References to article, Normal Aging or Disease-the Demarcation Fades in Sept. Oct. 2013 issue of The Humanist
The article revolves around two themes. One is a specific aspect of the Affordable Healthcare Act that I described in this essay, "MCI or CRS, why the name of a decline of memory matters." Since this requirement is virtually unknown to the public, this essay has an appendix that describes details of this law and its application. This was the original essay submitted to The Humanist, expanded to cover a broader prospective
The larger issue of The Humanist article is the group and individual dynamics between the aging population and the medical services enterprise. Dr. Gary W. Small is featured as representative of the tension between scientific endeavor and commercial interests. My own perspective on Dr. Small's approach is expressed in The Humanist article, which can be evaluated by viewing his video presentation to a general audience at UCSD. He gave a similar presentation to the 2013 Psychiatric Convention that was reviewed in this article. On the first page is his defense of use of the phrase "Alzheimer's Prevention"- identical to the UCSD presentation, allowing the reader to evaluate its legitimacy. I have written an extensive detailed critique of elements of his presentation, at this site.
The long quote is from Dialogues
in Clinical Neuroscience in 2004 is titled: Mild cognitive impairment: historical development and summary of research. James Golomb, MD principle author. It was sponsored by the National Institute of Health based on analyses of all relevant studies in this area.
In The Humanist article I wrote:
"I shared my own experience of being tested for this
condition. After disagreeing with some of my conclusions, he (Dr. Brewer) wrote...." For those interested, here is the link to the article, My Alzheimer's Screening, personal narrative and technical discussion, The personal story can be skipped to go to the addendum with dialogs with administrators and discussion of limits of non physiological testing for MCI.
There were several digressions that were necessarily left on the cutting room floor in The Humanist article that I want to include here. While the article contained Nancy Pelosi's famous words expressing, "we have to pass it (ACA) to see what it does," my draft said this should be extended to "We passed it, and now seeing what it does, we have to fix it to make it work."
My closing self description as a "Tennis player" continued with "....who plays doubles with some people in their tenth decade- an alternative approach to what is described here." It didn't fit editorially, but the message remains to be explored that by activities such as this, with no professional oversight, these men who could be diagnosed with incipient dementia, manage to have one hell of a good time. We can laugh, enjoy each others company, and better accept the reality of our aging brain as we draw on something within us from another domain, something that is too valuable to be dismissed.
I also included an article from a textbook written in 1904, before Dr. Alzheimer identified his eponymous disease. I had included it only because I found the lack of alarm over memory decline personally comforting, so will include the quotation here:
Psychology by James Rowland Angell, pp234 :
Disintegration of Memory in Old Age----when memory begins to decay under the advance of age there is a remarkable uniformity in the order in which certain kinds of knowledge disappear.......thus the memory of proper names is among the earliest of losses, and the more concrete are our ideas, the earlier do we lose the memory of the words for them. Abstract ideas which depend very largely on their existence upon the words that we use to designate them are by virtue of the law of habit much more persistent; because the word is in this case bound up much more widely and intimately with our use of the idea.
No panic, no fear of disease, just a description of getting older and the comfort that memory of meaningful concepts will normally be "much more persistent." It could be that the aggregate suffering caused by fear of dementia approaches that of the disease itself. If this article provides some relief from this, the effort will have been worthwhile.
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I want to acknowledge Mario Garrett, Ph.D., a psychology professor at San Diego State University, for his multifaceted support. As a member of the board of the Alzheimer's Association, he was able to forward my request that they correct their statement that it is a myth that "Memory loss is a natural part of aging." They did moderate their position, but the website still casts doubt on the undisputed universal finding that memory does significantly decline with advancing age
As a gerontologist, he attempted to get more fine grained details of the cognitive assessment procedure from his physician contacts. They were not forthcoming, nor were my own similar attempts or my multiple request for more details from the Medicare agency.
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From the International Journal of Alzheimers Disease
To Know or Not to Know: Ethical Issues Related to Early Diagnosis of Alzheimer's Disease
A comprehensive analysis showing the predominance of adverse arguments. This is assuming the individual's choice not the imposition of assessment described in the ACA.
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Extensive survey of research recently reported in Canadian Medical Association Journal concludes:
Cognitive Enhancers for MCI: No Benefit, Possible Harm
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Alzheimer's Organization Seven Stages of Alzheimer's
"Stage 2 Alzheimers:
Very mild cognitive decline (may be normal age-related changes or earliest signs of Alzheimer's disease)
The
person may feel as if he or she is having memory lapses — forgetting
familiar words or the location of everyday objects. But no symptoms of
dementia can be detected during a medical examination or by friends,
family or co-workers."
By thier definition almost all people over 65 are in the pre-clinical stage of this disease.
Stage 1 Alzheimer's disease is less than this, meaning no memory problems at all!
Actual wording of the law can be found in this HHS document of ACA pp 1154 bottom line
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