Use It or Lose It

Looking healthy (medium.com)

U.S. researchers found that (pre-GPS) professional drivers had a lower incidence of Alzheimer's disease: [bold added]

A new study found that U.S. taxi and ambulance drivers had the lowest percentage of deaths attributed to Alzheimer’s disease among more than 400 occupations. The drivers mostly worked before GPS navigation systems were widely used.

The researchers hypothesize that taxi and ambulance drivers could have a lower risk of developing Alzheimer’s because they are constantly using navigational and spatial processing, says Dr. Anupam Jena, a professor of health at Harvard Medical School and associate physician at Massachusetts General Hospital and senior author of the study.

Those on-the-fly decisions about how to get from point A to point B when a road is closed or blocked may protect the drivers’ cognitive abilities, the researchers speculate.

“They’re making decisions literally every few seconds about where to go, where to turn,” says Jena. “The way that your brain is used over the course of your career or the course of your life might impact the likelihood that someone develops dementia.”

The research supports other evidence that education and brain stimulation may help to at least delay symptoms of Alzheimer’s. An earlier study concluded that dementia risk was lower among people with cognitively stimulating jobs compared with those whose jobs were more repetitive, according to the 2021 research in the journal BMJ that looked at the occupations of more than 100,000 people across multiple studies...

A well-known 2000 study found that London cabdrivers had an enlarged part of their hippocampus. That section of the brain plays an important role in many cognitive functions, including spatial and navigational memory. The hippocampus is typically among the first parts of the brain that Alzheimer’s affects, which is why trouble with navigation and remembering directions is often an early symptom, says Wolk.

The theory goes that the brain, like muscle, grows stronger and bigger with use and makes individuals more resistant to the maladies of aging. (Earlier this year we had commented on the hypothesis that the human brain had been shrinking over millennia because more of its functions have been off-loaded to technology.)

Whether true or not, it can't hurt to use our brains more, especially now that there are many enjoyable (puzzles, education, social interactions) activities to choose from. And certain professions--like taxi and delivery-truck driving--allow one to earn a living and keep one's brain healthier for longer.

Another Group That is Falling Through the Cracks

Elena Portacolone (research gate photo)

We are used to hearing about vulnerable subsets of the American population who need a lot of help in taking care of themselves. Here's another one that numbers in the millions: [bold added]

]Sociologist Elena] Portacolone got to work and now leads the Living Alone With Cognitive Impairment Project at UCSF. The project estimates that that at least 4.3 million people 55 or older who have cognitive impairment or dementia live alone in the United States.

About half have trouble with daily activities such as bathing, eating, cooking, shopping, taking medications, and managing money, according to their research. But only 1 in 3 received help with at least one such activity.

Compared with other older adults who live by themselves, people living alone with cognitive impairment are older, more likely to be women, and disproportionately Black or Latino, with lower levels of education, wealth, and homeownership. Yet only 21% qualify for publicly funded programs such as Medicaid that pay for aides to provide services in the home.

Increased longevity is a societal good, but smaller families, that is, fewer relatives to check on a person, and the decline of churches and other community organizations have resulted in millions of aging, cognitively impaired adults falling through the cracks.

Brain Trends: the Science isn't Settled

(Quora image)

Last September we posted about how the human brain has shrunk by the size of a lime since the end of the last ice age about 12,000 years ago. Scientists even hypothesized the reason:

Traniello said the inspiration for applying this idea to why human brains may have shrunk came from “ultrasocial” insects such as ants. Ants form highly cooperative societies in which division of labor has favored smaller-brained individuals due to an advanced level of social organization.

The researchers suggested that perhaps our need to maintain a large brain—to keep track of information about food, social relationships, predators and our environment—has also relaxed in the past few millennia because we could store information externally in other members of our social circles, towns and groups.

The increased offloading of storage and other tasks to the cloud means that our personal computers and cellphones don't need to have as much memory. The brain analogy: no longer do we have to memorize phone numbers, recipes, and addresses, nor do we have to know how to hunt, fish, and farm in order to survive. If we need it, the information is available on the internet. (Isaac Asimov envisioned a future where all knowledge is stored in an Encyclopedia Galactica.)

