Cathryn Jakobson Ramintag:carvedinsand.com,2007:/blog//12007-10-20T01:08:20ZMovable Type 3.35Hunting for Biomarkerstag:carvedinsand.com,2007:/blog//1.152007-10-20T01:06:31Z2007-10-20T01:08:20Z"Is what I'm experiencing ordinary midlife forgetfulness? Or do these memory lapses signify something more serious—like the first signs of Alzheimer's disease?" Practically every day, someone asks me these questions. And I wish I had better answers. One evening, a...
Penn Institute on Aging and Alzheimer's Disease at the University of Pennsylvania. "It is in your forties, or maybe even younger, that normal memory loss begins to diverge from pathological memory loss. In my lab, we’re spending a lot of time trying to define that fork in the road, where you either continue to lose a little bit of your memory capacity each year, and remain essentially normal, or you take the other fork, where you are on a downward trajectory, culminating in dementia."
Trojanowski's lab at Penn is on the leading edge of the hunt for a biological marker—the equivalent of a pregnancy test—for Alzheimer’s disease. This "biomarker" must be fast, painless, inexpensive and able to pick up indicators of the disease at a very early stage, permitting early diagnosis, before neurons begin to die. In order to know whom to treat, it's essential to know who is vulnerable. As part of a National Institute of Aging investigation, the Alzheimer's Disease Neuroimaging Initiative, or ADNI, Trojanowski’s lab has made significant progress in tracking down a marker for the elevated presence of tau and amyloid beta proteins in cerebrospinal fluid. It's accurate, and meets most of the criteria, but is of limited use in a once-a-year doctor's check up, since not many of us would like to top off our annual physicals with a spinal tap.
That's why people got so excited earlier this week when scientists at Stanford University announced that they had developed a blood test that can diagnose Alzheimer's disease years before memory loss is evident. The test shows a 90 percent accuracy rate in its ability to predict who would develop Alzheimer's disease two to six years in the future, by measuring eighteen proteins involved in cell signaling. The proteins that neurologist Tony Wyss-Coray assessed were not even on the list of "promising" blood chemicals identified in 2003 by the National Institute on Aging study—but often, that's how science works. For years, researchers pursue a hypothesis, adding bit by bit to existing knowledge—only to have another team of researcher turn that hypothesis on its ear and shout "Eureka, we’ve found it!"
The Stanford blood test, promising as it is, requires more extensive testing, in a larger sample of patients and control subjects, including confirmation of accuracy that can emerge only after the autopsies of deceased study participants. It will take several years to do these studies, and in the meantime, given the intense focus on this effort, other biomarkers in blood and urine are likely to emerge. That's good news for all of us. Within a few years, when you go to see your primary care practitioner, there will be one more box checked on the sheet you take to the blood lab—one that will tell your physician what’s going on in your brain. "It goes painful step by painful step," John Trojanowski emailed me, when I asked him what he thought of the Stanford news, "but this is progress that takes us closer to meaningful therapies."
For more on biomarkers, go to Carved in Sand Chapter 1, Your Unreliable Brain, and Chapter 18, Do You Really Want to Know.]]>
Hope Springs Eternaltag:carvedinsand.com,2007:/blog//1.142007-10-10T19:13:55Z2007-10-10T19:25:25ZThere’s no such thing as a quick fix—or is there? I’ve spent much of the last five years researching vitamins and supplements that maximize cognitive ability. In brief, here’s what I know: In order to keep your marbles, you need...
du jour when it comes to maintaining your midlife cognitive chops. Up to 80 percent of people in the United States are magnesium deficient, a condition that may result in a short attention span, confusion, memory loss, insomnia, mood changes, apathy and fatigue. Sound familiar? Unless you’re a serious fan of Brussels sprouts and kale, there’s practically no magnesium in the food we eat. Research emerging from MIT shows that 420 milligrams of magnesium for males, and 320 milligrams for females helps maintain the plasticity of nerve cells, as well as several levels of neurotransmitters. Taking calcium and magnesium helps both supplements work better—and may contribute to sounder sleep.
Yesterday, I was paging through Science News, one of the scientific journals I read every week, and I found something that sent me scuttling to the Whole Foods vitamin and supplement aisle. It was an article about Rhodiola rosea, a sweet-smelling mountain herb that has been studied for decades in Russia. I'd heard about it before, but I'd put it on a long list of untested herbs of questionable value. (Virtually all studies that come out of the former USSR find whatever treatment is being tested to be effective. In the case of rhodiola, the details of research remained locked away because the herb was considered a top military secret.) Here, on the page, were the results of several high-quality clinical trials, in Sweden and the U.K., in conjunction with Russian investigations.
Apparently, the root of this yellow, flowering plant—one of a family of plants known as adaptogens—can do some remarkable things. Laboratory and animal studies show that the herb may inhibit cancer cells, protect healthy cells from toxins, and correct enzyme imbalances associated with diabetes. In animals, rhodiola lowers the stress hormone known as cortisol, and acts as an antioxidant. In addition, four trials with human volunteers show that rhodiola extracts can boost mental performance, prevent altitude sickness and reduce fatigue. It has been used successfully to alleviate depression. And it seems to help people who are suffering from the neurocognitive side affects of Lyme disease. In Russia, athletes and cosmonauts use it because it appears to increase aerobic capacity, speeds recovery of the circulatory system, and allows them to function under conditions of sleep deprivation, while maintaining their cognitive capacity.
How does it work? Russian studies suggest rhodiola optimizes serotonin and dopamine levels, and stimulates production of endorphins, but that’s obviously just the tip of the iceberg—more research is needed. If the herb can alleviate depression and improve mental functioning, it would be valuable indeed. Typically, antidepressants, which are strongly sedating, make patients a little foggier than they’d normally be.
A typical dosage is two 100-milligram capsules, taken in the morning. Taken too late in the day, rhodiola might interfere with sleep. There are no known safety issues with rhodiola, but comprehensive studies have not been performed. Check with your physician before taking it or any other vitamin or supplement, especially if you are taking other medications, including antidepressants. The response to this herb is very rapid—some people report improved mental states in a matter of days.
I’m swallowing my capsules right now. Give me a few weeks, and I’ll let you know. I’m not depressed. But it would be nice to feel a little sunnier as winter sets in. Hope springs eternal—maybe there is a quick fix after all.
