Brain Ages Well : Alzheimer’s Fear Usually Unfounded
Dr. Jeffrey Levine sits in a small examining room at Mount Sinai Medical Center with a 74-year-old Spanish-speaking woman. Her face deeply lined, she complains of headaches, dizziness and constipation. Her medical chart reveals high blood pressure and congestive heart failure.
And on top of the physical ailments, her English-speaking daughter tells Levine, she has a greater fear: that advancing years are eating away her mind. Already she fails to take all her dozen medicines on time. “Sometimes she forgets; sometimes she remembers,” says the daughter. “She doesn’t want me to say anything because she feels bad about it.”
Mounting Fear
Call it Alzheimer’s anxiety: the mounting fear, fueled by a wave of dramatic television and newspaper stories, that Alzheimer’s disease will destroy the brain, erase memories and turn active adults into helpless, bedridden, infantile patients. According to a recent national poll by the University of Southern California, 44% of Americans over age 45 fear that they are likely to fall victim to the terrible malady, which was scarcely noticed by the medical profession as recently as a decade ago.
But for the great majority, such fears will prove unfounded. The recent publicity about Alzheimer’s disease has obscured the good news about getting old: 95% of Americans over age 65 will live out their lives with their thinking powers largely unimpaired.
Medical science, transforming long-held assumptions about mental decline, now believes that the mind weathers old age in surprisingly strong shape. It remains true that irritating memory lapses increase and minor mental tasks, such as memorizing a grocery list, become more daunting. But at the same time, some researchers contend that the mind actually grows stronger in more subjective but no less important tasks, such as reaching judgments.
Alzheimer’s, although it now afflicts an estimated 1 million Americans in its severe form, remains the exception, not the rule. And a frightening affliction it is--a progressive degeneration of the brain that renders its victims virtually without memory, as dependent as newborn infants on support from others. Despite promising new approaches to treatment, it still has only one outcome--death.
No wonder that Alzheimer’s has become the Big A, just as cancer is the Big C. “I see people who are incredibly nervous and upset the minute they can’t find their keys, petrified that they have the disease,” said Dr. Nancy Foldi, a psychologist and colleague of Levine.
Absent-mindedness, however, is a far cry from Alzheimer’s disease. Normal aging, said James E. Birren, dean of gerontology at USC, does not bleed the mind of its faculties.
“If you find a confused older adult who cannot reason, you’re faced with an instance of disease,” he said. “It’s not like you get older and your mind dribbles a little away each day. That’s not the way it is.”
To be sure, everybody experiences some minor memory loss with age. “Young people forget and say they are busy; old people forget and get worried,” said Denise Park, a University of Georgia psychologist.
Robert S. McCarthy, 90, still jogs three times a week, swims, plays bridge, takes his 1971 Cadillac and newer Volkswagen on the freeway, lives alone and manages his own financial affairs. Concerned about a little forgetfulness, the retired banker recently asked UCLA doctors to check whether his mind was on the wane.
‘Assured Me’
“You’ve been hearing more about Alzheimer’s disease lately. You read about in the paper,” said the slight--5-foot-6, 122 pounds--Whittier man. “I was just wondering if I had any symptoms, and they assured me I didn’t. The most unproductive thing you can do is worry.”
Most people have nothing more to worry about than McCarthy. New research suggests that the mind loses only about 20% or 25% of its peak speed with age. There are good, natural reasons.
Dr. John C. Beck, a specialist in aging at UCLA Medical School, likens the mind to a computer. “The older we get, the more data tapes we have stored,” he said. “To retrieve an old piece of information requires scanning more files than it did when we were 20.”
The normal loss of mental powers, however, does not seriously interfere with an active life. University of Missouri researchers, for example, found slower reaction times among older typists than younger ones, but the older workers compensated by looking farther ahead in the text as they typed. And, according to a similar University of Michigan study, older waiters kept up with younger ones because they accomplished more during each visit to the table.
