Older people with mild cognitive impairment showed improvements in brain blood flow and memory after a yearlong aerobic exercise program.
Brisk walking improves brain health and thinking in aging people with memory impairments, according to a new, yearlong study of mild cognitive impairment and exercise. In the study, middle-aged and older people with early signs of memory loss raised their cognitive scores after they started walking frequently. Regular exercise also amplified the healthy flow of blood to their brains. The changes in their brains and minds were subtle but consequential, the study concludes, and could have implications not just for those with serious memory problems, but for any of us whose memories are starting to fade with age.
Most of us, as we get older, will find that our ability to remember and think dulls a bit. This is considered normal, if annoying. But if the memory loss intensifies, it may become mild cognitive impairment, a medical condition in which the loss of thinking skills grows obvious enough that it becomes worrisome to you and others around you. Mild cognitive impairment is not dementia, but people with the condition are at heightened risk of developing Alzheimer’s disease later.
Scientists have not yet pinpointed the underlying causes of mild cognitive impairment, but there is some evidence that changes in blood flow to the brain can contribute. Blood carries oxygen and nutrients to brain cells and if that stream sputters, so can the vitality of neurons.
Unfortunately, many people experience declines in the flow of blood to their brains with age, when their arteries stiffen and hearts weaken.
But the good news is that exercise can increase brain blood flow, even when exercisers are not moving. In a 2013 neurological study, the brains of physically active older men showed much better blood saturation than those of sedentary men, even when everyone was quietly resting. The greater brain blood flow in people who exercise also is associated with better scores on tests of memory and thinking than among sedentary people.
But these studies generally focused on people whose brains and cognition were relatively normal. Exercise bulked up, for them, what already was reasonably sound. Far less is known about whether physical activity similarly benefits the blood flow, brains and thinking of people who are starting to experience more serious memory loss.
So, for the new study, which was published this month in the Journal of Alzheimer’s Disease, researchers at the University of Texas Southwestern Medical Center in Dallas and other institutions asked a group of 70 sedentary men and women, aged 55 or older and diagnosed with mild cognitive impairment, to start moving more.
They first brought everyone into the lab and tested their current health, cognitive function and aerobic fitness. Then, using advanced ultrasounds and other techniques, they measured the stiffness of their carotid artery, which carries blood to the brain, and the amount of blood flowing to and through their brains.
Finally, they divided the volunteers into two groups. One began a program of light stretching and toning exercises, to serve as an active control group. The others started to exercise aerobically, mostly by walking on treadmills at the lab, and then, after a few weeks, outside on their own. The exercisers were asked to keep their exertions brisk, so that their heart rates and breathing rose noticeably. (They could swim, ride bikes or do ballroom dancing if they chose, but almost everyone walked.) The control group kept their heart rates low.
Everyone in both groups worked out three times a week at first, for about half an hour and under supervision. They then added sessions on their own, until after six months, they were completing about five workouts most weeks. This program continued for a year, in total. About 20 volunteers dropped out over that time, mostly from the walking group.
Then the volunteers returned to the lab for a repeat of the original tests, and the researchers compared results. To no one’s surprise, the exercise group was more fit, with higher aerobic capacity, while the stretchers’ endurance had not budged. The aerobic exercise group also showed much less stiffness in their carotid arteries and, in consequence, greater blood flow to and throughout their brains.
Perhaps most important, they also performed better now than the stretch-and-tone group on some of the tests of executive function, which are thinking skills involved in planning and decision-making. These tend to be among the abilities that decline earliest in dementia.
Interestingly, though, both groups had raised their scores slightly on most tests of memory and thinking, and to about the same extent. In effect, getting up and moving in any way — and perhaps also interacting socially with people at the lab — appeared to have burnished thinking skills and helped to stave off accelerating declines.
Still, the researchers believe that over a longer period of time, brisk walking would result in greater cognitive gains and less memory decline than gentle stretching, says Rong Zhang, a neurology professor at UT Southwestern Medical Center, who oversaw the new study.
“It probably takes more time” than a year for the improved brain blood flow to translate into improved cognition, he says. He and other researchers are planning larger, longer-lasting studies to test that idea, he says. They hope, too, to investigate how more — or fewer — sessions of exercise each week might aid the brain, and whether there might be ways to motivate more of the volunteers to stick with an exercise program.
For now, though, he believes the group’s findings serve as a useful reminder that moving changes minds. “Park farther away” when you shop or commute, he says. “Take the stairs,” and try to get your heart rate up when you exercise. Doing so, he says, may help to protect your lifelong ability to remember and think.
I loved the strenuous labor, the smell of the upturned soil as I planted a seed, and learning from her how to shepherd a plant through its life cycle.
The day I met Carole, I was determined to hate her.
It’s hard to embrace a stepparent, harder still to keep adjusting if your father, like mine, married many times. Carole was his fifth wife; their marriage bestowed on her the thankless title of my fourth stepmother.
I was 22. My mother had been my father’s first wife. The opposite of Carole, Mom was a frail woman who locked herself in her room to write and never left the house without earrings and a hat. When I was 7, my parents divorced and Dad left us in New York to move to California. While Mom raised my sister and me, he became the founding director of the Berkeley Art Museum. He married and divorced three more times. When I graduated from high school — between wives No. 3 and No. 4 — he’d beckoned, “Come to college in California.”
It was not the father and daughter reunion I had imagined. A steady parade of his girlfriends streamed through our lives. By the time Carole arrived, I was sick of women moving into his house with their cats and cozy furniture, wanting to be my “friend.” As soon as their relationship with Dad fell apart, they’d disappear, along with any semblance of friendship.
Dad’s previous wives had revamped the kitchen. Carole focused on the rock-strewn front yard where Dad and I had attempted to grow agave and ice plant. “Ice plants attract slugs and snails,” she declared as she ripped out the neon pink flowers. “We can do better.”
Carole was all about renewal. She volunteered for Berkeley’s Parks and Recreation Commission. She ran a watershed project whose mission was to reopen streams and creeks that lay beneath Berkeley’s city streets. I did not want to be another restoration project.
I was used to running wild. My father had lax rules. Most weekends, before Dad married Carole, I drove the two hours north, with my troop of friends from the University of Santa Cruz, where I attended college, to his house in the Berkeley hills. We drank his wine and partied in his living room. As long as I didn’t interfere with his dating life, he didn’t care if I passed out on the couch. Carole didn’t like this arrangement. She wanted me to call before I arrived. She wanted me to “be safe” when I went out at night.
“You’re not my mother,” I snapped. The last thing I wanted was to be cared for by someone who I was certain would soon leave.
“No, but I’m your stepmother, and this is now my home,” Carole replied calmly.
It was her home and she transformed it. After graduating from college, I left for a year abroad. When I returned, the barren front yard was adorned with climbing vines of bougainvillea and princess flower trees, a subtropical evergreen with deep purple flowers as soft as velvet. Where once fluorescent ice plant had struggled to take root, spears of scented lavender, woolly thyme and trailing rosemary flourished. At dinner, Carole sent me outside with garden shears to cut chives for the salad. I couldn’t help but be impressed.
Three years into the marriage, long past the time when previous wives, frustrated with Dad’s philandering, had vanished, Carole stayed. When she got mad, she stormed off for a walk, but she always returned. Saddened, disheartened, but not defeated. As I watched her hold her ground no matter what chaos my dad threw her way, my resentment against her withered away. I recognized the anguish of being enticed and then ignored by my father.
