Tag Archives: dementia

S2E34. Uh-oh: Memory Failure!

(Theodore Ribot, in The Diseases of Memory published in 1881, pointed out that the first characteristic of amnesia in patients with dementia is the loss of memory for recently experienced events with relative preservation of remote events.)

I opened an email from Greg, a classmate at Brown some 50 years ago, that include a link to a recent article in The Guardian titled “Stop drinking, keep reading, look after your hearing: a neurologist’s tips for fighting memory loss and Alzheimer’s.”

I appreciated his thoughtfulness in sending it to me as I am always on the lookout for articles that might generate the inspiration for a blog episode. This article was an interview with Dr. Richard Restak and the occasion was the release of his new book The Complete Guide to Memory: The Science of Strengthening Your Mind.

I googled the book before I even finished reading the article, then downloaded the electronic version so I could scan its contents. A lot of the usual material was covered and I was struck by the fact that here was yet another neurologist covering a lot of the same material that is standard for this type of tome. It didn’t look like there was much that I hadn’t covered in prior posts.

 As I was moving it to the trash, though, I noticed that I had previously downloaded this very book!

Strange, I thought, that I hadn’t recognized the cover art. The name ‘Restak’ seemed familiar, but I couldn’t place it. Thinking logically, I realized that I must have read the book and, therefore, I must have blogged about it. So I scanned the titles of all my posts looking for one in which I might have written a review of the book. Since nothing jumped out at me, I began opening posts with potentially related titles and soon found it. It was S2E28: Working Memory Workout? published on July 15th.

That was only a month ago…and my memory of reading that book had all but evaporated!

What a kick in the pants! Here I was doing daily workouts to improve brain performance and I just had a major fail of episodic memory, the kind of memory malfunction that Ribot described back in 1881.

Episodic memory is our memory of what happens to us: what we do and what we experience. How could I not remember reading this book just a few weeks ago when I had obviously spent a lot of time reading it, thinking about it, and finally writing about it?

Forming an episodic memory has three stages. First you have to pay attention to the event. Basically, if it didn’t make much of an impression when you first experienced it, it’s unlikely that you will recall it later on. 

Second, you need to encode it into memory. You do this by thinking about it, processing it, replaying it, and linking it to other experiences so it fits into a framework for remembering. 

Finally, you need to be able to retrieve it. Recall memory is when you can retrieve it from your memory banks without any assistance. Recognition memory is when you need cues or hints in order to find it. Unsurprisingly, recognition is easier than recall. In either case, though, the memory must have been encoded for you to unearth it later on, with or without a little help from your friends.

So what had happened to cause my memory failure? I clearly had paid attention to the book and processed it more than enough to guarantee encoding. It would be easy to conclude that this was therefore a retrieval error…but maybe not. Why did it not come rushing back to me after seeing multiple cues, including the cover and table of contents? Alternatively, the breakdown could have been caused by a failure in any one or in any combination of the three functions.

I did a quick web search of articles about episodic memory and came across one that suggested you could improve it by watching a movie and then listing as many of the scenes as you could remember. It seemed to me that this could also serve as a reasonable test of your ability to recall episodic memories, so I tried it with a movie I had just watched the night before: ‘Hud’ starring Paul Newman.

I waited 5 days to give my brain a chance to consolidate the memory and, perhaps, even time enough to forget a little about it before attempting the task. 

Now, obviously, I don’t know how many scenes there were nor how many scenes a brain-healthy 71-year old would remember, but I came up with 43.

I’ve got to believe that that’s pretty good. I’m pretty sure I didn’t miss much, so I’m going to put off worrying about any possible episodic memory failures for the time being.

But it is a little scary to see how it might sneak up on you.

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S2E33. How To Keep Your Brain Young

I stumbled across a book referenced in an article I was reading and was intrigued by the description of the author: “Professor Kerryn Phelps AM, Australia’s most trusted GP.”

Interesting! A book about brain health by a general practitioner and not a neurologist or neuropsychologist? A consumer of research instead of a creator of research? And from Australia? Because of these anomalies, I wondered if her perspective would differ from everything else I’ve been reading written by Americans with more traditional backgrounds…so I read her book, How To Keep Your Brain Young which was published last September.

Some differences were immediately apparent, such as the spelling of words like ‘foetus’ and ‘coeliac disease.’ When citing research studies, she tends to reference where the work was done instead of the authors’ names, so you come across things like, ‘in a study done at the University of Sydney…’ She seemed to prefer citing work done in Australia, and that was layered on top of references to Australian epidemiological studies and policies of Australian public health agencies. All in all, it was refreshing to see the view from down under.

The most striking thing about this book, though, is the range of topics covered. Although any book about brain health will necessarily cover dementia-related topics, Professor Phelps goes above and beyond in cataloguing the wide variety of things that can affect one’s brain health over one’s lifetime. You might expect a cradle-to-grave approach, but she goes beyond that, not just to pre-natal concerns, but all the way to pre-conception factors that might affect the brain-in-waiting!

Her thoroughness is carried throughout the book with an attention to detail that could only be rooted in the curiosity of someone who found every fact about the brain to be enormously fascinating. She begins with a description of the various brain structures, their functions and the neurotransmitters that drive the system. I have to admit that if I was not already well-versed in those topics, I would have found it very difficult to follow. It’s not that she uses a lot of technical jargon, but that she presents the information in a rapid, unadorned format. ‘Just the facts, ma’am,’ as Sergeant Joe Friday used to say. Her writing is unembellished. There are few anecdotes and personal reflections. There is no poetry in her prose. She writes like a GP speaks: ‘Here’s what the tests show and here’s what you can do about it. I’ve written you a prescription.’

Nonetheless, it’s riveting and breathtaking in its scope. There are short chapters about virtually all the things that can affect your brain in a lifetime, including alcohol, medications, chemotherapy, smoking, anesthesia, gluten, glucose, blood pressure, street drugs, menopause, stress, depression, your gut biome, stroke, brain injury and brain cancer. Factors that don’t merit their own chapters are covered in the chapter on dementia. Oddly, though, she doesn’t address air pollution, toxic chemicals or pesticides.

I thought the best line of the book came in her summary of the effect of using methamphetamines. After detailing all the different ways it kills neurons and affects brain function, she dryly remarks that ‘it really doesn’t have a lot going for it.’

After detailing what proper brain function looks like and inventorying all the things that can go wrong, she settles into a discussion of the things you can do to protect your most valuable organ throughout your lifespan, or as she puts it, ‘how to keep your brain young.’ There are chapters dedicated to cognitive challenge, exercise, diet, supplements, social connectedness, relationships, sleep and mind-body therapies. She also includes a chapter on the brain-enhancing properties of pets, which is something I hadn’t come across anywhere else.

Professor Phelps closes the book with a lifetime prescription for protecting your brain and preserving its performance. It comes down to avoiding brain injury, exercising, optimizing your diet, controlling your blood sugar, managing cholesterol, improving your gut health, controlling your blood pressure, building and maintaining social networks, sleeping soundly, stimulating your mind, taking care of your emotions, being cautious with prescribed medications, avoiding illicit drug use, not overusing alcohol, never smoking, and considering using supplements and herbs.

It seems like a lot until you realize that you’ve got a whole lifetime to figure it out. Obviously, the earlier you start, the better off you’ll be. Nonetheless, the research says that benefits will accrue no matter when you engage.

So, to answer my initial question, the view from down under is pretty much the same as it is from here in West Chester, PA!

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S2E32. Still Making Mistakes

I’m doing all the right things. I’m eating right, exercising, staying mentally active, getting good sleep, and hanging with friends whenever possible…and I’m still making lots of mistakes. What’s up with that?

Well…actually…nothing. It’s perfectly normal. The brain research doesn’t promise that you’ll stop making errors. It doesn’t even say you will have significant improvements in your memory, language skills, motor or executive functions. All it says is that your decline will be slower than it would have been had you not done all the right things. 

It’s akin to trying to protect a sand castle you built on the beach. You can pile wet sand around it to keep out the incoming tide, and that will work for a little while. Your castle might last a little longer than the one 3 umbrellas over, but at some point, it will be lost. The idea, though, is to enjoy it as long as possible. And that’s about all we can ask and hope for.

Unfortunately, we only get to live life once, so we’ll never get to compare the two trajectories for ourselves. We just have to take it on faith that living a brain-healthy lifestyle gives us our best shot at preserving our mental faculties for as long as possible.

So what kind of screw-ups have I committed recently? Here are three that stand out:

1. We made an overnight visit to Virginia to help my niece Kay celebrate her 70th birthday. On the return trip, we detoured to Harper’s Ferry for some sightseeing, arriving home around 6pm. 

At our apartment building we need to put the garbage outside our doors between 6-8pm for pick-up later that evening, so I was glad we got home early enough for me to get it out on time.

It’s usually picked up by 9pm, but when I went to bring the receptacle back in at 9:15, it still hadn’t been picked up. And not at 10pm, either. I checked once more at 10:30 and it still hadn’t been picked up.

I wondered what was wrong, as this had never happened before. If there was going to be a disruption in trash collection services, we always got an email notice from management, but that hadn’t happened.

So I looked up and down the hall to see if our neighbors’ trash had been removed and immediately noticed that no one else had put their container out.

DOH!

I knew full well that garbage is picked up 5 nights each week, Sunday through Thursday…and it was SATURDAY!

2. I was making a grilled cheese sandwich for Sally and had just placed it into the frying pan to brown when she asked me to help her with a problem she was having ordering concert tickets online.

I walked over to her chair, picked up her computer, and quickly found the problem. I clicked my way through the various menus and got to the point where she could finalize payment…when I smelled something burning.

OMG!

I had completely forgotten about the grilled cheese sandwich! Fortunately, the living room where Sally was sitting and the kitchen bookend a single open area and so I was able to see, hear, and smell what was on the stove from where I was standing. I sprinted the length of the apartment in record time and was able to get the pan off the burner before the sandwich was completely ruined.