Too Many Medicines
Thus Levine is not surprised that his patient at Mount Sinai Medical Center, who frets about being forgetful, cannot remember to take all her medicines on time. In fact, he wonders why she should take some of them at all.
“This is iron; it can make her constipation worse,” he says, tossing a big jar into the trash can. Another drug, for arthritis, suffers the same fate--”this isn’t any good at all.”
“You would have to be a genius,” he says, “to follow the schedule for all these drugs.”
In contrast to Levine’s frightened elderly patient, some people can do serious, intellectual work even in the autumn of life. Morris Hirsh proves that.
His body stooped, Hirsh, 94, wears two hearing aids and strains to read small print with the help of eyeglasses and a magnifying glass. But twice a week, the Los Angeles resident enthusiastically teaches classes in the Talmud, a highly complex compilation of Jewish law and tradition that includes commentaries on the Bible, ethics, legal issues and philosophy. Written in Hebrew and Aramaic, it represents the product of scholars who have thrashed through these issues for centuries.
‘All That I Do’
Asked how many hours a day he spends reading, Hirsh replied: “You asked an incomplete question. The question is how much day and night. That’s all that I do.”
The shelves in Hirsh’s room at the Shalom Retirement Kosher Hotel are crammed with books, some held together with masking tape. “The important part in my life is the mental part that’s left,” he said. “Physical abilities leave you. I hear and see to a limited degree. The only pleasure that’s left at this age are these books over there. Reading is my exercise and satisfaction.”
Although Hirsh, a Russian native, has pored over the material many thousands of times, it still inspires him. “In teaching Talmud,” he said, “my job is not only they shall see life of 2,000 years ago. They shall feel it. You have to understand the influence of the Greeks and the Romans and the Syrians and the Babylonians and the Persians. When you show them that--and they see it--it becomes enjoyable.”
Hirsh demonstrates that the principle of “use it or lose it” applies to the mind as well as the body. Doctors agree that the brain, even more than physical health, determines whether an elderly person can live independently or requires the attention of a nursing home.
Possible Improvements
“Those (elderly) with the least involvement in life show the greatest intellectual declines in old age,” said Warner K. Schaie, a psychology professor at Pennsylvania State University. And University of Michigan psychologist Marion Perlmutter said some skills, such as the ability to distill lessons from experience, may not only endure, but actually improve with age.
The confusion and forgetfulness that sometimes mimic Alzheimer’s disease may be triggered by other, often treatable conditions, such as depression, thyroid disease, the body’s reaction to medication and anxiety after surgery. The USC poll showed that 80% of those who are aware of Alzheimer’s disease do not realize that there are other causes for the same symptoms. As a consequence, said Prof. Neal E. Cutler, who conducted the poll, “people needlessly begin to fear that they are losing their mind.”
An 86-year-old Los Angeles man, who was embarrassed to be identified by name, remembered his fright when he suddenly began losing his ability to concentrate and could not walk on the golf course without falling down.
“The first thing that went through my mind was that I certainly didn’t want to end up being unable to add a column of figures or make a deposit in the bank,” he said. “If there’s anything in the world I would hate to face, it would be not being able to cope with a problem.”
Not Alzheimer’s
The culprit turned out to be not Alzheimer’s but hydrocephalus, a fluid disorder affecting the brain. The man was treated and, though he sometimes relies on a cane these days, he goes to the driving range three times a week to polish his golf swing. And most important, he has no trouble balancing his bank account.
“The reason these (dementia) diseases are so feared is that they attack what being human is really all about,” said Dr. Stephen Read, a psychiatrist who specializes in such cases. “To see somebody come back even a little is tremendously gratifying.”
Often, the life style of retirees makes them less aware of things that seemed important when they were working. This can spark false alarms about confusion. Ruth Swan, 66, who retired from a job at the USC hospital, said: “Almost everybody I speak to thinks that at one time or another, they’re losing their memory. I know I’ve felt it.”