One day she found me sitting on the front steps crying. I’d just broken up with an unfaithful boyfriend. “How can you stand it?” I sobbed, meaning infidelity.
“Sometimes I can’t,” Carole admitted. Then she handed me a trowel. “Dig. It will help.” She had a box of species tulips to plant. “They’re not as flashy as hybrid tulips,” she said, placing a bulb in the earth. “But they’re reliable. Every year, they return and multiply.”
By then, I was living in San Francisco, working as a receptionist. I hated answering a phone in a stuffy office. Gardening with Carole became my weekend release. I loved the strenuous labor, the smell of the upturned soil as I planted a seed, and learning from Carole how to shepherd a plant through its life cycle.
After Carole started a landscaping business and realized that I was immune to poison oak, I became her go-to person for clearing properties. She bought me pruning shears and a garden belt to wear around my waist with pouches for my tools. Up and down the slopes of Berkeley, I swaggered beside Carole in heavy boots as she recited the botanical names of every plant we encountered. Rosemary was of the genus Salvia. Lavender was the easy Latinate Lavandula, and the glorious princess flower tree was Tibouchina urvilleana. “It’s native to Brazil.” Carole said, “but it does well here.”
“Why do you care about knowing every name?” I asked.
She stopped beside a Helleborus bedecked in nodding burgundy flowers. “I was lonely,” she said. “But once I learned the names of plants, wherever I went, I recognized things I knew. I saw friends.”
Carole might have looked as sturdy as a tree trunk. In fact, she was riddled with the same insecurities that plagued me. In that new house, with a contentious stepdaughter and an impulsive husband, she was often angry. She was lonely and lost. Plants were her signposts in an alien landscape. They comforted her and helped her orient and navigate. The early blooming hellebores meant spring had arrived; a purple Tibouchina signaled the climate was mild; and even though a blooming Agave heralded the plant’s demise, it also meant the succulent had prepared for death by propagating “pups” at its base.
Unlike Carole, I never again chose a faithless partner like my dad, but I’m thankful that Carole’s commitment to us endured. She was the reliable Tulipa, the species tulip in our tumultuous home life. She was not just my fourth stepmother; she was my final stepmother, her marriage to Dad lasting 36 years. He is now dead, and Carole suffers from late-stage Alzheimer’s — the same disease that ended my mother’s life in 2010. Yet Carole persists.
Separated for this last year because of Covid, I was finally able to visit her again. I wheeled her along the streets of Berkeley. Though Carole could no longer remember the names of her beloved plants, I could. Bending over, I held a sprig of rosemary to her nose.
“Salvia rosmarinus,” I said.
Inhaling, she smiled in recognition.
Gabrielle Selz is a writer, art critic and the author of the memoir “Unstill Life” and the forthcoming biography “Light on Fire.”
When I saw my sister Peggy in her nursing home last June, she was sitting up in bed, leaning forward slightly and staring into the corner of her room. She was 67, and did not know who I was. It had been five months since my last trip to see her. That time, she was in a hospital psychiatric unit being re-evaluated for treatment for both bipolar disorder and Alzheimer’s disease. It had taken her a moment to recognize me then, but once she did she hugged me and kept up a stream of chatter as we walked laps around the floor.
But by our June visit, the only evidence that there was anything going on in her mind was the constant motion of her hands, drifting up from her lap to touch her face and then fluttering down again, like fledglings not quite able to fly.
I had been given special permission to see her because she had just suffered a pulmonary embolism and her hospice workers believed she was weeks, if not days, away from death. I flew from Milwaukee to Austin, and my other sister picked me up and drove me straight to the nursing home, where Peggy was recovering, having fought her way back to life, such as it was.
I rolled her wheelchair next to her bed and sat in it, quiet and still, hoping that she could feel my presence and that it was familiar and comforting to her. I held her hand. Taking deep breaths, I summoned all of my love for her. I tried to bring into the room every moment of the life we have shared as sisters. I felt my lungs expand and release what felt like a greedy abundance of good health, and I gave it to Peggy. Here is my health, here is my love, I prayed. Take it. I have too much.
While the nursing assistants came to change Peggy’s bedding, I talked to her treatment nurse in the hallway. When Peggy had arrived at this facility about two weeks earlier, she had bedsores on her heels and on her lower back. In Peggy’s room, her nurse changed her bandages, pointing out the wounds on her heels, which did not look too bad, but on her back, just above her tailbone, was a dinner-plate-size sore, yellowish and raw. “That has gotten so much better,” the nurse said, her finger air-tracing a circle that was about a third larger than the one I could see.
Both bedsores and pulmonary embolisms can be caused by lying in the same position for too long. No one accused her previous nursing home of neglect, but they made it clear that when she arrived, the sores were already there. They had developed over the first four months of the Covid shutdown when my sister, her primary advocate, was not allowed to visit.
Her bandages changed and her sheets fresh, Peggy was turned on her side. Her eyes were calm and as she drifted off to sleep, I could see that she knew who I was.
While she slept, I explored her room to see what remnants of her curious and acquisitive life had persisted into that institutional space. Her photo album was sticky, its pages crackling with age. I knew many of those photos. There she was as a bridesmaid, tall and deeply tanned, her blue eyes bright, holding the hand of our father, who did not live very long after that picture was taken. There were photos of us as the five sisters we once were, and one of Peggy, 10 years older than me, standing in as surrogate mother at my high school graduation. There was a photo of the boyfriend who followed her to the ends of the earth but to whom she was not able to commit. There are photos from our house in New Jersey, of nieces and nephews, leafy patios and swimming pools, and Peggy on her skis.
They were from a life that none of us live anymore and they ended around 2005, when my mother sold her house and moved into assisted living, leaving Peggy, for the first time in her life, without a place to land. Her bipolar disease, which she struggled to manage, began to eat away at the life she’d built for herself before Alzheimer’s came to finish the job.
In the last hour of my visit on that June day, Peggy woke from her nap and wanted to talk. I held her hand and she stared at it as if it was not attached to her body, as if I had brought some strange little animal to her bed and was showing it to her. She mumbled phrases, the beginnings of sentences, and I offered endings. She watched me fish for meaning and then sighed, resigned but not unhappy, and we tried again. In this way we chatted like sisters until it was time for me to go.
This touch, the connection to family members, is crucial to the health of Alzheimer’s patients. Before my visit, it had been four months since anyone was able to visit Peggy. After this visit, it would be another four months before the nursing home eased its Covid-related restrictions and my sister was allowed to visit again. During that time, we called her, but she was losing her ability to speak. I sent pop-up greeting cards in the hopes that they would interest her.
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Without anyone there to bring her back to this moment in time, Peggy has begun to fade. We were once five sisters. We are already down to four, and when Peggy goes, if she is next, we will be just three. With the loss of each sister go her special memories of us and ours of her. Our life together as sisters, as children of our parents, is known by fewer people and when they are gone, we are no longer completely knowable. When I lose the person who can help me burnish the memories of our lives together, I begin to lose those memories myself. The mirror of my past grows dark.
When the Covid restrictions were lifted, Peggy got a roommate — a former Head Start teacher who has been teaching Peggy to say thank you to her caregivers instead of yelling at them and calling them names.
And then recently, just days after Peggy got the first of her Covid vaccines, she, like many people with dementia, tested positive for the virus. She did not have symptoms, but she was moved to isolation, again alone without the familiar voice of her roommate or the touch of my sister that were both vital to keeping her connected to this world.
