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Message: <br /><br /> If you are having trouble reading this email, you may view this article online at: http://www.jweekly.com/22920/full/22920/jewish-home-geriatrician-ponders-the-difference-between-forgetfulness-and-d/ <br /><br /> <b>Jewish Home geriatrician ponders the difference between forgetfulness and dementia</b> <br /> Friday, June 11, 2004 | by <p>janet silver ghent </p> <br /><br /><p>Have you seen my keys?<br /><br /> In which aisle did I leave the car?<br /><br /> Honey, what’s the name of the CEO you just introduced me to?<br /><br /> Yes, we are all losing it. But is it cause for concern?<br /><br /> “Truthfully, we all lose memory, starting in our teens,” says Dr. Jay Luxenberg, medical director of the Jewish Home in San Francisco, who recently gave a talk there on the topic. Such changes are “inevitable parts of the aging process — our cognition changes.”<br /><br /> But such “age-related changes are separate from Alzheimer’s” — the illness that afflicted former President Ronald Reagan, who died this week, for a decade — and these changes don’t constitute dementia, he says, reassuringly.<br /><br /> The mild memory loss, associated with aging, is incremental but slow, creeping along at a snail’s pace. Dementias, by contrast, are aggressive.<br /><br /> With mild memory loss, he suggests, people can use mnemonic devices to help them remember or jot names and vital information into a PDA or notebook. They can also tie a colored ribbon to the antennas of their cars, he adds, noting that he was recently looking in the wrong aisle for his car, when a young friend of his son’s remembered exactly where it was.<br /><br /> “We use technology to help us remember appointments. That works for age-associated cognitive impairment, but not Alzheimer’s,” he says, emphasizing that Alzheimer’s is a disease.<br /><br /> But because normal memory loss is not an illness, “there is no drug I can advocate” to prevent it. “That doesn’t mean there won’t be such a drug. I’m hopeful.”<br /><br /> Meanwhile, new treatments are being developed for Alzheimer’s. And some physicians are recommending ginkgo biloba, a plant that has played a crucial role in Chinese herbal medicine and that can treat Alzheimer’s but won’t prevent it.<br /><br /> Can it be prevented? The jury is out, says Luxenberg, a clinical professor at the UCSF medical center, where he specializes in geriatric medicine. <br /><br /> “At one point, we were touting estrogen, only it didn’t prevent Alzheimer’s.” More recently, some authorities are advocating non-steroidal anti-inflammatory drugs, such as Advil. A recent study documented in the New England Journal of Medicine said that such medications, taken regularly, may provide protection against Alzheimer’s.<br /><br /> In addition, some people are taking such drugs as Lipitor, to lower cholesterol, and it may have some protective effect against Alzheimer’s. <br /><br /> Others are touting vitamin E, he says, although the evidence is weak. “The good thing about vitamin E is it’s not very expensive.”<br /><br /> But the main thing people should be doing as they age, Luxenberg says, is the common-sense steps that promote health: regular exercise, good diet, taking calcium and dealing with any health problems that can aggravate dementia. <br /><br /> He points out that there is a high association between Alzheimer’s and diabetes, and that high blood pressure untreated can lead to small — or major — strokes, and brain damage. “The advice is take care of your blood pressure.”<br /><br /> But “there isn’t a lot of evidence we can prevent Alzheimer’s by these measures,” he adds.<br /><br /> Although there are tests that can point out whether someone is carrying a risk-factor gene — and such tests are helpful in medical studies of large groups — they are extremely expensive and they cannot determine whether a particular individual will develop Alzheimer’s.<br /><br /> “Alzheimer’s disease is really a disease — there may be triggers, environmental triggers or protective [factors], but the risk is very strongly genetically linked.”<br /><br /> While memory loss is inevitable, he points out, dementia is not, adding that he has attended birthday parties of centenarians who were still able to do their taxes. <br /><br /> However, the majority of residents in nursing homes are there because they have some kind of dementia, perhaps coupled with physical illnesses. “If you eliminated dementia, you could close three-quarters of the nursing homes in the United States and we wouldn’t notice.”<br /><br /> The goal, he emphasizes, is maintaining quality of life, rather than keeping people alive for a long time after their brains have ceased to function well. Few would want to face the kind of “long goodbye” endured by the Reagan family.<br /><br /> “What we want to do is square out the morbidity curve — die the ‘One-Hoss Shay,’ death,” he says, referring to the Oliver Wendell Holmes poem about a carriage that collapses all at once. “We want to be able to travel, go to restaurants, be active until the time we die. That’s a rarity. For most, there will be a time of disability. They will need some help. My goal would be to have lots of options, whether it’s assisted living or a nursing home. We’re a lucky community because we have lots of choices, but we need them.<br /><br /> “There are wonderful scientists at UCSF working to expand the life span,” he adds. “But until we can address this disability problem — strokes, dementia — it isn’t very attractive to live to 200.”</p> <p> </p>

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