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A Book Review: Aging with Grace - 2

Aging with Grace

What the Nun Study Teaches Us About Leading

Longer, Healthier, and More Meaningful Lives

David Snowdon, PhD

Bantom Books, 2001

In part one, we looked at the study parameters and tests that participants experienced. Now we see some of the results of studies on “Alzheimer’s.”

Growing Understanding of what we call, “Alzheimer’s”

  • Beginning in 1901, Dr. Alois Alzheimer of the Hospital of the Mentally Ill and Epileptics in Frankfort, Germany observed a patient named August D., a 51-year-old woman. Her behavior was unpredictable: “bears the stamp of utter bewilderment” – he couldn’t identify it as any known disease.

  • Dr. Alzheimer was greeted as a guest, and she would excuse herself to “finish her work.” Or --- she screamed madly to avoid being cut open. Or --- she would indignantly send him away as she feared that he threatened her “honor as a woman.” (p. 46)

  • As Auguste D. read, she would confuse lines. As she wrote, she repeated single syllables multiple times. When she spoke, she used odd phrases (milk pourer for cup). “She clearly does not grasp some questions, and it seems that she no longer knows the use of certain objects and was totally dulled, lying in bed with legs drawn up, incontinent” by the time she died in 1906. (p. 47)

  • Dr. Alzheimer autopsied the brain of Auguste D. “The autopsy revealed ‘a consistently atrophic brain’; damage and cell death had shrunk the tissue. …the nerve cells contained ‘a tangled bundle of fibrils.’ These he observed appeared ‘to go hand in hand with the storage of a pathological metabolic product’ around the nerve cells, which later researchers dubbed ‘plaques.’ Today, tangles and plaques are the two most important pathological features of what became known as Alzheimer’s disease.” (P. 47)

  • Snowdon and Jim Mortimer discussed this and successive work in the area in the late 1980s and “scientists still only had a flimsy handle on the degree to which plaques, tangles and strokes contributed to Alzheimer’s.” (p. 47)

  • “Nearly one hundred years after Alois Alzheimer first described the disease, it still defies a simple diagnosis for clinicians and pathologists alike. Dementia simple means ‘out of one’s mind’ in Latin. The diagnosis is usually made if three types of symptoms are present: There must be impairments in short-term memory, in another area of cognition (such as language), and, finally, in social or daily functioning (such as dressing). Dementia has, to date, at least sixty known causes.” (p. 86, 87) Possible causes include: infection by a bacterium (ex. untreated syphilis), a virus (ex. AIDS), prion (ex. Creutzfeldt-Jakob or its variant – Mad-Cow disease), Vitamin B12 deficiency, hypothyroidism, drug side-effects, toxins, tumors, strokes, head trauma (ex. boxing injuries), Huntington’s or Parkinson’s or Alzheimer’s (p. 87)

  • “Almost a century later, scientists are still debating the most basic issues first raised by Dr. Alzheimer: Which of the two Alzheimer’s lesions are more important in damaging and killing brain cells? How many plaques and tangle must be evident, and in which parts of the brain, before it is considered to be an ‘Alzheimer’s brain’?” (p. 89)

  • In 1992, “a team of researchers at Duke University Medical Center discovered that people who had a particular type of apoligpoprotein E had much higher rates of Alzheimer’s disease.” (p.122)

  • ·Alzheimer’s disease “appears to increase with age, hit a plateau, and then decline.” (p. 215)

Conclusions / Other Comments

  • Before this study, it was believed that a patient had to be at Stage III or IV on the Braak scale to show symptoms of Alzheimer’s. Baffling results lead researchers to speculate that depression can contribute to an earlier onset of symptoms at Stage II. (p. 95)

  • “The Nun Study’s real eye-opening findings, however, are the ones that add to the evidence that Alzheimer’s is not a yes/no disease. Rather, it is a process – one that evolves over decades and interacts with many other factors. We have shown dramatically how pathology alone often can mislead.” With one of these genes from one parent the risk factor is 3 times higher. With genes from both parents the risk factor is 8 times higher. (p,. 100)