For more on the subject of brain nutrition, take a look at “Swallow This,” Chapter Six of Carved In Sand: When Attention Fails and Memory Fades in Midlife.]]>
Not so funny, after alltag:carvedinsand.com,2007:/blog//1.132007-09-26T17:23:30Z2007-09-26T17:26:59ZI don’t usually send jokes over the Internet (or even tell them very often), mostly because I can’t remember them. This howler arrived last week from my cousin Jodi—who received it from a friend whose father was in the pharmaceutical...
Alzheimer's Association website. For a list of universities with active Alzheimer's research programs, go to this list on my website. For more on the subject of Alzheimer's research, see Chapters 17 and 18 of Carved in Sand: When Attention Fails and Memory Fades in Midlife. You’ll be doing yourself—and the rest of us—a big favor.]]>
Mind your headtag:carvedinsand.com,2007:/blog//1.122007-09-17T20:39:42Z2007-09-17T20:58:40ZI don’t mean to be unsympathetic, but I have to believe that from the day he signed his contract with the New England Patriots, middle linebacker Ted Johnson knew he had chosen a career path that mandated headlong collisions with...
Ted Johnson knew he had chosen a career path that mandated headlong collisions with speeding flesh dressed in helmets and shoulder pads. The same could be said for other professional athletes whose brains have made the news in the last year—the late Andre Waters, formerly of the Philadelphia Eagles, and Bob Brudzinski, who played 13 seasons with the Miami Dolphins and the Los Angeles Rams. They took some hard knocks—okay, a lot of them—and they've paid a grave price.
But what about the rest of us? You don’t have to be a pro football player to put your head in jeopardy. According to the National Center for Injury Prevention and Control, at least 1.1 million people each year sustain mild traumatic brain injuries. No doubt, that number is set too low: Most people who sustain such "minor" injuries do not go to the emergency room or a doctor’s office. They go home and lie down on the sofa.
The assumption has always been that our skulls—which seem pretty hard—function as protective shells. In fact, what’s inside—a brain with the consistency of gently scrambled eggs—is very vulnerable. Throughout our lives, the injuries that we experience accumulate in a way that can result in noticeable cognitive deficits. It is impossible to say how many middle-aged adults who presume they are suffering from age-related memory impairment, or maybe adult ADHD, are actually feeling the consequences of a series of earlier head injuries.
Until a decade ago, scientists regarded mild traumatic brain injury—where there is no loss of consciousness or evident structural damage—as inconsequential. You were expected to recover quickly and entirely from such an accident, and anyone who presented symptoms after a month or two was considered to be "malingering," probably in the interest in settling a large lawsuit.
Only in the last several years have experts begun to understand what happens when your brain meets the bony protuberances behind the forehead, surrounding the prefrontal cortex. Forget about being knocked unconscious: Most mildly concussed individuals remain wide awake, working their way through a variety of symptoms, from feeling dazed and confused to seeing stars. Often, there's a touch of amnesia involved—they're not sure what happened to them, before, during or immediately after the impact.
As used here, the word "impact" requires some clarification. You can have a concussion when your head encounters an immovable object—for instance, the windshield during an auto accident. But the collision can also occur internally. Slam on the brakes when you’re driving twenty miles an hour, secure in your seatbelt and guess what: Your car screeches to a stop, but your brain keeps going forward. In fact, this three-pound bolus of fat smacks your bony prefrontal protuberances at your previous pace, and then begins to imitate a Superball, ricocheting all over the place inside your skull.
Car accidents are responsible for the bulk of mild traumatic brain injuries, but increasingly, we're finding other ways to mess up our heads. Sports injuries account for more than 20 percent of the mild traumatic brain injuries each year. You can have a closetful of helmets—biking, riding, rafting, hockey, lacrosse, skiing, even river rafting—and while they'll do wonders to preserve the exterior of your skull, they don’t help much with what is inside. You can wallop your head executing perfectly innocent maneuvers: one Los Angeles woman I know walked headlong into a low hanging branch of a sturdy oak tree while reading a catalog from an art gallery she'd just visited, and knocked herself flat. Some weeks later, she was cleaning up a Coke that had exploded in the little refrigerator under a granite counter in her family room. She stood up suddenly—and wham, she was down again.
Right about the time that you’re catching your breath, impressed with your evasive driving skills and your anti-lock brakes, the cascade of damage inside your head begins. Researchers are still trying to understand exactly what happens when these injuries occur. One common hypothesis is that arteries in the brain constrict, make it impossible to deliver sufficient glucose, but that is only part of the story. When the brain makes contact with the sharp bones inside the skull, small blood vessels may rupture, releasing blood into the cranium, which, unlike other parts of the body, cannot expand to encompass it. The brain is uncomfortably squeezed for space. "Second impact syndrome," as too often experienced by Mr. Johnson and other athletes, is especially dangerous because that second hit increases that intracranial pressure. Often, as the brain does its Superball routine, microscopic tears develop in the myelin sheath surrounding the nerve fibers that transmit information from one part of the brain to another. These torn nerve fibers, called axons, develop scar tissue, which will eventually affect the speed and efficiency of synaptic impulses.
Typically, we put our mild head injuries behind us, heading back to work or school. Weeks or months later, we’re befuddled when we find that we’re suffering from inexplicable impairment—typically, problems with working memory and executive function, cognitive faculties regulated mostly by the prefrontal cortex. The real damage shows up long after the injury has been forgotten, as ruptured axons, rife with scar tissue, begin to die, reducing the capacity to process information. For many people who experience mild traumatic head injuries, the senior moments start coming fast and furiously, no matter what age they are.
It’s becoming evident that even mild traumatic head injuries (defined as injuries where you do not lose consciousness) may lead to an increased risk of Alzheimer's disease, particularly if you are a carrier of a genetic variant called the ApoE-4 allele. So far, most of the research (performed on rats at the University of Pennsylvania's Head Injury Center) suggests that repetitive mild brain trauma accelerates the emergence of Alzheimer's disease. No one has nailed down how this happens, but the theory is that the axons sheared in the Superball routine release a sudden bounty of lipids, which attract hordes of greedy free radicals, which in turn step up oxidative damage to the brain. It's been hypothesized that excessive oxidation makes neurons more vulnerable to the effects of amyloid proteins, and may also escalate the development of amyloid plaques, which slowly strangle nerve cells.