That might have been my worst mistake to date. It had the potential to be disastrous. And it’s the kind of thing we, unfortunately, hear about all too often. It frequently signals the beginning of the descent into a world where there is reason to question our ability to live independently. 

3. “What we’ve got here is failure to communicate.”

Remember that line from “Cool Hand Luke?” That scene had to do with Paul Newman’s resisting the authority of the prison boss…which has nothing at all to do with the misunderstanding that Sally and I had last week. I just love that line, which is why I quoted it. 😀

Our ‘failure to communicate’ was not at all passive aggressive on my part. Sally asked me if I would do something for her while she was visiting a friend in New Hampshire and I said that I would. The problem, though, is that what I thought she wanted me to do and what she actually wanted me to do bore no resemblance to each other!

So when the time came, I remembered full-well that I had an assignment, taking several actions to make certain that I could fulfill my responsibility. I was ready. The problem was that I was faithfully attempting to fulfill the wrong task.

Upon her return home the next night, Sally was not at all pleased to learn that I hadn’t done what she asked. We tried to recall the conversation where things went awry and both of us had solid recollections supporting our respective positions. 

There’s no doubt in my mind that Sally did, indeed, say what she intended to say and that I latched on to an errant phrase and ran with it in a different direction, leading to the snafu. Regrettably, other people were involved.

We all know that you can’t remember something if you don’t first pay attention to it, so I guess I need to work on my listening skills, as well.

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S2E31. Sweet Dreams Are Made Of This

When I was growing up, my mother valued her children’s sleep above all other bodily functions. When I was 12, I used that to my advantage when I wanted to play hooky from Hebrew school by staying up late the night before and then pretending not to wake up the next morning when she called me.

In college, a had a fierce bout of depression and found myself sleeping 12-16 hours every day. My therapist told me it was a defense mechanism whereby I tried to escape from reality. It sounded plausible at the time.

I used to wake up most nights at 3am. My best guess was that it was a little bit of residual trauma from when I was 6 or 7 and I was startled awake by the phone ringing. It was the hospital calling to tell us that my grandmother had died. My mother jumped out of her bed, wailing and crying hysterically. I glanced at the clock in my room and saw that it was 3am. Just recently, I learned that about 35% of us habitually wake up at 3am…and a related trauma is not a prerequisite at all.

In my early 30s, when I was the executive director of a performing arts center, I used to doze off in my office every afternoon. I fought it for a long time in the belief that I shouldn’t  be sleeping on the job, but then I decided, screw it! As soon as I’d start to get drowsy, I would buzz my secretary and ask her to hold my calls, lean back in my chair and nod off.

My afternoon napping habit never left me. When my first wife and I ran a B&B in northeastern Pennsylvania, I would retreat to the rope hammock hung between a pair of birch trees or lie down on the porch swing on most days in the late spring, summer and early fall. Those were the best naps of my life!

Fifteen years later, as the staff psychologist on an inpatient behavioral health unit, I took my nap a little earlier to coincide with my lunch break. Without my asking, our director sent out a notice that staff should not disturb Dr. Braffman during lunch unless there was an emergency and a patient was in crisis. Now that’s how you value nap time!

In graduate school, I learned about the 4 phases of sleep. Later studies revealed that you cycle through these phases 4-6 times every night, and that you can dream at any time, not just during REM sleep. 

New research published last month reported that there is a noradrenaline cycle that wakes you up as many as 100 times during the night. The awakenings are measured in milliseconds, so you are unaware of the vast majority of them.

Although we appear quiescent while we sleep, there’s actually a lot of important business going on under the hood. It’s the time when we consolidate memories and new learning and replenish our available stores of vital neurotransmitters. If you don’t sleep well or long enough, you’re going to have cognitive problems the next day, e.g., brain fog and you’ll be prone to making a lot of mistakes.

Another critical function of sleep is to clean up the chemical detritus left over from your brain’s daily activities. There is a whole separate network in your head that performs this task, running in parallel with the neural networks with which we are all so familiar. It’s called the brain’s glymphatic system.

It’s hypothesized that your brain’s ability to clean up the daily messes that it makes plays a critical role in preventing dementia. One way this might work would be by removing beta amyloid that is created as part of an immune response like a fever. 

What I haven’t been able to find anywhere in the literature, though, is a description of the magnitude of this cleaning power. Can your brain completely clean house every day? Is there enough residual power to clean up festering messes that overwhelmed the system on earlier occasions? In other words, is it destiny that our brains eventually be overrun with chemical garbage? Or can we chip away at accumulations of waste products until all our neural pathways are functioning again? Or is breaking even on a daily basis the most we can hope for?

We don’t know the answer to those questions yet, but we do know that somewhere between 7-9 hours of restful sleep on a regular basis helps tremendously. And naps are good for you, too (thank you, lord!), so long as you don’t overdo it to the point where they start to affect your nighttime slumber.

The impact of consistently high-quality sleep on your brain’s health can not be overstated. If you aren’t sleeping well (i.e., less than 6 hours each night), you might want to consider implementing some behavioral changes now that will reduce your risk of dementia by 30-50% later on.

To sleep better, lay off the alcohol in the evening and no more caffeine after 12 noon. Set a fixed schedule for going to bed and waking up. Stow your electronic devices about an hour before bedtime. Make a list of all the things you want to do the next day so you don’t lie awake thinking about them. You might want to do a meditation/relaxation/deep breathing exercise just before bedtime. Make sure your bedroom is dark and the temperature is somewhere in the 60s.

If you do all of these things and still have trouble sleeping, it will be well worth your while to get evaluated. There are a range of products out there—both natural and pharmaceutical—that can offer you support, if you need it.

Pleasant dreams!

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S2E29. Brain Training Is Hard Work!

As I mentioned at the end of the last episode, my disappointment with my short-term memory led me to subscribe to ‘BrainHQ,’ a computerized cognitive training program. This past week was my first week using it and…man o’ man!!!…it’s hard work!

Before I continue, let me reassure you that I am not shilling for BrainHQ. I chose it from the myriad of online cognitive training offerings because it is being used in a range of research programs and has some published studies to support it. Having said that, the data is mixed and the jury is still out as to whether or not this particular program (or any purported brain-enhancing program) generates any meaningful improvement in one’s life.

But—just as I decided that in regards to diet that if I’m going to put something in my mouth, then it might as well provide something that supports brain health—I came to the same conclusion about computer games. Instead of wasting an inordinate amount of time playing a mindless but addictive game like ‘Bubble Shooter,’ I might as well get some benefit out of that same block of time by playing games that just might provide some health benefit. 

To see if it was really worth doing, though, I spent time this week looking at some of the recently published research about the effects of cognitive training programs. One study that caught my eye was a meta-analysis (i.e., a study that analyzes the data from many studies all at once) of changes in brain connectivity attributable to cognitive training. 

You might recall from S2E23: Repaving Your Cognitive Infrastructure that our brains develop neural circuits that connect distant areas that are used simultaneously to complete tasks. As we age and our abilities start to decay, we recruit more areas to help perform the same functions. This is made possible by brain plasticity and is at the heart of cognitive resilience as a protective factor against dementia.

The meta-analysis I read combined data from a number of fMRI studies and revealed that computerized cognitive training changed these pathways and linkages. There were increases in activity in some areas and decreases in others. The overall pattern was to move in the direction of restoring the circuitry that existed before age-related attrition began. In effect, it (roughly) restored your brain to the way it was two years earlier. That’s pretty impressive, no?  

If I’m understanding it correctly, when your frontal lobes begin to atrophy, your brain recruits neurons from other more posterior regions to pick up the slack. But cognitive training strengthens your frontal lobes so they no longer need to use the support they had previously requisitioned. Thus the frontal areas showed more activation and the more posterior areas showed less. Fascinating!

So I jumped into my training with the fervor of a new convert and immediately set a goal of ‘working out’ for an hour every day. This, apparently, was considered a very aggressive plan of action as BrainHQ recommended 20 minutes/day at least 3 times a week as a good place to start.

The program allows you to target a variety of brain functions (e.g., attention, speed, memory) and so I went after memory instead of following the suggested general approach which covers all the bases. Was I in for a surprise!

It was really hard. The tasks included both audio and visual versions of the ‘N-Back’ card task that I described in last week’s episode (S2E28), as well as an audio version of the card game ‘Concentration.’ 

The program is designed to push you to a challenging level without frustrating you to the extent that you quit. So the exercises start off easy, progress until you fail, and then drop back to easier versions. The sweet spot is when you maintain an 80% correct response rate.

I struggled with the frustration, though. On the N-Back card task, I mustered up all the attention and focus I could to visualize the briefly-shown cards in an order that would help me identify the correct one when the time came….but I didn’t get very far.  😦

All of my best efforts not withstanding, my visualizations of the cards would disappear shortly after a few new cards were turned over. It was as if an evil magician was doing a disappearing act inside my head. Poof! Now you see it…now you don’t!

I beat up on myself because I knew that my performance represented a decline from my peak abilities. Yes, I know that this is true for all of us if we are fortunate enough to get to this age, but having it slap me in the face like that was a little hard to take.

About three days into my training, I recalled something I learned in graduate school. Your brain has a ready supply of neurotransmitters on call to maintain a high level of focused attention for about 45 minutes. After that, you can still focus, but your efficiency drops off. I used this fact when I was taking hours long exams by stopping every half hour and doing deep-breathing exercise for 3 minutes to restore my neurotransmitter reserve before returning to the test. It seemed to work then, so I applied the principle again now: I divided my hour of daily exercise into two 30-minute sessions several hours apart. I could feel the difference and see the improvement in my performance during the second half of the workout. 

(Come to think of it…45 minutes is about how long I can practice the recorder or read a book without losing focus. Interesting!)

The good news here is that, after a week of training, I can see that I’ve made progress on all of the tasks. Not a lot, but progress, nonetheless. Enough progress to keep me from quitting. But, damn…this is hard work!