But what are we to make from this week's headline?

(Image from bigthink)

Our brains are getting bigger — and that could lower the risk of dementia

Human brains are gradually getting bigger, decade by decade, potentially lowering people’s risk of developing age-related dementia, according to a recent study published by Alzheimer’s researchers at UC Davis Health.

People born in the 1970s have more brain volume and more brain surface area than people born in the 1930s, according to the study, published March 25 in JAMA Neurology...

The reasons brains are getting larger are believed to be linked to improvements in the early childhood environment at the population level, including better prenatal care, nutrition, health care and education...

Researchers found that brain volume and surface area grew gradually but consistently in people who were born in each subsequent decade between the 1930s and 1970s. People born in the 1970s had 6.6% more average brain volume than those born in the 1930s — 1,321 milliliters compared with 1,234 milliliters, the analysis found. And people born in the 1970s had nearly 15% more average brain surface area — 2,104 square centimeters compared with 2,056 square centimeters.

There are scenarios where both studies could be true, for example, brains have been shrinking over millennia, but they have been growing over the past century. If I haven't lost so many brain cells, I might be able to think of more of them.

They Aren't Forget-Me-Nots

Yesterday I couldn't remember the name of this flower that's been blooming in our yard for over 20 years. Refusing to do an internet search, I wanted to see when the name would come back to me. This morning, after six hours of sleep, the answer came instantaneously: nasturtiums.

Such lapses now come about once a month--well within "normal" and not necessarily a sign of impending dementia--yet I have come to realize that I could have taken better care of my brain when I was middle-aged:

More scientists are looking for clues in the midlife brain because efforts to target dementia in older people have largely failed, says Ahmad Hariri, a professor of psychology and neuroscience also at Duke...

Parts of the brain start to change faster during middle age, especially the hippocampus, which is important for remembering everyday events, says Sebastian Dohm-Hansen, a doctoral student at University College Cork in Ireland and first author of a March review study on brain aging published in the journal Trends in Neurosciences.

In your 40s and 50s, the white matter in your brain—the connections between brain areas—decreases in volume, says Dohm-Hansen. That likely results in slower processing speed, which could have further effects on cognition, he says.

In addition, proteins can build up in your blood, resulting in low-grade inflammation that can affect the hippocampus’s ability to encode and store new information, he says.

People keep their verbal language-based skills their whole life, says Moffitt. But the speed at which you process information and your capacity to solve new problems of logic and reasoning gradually diminishes with age...

There are no guaranteed ways to prevent dementia. But steps that help both your brain and your heart include exercising regularly, eating a healthy diet, and not smoking, as well as trying to avoid getting or managing conditions such as diabetes, high blood pressure and cholesterol, and obesity, and treating obstructive sleep apnea...

Also important is staying socially and mentally active and engaged, [Mayo Clinic Dr. David] Knopman says. “There are benefits of working in a challenging environment—it stimulates the brain—and it seems to be associated with better outcomes,” he says.

It's too late for me but maybe not for you, dear reader. Save yourself!

Reducing Nuisances with Technology

When spending time with your kid gets tiresome, just give him an iPad.

Technology has also come up with the solution when grandma-with-dementia is too demanding.

The robot cat for your geriatric boomer from the local CVS pic.twitter.com/oPUoZyLk4B

— Adrian Georges (@BasedMaterialsm) August 6, 2023

Deep Sleep and Alzheimer's

The Apple Watch says I'm not getting enough
Deep Sleep. Alzheimer's could be in my future.

Sleep has long been correlated with brain health, and inadequate deep sleep in particular is connected with Alzheimer's disease.

During deep sleep, the brain produces slow electrical waves and flushes out neurotoxins including amyloid and tau, two hallmarks of the disease.

Studies have shown that even one night of lousy deep sleep can lead to an increase of amyloid. A week of disrupted sleep can raise the amount of tau, which is especially insidious because over time it can strangle neurons from the inside out...

In their study, researchers from the University of California, Berkeley, examine how deep sleep affected memory in cognitively normal seniors. What they found is that more deep sleep significantly improved performance on memory tests in patients with higher levels of amyloid and who were therefore at higher risk for Alzheimer’s...