In a recent edition of the New York Times, journalist Alan Schwarz wrote an excellent piece about how head injuries are affecting 1.2 million teenagers who play high school football. As I said earlier, I'm not overwhelmed with sympathy for pro players, but my heart goes out to these high school kids. They're suffering from a common adolescent misconception: Their fervent belief in their own immortality. They keep their head injuries secret, conscientiously reporting, after they've been hit, that they feel fine—not the slightest hint of headache, no nausea or disorientation, in order to remain in the game. Pre-season, team members submit to baseline neuropsych evaluations, but they've figured out how to work 'em. Intentionally, they perform poorly—so that if they're hit, and experience cognitive sequellae, there won’t appear to be a change in their performance. Very tricky—but in large numbers, they make themselves vulnerable to second-impact syndrome.
These high school players are also suffering from lack of information—in his article, Schwarz noted that most players "did not quite know what a concussion was," and still believed that to have suffered one, you had to fall unconscious. Teenagers, observes Schwarz, are "more susceptible to immediate harm from such injuries because, studies show, their brain tissue is less developed than adults’ and more easily damaged. High school players also receive less capable medical care, or none at all." According to Schwarz, many parents and coaches exacerbate the situation by encouraging players who have taken a hit to get back in the game. One source reported that "he’d seen coaches...berate and ostracize players who complained of concussive symptoms." Parents have been known to "shop a doc," who is willing to give a concussed teen player a clean bill of health, another coach told Schwarz, so that their child can return to the game.
At least 50 high school or younger football players in more than 20 states since 1997 have been killed or have sustained serious head injuries on the field, according to the New York Times' research. The dedicated and sometimes obsessively competitive people who coach children's sports ought to acknowledge that they are not capable, at a glance, of assessing whether a young athlete might have suffered a concussion. No matter how good a player is, the only place for him or her after a bell-ringing incident (even a suspected one) is on the bench for a couple of weeks, to avoid the vastly increased danger of second-impact syndrome. Parents should demand this, but unaware of the consequences, most do not. They want to see Junior back in the game. Maybe, if he gets a little more play, he can make it to the NFL.]]>
I Never Forget a Furry Facetag:carvedinsand.com,2007:/blog//1.112007-09-06T22:44:30Z2007-09-06T22:47:40ZPeople ask me all the time why they blank on names. One scientist, Marilyn Albert, the director of cognitive neuroscience at Johns Hopkins, told me that the failure to retrieve people’s names is so common that when her researchers select...
de rigueur to insert a bunch of identifying information into a name. You were Jacob, son of Isaac and Rebecca, or Pocahontas, whose name translates as “always playful,” or, in early feudal Europe, The Lord of Something Really Big. When surnames came along—so the census takers for the Domesday Book could keep track—identifying names were handed out based on occupations—Smith, Baker, Weaver, Carpenter, Taylor, Brewer, Mason—or geography—Brook, Dale, Hill—or physical characteristics—Stout, Moody, Wise, Rich, Poor, Strong.
It’s rare to find anyone today whose given name or surname name reflects his or her demeanor, physique, hometown or profession. When you find one—the aptly named dentist, Dr. Needleman, comes to mind—you don’t have any trouble looking him up your address book. Given names or nicknames that allude to physical or psychological traits used to be good for a fond chuckle—I knew a hefty bartender everyone called Chubby, someone’s aunt who was actually named Pussy, my mother’s lively English friend who has struggled for years with the old-fashioned name Gay, and the trash collector of my childhood, who answered to Stinky. Understandably, these names are out of fashion, deemed politically incorrect. Still, I’d just love it if my electrician were named Sparky. I might not have to go through my entire database, searching for likely names, before I phoned him.
Although I do not know the name of a single human being in our local dog park, I can reliably greet most of the canine regulars. So many are endowed with names that mirror their physical traits or provenance. There’s Fidel, the Havanese, whose handle reflects his Cuban roots. There’s Einstein, a charmingly disheveled Schnauzer, and Bounce, a Jack Russell mix who came from the pound equipped with heavy-duty rocket thrusters. There’s Speed Bump, a Bassett-Beagle cross, and of course my dog Radar, who never leaves my side. My other pet, Rosie, a shepherd mutt, is more obscurely named, but I rescued her from the Santa Rosa Animal Shelter, a fact that allows people who make the connection to recall her name with ease.
Some well-known memory trainers (the kind who write books that promise that you can learn the names of thirty people at your next cocktail party) suggest that whenever you meet someone new, you ought to make a quick survey of his or her physical appearance—an attractive scarf on a redhead named Rose Sharf, for instance—and then try to link specific characteristics to the person’s name. Unlike dogs, people change things up, so this technique is loaded with ways to go astray. While you’re busily creating this image, you’re likely to miss the next six things that are happening, including introductions to several other people. It’s a fair bet that Rose won’t be wearing that pink scarf the next time you see her, or even twenty minutes later, if the day is warm. In fact, the next time you and Rose rendezvous, she may have decided that with her coloring, the russet tones are just too harsh—and gone blond.
What can you do? Before you go to an event where you are likely to see people you feel you should know, but haven’t encountered recently or frequently, review the list of names of those who will probably attend. Use a school or club directory, or check back through related correspondence. Email announcements or invitations, or anything that comes through the party invitation website Evite can be great memory joggers: Often the list of everyone who is invited is right there, in the “To” box, awaiting your inspection. Ignore it at your peril.
For more about how to stop forgetting proper nouns and other words, see Chapter Four in Carved In Sand, “Blocking, Blanking and Begging For Mercy.”
]]>
Find a Sharper Mind at the Farmers’ Markettag:carvedinsand.com,2007:/newblog//1.102007-08-20T14:44:24Z2007-08-22T17:46:32ZPhew! I’ve just returned from the San Rafael farmers’ market—gorgeous day here, so unusual for August in coastal northern California, where it’s typically foggy until noon. My kitchen counter is strewn with corn and tomatoes, peaches and nectarines, bags of...
