Monday, May 22, 2017
In what is described as a "first" for the National Academy of Elder Law Attorneys (NAELA), the organization through its New York Chapter will present argument on behalf of individuals seeking to establish access to "aid in dying." On April 27, the New York Chapter was granted leave to appear as amicus curiae in Myers v. Schneiderman before the New York Court of Appeals. Oral arguments are scheduled in Albany on May 30, 2017.
At issue is New York's penal law prohibiting assistance in "suicides." The original suit, filed in February 2015, sought a ruling that the statute, characterized by opponents as "antiquated," should be interpreted as not reaching the conduct of a physician that provides aid-in-dying where the patient is terminally ill and mentally competent and voluntarily seeks "terminal medication." Alternatively, the opponents of the law argue that the statute violates the rights of privacy and/or equal protection guaranteed by the New York State Constitution. New York's trial level court dismissed the challenge as a matter of law, on the grounds that New York's penal law was "clear on its face."
In joining the challenge to the dismissal, which was affirmed by appellate division, New York NAELA wrote:
As an organization of lawyers who represent the elderly and persons with disabilities, the New York Chapter [of NAELA] believes that a proper interpretation of New York's "assisted suicide" laws and due consideration of Appellants' constitutional challenges should be based on a fully developed factual record. These are issues of great moment to the elderly and those who love them and to the administration of justice in this State. This Court should have the benefit of a hearing and findings of relevant evidence before deciding them. . . .
What would assist this Court in fairly construing the Penal Law are facts relating to aid-in-dying. While the language of the statute is the starting point for interpretation, its words do not exist in a vacuum.
For more on the arguments, including links to the various parties' appellate briefs in Myers, see the "End of Life Liberty Project."
May 22, 2017 in Advance Directives/End-of-Life, Cognitive Impairment, Discrimination, Ethical Issues, Health Care/Long Term Care, Science, State Cases, State Statutes/Regulations | Permalink | Comments (0)
Thursday, April 20, 2017
The New York Times ran an article earlier this month about a 94 year old genius. To Be a Genius, Think Like a 94-Year-Old features Dr. John Goodenough. who "at 94, has just set the tech industry abuzz with his blazing creativity. He and his team at the University of Texas at Austin filed a patent application on a new kind of battery that, if it works as promised, would be so cheap, lightweight and safe that it would revolutionize electric cars and kill off petroleum-fueled vehicles." Back when Dr. Goodenough was 23 and starting college, he was told by a professor that he was too old to succeed in his chosen field of physics. The article mentions how for some creativity increases with age but there are biases and hurdles in their way.
At least in Silicon Valley, the article notes, youth seems to be the common denominator. But, for others "there’s plenty of evidence to suggest that late blooming is no anomaly. A 2016 Information Technology and Innovation Foundation study found that inventors peak in their late 40s and tend to be highly productive in the last half of their careers." Even someone from the Patent Office has noticed that “there’s clear evidence that people with seniority are making important contributions to invention.”
The author asks Dr. Goodenough for his thoughts.
When I asked him about his late-life success, he said: “Some of us are turtles; we crawl and struggle along, and we haven’t maybe figured it out by the time we’re 30. But the turtles have to keep on walking.” This crawl through life can be advantageous, he pointed out, particularly if you meander around through different fields, picking up clues as you go along. Dr. Goodenough started in physics and hopped sideways into chemistry and materials science, while also keeping his eye on the social and political trends that could drive a green economy. “You have to draw on a fair amount of experience in order to be able to put ideas together,” he said.
Plus being a 94 year old scientist is freeing. "Last but not least, he credited old age with bringing him a new kind of intellectual freedom. At 94, he said, 'You no longer worry about keeping your job.'"
Friday, March 17, 2017
I've blogged a couple of times recently about the fight against Alzheimer's disease. Here's a recent story about research efforts stymied by federal law. Big Alzheimer's research roadblock: Federal government was published by CNBC on March 9, 2017. "Promising new research conducted last year at the Salk Institute for Biological Studies has shown that marijuana extracts may hold a key to treating Alzheimer's disease. The next step: To conduct tests on mice and, if the results are promising, move on to human trials. But Salk Institute researchers have run into a major hurdle, and not a scientific one: the federal government. The Salk Institute is based in La Jolla, California — a state that legalized marijuana last November — but it is a federally funded research institute."
The story reminds us that although marijuana use may be legal in several states, it's still not ok at the federal level-it's still a controlled substance. And when a research institute like Salk gets federal dollars for research, there's a problem.
