Friday, August 19, 2016

Want to Laugh? Read "Old Age: A Beginner's Guide," by Michael Kinsley

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. 

August 19, 2016 in Advance Directives/End-of-Life, Books, Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Science, Statistics | Permalink | Comments (0)

Tuesday, August 9, 2016

Does Use of "Alzheimer's" as a Catch-all Label Cause Confusion?

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.  

August 9, 2016 in Cognitive Impairment, Dementia/Alzheimer’s, Estates and Trusts, Ethical Issues, Science | Permalink | Comments (0)

Monday, August 8, 2016

Which "Breakthrough" Will Prove to be the Real Miracle Needed to Prevent or Cure Alzheimer's?

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.

August 8, 2016 in Cognitive Impairment, Dementia/Alzheimer’s, Ethical Issues, Science | Permalink | Comments (0)

Tuesday, July 26, 2016

Are Certain Professionals, including Lawyers, Less at Risk for Cognitive Decline?

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."  

 

July 26, 2016 in Cognitive Impairment, Dementia/Alzheimer’s, Health Care/Long Term Care, Retirement, Science | Permalink | Comments (0)

Thursday, May 19, 2016

Simulated Aging

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 :-))

May 19, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Science | Permalink | Comments (0)

Wednesday, May 18, 2016

Aging. Can We Cure It?

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.”

 

May 18, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Science | Permalink | Comments (0)

Sunday, May 1, 2016

Go For A Walk Outside-Nature Increases Length of Life!

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).

 

 

 

 

May 1, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other, Science | Permalink | Comments (0)

Tuesday, April 19, 2016

Lessons About Protecting the Teenage Brain Can Resonate in Later Life

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.

 

April 19, 2016 in Cognitive Impairment, Consumer Information, Dementia/Alzheimer’s, Health Care/Long Term Care, Science | Permalink | Comments (0)

Monday, April 11, 2016

Is Aging Something to Be Cured?

We have all seen advertisements for "anti-aging" products and claims of products and research to defeat aging, reverse the effects of aging or at least slow down time.  Last month Fortune ran the article, The Obsession With 'Curing' Aging Is Now Big Business. Opening with statistics about Baby Boomers, the article next notes that "[i]t comes as little surprise, then, that finding ways to extend a healthy life has become big business, attracting many tens of millions in investment dollars from the likes of Google ...  and numerous biotechnology companies."  The article looks at six "tech titans" who are financing research for "longevity solutions," including the co-founder of the Methuselah Foundation who explains "[t]he Methuselah Prize has been credited for encouraging scientists to work on anti-aging research and treat aging as a "medical condition...." The research is fascinating. Check out the article and consider including this topic in a class discussion.

April 11, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Science | Permalink | Comments (0)

Monday, March 28, 2016

Recovering Memories Lost to Alzheimer's?

The Washington Post ran an article on March 17, 2016 about the work on Alzheimer's researchers at MIT have been doing . MIT scientists find evidence that Alzheimer’s ‘lost memories’ may one day be recoverable explains that "[a] new paper published Wednesday by the Massachusetts Institute of Technology's Nobel Prize-winning Susumu Tonegawa provides the first strong evidence of this possibility and raises the hope of future treatments that could reverse some of the ravages of the disease on memory." The research and results were featured in an article in Nature  The abstract explains

Alzheimer’s disease (AD) is a neurodegenerative disorder characterized by progressive memory decline and subsequent loss of broader cognitive functions. Memory decline in the early stages of AD is mostly limited to episodic memory, for which the hippocampus has a crucial role. However, it has been uncertain whether the observed amnesia in the early stages of AD is due to disrupted encoding and consolidation of episodic information, or an impairment in the retrieval of stored memory information. Here we show that in transgenic mouse models of early AD, direct optogenetic activation of hippocampal memory engram cells results in memory retrieval despite the fact that these mice are amnesic in long-term memory tests when natural recall cues are used, revealing a retrieval, rather than a storage impairment. Before amyloid plaque deposition, the amnesia in these mice is age-dependent, which correlates with a progressive reduction in spine density of hippocampal dentate gyrus engram cells. We show that optogenetic induction of long-term potentiation at perforant path synapses of dentate gyrus engram cells restores both spine density and long-term memory. We also demonstrate that an ablation of dentate gyrus engram cells containing restored spine density prevents the rescue of long-term memory. Thus, selective rescue of spine density in engram cells may lead to an effective strategy for treating memory loss in the early stages of AD.

