On telling a patient a dementia diagnosis
I was initially startled when I clicked on a link to this New Yorker article and discovered that, although it’s in a brand new issue, it’s written by Oliver Sacks. I have long been a Sacks fan (in addition to a Sox fan), but I’m well aware that he died some time ago (2015). Does the New Yorker hold its non-political pieces for that long prior to publication?
The article itself is short, but treats the very interesting topic of whether doctors should tell dementia patients their diagnoses, and under what conditions:
If there is a serious, perhaps life-threatening or life-altering condition, what should one tell the patient, and when? How should one tell the patient? Should one tell the patient? Every situation is unique, but, for the most part, patients want to know the truth, however dire it is. They want to hear it delivered with tact, though, and with a sense, if not of hope, then at least of how such life as they have left can be lived in the most dignified, fulfilling way.
Such telling assumes a whole other order of complexity when a patient has a form of dementia, for here one is intimating a sentence not only of death but of mental decline, confusion, and, finally, to some degree, loss of self.
When I was a child, patients were not routinely told their diagnoses for terminal illnesses like cancer. The idea was that it would only destroy their quality of life and since there weren’t many effective treatments it also wouldn’t do any good. Yes, it would help them get their affairs in order, but other than that the benefits seemed small compared to the drawbacks.
That all changed many many decades ago. Now, with the internet and many more types of treatment that can extend life (or even at times perform what amounts to a cure), patients not only are told their diagnoses but can do enough research to deluge a doctor with facts or even “alternate facts.” Some patients opt out of knowing that much; it’s a personal decision. But just about everybody is told the news, complete with percentages and/or chances for short- as well as long-term survival, and choices for treatment. It sometimes can be overwhelming, although my guess is that most patients are in favor of truth-telling in these sorts of circumstances.
But a diagnosis of progressive dementia such as Alzheimer’s is in a different class. For some people, it may even be more terrifying than a diagnosis of a terminal illness would be, for exactly the reasons that Sacks states. For example, I know a couple of people whose reaction on being told they had cancer (in one case, rapidly terminal cancer) whose reactions were to crack the mordant joke, “Well, at least now I know I won’t get Alzheimer’s.” That how frightening the latter is. And I know two people with a dementia diagnosis—one probably Alzheimer’s, one just mild cognitive impairment that may or may not ever get worse—and it’s shaken their lives, lives that were already shaken by the problems they were having that led to their diagnoses in the first place.
I don’t have a solution. But my own rather bleak observation is that if it’s really a progressive dementia situation, the person will eventually end up forgetting his or her diagnosis even if told. Of course, in the meantime (which can be years and years and years) does that person want to be under the cloud of the diagnosis or not? Again, there’s the advantage of getting enough warning to put one’s affairs in order, but otherwise, until better treatments develop, I just don’t think it likely that it would help most people to be told, although I am virtually certain that individual differences in reactions abound.
Such a sorrowful and difficult topic.
[NOTE: The Sacks article also discusses the importance of a familiar setting and familiar role in orienting dementia patients, with some fascinating examples.]
I have a friend with dementia and I don’t think she could remember anything a doctor told her. Friends noticed problems several years ago, but the situation has really worsened since she had a heart attack about a year ago. She went through a somewhat argumentative phase with her husband, but now she is mostly quiet. It’s really like there is no there there. She wouldn’t even know what dementia is.
Tell me so I can better understand what I might be going through. I have had Prostate cancer so I would want to know anything else.
expat:
The problem doesn’t really arise with a patient such as the one you describe. But nowadays people are often diagnosed with Alzheimer’s or other forms of dementia or cognitive impairment much earlier in the game, when they are well aware what it means and they can remember it. The people I know are like that.
My sister had stomach cancer that metastasized throughout her body in her last six months. She knew she was terminal, but hoped to delay it for several years so she could see her son grow up. That was not to be. Our father died in January of that year, and I came back from overseas for his funeral. I then traveled to my sister’s house to see her one last time. That’s when I learned she wanted to live 2 more years to see her 15 year old son finish high school. I got the call to return to the US in March — she was on her way out. She died two days after I arrived at her house, but we were not able to talk — she was too sedated for us to communicate.