So does this mean a dead end for marijuana/Alzheimer's research? Not necessarily. There is a path, but it won't be a quick or guaranteed one. "In order to acquire marijuana for further studies, the lab must first apply to the Drug Enforcement Agency, which carries out the application process jointly with the U.S. Department of Health and Human Services. The Salk researchers sent in their application in December...." It takes several months for such a request to be approved. The article discusses the costs of Alzheimer's disease (which we have written about in prior posts)
The cost to the economy of caring for Alzheimer's and dementia patients was estimated to be about $236 billion in 2016. In 2015 a study funded by the National Institutes of Health estimated that the costs associated with late-stage dementia are greater than for any other disease.
During the last five years of a person with dementia's life, total health-care spending was more than a quarter of a million dollars per person ($287,038), about 57 percent greater than costs associated with death from other diseases, including cancer ($173,383) and heart disease ($175,136).
We all know how important it is to find an effective treatment (or even cure?) for Alzheimer's. For now, the folks at Salk have to wait to hear if they can move forward.
BTW, those astute readers will notice the url for the story includes the phrase "major buzz kill." To follow up, I'll close now with some my own pithy phrase, "dude, serious bummer". You insert your own pithy phrase here.....
Tuesday, March 7, 2017
From the Washington Post, an especially moving account written by former White House Communications Director Jennifer Palmieri about her sister, who died at age 58 following some ten years with "early onset" Alzheimer's:
Every day, more Americans receive the devastating news that someone in their family has this affliction. For now, there is not a lot of hope for recovery. It can make you envious of cancer patients; their families get to have hope. Having come through this experience with my sister, I am afraid that I can’t offer these new Alzheimer’s families hope for a recovery. But I do hope that by relaying the story of my sister’s journey, I can offer them some peace.
My sister Dana was brilliant, beautiful, full of positive energy, a force of nature. She was not an easy person. She was driven and successful, and, as the disease progressed unbeknown to all of us, it became harder to connect with her. Ironically, that began to change once she got the diagnosis.
When she called each of us with the news, she already had it all figured out. We were all to understand that, really, she saw the diagnosis as a blessing. It was going to allow her to retire early. It would motivate our family to spend time together we would not have otherwise done. It would shorten her life, but she would make sure the days she had left were of the highest quality.
The thoughtful piece can help all of us as we and our family members tackle challenges. For more, read The Blessings Inside my Sister's Alzheimer's Disease.
Tuesday, February 28, 2017
Paula Span, the thoughtful columnist on aging issues from the New York Times, offers "Gorsuch Staunchly Opposes "Aid-in-Dying." Does It Matter?" The article suggests that the "real" battle over aid-in-dying will be in state courts, not the Supreme Court.
I'm in the middle of reading Judge Gorsuch's 2006 book, The Future of Assisted Suicide and Euthanasia. There are many things to say about this book, not the least of which is the impressive display of the Judge's careful sorting of facts, legal history and legal theory to analyze the various advocacy approaches to end-of-life decisions, with or without the assistance of third-parties.
With respect to what might reach the Supreme Court Court, he writes (at page 220 of the paperback edition):
The [Supreme Court's] preference for state legislative experimentation in Gonzales [v. Oregon] seems, at the end of the day, to leave the state of the assisted suicide debate more or less where the Court found it, with the states free to resolve the question for themselves. Even so, it raises interesting questions for at least two future sorts of cases one might expect to emerge in the not-too-distant future. The first sort of cases are "as applied" challenges asserting a constitutional right to assist suicide or euthanasia limited to some particular group, such as the terminally ill or perhaps those suffering grave physical (or maybe even psychological) pain....
The second sort of cases involve those like Lee v. Oregon..., asserting that laws allowing assisted suicide violate the equal protection guarantee...."
While most of the book is a meticulous analysis of law and policy, in the end he also seems to signal a personal concern, writing "Is it possible that the Journal of Clinical Oncology study is right and the impulse for assistance in suicide, like the impulse for old-fashioned suicide, might more often than not be the result of an often readily treatable condition?"
My thanks to New York attorney, now Florida resident, Karen Miller for pointing us to the NYT article.