(citations omitted). A subscription or fee is required to access the full article.

March 28, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Science | Permalink | Comments (0)

Thursday, March 24, 2016

Immortality through a Robot Clone?

There was an article in Motherboard last week that intrigued me. ​Companies Want to Replicate Your Dead Loved Ones With Robot Clones explains how many struggle with grief and moving on after the death of someone well-loved. 

Many grieving people feel n emotional connection to things that represent dead loved ones, such as headstones, urns and shrines, according to grief counselors. In the future, people may take that phenomenon to stunning new heights: Artificial intelligence experts predict that humans will replace dead relatives with synthetic robot clones, complete with a digital copy of that person's brain.

 According to the article, one research company has taken the first step down this path, with the goal " to 'transfer human consciousness to computers and robots.' The firm has already created thousands of highly detailed “mind clones” to log the memories, values and attitudes of specific people. Using the data, scientists created one of the world's most socially advanced robots, a replica of [the wife of the] ... founder...." 

According to the article, creating these "mind clones" achieves "[t]he goal ... to capture a person’s attitudes, beliefs and memories and create a database that one day will be analogged and uploaded to a robot or holograph, according to the Lifenaut website. Everything down to a person’s mannerisms and quirks can be recreated."

Why you might ask, would one want a have a robot clone of oneself? According to the article, there are several reasons. "Some users simply like the idea of living forever. Others want to document themselves as a part of human history. Some hope to pass on an artistic project or genealogical information to offspring. Fewer will use it to “memorialize” and “communicate with” the dead...."

Google has also filed a patent, according to the article, that focuses on duplicating a personality and would use, the article notes " a cloud-based system in which a digital “personality” can be downloaded like an app."  The article continues, discussing the pros and cons of moving forward with this technology and debates whether humans can really be replicated.

To reference Aldous Huxley, it's a "brave new world."

March 24, 2016 in Consumer Information, Current Affairs, Other, Science, Web/Tech | Permalink | Comments (0)

Tuesday, February 23, 2016

More Articles on Physician-Aided Dying

Here are three recent articles of note on Physician-Aided Dying (PAD) that might be useful in your classes.

First,  the Journal of the American Medical Association (JAMA) Psychiatry ran at article on February 10, 2016, Physician-Assisted Death for Patients With Mental Disorders—Reasons for Concern.  As the article opens: 

Physician assistance to help people end their lives—by prescribing or directly administering medication—is now legal in some form in 4 American states, Canada, and 4 European countries. In the United States, laws permitting physicians to write prescriptions for medications intended to end patients’ lives are limited to patients with terminal conditions and preclude physician administration of the medication. However, other countries, including the Netherlands, allow direct physician involvement and have expanded the criteria to include patients with irremediable suffering, whatever the cause. Therefore, the door has been opened for people whose suffering is primarily due to mental disorders to seek assistance in dying. (citations omitted)

Next in the same volume is the article about the study referenced in the first article: Euthanasia and Assisted Suicide of Patients With Psychiatric Disorders in the Netherlands 2011 to 2014.  The full article is free, and the tables and references are also available in the online version.  The authors conclude

Despite some limitations, an important strength of our study is that we examined reports of actual psychiatric EAS cases across an entire jurisdiction, rather than asking physicians to recollect their experiences or opinions. The results show that the patients receiving EAS are mostly women and of diverse ages, with various chronic psychiatric conditions, accompanied by personality disorders, significant physical problems, and social isolation or loneliness. Refusals of treatment were common, requiring challenging physician judgments of futility. Perhaps reflecting the complexity of such situations, the physicians performing EAS generally sought multiple consultations (but not always), and disagreement among physicians—especially regarding competence and futility—was not unusual. Despite these complexities, a significant number of physicians performing EAS were new to the patients. We conclude that the practice of EAS for psychiatric disorders involves complicated, suffering patients whose requests for EAS often require considerable physician judgment. The retrospective oversight system in the Netherlands generally defers to the judgments of the physicians who perform and report EAS. Whether the system provides sufficient regulatory oversight remains an open question that will require further study.