Tne implication is that improving deep sleep could help people at highest risk for Alzheimer’s retain their mental capacities. Sleeping aids might be one way to do it. Studies have also found that exposure to odors like lavender and auditory stimulation at night can improve deep sleep. Regular, moderate exercise does too.

Overnight observation at a sleep clinic is still the gold standard for diagnosis, and a doctor's order is necessary to obtain a CPAP machine and certain medications.

The Apple Watch did confirm the tiredness that I had been feeling, and if lifestyle changes don't do the trick I'm off to the local sleep center. Staving off Alzheimer's is a powerful motivator.

Light Me Up Some Loco Weed

(Image from Veriheal)

There's some evidence that cannabis can help late-stage Alzheimer's patients: [bold added]

Approximately 6.5 million Americans, or 1 in 9 people aged 65 and older, are living with Alzheimer’s dementia. Agitation, aggression, wandering, delusions, hallucinations, mood disturbances and repetitive vocalizations are very common symptoms as the disease progresses. There are no FDA-approved pharmaceuticals to treat the condition, so when behavioral techniques fail, doctors use off-label medications such as antidepressants, mood stabilizers or antipsychotics. Antipsychotics become necessary when the patient risks harming themselves or others due to the severity of the agitation, but they are only modestly effective and carry a black box warning for increasing the risk of death in this population.

Recent research suggests that cannabis may help to relieve agitation by regulating neurotransmitters, reducing brain inflammation and improving circadian rhythm disturbances seen in dementia. It is thought that cannabis binds with receptors located in the same regions of the brain implicated in dementia agitation. A study in mice further found that THC (the major psychoactive component in cannabis) may prevent the harmful plaques associated with Alzheimer’s from accumulating between neurons. Further research may yet determine whether cannabis has the potential not only to treat Alzheimer’s symptoms but to halt the disease’s progression.

I never touched the stuff when younger, but trust the science. If I get Alzheimer's agitation, my caregivers are authorized to light me up some loco weed.

The Unhelpful Answer: Take Care of Your Brain

Atria Park of San Mateo is a senior-living facility less than two miles from our house. Although a few residents do not require daily medical attention, the majority do, with many suffering from dementia. Alzheimer's patients whom we knew personally spent their final years at Atria Park.

Today's headline is a blow to its business:

Woman suffering from dementia dies at Bay Area nursing home after being served dishwashing liquid

San Mateo police said a 93-year-old woman residing at an assisted living facility in the city died, and two others were hospitalized, after “ingesting toxic chemicals.”

Employees at Atria Park of San Mateo mistakenly served the three residents dishwashing liquid on Saturday morning, facility officials said in a statement...

The woman who died was Gertrude Elizabeth Murison Maxwell, who had eight children and 20 grandchildren, KRON-TV reported. The woman’s daughter said Maxwell, who suffers from dementia and cannot feed herself, had “severe blistering of her mouth and throat and esophagus.”

I often walk by the facility.

I have learned not to form snap judgments, but in this case I don't see how dishwashing liquid could reasonably be mistaken for a juice beverage. If the aides were incredibly harried, I suppose it's possible--for example, in my mother's facility in Hawaii multiple patients must be given medication at 3 p.m. according to doctors' orders--but then the under-staffing had to be extreme.

As the Journal noted last month:

70% of people over 65 will need long-term services and support, but many won’t get it because there aren’t enough caregivers. This shortage, the AARP says, is going to get worse in the next decade. There will be a national shortage of 151,000 caregivers by 2030.

Atria Park won't be on my list of final destinations, but the real answer seems to be to take care of my brain. If poor Ms. Maxwell understood what was happening to her and could communicate her distress, this wouldn't have happened.

Going Uncomfortably into that Good Night

The boomer puzzle.

The decline of family connections and traditional social organizations (churches, Elks/Kiwanis/Freemasons, etc.) heralds a grim future for many baby boomers: [bold added]

According to the American Association of Retired Persons, 70% of people over 65 will need long-term services and support, but many won’t get it because there aren’t enough caregivers. This shortage, the AARP says, is going to get worse in the next decade. There will be a national shortage of 151,000 caregivers by 2030...