February 28, 2017 in Advance Directives/End-of-Life, Consumer Information, Crimes, Dementia/Alzheimer’s, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Cases, Health Care/Long Term Care, Religion, Science, State Cases, State Statutes/Regulations | Permalink | Comments (0)
Friday, February 10, 2017
When I first saw the news stories of the French cyclist who had set a cycling record for sixty minutes, I wasn't particularly impressed -- that is, until I realized that Mr. Robert Marchand is now age 105 and he's trying to break his own record of almost 17 miles per hour, set when he was 103. Turns out this is part of a much larger story about fitness in aging. From the New York Times:
At the age of 105, the French amateur cyclist and world-record holder Robert Marchand is more aerobically fit than most 50-year-olds — and appears to be getting even fitter as he ages, according to a revelatory new study of his physiology.
The study, which appeared in December in the Journal of Applied Physiology, may help to rewrite scientific expectations of how our bodies age and what is possible for any of us athletically, no matter how old we are.
For more, read Lessons on Aging Well, From a 105 Year-Old Cyclist. Inspiration for your own weekend workout, perhaps!
Wednesday, January 25, 2017
The winter issue of Columbia University's Magazine has an article on Your Beautiful Brain: Dispatches from the Frontiers of Neuroscience. I was particularly interested in the account of Nobel Prize-winning Professor Eric Kandel's 50+ years of research that began by looking at Aplysia -- a "blobby mollusk with protruding feelers that resemble rabbit ears" -- thus contributing to the mollusk's nickname, the "sea hare."
Clearly to Professor Kandel, the mollusks' brains were beautiful, not least because their comparatively large neural structures provided an accessible way to study more complex structures such as the human brain. Dr. Kandel, now 87, admits that "hunches" have played a role in his research.
From Columbia Magazine:
Today, as neuroscientists worldwide pursue remedies for Alzheimer’s and age-related memory loss, Kandel’s half century of findings are considered indispensable. Substantive therapies for Alzheimer’s in particular are “poised for success,” says Jessell, a colleague of Kandel’s for thirty-five years. “We’re on the cusp of making a difference.” But accompanying that claim is a caveat; the fledgling remedies are not panaceas. “We’re not necessarily talking about curing the disease,” he says. “But we are talking about slowing the symptomatic progression of the disease so significantly that lifestyles are improved in a dramatic way. If in ten years we have not made significant progress, if we are not slowing the progression of Alzheimer’s, then we have to look very seriously at ourselves and ask, ‘What went wrong?’”
Breakthroughs could happen sooner, however. Some of the Alzheimer’s medications available now “probably work,” says Kandel, except for one obstacle: “By the time patients see a physician, they’ve had the disease for ten years. They’ve lost so many nerve cells, there’s nothing you can do for them.” Possibly, with earlier detection, “those same drugs might be effective.” That’s not a certainty, insists Kandel, only a “hunch.”
Professor Kandel has also explored the biological differences between "ordinary" age-related memory loss and Alzheimer's Disease.
Years ago, Kandel had another hunch — that age-related memory loss was not just early-stage Alzheimer’s, as many neuroscientists believed, but an altogether separate disease. After all, not everyone gets Alzheimer’s, but “practically everyone,” says Kandel, loses some aspects of memory as they get older. And MRI images of patients with age-related memory loss, as demonstrated by CUMC neurology professor Scott Small ’92PS, have revealed defects in a brain region different from those of the early-stage Alzheimer’s patients.
Kandel also knew mice didn’t get Alzheimer’s. He wondered if they got age-related memory loss. If they did, that would be another sign the disorders were different. His lab soon demonstrated that mice, which typically have a two-year lifespan, do exhibit a significant decrease in memory at twelve months. With that revelation, Kandel and others deduced Alzheimer’s and age-related memory loss are distinct, unconnected diseases.
Then Kandel’s lab (again, with assistance from Small) discovered that RbAp48 — a protein abundant in mice and men — was a central chemical cog in regulating memory loss. A deficit of RbAp48 apparently accelerates the decline. Knocking out RbAp48, even in a young mouse brain, produces age-related memory loss. But restoring RbAp48 to an old mouse brain reverses it.
Now what may be the eureka moment — this from Gerard Karsenty, chairman of CUMC’s department of genetics and development: bones release a hormone called osteocalcin. And Kandel later found that osteocalcin, upon release, increases the level of RbAp48.
“So give osteocalcin to an old mouse, and boom! Age-related memory loss goes away.”
The same may prove true in humans. A pill or injectable could work, says Kandel: “Osteocalcin in a form people can take is something very doable and not very far away.” In less than a decade, age-related memory loss might be treatable. “This,” he says, “is the hope.”
For more on beautiful brains, read the full article on Columbia University's website.
Tuesday, January 24, 2017
A new one hour documentary, Alzheimer's: Every Minute Counts, is scheduled to begin airing nationally on PBS stations on Wednesday, January 25.