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S2E28. Working Memory Workout?

A majority of the mistakes and cognitive errors that I have documented in this blog involve failures of working memory. Working memory is where we hold information online while we manipulate it and/or consider what to do with it. It’s where we hear our internal voice. It’s the central cog in our executive functioning network.

Consequently, it’s not pretty when you start to experience declines in your working memory abilities which, as it so happens, are usually the first to go as we get older.

So I was intrigued by an article in The New York Times last week that reviewed a new book (The Complete Guide to Memory: The Science of Strengthening Your Mind) by neuroscientist Dr. Richard Restak in which he asserts that exercising your working memory can forestall its decline and possibly even restore prior losses. The article covers his 7 key recommendations and you can read it here.

Regular readers of this blog know me well enough to figure out that I downloaded the book and read it this week. It reviews all the usual types of memory and he adds a few new ones of his own construction. He pays more attention to brain structures than most books of this type, but he keeps his narrative breezy and conversational, including examples ‘ripped from the headlines,’ as they say.

He recounts the usual litany of techniques you can use to better remember lists, but I was most intrigued by his lengthy discussion of working memory and exercises you can do to actually strengthen it.

One such exercise was to name all of the United States presidents in chronological order, beginning with FDR. Then do it in reverse order. Then do it alphabetically. Then do it in reverse alphabetical order. If you want to try this, I’ll give you a hint: there are 15 of them.

It took me a little while one sleepless night to master this task. As I did so, I felt like I could actually see the places where my working memory let me down and where answers were swimming nearby but just out of awareness.

He recommended making other lists that you can manipulate in similar ways, and to practice organizing them in your mind every day. 

He also recommended daily practice with what is known as the ‘N-back task.’ The easy-to-do-at-home version of this only requires a deck of playing cards. First, you select two cards that will be your ‘trigger’ cards, say a ten and a three. Then you turn over the cards one by one, look at them, and place them face down in a pile. When one of your trigger cards appears, you have to name the card that preceded it. This is the ‘1-back’ version of the task. After you’ve mastered it, you can make it more difficult by trying to name the card that was two cards before the current card, or ‘2-back.’ 

I immediately pulled out a deck of cards and tried it…and failed miserably at the 2-back version. I did alright with the 1-back version, actually having the most difficulty remembering which were my 2 trigger cards!

This piqued my interest in working memory tasks and so I googled it. I discovered quite a number of sites offering (for a subscription fee) computerized versions of a wide variety of working memory tasks. 

I tried a number of them and quickly discovered how limited my working memory is. I was especially bad at tasks that required me to remember visual images. In fact, I noticed that I retained virtually no memory of the images and had to resort to semantic memory to complete the task, i.e., naming the images that had flashed on the screen and remembering the names, not the pictures.

Neuropsychological tests are very good at isolating and identifying your weaknesses, and these were no exception.

Dr. Restak talked about my condition in his book. It’s called ‘hypophantasia’ which is the inability to retain fleeting visual images in your mind’s eye. Conversely, people who are exceptionally adept at doing this have ‘hyperphantasia.’ My first wife was such a person. She could walk through someone’s house once and later draw a diagram of all the rooms on every floor…to scale! Most of us have abilities that fall somewhere along this spectrum from hyper- to hypophantasia.

This experience alarmed me enough to want to initiate a structured workout routine to try to improve (or at least slow the deterioration) of my working memory. My recollection, though, was that—Dr. Restak’s exhortations notwithstanding—the research is mixed about whether computer games and tasks can actually improve your cognitive abilities. In most cases, it appears that you can get better at the computerized task, but that it doesn’t generalize to improve your ability to perform other tasks of daily living. What was I to do?

Right on cue, I received an email from one of my college roommates, Tom, with an article from The Boston Globe about several large-scale, age-related cognitive studies that are being launched in New England. Among the variables being tested are brain training techniques. The program offered by a company called BrainHQ will be used in these studies.

Well, if it’s good enough for the researchers, then it’s good enough for me! So I went to www.BrainHQ.com and subscribed for a year for $96.00. My intention is to do a 1-hour workout each day…if the frustration from getting too many wrong answers doesn’t overwhelm me.  

Wish me luck!

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S2E27. And The Diagnosis Is…

For the last year and a half now, I’ve been attempting to faithfully record the types of cognitive errors I notice myself making. At the same time, I’ve been researching the differences between normal aging, mild cognitive impairment, and dementia. So it’s about time I made the call and diagnosed myself, don’t you think?

Making a diagnosis like this isn’t a 1-time thing nor is it an all-or-nothing thing. It’s a snapshot of where I stand today. It’s not predictive of where I will be a year from now, or ten years from now. It’s more like an annual check-up than it is a definitive conclusion.

Before the ‘big reveal,’ though, I thought I’d summarize the range of mistakes I’ve previously documented in this blog. Here you go:

S1E2. Short-Term Memory Peek-A-Boo: walking into a room and forgetting why I went there; being able to hold fewer items in short-term memory (e.g., a 10-digit telephone number) than before.

S1E4. Mistakes On The Journey: doing things without intending to; tip-of-the-tongue word-finding problems; saying a word that isn’t the one I intended; not checking things after I’ve completed them so I don’t catch the errors I’ve made.

S1E5. Testy & Edgy: irritability; lowered frustration tolerance.

S1E6. Did I Do That?: Not remembering doing something right after I did it.

S1E8. Splotchy Thinking: more examples of doing unintended things; more examples of not remembering recent events.

S1E15. Vivid Memories That Aren’t: clear recollections of past events that turn out to be false.

S1E16. The Name Game: Not remembering the names of people I knew well years ago.

S1E18. 2 Runs, 4 Hits, 1 Error: Errors made in social situations.

S1E20. Dear Diary…: Errors in completing complex tasks.

S1E22. Making Coffee Isn’t Hard…Is It?: More problems with complex tasks and routines.

S1E24. Scary & Scarier: Breakdowns in implementing well-learned routines.

S1E28. Potholes On Open Highways: a variety of mistakes including memory, word-finding, and getting distracted.

S1E33. Poor Judgment: exactly what the title says!

S1E35. Mini-Miscues: A collage of errors, including visuo-spatial challenges.

S1E43. No Comment: Talking less in social situations.

S2E7. More Mistakes On The Journey: a grab bag of recent errors.

S2E12. When Your Fact-Checker Doesn’t: problems with executive function and meta-cognition.

S2E18. Subtle Symptoms?: Things that aren’t really problems now, but could become problematic if they worsen. 

(You can read all of these episodes by going to the home page and scrolling down: www.MistakesOnTheJourneyToNowhere.com.)

Reviewing these episodes in order to write this post was pretty sobering. It seemed really bad at the time and I remember being nervous about all the ways I was failing. But I don’t feel that way anymore, even though I recognize that I am still committing most of these categories of errors. What changed?

For one thing, I realized that none of the mistakes that were dogging me had serious consequences. When playing schoolyard basketball, we used to say ‘No blood, no foul’ and these cognitive ‘fouls’ aren’t drawing any ‘blood.’

Secondly, I think I’ve become used to committing this range of errors. They were pretty shocking when I first focused my attention on them, but now, not so much. When I do a mental belly flop I’m more likely to react with a ‘Meh’ than an ‘OMG!’

Finally, I’ve gotten better at compensating for a wide variety of them. In most cases, the duration of a screw-up is very short (measured in just a few seconds) and quickly corrected.

So here’s my bottom line as of July 8, 2022 as I’m just a few days short of 71½:

I definitely don’t have dementia. This is primarily based on the fact that none of the errors I’m committing have serious consequences or affect my ability to live independently.

For the same reason, I don’t think I meet the criteria for a mild cognitive impairment, either: there are no noteworthy consequences to my miscues. Even Sally, who is uniquely adept at spotting my screw-ups, would agree that they are mainly trivial in nature.

By process of elimination, then, it would appear that what I’ve been documenting is normal aging. Not only do my errors fall within a harmless range, but I’m maintaining pretty good executive functioning (e.g., writing this blog every week) and I am still able to find creative solutions to problems. 

So that’s the diagnosis I’m going with for now: normal aging. And if I’m correct about that, then it’s both reassuring and terrifying to know that one’s brain circuits can misfire so frequently and you still get to call yourself ‘normal!’ 

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S2E26. Losing My Mind

“Every day is new now, with little remembrance of the day before, but with enough memory retained to know there was a yesterday. This is a new way to live and it takes getting used to.”

Thomas DeBaggio, author of the above quote, was diagnosed with early onset Alzheimer’s in 1997 at the age of 57. His book detailing the progression of the illness (Losing My Mind: An Intimate Look At Life With Alzheimer’s) was published in 2000. He went on to write another book in 2002 chronicling his life with dementia, and became a tireless advocate for Alzheimer’s research. He passed away in 2012.

Up until now, all of my posts have focused upon discerning the difference between normal age-related errors we all make and the more problematic mistakes associated with the onset of dementia, as well as preventative measures we can adopt to try to dodge the illness which affects about half of those who make it beyond the age of 85.

Reading this book last week, however, was my first road trip into the world of life with dementia…and it was sobering. 

The book is presented as a braid of three interwoven threads. Fortunately for us, DeBaggio’s first love was writing. He was a journalist before settling into his career growing and selling herbs, which also led to his writing about that experience.

The book is not written in chapters. Instead, paragraphs alternate between the three threads. It’s a surprisingly effective technique that captures the essence of the relentlessly vanishing world in which he lived.

The first thread is his biography. Reading it, I wondered if he wanted to leave a trail he could follow to find himself once his memory of his own personhood failed him. A noble effort, for certain, but doomed to failure as the disease progresses inexorably through its mind-sucking stages which would ultimately rob him of the ability to understand that the story he had penned years before was about him. 