She has learned not to be alarmed just because she cannot remember, for example, what day it is. “I’m not going into work every day where I have calendars in front of me,” she said. “I don’t have work routines that I do every day. Frequently, I’ll wonder if this is Tuesday or Friday. When you’re retired, it doesn’t matter as much.”
Until not long ago, physicians subscribed to the gloomy view that long life would inevitably lead to a loss of the mind. Only since the 1970s have many doctors and psychologists decided that old age is not synonymous with senility, said Dr. Lissy Jarvik, a psychiatrist at UCLA.
Of the 200,000 new cases of actual severe dementia diagnosed each year, Dr. Bob Cook-Deegan of the congressional Office of Technology Assessment says Alzheimer’s disease accounts for about two-thirds. Small strokes and tumors cause most of the rest. In only about 2% of all dementia cases can the patient’s life be restored to normal.
Stages of Disease
More than 90% of dementia victims are over 65, and Cook-Deegan says 1.5 million of them are so severely afflicted that they need help with life’s daily chores. Another 1 million to 2 million people, he says, have a milder stage of Alzheimer’s disease; they can manage to live on their own for now but will become helpless later.
Caring for the incurable victims imposes a staggering cost on society. The Clearing House for the Future, a research group for Congress, estimates that medical costs--drugs, hospitalizations, nursing home care--plus the value of wages lost by patients and their family care givers range between $24 billion and $48 billion a year.
Strains of Care
And families bear the brunt of the costs. Spouses and children commonly suffer physical and mental strains as they care for those who no longer know the names or even the faces of their closest loved ones. A book on the grueling ordeal was titled “The 36-Hour Day.”
A network of day-care centers for Alzheimer’s patients and support groups for families is developing rapidly. The 6-year-old Alzheimer’s Disease and Related Disorders Assn., with 149 local chapters and 1,000 support groups, works closely with victims and families, offering aid and advice through a toll-free hot line (1-800-621-0379).
Although they attract overdue attention to the disease, such efforts have also spread fears--so successfully that, according to the USC poll, 80% of those who are aware of Alzheimer’s disease realize that it is incurable. Although doctors in Los Angeles announced Nov. 13 that they had found an experimental drug that provides symptomatic relief for Alzheimer’s sufferers, Dr. David A. Drachman, chairman of the neurology department at the University of Massachusetts Medical Center, said an actual cure is probably a generation away. Science must first develop a greater understanding of the brain’s workings.
‘Be Certain’
Doctors increasingly appreciate the dangers of falsely determining that patients have Alzheimer’s. “The really important thing is to be sure first of all if someone is quite normal and not just worried about the fact he can’t find his car every time in the parking lot,” Drachman said. “The second thing is to be certain there isn’t a treatable disease that is being missed.”
At New York’s Mount Sinai geriatrics clinic, doctors, nurses, psychologists and social workers try to cope with their elderly patients’ forbidding tangle of physical and mental problems. Levine sees a parade of patients whose problems are as diverse as the elderly population itself.
One is Ruth, 84 and gaunt, her eyes set deep in sunken cheeks. The victim of several strokes, she just sits and smiles, unable to answer any of Levine’s simple questions except to give her maiden name. Levine, who believes that Ruth is suffering from malnutrition, wants to put her in a nursing home, but her family will not agree.
Variety of Abilities
“There is such a huge spread of abilities and illnesses,” Levine says. “At age 80 you have a lot of healthy and vigorous people. You also have a lot of frail, demented and bedridden people.”
But in today’s atmosphere, dementia itself is far less common than the anxiety that it will strike. For those who wonder fearfully about life after 80, experts more and more seek to emphasize the positive.
“Some people are not going to survive,” said the University of Michigan’s Perlmutter. “Some people are going to survive and not be healthy. But those people who survive and are healthy have the potential for wisdom.”