I always admired the reason she wanted to delay her demise — to be there for her son. I am sorry that was not to be.
Recently I visited an old friend in his late-sixties, a wonderfully vital fellow, who all but boasted he had just scored a bottle of pain pills sufficient for an overdose. He said it was a great relief.
His father had Alzheimer’s and my friend has begun to notice memory lapses even when he tries really hard not to forget something.
I don’t know if he’s worrying too much, but I sure get the concern.
Everyone: Read Dr. Dale Bredesen “The End of Alzheimer’s.”
En route to his Nobel Prize, the good doctor is the first to reverse cognitive decline — often remarkably so.
ISBN 978 0735216204 (Avery)
He has the first working theory that results in success.
He does get off to a slow start, being a much better doctor and medical researcher than author and editor. But at only 300 pages, you can get to the essence mighty quickly. ( Jump ahead. )
&&&&&&&
As for being told in advance about your prospects…
I have to tell you being informed that you’re not expected to live is a bit shocking.
Later, when your own attending physician says, “Why aren’t you dead?” — it’s the capstone to your morning.
Unlike doubting Thomas, she wasn’t enthused about even touching my body. ( Just a handshake was traumatic for her. )
Soon, she was running around like a kid on a Christmas morning. She adjusted quickly. Heh.
For those curious about Bredesen’s method, a quick web search reveals that it involves some extensive tests and lab work plus:
The ReCODE protocol emphasizes nutrition but also includes exercise, sleep, and stress reduction. The nutrition is at least 12 hours of daily fasting to achieve ketosis and a fasting insulin level of 4.5 or less. Fasting blood sugar should be below 90 and hemoglobin A1c less than 5.6 percent. The food choices are a low glycemic Mediterranean diet with olive oil and lots of vegetables and whole fruit. Poultry and eggs should be pasture raised, other meat is grass-fed and used as a condiment rather than a main course. Seafood should be wild and to avoid mercury and other toxins, large-mouthed fish such as shark, swordfish and tuna are to be avoided. He recommends the “SMASH” fish: salmon, mackerel, anchovies, sardines, and herring. Bredesen recommends many supplements, consistent with a functional medicine approach. I counted over 20 supplements, and Bredesen suggests a person does not need to start all of them at once.
https://journals.stfm.org/familymedicine/2018/june/br-jun18-scherger/
There are some indications that Alzheimer’s might be an infection (from the teeth). I’m now old enough to be a bit worried.
My father in law died 2 years ago, after having increasing mental problems for 4 years before. He had been a genius in physics, slowly and gradually reduced to very long periods of quietness. He had been so actively kind, so alive.
It’s so sad.
A hospital nearby has set up a “retro wait” room, with old-fashioned 60s socialist styling and magazines from the 60s (in Slovakia). Many of the older patients are happy to remember their youth, in a comfy, remembered environment.
Making such folk comfy seems the right goal, but it’s not at clear how to do it best.
F:
I’m very sorry.
As a physician, I have long despised (strong word) Dr. Sacks for his writings. IMO he took advantage of being a physician to his patients by telling “tales” of them, sometimes with a mocking tone: “The Man Who Mistook his Wife for a Hat…And Other Clinical Tales”.
Tales, not case reports. Tales, from which he profited. Greatly. Did he share those revenues with his subject patients? Or put them to any form of non-personal beneficial use?
Remember, in the Sacks era, neurologists were primarily observers and documentarians even after CT and MRI came along; clinical brain anatomists. They had few medicines or means with which to treat any neuro ailment. They were impotent; the neurosurgeons had the oomph, and today we still speak of brain surgery as a metaphor for great skill and difficulty.
Sacks was an able writer.
Resembled Freud, another tale writer who wrote up “Anna O” and other tales of certain misdiagnosis. Freud was nonsensical and a great, enduring source of social decay with his “sex is everything” dogma, who lives on in popular jargon…”ego”, though no one recalls superego or id.