The second thread is a description of his current status as it unfolds over the course of his first three years living with Alzheimer’s. At this point, he still has the introspective awareness to be able to recognize when he is making a mistake or losing a cognitive capacity or experiencing something new and unfamiliar. It is here that I am most thankful for his literary skills…which makes it all the more painful to travel with him as he loses access to his words and to the thoughts that he can’t pin down and retain:

“There is a dullness in my brain now to allow me to stare into silence without an idea or thought breaking the stillness.”

Juxtaposed against his past and his present (and looming future) is a summary of his research into Alzheimer’s disease circa 1999. He details the state of the research with excerpts from scholarly publications. It soon becomes frustratingly apparent that there has been very little progress in the past 22 years.

I’m glad I read this book as it helped better define for me the seamless spectrum that runs from the errors of normal aging to indications of cognitive decline to the early experience of dementia. It’s the transition from making errors that are irritating but readily resolved to awareness of problematic thinking that has real-time consequences to the loss of control of your inner dialogue.

Thankfully, I’m still in pretty good shape. When I woke up Thursday morning thinking about how I would end this episode, I was able to table my ideas and return to them after breakfast without any problem. 

My thoughts don’t simmer in a quantum soup where they live lives measured in nanoseconds and their very existence is always uncertain. 

My computer’s spell-check isn’t working overtime to try to figure out what it is I really meant to type.

I’m nowhere near traveling DeBaggio’s path, yet I am grateful to him for illuminating the way.

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S2E25. The 10 Warning Signs of Alzheimer’s

I’ve been blogging for a year and a half now and, surprisingly enough, have yet to delve into the early symptoms of dementia in their entirety. I’ll correct that oversight below, but before I do, I’d like to add a little perspective.

When you go through the list below, I think you’ll agree with me that there has already been a significant cognitive decline by the time you experience those kinds of problems. Given that we have no treatment that can reverse the effects of dementia, the primary value of diagnosis at that point would seem to be to initiate the transition to some form of assisted living, whether it be in a facility or via support provided by your family.

But there is another really good reason for getting checked out. It’s very possible that the cognitive mistakes you are making have a cause other than dementia. In particular, depression, sleep disturbance, stress and medication interactions can all generate symptoms that mimic dementia. There is great value, then, in ruling out these other causes before you start to fret over beginning your long goodbye.

Having said that, I hearken back to my original intent in writing this blog which was to try to identify indicators that you were slipping well before you get to the debilitated state described in the ‘warning signs’ below. My hope was that perhaps an extra year or two of awareness would give you time to make lifestyle changes that might slow the progression of the illness. What I’m searching for is cognitive errors (my ‘mistakes on the journey’) that are more worrisome than ‘normal aging’ yet not as debilitating as a ‘warning sign.’

As for now, it appears that dementia-related errors are (1) more frequent and (2) more disruptive than those found in normal aging. It’s a fine line, indeed.

With that in mind, I joined a webinar this past Tuesday presented by the Alzheimer’s Association (www.alz.org) titled ’10 Warning Signs of Alzheimer’s’ in hopes of hearing about more subtle indicators of an approaching dementia. 

Spoiler alert: I was disappointed. The material covered was no different than that already posted on their website and, in fact, utilized the same slides. So rather than provide a summary of what I learned, it makes more sense for me to just present the information directly from their website, as I really don’t have anything to add. These are the best guidelines we as laypeople have to differentiate normal aging from dementia. The take-home message is this: If someone you know is exhibiting one or more of these symptoms, it’s probably time for a full diagnostic evaluation.

Here are the 10 warning signs:

1. Memory loss that disrupts daily life.

One of the most common signs of Alzheimer’s disease, especially in the early stage, is forgetting recently learned information. Others include forgetting important dates or events, asking the same questions over and over, and increasingly needing to rely on memory aids (e.g., reminder notes or electronic devices) or family members for things they used to handle on their own.

What’s a typical age-related change?
Sometimes forgetting names or appointments, but remembering them later.

2. Challenges in planning or solving problems.

Some people living with dementia may experience changes in their ability to develop and follow a plan or work with numbers. They may have trouble following a familiar recipe or keeping track of monthly bills. They may have difficulty concentrating and take much longer to do things than they did before.

What’s a typical age-related change?
Making occasional errors when managing finances or household bills.

3. Difficulty completing familiar tasks.

People with Alzheimer’s often find it hard to complete daily tasks. Sometimes they may have trouble driving to a familiar location, organizing a grocery list or remembering the rules of a favorite game.

What’s a typical age-related change?
Occasionally needing help to use microwave settings or to record a TV show.

4. Confusion with time or place.

People living with Alzheimer’s can lose track of dates, seasons and the passage of time. They may have trouble understanding something if it is not happening immediately. Sometimes they may forget where they are or how they got there.

What’s a typical age-related change?
Getting confused about the day of the week but figuring it out later.

5. Trouble understanding visual images and spatial relationships.

For some people, having vision problems is a sign of Alzheimer’s. This may lead to difficulty with balance or trouble reading. They may also have problems judging distance and determining color or contrast, causing issues with driving.

What’s a typical age-related change?
Vision changes related to cataracts.

6. New problems with words in speaking or writing.

People living with Alzheimer’s may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. They may struggle with vocabulary, have trouble naming a familiar object or use the wrong name (e.g., calling a “watch” a “hand-clock”).

What’s a typical age-related change?
Sometimes having trouble finding the right word.

7. Misplacing things and losing the ability to retrace steps.

A person living with Alzheimer’s disease may put things in unusual places. They may lose things and be unable to go back over their steps to find them again. He or she may accuse others of stealing, especially as the disease progresses.

What’s a typical age-related change?
Misplacing things from time to time and retracing steps to find them.

8. Decreased or poor judgment.

Individuals may experience changes in judgment or decision-making. For example, they may use poor judgment when dealing with money or pay less attention to grooming or keeping themselves clean.

What’s a typical age-related change?
Making a bad decision or mistake once in a while, like neglecting to change the oil in the car.

9. Withdrawal from work or social activities.

A person living with Alzheimer’s disease may experience changes in the ability to hold or follow a conversation. As a result, he or she may withdraw from hobbies, social activities or other engagements. They may have trouble keeping up with a favorite team or activity.

What’s a typical age-related change?
Sometimes feeling uninterested in family or social obligations.

10. Changes in mood and personality.

Individuals living with Alzheimer’s may experience mood and personality changes. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, with friends or when out of their comfort zone. 

What’s a typical age-related change?
Developing very specific ways of doing things and becoming irritable when a routine is disrupted.

If these are the 10 criteria by which we are to measure our cognitive health, then I passed my 71½-year check-up with flying colors!

The only item that is close to raising a warning flag is #9: Withdrawal from work or social activities. As Sally has pointed out, I’m not as talkative as I used to be and now have a tendency not to participate in conversations. But it’s not because I’m not following along or can’t find the words or put together a sentence. I would describe myself in those situations as being comfortable and attentive, albeit not actively engaged. To the extent that my silence might represent a precursor to the development of poverty of thought, though, it’s worth keeping on eye on.

So I’ll take my current mental status as a win…and continue to search for earlier warning signs of dementia.

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S2E24. Supplements? I Don’t Think So.

Last November, I posted that I wasn’t a fan of probiotic supplements (S1E44: Probiotics…really?)

Actually, I’m not a fan of supplements, period. There is no meaningful oversight by the FDA, you’re not guaranteed that you are getting the ingredients you think you are getting, and the research trail is pretty spotty for most of them, if there is a research trail at all. In fact, the World Health Organization has concluded that vitamins and supplements should not be prescribed to treat cognitive decline or dementia. Finally, I hate to take pills. So there’s that.

There is one important exception to my recalcitrance. I think it’s ok to take supplements if lab tests indicate a meaningful deficiency. If a doctor orders them for you and can recommend a reputable manufacturer, well, then, I guess I have no qualms with that.

As I continue to monitor the brain health literature, though, I’m always on the lookout for anything beneficial that I might be able to fit into my diet. My niece, Kay, has been helpful in that effort. She is a consumer par excellence and does her own research before telling me about a food or a product that might be of interest. A little while back, she told me about Lion’s Mane mushrooms and just this past week she asked if I knew anything about matcha tea. So I followed-up with both.

From what I can tell, Lion’s Mane has a decent empirical track record. Studies have used a wide variety of dosage levels, though, and there is no recommended level of daily intake. You can eat them, use them in powdered form to make tea and smoothies, or take a pill. 

I once ate them when I lived in Kennett Square (‘Mushroom Capital of the World’) where they were readily available…and I gagged on it. I’m sure I didn’t cook them correctly, but I’m not willing to give it another shot. And you already know how I feel about pills, so that left the powder form as my only viable option. Since I drink tea every morning, I decided to add ½ teaspoon (about 2 mg.) of the powder to my mug which is already laced with a ½ teaspoon mixture of turmeric, cinnamon, ginger, cumin and black pepper.

Matcha (which is sold in powder form) appears to be green tea on steroids. It has more of all the active ingredients of regular green tea and appears to give an additional boost above and beyond what you would otherwise get. Apparently, turning the entire leaf into a powder instead of steeping the leaves is what creates the potency. It is also cultivated a little differently from regular tea, adding to its mystique. There’s quite a ritual around serving it, as well, but the pageantry has no appeal for me.

The instructions on the label suggest adding ½ teaspoon of powder to 2 cups of hot—but not boiling—water and letting it steep. Looking for a boost, though, I upped that to 1 full teaspoon and, thankfully, it tasted just fine.

My morning tea, then, is brewed with: 1 teaspoon of matcha powder, ½ teaspoon of mixed spices, ½ teaspoon of Lion’s Mane powder and 2 cups of filtered water. (Yes…everything is organic.)

Now, if you had put all those powders into a pill and told me to take it every morning, I’d have told you to shove that pill where the sun don’t shine! But using the same powders to make tea seems perfectly acceptable to me. Why is that?

