Posts tagged: Alzheimer’s Disease

A Question of Alzheimer’s

There is a single question that may accurately and reliably differentiate between dementia and normal aging.  Not only is this question  potentially able to discriminate between normal senility and dementia, it may prove a powerful method to differentiate Alzheimer’s Disease from other types of dementia.

Here is the question.  How is your memory?

Perhaps this appears too simple to be elegant.  As with any rule to describe complex phenomenon, the rule only has power within specific boundaries.  For example, Newtonian physics is so powerful that it largely accounts for the success of NASA’s space program.  Newtonian physics loses most of its predictive power when the object is going very fast, or is very small.  This in no way renders Isaac Newton’s mechanics useless, rather his worldly physics is extremely useful within certain parameters.  If the observer loses sight of these parameters, then the power of the system may suffer.  A rule that holds true for all phenomenon is compelling, but it may come at the expense of explaining anything in the particular.

The boundaries that are important for this rule are predicated on the functioning of the person before dementia is suspected.  When a person is questioned regarding the status of their memory, this directly calls upon their level of self-awareness.  The awareness of self appears to be well correlated to intelligence, but again within specific parameters.  If one questions a person with mild mental retardation regarding a cognitive skill, they will likely have some idea of the meaning, but their responses will not be very accurate in relation to informants.  Questioning someone with moderate mental retardation will reveal that they do not understand abstract concepts regarding cognition.  Once low average intelligence is reached, self-awareness is typically functional.  There is a lack of evidence indicating that self-awareness increases with above average intelligence.  It may increase, but research that converges on this conclusion is lacking.  A general rule offered is that self-awareness is likely normal until intelligence falls below the average range.  As with any cognitive skill, self-awareness may be significantly greater or lesser than one’s Full Scale IQ, but it will likely be well correlated across thousands of individuals.
These herbal erection enhancers are made levitra on line of ancient aphrodisiac ingredients that are known to boost the male sexual functions and preserve sexual pleasure at the same time. the medicine is Sildenafil citrate. The medications are: Oral Tablets: Tablets made of Energetic Key Ingredient: This medication has formulated with the best price on cialis vibrant key ingredient sildenafil citrate. A few of them are -Tadalafil (Adcirca, generic viagra cipla)Avanafil (Stendra)Sildenafil (Revatio, viagra)Vardenafil (viagra sale, Staxyn) All of the above listed Erectile Dysfunction Drugs and, when you buy online, significantly cheaper than any equivalent herbal product. A subluxation is a dysfunction in a joint causing nerve interference. cialis online pharmacy
The other boundary that needs to be considered is age.  It is unlikely that this question has much utility before the age of 75.  Purely as an artifact of testing thousands of patients, it is rare for someone before the age of 70 to complain about their memory.  By the age of 80, most non-demented patients of average intelligence complain about their memory.  People in their 80’s are self-aware that their memory has declined, which is realistic and insightful.  The ability to name common objects and freely recall verbal information starts to decline in our 50’s, and is very evident to ourselves and others by the late 70’s.  In addition, people who age well are typically irritated by their inability to recall and generate names for people and objects.  Even in the early stages of a senile dementia, the victim is not bothered by their poor performance, and they frequently generate external causes for their inability to name or recall.

The next time you speak with someone in their 80’s who is constantly bemoaning their memory, let them know their cognition is likely just fine!  Conversely, the next aged person with whom you speak reporting an excellent memory should be a cause for concern.  If this person is college educated and held a middle-class job, then be very concerned.  If the person is suspected to be below average in terms of education and vocation, then the answer to this question is less revealing.  Also remember that this question is less able to discriminate between normal aging and Alzheimer’s in those younger than 75.  There are many causes of poor verbal memory throughout our lifespan, but the early degradation of self-awareness is nearly unique to Alzheimer’s Disease.  This is likely the source of the question’s utility and power.