San Rafael farmers’ market—gorgeous day here, so unusual for August in coastal northern California, where it’s typically foggy until noon. My kitchen counter is strewn with corn and tomatoes, peaches and nectarines, bags of salad greens, cartons of raspberries and blackberries, a huge bunch of sunflowers, a couple of fresh loaves of bread and a big hunk of creamy local blue cheese. Oh, yeah—there are two roasted chickens with potatoes, the delectable scent of which has, just short of noon, lured my sleepy thirteen-year-old son out of bed. Hands off, I tell him—those chickens are earmarked for dinner. I stood in line for twenty minutes for those chickens, chatting with two dozen other eager people, watching the birds go around and around, getting crispier and browner, on six spits engineered into the side panel of a vending truck. Now, I’m enjoying my just reward: a glass of fresh lemonade from a half-gallon jug, and time to write to you.
Before I get around to unpacking and washing all that produce, I wanted to record a few thoughts on the subject of brain fitness. A couple of weeks ago, I was supposed to be on a television show where—I learned at the last minute—I was to smilingly endorse the concept of computer software that helps keep your brain in shape. This, I know, is turning into a big business—venture capitalists are funding companies that bring these products to market, and TV shows, hungry for Boomer stories, are making much of these exercises. Go online and Google “brain fitness” and you’ll be inundated with new ways to sit in the dark, in isolation, in front of your computer screen, living your virtual life. Such programs have their place, of course—they can be very helpful to people who because of physical limitations are unable to get out and get their brain exercise in the real world.
I couldn’t bring myself to endorse such activities because I believe that a superior source of brain fitness exists right outside your front door.
If you’ve got two good legs (or for that matter, a nimble set of wheels), some grocery money, a sturdy tote bag or rolling cart and the gift of gab, I say leave the computer all alone in the dark, and get the heck out. Go to the farmers’ market early in the morning, just about the time the sun hits the peaches, and sop up the smells, colors and flavors. First stop: the baked-goods and coffee stand, where someone will hand you a dark brew topped with foam and a fresh-baked, slightly greasy chocolate croissant. Pause for a moment to savor these—bitter chocolate on the back of your tongue—then observe the families with flocks of giggling small children stuffing samples of juicy nectarines into open bird mouths.
When you’ve licked the crumbs from your fingers, pull a beautiful sun-warmed tomato out of the pile, squeeze it gently and sniff. If you don’t smell the vine and the soil in which it was grown, put it back and try another. No one will mind: This isn’t the supermarket, where nothing (not even the fish) is supposed to smell, everything is encased in plastic, and someone may stare if you hold a cantaloupe to your nose and sniff for signs that this ever grew from the ground. Chat with the woman responsible for growing and selling those farmers’ market tomatoes. She’ll fill you in on the crazily striped heirloom you’re holding in your hand. She may even nudge you in the direction of some other tomato—something a little sweeter, perhaps.
Maybe later, after you’ve made it home and had your lemonade (and a Sunday afternoon nap) you’ll share the bounty with friends. We’re having a couple over for dinner tonight. It won’t be fancy, just fresh greens—the kind you can’t find in the supermarket because already they’ve traveled a week to get there—and some tiny sweet peaches, sliced in two, and blue cheese, tossed in a light vinaigrette, with sugared pecans layered on top. Sweet, sour, tart, and perfect with that roasted chicken, potatoes and fresh bread—unless of course my kids get to those chickens first.
Don’t be surprised if you feel especially alert and alive when you pile your produce into your fresh basil-scented, yeasty car and head home. You’ve given your neurons a sensory treat—all five of them, sight, hearing, taste, smell and touch—the kind of workout they rarely receive. You’ve done your brain another favor—you’ve interacted with quite a few other human beings, breaking a pattern of social isolation that can become habitual with age. And, if you’ve followed my advice and invited your neighbor over to feast on the bounty, you’ve made a perfect score: Now, you’re going to have to exercise both your working memory and your long-term memory in order to make that blackberry crisp and bring it to the table perfectly browned and steaming hot.
For more on brain fitness, see Chapter Seven of my book, Carved In Sand: When Attention Fails and Memory Fades in Midlife.]]>
An Eloquent Film that Sends the Wrong Messagetag:carvedinsand.com,2007:/newblog//1.92007-06-12T14:34:43Z2007-08-22T16:42:58Z“But that’s complete nonsense,” I muttered to myself, irritating the people sitting next to me in the theater. At the end of a long book tour, I’d taken myself to see Away From Her, a film from the talented young...
Away From Her, a film from the talented young screenwriter and director, Sarah Polley. The movie addresses the relationship of Grant and Fiona Andersson, as they confront Fiona’s descent into Alzheimer’s disease. For me, it was a busman’s holiday: Several chapters of new book, Carved In Sand: When Attention Fails and Memory Fades in Midlife, address new options for early assessment, diagnosis and treatment of Alzheimer’s. There is still no cure, but caught very early in its trajectory, this disease can be treated and its insidious progress can be slowed. In the next five years, someone is going to find an answer.
To be fair, I might have been the only person in the audience – maybe in the film-going world – who had a problem with this picture. The critics reveled in the youthful Ms. Polley’s sensitive direction of her own script, based on Alice Munro’s short story, The Bear Came Over the Mountain. Julie Christie, always so beautiful, this time seemed illuminated from within, in a performance that would surely put her on the short list for an Oscar. Everything in the film gleams: the snow-covered Canadian lake where Grant and Fiona cross-country ski from their perfect cottage, the winter light through dark, lacy branches of trees.
Why, then, was I so bothered by what I saw? I knew there were people in this movie theater – in theaters across the country and ultimately around the world – who would go home, awash in silent misery, having recognized that they, or someone they knew, were already on the road to Alzheimer’s disease. They’d follow Grant and Fiona’s lead, and as a result, they’d make some terrible choices.
In the first few minutes of the film, we understand that for some time, both husband and wife have been aware of changes in Fiona’s memory. Youthful, energetic Fiona, who looks to be younger than 65, (although the film’s Web site notes that she’s meant to be 70) has been struggling for a while. Neither spouse has taken steps: Their attitude is one of quiet resignation. The Anderssons regard Fiona’s increasing forgetfulness with vague curiosity: How will it manifest itself next? Will she stow the frying pan in the refrigerator?
When Fiona skis out across the lake at dusk, and fails to return, Grant finds her asleep in the snow, and only then takes her to see the family physician. What happens in that office does not speak too highly for Canadian socialized medicine, but what usually occurs here in the States is much the same. The doctor, whose waiting room is full of mothers and children, administers a brief neurocognitive evaluation, through which Fiona stumbles, and promptly gives the couple the bad news: Dementia has Fiona in its grip.