Maybe I’m just being a big old hypocrite, but I rationalize what I’m doing by saying that if I use it in cooking, then it’s not a supplement. And brewing tea is ‘cooking.’

So what do you think? Am I really taking a supplement? Do I need an intervention here to break through my denial?

Whatever it is I’m doing, I’m convinced that drinking 2 cups of this tea followed by my bowl of granola overflowing with a ton of fruit is about as brain-healthy a way to start each day as I can imagine!

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S2E22. An Abundance Of Caution

Every few days, it seems, a public figure issues a statement saying that although they are fully vaccinated, they just tested positive for COVID. And, although they are asymptomatic at this time, out of “an abundance of caution” they will quarantine for five days.

I just love the phrase “an abundance of caution.” Is that like a gaggle of geese? Or a congress of baboons? In any event, I appreciate the sentiment.

It is out of an abundance of caution, then, that I am switching to organic toiletries: soap, shampoo, hair conditioner, toothpaste, deodorant and shaving cream. The links between these products and dementia are weak at best, but I figure it can’t hurt, so why not?

Toothpaste

Gum disease and gingivitis are both risk factors for dementia. Daily brushing, therefore, is important. As the old Crest carton and tv ad reminded us: ‘…when used in a conscientiously applied program of oral hygiene and regular professional care.’

The primary concern about toothpaste seems to be the presence of fluoride. From what I can gather, though, the best documented effects involve embryonic neurodevelopment and young children. Deposits have also been found post-mortem in the brains of those with Alzheimer’s, but no correlational or causal links have been proposed.

Other ingredients in toothpaste (e.g., artificial sweeteners, artificial coloring, parabens, propylene glycol) might harm you in various ways, but my concern here is brain health. But…out of an abundance of caution…I made the switch. 

It appears that a solution of equal parts baking soda and water will work just fine as a daily toothpaste and it’s as inexpensive as it gets. Alternatively, there are a variety of organic toothpastes available online, although most are on the pricey side.

Shampoo and hair conditioner

Did you know that there are emissary veins in your scalp that provide a conduit into your brain? Their presence means that what you rub into your scalp has the potential to get into your brain…and that’s cause for concern.

A few chemicals in the United States have been banned from use in hair dyes for this reason, but there are many others that are suspect but for which there are inadequate studies to establish the danger. The European Union, on the other hand, has banned some 1,300 chemicals from cosmetics.

Since we massage shampoo and hair conditioner into our scalps on a regular basis, and the potential exists for it to be absorbed into our brains, then I think it makes sense to pay attention to what we’re using.

I used Pert shampoo with conditioner for years. It always burned my eyes, but I didn’t think anything about it. After all, at an early age we were taught to close our eyes when shampooing. Now, though, I figure that that isn’t such a good thing after all, and so I tried organic products and…lo and behold…no more eye irritation!

Soap

I’ve been using Zest for as long as I can remember, and, just like with my shampoo, the fumes burned my eyes. That was enough to get me to try an organic milled soap. And just like with the shampoo, the burning disappeared.

One theory about Alzheimer’s posits that an ineffective immune system can be responsible for the disease. The thinking behind it is somewhat counter-intuitive: we are so germ-conscious that we sanitize ourselves to the extent that our bodies don’t learn how to fight off a range of bacteria, and it is our under-developed immune systems that fail us when it comes to preventing dementia caused by bacteria.

One of the recommendations that this suggests is to stop using anti-bacterial soap. Fascinating!

In addition, chemicals can be absorbed through our skin, some of which can cross the blood-brain barrier, so it makes sense to pay attention to the ingredients in your soap…out of an abundance of caution!

Deodorant

The suspect chemicals to be avoided in deodorants are parabens, triclosan, phthalates, propylene glycol and aluminum. Their effects are linked to cancer more than dementia, but as long as we’re protecting ourselves, we might as well go all in.

It turns out I was already using a safe deodorant: unscented Arm & Hammer Essentials, so no need to change.

Shaving soap

The ill effects of the chemicals that might be found in shaving soaps are generally not too severe except for aerosols which may contain carcinogens. But just like with deodorant, we’ve come this far, so we might as well finish the job. In this case, too, I was already using a natural, unscented shaving soap.

So for me, it wasn’t that hard to make the switch to natural toiletries. The fact that I only use 6 items certainly helped! Did I really have to do it? No. Will it decrease my likelihood of getting dementia by a significant degree? Probably not. But out of an abundance of caution, I did it anyway.  😀

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S2E21. A Brain Healthy Bibliography

Over the course of the last year and a half, I’ve relied upon a wide variety of resources to help me prepare these blog posts. At times I’ve identified them and provided links; at other times, not so much. To remedy that, I thought I’d dedicate this episode to putting all of those resources at your fingertips. There are movies, videos, lectures, websites and books in the following list, just in case you feel compelled to take a deeper dive into the data:

Movies:

‘The Father’ starring Anthony Hopkins

‘Still Alice’ starring Julianne Moore

Books:

The End of Alzheimer’s by Dr. Dale Bredesin (see S1E34)

Remember: The Science of Memory and the Art of Forgetting by Lisa Genova (see S2E4)

In Love: A Memoir of Love and Loss by Amy Bloom (see S2E16)

Lecture Series:

The Aging Brain from The Great Courses (see S2E9, S2E10, S2E11)

Video:

Can Alzheimer’s Be Stopped? – PBS NOVA

Determined: Fighting Alzheimer’s – PBS NOVA

What You Can Do To Prevent Alzheimer’s – Ted Talk with Lisa Genova

Links:

Alzheimer’s Association

Being Patient

WebMD (search ‘dementia’, ‘Alzheimer’s,’ and ‘aging’)

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S2E20. Brain-Healthy Menu Plan

I’ve written often about your diet’s effect on your brain’s health, but it occurred to me that I haven’t yet put all the pieces together to demonstrate that it’s possible to incorporate this kind of diet into a daily routine. I’ll try to do that now.

One of the things that has always bothered me about diet recommendations is the idea that you have to have X many servings of various foods every day or week. I just don’t have the patience to measure things out to see if I’ve got enough to meet the criteria for a ‘serving,’ nor do I possess the discipline to keep track of all of those servings to see if I’ve met the goal. 

Working that hard can take all the joy out of eating!

Instead, I’ve developed a practical approach (some would call it a rationalization!) toward eating. Here are the 3 key points:

1. You can only eat but so much in a day or a week, so eat when you’re hungry and eat things you like that fit your diet plan. I have faith that your body will figure out how to maximize the benefit from the selection you offer it as long as you provide it with a buffet that covers all the basic areas, like Omega3 fats, antioxidants, etc. A little of something good is better than none at all, and it’s probably good enough when you just can’t work the recommended volumes into your plan.

2. Except for #3 below, everything you put in your mouth should provide some nutrient that is protective of your brain.

3. There is no such thing as cheating. So what if you eat something you shouldn’t every so often? What’s the big deal? Maintaining brain health is a long-term project that plays out over decades. The more days I eat all the right things, the better off I am. But it’s not fatal if I have a piece of cake or a hamburger once in a while. It might set my project back a day or two, but that’s not so terrible and it’s more than offset by the soul-satisfying lift I get from eating something that’s taboo. Bottom line: your eating lifestyle should be guilt free!

Let me offer one disclaimer before showing you what I eat:

I’m not recommending that you adopt my diet. I’m just trying to demonstrate that a brain-healthy diet is do-able. Only you can decide what will work for you: what times of the day, how often, and what you like to eat. So I’m not going to give you a ‘meal plan,’ per se. It’s more like an outline to help get you started. 

The diet that emerged for me was the result of my researching brain health in order to write this blog. As I learned about foods that contained important nutrients and compounds, I tried to add them to my diet. Having eaten this way for nearly a year now, I don’t remember what foods provide what benefits, but I can tell you that everything I swallow has a purpose based on the research.

Finally, before showing you what I eat, it’s important to show you what I don’t eat: products with added sugars of any kind, rice, grains (except for oats), dairy (except for kefir), refined flour, bread, fried foods, white potatoes, beef and pork. It sounds pretty restrictive, but it’s actually not all that bad.

Oh yeah…I almost forgot…the goal is to use all organic ingredients.

Here’s what my diet looks like:

Morning Tea: I try to do a 14-hour overnight fast each day, so I stop eating at 7:30pm the night before and have breakfast at 9:30am the next morning. Since I wake up hungry, though, I have 2 cups of tea at around 8:00am to hold me over. Decaf green tea is preferred, but I don’t like the taste all that much, so I mix ½ tablespoon of green tea leaves with an equal amount of mint leaves and then add ½ teaspoon of mixed turmeric, cumin, cinnamon, ginger and black pepper.

Breakfast: It’s the same thing every day: homemade granola with fruit. And it never gets old! It’s now my favorite meal. I linger over and savor every mouthful. Here are the ingredients: oats, chopped walnuts, pecans and almonds, turmeric, ginger, cumin, cinnamon, nutmeg, cocoa, flaked coconut, flax seed, chia seed, oat bran, figs, prunes, apples, raspberries, blueberries, strawberries, and grapes, with flax milk.

(I added oats to the mix after I wrote ‘A Granola Ritual’ because I wanted help in lowering my LDL (bad) cholesterol.)

As you can see, I pack a ton of brain-healthy goodies into this one meal. 

Lunch: Well…not really. I get hungry between noon and 2:00pm, but I don’t prepare anything that could legitimately be called ‘lunch.’ More accurately, I nosh…usually standing up. I know, I know…I should sit down when I eat…but I’m hungry!

I hope this doesn’t gross you out, but my go-to noshes are pickled herring, homemade sauerkraut and seaweed salad. Hummus with vegetables, guacamole, and a few mouthfuls of dinner leftovers are also on the noshing menu. So are oranges and almonds.

Post-workout hydration: 1 pint pomegranate juice made with 1 part juice and 2 parts filtered water.