The New York Times ran an article about the study on February 10, 2016. Assisted Suicide Study Questions Its Use for Mentally Ill notes that

A new study of doctor-assisted death for people with mental disorders raises questions about the practice, finding that in more than half of approved cases, people declined treatment that could have helped, and that many cited loneliness as an important reason for wanting to die. The study, of cases in the Netherlands, should raise concerns for other countries debating where to draw the line when it comes to people’s right to die,

Discussing the findings from the study, the NY Times article notes that that it

finds that cases of doctor-assisted death for psychiatric reasons were not at all clear-cut, even in the Netherlands, the country with the longest tradition of carefully evaluating such end-of-life choices. People who got assistance to die often sought help from doctors they had not seen before, and many used what the study called a “mobile end-of-life clinic” — a nurse and a doctor, funded by a local euthanasia advocacy organization.

Good sources for your classes and for students writing papers on the topic!

 

February 23, 2016 in Advance Directives/End-of-Life, Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, International, Science | Permalink | Comments (0)

Stakeholders and Policymakers Collaborate on Proposals for Better Approach to Financing Long-Term Care

On February 22, 2016, a diverse collection of individuals, representing a broad array of stakeholders interested in long-term care, released their report and recommendations for major changes.  In the final report of the Long-Term Care Financing Collaborative (LTCFC) they propose:

•Clear private and public roles for long-term care financing

•A new universal catastrophic long-term care insurance program. This would shift today’s welfare-based system to an insurance model.

•Redefining Medicaid LTSS to empower greater autonomy and choice in services and settings.

•Encouraging private long-term care insurance initiatives to lower cost and increase enrollment.

•Increasing retirement savings and improving public education on long-term care costs and needs.

The full report is available here.  

ElderLawGuy Jeff Marshall wrote to supplement this post by providing details of the report, written by Howard Glecknan of the Utban Institute.  Thanks, Jeff!  

Members of the Collaborative included:

Gretchen Alkema, The SCAN Foundation; Robert Blancato, Elder Justice Coalition; Sheila Burke, Harvard Kennedy School; Strategic Advisor, Baker, Donelson, Bearman, Caldwell & Berkowitz; Stuart Butler, The Brookings Institution; Marc Cohen, LifePlans, Inc.; Susan Coronel, America’s Health Insurance Plans (AHIP); John Erickson, Erickson Living; Mike Fogarty, former CEO, Oklahoma Health Care Authority; William Galston, The Brookings Institution; Howard Gleckman, Urban Institute; Lee Goldberg, The Pew Charitable Trusts; Jennie Chin Hansen, immediate past CEO, American Geriatrics Society; Ron Pollack, Families USA; Don Redfoot, Consultant; John Rother, National Coalition on Healthcare; Nelson Sabatini, The Artemis Group; Dennis G. Smith, Dentons US LLP; Ron Soloway, UJA-Federation of New York (retired); Richard Teske (1949-2014), Former U.S. Health and Human Services Official; Benjamin Veghte, National Academy of Social Insurance; Paul Van de Water, Center on Budget & Policy Priorities (CBPP); Audrey Weiner, Jewish Home Lifecare, immediate past Chair, LeadingAge; Jonathan Westin, The Jewish Federations of North America (JFNA); Gail Wilensky, Project HOPE;Caryn Hederman, Project Director, Convergence Center for Policy Resolution; Allen Schmitz, Technical Advisor to the Collaborative, Milliman, Inc.