We were lucky that Peggy got the vaccine before she got infected. Her life may have been saved. But what the pandemic has taken from me and my sisters is our precious time together, time in which we could still share our lives, time in which we could continue as sisters, time to surround the sister we are losing with our love so that she does not have to face death alone.
Without us to remind Peggy of who she is, she has slipped away from us. The millions of moments that connected us to each other recede into a fog of time, their edges blurring together and disappearing like shadows in a darkening room. Without us there to say her name, to touch her hand, she is in that room alone.
Susan Nusser is an author and freelance writer who lives in Milwaukee where she teaches writing at a technical college.
People with dementia had significantly greater risk of contracting the coronavirus, and they were much more likely to be hospitalized and die from it, than people without dementia, a new study of millions of medical records in the United States has found.
Their risk could not be entirely explained by characteristics common to people with dementia that are known risk factors for Covid-19: old age, living in a nursing home and having conditions like obesity, asthma, diabetes and cardiovascular disease. After researchers adjusted for those factors, Americans with dementia were still twice as likely to have gotten Covid-19 as of late last summer.
“It’s pretty convincing in suggesting that there’s something about dementia that makes you more vulnerable,” said Dr. Kristine Yaffe, a professor of neurology and psychiatry at the University of California, San Francisco, who was not involved in the study.
The study found that Black people with dementia were nearly three times as likely as white people with dementia to become infected with the virus, a finding that experts said most likely reflected the fact that people of color generally have been disproportionately harmed during the pandemic.
“This study highlights the need to protect patients with dementia, especially those who are Black,” the authors wrote.
Maria Carrillo, chief science officer of the Alzheimer’s Association, which runs the journal that published the study, Alzheimer’s and Dementia, said in an interview, “One of the things that has come from this Covid situation is that we should be pointing out these disparities.”
The study was led by researchers at Case Western Reserve University who analyzed electronic health records of 61.9 million people age 18 and older in the United States from Feb. 1 through Aug. 21, 2020. The data, collected by IBM Watson Health Explorys, came from 360 hospitals and 317,000 health care providers across all 50 states and represented a fifth of the American population, the authors said.
Rong Xu, a professor of biomedical informatics at Case Western and the senior author of the study, said there had been speculation about whether people with dementia were more prone to infection and harm from Covid-19.
“We thought, ‘We have the data, we can just test this hypothesis,’” Dr. Xu said.
The researchers found that out of 15,770 patients with Covid-19 in the records analyzed, 810 of them also had dementia. When the researchers adjusted for general demographic factors — age, sex and race — they found that people with dementia had more than three times the risk of getting Covid-19. When they adjusted for Covid-specific risk factors like nursing home residency and underlying physical conditions, the gap closed somewhat, but people with dementia were still twice as likely to become infected.
Experts and the study authors said the reasons for this vulnerability might include cognitive and physiological factors.
“Folks with dementia are more dependent on those around them to do the safety stuff, to remember to wear a mask, to keep people away through social distancing,” said Dr. Kenneth Langa, a professor of medicine at the University of Michigan, who was not involved in the study. “There is the cognitive impairment and the fact that they are more socially at risk,” he said.
Dr. Yaffe said there could also be a “frailty element” to people with dementia, including a lack of mobility and muscle tone, that could affect their resilience to infections.
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Dr. Carrillo noted that coronavirus infection was associated with an inflammatory response that has been shown to affect blood vessels and other aspects of the circulatory system. Many people with dementia already have vascular impairment, which may be compounded or amplified by Covid-19.
Indeed, the study authors subdivided patients by the type of dementia listed in the electronic records and found that people designated as having vascular dementia had a greater risk for infection than people designated as having Alzheimer’s disease or other types.
But Dr. Langa and Dr. Yaffe cautioned that there was significant overlap between types of dementia. Many patients have both Alzheimer’s pathology and vascular pathology, they said, and physicians who are not specialists may not distinguish subtypes in providing codes for electronic records.
In examining the risk of hospitalization and death for Covid patients with dementia, the researchers did not adjust for demographics like age or whether they lived in nursing homes or had underlying medical conditions. They found that Covid patients with dementia were 2.6 times as likely to have been hospitalized during the first six months of the pandemic as those without dementia. They were 4.4 times as likely to die.
Black people with Covid-19 and dementia were significantly more likely to be hospitalized than white people who had both diseases. The authors did not find a significant difference in the mortality rate for Black and white coronavirus patients with dementia, although they wrote that the number of deaths analyzed, 170, might be too small to provide a solid conclusion about that.
Experts noted that one limitation to the study was that researchers did not have access to socioeconomic information, which could provide increased understanding of patients’ risk factors.
Dr. Langa also noted that the data reflected only people who have interacted with the health care system, so it doesn’t include “more isolated and poorer patients that have a harder time getting to doctors.”
Consequently, he said, the study may be “an underestimate of the greater Covid infection risk for those with dementia.”
Austrian researchers reported that people who tended to be physically active performed higher on tests of:
IBM researchers reported that artificial intelligence analysis of writing samples could predict the onset of this neurologic illness years later:
Amyotrophic lateral sclerosis
Myxomas are rare and slow-growing tumors usually found in this organ:
A warming climate has been linked to an increased risk of this ailment:
All of the above
Four of the five metropolitan areas with the highest rates of recent coronavirus cases are in this state:
Which statement about people who have already had Covid is true?
They do not need to be vaccinated
They are more likely experience intense side effects after vaccination
They tend to generate low levels of antibodies after vaccination
All of the above
Some brands of baby foods sold in the United States were found to contain this toxic metal:
All of the above
My father stood in the kitchen eating refried beans from the can with a fork as Paul Simon sang “Graceland” on repeat for 20 minutes.
“Hey Alexa, why don’t we take a break, huh?” he finally said, as if the speaker were a child who had taken too many turns on the slide. “Yeah, let’s give it a rest for a little bit.”
I watched him pet the device and gently shush it.
“Alexa, turn off,” I said, and the kitchen fell silent.
My father gave me a look, the same look he used to give me when I was 10 and didn’t want to call my grandmother or send thank-you cards after my birthday party. A look of a lesson to impart.
“Yes?” I said.
“Next time,” he said, “say please.”
My father has always been the type of person who likes listening to birds and picking up litter. I grew up admiring the way he would walk into a room full of friends watching TV and ask, “Who wants to talk?” He wanted to know what people were thinking about, and when phones lit up at the dinner table, he would sit and watch as the rest of us hunched and stared at our laps like phone-addicted zombies.
I try to be more like my father and make these values my own. But these characteristics of his are fading along with his memory, and the means through which I connect with him feel less like bonding and more like desperation.
Almost five years ago, when my father was 62, he learned he had Alzheimer’s disease. Over this time, my mother and I have watched his decline. He forgets his friends’ names and can no longer read. Every morning, he sits in a baby blue polka-dot towel and waits for one of us to prompt him to start his day.
My mother will say: “Come in here and get dressed, honey.” “Brush your teeth, honey.” “Come drink some orange juice, honey.”
I look at other fathers who make money and pancakes and kiss their wives, and I feel depressed for how small my father’s world has become. I see how my mother is nervous to socialize with him or take him to dinner parties where the other husbands talk about work and politics, while hers asks, over and over, if Frank Sinatra is alive.
Since graduating from college two years ago, I have split my time between my apartment in Brooklyn and my parents’ house in Hastings-on-Hudson. Every week, I pack a bag and take the train 30 miles north to help with the caregiving. I joke about how it’s confusing to live in two places. “It’s like I have divorced parents,” I say as I hug my roommates goodbye.