In “The Silken Tent,” Robert Frost praises a person who is “loosely bound / by countless silken ties of love and thought.” Unfortunately, an increasing number of elderly Americans lack these ties; they are childless or live far from family. Many also are unaffiliated with a church or synagogue.....

According to a Harvard study, 58% of Americans over 80 live alone. “As the baby boomers cross into their 80s over the next 20 years, the numbers of single-person households among the oldest age group will grow dramatically, from 4.7 million households in 2018 to an estimated 10.1 million in 2038.” And many of them are likely to suffer from cognitive decline. According to the Cleveland Clinic, “It’s estimated that as many as half of people 85 years of age and older have dementia.”

The boomer generation in our family has been lucky so far. We have reasonably good health for our ages (61-72) and financial resources are adequate. On the other hand, none of us has more than two children, and the "silken ties of love" aren't the thick safety net that our parents had.

Pursuing professional success and keeping families small was a trade-off that most boomers made, and I suspect many of us have regrets about that choice.

Forgetfulness: Not Just an Elderly Problem

(Image from Dr. Jenny Brockis)

We've written about memory issues before. They are most apparent in elderly acquaintances who have dementia and/or Alzheimer's disease. Now they are increasingly manifested in younger people. [bold added]

Short, temporary instances of forgetfulness—those ‘senior moments’—are happening to more of us more often these days, memory experts say. We’re finding it difficult to recall simple things: names of friends and co-workers we haven’t seen in a while, words that should come easily, even how to perform routine acts that once seemed like second nature.

We’re living in yet another moment of big change as we return to offices, create new routines and find our footing in yet another new normal. (And don’t forget a scary war in Europe on top of that.) All this change consumes cognitive energy, often much more than we think, neuroscientists say. It’s no wonder we can’t remember what we had for breakfast. Our minds are struggling with transition moments...

The chronic and cumulative stress of the past two years has taken its toll, too. Research led by Dr. Shields shows that people who have experienced recent life stressors have impaired memory. Stress negatively affects our attention span and sleep, which also impact memory. And chronic stress can damage the brain, causing further memory problems, says Dr. Shields, an assistant professor in the department of psychological science at the University of Arkansas.

The deluge of information coming at us on multiple channels is cluttering our brains, too. We’re terrible at paying attention, constantly scrolling our phones while we’re doing other things, which neuroscientists say makes it hard to encode memories in the first place. And it can be hard to remember something out of context, such as the name of the co-worker suddenly talking to us in person, rather than on Zoom.

Then there’s the sameness of our lives during the pandemic. How are we supposed to remember a specific event when each day was exactly the same as every other?

“Memory benefits from novelty,” says Zachariah Reagh, a cognitive neuroscientist and assistant professor of psychological and brain sciences at Washington University in St. Louis. “When all of our experiences blend together, it’s hard to remember any of them as distinct.”

Alzheimer's may not be under our control, but our environment mostly is. So turn off the TV, radio, and other distractions while you are focusing on a task, pay attention to the other person while engaging in conversation, and get enough sleep.

The brain is the most important organ, and compared to the heart, lungs, liver, and stomach we are still at the early stages of learning how to take care of it.

Depression and Dementia

(Image from sharpbrains.com)

As if life wasn't difficult enough for teens and young adults with depression, UCSF researchers say that this condition is highly correlated with dementia. [bold added]

Depression in young adulthood might increase risk for cognitive impairment in old age, a new UCSF study has found.

The study — which used predictive models to determine depressive symptoms over a lifetime — found that the chances of cognitive impairment were 73% higher for those estimated to have elevated depressive symptoms in early adulthood, and 43% higher for those estimated to have elevated depressive symptoms in later life.

The conclusions find a receptive audience because they play into our belief that brain disorders are related. However,....

1) There are a great many years between youth and old age. Youthful disease is not destiny.

2) Depression is better understood today than in the past. Therapy and changes in attitudes and behavior (gratitude, social interaction, self care, hobbies, and "cognitive restructuring") can help, and for severe cases medications are available.