Sacks died of melanoma originating in an eye.
IN a bit of irony, there is now a drug that will put melanoma into remission quickly.
My wife’s sister now has Progressive Supra nuclear Palsy. I noticed she was not alright last summer at a family wedding. She is now in a nursing home but refuses to move closer to her daughter, Difficult choices.
My policy on telling patients bad news was that they had a right to know but not all want to know. l remember one man who was very interested in his treatment until it became apparent that he was not doing well. He lost interest in the details.
The trouble is that Alzheimer’s is not an objective diagnosis. A dear close relative of mine suffered some mild cognitive decline and was told by her doctor that she had Alzheimer’s. I can’t begin to describe to you the pain and fear and sadness that this triggered in her — and it turned out not to be true. Whatever cognitive issue was causing her decline, it was not Alzheimer’s. Her disability moved far more slowly and gently and was far less malignant, and eventually the doctor conceded that whatever was going on, it wasn’t Alzheimer’s. She had many years of happy, somewhat compromised life after that wrong diagnosis, with mild to moderate, slowly increasing disability. She enjoyed her life and knew her family into her late 90s, though she couldn’t live independently in her last few years. I don’t know what the answer is for everyone, but giving her that diagnosis was a dire and painful mistake that cost her — and those of us who loved her — many hours that might have been happier and more hopeful.
When my mother had glioblastoma (this was 2002), the oncologists were quite dishonest with us, and intimated that their therapies might significantly prolong her life. Her neurologist, whom she had previously been seeing for Parkinson’s, was much more honest, and told my father to take her home and let her die in peace, which he did eventually after several pointless months of suffering. So despite what neo says, honesty is not necessarily the order of the day.
Real life stuff, a good friend of mine, grad of a military school who became a Colonel I have been visiting regularly for the past three years was put on hospice today. I have watched this gentleman in his 80’s make the transition from a brilliant man to the state of not exactly knowing much of anything that is going on and he know as his brain was losing its ability to process information that he was losing his abilities to process information and he would apologize to me from time to time as he went in and out of mental focus. He played football for a couple of years for the academy and he quit after he took such a blow to the head that he was sidelined for a month and he spoke to me about that blow to the head could be some of the cause of his failure to process information.
I have continued to stay in touch with him, the last time I visited he did not seem to know who I am so I spoke to his wife about another visit and would it be helpful at all. She was not sure if I know who he was and she has not seen him for several weeks because she had a double mastectomy since I saw them last month. She is ten years younger than him and has a good attitude however her margins were not good and she came down with a staph infection after her surgery which has delayed her radiation. At the same time her attitude is great and she will start treatment next week and this stuff is real life stuff, as she said she knows what she needs to do and she is staying positive about her outcome.
When I first had cancer in 2001 I said a prayer the I would like to see my two grandsons graduate from high school, that wold be enough. Now four more grandchildren and two more bouts of cancer, the last in 2010 I am looking forward to my one and a half year old graduating from high school and if that does not happen every day is a bonus. Life deals us difficult cards to play and it is our choice how to play them, my heart goes out to every person as they deal with this stuff.
Old Texan:
So rough. So sorry.
When they said old age wasn’t for sissies, they meant what they said.
If I understand correctly, doctors would tell a proximate relation of the cancer diagnosis and said relation would relay what information to the patient he thought apposite. I think it was in the early 1970s when practice changed.
Pleased you did “Sacks” and “Sox” so I didn’t have to.
vanderleun:
Just trying to lighten your labors.
Cicero:
Did you bother to find out whether Sacks got his patients’ permission? Do you care, or would you only be satisfied if he paid them, too?
Sacks has stated that he always got permission:
I certainly wouldn’t expect to get any money from him. I actually sent Sacks a letter once, describing a loved one’s situation (with that loved one’s permission), because I thought Sacks might be interested in it. Not only did Sacks send me back a 4-page, handwritten letter in response, but he spent a short part of a book of his on that case, and I was one of many many people he thanked in the acknowledgements. It never for a single moment occurred to me that he should pay me, nor did it occur to my relative.