In no time at all, the papers are signed, and Fiona – at her own insistence, and clearly against Grant’s wishes – is ensconced in Meadowlake, an assisted living facility that permits patients to remain on the lively first floor as long as they can feed and dress themselves, but sends them “upstairs,” where the bedspreads do not have cheerful flowers, when things get really bad. We never understand why Fiona is so determined to leave the home she loves, but she is: There is never talk of hiring a part-time home care aid. Not that she needs one: Fiona is so fully functioning that she packs her own suitcase, styles her magnificent silver-blond hair and leaves the house looking like she’s going to Le Cirque for lunch. One month after she arrives at this facility, she no longer recognizes her husband. She’s taken up with another man. Within the confines of that same cold, dark winter, she declines so much that she is moved to the dreaded “upstairs,” where she curls herself into a fetal position and prepares to leave the world behind for good. That makes for a great plot twist, but once again, it’s wrong: Early stage Alzheimer’s patients do not deteriorate that rapidly. Only in the last, brutal stages of the disease do patients fail to recognize their closest loved ones. The process of dying takes many years. In reality, Fiona, fit as can be from all that skiing, would likely live a decade or more at Meadowlake, no doubt swamping the family finances.
Maybe I was being unfair. I couldn’t blame Sarah Polley or Alice Munro for dispensing inaccurate scientific information, not when the emotional content of the film and the short story were so bang-on. I couldn’t blame Julie Christie for looking preternaturally young -- she is in fact 66 years old. Nor did I hold other movies to similar standards: After seeing last year’s hit, Little Miss Sunshine, I did not worry that everyone would go home, intent on reconfiguring their households to be equally dysfunctional. But Away From Her isn’t hyperbolic black comedy. It presents such an accurate portrait of the last days of a long marriage that I fear that people will accept it as gospel. If they do, they will not find their way to the right doctors. They will not go after this disease with all guns blazing. And increasingly – as scientists find new ways to intervene – that would be a mistake.
If you think that you or a loved one, or a colleague is experiencing significant or progressive changes in memory, it’s time to get a baseline neurocognitive evaluation. At the very least, this will allow for a straightforward assessment of change, six months later. Alzheimer’s disease can be treated aggressively, but you have to start early: Wait, like most people do, until destructive beta amyloid and tau proteins have woven themselves into the plaques and tangles that murder neurons, and there is nothing to be done. Never rely exclusively on a family physician for diagnosis: Instead of waiting months (or was it years?) to take their big truck down the road to Meadowlake, the Anderssons ought to have driven to the University of Toronto, or to McGill, where Fiona might have been evaluated by those who actually have expertise in diagnosing and treating memory disorders. (A complete list of Alzheimer’s research centers can be found on my website, at www.carvedinsand.com/ramin-links.htm. A list of experimental clinical trials can be found at www.clinicaltrials.gov. On that site, you’ll find trials of every piece of heavy artillery in the fight against Alzheimer’s – new drugs, vaccines, and gene-based therapy, shunts that sift the rogue proteins out of the bloodstream. At this moment, 153 such trials are recruiting participants. Over the next five years, one (or more) of them is likely to stop Alzheimer’s in its tracks. They are as varied as science is, but all rely on the willingness of human participants to volunteer. There is no need to sit quietly, like Fiona, and wait to succumb.
Cathryn Jakobson Ramin is the author of Carved in Sand: When Attention Fails and Memory Fades in Midlife, published by HarperCollins.]]>
In Praise of an Imperfect Memorytag:carvedinsand.com,2007:/newblog//1.82007-05-30T19:23:06Z2007-08-22T16:42:58ZDr. Michael Seabaugh, a clinical psychologist in Santa Barbara, California and author of Healthspan, a weekly column on healthy aging, is a new friend of mine. We met each other online, after he wrote a rather wonderful column about CARVED...
Dr. Michael Seabaugh, a clinical psychologist in Santa Barbara, California and author of Healthspan, a weekly column on healthy aging, is a new friend of mine. We met each other online, after he wrote a rather wonderful column about CARVED IN SAND. Since then, he’s been sending me his work. Here’s an essay of his I love so much that I asked him if I could put it in my blog. Fortunately, he agreed. I hope you enjoy it as much as I did.
As the old observation goes: Today’s sorrow, plus time passing, equals tomorrow’s comedy. Memory can be kind in that way. Today we cry, tomorrow we laugh.
We complain endlessly about our skeedaddling memories, yet there is more to consider than whether or not we can remember where we put our keys. Sometimes our unreliable memories can be most helpful and forgiving.
Think of it this way: We will often remember the giddy feeling of the champagne and not the hangover, ergo the tendency to pop the cork on that next bottle of bubbly. Women who’ve gone through childbirth tell me that if they could actually remember the pain they went through, they would never choose to go through it again.
According to the Nobel Prize-winning Princeton psychologist Daniel Kahneman, we tend to repeat experiences that seem more palatable in hindsight than they actually did at the time. In other words, our experiences and our tendencies to repeat them have less to do with pleasure and pain — as one might suspect — but more to do with our fallible memories of pleasure and pain.
I have noticed that we filter our memories differently. There are those who only remember the pain of life, ignoring the more blessed moments. And then there is the “half-full memory” crowd that only remember the good times, forgetting all those dark corners. I happen to fall in the latter category. People close to me will sometimes remark on my ability to forgive and move on. Truth is, I really can’t remember the pain and drain of those bad times. It is not some moral highness I possess; it is probably just good, old-fashioned denial.
In other words, the fidelity of our memories can be very much a function of our individual coping styles. Some will happily wear yesterday’s memories today like outdated fashions, while others will deliberately cut themselves off from memory, retaining no keepsakes from the past. Some will become overtaken by a memory in a way that they can’t escape; such is the case of PTSD (Post-Traumatic Stress Disorder). Of course, there is also the garden-variety neurotic who stews in the past, like some Woody Allen bobblehead.
There is the boon of not remembering all those terrible things we did once upon a time but wish we hadn’t. I remember my father saying that a man with a clear conscience probably has a poor memory. And then there is someone else’s father — Franklin Adams — who opined: “Nothing is more responsible for the good old days than a bad memory.”
And sometimes an abstracted memory can provide us with some of life’s greatest pleasures. Have you ever noticed there is no summer day in the present that compares to the remembered summer day from childhood where there was a swarm of fireflies on a balmy night that smelled of honeysuckle?