I struggle to understand myself as a 23-year-old who is also taking care of a parent. I feel stiff when my roommates get dressed for work and ask which shoes I like best, or when they talk about their goals: what they want to do, where they want to live. I marvel at the ease with which they can sound so sure of their freedom and choices.
It’s not that I don’t have plans for myself, or that I dislike shoes. There’s just something about when my father calls me “Mommy” in front of the neighbors that morning, and then says he’s sorry, that makes my mouth feel tight when it comes to offering style advice or talking about my dreams.
I often wish I could ask my father who he was at 23. I wish I could ask what his bad habits were, or how he treated his mother, or what he did on Saturdays. But his ability to recall his past has disappeared, so I have come to terms with not knowing. I spend a lot of time asking him other questions instead, but my queries have surpassed casual curiosity.
Every week I ask: “Dad, what do you love about Mom?” “Dad, what is your favorite thing about yourself?” “Dad, do you like to cry?”
I shake him up like a Magic 8-Ball and throw him as many questions as I can. But just like the toy, his answers are random lines I have heard before. I’m patient as he searches for words and pronunciations, but we often end up playing charades as I guess at the words he has lost.
Last September, my parents and I were organizing our storage bin in the basement of our apartment building when I uncovered a chest of my father’s old journals. Under yellowed Superman comics and water-damaged concert tickets were 15 or so composition notebooks, dating from 1978 to 2002.
My mother said journals are private and attempted to hide them from me, but she soon realized I would keep coming back. Morals and privacy seemed unimportant if these journals could give me access to the person my father used to be. So I began to read them. And they have been a gift.
In his journals, my father wrote about self-doubt and fear and all the things that brought him joy. I copied his sentences into my own journal and cited his wisdom when I spoke to my friends. He also wrote about riding his bike around Brooklyn, reporting for small newspapers and exiting the subway at Seventh Avenue to walk home through the park.
Until I read those journals, I had no idea he’d done those things, and the similarities between us stunned me. I have spent the last two years working as a reporter for small Brooklyn papers, and every Sunday, heading home from the train that carries me back to the city from Hastings, I too take that walk home from Seventh Avenue.
When I read my father’s entries, I feel less lost. I not only recognize the person my father used to be, but I recognize myself.
My mother gave me permission to quote a few of them.
On Sept. 9, 1991, he wrote: “I want to stand up outside between the cars, head blowing in the wind, and scream, scream until I nearly start living … start living my dream. I need something. Too much time and too little touch in my life lately. Loneliness can kill, I believe.”
A few months later, on Feb. 10, 1992: “I feel giddy, like a kid. I want to dance! She called. Suzanne from Brooklyn. Yes, she’d love to go out again. So it’s brunch and watching the playoffs at her place Sunday. God I feel happy.”
“Later last night after 11:00, spurred by the phone call, I danced in the kitchen in the dark. A Stones song, I danced alongside old ghosts and laughed at them. Whether trying to shake demons or embrace a new dream, dancing in the dark always felt good.”
Suzanne is my mother, and it was through these journals that I learned how much my father loves her. His journals also showed me how much he loves his friends, and how much he loves me. Every entry from 1997 to 2002 mentions “little Annabelle.”
What I wasn’t prepared for, however, was the moment the entries stopped. On April 28, 2002, my father wrote about my bathtub performance of “Tomorrow” from the musical “Annie,” and then the next page is blank. And so is the next, and the one after that. I flipped through wide-eyed, in denial. I didn’t want this version of my father to be over.
As I read that last entry, he and I were sitting beside each other on the couch with “Ellen” on TV. She was playing Burning Questions with Bradley Cooper, but their exchanges were too quick for him, so he stared at the rug instead.
I thought about the scenes I’d just read: my father calling his friends at midnight to tell them a joke, riding the subway and reading the paper, asking my mother to dance. Watching him now as he gazed at the rug, I felt uneasy about all the time he spends in silence. I felt afraid of how much he had lost and would continue to lose.
“Dad,” I said.
“Do you love Mom?”
He laughed. “Of course.”
I took a breath and turned off the TV. I did my best to join him in the moment, as that is all we have.
“How much do you love her?”
“What do you mean, how much?” He laughed again. “One quart.”
“And you love me a gallon?”
“Yes,” he said. This much he understood. “Very many gallons.”
Annabelle Allen is a freelance journalist in New York City.
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Is it possible to predict who will develop Alzheimer’s disease simply by looking at writing patterns years before there are symptoms?
According to a new study by IBM researchers, the answer is yes.
And, they and others say that Alzheimer’s is just the beginning. People with a wide variety of neurological illnesses have distinctive language patterns that, investigators suspect, may serve as early warning signs of their diseases.
For the Alzheimer’s study, the researchers looked at a group of 80 men and women in their 80s — half had Alzheimer’s and the others did not. But, seven and a half years earlier, all had been cognitively normal.
The men and women were participants in the Framingham Heart Study, a long-running federal research effort that requires regular physical and cognitive tests. As part of it, they took a writing test before any of them had developed Alzheimer’s that asks subjects to describe a drawing of a boy standing on an unsteady stool and reaching for a cookie jar on a high shelf while a woman, her back to him, is oblivious to an overflowing sink.
The researchers examined the subjects’ word usage with an artificial intelligence program that looked for subtle differences in language. It identified one group of subjects who were more repetitive in their word usage at that earlier time when all of them were cognitively normal. These subjects also made errors, such as spelling words wrong or inappropriately capitalizing them, and they used telegraphic language, meaning language that has a simple grammatical structure and is missing subjects and words like “the,” “is” and “are.”
The members of that group turned out to be the people who developed Alzheimer’s disease.
The A.I. program predicted, with 75 percent accuracy, who would get Alzheimer’s disease, according to results published recently in The Lancet journal EClinicalMedicine.
“We had no prior assumption that word usage would show anything,” said Ajay Royyuru, vice president of health care and life sciences research at IBM Thomas J. Watson Research Center in Yorktown Heights, N.Y., where the A.I. analysis was done.
Alzheimer’s researchers were intrigued, saying that when there are ways to slow or stop the illness — a goal that so far remains elusive — it will be important to have simple tests that can warn, early on, that without intervention a person will develop the progressive brain disease.
“What is going on here is very clever ” said Dr. Jason Karlawish, an Alzheimer’s researcher at the University of Pennsylvania. “Given a large volume of spoken or written speech, can you tease out a signal?”
For years, researchers have analyzed speech and voice changes in people who have symptoms of neurological diseases — Alzheimer’s, ALS, Parkinson’s, frontotemporal dementia, bipolar disease and schizophrenia, among others.
But, said Dr. Michael Weiner, who researches Alzheimer’s disease at the University of California, San Francisco, the IBM report breaks new ground.
“This is the first report I have seen that took people who are completely normal and predicted with some accuracy who would have problems years later,” he said.
The hope is to extend the Alzheimer’s work to find subtle changes in language use by people with no obvious symptoms but who will go on to develop other neurological diseases.
Each neurological disease produces unique changes in speech, which probably occur long before the time of diagnosis, said Dr. Murray Grossman, a professor of neurology at the University of Pennsylvania and the director of the university’s frontotemporal dementia center.
He has been studying speech in patients with a behavioral form of frontotemporal dementia, a disorder caused by progressive loss of nerves in the brain’s frontal lobes. These patients exhibit apathy and declines in judgment, self control and empathy that have proved difficult to objectively quantify.
