Author Topic: Aging well  (Read 45121 times)

skdadl

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Re: Aging well
« Reply #30 on: February 21, 2010, 03:15:18 PM »
Toe, are you getting help through the CCAC? What you say about the paperwork in particular sets me off, because I really know that problem. In these situations, for some reason, the paperwork area of the brain just turns to mush. So few people understand that, but it is physically painful to try to do it on your own.

Anyway, I think that if you get a good CCAC worker (and I met good ones), you should be able to raise that issue. Tell them you need help doing the paperwork, that it really is too hard. They will understand. I wish I had said that, actually.

I really think you are entitled to a good, full-ranging talk with a CCAC person. Tell them all the things you just told us. I don't know how they decide that people are qualified, but I think you're qualified.

lagatta

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Re: Aging well
« Reply #31 on: February 21, 2010, 04:29:42 PM »
I'm so glad you are having a bit of respite gardening - in February! and having a nice supper with a little roast chicken and some vino.

Daughter should be able to find bicycle bags in Hanoi, although alas modernity has meant many Vietnamese have switched over to motorbikes. Vietnamese cities used to be among the most cyclable in the world. They sell fairly cheap bicycle bags at Canadian Tire, though they are way overpriced for what they are and not sturdy at all. I bought my pair at a street market in Amsterdam for 7 euros...

If you buy expensive ones they get stolen; you have to take them in to shops with you which is a royal pain in the tuchis.
" Eure \'Ordnung\' ist auf Sand gebaut. Die Revolution wird sich morgen schon \'rasselnd wieder in die Höhe richten\' und zu eurem Schrecken mit Posaunenklang verkünden: \'Ich war, ich bin, ich werde sein!\' "
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Toedancer

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Re: Aging well
« Reply #32 on: February 22, 2010, 02:07:41 PM »
Quote from: skdadl
Toe, are you getting help through the CCAC?

NO, I'm not, but they are always there if I need them. The Arthritis Society is doing the bargaining with Manulife and the AS is going to make up the difference. Still though, it is a grueling procedure.

Lagatta, you know what, I think I want my zoomer separated from grocery p/u, like the 3 wheeled the Chinese use to pick up huge bundles of recycling. I'm gonna keep my eye out for one.
"Democracy is not the law of the majority, it's the protection of the minority." -Albert Camus 1913-1960

deBeauxOs

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Re: Aging well
« Reply #33 on: April 13, 2010, 03:17:23 PM »
Some tips regarding the prevention of Alzheimer's can be found in the results of this research.
Quote
A diet rich in olive oil, nuts, fish, poultry and certain fruits and vegetables may have a powerful effect at staving off Alzheimer's disease, researchers reported on Monday.

People who ate nutrients specifically selected for brain health had a 40 percent lower risk of developing Alzheimer's disease compared with others, Yian Gu, an Alzheimer's disease researcher at Columbia University in New York and colleagues found.

"Diet is probably the easiest way to modify disease risk," said Gu, whose study appears in Archives of Neurology. She said because there are no cures for Alzheimer's, prevention is key, especially as the population ages.

skdadl

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Re: Aging well
« Reply #34 on: April 13, 2010, 08:30:59 PM »
I'm sure that the healthier diet is just generally, well, healthier, especially as regards heart health, although none of that is ever a guarantee.

And it may be that the actual study is more carefully written than that squib, but a couple of obvious problems:

Quote
She said the diet likely works in two ways. Because it is rich in heart-healthy foods, it may be protecting the brain from strokes that could make it more vulnerable to Alzheimer's disease.

Unless the research has changed a lot since I was last deeply into it, this is a strange thing for a medical scientist to say. If strokes lead to dementia -- and they don't necessarily; you can live with a lot of brain damage and not technically be in the specific process that is dementia -- they lead to what is called multi-infarct dementia, itself a specific form of dementia that can be detected fairly early on while the patient is still alive through brain scans -- that is, the damage caused by strokes can be seen.

