Thursday, October 19, 2017

Scary Alzheimer's



Halloween is approaching and so we thought we should do a blog about the thing that scares people most about growing older—Alzheimer’s disease and the other disorders that lead to dementia. 

So you’re in the doctor’s office for an annual physical and the doctor says three words, for example, ball, flag, tree, and asks you to remember them.   Or asks you to subtract 7 from 100 and then continuing subtracting 7s.  You know what’s going on.  You are being tested on the kinds of tests used to screen for dementia.  So are you feeling a little anxious about how you will do?  It is probably no surprise that anxiety is likely to make it harder for you to do those tasks.

A new study done by a French and American team of researchers shows that giving people instructions that increase their fears about how they will perform on a dementia screening test leads to poorer performance on the tests.  In the study, a sample of community living adults who were 75 years old were given two tests that are widely used by doctors and other health professionals to screen for dementia and for Mild Cognitive Impairment, the Mini-Mental State Exam (MMSE) and the Montreal Cognitive Assessment (MoCA). 

If participants were told they were taking a test that older and young people performed differently on, then about half of them scored on the impaired range.  If they were told that older people and younger people did about the same, between 5 and 15 percent fell in the impaired range.  Before they were given the second test, the investigators gave new instructions to the people who had previously been told that they might do more poorly because they were older.  Now they were told that the second test was one that young and old did equally well on.  As a result, their performance improved.

The take home message is if you scare 75 year olds before giving them a test, up to one half will show some impairment.  But if you give them neutral instructions, the actual number that have impairment is between 5 and 15 percent, depending on the test.  This leaves a huge chunk of people who could be misdiagnosed.

When Judy was in private practice doing neuropsychological testing for dementia, she felt strongly that it was important to err on the side of under-diagnosis.  If she had any doubt in the testing, she felt that giving people reassurance would help them worry less, which could improve their everyday performance.  She would arrange for re-testing in a year, and told clients it could lead to three possible outcomes, two of which are good.  A person could get better or stay the same, which are both good outcomes indicating they do not have dementia.  If they declined, it was important to consider how much of a decline was shown before concluding it was dementia.  There can be a little bit of age-related decline that is not early dementia.  In other words, she believed it was unethical to conclude that someone had dementia without being 100% sure. 

From the beginning of our careers, we have seen people who were wrongly diagnosed as having some type of dementia.  Mild Cognitive Impairment is an even fuzzier concept.  Many health care professionals regard it as the first stage of Alzheimer’s but there is increasing evidence that as many as 53 percent of people who are given the diagnosis do not have dementia.  These false positive findings may be due to many factors, such as medications, transient health problems, or as this study showed, just the perceived threat that the test holds can lead to anxiety which leads to poor performance.

The Mild Cognitive Impairment category has become popular because of an emphasis on early detection of Alzheimer’s.  The argument goes that a treatment will only be effective early in the disease, before a lot of the damage to brain neurons occurs.  But efforts at early detection raise the risk of false positive diagnoses, which can cause considerable anxiety and potentially could lead to people trying treatments for a disorder they do not even have, and that are not without their own dangers.  Alzheimer’s is a scary and awful disease.  Efforts at detection need to be tempered by an awareness of the limits of current tools for diagnosis. 

Happy Halloween.

Reference:

Mazerolle, M., et al., (2017).  Negative aging stereotypes impair performance on brief cognitive tests used to screen for predementia.  Journals of Gerontology: Psychological Sciences and Social Sciences, 72, 932-936.  doi:10.1093/geronb/gbw083


Friday, October 13, 2017

Old Dogs, New Tricks and Time



One of the most prevalent of the beliefs about aging is that creativity declines for writers and artists as they grow older.  To some extent that is true, but there are lots of exceptions. 

Our friend Murna Downs was visiting from England and we took her to one of our favorite places in Pennsylvania, Fallingwater, which is a house designed by the great American architect, Frank Lloyd Wright.  We have been there several times, but Murna did not know about the house and had never seen a photo of it, so seeing it with her helped us view it in a fresh way.  As we walked down the wooded path from the Visitors Center, and the house emerged from the trees, its beauty took our breath away.  In our tour through the house, we saw features that we had not noticed before, in particular the way the design inside led your eyes past the walls to the outdoors.  House, trees, mountain and water formed one organic whole.  It is a great work of art and maybe the most beautiful house we have ever seen.

Wright was in his late 60’s when he designed it.  In fact, the story is that he sketched out the design in under two hours. Too old indeed!  If you have not visited Fallingwater in person, it is well worth a trip.


One of the gifts of retirement is gaining a new perspective on time.  We have time for excursions like the trip to Fallingwater.  Instead of rushing around to get things done, we can slow down and savor time.  We don’t have to meet anyone else’s schedule, at least not most of the time.  I have been thoroughly caught up in watching the baseball playoffs, and do not have to worry that I am neglecting work that needs to be done.  Cubs versus Dodgers in the National League Championship Series raises a rift in the family—Ben an ardent Cub fan as well as many other of my Chicago relatives, Matt and Tom as lifelong Dodger fans.  I think I’ll sit back, have a beer (or a chardonnay if I want to blend in with the Dodger faithful), and see how it turns out.