3) By social interaction we mean the in-person kind, not social media, which can be mentally toxic to teenagers.

4) The UCSF study is based on "predictive models" that have not been verified by observation:

The study pulled data from 15,000 people in different age cohorts, ranging from 20-89 — divided into older, midlife and young adulthood — and used predictive methods to estimate the average trajectory of depressive symptoms. That trajectory is used to make a “best guess” of how older adults with dementia might have been in early adulthood.

While this methodology isn’t as good as studying someone over a lifetime,[ Dr. Willa] Brenowitz said, it’s the best researchers have now — and should spotlight the need to start observation for dementia risk factors earlier in life.

Predictive models are works-in-progress, as we have seen from much more elaborate climate, epidemiological, and econometric models that have made predictions that proved to be wildly inaccurate.

It's useful that the connection between depression and dementia is being explored. It's also true that the models can be wrong, and even, if true, there is time to take the steps that can break the connection.

Gout's Silver Lining

Probenecid has an unexpected benefit

The first and only gout attack occurred in my 40's when I began drinking a glass of red wine every day for health reasons. After a month of this regimen my left foot hurt so much I couldn't walk. The diagnosis was gout, which my father and brothers all suffer from. I thought I had avoided gout, but alas, I had the gene after all.

Gout is caused by high concentrations of uric acid that crystallize in joints, resulting in painful inflammation. Known triggers include organ meats, shellfish, and alcohol. Drinking plenty of water to dilute and flush the uric acid out of one's system is the way to avoid gout, and probenecid is often prescribed to aid in uric-acid reduction. Your humble blogger has been on probenecid for over 20 years.

Researchers have discovered that probenecid may be an effective treatment for COVID-19:

[Georgia professor of infectious diseases Ralph] Tripp found probenecid blocks the virus from replicating and infecting individual cells, a major discovery.

“Because it works on the whole cell, not the virus, you can’t get resistance to the drug,” Tripp said.

Tested on ten individuals in Florida with COVID-19, researchers found after the individuals were given probenecid symptoms eased in three days instead of weeks.

Funding for large clinical trials must follow, but the outlook is that a drug that has helped with gout for four decades may be what’s needed to stop the suffering from COVID-19.

I've been upping a daily supplement of Vitamin D to help ward off the coronavirus, and now it just may be that I have been regularly taking a drug that affords additional protection. Maybe I did luck out genetically with gout, just not in the way that I thought.

Another silver lining: High uric-acid levels of gout sufferers may afford protection against Alzheimer's disease.

Explains my Attraction to Smart Women

More evidence of women's biological advantages: [bold added]

Glucose metabolism is impaired
in Alzheimer's (researchgate)

Women tend to live longer than men. This is one of the most robust findings in biological science, and the evidence isn’t hard to find. In the U.S., women outlive men by almost five years, on average, while the gap is as wide as 10 years in Latvia and Vietnam. Now there is fresh evidence that women not only have a longevity advantage; their brains seem to be more youthful throughout adulthood, too.

We ought to be spending more research dollars on why men die earlier and why men are more susceptible to neural degeneration. Sure, this "unfairness" in allocating university research dollars is potentially a violation of Title IX, but the important scientific question is: do zombies prefer women's brains?

Brush Your Teeth, Save Your Brain

Tools to prevent Alzheimer's?

The battle against Alzheimer's Disease has been frustrating because definitive causes haven't been identified. Genetics, trauma, depression, sleeplessness, and obesity have all been proposed.

The most promising candidates have been amyloid plaques and tangles found in the brain tissue of deceased Alzheimer's sufferers. While suggestive, plaques and tangles have also been found in the brains of people who evidenced no Alzheimer's while they were alive.

Some researchers are now looking into the bacteria responsible for gum disease:

Multiple research teams have been investigating P. gingivalis, and have so far found that it invades and inflames brain regions affected by Alzheimer’s; that gum infections can worsen symptoms in mice genetically engineered to have Alzheimer’s; and that it can cause Alzheimer’s-like brain inflammation, neural damage, and amyloid plaques in healthy mice.

