
We Are Entering the Age of Alzheimer's - prostoalex
http://www.newrepublic.com/article/119265/alzheimers-disease-statistics-show-illness-will-define-our-times/?utm_source=pocket&utm_medium=email&utm_campaign=pockethits
======
jgable
This comment is asking for trouble, but I'm making it in the hope of getting
some good discussion going, and hopefully not a flamewar. I've been thinking
about this a lot lately since my own family is struggling with this issue.

I very strongly feel, like many people probably do, that I would not want to
live with dementia. I would not want to live that non-life, I would not want
my family to have to experience it, and I would not want to burden them with
my care. In the not-unlikely event that I'm diagnosed with Alzheimer's or some
other form of dementia, I would want to end my life while I'm able to
competently choose to do so. I would want to do so with quick and painless
drugs instead of a gun. However, assisted suicide is only legal in a handful
of US states, and then only in cases of terminal illness with less than six
months to live. There is nowhere in the US for an early-state dementia patient
to commit assisted suicide.

It is currently legal in Switzerland to do so, and people have traveled there
for that very purpose. [1] Other people have committed suicide without
assistance to avoid the ravages of dementia. [2]

I'm aware of the counter-arguments to assisted suicide: that it can cross the
line into euthenasia, that it makes the most vulnerable in our society even
more so... but still, there has to be some way for this to be legalized.

What to do? What are some concrete proposals for how to alter existing
legislation to allow assisted suicide in cases of dementia? Does anyone have
personal stories that make the argument against it?

[1]
[http://www.bbc.com/news/health-22715363](http://www.bbc.com/news/health-22715363)
[2] [http://news.nationalpost.com/2014/09/01/ethically-this-
seems...](http://news.nationalpost.com/2014/09/01/ethically-this-seems-to-me-
the-right-thing-to-do-wrenching-suicide-of-b-c-woman-with-dementia-spurs-
euthanasia-debate/)

~~~
bennettfeely
I understand your position however I am ultimately against assisted suicide
and euthanasia. Suffering and hardship are not bad things. They are means to a
greater end, a crucial part of the human journey. Anyone who tries to
eliminate suffering by killing "sufferers" is establishing a horrific trend.

~~~
barry-cotter
I hope you die in terrible pain. I hope it takes years.

~~~
coldtea
Well, I hope the same for you and your family.

Only I don't. But how does it felt? Do you really stoop to being so low a
human being as to wish BS upon other people because you disagree with in a
discussion?

Do you think that makes you better than whatever you think he is?

~~~
barry-cotter
I don't care about this guy's family. Why did you bring mine into it?

I do not merely disagree with his position. I consider it vile and a threat to
me and everyone I know. It is one of those positions where compromise is
immoral. Some disagreements are not matters for civilised discussion if you
actually believe in it, slavery, religion, gay rights, morality in other
words.

I feel just fine about wanting an end to Alzheimer's, to aging and senescence
in general and I feel equally fine about wanting him to live out his beliefs
about how suffering brings meaning to life.

------
apsec112
Alzheimer's is terrible, but the way our current medical system handles old
age makes it even worse. A doctor friend of mine wrote an essay on this,
titled _Who By Very Slow Decay_ ([http://slatestarcodex.com/2013/07/17/who-by-
very-slow-decay/](http://slatestarcodex.com/2013/07/17/who-by-very-slow-
decay/)):

"Somewhere in the process your mind very quietly and without fanfare gives up
the ghost. It starts with forgetting a couple of little things, and progresses
until you have no idea what’s going on ever. In medical jargon, healthy people
are “alert and oriented x 3″, which means oriented to person (you know your
name), oriented to time (you know what day/month/year it is), and oriented to
place (you know you’re in a hospital). My patients who have the sorts of
issues I mentioned in the last paragraph are generally alert and oriented x0.
They don’t remember their own names, they don’t know where they are or what
they’re doing there, and they think it’s the 1930s or the 1950s or don’t even
have a concept of years at all. When you’re alert and oriented x0, the world
becomes this terrifying place where you are stuck in some kind of bed and
can’t move and people are sticking you with very large needles and forcing
tubes down your throat and you have no idea why or what’s going on.