There are a number of types of dementia, and most of them can be diagnosed with some certainty before death, in various ways. Alzheimer's cannot; it is diagnosed before death by exclusion -- that is, none of the other causes presents -- and post mortem for a certainty only by a neuropathological autopsy, very few of which are done. The neuropathological description of Alzheimer's is precise, and quite different from the description of a brain damaged by strokes, although both conditions could be present, but would be described separately. I know this because I have a neuropathological autopsy report that excludes all other causes but Alzheimer's. I got it because of medical relatives who persisted in believing in multi-infarct, all evidence to the contrary. It was not easy to obtain -- there are only about a dozen neuropathologists in Canada, and the brain banks have lost their funding, or had at the time.

So anyway, I find it very odd that a medical scientist would fuzz the lines between stroke damage and the puzzle that is still Alzheimer's, even though both sub-types of dementia, once they start, progress through the same stages. All the sub-types do.

It may be that there is some connection as yet undetected between the two, but I haven't read of it, and I watch.

My second observation is statistical. (I'm not a statistician but I sometimes play one on the intertubes, having worked with a couple of very good ones.) All the numbers reported in that squib seem to me risibly small. It's a very small sample; and then "over 65" is not very helpful, especially when the study lasted only 4 years?!?

Age 65 is a cut-off date for one reason only: dementia that begins earlier is called early-onset Alzheimer's; the guess is that it is genetic since there are strong family correlations for early onset. After age 65, incidence rises broadly throughout the population with age.

So the first and most obvious question is: how old were those people "over 65" in whom onset could be detected within 4 years of their being considered healthy? I'm guessing that few of them were still in their sixties.

Then there's the 40 per cent figure. In such a small sample, given that it would already be broken down into at least two parts by someone's raw judgement of which way the diets tended, and then the incidence of Alzheimer's onset would also be broken into two corresponding parts, 40 per cent could be a fairly small number. Here I truly fail as a statistician because I don't know this kind of math, but even someone who did would need all the figures and would end up giving you a much less dramatic contrast than that 40 per cent claim appears to be.

So anyway, what can you say? Eat well for the sake of your heart and other blood vessels -- always a good idea, since the blood vessels go to your brain. Don't take up boxing. Try not to get a brain infection (search me, but sadly, I've known people who did). Watch the alcoholism (although alcoholic dementia is the one that can be reversed sometimes). Stop smoking (blood vessels again). Try not to fall off your horse or sustain any other kind of concussion (small risk, but present). Make sure to be born into a low-risk family. Die young of something else, and heroically, if possible.

Some day, we'll know, but at the moment, all the other tips are just guesses, and the doctors know that.

deBeauxOs

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Re: Aging well
« Reply #35 on: April 13, 2010, 09:11:56 PM »
Quote from: skdadl
And it may be that the actual study is more carefully written than that squib
Here's a link to the text published in the Archives of Neurology.

Your definition of Alzheimer's and the working definition of AD used in the study may not be the same.

skdadl

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Re: Aging well
« Reply #36 on: April 13, 2010, 09:27:25 PM »
The definitions look the same to me. They both go by the DSM (whichever vol we're up to now -- I actually knew that recently, because they're working on the revision -- see oldgoat at babble). Neither stroke nor AD precludes the other -- I said that; see above. But a neuropathologist would describe them separately, as was made very clear to me by the neuropathologist.

Almost no one who is diagnosed within four years of onset is going to be dead by then, and thus available for the neuropathological autopsy, which means the researchers don't know whether they were looking at Alzheimer's, although they well could know -- in fact probably did know -- that they were looking at stroke damage leading to multi-infarct.

Boom Boom

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Re: Aging well
« Reply #37 on: April 13, 2010, 09:34:04 PM »
Question: how do doctors test for Alzeimer's?

skdadl

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Re: Aging well
« Reply #38 on: April 13, 2010, 09:50:29 PM »
Strictly speaking, they can't test for Alzheimer's. They test for dementia. There's a common 30-question test (I forget the name, but it's easily googled) that any GP can give. (I've heard it so many times that I can now give it.)

A certain score will be a warning signal, and lower than that is considered diagnostic, although I would say that at that point you ask for a referral to a geriatrician. There are more advanced tests, and I've been out of the loop for a few years, so I would advise anyone in situation to go for whatever is available.