Friday, September 22, 2017

Déjà Vu



Are you watching the PBS/Ken Burns and Lynn Novick Film, “The Vietnam War?”  For those of us in the Baby Boomer Generation, it’s our war.  I have watched the first three episodes.  During the second episode I began to feel depressed, mainly because of all the mistakes and missed opportunities to avoid war, and I could barely get through the third episode, which brought out how brutal the war was.

It is easy to see the mistakes now and also to recognize that this country continues to make the same mistakes.

There was the belief we were in a global death struggle with a monolithic and powerful enemy—Communism, and so we believed we had to take a stand there.   But we didn’t know the land, the culture or how to fight a war there.   And we didn’t understand that the Vietnamese were nationalists first and communists second.

There were also our government’s lies about the build up, the bombing, the goals, the prospects for victory.

And we never had a viable partner governing South Vietnam, who would fight corruption and find ways to win over the “hearts and minds” of the population.  We couldn’t do that on our own.

It’s not that the North held the moral high ground.  The North was a regime that at times was brutal and repressive, and they were willing to sacrifice a huge number of their young men and women in waging the war.

I visited Viet Nam in 2007 and 2008, the first time with Judy, our friend Leta Myers and my Swedish colleague Stig Berg.   Stig had begun a partnership between Jönköping University and the Medical and Technical College #2 located in Da Nang (now Da Nang University of Medical Technology and Pharmacy) .  The partnership was part of a larger EU effort to form partnerships between universities in Europe and in developing countries like Vietnam.  There were regular exchanges of faculty and students between the two universities and there were plans for a joint research program, which is why Stig invited me to visit. It was quickly obvious that Stig had built relationships with faculty and students in Da Nang characterized by mutual respect and genuine affection for one another.  His colleagues from Jönköping University who also visited at various times—Bo Malmberg, Susanne Johannesson and others, also formed strong friendships with faculty and students. 

I was struck by the optimism and energy I found at the college and in the wider community.  The students in particular were bright, energetic and eager to learn.  Life was not easy there and there were few of the comforts we are used to.  The students’ dorms were remarkable—8 to 10 students crammed into a single room filled with bunk beds.  No air-conditioning.  Bathrooms down the hall somewhere.  Yet the students were cheerful and upbeat, and were excited about the path they saw for their lives.

I doubt that Vietnam could have turned out any better if we had somehow won the war and it certainly would have been better if there had been a peaceful resolution of the conflict in 1962 or 1963, even if that led to a Communist regime.  There had certainly been a period after the war of retaliation and imprisonment of supporters of the regime in the South.  And the current government does not tolerate criticism or allow a political opposition.  But the various governments in the South showed similar authoritarian tendencies.  And the fear that we had that Southeast Asia would become dominated by communism—that the dominoes would fall—never materialized.  Instead, Vietnam fought a war with China and overthrew the brutal Khmer Rouge regime in Cambodia, and now they are our allies in trying to contain China’s expansionist dreams.

One of the gifts of aging is learning from experience.  There are lessons from the Vietnam War that as a country we have yet to learn.


The photo is of Stig, Judy, Leta and one of our hosts in Da Nang.

Wednesday, September 13, 2017

Learning How To Let Go

The Elephant from Murano circa 1994

We had such a great response to the last post about down-sizing, that we decided to follow up with one strategy for getting rid of all the stuff that you no longer want or need.  Last June one of our across-the-street neighbors sold their home to move into a 55+ community, and they had an auction.  We became aware of it when pick-up trucks and giant SUVs started pulling up and parking up and down the street.  There was a "blue house" (port-a-potty), and one of those fast-talking auctioneers...it was the real deal.  Now our neighbors had built their house in 1983 or so, and she had it filled with antiques, and he was a hunter, and was also selling some of his rifles.  So we thought they had enough valuable stuff to appeal to an auctioneer.  We didn't really think we did, though.  And our experience with yard sales in State College is that they're a lot of work with very little return.  So we've been boxing things up and carting them to Habitat, AAUW and Goodwill.

When we met with our realtor to discuss our plans, he gave us the name of a local auctioneer who specializes in on-line auctions.  We met with him, and it was a real education. Over the past ten years, the entire auction industry has been evolving, so that there are fewer and fewer traditional auctions.  Even for a well-publicized auction you might get a hundred people, and it limits your audience to those who are near enough to travel to it.  With an on-line auction, things are put on the website for two weeks, and then after the auction happens, there is a two-hour window when people who are local can come pick up items, and then everything else is shipped (and the buyer pays for it!).  Your items will be viewed by thousands of people all over the country.  Smaller items are generally taken to their warehouse, and distributed from there.  And here's the real kicker:  the things that sell the best are everyday items.  I mean dishes, decor items, cookbooks, kitchen utensils, cookware, garden tools, rugs, appliances, lamps, and, of course, furniture.  Apparently there are some people who furnish their entire houses with items they buy at these auction sites.  