Speech is different, Dr. Grossman said, because changes can be measured.
Early in the course of that disease, there are changes in the pace of the patients’ speech, with pauses distributed seemingly at random. Word usage changes, too — patients use fewer abstract words.
These alterations are directly linked to changes in the frontotemporal parts of the brain, Dr. Grossman said. And they appear to be universal, not unique to English.
Dr. Adam Boxer, director of the neurosciences clinical research unit at the University of California, San Francisco, is also studying frontotemporal dementia. His tool is a smartphone app. His subjects are healthy people who have inherited a genetic predisposition to develop the disease. His method is to show subjects a picture and ask them to record a description of what they see.
“We want to measure very early changes, five to 10 years before they have symptoms,” he said.
“The nice thing about smartphones,” Dr. Boxer added, “is that you can do all kinds of things.” Researchers can ask people to talk for a minute about something that happened that day, he said, or to repeat sounds like tatatatata.
Dr. Boxer said he and others were focusing on speech because they wanted tests that were noninvasive and inexpensive.
Dr. Cheryl Corcoran, a psychiatrist at Icahn School of Medicine at Mount Sinai in New York, hopes to use speech changes to predict which adolescents and young adults at high risk for schizophrenia may go on to develop the disease.
Drugs to treat schizophrenia may help those who are going to develop the disease, but the challenge is to identify who the patients will be. A quarter of people with occasional symptoms saw them go away, and about a third never progressed to schizophrenia although their occasional symptoms persisted.
Guillermo Cecchi, an IBM researcher who was also involved in the recent Alzheimer’s research, studied speech in 34 of Dr. Corcoran’s patients, looking for “flight of ideas,” meaning the instances when patients were off track when talking and spinning off ideas in different directions. He also looked for “poverty of speech,” meaning the use of simple syntactic structures and short sentences.
In addition, Dr. Cecchi and his colleagues studied another small group consisting of 96 patients in Los Angeles — 59 of whom had occasional delusions. The rest were healthy people and those with schizophrenia. He asked these subjects to retell a story that they had just heard, and he looked for the same telltale speech patterns.
In both groups, the artificial intelligence program could predict, with 85 percent accuracy, which subjects developed schizophrenia three years later.
“It’s been a lot of small studies finding the same signals,” Dr. Corcoran said. At this point, she said, “we are not at the point yet where we can tell people if they are at risk or not.”
Dr. Cecchi is encouraged, although he realizes the studies are still in their infancy.
“For us, it is a priority to do the science correctly and at scale,” he said. “We should have many more samples. There are more than 60 million psychiatric interviews in the U.S. each year but none of those interviews are using the tools we have.”
Credit Paul Rogers
Can you keep the love light shining after your partner’s brain has begun to dim? Just ask Denise Tompkins of Naperville, Ill., married 36 years to John, now 69, who has Alzheimer’s disease.
The Tompkinses participated in an unusual eight-week storytelling workshop at Northwestern University that is helping to keep the spark of love alive in couples coping with the challenges of encroaching dementia.
Every week participants are given a specific assignment to write a brief story about events in their lives that they then share with others in the group. The program culminates with a moving, often funny, 20-minute written story read alternately by the partners in each couple in front of an audience.
Each couple’s story serves as a reminder of both the good and challenging times they have shared, experiences both poignant and humorous that reveal inner strength, resilience and love and appreciation for one another that can be easily forgotten when confronted by a frightening, progressive neurological disease like Alzheimer’s.
“It’s been an amazing experience for us,” Mrs. Tompkins said of the program. “Creating our story revealed such a richness in our life together and is helping us keep that front and center going forward.”
She added that the program provides “an opportunity to process what you’re going through and your relationship to each other. It helped me digest all the wonderful things about John and how well we relate as a couple, things that don’t go away with Alzheimer’s disease. John is so much more than his disease.”
Ditto for Robyn and Ben Ferguson of Chicago, married 42 years in 2012 when they learned that Ben, a psychologist, had Alzheimer’s disease. “The diagnosis was crushing,” said his wife, who is also a psychologist. “Telling people in the program about it helped us recognize the impact on our lives and relationship and really face that. It made things feel not quite so bad.”
The Fergusons have publicly presented their 20-minute story together 19 times so far, helping to enlighten medical students and those training in social work and pastoral care, as well as researchers and members of the general public. “It reinforces our relationship as a couple, rather than caregiver and patient, even though he is 85 percent dependent on me for the activities of daily living.”
Dr. Ben Ferguson, now 69, said, “I feel we’re giving people information that could be very valuable in their future. It’s helpful to them to see us smile, have a good time and give a good report – as well as a bad report – about what goes on with this disease. It’s helpful for people to hear it from someone who has it, and it’s helped us avoid getting so morose.”
As for their presentations, which they now give almost monthly, his wife said, “They help us stay positive and give us a sense of purpose. We both feel a real need to do advocacy work, and this is the best thing we can do right now. We know there’s a sell-by date on this – we won’t be able to do it forever. But we don’t think about that now. Now we’re focused on helping people understand that your life doesn’t stop with the diagnosis. We want people to hear that you go on with your life, even though you may need a lot of help.”
Another workshop participant, Sheila Nicholes, 76, of Chicago, said of her husband, Luther, who has vascular dementia, that the storytelling “brings him back to being funny again. Writing our story together gave us a way to talk about these things, to think about where we were then and where we are now.”
Noting that dementia is “a very hush-hush illness in our black community,” Ms. Nicholes said she hoped that telling their story would help others speak more openly about it and learn to “just roll with the flow.”
The storytelling workshop, which started in January of 2014, was the brainchild of Lauren Dowden, then an intern in social work at Northwestern’s Cognitive, Neurological and Alzheimer’s Disease Center. She quickly learned from family members in a support group that “their concerns were not being addressed about dealing with loss, not just of memory, jobs and independence, but also what they shared as a couple.”
During the group sessions, Ms. Dowden said, “there’s so much laughter in the room, so much joy and love of life as well as poignancy and tears. As they move forward, as the disease progresses, they can be reminded of who they are, their strength and resilience, what has made their relationship strong, what they loved about the person, as opposed to just being patient and caregiver.”
As the program moves week to week, Ms. Dowden said, “there’s more touching, affection, looking at one another and laughing. There are delightful moments of connection when one member of a couple reveals something the other didn’t know.”
The weekly story assignments require that the couple collaborates, “and they learn how to work together in new ways, how to make adjustments, because they’ll have to make thousands and thousands of adjustments throughout the course of the disease.”
In executing the workshop assignments, Dr. Ferguson said she would ask her husband questions, he would answer and she would write down what he said. “The workshop was really transformative,” she said. “It gave us hope for our future together in dealing with this disease.”
Ms. Dowden said the feedback from those in the audience for the 20-minute joint stories has been heartening. She explained, “Students learn about the biology of neurodegenerative conditions. These stories enable them to see the human side of the disease, what it’s like to live with it, and may help them develop programs that help these families live better. In addition to the stigma, there’s a tendency to write off people with dementia.”
Ms. Dowden said she is currently refining the workshop curriculum so that it can be used as a model for other institutions to replicate. She is also expanding it to include mother-daughter and sibling pairs.
She realizes, of course, that a storytelling workshop may not be suitable for every couple. “It’s not good if there’s a lot of behavioral issues, a lot of conflict, and no insight,” she said. “But for those it does fit, it’s an opportunity to tap into the core of relationships, to still grow and learn and be delighted by one another.”