In part, the documentary will focus on research funding issues. Dr. Ruby Tanzi, a Harvard Medical School researcher who appears on the film, explained for NextAvenue's website:
We should be absolutely panicked at the government level. When the Medicare and Medicaid [treatment and care] bill for Alzheimer’s goes from one in five dollars to one in three dollars — that could happen over the next decade with baby boomers getting older — we could single-handedly collapse Medicare and Medicaid with Alzheimer’s disease.
Now, the government [research funding for Alzheimer's] has gone up to about a billion dollars. Which is great, it’s more money. It’s still not the billions of dollars that go to other age-related diseases. I’m glad that cancer and heart disease and AIDS get many billions of dollars, but Alzheimer’s has to get as much or more now given the epidemic and the urgency here with how many cases we’re going to have.
It’s going to crush us. Never mind the social burden on the families. I might add that two-thirds of patients are women. And most caregivers are women. What’s going to happen when so much of our female population is (struck) with this disease? So it’s a huge problem and if we don’t throw a ton of money at it now, it’ll be a disaster.
For more information on the documentary, including links to watch it on-line (free!), see PBS "Alzheimer's: Every Minute Counts." There is an important opportunity here for schools, including law schools, to host an airing of the documentary to promote discussion about strategies.
Wednesday, January 11, 2017
I'm much overdue in writing about a terrific, recent workshop at Arizona State University's Sandra Day O'Connor College of Law on "The Aging Brain." For me it was an ideal gathering of disciplines, including experts in neurology, psychology, health care (including palliative care and self-directed aid-in-dying), the judiciary, and both practitioners and academics in law (not limited to elder law). Even more exciting, that full day workshop (11/18/15) will lead into a public conference, planned for fall 2017.
Key workshop moments included:
- Preview of a potentially ground-breaking study of early-onset Alzheimer's Disease (AD) centered on a family cluster in the country of Columbia with a genetic marker for the disease and a high incidence of onset. By "early onset," we're talking family members in their 40s. The hope is that by studying the bio-markers in this family, that not only early onset but later-in-life onset will be better understood. Eric Reiman, with professional affiliations with Banner Health, Arizona State University and University of Arizona, spoke at the workshop, and, as it turned out, he was also featured on a CBS 60 Minutes program aired a short time later about the family-based study. Here's a link to the CBS transcript and video for the 60 Minutes program on "The Alzheimer's Laboratory."
- Thoughtful discussion of the ethical, legal and social implications of dementia, including the fact that self-directed aid-in-dying is not lawful for individuals with cognitive impairment. Hank Greely from Stanford University Law and Medical Schools, and Professor Betsy Grey for ASU's Sandra Day O'Connor College of Law led discussions on key issues. As biomarkers linked to AD are identified, would "you" want to know the outcome of personal testing? Would knowing you have a genetic link to AD change your life before onset?
- Overview of recent developments in "healthy" brain aging and so-called "anti-aging" treatments or medications, with important questions raised about whether there is respected science behind the latest announcement of "breakthroughs." Cynthia Stonnington from the Mayo Clinic and Gary Marchant from ASU talked about the science (or lack thereof), and Gary raised provocative points about the role of the FDA in drug approvals, tracking histories for so-called off label uses for drugs such as metformin and rapamycin.
I very much appreciate the opportunity to participate in this program, with special thanks to Betsy Grey and federal Judge Roslyn Silver for making this possible. I've also enjoyed serving as occasional guest in Judge Silver's two-semester Law and Science workshop with ASU law students. Thank you! For more on the Aging Brain programming at ASU, see here.
January 11, 2017 in Advance Directives/End-of-Life, Cognitive Impairment, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Programs/CLEs, Science | Permalink | Comments (0)
Friday, January 6, 2017
I was reading a recent blog post on the Scientific American that featured a guest blog by Dr. Snyder, the Senior Director of Medical and Scientific Operations, Medical and Scientific Relations for the Alzheimer's Association. The blog, Alzheimer's Falls More Heavily on Women Than on Men, opens with two vignettes of women who early-onset Alzheimer's.
Alzheimer’s dementia disproportionately affects women in a variety of ways. Compared with men, 2.5 times as many women as men provide 24-hour care for an affected relative. Nearly 19 percent of these wives, sisters and daughters have had to quit work to do so. In addition, women make up nearly two-thirds of the more than 5 million Americans living with Alzheimer’s today.