February 23, 2016 in Current Affairs, Ethical Issues, Health Care/Long Term Care, Housing, Medicaid, Medicare, Property Management, Retirement, Science, Statistics | Permalink | Comments (1)

Monday, February 22, 2016

Good News on the Dementia Front?

The latest issue of the New England Journal of Medicine (NEJM) has two articles about a recent study on dementia.  The first Is Dementia in Decline? Historical Trends and Future Trajectories and the second is Incidence of Dementia over Three Decades in the Framingham Heart Study.

A subscription is required to access the full article about the Incidence article, but a free preview is available.  Here is an excerpt from the preview

Background

The prevalence of dementia is expected to soar as the average life expectancy increases, but recent estimates suggest that the age-specific incidence of dementia is declining in high-income countries. Temporal trends are best derived through continuous monitoring of a population over a long period with the use of consistent diagnostic criteria. We describe temporal trends in the incidence of dementia over three decades among participants in the Framingham Heart Study.

The Dementia in Decline perspective article is available for free. A pdf of the article is available here.  Here is the opening paragraph from that article

In 2005, researchers from the Duke Center for Demographic Studies reported a “surprising trend”: data from the National Long-Term Care Surveys showed that the prevalence of severe cognitive impairment in the Medicare population had decreased significantly between 1982 and 1999. At a time when baby-boomer demographics led to predictions of a looming dementia crisis, this finding offered hope. Since that time, other reports have similarly shown that the incidence or prevalence of dementia is decreasing in various populations. Researchers have offered many possible explanations, including increased wealth, better education, control of vascular risk factors, and use of statins, antihypertensive agents, and nonsteroidal antiinflammatory drugs. However, even as researchers describe their “cautious optimism” about specific populations, they still project a quadrupling of global prevalence over the coming decades. (citations omitted)

February 22, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Science | Permalink | Comments (0)

Monday, February 15, 2016

Time Magazine's 4th Cover Issue on "Hope" for Alzheimer's Disease Solutions

Time Magazine's February 29 issue has a provocative image and title, showing a silhouette of a young woman about to ingest a spotlighted, shining capsule.  The issue, titled "The  Alzheimer Pill: A Radical New Drug," focuses on a pill called LM 11 A-31.

By my count, this is at least the fourth cover by Time focused on the latest hopes for a solution to this disease. Prior issues include:

  • October 25, 2010: Alzheimer's: At Last Some Progress Against the Most Stubborn Disease
  • May 14, 2001: Believe it or Not, this 91 Year-Old Nun Could Help Your Beat Alzheimer's, promoting a "landmark study of the disease." 
  • July 17, 2000: The New Science of Alzheimer's Disease

 

February 15, 2016 in Cognitive Impairment, Dementia/Alzheimer’s, Science | Permalink | Comments (0)

Thursday, February 4, 2016

"Compression of Morbidity" and its Relationship to "Healthy Aging"

My colleague Laurel Terry sent a link to this week's New York Times article that delves into the topic of "healthy aging."  Thank you! While I can see "healthy aging"as a goal, I have to admit I had not thought carefully about what we mean with those words.  Jane Brody's article, Finding a Drug for Healthy Aging, helps to explain, while also examining the latest push for medications that might serve the goal:

In 1980, Dr. James F. Fries, a Stanford University physician who studied chronic disease and aging, proposed that a “compression of morbidity” would enable most people to remain healthy until a certain age, perhaps 85, then die naturally or after only a brief illness.

 

Now, a group of experts on aging envisions a route to realizing Dr. Fries’s proposal: one or more drugs that can slow the rate of aging and the development of the costly, debilitating chronic ailments that typically accompany it. If successful, not only would their approach make healthy longevity a reality for many more people, but it could also save money. They say that even a 20 percent cut in how fast people age could save more than $7 trillion over the next half-century in the United States alone.