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In her memoir “Aliceheimer’s: Alzheimer’s Through the Looking Glass,” Dana Walrath uses drawings and stories to chronicle three years of caregiving for her mother, Alice, who was in the middle stages of Alzheimer’s disease. The experience turned out to be a magical trip down the rabbit hole of memory loss, an outcome that inspired Dr. Walrath, a medical anthropologist who taught at the University of Vermont College of Medicine and who also studied art and writing, to share their tale.
Refusing to accept the dominant narrative of Alzheimer’s disease as a horror story, Dr. Walrath used the techniques of graphic medicine to create “Aliceheimer’s,” an 80-page, 35-picture tribute to her mother’s animated mind. Graphic medicine uses text and graphics to, as she writes in the book’s introduction, “let us better understand those who are hurting, feel their stories, and redraw and renegotiate those social boundaries.”
We spoke with Dr. Walrath to learn more about graphic medicine, how the book came into being, and what it can teach others about caring for someone with Alzheimer’s disease. Here’s an edited excerpt of our conversation.
You say that “Aliceheimer’s” found you, not the other way around. What’s the backstory of your story?
After a lifetime of mutually abrasive interaction, my mother moved into my home when a lock-down memory-care unit was her only other option. The years of living together not only brought us closure, but it also integrated my disparate career threads. Medical anthropology, creative writing, visual art — who knew they were connected? I sure didn’t. But Alice must have. During dementia, she said to me, “You should quit your job and make art full time.”
What is “graphic medicine” and how did you discover the genre?
I started making “Aliceheimer’s” comics before I knew that graphic medicine existed. Watching Alice — a lifelong reader who was finding straight prose too hard to track — eat up books like “Maus,” “Persepolis,” “American Born Chinese” and “Fun Home” when she lived with me, made me certain that to tell our story I wanted to use a form that a person with dementia could access. When a fellow medical anthropologist introduced me to graphic medicine, I knew I had found my tribe. The “Graphic Medicine Manifesto” defines graphic medicine as “the intersection of the medium of comics and the discourse of health care.”
Which came first: your drawings or your stories? When and how did they merge?
The drawings came first. If you page through “Aliceheimer’s” looking only at the left-hand pages, you can read the original comic, a love story in pictures. I started writing short vignettes, each one in response to one of the original drawings. I began posting them on a blog until the content felt right for the intimate interior of a book.
How did the “Alice in Wonderland” theme come into play?
My father had read it out loud to us as kids, and during dementia Alice and I often recited parts of it together. But the day I cut up a cheap paperback copy of “Alice in Wonderland” to depict Alice’s bathrobe, her favorite garment, I knew I had found the voice for the story. Life with dementia is filled with alternate realities and magic, both scary and uplifting. Accepting wonderland as our baseline made day to day life an adventure.
How might “Aliceheimer’s” influence the medical, artistic and caregiving communities?
I would love to see “Aliceheimer’s” contribute to reframing dementia as a diversity issue. Of course there is loss involved, but the more we can see people living in this state as useful true humans who might teach us all something about living in the present, about knowing sides of our loved ones that social processes kept inaccessible, the better it will be.
I would love for the medical community to start to touch on the opportunities for closure and forgiveness that this condition might bring instead of the ongoing fight for the cure. For artistic and caregiving communities, I hope the book empowers people to tell their stories, particularly in comics form.
In “Aliceheimer’s,” you suggest new ways of thinking about Alzheimer’s. How did your mother’s memory-stealing disease open your mind?
The dominant zombie story of bodies without minds strips people with dementia of their humanity and interferes with creating new kinds of familial connections. How many of us have the privilege of knowing our parents as children? Through connection we heal. Comics lead us to light because, subconsciously, we associate comics with laughter, and we need permission to laugh at sickness and not just describe it in medical terms. Laughter is respite. It opens new possibilities for how to cope.
What suggestions do you have for people caring for a loved one with Alzheimer’s?
Learn to read the signs and messages embedded in your loved one’s actions. Often what looks delusional is an attempt to express a deeply felt need or desire. Dementia has them communicating through a code that we can track. Use the “Yes, and” principle from improv — in which you accept what the other person has said (“yes”) and then expand on that line of thinking (“and”) — to build on what your loved one is experiencing instead of contradicting them, and it will be easier to decipher his or her intentions.
Dementia lets all of us connect back to our deepest memories, to a time when we could communicate — give and receive stories — through the looks in each other’s eyes, through touch, facial expressions, actions and gestures. In this way, even in the midst of loss, dementia lets us heal.
Credit Giselle Potter
When I was a small boy my dad used to ask me for show tunes. “Sing ‘Happiness!’” he’d say to me on the ferry to Shelter Island, and I’d happily comply, the wind blowing the notes out into the Peconic Bay. And he liked to call me into the living room when he and my mom had company and say, “Sing something for us, Artie!”
My two older brothers dealt with this by secretly teaching me the song “Sodomy” from the show “Hair,” telling their credulous little brother that this would be a big hit next time Dad asked for a party number. It was a big hit all right.
Dad loved us all equally, but that didn’t mean he saw us as the same. “The boys and Artie” was a phrase I heard a lot, despite my protestations that I, too, was a boy. Perhaps he’d just gotten used to my brothers as a duo because they were only two years apart, and there was nearly a four-year gap between the middle one and me. Perhaps they were just more boyish.
My brothers certainly were the smartest kids I knew. (The smartest kids, it seemed, that everyone knew; as I came up behind them in school, I could count on teachers to say, “Oh, you’re a Levine brother – I’m expecting a lot from you.”) They never got less than an “A” as a grade. Each one, in turn, became the captain of the wrestling team and the tennis team. I idolized them even as I struggled with a sense that I’d never truly measure up. I was diabetic and I struggled physically. I was less perfect in school.
Dad didn’t make these comparisons (at least out loud). He expressed his love by showing up. He came to the musicals I performed in and clapped loudly. He went to every wrestling match my brothers competed in, shouting advice and living every takedown and pin, as if it were happening to him.
He wasn’t a heart to-heart conversation guy. As a gastroenterologist, Dad was more interested in talking about organs in the digestive tract. But he proudly (some might say relentlessly) reported our accomplishments to his patients and friends.
My father may have passed his tendency to express love by proxy on to us. Once when I was in seventh grade, I overheard my middle brother, Dan, who was a high school junior, talking to the kid who was running the school variety show. “You should get my brother to sing,” he told her. “He has a beautiful voice.”
Forty years later, this small comment still sits on the open shelves of my brain like a trophy, for an accomplishment you’d think I’d have outgrown by now.
Of course, overhearing something requires being in earshot of one another. And for us, that kind of proximity was fleeting. As adults we lived too far apart for a spontaneous hamburger or a cup of coffee, or a guy-like sharing of a sports event.
Over time my brothers seemed to have become more and more like my dad and I less so. Both became doctors, like my father. Both married nice Jewish girls. I married an Italian guy (O.K., a doctor, but still… ) and became a children’s book publisher. We each found “success,” but were careful not to talk about it with each other too directly.
For my dad, however, I would save up facts to report. If I was getting a promotion at work, if a poem had been accepted for publication, if someone praised my son, I would enjoy the good news. And then I’d enjoy packing it up for my dad and unpacking it in our next phone conversation, after which he’d say, “Terrific!! Want to talk to your mother?”