So of course you start screaming and trying to attack people and trying to
pull the tubes and IV lines out. Every morning when I come in to work I have
to check the nurses’ notes for what happened the previous night, and every
morning a couple of my patients have tried to pull all of their tubes and
lines out. If it’s especially bad they try to attack the staff, and although
the extremely elderly are really bad at attacking people this is nevertheless
Unacceptable Behavior and they have to be restrained ie tied down to the bed.
A presumably more humane alternative sometimes used instead or in addition is
to just drug you up on all of those old-timey psychiatric medications that
actual psychiatrists don’t use anymore because of their bad reputation."

~~~
x0x0
emts get to deal with this all the time too. People get sick in nursing homes
-- they are cesspools -- and have to be transported to a hospital.
Unfortunately, they have no idea what's going on, and they're being strapped
down in a van and manhandled by strangers. You can imagine how they react.
After a while they get notes in their medical records saying they have to be
physically restrained during transport, which terrifies them even more.

I would much _much_ rather be dead.

------
melling
Part of the problem is that it affects much older people so it's out of our
daily thoughts, and we might not know them as well. Also, when people get the
disease, they often go into hiding. Ronald Reagan, Margret Thatcher, and
Charlton Heston come to mind.

I noticed that there's a Glenn Campbell documentary that covers his
Alzheimer's. He was a little before my time and a superstar in his time.

[http://en.m.wikipedia.org/wiki/Glen_Campbell](http://en.m.wikipedia.org/wiki/Glen_Campbell)

Maybe the movie will bring a little more attention to the disease.

[http://www.imdb.com/title/tt2049586/](http://www.imdb.com/title/tt2049586/)

------
tokenadult
Figures from the article may help us think about this issue more clearly.
"Alzheimer’s disease is practically unheard of in adults younger than 40, and
very rare (one in 2,500) for those under 60. It affects 1 percent of 65-year-
olds, 2 percent of 68-year-olds, 3 percent of 70-year-olds. After that, the
odds start multiplying. The likelihood of your developing Alzheimer’s more or
less doubles every five years past 65. Should you make it to 85, you will
have, roughly, a fifty-fifty shot at remaining sane."

When we are talking about a disease with base incidence of only 3 percent even
for seventy-year-olds, we are so far talking about a disease that has been a
low-priority disease. It's only in recent decades, as life expectancy has
increase at all ages from 40 on up to 80,[1] that a lot of people have
outlived heart disease, cancer, and the infectious diseases that used to cut
life short at younger ages. As more people who are otherwise healthy age into
ages at which their risk for Alzheimer disease increases, there will be
increasing research and study of treatments related to Alzheimer disease. The
fact that there are still people who can live past age 100 without getting
severe signs of any kind of senile dementia suggests that we have something to
discover about individual differences to find out what protects some people
from Alzheimer disease decade after decade after decade. There is no need to
give up hope. Incremental improvement--a little change in treatment here, a
little change in lifestyle there, and a better understanding of prevention
overall--is most of what has improved healthy lifespan in relation to other
diseases, and there is no reason to think that Alzheimer disease is any
different.

My own maternal grandmother, born in the 1800s, lived to the age of ninety-
nine. Near the end of her life, she plainly had some kind of dementia, and
presumably that was Alzheimer disease, and I think that was her cause of
death. But she had a lot of interaction with her eleven children and thirty-
eight grandchildren and various great-grandchildren for a long time after she
was widowed, and I don't think anyone in the family looks back on her life and
thinks that her death needed to be hastened. Some people retain memories of
childhood in extreme old age even after they no longer form new memories of
current events. For my grandmother, this was shown by one visit I had with her
in her mid-nineties, when she no longer was sure who I was, but still
remembered and was able to sing along me a song she had learned in childhood.
(The song was in German, her native language, so I know she had not heard it
for many years by the time I sang it with her. I had learned the song only
when I studied German in university studies.) So don't give up on
communicating with your aged relatives. Try to reach back in time to the best
memories they have of their childhoods. They may surprise you with their
understanding for a long time. And by a long time from now, when all of us
reading this are old, Alzheimer disease may be largely a thing of the past.

The lengthy second-person-viewpoint account of caring for an aged parent with
Alzheimer disease in the article is disturbing and moving. It reminded me
deeply of caring for my late dad during the last six years of his life, when
his thinking was completely intact but his mobility was destroyed by a spinal
cord injury. There are a lot of devastating forms of disability that human
beings can face, and, no, Medicare in the United States does not take care of
patients with long-term disability of any kind. I did feel a lot of futility
when talking to my dad (who had difficulty talking not because his brain
wasn't working, but because he was paralyzed from his second spinal vertebra
down, and couldn't even clear his throat or swallow on his own). He wanted to
walk again--or at least to be able to scratch his own nose again--but he never
did after his injury. Taking care of a helpless relative is rough--any time,
for any reason--but we didn't give in to the idea that he should die early
just to make our lives more convenient. He died only when a lot of other
health problems (many of them aggravated, surely, by six years of immobility)
piled up just after his seventy-eighth birthday. There a lot of memories I
have of my dad (and my children have almost ALL of their memories of their
grandfather) after the day on which his spinal cord was injured. I was willing
to interrupt a career transition and diminish my "free" time to almost nothing
to be with him in his old age. That wasn't easy, but that's what we did.

[1]
[http://www.nature.com/scientificamerican/journal/v307/n3/box...](http://www.nature.com/scientificamerican/journal/v307/n3/box/scientificamerican0912-54_BX1.html)

------
c4urself
Wonder if the advance of virtual reality could improve these peoples lives in
some way -- kind of what they're doing in the Hogewey complex -- simulate a
life that is somewhat "normal" to these people to reduce stress and anxiety.

------
mjcohen
It's going to get so expensive and aggravating that killing people with
extreme Alzheimer's will be allowed, or even encouraged.

Don't say never until you have had to take care of one.

------
jqm
From the article...

"1 percent of 65-year-olds, 2 percent of 68-year-olds, 3 percent of 70-year-
olds. After that, the odds start multiplying. The likelihood of your
developing Alzheimer’s more or less doubles every five years past 65. Should
you make it to 85, you will have, roughly, a fifty-fifty shot at remaining
sane."

1% at 65 doubling every 5 years for 20 years = 16%

3% at 70 doubling every 5 years for 15 years = 24%

What am I missing?