You can despise Sacks if you wish. I thought he broadened knowledge of many conditions, and that his writing was almost always quite compassionate. Nor did he hold himself out to be writing scientific tracts or research. His books were of course anecdotal and descriptive, and dealt with cases, and didn’t really purport to be otherwise. There may be some exceptions, but I never encountered them, and I’ve read many of his books.
Neo and GV: The PC phrase for Neo’s team is “Hose of Color” (HOC), to distinguish the Boston guys from the Hose of Pallor (HOP) in Chicago. I always thought it was funny or ironic, take your pick, that Obama claimed to be a fan of the “White” Sox.
Neo – I have also read and learned much from Sacks, and enjoyed his writing; I think you are correct in your depiction. He always seemed very respectful of his patients, and most interested in conveying a picture that people facing the same difficulties in themselves or loved ones could benefit from seeing.
On keeping people in familiar surroundings — in one of his books, (Musicophilia IIRC), Sacks mentions that people who have forgotten family, friends, and everything else, will still sing along quite well with entertainers when the songs are ones they knew in their youth.
This topical pic from Gerard’s sidebar tickled me – except I have to move the date to the 50s & 60s.
http://americandigest.org/wp/wp-content/uploads/2019/02/AAAKITCHENTHING.jpg
A former choir member lost most everything else to Alzheimers but could still sing quite well until the end.
Neo misses the points I attempted to raise.
But she likes Sacks because he was kind to her, even recognized her in his writing.
There is not enough caring, as doctor of patient, by Sacks. He was more of an interested observer than a therapeutic intervenor, as I have said. Not my idea of healing or efforts to heal, not at all.
Wonder how many myasthenia patients he had under his care, in hospital on respirators for months. Probably not very many; too much trouble, too few tales.
Aesopfan:
Remote memories are the most durable. But as to singing along with pop music of one’s youth, imagine the Alzheimer’s crowd of 2080 trying to sing along to rap and hip-hop, with the ho’s and killsdacops and F and M-F words. What a jolly nursing home that will be!
Cicero:
It is you who misses the point of what I said.
I “liked” Sacks long before I ever wrote to him, which was quite late in the game. I like his books.
You made a certain accusation against him that had to do with how he treated people. I gave you a link that was relevant to how he treated the people he wrote about—he got their consent. I mentioned my impressions of the way he wrote about people in his books. And I added a personal experience with him, since I happen to have written to him about someone close to me, and was treated well by Sacks (as was the person I wrote about).
Nothing—absolutely nothing—in what I wrote there indicates that I “like” Sacks because of that experience I had with him. The experience was both late in my impression of Sacks and also relevant to your impression of how he treated the subjects of his anecdotes.
You seem to have come to conclusions about Sacks based on very little evidence. I gave you some evidence; you chose to insult me with it, and make up stuff about me. I can’t imagine why you think that would bolster your point of view on this thread.
Not only that, but you’ve been reading and commenting on this blog for many many years. You should know better than to assume I would form an opinion of Sacks’ lifework based on whether he was kind to me or mentioned me as one in a very lengthy list of names in the acknowledgements of his book. I assure you that I’m probably the only person who even saw my name there; who bothers to read acknowledgments? If memory serves me, I only saw it myself because I believe I got some notice or other about it from the publisher. That was more or less a non-event except that it told me something about Sacks and how he treated people whose stories he told in his book—which is the subject matter that you were speculating about with no evidence.
And so I trotted it out only to give you some evidence. And, as I said, you used it to speculate about me in an insulting manner.
If you want to read a tribute by someone who knew Sacks better than you or I, see this. No doubt you’ll discount it as well.
While we’re at it, there’s this:
Much much more at the link.
Sacks continued to see patients, usually in hospital settings.
And here’s what he was doing at around 80:
I’ve known several elderly people who were diagnosed with Alzheimer’s. Their minds were working quite fine at the time, but their doctors told them, “Well, you have the disease, we’d better put you on medication pronto.”