If my father was satisfied by this, I think my brothers and I were less so. Certainly, over time, it seemed to serve our relationships less and less well. What fact exchange over the phone can convey the complications of a marriage? What fact can express the near-fatal vulnerability of parenthood? What fact can reveal the passage from youth to middle age, the glimpses of what comes next?
And so we actually communicated less. It was nothing dramatic. We still loved one another. But we didn’t see one another more than once or twice a year. I’d drive past my brother’s town and think about stopping, but wouldn’t. We’d each visit our parents. Separately.
As my dad got older and developed cancer and heart problems, my brothers’ roles as medical consultants became more prominent, but we didn’t truly draw together. To spare my feelings they sometimes spoke with my husband about my dad’s problems, but in our concern we were still siloed, even as age began to make us all look more like each other … and more like him. And even as age began to take my father away from us all.
We started talking more during Dad’s long, slow, torturous decline from Alzheimer’s disease, but in some ways this just meant that the facts we had to report were not vacations, business news or our kids’ activities, but sad, tactical communiqués from a losing battle.
Then, after my dad died, a strange thing happened. My brothers began to call me just to check in. My oldest brother took to texting cartoon strips with fart jokes in them that he thought my dad would have loved. (And it’s true, the phrase “break wind” was a real favorite of his.) They asked to visit. They meant it.
I realized that the most powerful, tangible reminders of my father resided in my brothers, and in me, too. I reminded them of him. And I was one of the very few people on earth who could remember him as a father, if not exactly as they did, well, then as closely as almost anyone could.
My dad, whose affections had been a (sometimes sore) point of comparison in my head, was becoming the person who might now draw us close.
The other day I got a starred review for a picture book I’d written based on my dad, and I so wanted to call him up to share that perfect, shiny fact.
Maybe I’ll send it to my brothers.
Arthur Levine is the publisher of Arthur A. Levine Books at Scholastic, whose books include the Harry Potter series. He is the author, most recently, of the picture book “What a Beautiful Morning,” about a family dealing with Alzheimer’s disease.
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A weekly routine of yoga and meditation may strengthen thinking skills and help to stave off aging-related mental decline, according to a new study of older adults with early signs of memory problems.
Most of us past the age of 40 are aware that our minds and, in particular, memories begin to sputter as the years pass. Familiar names and words no longer spring readily to mind, and car keys acquire the power to teleport into jacket pockets where we could not possibly have left them.
Some weakening in mental function appears to be inevitable as we age. But emerging science suggests that we might be able to slow and mitigate the decline by how we live and, in particular, whether and how we move our bodies. Past studies have found that people who run, weight train, dance, practice tai chi, or regularly garden have a lower risk of developing dementia than people who are not physically active at all.
There also is growing evidence that combining physical activity with meditation might intensify the benefits of both pursuits. In an interesting study that I wrote about recently, for example, people with depression who meditated before they went for a run showed greater improvements in their mood than people who did either of those activities alone.
But many people do not have the physical capacity or taste for running or other similarly vigorous activities.
So for the new study, which was published in April in the Journal of Alzheimer’s Disease, researchers at the University of California, Los Angeles, and other institutions decided to test whether yoga, a relatively mild, meditative activity, could alter people’s brains and fortify their ability to think.
They began by recruiting 29 middle-aged and older adults from the Los Angeles area who told the researchers that they were anxious about the state of their memories and who, during evaluations at the university, were found to have mild cognitive impairment, a mental condition that can be a precursor to eventual dementia.
The volunteers also underwent a sophisticated type of brain scan that tracks how different parts of the brain communicate with one another.
The volunteers then were divided into two groups. One began a well-established brain-training program that involves an hour a week of classroom time and a series of mental exercises designed to bolster their memory that volunteers were asked to practice at home for about 15 minutes a day.
The others took up yoga. For an hour each week, they visited the U.C.L.A. campus to learn Kundalini yoga, which involves breathing exercises and meditation as well as movement and poses. The researchers chose this form of yoga largely because people who are out of shape or new to yoga generally find it easy to complete the classes.
The yoga group also was taught a type of meditation known as Kirtan Kriya that involves repeating a series of sounds — a mantra — while simultaneously “dancing” with repetitive hand movements. They were asked to meditate in this way for 15 minutes every day, so that the total time commitment was equivalent for both groups.
The volunteers practiced their programs for 12 weeks.
Then they returned to the university’s lab for another round of cognitive tests and a second brain scan.
By this time, all of the men and women were able to perform significantly better on most tests of their thinking.
But only those who had practiced yoga and meditation showed improvements in their moods — they scored lower on an assessment of potential depression than those in the brain-training group — and they performed much better on a test of visuospatial memory, a type of remembering that is important for balance, depth perception and the ability to recognize objects and navigate the world.
The brain scans in both groups displayed more communication now between parts of their brains involved in memory and language skills. Those who had practiced yoga, however, also had developed more communication between parts of the brain that control attention, suggesting a greater ability now to focus and multitask.
In effect, yoga and meditation had equaled and then topped the benefits of 12 weeks of brain training.
“We were a bit surprised by the magnitude” of the brain effects, said Dr. Helen Lavretsky, a professor of psychiatry at U.C.L.A. who oversaw the study.
How, physiologically, yoga and meditation had uniquely changed the volunteers’ brains is impossible to know from this study, although reductions in stress hormones and anxiety are likely to play a substantial role, she said. “These were all people worried about the state of their minds,” she pointed out.
Movement also increases the levels of various biochemicals in the muscles and brains that are associated with improved brain health, she said.
Whether other forms of yoga and meditation or either activity on its own might likewise bulk up the brain remains a mystery, she said. But there may be something especially potent, she said, about combining yoga with the type of meditation practiced in this study, during which people were not completely still.
The Alzheimer’s Research and Prevention Foundation, which partially funded this study, provides information on its website about how to start meditating in this style, if you would like to try.
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The first sign that the Alzheimer’s disease that ravaged my grandmother was back for her daughter was when Mom began having trouble saying “CNN.” She’d watched the cable news network for years with ferocious interest ever since returning from a life abroad in the Foreign Service to rural New Hampshire. There she nested in her mother’s house, saying she’d never move.
It was a distinctly peaceful life. I’d listen to her play the grand piano — the passion that had taken her to Juilliard decades earlier — and marvel at the lightness of her hands on the keys. On Sundays, she was the favorite lector at our church, reading the liturgy with an elegance instilled by her mother and grandmother, both trained elocutionists.
She also wrote and recorded essays on country living for NPR on subjects like “Mahler and Macaroni.” Words mattered a great deal to her. She mattered the world to me. I used to say I’d won the lottery when it came to mothers.
After Dad died, my mother continued to live alone in the big white house on the common. It was here in 1988 that she’d written a keenly observed Sunday commentary for this newspaper about her own mother’s battle with aging — and the dementia that “erased her life, line by line.”
She wanted me to promise that if her own light dimmed – or as she put it, “when I lose my mind too” – I wouldn’t upend my own life to care for her. But we never came up with a real plan.
About a year after CNN became “C…D…D…” and the home care team we’d improvised announced my mother’s decline was too much for them, my brothers and I barely convinced her to “visit” sunny California where my middle brother lived.
That visit became a new “post” in a fancy retirement community where, for $7,500 a month, she had her own studio and bathroom. She enjoyed music events and a stately dining room with a menu. There was even a church on the corner.
But like so many living with Alzheimer’s, Mom’s biorhythms were upside down. She’d often sleep during the day and be up all night doing what is known as “exit-seeking.”