Whether it is termed the “dementia question” or the “Holzmacher paradigm” is less important than future research into the uses of this questions for clinical practice.  This single brief question may offer physicians a procedure to accurately make dementia referrals, as well as provide a simple way for caretakers to make treatment decisions.  The greatest difficulty with the question is that it appears too simplistic to be meaningful, let alone useful.  Perhaps Friar Ockham was correct, amongst competing explanations, the simplest solutions are most satisfactory.  If anyone knows of a simpler method to reliably differentiate between normal aging and Alzheimer’s Disease, please write as soon as possible.  It is hoped that clinicians will weigh in on this proposal, as my razor may have removed a bit too much.  As always, comments from any interested party are welcome.

Is Alzheimer’s a Disease?

Is Alzheimer’s Disease truly a disease?  The word “disease” is defined as an “abnormal condition or illness” in the dictionary, and Wikipedia describes disease as “an abnormal condition affecting the body of an organism.”  The word shared in common between these definitions is “abnormal.”  What is labeled as “normal” or ” abnormal” is not a trivial distinction.  It encompasses much of the training I received towards becoming a clinical psychologist.  For something to be regarded as “normal” it must be observed to be the typical/common state of affairs.  This rests on the assumption that people are accurately and reliably able to distinguish between what is common and what is exceptional.  Where does one draw the line between the average and the exceptional?

Consider shoe sizes.  My feet are a size 12, and about 5% of males share this large size.  A size 12 foot is not the average for a male, but it is not uncommon.  The same size foot in a female is not average and it is fortunately uncommon.  What is considered or measured to be the average is highly dependent on the group being considered.  The deviation of my foot size from the human average increases when compared to females, Asians, and pygmy tribesmen-no relation is expressed or implied.  Though my feet are abnormal, they function quite well notwithstanding!  The notion of “normal” is an interval centered about the average of the population under consideration.  The notions of “normal” and “average” only have meaning in light of the specific population(s) being considered.  A statistical analysis may discover that male shoe sizes between 6 and 10 are within the “normal” range, whereas sizes less than 6 or over 10 are labeled “abnormal.”  The term “abnormal” should not be equated with the word “dysfunctional.”  An IQ of 130 is certainly abnormal, but definitely not dysfunctional.  These terms only have real meaning when nested within specific groups, defined by measurable functional outcomes that are evaluated over a finite period of time.

Most men are interested in enlarging their penis size Erectile dysfunction purchase female viagra affects one-third of men irrespective of age or race. Since different companies manufacture tadalafil best prices and cialis, these pills differ also in color, form and names. Decreased activity of mitochondria-specific proteins, including the transcription factor levitra free PGC1, a regulator of mitochondrial biogenesis, were also noted. One such issue which has bad effects later on is the dosage pattern which basically decides the after eating online viagra effects. So is a senile dementia of the Alzheimer’s type really a disease?  The quickest answer is that the biological process of Alzheimer’s is not a disease, but the end result of the process could be termed a disease.  All humans acquire neuritic plaques and neurofibrillary tangles as we cross the age 50 boundary.  Correspondingly, free verbal recall and naming decline with so-called normal aging.  The tangles and plaques are the organic hallmarks of Alzheimer’s Disease.  Less mentioned is that these tangles and plaques increasingly infest the brains of all middle-aged humans.  It is largely a question of degree.

Once the neurofibrillary tangles and neuritic plaques encompass about 30% of the cerebral cortex (brain’s outer coating of gray cells), the unfortunate person will exhibit the early symptoms of Alzheimer’s Disease.  Less than 30% of the cortical area manifests as “normal” cognitive decline, and over 30% of the cortex affected results in symptoms of early AD.  The organic pathology of AD is undifferentiated from normal aging until it is observed to cause functional impairment.  Even though the organic pathology is “normal,” the uncommon extent of the pathology and the unusual decline of mental skills could be termed a “disease.”  Similarly, all humans lose critical neurons that help us modulate and initiate motor movements as we age.  If more than 60% of these dopamine producing neurons are lost during our lifetime, we will exhibit the symptoms of Parkinson’s Disease.  Generally, under a 60% loss of the dopaminergic neurons will result in “normal” age-related tremors.  Once again the natural process of aging is labeled as a disease if its manifestation is unusually powerful and negative.  In the near future, I will address what people can do to minimize their chance of becoming “abnormal” in their old age.