At the warning-signal level, the GP will send the patient for the standard range of tests for heart and stroke problems. If those show little to nothing but cognitive problems continue, again, I would ask for a referral to a geriatrician. There are other conditions that can cause dementia, and can be diagnosed in other ways. I haven't seen that, just read about them.

Alzheimer's is the diagnosis by exclusion -- ie, none of the other causes of dementia can be identified. Only then do they say that a patient has Alzheimer's, and even then, they can't prove that until after death, when a neuropathologist finds and describes the characteristic "plaques and tangles."

It's still true that the majority of people with dementia are said to have Alzheimer's. The second biggest group are those with multi-infarct. The majority are also older women, and they often have other health problems as well -- often diabetes, but also heart problems, anything, really. For some reason, the incidence of cancer among Alzheimer's patients is low.

deBeauxOs

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Re: Aging well
« Reply #39 on: April 13, 2010, 09:58:29 PM »
You can't "test" for Alzheimer's.  You can test for diminished cognitive capacity, often grossly labeled dementia.  A number of medical conditions can result in dementia; Alzheimer's is one.

eta - the verbal test administered is MMSE but other physiological testing is done too.

Boom Boom

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Re: Aging well
« Reply #40 on: April 13, 2010, 10:05:49 PM »
Thanks. I had no idea. I think I'll do a quick google for more info.

skdadl

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Re: Aging well
« Reply #41 on: April 13, 2010, 10:34:34 PM »
Quote from: deBeauxOs
diminished cognitive capacity, often grossly labeled dementia  

No. Dementia is the recognized overall medical category. It is the name of a process, an inexorable terminal illness whose major phases can be described in some detail and roughly timed, but which may have a number of causes. (It is also true that there are endless individual variations in the way people go through the process, but the general descriptions of the phases are good general guides. In my experience, the textbook descriptions of the phases are close to month-perfect.) Each of the sub-types has its own name: Alzheimer's, multi-infarct or vascular dementia, dementia pugilistica, Creutzfeld-Jakob, Lewy's, Korsakoff's (alcohol-related), Parkinson's or Huntington's-related dementia, AIDS-related dementia, etc. I forget how many there are, but again, easily googled. Just go to the DSM.

Many people may have "diminished cognitive capacity" for many reasons and not have dementia, which, I repeat, is a progressive terminal illness. One of the first things geriatricians look for is depression -- depressed people can begin to exhibit symptoms of dementia that can easily be reversed. Illnesses that starve the brain of oxygen can produce dementia-like symptoms that are reversed by ... oxygen. Und so weiter.

People can have severe brain damage that leaves them dependent indefinitely and not progress into dementia.

The DSM is basically a behavioural manual, meant for practical use by psychiatrists and psychologists and GPs, but it is informed by neuroscience, which is where the categories of dementia were reorganized and redefined in major ways during the 1970s. Many medical people still in practice but trained before, say, 1985, still don't grasp the best available scientific understanding of the process they're looking at. That's why I advise people to ask for the referrals to a geriatrician as early as possible.

deBeauxOs

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Re: Aging well
« Reply #42 on: April 13, 2010, 10:53:10 PM »
Quote from: skdadl
Quote from: deBeauxOs
diminished cognitive capacity, often grossly labeled dementia  

No. Dementia is the recognized overall medical category. ...
Um, yes.  My complete statement was: ...diminished cognitive capacity, often grossly labeled dementia.

The actual term dementia when used in a medical context is precise.  It is sometimes used grossly and often gratuitously for any distracted or unusual behaviour observed in elderly people.

skdadl

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Re: Aging well
« Reply #43 on: April 13, 2010, 11:25:47 PM »
Before the 1970s, the expression "senile dementia" was commonly used for anyone over, say, sixty, who headed into the process. "Alzheimer's" had been studied neuropathologically early in the C20 (by Dr Alzheimer, eh?) in a youngish woman who developed dementia in her late forties, died in her fifties, and his description of the plaques and tangles became (correctly) the description of the disease, although people interpreted his study to mean that that particular disease occurred only in younger people (before age 65) and that it was probably genetically related, which early-onset Alzheimer's is still considered (maybe) to be.

