by janet silver ghent
staff writer
Have you seen my keys?
In which aisle did I leave the car?
Honey, what’s the name of the CEO you just introduced me to?
Yes, we are all losing it. But is it cause for concern?
“Truthfully, we all lose memory, starting in our teens,” says Dr. Jay Luxenberg, medical director of the Jewish Home in San Francisco, who recently gave a talk there on the topic. Such changes are “inevitable parts of the aging process — our cognition changes.”
But such “age-related changes are separate from Alzheimer’s” — the illness that afflicted former President Ronald Reagan, who died this week, for a decade — and these changes don’t constitute dementia, he says, reassuringly.
The mild memory loss, associated with aging, is incremental but slow, creeping along at a snail’s pace. Dementias, by contrast, are aggressive.
With mild memory loss, he suggests, people can use mnemonic devices to help them remember or jot names and vital information into a PDA or notebook. They can also tie a colored ribbon to the antennas of their cars, he adds, noting that he was recently looking in the wrong aisle for his car, when a young friend of his son’s remembered exactly where it was.
“We use technology to help us remember appointments. That works for age-associated cognitive impairment, but not Alzheimer’s,” he says, emphasizing that Alzheimer’s is a disease.
But because normal memory loss is not an illness, “there is no drug I can advocate” to prevent it. “That doesn’t mean there won’t be such a drug. I’m hopeful.”
Meanwhile, new treatments are being developed for Alzheimer’s. And some physicians are recommending ginkgo biloba, a plant that has played a crucial role in Chinese herbal medicine and that can treat Alzheimer’s but won’t prevent it.
Can it be prevented? The jury is out, says Luxenberg, a clinical professor at the UCSF medical center, where he specializes in geriatric medicine.
“At one point, we were touting estrogen, only it didn’t prevent Alzheimer’s.” More recently, some authorities are advocating non-steroidal anti-inflammatory drugs, such as Advil. A recent study documented in the New England Journal of Medicine said that such medications, taken regularly, may provide protection against Alzheimer’s.
In addition, some people are taking such drugs as Lipitor, to lower cholesterol, and it may have some protective effect against Alzheimer’s.
Others are touting vitamin E, he says, although the evidence is weak. “The good thing about vitamin E is it’s not very expensive.”
But the main thing people should be doing as they age, Luxenberg says, is the common-sense steps that promote health: regular exercise, good diet, taking calcium and dealing with any health problems that can aggravate dementia.
He points out that there is a high association between Alzheimer’s and diabetes, and that high blood pressure untreated can lead to small — or major — strokes, and brain damage. “The advice is take care of your blood pressure.”
But “there isn’t a lot of evidence we can prevent Alzheimer’s by these measures,” he adds.
Although there are tests that can point out whether someone is carrying a risk-factor gene — and such tests are helpful in medical studies of large groups — they are extremely expensive and they cannot determine whether a particular individual will develop Alzheimer’s.
“Alzheimer’s disease is really a disease — there may be triggers, environmental triggers or protective [factors], but the risk is very strongly genetically linked.”
While memory loss is inevitable, he points out, dementia is not, adding that he has attended birthday parties of centenarians who were still able to do their taxes.
However, the majority of residents in nursing homes are there because they have some kind of dementia, perhaps coupled with physical illnesses. “If you eliminated dementia, you could close three-quarters of the nursing homes in the United States and we wouldn’t notice.”
The goal, he emphasizes, is maintaining quality of life, rather than keeping people alive for a long time after their brains have ceased to function well. Few would want to face the kind of “long goodbye” endured by the Reagan family.
“What we want to do is square out the morbidity curve — die the ‘One-Hoss Shay,’ death,” he says, referring to the Oliver Wendell Holmes poem about a carriage that collapses all at once. “We want to be able to travel, go to restaurants, be active until the time we die. That’s a rarity. For most, there will be a time of disability. They will need some help. My goal would be to have lots of options, whether it’s assisted living or a nursing home. We’re a lucky community because we have lots of choices, but we need them.
“There are wonderful scientists at UCSF working to expand the life span,” he adds. “But until we can address this disability problem — strokes, dementia — it isn’t very attractive to live to 200.”
CopyrightJ, the Jewish news weekly of Northern California