The blog explains that researchers are studying this to see if they can find the answer, but longevity alone isn't likely it. The post also reports on the work of the Alzheimer's Association including a funding initiative for 9 research projects. Some are looking at lifestyle factors including stress and education. The article concludes with a discussion of the role and importance of advocacy
Thursday, November 24, 2016
We all need a little good news right now. So this one caught my eye. Dementia rates have declined amongst elders (yay). Kaiser Health News reported Dementia Rates Decline Sharply Among Senior Citizens citing to a study recently published in the AMA Journal of Internal Medicine. A Comparison of the Prevalence of Dementia in the United States in 2000 and 2012 reports on a drop from 11.6% to 8.8% on the years of the study.
Here's the abstract:
Importance The aging of the US population is expected to lead to a large increase in the number of adults with dementia, but some recent studies in the United States and other high-income countries suggest that the age-specific risk of dementia may have declined over the past 25 years. Clarifying current and future population trends in dementia prevalence and risk has important implications for patients, families, and government programs.
Objective To compare the prevalence of dementia in the United States in 2000 and 2012.
Design, Setting, and Participants We used data from the Health and Retirement Study (HRS), a nationally representative, population-based longitudinal survey of individuals in the United States 65 years or older from the 2000 (n = 10 546) and 2012 (n = 10 511) waves of the HRS.
Main Outcomes and Measures Dementia was identified in each year using HRS cognitive measures and validated methods for classifying self-respondents, as well as those represented by a proxy. Logistic regression was used to identify socioeconomic and health variables associated with change in dementia prevalence between 2000 and 2012.
Results The study cohorts had an average age of 75.0 years (95% CI, 74.8-75.2 years) in 2000 and 74.8 years (95% CI, 74.5-75.1 years) in 2012 (P = .24); 58.4% (95% CI, 57.3%-59.4%) of the 2000 cohort was female compared with 56.3% (95% CI, 55.5%-57.0%) of the 2012 cohort (P < .001). Dementia prevalence among those 65 years or older decreased from 11.6% (95% CI, 10.7%-12.7%) in 2000 to 8.8% (95% CI, 8.2%-9.4%) (8.6% with age- and sex-standardization) in 2012 (P < .001). More years of education was associated with a lower risk for dementia, and average years of education increased significantly (from 11.8 years [95% CI, 11.6-11.9 years] to 12.7 years [95% CI, 12.6-12.9 years]; P < .001) between 2000 and 2012. The decline in dementia prevalence occurred even though there was a significant age- and sex-adjusted increase between years in the cardiovascular risk profile (eg, prevalence of hypertension, diabetes, and obesity) among older US adults.
Conclusions and Relevance The prevalence of dementia in the United States declined significantly between 2000 and 2012. An increase in educational attainment was associated with some of the decline in dementia prevalence, but the full set of social, behavioral, and medical factors contributing to the decline is still uncertain. Continued monitoring of trends in dementia incidence and prevalence will be important for better gauging the full future societal impact of dementia as the number of older adults increases in the decades ahead.
The authors offer these findings from their study "Population brain health seemed to improve between 2000 and 2012; increasing educational attainment and better control of cardiovascular risk factors may have contributed to the improvement, but the full set of social, behavioral, and medical factors contributing to the improvement is still uncertain."
The Kaiser article offers some perspective about what this drop means: "The number of Americans over age 65 is expected to nearly double by 2050, reaching 84 million, according to the U.S. Census. So even if the percentage of elderly people who develop dementia is smaller than previously estimated, the total number of Americans suffering from the condition will continue to increase, said Keith Fargo, director of scientific programs and outreach, medical and scientific relations at the Alzheimer’s Association."
So with the end of the semester, and we are grading exams, just think how good this will be for us in the long run!
Friday, October 21, 2016
LeadingAge, the trade association that represents nonprofit providers of senior services, begins its annual meeting at the end of October. This year's theme is "Be the Difference," a call for changing the conversation about aging. I won't be able to attend this year and I'm sorry that is true, as I am always impressed with the line-up of topics and the window the conference provides for academics into industry perspectives on common concerns. For example, this year's line up of workshops and topics includes:
- General sessions featuring Pulitzer Prize winning journalist Charles Duhigg on the "The Science of Productivity," 2013 MacArthur Fellow and psychologist Angela Duckworth on the the importance of grit and perservance for successful leadership, and famed neurosurgeon and speaker Sanjay Gupta on "Medicine and the Media."