The effect on them was dramatic. All of them immediately began showing dramatic signs of cognitive decline. I honestly think it was in all cases a “reverse placebo effect.” The doctor tells you you’re losing brain function, and so you do. And I’ll swear the drugs they were given just made their thinking fuzzier.
I think telling a perfectly functional person they’re doomed to lose their minds is cruel and counterproductive.
I spent years watching my father-in-law die of Alzheimer’s, and I would not wish my family to experience what that cost his family. I’d rather take a bullet to the brain. And I would not appreciate a doctor (or anyone else) playing God by not telling me.
Cicero on February 28, 2019 at 12:00 am at 12:00 am said:
Aesopfan:
Remote memories are the most durable. But as to singing along with pop music of one’s youth, imagine the Alzheimer’s crowd of 2080 trying to sing along to rap and hip-hop, with the ho’s and killsdacops and F and M-F words. What a jolly nursing home that will be!
* * *
I joke with my kids that I quit listening to popular music when Simon and Garfunkel broke up, but it’s really quite true. There are a few pop/rock & Boradway songs that “have a tune you can hum” (Tom Lehrer), but most of them are either vocally inaccessible for normal people, and else very boring without the backup band.
On the other hand, some modern Christian pop, country/Western, and generically folk-ish music (which I occasionally hear on the radio) are still good.
More sadly, children are not growing up with any kids songs like the ones we knew.
Neo, I was aware of Sacks and never heard any negatives about him. As for recounting patients’ stories, I have written just such a book called “War Stories” in which I do not identify patients, many of whom are probably deceased now anyway.
The reviewers on Amazon seem to like it.
On a related topic, at least one of the common DNA testing companies (23andMe) offers a kit which tests for, among a long list of other heritable conditions, genetic risk factors for Alzheimers. Setting aside the separate debate about handing over one’s genetic material to a private company, would you want to know if you have risk factors for Alzheimers?
Neo, kindly pay attention to my words, which opened with my remark that I despised Dr. Sacks “for his writings”. Not as an individual, but for his writings.
I then attempted to explain why.
We have had disagreements about medical issues in the past.
My view of our shared experience is that you tend to oppose the medical point(s) of view that I as an MD am trying to explain to you as a non-MD. I know what I’m talking about, even if I sometimes don’t express it very well.
I care a very great deal about medical ethics. In my view, medicine is a calling, not just a job or a business. I am not persuaded that Sacks hewed to a high ethical standard when he used his patients’ “Tales” for lavish personal gain, particularly, as I pointed out, when he could do next to nothing neurologically, as a physician, for them. Narrations about men who mistook their wives for hats are a source of surprise and amusement, akin to putting them in a freak show for the public to view (or, in Sacks’ case, read about) at a fee. At a fee.
“When he tried to publish a systematic study of these “side effects” (which he thought were really “effects” of the drug) in the same medical journals that had published his first findings, and others, he was refused…”
Neo, those are peer-reviewed journals of high standing. He did NOT MEET peer review standards, though this remark casts him as a victim of orthodoxy.
“daring to question authority”. So Sacks was speaking truth to power?
“and others – if they’re nearby – he will meet personally to discuss their symptoms.” Discuss. I see.
I find your pro-Sacks quotations of dubious merit.
******
P.S. Side effects are always effects of drugs. They don’t just fall out of trees onto people!
KyndyllG:
Absolutely would not want to know, particularly since we have so little knowledge on how to prevent it. The news that one has the gene can only have bad consequences at this point, IMHO. Either you become intensely fearful every time you forget a name (which I already am), or you become falsely confident. Many people who have the gene don’t ever get Alzheimer’s, many people who don’t have the gene get it. All it tells you, as far as I know, is what your relative chance of getting it is. It rises if you have the gene.
Despite having just been through over six years of this, the latter 3 and a half which saw my declining mother being tended at home 24/7, 365 days per, I’m not certain that I have anything particularly constructive to say.
I’ll just relate how it went.