Dinner: One of the joys of adopting this food lifestyle is trying out new recipes…and being surprised that things taste as good as they do! Here is a list of the items that have become staples of my evening meals: salmon, chicken, shrimp, eggs, kale, quinoa, roasted vegetables (eggplant, acorn squash, sweet potato, Brussels sprouts, carrots), mackerel salad with celery, grapes and walnuts, spinach, asparagus, salad (spring mix, grape tomatoes, onions, sweet peppers (red, yellow, orange & green), mushrooms, anchovies, avocado, parsley, olive oil, balsamic vinegar, lemon juice), red lentil pasta, and 4 ounces of organic pinot noir.

Although garlic isn’t mentioned above, it, too, is a staple. You’re not doing it right if you’re not mincing garlic every day!

Dessert: This is the same every night: a half cup of homemade banana-strawberry kefir with a quarter cup of oat milk, a few dashes of cinnamon and nutmeg, and some stevia to make it sweet enough to pass as a dessert.

Bon appetit!

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S2E19. Dementia Screening Exam #2

It was just about a year ago that I reported on a cognitive exam I took (S1E19) and passed with flying colors. This week, I had occasion to take another very brief screening test. I didn’t do as well.

Sally and I have an insurance policy that provides support should we need any form of assisted living. Our contact, Linda, came for her annual visit on Tuesday to check our apartment for safety and fall risks and to see, in general, how we were doing.

Her screening exam was very brief (it took less than 10 minutes to administer), but it hit all the important functions. 

First came the orientation questions: naming the year, day of the week, and our location. I actually had to think about the date for a little bit as, just before she arrived, I was making appointments for medical checkups that all turned out to be on Wednesdays. So when she asked me to name the day of the week, ‘Wednesday’ popped into my head, but I knew that wasn’t right. I had to think about it for a second before remembering that I had done The New York Times Crossword puzzle the night before and that it was Tuesday’s puzzle. Hell of a way to remember the day of the week, eh?

Then she gave me 5 unrelated words to remember. I repeated them out loud to create a stronger memory trace before I set about trying to conjure up an image that included all 5 items. While I was doing that, though, she moved on to a math word problem that required you to add two numbers and subtract them from 100.

I realized that since my attention was focused on remembering the 5 words, I wasn’t listening to her at all and didn’t catch the numbers, so I asked her to start again. This time, though, since I knew I wouldn’t have time to form an image, I figured I would just divide my attention between listening to her and rehearsing the five items.

Much to my chagrin (and surprise), that didn’t work either. I still wasn’t able to follow her words. So I apologized and asked her to start again. At that instant, I knew that I would only remember 3 of the 5 words when she got around to asking me to repeat them.

Now attentive to the math problem she was reading, I solved it without any problem.

She gave me 3 numbers and asked me to repeat them backwards. Then 4 numbers. I did it by visualizing the numbers and then reading them from right to left. 

Then she read me a brief story and asked me three questions about it. Again, no problem. 

The next item was to name as many animals as I could in 30 seconds. I started quickly with a rush of jungle animals. I noticed, though, that at one point I had an image of a tiger in my head but that it took me a few beats to name it. That surprised me. 

It wasn’t long before I ran out of jungle animals and, in my mind’s eye, all I could see was a vast savanna without any animals on it. I was surprised that I had hit a blank spot so quickly. 

It took me a few seconds before I realized I needed to change habitats if I was going to name more animals and so I thought of a farm and came up with another bunch. Then household pets. But then I blanked out again.

Time was up.

I’m pretty sure I scored above a level that would have signaled an impairment, but I should have done a lot better. There were two problems with my performance. First, I encountered word-finding difficulty which is generally infrequent for me. Second, I didn’t shift gears quickly; I wasn’t flexible; I stayed stuck on ‘jungle animals’ for way too long. To do better, I would have had to cue myself more frequently and more quickly to generate associations that would connect me to more animal names. As it was, I never got around to fish or birds at all.

I last discussed this more than a year ago in ‘When Words Hide.’ IMHO, my performance has deteriorated a bit since then.

It wasn’t easy for me to flounder like that. The test shone a spotlight on something I didn’t think was there. When you combine this performance with my reduced participation in conversations, it starts to make sense: I’m not generating content as quickly as I used to.

Linda then got around to asking me to name the 5 objects she had asked me to remember and, as expected, a rattled off 3 of them. There was a fourth that seemed very vague and distant and I wasn’t at all sure it should be included, so I didn’t say it. Turns out it was one of the five.

We moved on to visuospatial questions. I was able to draw a clock and set the hands at ten to eleven (I can’t help but wonder if young people born in the digital age can do this task), identify a triangle from among 3 shapes, and determine which was the biggest of those 3 shapes.

And that was pretty much it.

I’m writing this the day after I took the test and I’m a little impressed with how many of the questions I remember. Sally was sitting at the table with us during the exam and she didn’t recall any items that I hadn’t already come up with. I think that’s pretty good, don’t you?

Bottom line: Although my performance was still well within the ‘normal aging’ range, there was a discernible drop-off from my previous level of functioning.

As always…I’ll keep an eye on it.

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S2E18. Subtle Symptoms?

Those of you who have been with me from the beginning will recall that the initial purpose of this blog was to record changes in my cognitive status over the years in the hope that it might be useful to a future researcher in helping to understand the differences between normal aging and prodromal dementia. So here’s an update on a few things I’ve noticed over the course of the last month or so.

1. Reading font. 

Strange choice for a possible symptom, right? Bear with me on this one.

We encourage the use of technology to help us with our daily activities, things like calendars and reminders on our computers and smart phones. Technology is our friend.

One of those wonderful technological advances is the introduction of ebooks and the programs used to read them. I’ve now completely abandoned real books and switched to their electronic versions.

One of the nice things about reading a book on my computer is that I can control the font size to make it easier to read. Although my vision has been fine since I had my cataract surgery last year and I can read 12-point type with ease and without magnifiers, I discovered that I really like reading with a much bigger font. In fact, with an enormous font!

The normal setting in the ‘Books’ app on my MacBook Pro uses a font that shows 2 pages on the screen, just like a real book. But I found that to be intimidating. Just looking at it, I felt a little twinge of ‘this is too much work.’ It took me by surprise the first time I noticed it, but after a while, I realized that keeping my eyes focused on the line I was reading and moving to the next line would be effortful. So I tried a bigger font.

And then I tried an even bigger font.

And then I tried even bigger fonts until there were only about 2 paragraphs on the screen…about half of one page.

That was comfortable…and easy to read…and I had a sense of accomplishment when I turned the page every 15-20 seconds or so!

As I thought about why this might be, it occurred to me that it could be a matter of focused attention. Apparently, I was finding it harder to maintain attention over a sustained period of time.

The ability to keep one’s attention focused is housed in the prefrontal cortex, so this change in my preference might indicate a subtle change in the efficiency (i.e., a decline in performance) of that brain area. 

Reinforcing this notion that there might be a problem with focused attention, I’ve notice that I sometimes skip a line of music when I’m practicing the recorder. It’s right there in front of me on the computer screen, but my eye skips it.

I think the two problems are related. I’ll keep an eye on it.

2. Talking less.

I’ve mentioned this before. I seem to be talking less when we’re out with friends. I can’t really put my finger on why that might be. I follow the conversation just fine, I can hear myself thinking about what is being said, and I come up with things I might want to say. But then I don’t say them.

Could it be that my timing is off? That while I’m waiting for someone to finish their comment, I wait too long and someone else jumps in? It’s possible. I can think of several times when conversations moved on to other topics before I had my say.

At other times, though, I just don’t feel the imperative to talk. I’m more than happy just to listen…but that’s not very sociable, is it?

Sally has also reflected back to me that I’m not talking as much at home when it’s just the two of us. Again, I’m thinking all the time, but I neglect to express my thoughts out loud. Or maybe I don’t think what I’m thinking is worth mentioning?

Bottom line: although my intention is not to isolate, I might be coming across that way. And although I’m feeling very comfortable and at ease, my silence can be uncomfortable for others.

Another thing to watch.

3. Perseverance and frustration.

If you do The New York Times crossword puzzle every day, you know that they start out quite easy on Mondays and then get more difficult as the week goes on. I breeze through Monday, Tuesday and Wednesday, then find Thursday more interesting (you usually need to discover a trick to solve it), but I have to work hard to get the Friday and Saturday puzzles.

In solving these latter two, I find that I’m now losing patience when I can’t solve them in short order. There was a time when my patience was endless. I might walk away and come back an hour later, but I would stick with it. I would persevere until I solved it.

Not anymore. Now I find I’m quick to hit the ‘check’ button which tells you which of your answers are incorrect. 

I didn’t used to do that, but I have very little tolerance for frustration these days.

Like focused attention, perseverance and frustration management are functions of the prefrontal cortex.

Is it possible that there is a pattern here?

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S2E17. Backsliding

The last 6 weeks have not been kind to the brain-healthy lifestyle to which I aspire. 

During the months that I was trying to lose weight, it seemed easy to establish new habits and maintain them. My motivation was clear and there was positive reinforcement when I weighed myself each morning. There was the added excitement of learning new things and implementing them as I went along. That went for food, sleep, exercise and learning to play the recorder. They were heady times, indeed!

There was a comfort in the routine that emerged, from my morning granola ritual to getting into bed every night at 10:30pm.  Every hour of my day seemed purposeful and, more importantly, healthy. 

All that began to change, though, after I reached my weight loss goal. I had to figure out how to stop losing weight. (Nice problem to have, eh?) I thought that just exercising a little less (i.e., burning fewer calories each day) might take care of it, but to my surprise, it didn’t. 

Although it wasn’t my intention, I stopped exercising altogether, which is obviously not part of any brain health plan. It began on the 3 extended weekends we were traveling to go to UConn women’s basketball games. Although all of our hotels had fitness centers where I could have worked out, I just didn’t feel compelled to use them. It was as if I were on vacation and exercising would have been akin to bringing my job with me. Strange, right?

