Archive for May, 2015

It is increasingly clear that becoming demented as we age is more than just Alzheimer’s disease. There may be few if any “pure” cases of Alzheimer’s disease. It may be the added wear and tear from added medical burdens in conjunction with the pathology of Alzheimer’s that leads to dementia. We already test for factors such as B12 deficiency, thyroid deficiency, and acute infections as they may impact cognitive function and are treatable conditions. However, we ignore many diseases that may take a toll on brain function and cognition. We are just coming to terms that such events as surgery, treatment of cancer, sleep apnea, and repeated head injuries have short and long term effects on cognition. The cumulative load is too much for biological and psychological compensation with time and aging. One often-ignored disease is lung disease such as […]


Lumosity, the “brain training company”, is booming. Everyone is looking for the magic, quick, easy way to fortify his or her brain in hopes of staving off dementia. However, know this. The brain is designed to elaborate itself from experience (in a very broad sense). The foundation of our being is learning and memory. That got us through growing up and it will get us through aging if we just do what comes naturally and you don’t have to pay a fee. That is, interact with the world about you. There is so much marketing and appeal to science – that is often not founded in reality – that one can lose track of a very simple fact. The brain enriches itself by the mere act of engaging in the world. Here are some ideas from an article in the […]


Has the diagnosis of Alzheimer’s disease outlived its usefulness? I have felt for some time that the diagnosis of Alzheimer’s disease has no clinical utility. First, one can have Alzheimer’s disease and never become forgetful. Second, one can have Alzheimer’s disease with memory loss but not become demented. Third, one can become demented and not have Alzheimer’s disease. Fourth, we do not know the cause of Alzheimer’s disease as evidenced by the massive failure of amyloid treatments to date. Fifth, there is no pure case of Alzheimer’s disease in the elderly. Finally, there is no specific treatment unique to Alzheimer’s disease. The real life problem is not that someone has Alzheimer’s disease but rather the practical issue is whether one can be competent to handle the tasks of independent living: self-care, toileting, dressing, doing the checkbook, getting around, learn, being […]


Despite the “therapeutic nihilism” that seems to dominate thinking about Alzheimer’s disease there are essential components that should be included in managing Alzheimer’s. Jeffrey Cummings details these components in the Annals of Clinical and Translational Neurology (A practical algorithm for managing Alzheimer’s disease: What, when, and why? 2015, 2, 307-323, PMID 25815358). An effective treatment plan should include: Strategies for managing risk factors starting at least in middle age. Consider adopting a “Mediterranean style” diet; minimize consumption of alcohol; supplement with omega 3, B vitamins, and E (if already clinically diagnosed); exercise regularly; engage in intellectual interests; become educated about Alzheimer’s disease; participate at some level in music and art; get adequate sleep; manage stress, let a pet adopt you; include stimulating day programs appropriate for the various stages of memory loss for those already diagnosed; and use a calendar […]

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