- Hundreds of sessions, organized by "interest groups":
October 21, 2016 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, International, Legal Practice/Practice Management, Medicaid, Medicare, Programs/CLEs, Property Management, Retirement, Science, Social Security, State Cases, State Statutes/Regulations, Veterans | Permalink | Comments (2)
Friday, August 19, 2016
I'm always just a bit suspicious of books that promise to make me laugh. I think it is because I like to be surprised by humorous moments, rather than feel duty-bound to chuckle, guffaw or giggle.
Nonetheless, I succumbed to the promise in the blurb for Michael Kinsley's 2016 book, Old Age: A Beginner's Guide, that it was a "surprisingly cheerful book ... and a frequently funny account of one man's journey to the finish line."
And I'm glad I did. I did indeed laugh, and at the most surprising of moments, as when he described the need to avoid the doors of his refrigerator because of the magnets that might interfere with the technology in his brain used to keep symptom of Parkinson's Disease at bay. He has the knack of making wry observations about his own mortal state to think broadly about what it is for all of us to age. I can see the short essays that make up this book being useful in a class on elder law or estate planning.
His words are perhaps most poignantly relevant to boomers. For example, on a goal of living longer, he writes:
Even before you're dead, you may want to ask yourself whether this is what you really want. Is being alive all that desirable if you're alive only in the technical sense? Millions of boomers are watching their parents fade until they are no longer there. As they approach their seventies, they start observing their own peer group losing their collective marbles, one at a time. And they reasonably conclude that the real competition should not be about longevity. It should be about cognition.
But he doesn't stop there, exploring other, potentially more important goals for the competitive boomer generation to consider.
This is a short, deep book. And I recommend it, not least of all because it gives readers welcome opportunities to smile.
Tuesday, August 9, 2016
Recently, a friend who is a neuropsychologist reminded me that the medical profession is moving away from using either dementia or Alzheimer's as a broad category label. For example, in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, commonly referred to as the DSM followed by a number that indicates the edition, the current edition (DSM-5) replaced the label "Dementia, Delirium, Amnestic and Other Cognitive Disorders" with "Neurocognitive Disorders" or NCDs. As we talked, it occurred to me that this is an important change, and one that legal professionals should also embrace more strongly. While short-hand labels can be useful, I think that using dementia alone as a label can invoke a stereotype that has the potential to confuse the public, while also unnecessarily frightening the client or client's family. It can invoke an image of nursing homes or institutionalization, rather than what may be more appropriate, such as supported or guided decision-making or use of alternative decision-makers or agents, especially in early stages of the disorders.
As the DSM-5 further explains:
Although cognitive deficits are present in many if not all mental disorders (e.g., schizophrenia, bipolar disorders), only disorders whose core features are cognitive are included in the NCD category. The NCDs are those in which impaired cognition has not been present since birth or very early life, and thus presents a decline from a previously attained level of functioning.
The NCDs are unique among DSM-5 categories in that these are syndromes for which the underlying pathology, and frequently the etiology as well, can potentially be determined. The various underlying disease entities have all been the subject of extensive research, clinical experience, and expert consensus on diagnostic criteria.... Dementia is subsumed under the newly named entity major neurocognitive disorder, although the term dementia is not precluded from use in the etiological subtypes in which the term is standard. Furthermore, DSM-5 recognizes a less severe level of cognitive impairment, mild neurocognitive disorder, which can also be a focus of care....
Indeed, greater appreciation for mild neurocognitive disorders is important in legal circles, as the changes may often be subtle or difficult to recognize, but still very important when talking about legal capacity or decision-making under the law.
Monday, August 8, 2016
I've been writing for the Elder Law Prof Blog for almost exactly three years, and it has been a wonderful way to keep up with the vast array of topics that affect "law and aging," Blogging has broadened my horizons, especially with respect to medicine and science. At first I would get excited about each new announcement of a potential drug or treatment that "might" cure Alzheimer's.
Over time, you learn to be more, shall we say, judicious in reporting on the report of cures.
Australian researchers announced last year that they "have come up with a non-invasive ultrasound technology that clears the brain of neurotoxic amyloid plaques - structures that are responsible for memory loss and a decline in cognitive function in Alzheimer’s patients." Their preliminary work is with mice:
Publishing in Science Translational Medicine, the team describes the technique as using a particular type of ultrasound called a focused therapeutic ultrasound, which non-invasively beams sound waves into the brain tissue. By oscillating super-fast, these sound waves are able to gently open up the blood-brain barrier, which is a layer that protects the brain against bacteria, and stimulate the brain’s microglial cells to activate. Microglila cells are basically waste-removal cells, so they’re able to clear out the toxic beta-amyloid clumps that are responsible for the worst symptoms of Alzheimer’s.
