Outliving Your Brain

By on February 27, 2012

In the debate on health care, many Americans cite Quality-of-Life issues as being an important yardstick. Few people I have spoken to express a desire to live on after the quality of their life has gone. Many state they do not wish to be a burden to their children, their family or loved ones. Trouble is, this is a situation beyond their ability to control.

Alzheimer's under the microscope

One of the major threats to quality of life in the 21st century is the mental deterioration associated with Alzheimer’s disease. It is now the most common form of dementia. Formerly known as pre-senile dementia, this condition is still little understood by the average American. Indeed, it is still something of a mystery to investigators.

Most people know that it starts with forgetfulness, leads to confusion, may exhibit paranoid behavior, and if it progresses to the end-stage, will leave the patient in a vegetative state. There is no cure. Newer drugs may slow the progression.

We know that all humans lose brain cells with aging. But some people can live into their second century with cognitive (reasoning) function pretty well intact. In Alzheimer’s disease, the loss of function is greatly accelerated. The incidence starts as early as 40, increases with age, and becomes more common after 70. President Ronald Reagan is perhaps the most famous American to have suffered from this  disease. It can start at any age.

Genetics is a factor. A family history increases the risk. There is also a higher incidence in patients already suffering with diabetes and Parkinson’s disease. There are others factors yet to be identified. Under the microscope scientists see the build up of protein deposits blocking nerve ‘message’ transmission. On imaging scans, they see loss of brain size. Under the microscope there are characteristic ‘tangles’ of nerve endings and protein plaques. What triggers this process is still unknown.

Ironically it is one disease that least concerns the sufferer over time. They retreat from life to a place unknown. Childhood memories are often the last to fade.

As modern Americans escape the ravages of other problems of aging like cancer, stroke  and heart disease thanks to scientific advances and healthier life styles, the likelihood of living long enough to experience  dementia looms larger. With the large numbers of baby boomers nearing the age when dementia significantly increases, how will our society cope with this problem in the future?

It is a health care reform concern. Its onset can be slow and insidious leading to many doctor visits before the diagnosis is made. Depression can masquerade as early signs of the disease. It will impact Medicare. It will impact Medicare co-payments. It will likely become a political football in the current climate in Washington.

It will have a great impact on the generation in-between, young people now with small children, holding jobs for financial reasons, caring soon for aging parents, perhaps not affluent enough to afford nursing homes or adult day care. Costs are increasing rapidly. Insurance to cover the care of dementia, which can drag on for years, is all ready expensive. The challenges of caring for a parent with Alzheimer’s is great, if they remain at home. The stresses are great. But, it is likely we will see a gradual return to elderly parents being kept at home for financial reasons.                                                                                                               

In spite of this, one futurist has predicted a honeycomb of ‘warehouse-facilties’ across the country, filled with senior citizens who do not know who they are or where, physically functioning but not mentally, financially dependent on their children or the state or whomever. It is an uncomfortable topic, even a painful one for kitchen table discussions. But one fully worthy of national attention.

For more on the disease, please visit: http://www.alz.org/

Tom Godfrey

About Tom Godfrey

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