The first three years, my mid-eighties and stupendously hale and youthful seeming father, took on almost all the burden of first investigating, and then managing, her slow but very emotionally wrenching deterioration. It was he who had to deal with her doctor and psychiatrist visits, with her sleeplessness, with her purposeless rummaging through closets in the middle of the night, her showering and getting dressed at 4 in the morning, her disinterest in cooking, and her wishing to nap most of the day.
Oddly, apart from these nightmarish – when seen in terms of the prolonged and repetitious disturbances to one’s emotional and psychic equilibrium – she was more or less “ok”, on the surface.
We tried the usual stopgaps. Supplements, exercises, the nightly Scrabble games which she loved; but, how many pints of blueberries and quarts of pomegranate juice can an elderly person consume on the off chance that it really will do some good. But we did all that, the cocoa extracts, the juices, the exercise schedules and regimes insofar as possible … and it may have done some good, although with no control subject, how can you be sure?
But her noticeable quietness and withdrawal, while not socially troublesome, meant that she initiated almost nothing, had interest in very little, and was therefore completely dependent on the prompting of others, to the point of having to be guided to shower and so forth; though once set in motion she would do it all one her own.
When Dad fractured a couple of vertebrae falling down some stairs, it was a clear sign that full time help was a couple years overdue. You can imagine though, what almost 4 years of quality round-the-clock care giving help was expected to mean in financial terms, and what it did in fact come in fact to mean to a middle class family’s finances. Even after the first year, when I decided to interview and hire on my own rather than use the agency, we were shooting cash out through a fire hose.
That said I don’t think we – and I speak for my siblings as well – regret a moment of it.
Perhaps because her personality never degraded, and she became only sweeter and more trusting and thankful, we had it easier than many others. She was remarkably strong, able to walk, and to talk sensibly; until the last 6 months put her in a wheelchair, but only because of the spread of cancer to her hip.
There were events that seemed exhausting at the time. The two or three nights a week I would spend there before we got in the full time help, left me feeling pretty sorry for myself at times, till I reflected that my dad was dealing with it on his own 4 or 5 days a week (the sibs are out of state).
Trying to stay awake for 48 hours at a time when caregivers called in sick at the last moment is not particularly fun … especially when the docs had not gotten her medications quite right and it was that which was keeping her awake and in an agitated but zombie-fied state for many days on end. (Turned out to be the side effects of two pills administered at night).
Anyway, at that, we were probably lucky or blessed, you take your pick, that she remained sweet, loving, thankful, generous, and relatively pain free, until the last, and died at home (albeit in a hospital bed, attended by my physician sister) surrounded by family and all four of her weeping caregivers.
I know people suffer great pain. Many have had bitter and disappointing lives up to that point, or harbor resentments, or nurse sins they cannot let go of; but being, that is Be-ing, is a great gift, as we all know, but sometimes forget.
We should strive to bear it in mind as much as possible.
I am an engineer with a PhD dissertation in medical x-ray imaging so I got interested in how alzheimer’s disease is diagnosed. I found this from NIH national institute on aging:
https://www.nia.nih.gov/health/diagnosing-dementia”
Basically it starts with subjective symptoms “Cognitive and neuropsychological tests. These tests are used to assess memory, problem solving, language skills, math skills, and other abilities related to mental functioning.”
Then there a series of (more objective) lab tests and brain scans TO RULE OUT OTHER CAUSES.
Then there is a psychiatric examination. My experience with MD psychiatrists is that they are basically pill pushers relying on vague symptoms from the DSM.
Finally the website adds genetic tests. These may indicate a propensity to get the disease but cannot say you have the disease.
My conclusion is that there are no reliable, objective tests and any MD who gives someone a definitive diagnosis that he will develop the disease when the patient does not have advanced symptoms is doing him a great disservice.
DNW–Preach it, brother! Must agree with your last paragraph.
DNW:
Very difficult indeed. The stress is incredible. But I’m glad that she kept her pleasant disposition.