The team reports fully restoring the memory function of 75 percent of the mice they tested it on, with zero damage to the surrounding brain tissue. They found that the treated mice displayed improved performance in three memory tasks - a maze, a test to get them to recognise new objects, and one to get them to remember the places they should avoid.
"We’re extremely excited by this innovation of treating Alzheimer’s without using drug therapeutics," one of the team, Jürgen Götz, said in a press release. "The word ‘breakthrough’ is often misused, but in this case I think this really does fundamentally change our understanding of how to treat this disease, and I foresee a great future for this approach."
What has happened since the first news "alert," published in March 2015? Perhaps one of our readers knows the latest on this particular approach, and can bring more light to bear on this breakthrough. For more, read, Science Alert: "New Alzheimer's Treatment Fully Restores Memory Function." Special thanks to GW Law Professor Naomi Cahn for bringing this item to our attention.
Tuesday, July 26, 2016
The Washington Post published an interesting article reporting on the recent Alzheimer's Association International Conference in Toronto. According to the article,
Two studies looked at how complex work and social engagement counteract the effects of unhealthy diet and cerebrovascular disease on cognition. One found that while a “Western” diet (characterized by red and processed meats, white bread, potatoes, pre-packaged foods, and sweets) is associated with cognitive decline, people who ate such food could offset the negative effects and experienced less cognitive decline if they also had a mentally stimulating lifestyle.
Occupations that afforded the highest levels of protections included lawyer, teacher, social worker, engineer and doctor; the fewest protections were seen among people who held jobs such as laborer, cashier, grocery shelf stocker, and machine operator.
“You can never totally forget about the importance of a good diet, but in terms of your risk of dementia, you are better able to accommodate some of the brain damage that is associated with consuming this kind of (unhealthy) diet,” said Matthew Parrott, a post-doctoral fellow at the Rotman Research Institute in Toronto, who presented the study.
In another study, researchers found that people with increased white matter hyperintensities (WMHs) – white spots that appear on brain scans and are commonly associated with Alzheimer’s and cognitive decline – were able to better tolerate WMH-related damage if they worked primarily with other people rather than with things or data.
For more of the intriguing findings, read "Complex Jobs and Social Ties Appear to Help Ward Off Alzheimer's, New Research Shows."
Thursday, May 19, 2016
While I was on the Genworth site looking at the looking at their annual Cost of Care survey findings, I noticed their simulated aging project, R70i Aging Experience. The Genworth R70i Aging Experience, according to the website "uses state-of-the-art technology to help people step into their future selves and directly experience the physical effects associated with aging. The experience reinforces the importance of thinking about future long term care needs and talking to loved ones about how they would like to age." The website offers interactive controls so the user can examine certain points of the "aging suit" as well as a video that shows how the suit functions along with a narration. This would be really cool if we could have one for our students to use, so they can experience it firsthand. (If anyone from Genworth is reading this and wants to donate one to us, I promise we'll share with other educational institutions :-))
Wednesday, May 18, 2016
We have blogged before about the idea of aging that is something to be "cured". The recent article in the New York Times explained some cutting edge research about fighting aging. Dogs Test Drug Aimed at Humans’ Biggest Killer: Age explains about a clinical trial with dogs that has implications for humans "the trial also represents a new frontier in testing a proposition for improving human health: Rather than only seeking treatments for the individual maladies that come with age, we might do better to target the biology that underlies aging itself." The drug being tested on dogs was previously tested on mice and "improved heart health and appeared to delay the onset of some diseases in older mice" but there is no guarantee that the same result will be achieved with dogs.
According to the article, age itself serves as a huge risk factor for a number of fatal diseases, so "[a] drug that slows aging, the logic goes, might instead serve to delay the onset of several major diseases at once." "Geroscience" that is "the study of aging’s basic biology" according to those quoted in the article, hasn't received a lot of attention. There's some genius in the approach of testing this drug with dogs, given American's love affair with their dog family members.
“Many of us in the biology of aging field feel like it is underfunded relative to the potential impact on human health this could have,” said Dr. Kaeberlein, who helped pay for the study with funds he received from the university for turning down a competing job offer. “If the average pet owner sees there’s a way to significantly delay aging in their pet, maybe it will begin to impact policy decisions.”