 

“Aging is by far the best predictor of whether people will develop a chronic disease like atherosclerotic heart disease, stroke, cancer, dementia or osteoarthritis,” Dr. James L. Kirkland, director of the Kogod Center on Aging at the Mayo Clinic, said in an interview. “Aging way outstrips all other risk factors.”

The practitioners of this field of study even have a name, geroscientists, "university scientists joined together by the American Federation of Aging Research to promote a new approach to healthier aging...." 

February 4, 2016 in Ethical Issues, Health Care/Long Term Care, Science | Permalink | Comments (0)

Monday, January 25, 2016

Stopping Alzheimer's?

Earlier this month I read an article about the role of brain inflammation in Alzheimer's.  Scientists May Have Just Discovered the Key to Halting Alzheimer's  was published on January 11, 2016 in Huffington Post Science.  "Researchers at the University of Southampton in England conducted a series of experiments showing a chemical that reduces neuroinflammation may have the potential to protect against the memory and behavioral changes associated with the disease that affects roughly 5.3 million Americans."  The article explains the research and notes that "[a]n overactive immune system can result in chronic inflammation, which previous research has linked to Alzheimer's. These new findings makes it increasingly apparent that inflammation is not a result of Alzheimer's as much as a key driver of the disease." Further research will be taking place.  Exciting!

January 25, 2016 in Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Science | Permalink | Comments (0)

Science, Elder Law and Genetic Counseling...

I think I might like winter better, if it always happened "conveniently" and with plenty of notice, as did Saturday's snow in Pennsylvania.  For once, I was prepared to be at home, with a stack of good reading materials for catching up when the joys of house-cleaning and snow shoveling faded. 

I am intrigued by the Fall 2015 issue of the NAELA Journal that focuses on how advances in genetic testing and medicine may be reflected in the roles of lawyers who specialize in elder and special needs counseling.  A leading article in the issue introduces the three primary uses of modern genetic testing -- for diagnosis of disease, for determination of carrier status, and for predictive testing -- while reminding us there are limits to each function.  In looking at age-related issues, the authors note:

 

Genetic testing is beginning to reveal information regarding susceptibilities to the dis­eases associated with old age: Alzheimer’s disease, Parkinson’s disease, diabetes, and cancer. Genetic test results showing a higher risk of such diseases can result in a cascade of conse­quences. Francis Collins, mentioned at the beginning of this article, responded to his test results thoughtfully by making lifestyle changes to reduce the probability that the increased genetic risk would be expressed in actual disease. It is important to note that, for some con­ditions, lifestyle factors’ influence on disease risk is understood; however, for many of the conditions that affect seniors, this influence is not yet known.

 

Other reactions to a high-risk test result may be more aggressive than diet and exer­cise changes. A well-publicized example is Angelina Jolie’s bilateral mastectomy. She was cancer-free but learned that she carries a BRCA1 mutation, which increases her lifetime risk for breast and ovarian cancer. She chose to undergo prophylactic mastectomy to reduce her breast cancer risk, whereas other women choose to increase breast cancer surveillance, such as undergoing more mammograms and breast MRIs. Both options are available to women who carry a BRCA1/2 mutation.

 

Will those found to be at elevated risk for more complex conditions such as Alzheimer’s disease or Parkinson’s disease make premature life choices, such as early retirement or mar­riage, based on perceived risk? Earlier in this article it is explained that an individual’s geno­type rarely determines his or her medical destiny. For example, many people with a higher genetic risk for Alzheimer’s disease will not actually develop it, while many with no apparent higher genetic risk will. Is the risk that members of the general public will misunderstand and overreact to the results of a genetic test sufficient reason to prevent them from obtaining the information gleaned from such a test? Should we be ensuring that those undergoing genetic testing are aware of its benefits and limitations through individualized genetic counseling? This, of course, presents its own challenges of access and availability.

In reading this, it seems likely that lawyers may encounter complicated issues of confidentiality, especially when counseling "partnered" clients, while also increasing the significance of long-range financial planning and assets management.  