Plaques, according to this theory, develop as a defense against the bacteria and are not the cause of Alzheimer's Disease. (Aside: if true, this would be a textbook example of correlation not equalling causation.)

After reading this article, your humble blogger will floss more often and run the electric toothbrush for the full recommended two minutes.

You're Not There for You

(Photo from asha.org)

It's been my experience that about half of my acquaintances and relatives who lived past 80 acquired dementia, ranging from mild to profound.

Digression--I might well be displaying some of the early signs: today, while lost in a (business) cellphone discussion in the parking lot, I opened the wrong car door, taking the seated driver by surprise. Apologizing profusely, I told him that I was distracted and imagined it was my car. Thank goodness he didn't have a gun.

For now I am on the good side of the dementia divide, and visit sufferers with more empathy than I had in my impatient youth. Here are 3 traps when talking to someone with dementia:

If you’re a stickler for accuracy, it’s tempting to correct someone who misspeaks.

If you’re impatient, it’s easy to interrupt and steer the dialogue in the direction you deem most important.

If you’re offended by what you hear, it’s understandable if you take it personally and express disapproval.

Don't correct, interrupt, or be offended, which are fundamentally manifestations of pride. You're not there for you.

The Dread Disease

(Image from hyperactivz)

Progress towards a cure for Alzheimer's is slow, in good part because scientists have not found a definitive cause for the dread disease. For years researchers had focused on the high correlation between Alzheimer's and amyloid plaques ("a type of protein which is often found in the brains of Alzheimer’s patients after they die"), but experimental drugs that reduced the plaques in mice did not reduce their Alzheimer's symptoms.

There is, however, significant evidence that factors that are associated with good health--a balanced diet and regular sleep and exercise---do reduce the risk of Alzheimer's.

Diet: [bold added]

the best evidence for nutritional prevention of Alzheimer's disease is through foods rather than vitamin supplements. Many of the foods that are good sources of vitamin E are also rich in n-3 fatty acids and unhydrogenated, unsaturated fats — the dietary components with the most convincing evidence of neuroprotection to date. Among these foods are oil-based salad dressings, nuts, seeds, fish, mayonnaise, and eggs. Patients should limit their intake of foods that are high in saturated and transunsaturated fats, such as red meats, butter, ice cream, commercially baked products, and some margarines that contain partially hydrogenated oils.

Sleep:

Impaired sleep has been associated with Alzheimer’s disease. Studies suggest that sleep plays a role in clearing beta-amyloid out of the brain. Moreover, lack of sleep has been shown to elevate brain beta-amyloid levels in mice.

Exercise:

New research shows that physical exercise can “clean up” the hostile environments in the brains of Alzheimer’s mice, allowing new nerve cells in the hippocampus, the brain structure involved in memory and learning, to enable cognitive improvements, such as learning and memory.

A healthy lifestyle is no guarantee that one won't contract the dread disease, but I think of it this way: it increases the odds of my hanging around until a cure is found.

Alzheimer's Patients: the Fifties Were Happier

I'd be happier there, too (WSJ photo)

A new aid for Alzheimer's patients is reminiscence therapy, [bold added]

a therapy that uses prompts from a person’s past—such as music, movies and photographs—to elicit memories and encourage conversation and engagement.

The 1950's are reconstructed in

Glenner Town Square, a new adult day-care center for dementia patients that is like entering a time warp. The 11 storefronts that surround an indoor park represent the time period from 1953 to 1961, when most of the patients were in the prime of their life.

Reminiscence therapy is not a cure, and the jury's out as to whether it even slows the advancement of the dieease:

Most participants showed no improvements in a series of cognitive tests done before and after the intervention. But they did become better at talking about autobiographical memories when triggered from older objects....The program is mostly geared toward patients who are in the early to moderate stages of dementia, who are typically living with family or at home with caregivers. Their family members or caretakers drop them off at the facility.

Glenner Town Square is an ingenious effort but only an intermediate treatment that will be superseded by virtual-reality rooms similar to Star Trek's holodeck minus the corporeal elements (touching a Studebaker instead of only viewing it).

There's nothing wrong with dementia sufferers reliving past times when they were happier. When the technology becomes available, we'll start doing it, too.