The article explains that research has been more "disease-specific" rather than globally looking at slowing down aging. Although the article does mention some projects that are specifically looking at slowing down or reversing aging. The article also explains the challenges for research in this field. What would be the results to humans if this research proves successful? A longer, healthier life. And if it isn't successful? Dr. Kaeberlein, explained: “I would argue we should be willing to tolerate some level of risk if the payoff is 20 to 30 percent increase in healthy longevity,” he said. “If we don’t do anything, we know what the outcome is going to be. You’re going to get sick, and you’re going to die.”
Sunday, May 1, 2016
We've all been reading the articles about global warming and the impact on the planet, and on us. Although Earth Day is a couple of weeks past us, there's even more reason to think about the future of the planet. The Washington Post ran the article Why living around nature could make you live longer. The article highlights a recent study that indicates that not only is living near nature good for your health, it may help you live longer! The study was published on April 14, 2016 in the journal, Environmental Health Perspectives (EHP), Exposure to Greenness and Mortality in a Nationwide Prospective Cohort Study of Women. Here are some excerpts from abstract from the EHP article: "Objectives: We aimed to examine the prospective association between residential greenness and mortality... Conclusions: Higher levels of green vegetation were associated with decreased mortality. Policies to increase vegetation may provide opportunities for physical activity, reduce harmful exposures, increase social engagement, and improve mental health. While planting vegetation may mitigate effects of climate change, evidence of an association between vegetation and lower mortality rates suggests it also might be used to improve health."
Now, back to the Washington Post story, which tells us "[t]his is all in line with the ways previous research has suggested greenness can affect health. Places with more vegetation are generally thought to be less polluted, and the presence of vegetation, itself, can help keep air cleaner. And green spaces like parks can help encourage people to get outside, exercise and engage with other people — all factors that can improve overall health. The effects on mental health may be somewhat less straightforward, but nonetheless important, as this study suggested." As far as mental health, the article notes that social engagement and human's long term connection with nature is rejuvenating.
The article quotes one of the authors that more study is needed on the "finer details" of our interacting with nature. But for now, go outside and take a walk (and maybe buy some houseplants, too).
Tuesday, April 19, 2016
I recently caught a rebroadcast of a Terry Gross interview -- from early 2015 and linked here -- with Dr. Frances Jensen, a neuroscientist from the University of Pennsylvania, on the "teenage brain." It was fascinating, especially as Dr. Jensen explained the latest thinking on trauma on the younger brain, and the potential for alcohol and drug use -- both illegal and legal -- to be especially significant to the still developing teenage brain. Given that we need those brains to last for a very long time, the broadcast seems relevant to our Elder Law Prof Blog topics.
This insulation process [from myelin] starts in the back of the brain and heads toward the front. Brains aren't fully mature until people are in their early 20s, possibly late 20s and maybe even beyond, Jensen says.
"The last place to be connected — to be fully myelinated — is the front of your brain," Jensen says. "And what's in the front? Your prefrontal cortex and your frontal cortex. These are areas where we have insight, empathy, these executive functions such as impulse control, risk-taking behavior."
This research also explains why teenagers can be especially susceptible to addictions — including drugs, alcohol, smoking and digital devices.
And as to that last item on the list -- digital devices -- Dr. Jensen emphasized her concerns about constant stimulation, especially when it lasts into time meant for sleeping. The intense light alone may be interfering with with sleep and brain development. She explains:
First of all, the artificial light can affect your brain; it decreases some chemicals in your brain that help promote sleep, such as melatonin, so we know that artificial light is not good for the brain. That's why I think there have been studies that show that reading books with a regular warm light doesn't disrupt sleep to the extent that using a Kindle does.
I'm from a generation that didn't pay much attention to closed head injuries -- indeed, I think we more or less thought of "mild concussion" as a right of passage for young athletes. Only in the last few years are we beginning to accept the connection between such injuries and later brain degenerative processes. Now, even as we're getting better about physical risks from sports, we need to work harder to avoid the almost round-the-clock effects of our computerized lives.
Dr. Jensen closed the interview with sound advice for everyone:
GROSS: We are out of time, but I just want to ask you if there's any quick tip you can give us to preserve our brain health - something that you would suggest that adults do?
JENSEN: I think [take] time to reflect on what you've done every day, to underscore for yourself the most important things that happen to you that day and to not respond to conflict - to try to not respond to conflict in the midst of your working environment, for instance, because it will color your efficacy.
For more, look for Dr. Jensen's book: The Teenage Brain: A Neuroscientist's Survival Guide to Raising Adolescents and Young Adults.