  • When Snowdon and Susan Kemper presented the results to Markesbery, he asked ‘What does this mean for our children?’ Susan responded: ‘Read to them, It’s that simple. It the most important thing a parent can do with their children.’ “Susan explained that idea density depends on at least two important learned skills; vocabulary and reading comprehension. And the best way to increase vocabulary and reading comprehension. ‘And the best way to increase vocabulary and reading comprehension is by starting early in life, by reading to your children,’ Susan declared.” (p. 117)

  • To help a loved one who is showing signs of Alzheimer’s the best thing to do is: visit and discuss: current events, childhood memories, read aloud, sing songs together, play cards, puzzles, or other activities the individual enjoys – anything that person can do will “help them maintain enjoyment, pride, and dignity in their lives.” (p. 123)

  • When talking to someone with Alzheimer’s, give him or her time to respond. Don’t quiz and ask questions like: “Do you remember me?” (p. 124)

  • “Nothing loves oxygen more than the brain, which accounts for only about 2 percent of the body’s weight but demands 15 to 25 percent of the available oxygen. The hippocampus, which is so critical to memory, is particularly sensitive to ischemic damage. So, the brain literally chokes when a compromised heart or a clogged artery cannot deliver enough oxygen-loaded blood. Hypertension again comes into play here, as extra pressure on the walls of arteries stiffens them, making it easier for fatty plaques to form.” (p. 148)

  • “Whichever culprit starves the brain of oxygen; the result is often the same: stroke. First nerve cells die. Then, in a second wave of insult and injury, the brain tissue becomes inflamed. This initiates the so-called inflammatory cascade, in which the cells release toxic chemicals, killing more brain cells and further damaging the blood vessels. Depending on the location of the damage, the results may include partial paralysis, impaired vision, loss of speech – and what is called vascular dementia.” (p. 149)

  • “As we reported in a 1997 paper published in the Journal of the American Medical Association, our autopsies showed that the small (lacunar) brain infarcts had a stunning link to dementia in the sisters – but only if their brains also had enough plaques and tangles to meet the criteria for Alzheimer’s disease. …Our data also suggested that sisters with evidence of a stroke required fewer tangles in the neocortex to show signs of dementia than if they had been stroke-free. We concluded than many sisters – in spite of having brain damage from Alzheimer’s disease – avoided dementia because they had not suffered small strokes.” (p. 155)

  • “It also strongly suggests that stroke-free brains can compensate for Alzheimer’s lesions to some extent and mute the symptoms of the disease.” (p. 156)

  • Snowden does not believe that aluminum and mercury toxicity is problem. (p. 163, 165) This reviewer would recommend looking at other sources for this issue.

  • “Markesbery and other scientists have proposed that oxidation plays a major role in Alzheimer’s disease. Compared to healthy controls, brain tissue from Alzheimer’s patients shows higher levels of oxidation. Amyloid, the ingredient of the plaques, also appears to generate free radicals that add to the damage done to neurons. And tissue damage in turn creates more free radicals – setting off a destructive cascade of events that can lead to the atrophy and death of brain tissue.” (p. 171) “The real question, however, is subtly---but critically --- different: Does a positive outlook early in life contribute to longevity? Our data suggest that the answer is yes.” (p. 194)

  • Two factors that this study does not address but the researcher believes are extremely important: the deep spirituality and the strong community of the nuns in the Schools of the Notre Dame. (p. 201-202)

  • “The real question, however, is subtly---but critically --- different: Does a positive outlook early in life contribute to longevity? Our data suggest that the answer is yes.” (p. 194)

  • Other nutritional areas have been proposed as applicable – Lycopene – red pigment found in tomatoes, guaves, watermelon, pink grapefruit (p. 173); Vitamin E (p. 174); poor nutrition due to crop failure in the 18th century (p. 176); folic acid deficiency in a 1977 study (p. 177, 179).

  • “Neurologist Bill Markesbery recommends that his patients in the early stages of Alzheimer’s disease take considerably higher doses of vitamin E, vitamin C and folic acid. He also recommends a trial of a prescription anti-inflammatory drug, such a celcoxib (brand name Celebrex), which is less likely to cause stomach ulcers and bleeding than aspirin or other common anti-inflammatory drugs. These drugs may help to reduce the brain-damaging effects of the inflammatory effects of the inflammatory process in Alzheimer’s disease.” (p. 181)


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