In Tim I Trust

The Apple Watch has already breached my defenses.

The inputs: a person's

internet searches,

driving patterns ("the number of trips taken, duration of trips, left turns versus right turns and time spent on the highway versus local roads"),

how he or she uses a computer mouse or touchpad.

the time it takes to fill out a weekly online health questionnaire.

The black box: artificial intelligence and big data.

The output: the probability that he or she has early-stage Parkinson's or Alzheimer's Disease .

The above is a trend sweeping health care: the use of artificial intelligence (AI) to help better diagnose and treat patients. [bold added]

A Duke University doctor working with Microsoft researchers sifted through data on the physical movements of computer users that came from millions of internet searches. Their study found links between some behaviors—such as tremors when using a mouse, repeat queries and average scrolling velocity—and Parkinson’s disease. They used artificial intelligence, or a computer analysis, to identify which of the metrics separated a control group from those searching for Parkinson’s disease symptoms.

It used to be that family members were the first to notice that something is amiss. The machines that we touch every day--cars, phones, computers--are now more accurate, quicker, and smarter diagnosticians than loved ones. But what about individual privacy?

I HOPE that Apple lives up to its standards.

For those who are too cautious to buy a TV that can watch them, or a smart speaker that monitors what they're saying, the promise of real-time health monitoring may the lure that allows the Internet of Things(IoT) into personal space.

As for me, it's too late. My Apple Watch, which has been tracking me for 1½ years, knows more about me than my doctor.

In Tim Cook I trust (because I don't have any choice).

No Reason to Feel Superior

Within the past 60 days your humble blogger

dropped an unprotected iPhone onto concrete, cracking its screen,

completely overlooked a registration renewal, incurring a $195 penalty,

lost his wallet.

No appointment? The line goes out the door at the DMV.

Each mistake had a reasonable excuse---the iPhone was perched on some papers and two cups of coffee as I tried to pull open a door, the DMV invoice was stuck behind other papers, and the wallet fell through a car-door crack while I was dozing---but maybe they're not a coincidence. Maybe the long slide into mental oblivion has begun.

Losing a wallet was most burdensome because it entailed the cancellation of four credit / debit cards and the replacement of a California driver's license in person at a DMV office. I surveyed eight locations and selected the one with the closest appointment, which was three weeks from now (forgetting one's valid license at home is an infraction that can be dismissed if one produces it, but I would not have been able to produce one for three weeks). My intrepid spouse persisted in searching after midnight for an appointment , however, and so it was that I found myself at the Hayward DMV office at 9 a.m., less than 24 hours after the wallet was lost.

The appointment line had only one person ahead of me. I was done in less than an hour, temporary license in hand, while the 50-deep no-appointments queue had hardly budged. Once upon a time I might have mocked others for their lack of foresight, but these days I have no reason to feel superior.

I (again) resolved to be more mindful about what I'm doing, but I'll probably forget this promise by tomorrow.

With Life There is Hope

We've been following developments in Alzheimer's Disease research and treatment not only because close friends and relatives have succumbed, but also because we ourselves may have a genetic susceptibility to the condition. From two years ago:

One leading theory postulates that Alzheimer's is caused by the buildup of "plaques" or "tangles" that block signals between brain cells. However, not everyone who displays symptoms has plaques, nor is the presence of plaques a surefire indicator of Alzheimer's. Like cancer, Alzheimer's appears to have multiple causes.

(WSJ image)

The improvement in imaging and chemical-analysis technologies has shifted Alzheimer's diagnosis toward objective "biomarkers" such as amyloid plaques and away from symptoms like memory loss and speech problems, which may have other causes. However, we're not there yet. A positive brain scan could needlessly alarm many people who won't get Alzheimer's. [bold added]

The likelihood that someone with a positive scan is going to progress to having clinical symptoms—called the positive predictive value—within the next few years is only about 40%, according to Duke’s Dr. Doraiswamy, who conducted one of the first studies on one of the brain-imaging tracers, florbetapir.

The advice from two years ago still holds: hang on for dear life. "The trick for us is to stay alive long enough to let the technology catch up."