Around the same time, I noticed that my body was starting to complain about working out. I was having fantasies about running 5k races again and trying to regain what little speed I had 5 years ago. It wasn’t long after I began increasing the intensity of my workouts that I tweaked something in my left hip. Then I noticed that there were a couple of spots in my shoulder and back that resented my weight workouts.

I decided that discretion was the better part of valor and that it would be smart, not brave, if I took a week or two off and let my body heal.

That was the plan I was implementing when COVID knocked me for a loop and kept me from working out for another two weeks.

But it wasn’t just about exercising. I went off my brain-healthy diet, too. 

Since we were traveling, we ate out all the time. For unknown reasons, I felt that this gave me license to eat anything. And I did: corned beef, bread with butter, cheese danish, deep-fried walleye, bratwurst, bacon, stadium pizza, french fries, coffee with half&half and sugar, ice cream…all the banned food groups found their way down my gullet.

It would have been easy to eat much more healthily as just about all the restaurants had vegan items on the menu. But when I saw them, a wave of ‘I can make that at home’ would sweep over me and I would move on to the taboo side of the menu. It wasn’t pretty. And it didn’t feel good, either.

Our sleep hygiene went out the window, as well. Instead of getting in bed at 10:30pm, we’d stay up as long as we needed to relax after the excitement of the basketball games. We’d get up whenever we got up. Intermittent overnight fasting went by the wayside, too, as did chilling the rooms down to the high 60s before bedtime because we didn’t have our heated sheets to jump into when the time came.

It’s not easy being brain-healthy on the road!

But now we’re home and healthy and I’m getting back in the groove. This week I made granola, sauerkraut and kefir and I’ve worked them all back into my diet. I faltered again, though, when we went out for dinner and I had a hamburger, of all things. But I’m doing better. Honest!

I had to start from ground zero with exercising by walking on the treadmill for half an hour. I was actually sore the day after my first workout! We’ve restored sleep hygiene to our life, and that’s a good thing.

We’ve got more trips planned in the months ahead and so I’m going to have to steel myself to maintain brain-health discipline while on the road. I don’t think my backsliding hurt my brain, but I’m pretty sure it didn’t help it, either. My sense is that I lost about a month in the long-term project of cleaning up whatever toxic waste sites that have amassed during my first 70 years. What I need to do going forward is to find a way to treat myself occasionally without running amok.

That’s probably easier said than done!

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S2E16. Dementia & Suicide

Tell the truth: you’ve thought about what you would do if you were ever diagnosed with dementia, haven’t you?

You’re not alone.

The topic came up again this past week when Sally and I watched a PBS NOVA episode about long-term Alzheimer’s research being done at the University of Wisconsin. One of the cases presented was a 73-year old woman with end stage dementia. She couldn’t talk or feed herself and her muscles constantly twitched and cramped. The story line followed her husband and children as they tried their best to make her last days comfortable.

“Don’t ever let me get like that…”

Sally didn’t need to finish the thought. We’ve talked about it before (S1E13), but we’ve never really come up with a plan.

This week, thanks to a new book written by Amy Bloom titled In Love, I learned that there is a path forward. The book is a memoir about her husband’s decision to suicide after being diagnosed with Alzheimer’s.

The path leads to Zurich, Switzerland, where there is a non-profit company, Dignitas, that will work with you. What makes Switzerland’s approach different from assisted suicide available in America is the conditions under which you are eligible to be helped.

In the 10 states in the U.S. that have some form of assisted suicide, the eligibility requirements are intentionally excruciatingly narrow. You’ll need to be diagnosed with a terminal illness with less than 6 months to live AND you’ll have to have all your faculties about you, be able to rationally discuss your decision, prove you are not depressed, and be physically able to self-administer your own lethal dose when the time comes. 

That pretty much rules out anyone with dementia. If you still have your wits about you, no doctor will certify that you are within 6 months of death.

Clearly, the notion of a right to death with dignity for those with dementia has not yet reached our shores.

In Switzerland, though, they’ve eased the restrictions by eliminating the 6-month life expectancy condition. You still have to be diagnosed with a terminal illness (which dementia is) and you still have to be mentally and physically competent to implement the plan (i.e., drink the sodium pentobarbital solution) on your own. That’s why they call it ‘attended’ suicide over there instead of ‘assisted.’ The final act must be yours and yours alone.

Reading about that process, though, shook up my thinking. In my previous imaginings (it seems wrong to call them ‘fantasies’) about a post-diagnosis suicide, I envisioned milking my good days for as long as I could and then pulling the plug when I stopped being me (however I might define that). From another point of view, if I were the one to assist Sally after her diagnosis, the timing would be when she was no longer herself and had lost the ability to marvel at the world of children and ask questions about everything.

In either case, the timing would be tricky, as there is no paper-and-pencil test one can administer to determine that the time has come. You just know it. At that moment, it should be a pretty clear moral choice, especially if you are (as I am) unencumbered by any religious prohibitions against ending a life in this situation.

In Amy Bloom’s case, however, her husband Brian makes the decision to suicide almost immediately after learning his diagnosis. In hindsight, it is clear that he has been symptomatic for several years, but he is still quite capable of enjoying a good meal at a restaurant, traveling and fishing, and he is cognitively strong enough to meet the criteria for mental competence.

That’s pretty brave. Although his journey on the road to nowhere is clear, he is still very much Brian, both to himself and to Amy. There is no waiting, there is no ‘making sure,’ there is no milking the last drop of pleasure from life.

It’s going to take me a little while to wrap my head around that.

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S2E15. My COVID-19 Detour

I suppose I had been lulled into a false sense of security by all the public figures who have announced that, although fully vaccinated and boosted like me, they had contracted COVID and were either asymptomatic or experiencing only mild symptoms. 

When we got to Minneapolis last weekend, mask-wearing was optional in  both the hotel and the arena. Only a very few people were wearing them at either location…and that number did not include me. The first game was Friday night and by Monday morning I had a mild sore throat. So mild, in fact, that I didn’t even consider it was COVID-related, as the simpler explanation was that I had done a lot of yelling at the games.

Masks were required on Minneapolis public transit, at the airport, on planes, and during the Uber ride home.

On Tuesday morning, when I weighed myself on my fancy scale that records not only my weight but a dozen other biometric markers, I was surprised to see that my pulse had shot up to 86 beats/minute from its usual range of 55-65. That was odd and, I thought, bore watching.

I did all the things I normally do on Tuesdays and Wednesday (in this case, days  4 & 5 post exposure), only mildly inconvenienced by a sore throat and some noticeable body ache, but no fever (97.6). I was sticking to the yelling-irritated-my-throat hypothesis.

On Thursday night (day 6), we were scheduled to go out with some friends and so we self-tested at home. Both Sally and I were negative. With no reason to be concerned, we went out.

The next night, though, (Friday, day 7), I had a bear of a night trying to sleep. My sore throat worsened, my temperature rose to 99.6, and I had muscle pain in my back. I’d never had that kind of discomfort with either a sore throat or fever before. That sent me to the google to check on COVID symptoms and there it was: muscle ache was a symptom along with sore throat and fever. (I later learned that it is common for symptoms to worsen 5-7 days after they first appear. Apparently, I was on schedule!)

Since we were supposed to go out on Saturday night (day 8), too, we re-tested. This time, I generated a pretty pink positive line. Damn it to hell!

The good news was that Sally’s test was negative.

Right on cue, I developed the signature COVID cough. Now there, my friends, is a symptom brewed in the Devil’s own basement! It’s relentless. A sea of phlegm gurgles just beneath every breath you try to take. The constant coughing grates at your raw throat, making it scream over and over again. It gets to the point where you fear your next breath. It’s no way to spend an hour, much less a day or more.

I started a regimen of aspirin and cough suppressants. In doing so, though, we discovered that all of our flu/cold remedies were hopelessly past their expiration dates. The bottle of spray I use for sore throat pain, for example, had expired 11 years ago! Sally set about re-stocking our medicine chest with currently active remedies.

I wrote to my primary care physician to see if I needed to do anything else and I emailed the COVID reporting form to the Chester County Health Department.

I shared the news on Facebook. Thank goodness for real and virtual friends and family! The speedy recovery wishes were overwhelming, along with suggestion about how to treat it. Here’s a summary:

  1. Get better.
  2. Get better fast.
  3. Drink lots of liquids and get lots of bed rest.
  4. Take lemon juice with honey and cayenne pepper.
  5. Homemade chicken soup.
  6. Open the windows in the apartment for ventilation.
  7. Buy and use a pulse oximeter.
  8. Ask my doctor for one of several antivirals now available.
  9. Nebulizing saline with hydrogen peroxide.

To the everlasting credit of all those who care about me and who I care about in return, please note that there was not a single recommendation to try Ivermectin or hydroxychloroquine.

My physician responded and suggested I go with #3 above, OTC products to treat symptoms, and a 5-day quarantine. She did not offer anything from #8.

Upon waking up Monday morning (day 10), I was delighted to see that my cough was gone. What a joy it was just to be able to take a deep breath! My pulse rate had also returned to a more normal level, so it seemed I might have turned the corner.

Thankfully, too, I never lost my sense of smell or taste, and my appetite was good. The biggest problem was getting things past my inflamed throat.

My throat was causing another big problem: a major communications breakdown.

I could talk with effort but could not project my voice at all. Sally’s difficulty in hearing me was compounded by the muffling effects of the KN95 masks we were both wearing all the time. Those masks also prevented any attempts at lip-reading. Bottom line: communication was farcical if not hopeless, even with Sally wearing her hearing aides. At one point, we seriously considered texting each other even though we were sitting only about 10 feet apart in the living room!

My brain fog lifted on Tuesday morning (day 11). I don’t think my temperature ever broke 100, but the mental dullness felt equivalent to a fever of about 102. I was glad to be able to think clearly and write again.