~~~
Someone
The _" likelihood of developing"_ vs incidence (what proportion of population
suffers from it)

1% at 65, 3% at 70 means that, in the 65-70 year range, about .4% of that
cohort develops Alzheimer's per year. Double that to .8% per year in the 70-75
year range and you get 7% incidence at age 75 (3% had it at age 70, 4% got it
between ages 70 and 75). Continuing, you get:

\- 1.6%/year in the 70-75 range gives you 15% incidence

\- 3.2%/year in the 75-80 range gives you 31% incidence

\- 6.4%/year in the 80-85 range gives you 63% incidence

That's in the right ballpark.

~~~
jqm
Didn't you use 70-75% twice? Once in the text body and once in the list?

Wouldn't your method leave you with 31% at the end if you just used this age
bracket once and didn't have the extra double cycle?

But for the record, I'm sure you are right. The ODDS of developing start
doubling. Not the amount of people afflicted (No doubt a somewhat complicated
figure as death, not insignificant at those ages, starts changing the
equation. Do people with Alzheimer die at the same rate as those without?).
Thanks for the explanation.

------
thisjepisje
> _In 1900, about 4 percent of the U.S. population was older than 65. Today,
> 90 percent of all babies born in the developed world will live past that
> age._

This comparison is a bit fishy, isn't it? The 4 and 90 don't have much to do
with each other, since the age at which people die isn't taken into account.
Even if everybody lives past 65, if they all die at 66, only 1/66th (or 1.5
percent) of the population is older than 65.

------
chaosfactor
Someone PLEASE make a startup that somehow enables people to stop suppressing
thoughts of death related to heart disease, cancer, alzheimers,etc., and
instead helps up mobilize a response. 3000 people die every 30 minutes. And
yet we spent trillions on 9/11\. A complete waste of money. We could do so
much better.

