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A
bountiful mind: San Francisco Chronicle, June 23, 2003
Hicks later taught management
at Sonoma State University and, after retiring, represented Sen. Barbara
Boxer, D-Calif., at events in and around Marin County. He's already
written his memoirs up through his business career and is piecing together
a second installment that will take him up to the present. It's no easy task, especially
for someone like Hicks, who has Alzheimer's disease. But while tests show
that the 85-year-old Fairfax resident has reduced mental functioning, he
isn't the typical Alzheimer's patient, doctors say. In person, he
demonstrates a remarkable vocabulary and recall. And although his
physician notified the Department of Motor Vehicles of his diagnosis, he
had no trouble passing both the written and driving test to keep his
license. Could his years of stimulating
mental and intellectual pursuits have played a role in how late Hicks'
disease showed up or the fact that it hasn't progressed very far? His wife, Diana King, thinks
so. "I believe that something started happening in his brain about 15
years ago, but he didn't get serious memory loss until about a year and a
half ago and has been functioning pretty well all this time," she
said. "Maybe the fact that he was so mentally active has slowed the
development of symptoms." PREVENTING
MENTAL DECLINE
Doctors believe that keeping an
active mind may indeed help people withstand the ravages of Alzheimer's
and other forms of dementia that set in late in life. One in 10 people
older than 65 -- about 4 million Americans -- has Alzheimer's disease, and
their numbers are expected to grow dramatically in coming decades as the
population ages. A study published last week in
the New England Journal of Medicine bolsters that idea further.
Researchers from the Albert Einstein College of Medicine followed a group
of 469 elderly people for 21 years and found that those who engaged in
mentally stimulating leisure activities -- such as playing board games,
doing crossword puzzles, playing a musical instrument and even dancing - -
reduced their risk of developing dementia. The more often they
participated in those activities, the more they seemed to be protected
against mental decline. It's not the first study to
document such an association. It's been noted for years that people with
higher levels of education and literacy seem to have lower rates of
Alzheimer's disease. Studies in mice also have shown that those given more
mentally stimulating environments, such as mazes, develop healthier brains
with more connections between neurons than those left with nothing to do. Many doctors now urge their
older patients to stay mentally, as well as physically, active as a way to
protect their health overall, and some specifically talk about its
benefits for brain function. IS IT CAUSE
OR EFFECT?
But even with the latest study,
experts say the evidence still isn't strong enough to say for sure that
having an active mind actually combats Alzheimer's disease, and the
Alzheimer's Association still doesn't have a formal position on the issue.
There's a chance, for instance,
that people who are starting to develop the disease -- which scientists
believe gets under way many decades before symptoms arise -- may simply be
shying away from mentally challenging activities in the first place. "If thinking was a little
bit harder for me, maybe I wouldn't be as eager to engage in it,"
said Dr. Lennart Mucke, director of the Gladstone Institute of
Neurological Disease and professor of neurology and neuroscience at UCSF.
In that case, Mucke said, engagement in mental activity could be more of a
symptom than truly related to its cause or prevention. While Mucke said such
strategies are good for the overall health of patients, he is wary of
promoting mental activities, vitamins or supplements as a way to combat
such a devastating disease. "It's like cancer,"
he said. "We're not going to cure it by doing crossword puzzles or
sprinkling vitamin E on it. It has to be treated like cancer, with major
drugs." The only medication approved
for Alzheimer's disease is Aricept, which Hicks takes and which can slow
the progress of the disease. Another drug, memantine, is not approved for
dementia but is used by many patients because it has also shown some
benefit for brain function. Neither drug can cure, reverse or prevent
dementia, although there are many efforts under way to find drugs or
vaccines that can. ADDING
CIRCUITS TO BRAIN CELLS
If mental activities do help,
it is probably because they stimulate the formation of more connections
between brain cells, Mucke and others say. Those extra connections are
like additional circuits that can carry on thinking and memory functions
even as other cells and circuits are obliterated by the disease. "What we're doing with
mental gymnastics is promoting neuronal reserve," said Dr. Michael
McLoud, a geriatrician at UC Davis who works with many patients with
Alzheimer's disease and their families. "The more you have, the more
you can lose before those first symptoms arise." In articles and talks he gives
to patients, McLoud encourages people to pursue mental activities. But he
finds he is often preaching to the converted, because they are the ones
showing up at community events and adult education classes. "The
person who really needs to hear this message isn't necessarily reading
what I'm writing or coming to a community lecture on this," McLoud
said. Researchers are continuing to
pursue studies to try to prove that mental activity can truly stave off
dementia. To do that, they need to assign people randomly to do certain
kinds of mental activities over time and compare the rates of dementia
that later develop. It's a difficult study to
design and fund, but Dr. Kristine Yaffe, assistant professor in the
departments of neurology, psychiatry and epidemiology at UCSF, said she is
planning such a study that could provide a more definitive answer. NO RISK IN
KEEPING MIND ACTIVE
Meanwhile, she said, "I'm
telling patients, 'Here is a wonderful opportunity to be active. There are
no side effects, and it doesn't cost anything, and it may work.' And we
can't say that about too many things." Hicks himself said he intends
to stay as mentally active as he can, as long as possible. Asking
questions and learning about strategies to cope with his disease are part
of that. Another is working away on his memoirs, which he is putting
together with the help of files and cards filled with specific incidents
and memories. "I don't
know if it helps. It might," Hicks said. "It's not a crossword
puzzle, but it is similar in that it relies on cognitive discernment and
executive (brain) function." Copyright
© 2002 Global Action on Aging
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