On the other hand, we must remember those who forget the past are more likely to repeat it in the future with potentially dire psychological and interpersonal consequences.
So what is better? The harsh comptroller of exact memory, or the more romanticized sieve of memory? It’s hard to say. One thing to consider is the well-researched finding that optimists do live longer. And it does seem that to be an optimist you need an errant memory. So maybe the fallibility of our memories — something that can cause chaos in the short run when we are trying to remember why we just walked into our living room — can be a boon to our longevity.
One of my mother’s favorite sayings is, “My imperfect memory has served me well; it has given me roses in winter.” This lovely and lively woman will be celebrating her 87th birthday in fine form next month.
Mothers' Day and Memoriestag:carvedinsand.com,2007:/newblog//1.72007-05-12T19:20:19Z2007-08-22T16:42:58ZAs mothers, when our children are young, it’s our job to remember everything: Birthday parties, the dates and times of appointments with the pediatrician, when the summer camp applications are due, and – before we try to leave him at...
As mothers, when our children are young, it’s our job to remember everything: Birthday parties, the dates and times of appointments with the pediatrician, when the summer camp applications are due, and – before we try to leave him at the kennel on our way to the airport - whether the dog is current on his vaccinations. Standing in the emergency room, alarmingly bloodstained, we must recall whether the child who just met a rusty nail is in fact the one who received a tetanus shot two years earlier. As mothers, our heads are stuffed with details, until we are certain that one more item on the list – something as simple as remembering to get pepperoni on one half of the pizza, but not the other – will cause a messy rupture.
Later, in middle age, just when you think you can safely stop reminding your kids to brush their teeth, it gets harder. Our maternal brains must continue to function as the central switchboard, through which all information is routed. If we’ve raised them right, adolescents will begin to do some of their own remembering. Unfortunately, they are inconsistent: The responsible young man who makes his own driving test appointment and reminds you of it ten times in three weeks must be pulled off the tennis court, sweaty and irritable, when it is time to sit down for dinner with Aunt Sarah. Mostly, we act as unpaid personal assistants, setting up and canceling appointments, tracking down books, ferrying supplementary meals over to the high school for hungry kids who are working on a project late into the evening. As mothers, we are quick to adopt a mea culpa stance. If we’ve neglected to remind a teenage child to rise at 6 am for a 7:30 date with the SATs, we know whose fault that is.
When that switchboard begins to fail - and for most of us, this happens somewhere between forty and fifty - those who have relied upon us are appalled. If you forget to make the traditional carrot pudding for Thanksgiving, or blank on the name of a teenager your child has known since pre-school, prepare to be awash in adolescent contempt. Dig deeper and you’ll discover that the kids are terrified that your internal hard drive is failing - that the archive will be lost. They have private memories, ones that you’ll never share, because thankfully, you weren’t there. But you’re still the Keeper of Who They Are. You, their mother, can tell them many embarrassing things about themselves that they’d prefer to keep buried in their unconscious. But you’re also the one who knew, way back in third grade, that one day they’d publish a novel, design a building, or find a way to make peace in this world. As mothers, we cling to those early memories, making regular forays through the photo albums we assembled when the children were small. Sometimes, to keep up the façade, we fib just a little – yes, of course we remember Jill, now 22 and impossibly beautiful, from the middle school soccer team. How could we possibly forget?
A Minor Distractiontag:carvedinsand.com,2007:/newblog//1.62007-04-10T17:16:08Z2007-08-22T16:42:58ZIn my book, CARVED IN SAND, I write about our inability to fend off distractions in middle age. One of my favorite research studies dealt with what one scientist called “the neural bouncer – just like the one outside the...
Good Morning America, I was living it. Usually – because I know my neural bouncer quit long ago – I’m conscientious about keeping my environment as free as possible from distractions. Unlike some people, I don’t keep the radio or TV on while I’m doing other things, because they prevent me from thinking straight. I can’t even tie my shoes if there’s something intriguing on the Discovery Channel – that’s how bad it is.
The producer at GMA picked me up from my hotel right on time, and walked me across the street for hair and makeup. Once in the chair – TV blaring, (even I knew that it would be wrong to ask them to lower the volume on Diane Sawyer so that I could concentrate) the fun began. While the hairdresser crimped my limp locks, and the makeup artist swabbed and sponged away the dark circles under my eyes, producers surrounded me, dropped documents in my lap, and started asking questions about the frontal lobes and the hippocampus – which was spelled how? Was it correct to say….? My head buzzed. My shoulders ached. I couldn’t talk, because my lips were being glossed. I wished to shout: “Did anyone read my book? Because if you did, you ought to know that I can’t talk more than one person at a time!”
That was just the beginning. We tiptoed on to the stage, winding our way amongst the always-present mob of technical crew and talent. A polite young man reached gingerly inside my sweater to position the microphone. Once escorted to my chair on the stage, I tried to compose myself, but this was unlikely: Ms. Sawyer was on the set, ready to talk to me about our segment. Although the noise and bustle level in the room was astounding, Ms. Sawyer spoke in a very soft voice. I leaned forward to hear her, commanding myself to focus on her words, despite the fact that another young man had decided that the microphone had to be repositioned and again had a hand down my sweater. In the split second we had remaining, I tried to remember what I’d said yesterday on the show – otherwise, I’d be likely to repeat myself. I drew a blank.
Five, four, three, two, one – all was silence, and then we were on. A miracle: total, in-the-flow focus. No one there – no one in the world – but the two of us. I answered her questions. I think I smiled. I might have thrown in a joke. And then, as fast as it had begun, it was over, the stage was abuzz, and I was on my way out the door. I barely avoided the knife-sharp edge of a monitor, aimed at my forehead, on the way out. Everybody congratulated me on a really good two-part segment, and I thanked them, doing my best to carefully pack away, in my treasure chest of memories, all that had happened since this trip began.]]>
Enormous Changes at the Last Minutetag:carvedinsand.com,2007:/newblog//1.52007-04-04T22:38:55Z2007-08-22T16:42:58ZI always loved that title – it’s Grace Paley’s. Yesterday, I experienced them first-hand. It happened so fast. Early in the morning, I was sitting at my desk, looking at a tour schedule that, to my way of thinking, included...