That was pretty much it. My pulse oximeter arrived on Tuesday afternoon and my oxygen level was at a healthy 96. Temperature was a normal-for-me 97. I took a shower and felt 1000% better.

On Wednesday, we tested again. Sally was negative but I was still positive. That was a huge disappointment, to say the least!

I’m feeling fine, though, with no symptoms, so I’ll continue to isolate and wear my mask and we’ll test again on Friday.

Looking back, if this was what a mild case of COVID feels like, then I’m eternally grateful for the vaccinations and booster that kept it from being the real thing.

The good news is that I escaped my close encounter with COVID.

The bad news is that I suspect that the week of COVID brain fog  inflammation has nudged up my risk of developing a dementia sometime down the road.

For now, though, I’m just happy to be able to take a deep breath again!

__________

S2E14. Do Something Different

In terms of cognitive challenges to keep your brain healthy, games and puzzles are fun, but they don’t provide any added brain benefit. The more you engage in them, the better you get at doing them…but that doesn’t help preserve the abilities you need to live independently, like memory and executive functioning.

The recommendation, then, is to do something different to challenge yourself: learn a new language or learn how to play an instrument or go on a trip.

Go on a trip? You don’t have to ask me twice!

The NCAA Women’s Basketball Tournament was played over the course of the last month. I’ve been a fan of the University of Connecticut Huskies since I was a graduate student there from 1996-2001, and Sally caught the fever from me.

So three weekends ago, we made the 4 hour drive up to Storrs, CT, where the first 2 rounds were played on campus. When the Lady Huskies won those games, I went online to get tickets for the next 2 games which were being played in Bridgeport, CT, the following weekend. And when they won those 2 games we made the decision to do something we’d never done before: go to the Final Four in Minneapolis, MN!

This is where the cognitive challenge came in. We had 72 hours to figure out how to get tickets, book a flight, and get a hotel room. We started on the drive home from Bridgeport with me driving and Sally googling hotel rooms.

She found a hotel that was 3 blocks from the arena, so we booked it. When we got home, I searched for tickets online and learned that TicketMaster runs a brisk scalping business. I didn’t want to go all that way (about 1,000 miles) to sit in the nosebleed seats and watch the game on the giant monitor, so I took a deep breath and bought lower-level tickets for a price I never imagined I would pay for any event.

Finally, I went to the American Airlines site to book a flight and, hopefully, use my 65,000 frequent flyer miles. Not only were the available flights at lousy times, but they told me I needed to purchase an additional 200,000 miles at a cost of over $3,000 to get the seats!

That sent me over to Travelocity where I found non-stop flights between Philadelphia and Minneapolis at reasonable times and at an affordable $500 for the round-trip.

Planning done!

Last Friday, we took an Uber to the airport, arriving in plenty of time. After boarding the flight, though, we learned that there was a mechanical problem and we’d have to de-plane while they fixed it. That put us 2 hours behind schedule, so when we arrived in Minneapolis, we took a taxi to the hotel instead of taking the tram as we had originally planned.

We checked in and immediately left for the arena where the 2 semifinal games were being played. UCONN was in the 2nd game and we defeated Stanford. On to the championship game!

The next morning (Saturday), we were having breakfast in the hotel when an older woman approached us and asked if we wanted to buy her tickets for the final. She was a Stanford fan and she and her husband were going back to California instead of going to the game on Sunday. The tickets were in the first row behind the team bench!

Having paid as much as we did for our seats, my first reaction was: “Not interested.” But then I thought about it. First row! So I went over to talk with her and her husband. They wanted half of what they paid for the tickets which they bought directly from Stanford at face value. What the hell…you only live once!

Now we had to figure out how to consummate the transaction. I didn’t have any cash and the tickets were only accessible on a cell phone (apparently they don’t print tickets anymore. Who knew?).

I recalled seeing a ‘transfer tickets’ feature on the app we had to use to buy the tickets, so I knew how she could deliver the tickets to me. Luckily, she had a Venmo account and I was able to make the payment to her that way. 

The transaction was completed in less than 5 minutes. It must have been a sight, though, watching these 70+ strangers figure out the technology to make it work.

But I wasn’t done yet. I went back up to the room and went to the TicketMaster site to see if I could sell my original tickets and recoup a little of what I had paid, or at least get back what I just spent to upgrade my seats.

It is possible to sell your tickets there, but apparently you had to register with a bank account to do so, and I hadn’t done that. Damn!

But wait…I recalled seeing a ‘sell tickets’ menu button on the mobile ticket app and so back I went. Yup…there it was! 

Placing the tickets up for sale was easy enough, but how to price them was the challenging part. It was only about 32 hours until game time, so I needed to get this right. I figured that a lot of fans of the semifinal losers (Stanford and Louisville) would be trying to sell their tickets just like the couple we had just met. And there wouldn’t be a lot of demand for tickets since only people in or within a few hours drive of Minneapolis were likely buyers. So instead of going for a killing, I took a safer path and offered the pair for $500 (we had paid $300 for the first-row upgrade).

In about 2 hours, I received an email notification that the tickets had been sold!

On Sunday afternoon, we took a bus to the Minneapolis Institute of Art. It’s a beautiful facility and we spent our time in the Impressionism and Modern Art galleries. Directionally challenged as we are, finding the exit was an adventure, but we kept meandering until we got there…to discover that it was snowing outside! So instead of walking back to the bus stop, we called an Uber.

That night at the arena, the seats were great! The UCONN pep band was to our right, the cheerleaders directly in front of us and the team bench was on our left. It would have been perfect if we hadn’t gotten clobbered by South Carolina 64-49.  😦

The next day we took the tram from downtown to the airport. The connections were a little tricky, but we muddled our way through it. The flight was on time and we got an Uber from the airport. We were home by 7:30pm.

Once I finished licking my wounds from the defeat, I got around to thinking about all the cognitive challenges that this adventure entailed. Going to new places, orienting yourself, and figuring out how to get from point A to point B were at the top of the list. Then there was the task of mastering new technologies. And most of all, you have to react to a lot of unique decision-making inflection points. These are the things that are generalizable and help you preserve and grow vital brain circuits. 

And best of all, when all is said and done (and unlike doing Wordle, jigsaw puzzles and crosswords), you have a great story to tell when it’s over!

__________

S2E13. Your Brain On Red Wine

I’ve always felt inadequate around wine drinkers. They ooze with sophistication as they immerse themselves in the complex flavors and aromas of the pampered liquid. They seem to possess a breeding, class and erudition that I lack.

It’s not like I haven’t tried to develop a taste for wine. I have.

Like most college students experimenting with pot, I tried to get into drinking wine to go along with it. Back then, you started with the fruit-punchy Bali Hai and worked your way up to Spanada and Mateus, avoiding Thunderbird and Ripple which were reserved for the old winos in the park. Then you graduated to real wine. It was part of your education.

But I flunked that course. For me, a sip of wine meant explosions of noxious tastes around the edges of my tongue. If my taste buds could have surrendered to stop the assault, they would have. And people thought this stuff was good?

Over the decades, I periodically made attempts to learn how to drink and, more importantly, like wine. I attended tastings and could swirl and sniff with the best of them, but the assault on my tongue continued. Oh, once in a while I came across something that was tolerable. And there was that one time when a friend (and wine connoisseur) sprung for a $150 bottle that was actually good. Alas…the experience was never to be repeated!

Fast forward to this past year when I discovered that drinking red wine is part of the Mediterranean Diet and, drunk in moderation, can reduce your risk of dementia. I was able to incorporate just about every other brain-healthy recommendation I came across into my diet, but not that one. One article suggested that if you don’t like wine, you can substitute 5 ounces of pomegranate juice, and so that’s the path I took, mixing the juice with 10 ounces of water and drinking it for my post-workout, cool-down hydration.

But that left me feeling somehow inadequate, as if I weren’t really implementing the plan. I’m supposed to be drinking wine, so I decided to give it another try.

I started with a google search for which red wine provided the most brain benefit and learned that it was pinot noir: “This is the healthiest red wine due to its high concentration of resveratrol, an antioxidant compound that lowers bad cholesterol and high blood pressure. Some studies also suggest that it can improve brain health, kill cancer cells, and increase insulin sensitivity.”

The recommendation comes with an asterisk, though. Let’s not forget that red wine is about 12% alcohol…and alcohol is very bad for your brain. The suggestion, then, is that you limit your intake to 1 glass (5 ounces) daily.

That seemed do-able at first, but it turns out that it’s really problematic for me. You see, I’m a cheap drunk (always have been!) and it doesn’t take much at all to get me tipsy. The first time I ever got buzzed was at the end of my freshman year in high school and all I had was half a can of Colt45 Malt Liquor!

So the 5 ounce guideline might be ok for most people, but I’ve got to believe that you need to stay on the sober side of tipsy if you want to get the resveratrol benefits without getting slammed by a bigger alcohol effect. 

Overcoming my inadequacy was not going to be easy!

I started my quest by ordering the house pinot noir whenever we went out for dinner. No, I didn’t come across anything I liked and, yes, I got buzzed on one glass.  😦

Anybody know how many ounces of wine restaurants serve in a glass of wine? Whatever it is, it’s too much for me.

Next, I asked my sister-in-law Phoebe (who, among other things, is the family expert on fine wines) for some recommendations. The first bottle I tried wasn’t bad…but it also wasn’t something I would look forward to drinking every night. I just opened the second bottle last night and it’s a little bit better, so I’m going in the right direction.

I need to play with the dosing a little more, too. I measured out 5 ounces, sipped it slowly through dinner, but could still feel the alcohol. I’ll drop it down to 4 ounces tomorrow night and see what happens, and then maybe start sipping an hour before dinner time to spread out the alcohol’s effect. 

I think I’ll ask Phoebe for another suggestion, too, as I’m encouraged enough to think there might be something out there I will enjoy. 

Overcoming my lifetime wine inadequacy could actually be within reach!

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