The beautiful thing is that they are really catering to the baby boomers who are down-sizing now.  We are planning to have them come take away the smaller items we won't be moving with us (or using in the next few months), and those will be auctioned first.  In January, when the stagers come in and inevitably want less furniture in the house, they will auction those things off.  Finally, when the house sells, they will hold the big auction of everything else.  We'll move out what we want to take with us, and they can sell the rest.  When the sale is over they will haul off and dispose of anything that doesn't sell, leaving an empty house.  

I can't begin to describe the sense of relief we are both feeling.  So many of the things we have carried with us over the years we keep because we feel they are worth something and we don't feel right just throwing them away.  Even donating them to Goodwill doesn't guarantee that they won't just end up in the trash.  There's something extremely validating about knowing that someone else appreciates your belongings...it's almost like you can fantasize that they are going to a good new home, where they'll be appreciated and loved.




Monday, September 11, 2017

Time for a Fresh Start? Clutter Counseling and Tchotchke Management


As we go through life, we all accumulate stuff—art work, knickknacks, souvenirs and gifts of various shapes and sizes, kitchen gadgets, tools, children’s old school papers.  The Yiddish word “tchotchke” captures the haphazard collection of objects that graces nearly every surface in our house and fills our storage areas.   Through the convergence of recent events in our lives, we are taking a new look at our clutter.

After her mother died in May, Judy had the job of clearing out her apartment.  For those of you who had the opportunity to visit Avis in her home, you probably remember the decorations—picture arrangements on the walls, display cases filled with objects that evoked memories for her, décor items on table tops and fireplace mantles.  The apartment was not cluttered—everything was neatly arranged, but it was definitely full.

For many people, these objects are mementos of a time and place, a link to moments in our past.  Downsizing often means stripping away many of these objects, particularly when people are moving into assisted living or other specialized housing.  When Avis moved from her condo into the addition we built onto our house, and which she helped design, she was pleased that she did not have to get rid of much of her stuff, because besides her two room apartment plus room-size closet on the main floor, there was a three room apartment below her that she filled with pictures, tchotchkes and furniture.  For the seven years she lived with us she was comfortably surrounded with her own belongings.

Another reason people hold on to these various objects is to pass them down to children and grandchildren.  When Judy began sorting through things after Avis’s death, she contacted her siblings and all of Avis’s grandchildren to see if they wanted any of the pictures, knickknacks or furniture.  A couple of the grandchildren were interested in an item or two, which Judy shipped off to them, but there was little interest overall.  A recent New York Times article described a similar story, that children of baby boomers have little interest in the furniture or stuff of their parents, even heirlooms such as fine china that may have some value.

Following Avis’s death, we also began re-evaluating our own situation.  We asked ourselves if two people really needed a house with 7 bedrooms and 6 ½ baths.  The house is full during the holidays with our children and grandchildren, and we have occasional visits from them and from friends during the year, but otherwise it’s just the two of us.  We had talked about moving closer to our youngest son and his family, and so we decided to put the house up for sale.  We will be downsizing, possibly even into an apartment while we take the time to decide upon a new house.

That decision brought us face-to-face with our own Tchotchkes.   The down side of a big house is that there are lots of places to store things conveniently out of sight.  We asked our kids what they might want, and there was little interest, even for treasures of theirs we had saved for years such as legos and baseball cards.  So we have begun to sort and ask ourselves—Is this something we need?  Some objects have sentimental value, for example, a glass elephant we bought in Murano over 20 years ago, but most of it is just a tchotchke, occupying space but with no functional value or meaning. 

So we have decided to make a fresh start.  We will get rid of anything that doesn’t “speak” to us and most of the furniture, taking only the basics.  The furniture we carefully selected for this house is unlikely to fit well in our next house.  Besides, we like the idea of getting new furniture and not being weighed down by lots of stuff.  We will still have photos and some objects with special meaning, but we don’t need nearly as much as we have now.  We have moved some things out already (we’re kind of waiting for Goodwill to ask us to stop coming) and will do the rest when the house sells. 

We bought this house ten years ago, and it has served us well as we transitioned into grandparenthood, and as a touchstone for our adult children to be able to gather together.  And it allowed Judy’s mother to have what she called her own “long term care insurance”…her apartment here.  But now it’s time for us to move on and for another family to pick up the baton.

If you know anyone who wants a 7 bedroom, 6 ½ bath house that can accommodate lots of people and things, send them our way.



Reference:  Tom Verde, “Aging Parents with Lots of Stuff, and Children Who Don’t Want It.”  The New York Times, https://www.nytimes.com/2017/08/18/your-money/aging-parents-with-lots-of-stuff-and-children-who-dont-want-it.html