USA Today piece had just been published, and I was happy. Casually, I considered how best to pack my suitcase for my departure on Saturday night. At 9:30 a.m., I threw on some clothes and headed up the highway for a haircut.
The salon is a noisy place, and even if I could have heard my phone ring in my bag on the floor, I wouldn’t have answered it in mid-snip. I glanced at the screen as I paid my bill, and noticed that I had four voice mails – a lot for me. Before I crossed the parking lot to my car, the cell rang again, and my publicist asked where I’d been – she had big news.
“Getting my hair done,” I said.
“Well, that’s a good thing,” she said, “because you’re booked on Good Morning America, and you have to leave tomorrow.”
Months ago, when we sent GMA the publicity materials for Carved in Sand, we’d had high hopes, tempered with low expectations. This was my first book, and attractive as the subject matter was, it would be sheer hubris to think that I’d make it to the big time.
“Can you do it?” Camille asked.
“My calendar,” I said. “Let me think.”
In the course of writing the book, I learned that two places that I once successfully stored information – the figurative “back of my mind” and the metaphorical “top of my head,” (as in, “off the top of my head”) ought to be avoided at all costs. I have proven, again and again, that there is no longer any such place as the “back of my mind,” and anything that comes “off the top of my head” is bound to be seriously inaccurate.
“My older son’s birthday,” I wailed. “Thursday. And my younger son’s classroom performance of A Midsummer Night’s Dream. He’s Bottom.”
There was silence on the other end. I knew what she was thinking. Would I really give up an opportunity like this in order to celebrate a 17th birthday, or view a bunch of 7th graders reciting Shakespeare? We’d run lines for weeks, and the kid had the part down. I sucked up the guilt. Briefly, I bathed in it. Then, I told her to say yes, wondering all the while how I was going to leave on my tour three days early. I’d sorted out a few clothes over the weekend, but the to-do list that remained was legion. My husband would not be pleased. Two and a half weeks away was a great long stretch that had to be carefully planned and negotiated. Now, it had stretched to three.
Within minutes, GMA’s machine was in motion. Last second airline tickets (ooh, how much did those cost?), limousines, hotel rooms and media escorts were all in place. Suddenly, my publisher, HarperCollins, a company that had taken a “let’s wait and see what happens” attitude for months, loved me and couldn’t do enough. Overnight, it seemed that my professional life had been transformed.
At three in the afternoon, around the time I usually turn from working writer to full-time mom, another call came. GMA would like to send a producer and a camera crew to my house for some pre-taping – just a little interview and some B-roll footage. Could they meet me at home at 5 pm? That gave me two hours, and to be honest, I still hadn’t found a moment to take a shower. My hair, freshly conditioned with some expensive thing the stylist insisted I needed, hung limply. I was to dress casually, as I would if I were hanging around the house. I assured the producer that he did not want to see – ever – what I looked like when I was hanging around the house. Remarkably, my once-a-week house-cleaning service had been in just that morning, so at least I was not going to have to get out the mop. I called the kids and my husband, warning them of the tornado that was about to strike.
“Where are you?” I asked my elder son, when I reached him on his cell.
“On the way to work,” he said.
“Um, when you get home, there will be a camera crew from Good Morning America in the house,” I said.
Another moment of silence. Then, with the utmost cool, the kind that an about-to-be 17-year-old musters better than anyone else: “O….kay, then.”
The crew turned up on time, and instantly, it was a party. Our two dogs assumed that the crew was there to film them, and began to bark insanely, while they chased each other from kitchen to dining room to living room. To escape, I suggested that we get some footage along the walking path near my house, with San Francisco Bay in the background. Back at home, they taped a long cuddle session with my boys on the sofa, photo albums open before us. “We really do this,” I assured the producer. “It’s one of our favorite ways to remember things, especially when it’s going to be somebody’s birthday.” Around 9 pm, the crew departed. We all looked at each other, thoroughly exhausted.
“This means you’re not going to be here for my birthday, are you, Mom?” my older son said morosely. “What about my presents and my birthday dinner?”
I shook my head, and again the guilt washed over me. I’d never missed a family birthday celebration before. In fact, I’d made a big deal about how showing up for family events was not optional, looking ahead to the years when the guys would have wives. And a mother.
“I am very, very sorry,” I told him. “But this is important, for all of us.” Could I really expect him to understand? Was he that grown up? One look at his face told me that he was struggling. I invited him to bring a friend and meet me for the weekend in Los Angeles in a couple of weeks, where I’d be giving a reading.
“We’ll go out for a fancy dinner,” I said brightly. “We’ll have fun. It will be okay.”]]>
Blind Faithtag:carvedinsand.com,2007:/newblog//1.42007-04-03T16:48:05Z2007-08-22T16:42:58ZYesterday, I wore my reporter’s cap in this space, writing about Scooter Libby’s putative cognitive deficits. Today, in the middle of my book tour, I’m going to try to catch up with myself. As of this morning, Carved in Sand...Carved in Sand is on the shelves of nearly every bookstore in America. A feature story about my journey appears in USA Today. For a slew of reasons, that is amazing. A decade ago, my cognitive firepower was definitely on the wane. As I write in the first pages of the book, “Something was happening to my mind. I felt vague and foggy. I couldn’t remember what I’d read for much longer than it took to get to the bottom of the page.”
I was suffering from something – but I couldn’t name it. I thought that maybe I’d lost my edge -- a sad thing at 40, especially when the career I loved – investigative reporting and feature writing for magazines – depended largely on my ability to retain and synthesize information. I couldn’t think of anyone I could tell, so I kept my troubles to myself. If the same difficulties hadn’t cropped up a few years later among just about everybody I knew – irritating glitches involving proper names, elusive mental calendars – I might have stayed silent. Instead, I decided to make myself a guinea pig, exploring every possible intervention, in an effort to figure out what was going on upstairs.
When I decided to take on Carved in Sand in my mid-forties, my confidence in my mind had seeped away. The steel trap I’d possessed in my twenties and thirties had been replaced with a kitchen colander. Frankly, the prospect of tackling relentlessly complex subject matter – neuroscience, biochemistry, and genetics – made me woozy. For months, I went blind with anxiety when I scanned the dense pages of peer-reviewed professional journals that formed the basis of my research. But here’s what surprised me: My editors and agent were absolutely confident that I had what it took to pull it off. They produced contracts and proffered advances, carefully ignoring the facts that I’d laid before them in my book proposal: My middle-aged mind was behaving unnervingly. When, in the interest of full disclosure, I noted this, they might as well have clasped their hands over their ears.