Bob: I recall an upper middle class woman in her sixties, in CA, who was fit, lively , very social, enjoyed a very good life. Because of some forgetfulness she was told she had dementia. So she and husband called “Doctor Death”, aka Kevorkian because she wished to avoid the allegedly inevitable decline. After a great, planned day, with 3 sets tennis, a superb last meal at a fine restaurant, she and her husband made love. On conclusion, Dr. Death’s gadget was used. She died of fear of the future.
KyndyllG – having had the 23andMe testing, and using a separate service to interpret all the results, I can say ‘yes’, I would like to know. Even if your odds went up 10-fold, that could be moving .001 to .01% chance of getting it. It’s not a death sentence by any means.
As far as Tom Grey above – I was just reading an article about a lone researcher who believes that the presence of amyloid plaques is a symptom rather than a cause. He rec’d one grant from the NIH and will likely not get another one. They prefer to fund research that assumes the plaque causes the disease.
The author of the piece mentioned that neurosurgeons had a higher rate of Alzheimer’s, and as well as spouses of patients.
I have no idea whether that is true, but it’s certainly interesting.
Dr Bredesen’s theory — which is proving out in cures — is that cognitive decline has multiple mechanisms:
Poor diet;
Toxins — from heavy metals to bio-toxins
Inflamation — very commonly gum disease
The latter is something not conceived of until pretty recently.
In Bredesen’s opinion, you have to tackle as many mechanisms as possible.
He has a podcast on “Found My Fitness.”
My estimate is that the vast bulk of injury occurs by way of inflamation, when your immune system stays chronically arroused. This results in loss of memory as a collateral impact. Your body is actually attacking itself.
Inflamation can be due to gum disease. My Mother’s has been severe enough to just about wipe out her memory — which used to be exceptional. Now that the dentist has addressed it, her cognitive decline is actually reversing. She still has a long way to go.
And gum disease is something that most doctors have ignored — deeming it to be within the province of dentists. Yet think of how common gum problems are once you get past fifty-years of age. Folks start to just put up with the malady. They don’t connect their gums with their mind.
Quirky diets, toxins, these are usually easily spotted during Bredesen’s “Cognoscopy” — the survey that Huxley mentioned, up thread.
The good doctor goes in not assuming anything.
You can jump ahead if you’ve got gum issues. Right there, they have to be addressed.
If you’ve got a screw-ball diet, that has to be addressed, too. Here we’re primarily talking about allergens. Something as basic as an allergy to eggs or milk is more than sufficient to arouse your immune response. When this response never lets up, your memory suffers… IQ, too.
As the first doctor with a practical and effective theory — Bredesen is on to something. All other theories have proved fruitless.
I recommend the podcast.
My experience with MD psychiatrists is that they are basically pill pushers relying on vague symptoms from the DSM.
Pretty close to true. Psychoanalysts are worse. There are good neurologists who are into the brain chemistry. One of my students wanted to go into pediatric neurology . I gave her a bunch of articles on autism and neuropeptides. I hope she followed through.
Oxytocin is expected to be a potential therapeutic resource for the social core symptoms of ASD, since this neuropeptide can modulate human social behavior and cognition. This review article provides an overview of both experimental and clinical studies on effects of oxytocin administration on behavior, neural underpinnings, and symptomatology of ASD.
This comes from studies of prairie voles’ behavior.
My mother had kind of a dark sense of humor.
When my parents “Dick and Jane” entered their late sixties, she said that she could imagine an end-of-life-issues scene like this, with the Doctor being their long-term primary care physician, who also went to high school with both of them:
Doctor to Dad: What was it Jane wanted us to do when she started losing her mind?
Dad: Jane who?
I had my husband and me take the 23andMe genetic profile. I was concerned with my husband’s family as it is littered with Alzheimer’s. My family on both sides had no dementia. It was interesting he did not have the APOE4 allele, but I had one. I have since scoured the APOE4.info website. I also wonder if all the type 2 diabetes in his family contributes to the Alzheimer’s.(Of the 6 siblings in my husband’s family, he is the only one w/o diabetes). My family has 1 case that I’m aware of and that was a great aunt. Interesting, and I’m careful about my diet and lifestyle.