The Dementia Plague
This is an excellent article, it covers the ground thoroughly. Here is something you can take away from it:
Almost every dementia patient has worried family members huddled in the background, and almost every story about dementia includes a moment when loved ones plead with the doctor for something—any medicine, any intervention, anything—to forestall a relentless process that strips away identity, personality, and ultimately the basic ability to think. Unfortunately, Evelyn Granieri is the wrong person to ask. In 2010 she served on a high-level panel of experts that assessed every possible dementia intervention, from expensive cholinesterase-inhibiting drugs to cognitive exercises like crossword puzzles, for the National Institutes of Health; it found no evidence that any of the interventions could prevent the onslaught of Alzheimer’s. She can—with immense compassion, but equally immense conviction—explain the reality for now and the immediate future: “There really is nothing.” Dementia is a chronic, progressive, terminal disease, she says. “You don’t get better, ever.”
We used to speak of senility – old people just got senile and useless. And nobody worried about it. The family just took care of them. This is still true in rural Costa Rica – the family takes care of its family members who are incapacitated - there are a large number of developmentally-retarded children here (and some adults), and taking care of them is just a normal family duty that people take for granted. In rural Indonesia, the village used to do this too – it took care of its own. If a woman gave birth, a midwife appeared and took care of her – and the whole village helped her to recover.
This is normal human behavior, which has disappeared as we become more obsessed (and identified) with our machines – especially our latest, the Computer.
However, to quote again:
An even more sobering perspective on the problem comes from a small unpublished pilot study that Granieri and her colleagues at Columbia recently undertook. They did a standard cognitive evaluation of every person 70 or older who was admitted to Allen Hospital for any reason—heart problems, pain, diabetes, breathing difficulties. The results stunned them. “In this hospital, of patients 70 years of age or older, 90 percent have cognitive impairment of some kind, which is much higher than we anticipated,” she says.
Not only is dementia distressingly widespread, but the complex overlap of symptoms and possible causes makes addressing the problem broader and trickier than just treating Alzheimer’s. The emerging reality, which has become increasingly apparent with better brain imaging, is that the majority of cases among the elderly are so-called “mixed dementias”; the cognitive impairment is due to a combination of vascular problems, such as mini-strokes in discrete parts of the brain, and the more classic Alzheimer’s pattern of amyloid plaques. Large-scale international studies in the past three years have shown, according to a recent scientific summary, that dementias caused by blood-vessel lesions in the brain, including vascular dementia and mixed dementia, “together comprise the most common forms of dementia at autopsy in community-based studies.”
In developing countries the situation is far worse. What medical services they do provide are oriented to acute, short-term problems (broken bones,for example) not chronic long-terms problems (such as cancer). Dementia is something they never considered – mainly because people didn’t live that long.
At this point, I must refer to another article in the same issue of the MIT Technology Review – which I have also written about Why We Can’t Solve Big Problems. The dementia problem is a big problem, tens of billions have already been spent – with nothing to show for it. Just like the Cancer problem, which we also threw lots of money at – with few results, except to recognize that the problem is much larger than can deal with – and we will just have to live with it.
There is a solution to all problems of this kind – chronic wasting diseases that cannot be cured (such as terminal cancer). And it is simple – to allow people to decide, in advance, that they want their life terminated when they become incapacitated. The mechanism for doing this would have enabled by legislation – as it has been done already in several states.
On the national level, however this cannot be done. People react with horror to the very idea of giving the terminally ill control over ending their lives.
Why this is so, I have no idea. But I suspect it is part of a much larger decision to deny people the right to live independent lives. The really Big Problem now facing us.
Just after posting this, I saw this in the NY Times - For Alzheimer’s, Detection Advances Outpace Treatment Options.