Nights are the Achilles heel of most eldercare facilities staffed by the fewest caregivers — and the most inexperienced. Across the country, in many well-meaning Alzheimer’s units, memory care residents are treated with confinement.
So Mom “graduated” to the locked Memory Care unit for her “safety.” It broke my heart to watch her on tiptoes, peering through the locked door’s porthole across to the dining room she once enjoyed.
Alzheimer’s is not a mere matter of Swiss cheese memory and odd behaviors. It is a serious medical condition. It is terminal. It should be known for what it is: Brain Failure.
One morning, Mom emerged from her Memory Care room covered with bruises. The police came. The state came. There was even suggestion of a rape kit because my mother, clearly agitated, could say only, “the man, the man.”
We will never know what happened. But it stands to reason that if you lock up the most advanced Alzheimer’s residents with their attendant behavioral disorders, and apply nominal supervision, well, something is bound to happen. On the night in question, one newly hired caregiver attended 17 residents.
So we moved her again, this time to Seattle, close to my eldest brother and me, thereby violating the cardinal rule of Alzheimer’s care: thou shalt not move the patient. Change registers a full 10 on the Alzheimer’s Richter scale. The more Mom’s brain failed, the more I twirled to try to make things better.
Within a matter of weeks in the new place, she had fallen and broken her hip. Surgery followed, then three months in a rehab facility, and finally a move to a small adult family home with just six residents. She was exhausted and utterly disoriented. I was a wreck.
Still, I knew I was among the lucky ones. Despite the recent scan that showed her brain a mostly blank white slate, my mother somehow always managed to recognize me during our visits (although she’d begun calling me “Mom.”)
Where once I’d thought I’d lose my mind if she asked me the same question one more time, now I prayed to hear any full sentence just one more time. Ever the peripatetic family caregiver, I rarely stopped to inhabit my mother’s world: the one with no past, no future, just the present.
On our last Mother’s Day together, I took her to the big morning Mass at St. James Cathedral. As I attempted a Houdini maneuver getting her out of the car, up the curb and down the sidewalk to the church door, she somehow slithered from my grasp.
My mother sank to the ground in what seemed like slow motion. She never made a sound. She just lay there in the green grass in her rose-colored tweed suit, brilliant white hair glinting in the spring sun, blue eyes open wide, staring straight up into an unusually cloudless Seattle sky.
With church bells pealing through the cool morning air, my beautiful, brilliant mother stretched out her arms and made angels wings in the grass.
And all the doctors and all the medications and all the years of worry that couldn’t bring my mother back together again, also couldn’t defeat the magic of that moment.
I lay down next to her, threaded my fingers through hers, and for a brief wondrous moment, we held the present.
Mary Claude Foster is a journalist living in Seattle.
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More people are living longer these days, but the good news comes shadowed by the possible increase in cases of age-related mental decline. By some estimates, the global incidence of dementia will more than triple in the next 35 years. That grim prospect is what makes a study published in March in The Journal of Alzheimer’s Disease so encouraging: It turns out that regular walking, cycling, swimming, dancing and even gardening may substantially reduce the risk of Alzheimer’s.
Exercise has long been linked to better mental capacity in older people. Little research, however, has tracked individuals over years, while also including actual brain scans. So for the new study, researchers at the University of California, Los Angeles, and other institutions analyzed data produced by the Cardiovascular Health Study, begun in 1989, which has evaluated almost 6,000 older men and women. The subjects complete medical and cognitive tests, fill out questionnaires about their lives and physical activities and receive M.R.I. scans of their brains. Looking at 10 years of data from nearly 900 participants who were at least 65 upon entering the study, the researchers first determined who was cognitively impaired, based on their cognitive assessments. Next they estimated the number of calories burned through weekly exercise, based on the participants’ questionnaires.
The scans showed that the top quartile of active individuals proved to have substantially more gray matter, compared with their peers, in those parts of the brain related to memory and higher-level thinking. More gray matter, which consists mostly of neurons, is generally equated with greater brain health. At the same time, those whose physical activity increased over a five-year period — though these cases were few — showed notable increases in gray-matter volume in those same parts of their brains. And, perhaps most meaningful, people who had more gray matter correlated with physical activity also had 50 percent less risk five years laterof having experienced memory decline or of having developed Alzheimer’s.
“For the purposes of brain health, it looks like it’s a very good idea to stay as physically active as possible,” says Cyrus Raji, a senior radiology resident at U.C.L.A., who led the study. He points out that “physical activity” is an elastic term in this study: It includes walking, jogging and moderate cycling as well as gardening, ballroom dancing and other calorie-burning recreational pursuits. Dr. Raji said he hopes that further research might show whether this caloric expenditure is remodeling the brain, perhaps by reducing inflammation or vascular diseases.
The ideal amount and type of activity for staving off memory loss is unknown, he says, although even the most avid exercisers in this group were generally cycling or dancing only a few times a week. Still, the takeaway is that physical activity might change aging’s arc. “If we want to live a long time but also keep our memories, our basic selves, intact, keep moving,” Dr. Raji says.
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The popular heartburn drugs known as proton pump inhibitors have been linked to a range of ills: bone fractures, kidney problems, infections and more. Now a large new study has found that they are associated with an increased risk for dementia as well.
Proton pump inhibitors, or P.P.I.s, are widely available both by prescription and over the counter under various brand names, including Prevacid, Prilosec and Nexium.
German researchers, using a database of drug prescriptions, studied P.P.I. use in 73,679 men and women older than 75 who were free of dementia at the start of the study. Over an average follow-up period of more than five years, about 29,000 developed Alzheimer’s disease or other dementias. The study is in JAMA Neurology.
After controlling for age, sex, depression, diabetes, stroke, heart disease and the use of other medicines, they found that regular use of P.P.I.s increased the risk for dementia in men by 52 percent and in women by 42 percent, compared with nonusers.
“Our study does not prove that P.P.I.s cause dementia,” said the senior author, Britta Haenisch of the German Center for Neurodegenerative Diseases. “It can only provide a statistical association. This is just a small part of the puzzle.
“Clinicians, pharmacists and patients have to weigh the benefits against the potential side effects,” she continued, “and future studies will help to better inform these decisions.”
Credit Kevin Miyazaki for The New York Times
Eating seafood is linked to a reduced risk of dementia-associated brain changes in people who carry the ApoE4 gene variation, which increases the risk for Alzheimer’s disease. Eating seafood was not linked to similar changes in those who carried other forms of the ApoE gene.
The study, published in JAMA, looked at 286 autopsied brains and also found that eating seafood was linked to increased mercury in the brain, but that mercury levels were not linked to brain abnormalities.
After controlling for age, sex, education and other factors, the researchers found that compared with those who ate less seafood, ApoE4 carriers who had one seafood meal or more a week had lower densities of the amyloid plaques and neurofibrillary tangles typical of Alzheimer’s disease. Over all, they had a 47 percent lower likelihood of having a post-mortem diagnosis of Alzheimer’s.
Consumption of fish oil supplements was not correlated with pathological brain changes.
The lead author, Martha Clare Morris, a professor of epidemiology at Rush University, said that mercury from fish appears to pose little risk for aging people. But, she said, there are studies that show that mercury consumption in pregnancy can cause cognitive problems in babies.
“Most studies in dementia have found that one seafood meal a week is beneficial,” she said, though “they haven’t found that the more you eat, the lower the risk.”