Often (usually in the middle of the night), I wondered what had allowed these experienced professionals to take such a bold step. Did they not see what I knew too well – that someone had snatched the poles from my intellectual tent? When they talked to me and read my work, did they somehow encounter a smarter, more insightful version of me than I could find in myself? Couldn’t they hear me grasping for words, fudging conversations when proper names disappeared, arriving windblown and out of breath because I was looking for a building I’d been to several times – on the wrong block? Wasn’t it obvious?
Finally, I concluded that their interests were wonderfully selfish: They, too, were in middle age, struggling with daily episodes of forgetfulness. For them, I was a Russian monkey-cosmonaut: If I – who had the nerve to go public with my cognitive shortcomings – could find a solution, maybe they – and the whole middle-aged world -- could benefit.
Their confidence – which never flagged – worked miracles. They knew, certainly, that responsibility was (and continues to be) my middle name. It’s a known fact that I’m constitutionally unable to let anyone down. They knew that I was meticulous, even compulsive in my research – the nagging voice that tells me that something is still missing from the picture won’t shut up until I get to the bottom of a difficult question. But these traits – however laudable – wouldn’t have been enough to produce a book of the size and scope of Carved in Sand. They had no way of knowing that I’d be able to sustain a narrative for 265 pages, or that I could manage the many hundreds of interviews that were required, nor that, once the book was published, I could handle three media appearances a day for a month straight. They took it for granted that I possessed the mental filing cabinet that would allow me to produce nearly 500 full citations – the list of endnotes that appear on page after page at the end of the book.
In short, those editors and that literary agent made a wager. They banked on my brain – that it was still good enough, and that it would get better. They bet right: The very work of writing Carved in Sand was exactly the antidote I needed. The intense mental effort involved – which went on seven days a week, for over three years kicked my lazy neurons back into action. Some days, I swore I could feel it happening, the ebullience of the hook-up …synaptic connections zinging to life, new associations made, deeper understanding emerging.
In Carved in Sand, I write about new research that suggests that the best way to maintain your brain is to offer it relentless challenges. Get out of your routine, and take on something that doesn’t come easily. Take up chess. Learn salsa dancing. Get into a bridge game. Leave the microwave alone. Instead, shop for and cook – from a recipe – a complicated meal – and time it so you get several courses on the table in a timely fashion.Or, if you have four years, write a book.]]>
“Startling...”tag:carvedinsand.com,2007:/newblog//1.32007-03-28T16:46:56Z2007-08-22T16:42:58ZIn the New York Times on March 21st, Jane Gross observed that a new report from the Alzheimer’s Association shows a 10 percent increase in the number of people who are suffering from Alzheimer’s disease. She writes, “…the report includes...
Alzheimer’s Association shows a 10 percent increase in the number of people who are suffering from Alzheimer’s disease. She writes, “…the report includes the startling finding that 200,000 to 500,000 people younger than 65 have some form of dementia…”
I’m not clear why she finds this startling: As procedures for early assessment and general awareness of the symptoms of the disease increase, increasingly, middle-aged people will receive the diagnosis of Alzheimer’s. That sounds like a terrible thing, but in fact, it is simply the acceptance of a barely acknowledged truth: That Alzheimer’s is not exclusively a disease of old age. (For further information about the prevalence of dementia in midlife, look at the Alzheimer’s Association’s report, Early-Onset Dementia: A National Challenge, A Future Crisis. Current research suggests that the seeds of Alzheimer’s are sown in midlife. Most important: The best time to treat the disease (and probably the only time that treatment can be effective) is in a very early stage, before neurons are crippled and begin to die. For more information on this, you may want to read Chapters 17 and 18 of Carved in Sand. The ease and accuracy of early assessment will depend on the effectiveness of new biomarkers that are currently under study by the Alzheimer’s Disease Neuroimaging Initiative (ADNI) and other groups.]]>
Feeling Puzzled?tag:carvedinsand.com,2007:/newblog//1.22007-03-27T13:54:17Z2007-08-22T16:42:58ZYou know that mental challenges are what keep your brain in trim, but even the toughest brain-teaser can start to seem like old hat. What do you do when you’re the office sudoku champion, or you whip through Friday’s and...
sudoku champion, or you whip through Friday’s and Saturday’s puzzles without setting down your pen ?(!) As cited in Sunday’s New York Times (March 21, 2007), you can take on one of Maki Kaji’s new offerings. He runs the Japanese company called Nikoli, marketing a vast array of puzzling offerings. The company doesn’t invent puzzles, but instead serves as a testing ground for thousands of ideas submitted by Japanese puzzle makers. Maki Kaji says he has at least 250 more puzzles, most known only in Japan, ready to go.]]>
And Today’s Forgetfulness Award Goes To...tag:carvedinsand.com,2007:/newblog//1.12007-01-29T01:35:30Z2007-08-22T16:42:58ZThis morning, as I entered my 8 a.m. exercise class, I encountered a fiftyish woman who was very upset -- someone had apparently walked off with her car key, which she had left on one of the shelves at the...
This morning, as I entered my 8 a.m. exercise class, I encountered a fiftyish woman who was very upset -- someone had apparently walked off with her car key, which she had left on one of the shelves at the back of the studio. Experienced in handling these sorts of emergencies, I told her that she’s probably placed it on a different shelf, at a different height, in a different part of the room, or perhaps on some surface that had shelf-like properties, but was not in fact a shelf – maybe a window sill? This, I explained was called “wrong vessel syndrome,” and it affected most of us. It was why you put the ice cream in the cabinet instead of in the freezer. The woman was not interested in my enlightening explanations. She was late for work, and unsure whether to head for the showers or to keep looking. I made a quick survey of all surfaces, but found nothing. Might she have left the key in her jacket pocket? Or even in the car? Had she perhaps left the key on a shelf at a prior class, but not before this one? Just then, another middle-aged woman sat down to lace up her sneakers, and plucked the key from the interior of her shoe. Mortified, she handed it back to its owner. “I have absolutely no recollection of picking up that key or putting it in my shoe,” she said. “It doesn’t even look like my car key. I must be losing my mind.”