In other words, they weren't connecting "Alzheimer's" with "senile dementia." (And there are still doctors around who don't.)

Only in the 1970s did a couple of researchers start to do neuropathological analyses of the brains of older people considered to have the inevitable "senile dementia" of age. They found the same plaques and tangles in the majority of cases. It seems obvious now, but it was a revelation at the time. At that point, a major reclassification of subtypes of dementia began, and I presume that continues to this day.

The neuroscience is more precise than the behavioural descriptions, but most of us can't really keep up with the neuroscience, only hope that the geriatricians will give it a try and then translate for us.

A lot of people my age and older will say things like, "Well, that happens to most old people -- they all go a little senile." Well, no. They don't. "Senile" is the word that has ceased to be useful. Most older people will have diminished cognitive capacity. I have diminished cognitive capacity, and I expect to keep diminishing. That's called aging.

But it isn't dementia. Your average charming 95-yr-old who repeats himself a lot doesn't have dementia -- he's just a little more limited than he used to be, and maybe he needs a nap.

Dementia is not just aging, and it's not just diminished cognitive capacity. It is something that starts somewhere, as though a switch had been flipped. And once that switch flips, it is a steady attack on the brain that cannot be stopped, although its effects can be described in considerable detail, and have been. It isn't just being tired and old and sometimes silly or repetitive or befuddled.

But where that switch is, when or why or how it gets flipped, even in the forms of dementia that have well-known causes -- we just don't know.

deBeauxOs

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Re: Aging well
« Reply #44 on: April 14, 2010, 01:46:12 PM »
Quote from: skdadl
... Dementia is not just aging, and it's not just diminished cognitive capacity. It is something that starts somewhere, as though a switch had been flipped. ...
I didn't say anything to the contrary, I was trying to express in succinct terms the notion that the term dementia is often used willy nilly, without much regard to the medical context.

You don't have to lecture me about it.

Most of the cells in the human body are programmed to be replaced by new ones when required. (Until recently, physiologists believed that brain cells did not regenerate, but recent discoveries suggest that may not be correct.) From here:
Quote
... human cells replace themselves--and avoid mutation within one person's lifetime.

In order to replace themselves, cells need to both reproduce and proliferate. According to Pepper, undifferentiated stem cells carry the burden of initiating the reproduction of cells by simple division. He hypothesizes that stem cells don't evolve because their populations are largely "small and quiescent." When they reproduce, they initially change just a little, enough to produce new kind of cells--transient amplifying cells (TACs)--which divide, and thereby proliferate, several times, each time becoming more differentiated, until they are mature cells, which can neither reproduce nor replicate. ...

So if the multi-stage process of cell reproduction and proliferation suppresses evolution and cell-change, why do we age?

"Somatic evolution has been proposed as a fundamental source of senescence. We have shown that serial differentiation can reduce somatic evolution, but not completely eliminate it. Some proliferation by stem cells is necessary, and self-renewal of TACs can arise by sporadic somatic mutations disrupting normal differentiation. By slowing somatic evolution, serial differentiation may not entirely eliminate senescence but delay it until old age," writes Pepper.

In other words, if it we replaced single cells by simple division, the errors associated with aging might occur quite rapidly. With the muti-stage process--stem cells to TACs--there is a slower accretion of changes characteristic of aging over a longer time.

This research also has implications for cancer research. Cancer is cell-division gone wild.

... "When cells reach the point where they divide constantly, instead of only when needed, they are cancer cells."
The moment where a "switch" goes off at the cellular level, precipitating a dysfunctional cell replacement process or cell death is currently the focus of many heavily funded, complex studies and research.  

The study that I mentioned yesterday observes the result of diet upon the development of disease.  Its conclusions are helpful, in terms of health maintenance.  So far, not much is known about the precise moment when the proliferation of cancer cells occurs in one specific body.  Or when Alzheimer's starts happening in the brain, or even why.

Nonetheless, information gathered by Dr Yian Gu can be helpful.  It might make a difference in delaying the onset of Alzheimer's.  What's so threatening about that knowledge?

 

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