For more, read Genetic Testing and Counseling Primer for Elder Law and Special Needs Planning Attorneys, by CELA Gregory Wilcox  and Rachel Koff, Licensed Certified Genetic Counselor. 

January 25, 2016 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Discrimination, Estates and Trusts, Ethical Issues, Retirement, Science | Permalink | Comments (0)

Thursday, January 21, 2016

A Closer Look at Goal Setting in Public Health: The Cuban Experience

I spent the first week of 2016 in Cuba with Dickinson Law students -- and it was an energizing experience (even as I fear I will never catch up on my other responsibilities this semester!).  The students' studies in Cuba were wide-ranging, with opportunities to engage with experienced legal professionals while discussing historic principles and modern plans for Cuba, including a close look at laws adopted just in the last two years that will affect economic development, international investment in Cuba, employment, property ownership and taxes.  For a full report on the course coverage and special events (including great photos by the students), see "Experience Beyond the Classroom Proves Invaluable."

Dr. Yoandra Adela Explaining Three Levels of Cuban Health Care SystemFor me, it especially interesting to hear directly about Cuba's health care system, which is highly regarded throughout the world, especially for its success in primary care for pregnant women.  From Dr. Yoandra Adelá (depicted left) we learned core principles that guide Cuba's plans for health care, including a goal of universal coverage, free and equally accessible to all Cubans.

Our professors freely admitted challenges that Cuba faces in trying to meet health care goals in a struggling economy, with international partners important in order for Cuba to maintain access to medicines, technology and even credit needed to improve buildings and make necessary repairs at treatment sites.

Since 1985, Cuba has recognized a medical specialization in "comprehensive care" -- which emphasizes preventative medicine and community-based contacts.  We saw this in action, where doctors from a local polyclinic spend half of their appointment days meeting patients in the office and half of those days seeing patients in their homes.   2L Student Corey Kysor Visits a Polyclinic in HavanaWe learned that for the elderly, many of the problems addressed by Cuban health care professionals mirror what is seen in the U.S., with hypertension and diabetes being significant health care risks; on the other hand, Cuba reports low incidence of infectious disease in their population.

I still need to learn more -- especially as I did not have time to fully explore "elder care," which reportedly includes some 380 hogares de ancianos and casas de abuelos, in addition to primary care offices that specialize in geriatric medicine. To the right is Corey Kysor, one of our law students visiting a Havana area polyclinic, the middle level of three components of health care available to all Cubans.  (And yes, our law school does plan to return to Cuba in the next academic year to offer additional opportunities for comparative legal studies.)

If you would like to read more, from the perspective of a law student who had already experienced foreign legal systems such as China before traveling for her first time to Cuba this January, read Joy Lee's "Inside Cuban Law and Culture: A Law Student's Perspective."  

January 21, 2016 in Current Affairs, Health Care/Long Term Care, Housing, International, Science | Permalink | Comments (0)

Tuesday, January 19, 2016

University of California-San Diego Rebuilds its Alzheimer's Research Program

Last summer, I blogged on news about the University of Southern California's controversial challenge to University of California-San Diego's position in Alzheimer's research, including USC's successful lure of top researchers (and their money).  Lawsuits were unsuccessful in blocking the move, an attempt to avoid the loss of key research dollars.  

However, the latest news is that UC-San Diego has "recruited a prominent Canadian neurologist to rebuild and lead" its Alzheimer's disease research program.  From the news coverage:

Dr. Howard Feldman comes to La Jolla from the University of British Columbia in Vancouver, where he achieved international acclaim for his examination of dementia and for carrying out large-scale drug trials. A science journal nicknamed him the “master of dementia.” He’s also known as a rainmaker for his ability to raise money for research.

 

Feldman, 61, is receiving a recruitment package that includes $10 million to set up his laboratory and support his research program. His annual salary is $390,000.

Let's hope this means that there are now two stronger sites for research into diagnosis, treatment and cure for this dreaded disease.  

January 19, 2016 in Cognitive Impairment, Dementia/Alzheimer’s, Science | Permalink | Comments (0)