability to focus on books or movies, leaving her unsure of how to spend her days. Her kids—especially Anna, who is now pregnant with twins—frequently come by to spend time with her and help her, but she struggles with not having a busy schedule to follow. One day John comes home with the news that he’s been offered a position in New York City. He and the kids argue about his decision to move Alice away from her home, and Alice resents that they talk about her while she is right there instead of asking her opinion. Alice herself does not want to move and resents the fact that John wants to even though he knows she wants to spend one more sabbatical year with him, which he won’t get if he changes jobs. Frustrated, Alice realizes that she can’t convince him to stay and gives up trying.
Alice’s condition continues to worsen and she frequently struggles to recognize Lydia. She still goes to appointments with Dr. Davis and delivers a speech at the Dementia Care Conference, but otherwise her life has slowed down as she loses touch with everyone outside of her immediate family. In April, Anna gives birth to her twins, Allison Anne and Charles Thomas, and Alice is lucid enough to recognize her and asks if the babies will grow up to have Alzheimer’s, too. Alice assures her that they will not. John ultimately decides to move to New York and leave Alice with the kids in Cambridge. Lydia is moving closer to home because she’s decided to study theater at college, and is excited to be closer to Alice and Anna’s new babies. Anna frequently brings the babies over to Alice’s house so she can hold and play with them.
Shortly before he leaves, John brings Alice to their beach house for a final vacation. While there, Alice momentarily becomes lucid and tells him that she remembers him and that she was smart once. John tells her she was the smartest person he’d ever known, and she tells him that she misses herself. The next month, John leaves and finds out that the experimental drug Alice had been taking didn’t pass the trial. A nurse, Carole, comes to take care of Alice, who no longer recognizes her children. Anna and Lydia help take care of her every day, and Alice enjoys holding the babies. In the final pages, Lydia acts out a scene of a play and asks Alice what it’s about. Alice tells her it’s about love, which makes Lydia happy, and she tells Alice that she’s right.