~~~
normloman
Why do you think a startup is the best solution? Remember, startups have to
make money. Good luck monetizing awareness.

~~~
DanBC
Everyone knows that obesity is a bad thing, and that it can be avoided by not
eating too many calories. Why are there so many obese people?

Since everything else we've tried to get overweight people to stop eating so
much has failed it might be worth looking at different approaches.

~~~
coldtea
> _Everyone knows that obesity is a bad thing, and that it can be avoided by
> not eating too many calories. Why are there so many obese people?_

Because unhealthy food is delicious, cheap AND addictive.

> _Since everything else we 've tried to get overweight people to stop eating
> so much has failed it might be worth looking at different approaches._

Well, a ban on refined starches and corn sugar work quite well. People were
much healthier (from an obesity perspective) when such products were not
available.

~~~
DanBC
> Well, a ban on refined starches and corn sugar work quite well. People were
> much healthier (from an obesity perspective) when such products were not
> available.

Do Scotland, New Zealand, Hungary use "corn sugar"? We don't use it much in
England and we (along with those other countries) also have problems with
obesity.

I'll happily accept that calories from sugar are a problem.

~~~
coldtea
> _Do Scotland, New Zealand, Hungary use "corn sugar"? We don't use it much in
> England and we (along with those other countries) also have problems with
> obesity._

How much of a problem, though, compared to say, the US? I've travelled quite a
bit in Europe, Asia, etc, and I've seen nothing compared to the US level of
obesity. Heck, the kind of people you'll see in a Walmart (and not isolated --
tons of them, and all over the states)...

I guess it's also other stuff: deep fried anything, Sneaker and Mars bars,
chips (crisps), BS "sports" drinks, sodas, etc etc.

~~~
SupremumLimit
New Zealand is 3rd in the OECD in terms of obesity, not far behind the US and
Mexico: [http://www.oecd.org/els/health-systems/Obesity-
Update-2014.p...](http://www.oecd.org/els/health-systems/Obesity-
Update-2014.pdf)

------
kolev
This shows how flawed the whole medical science is today. The issue is not
Alzheimer, the issue is autoimmune diseases, specifically, leaky gut, constant
low-grade inflammation, and others. If you try to fix just Alzheimer's alone,
you've accomplished little! Fix the leaky gut issue, you've solve tens of
chronic diseases at once. But, I guess, it's more profitable to sell 10
different "targeted" therapies instead of fixing one thing with lifestyle and
proper nutrition! Another thing to add is the Hygiene Hypothesis - we're not
adapted to live in a sterile environment, so, either get a bit more filthy
(and resilient) or adjust your nutrition to more anti-inflammatory state.
Anyway, I'm happy that there are conscious physicians who are revolting
against the status quo and practicing Functional Medicine like Dr. Mark Hyman
and others.

~~~
ggreer
Your pet issue has little or nothing to do with Alzheimer's. Alzheimer's
results from a combination of three things:

1\. Amyloid plaques forming between brain cells.

2\. Neurofibrillary tangles forming in brain cells.

3\. Loss of brain cells, likely from the build-up of 1 & 2.

All three of these things happen to everyone as we age. This is true no matter
how good your immune system or diet is. Many of us just get killed by
something else before it becomes pathological.

~~~
kolev
A good example is the Sardinians whose lifestyle is in the base of the
Mediterranean Diet. They are actually getting pretty sick recently from
autoimmune diseases and one of the leading hypotheses is the eradication of
malaria, which has kept their immune response overactive before that.

~~~
sliverstorm
Or now they aren't dying from malaria so now they die of something else?

~~~
kolev
They've had remarkable life expectancy with the malaria as well. I'm sure
everybody would prefer dying from malaria than MS, getting blind or an amputee
from diabetes, and so on. Improvements in life expectancy today is not an
improvement of overall health, just the medicine found ways to keep sicker
people alive for longer (i.e. countering natural selection). If infectious
diseases like tuberculosis and others were eradicated just a couple of
centuries earlier, modern medicine today wouldn't be so proud of the
accomplishments in life expectancy! Unfortunately, due to widespread abuse,
antibiotics are no longer the panacea that they used to be!

