Apr 062024
 

When I saw this article (and particularly when I learned something else I’ll get to after the article). I figured I had to go right to the top – Athena, the goddess of wisdom. Athena is likely so intellectual because she wasn’t born as we understand it – she emerged fully formed and an adult from Zeus’s head (I assume without the helmet, although the size of the helmet does suggest a large brain.)

At a time when we are aware that Alzheimer’s disease exists, and that there is no cure, many of us are terrified of it – of having it ourselves, and of it happening to someone near and dear. I know my mother was terrified of it. (She was spared it – she was still expertly solving crossword puzzles until her final coma, caused by pneumonia, at age 93.) So I can’t imagine anyone willing to miss out on any opportunity to avoid it, or to slow its progress.
=============================================================

New studies suggest millions with mild cognitive impairment go undiagnosed, often until it’s too late

Mild cognitive impairment can be an early sign of Alzheimer’s disease or other dementias.
ivanastar/iStock via Getty Images Plus

Soeren Mattke, University of Southern California and Ying Liu, USC Dornsife College of Letters, Arts and Sciences

Mild cognitive impairment – an early stage of dementia – is widely underdiagnosed in people 65 and older. That is the key takeaway of two recent studies from our team.

In the first study, we used Medicare data for about 40 million beneficiaries age 65 and older from 2015 to 2019 to estimate the prevalence of mild cognitive impairment in that population and to identify what proportion of them had actually been diagnosed.

Our finding was sobering: A mere 8% of the number of cases with mild cognitive impairment that we expected based on a statistical model had actually been diagnosed. Scaled up to the general population 65 and older, this means that approximately 7.4 million cases across the country remain undiagnosed.

In the second study, we analyzed data for 226,756 primary care clinicians and found that over 99% of them underdiagnosed mild cognitive impairment in this population.

Why it matters

Mild cognitive impairment is an early symptom of Alzheimer’s disease in about half of cases and progresses to dementia at a rate of 10% to 15% per year. It includes symptoms such as losing the ability to remember recent events and appointments, make sound decisions and master complex tasks. Failure to detect it might deprive patients of an opportunity to get treated and to slow down disease progression.

Mild cognitive impairment can sometimes be caused by easily addressable factors, such as medication side effects, thyroid dysfunction or vitamin B12 deficiency. Since mild cognitive impairment has the same risk factors as cardiovascular disease, such as high blood pressure and cholesterol, medication management of these risks combined with diet and exercise can reduce the risk of progression.

In 2023, the Food and Drug Administration approved the drug lecanemab as the first disease-modifying treatment for Alzheimer’s disease, the most common cause of mild cognitive impairment. In contrast to previous drugs, which can temporarily improve symptoms of the disease, such as memory loss and agitation, this new treatment addresses the underlying cause of the disease.

Lecanemab, a monoclonal antibody, reduces amyloid plaques in the brain, which are toxic protein clumps that are believed to contribute to the progression of the disease. In a large clinical trial, lecanemab was able to reduce the progression of early-stage Alzheimer’s disease. A similar drug, donanemab, also succeeded in a clinical trial and is expected to be approved sometime in 2024.

However, these drugs must be used in the early stages of Alzheimer’s disease, ideally when a patient has only mild cognitive impairment, as there is no evidence that they are effective in advanced stages.

An earlier diagnosis leads to early treatment and better outcomes.

What still isn’t known

Many factors contribute to the lack of timely detection. But researchers don’t have a good understanding of the relative importance of those individual factors or how to reduce the high rate of underdiagnosis.

While distinct, symptoms are subtle and their slow progression means that they can be overlooked or misinterpreted as normal aging. A neurologist in China told our research team that diagnosis rates spike in China after the New Year’s holiday, when children who haven’t seen their parents for a year notice changes that are harder to pick up when interacting with someone daily.

Doctors also commonly discount memory concerns as normal aging and doubt that much can be done about it. While cognitive tests to distinguish mild cognitive impairment from pathologic decline do exist, they take about 15 minutes, which can be hard to come by during the limited time of a doctor’s visit and may require a follow-up appointment.

What’s next

People, particularly those in their 60s and beyond, as well as their families and friends need to be vigilant about cognitive decline, bring it up during doctor’s appointments and insist on a formal assessment.

The Medicare yearly “wellness” visit is an opportunity to explore such concerns, but only about half of beneficiaries take advantage of it.

Just as physicians ask patients about unexplained weight loss and take those concerns seriously, we believe questions that explore a patient’s cognitive state need to become the norm.

The Research Brief is a short take on interesting academic work.The Conversation

Soeren Mattke, Director of the USC Dornsife Brain Health Observatory, University of Southern California and Ying Liu, Research Scientist, Center for Economic and Social Research, USC Dornsife College of Letters, Arts and Sciences

This article is republished from The Conversation under a Creative Commons license. Read the original article.

==============================================================
Pat B, (who is celebrating her fiftieth wedding anniversary today) has graciously given me permission to share that this coming Friday she has an appointment with her Doctor to discuss her memory loss. While no one can prove it, I would not be surprised to learn this was inspired by Athena. I can’t imagine anything wiser than getting checked out for any possible signs of dementia, knowing that waiting will not make it any better but it could make it worse. Thank you, Athena, and may you inspire all of us who are 65 or older to be wise also.

Share
Mar 132024
 

Yesterday, I got a new email from the Theater of War and immediately thought of SpyCat, because they will be doing two readings of “An Enemy of the People” live in Ohio in April, in Mount Vernon and Gambier on the 6th and 7th respectively (and of course also on Zoom.) These productions are not just theater – there’s no stage, no sets, no costumes or makeup, just readings, and voice acting. And the whole play is never presented – selections are read pertinent to the public health topic addressed. And after the reading, audience members react, both on site and now, since the pandemic, through Zoom, and share through their experience what has touched them and what applies to today. Their website is theaterofwar.com, and it’s headed up with a four minute video describing what they do and why, with three examples (obviously very short.) But there’s also a lot of information there with more detail. “An Enemy of the People,” written in 1882, could almost be the story of CoViD and Dr. Fauci.

Robert Reich makes the case for what he calls “Nauseous Optimism,” by which he means being optimistic even when one’s stomach is churning. but he explains it better than I can.

One of the Mar-a-Lago documents case who has been known as “Employee Number 5” is speaking out on the case and his part in it. I think he’s hoping it will make a bigger difference than I think it will – but any difference in the right direction is a good thing.

Share
Mar 022024
 

I learned that another state – Illinois – is now onn the bandwagon of keeping Trump off the ballot. Good luck to all of us.

Heather Cox Richardson is reminded in our time of the times of the “Know Nothing” Party in the 1850s. And with good reason. The actual party name was “the Native American Party,” and later just “the American Party.”  Just as misidentified as today’s “Patriots.”

(I have multiple sources for all of this – Wikipedia is the main one but Performance Today deserves mention.) Today being the second day of Women’s History month, and on the heels of Black History month, it seems to me a good day to bring up Florence Beatrice Price, an American woman of color who was a composer in the 20th Century. She was told many times she was “not a good fit” by publishers – but the Chicago Symphony played her works and they were met with appreciation. Wanamaker’s there (the first retail department store in the U.S.) would hold annual composition contests for local composers, and she was a consistent winner, in one year winning first, second, and third place. But all her manuscripts were kept in the home she used as a summer residence, and when she died, it was abandoned. It was not until 2009 that someone interested in purchasing the home discovered them, and fortunately, was musical enough to know what they had. The works included four symphonies, two violin concertos, a piano concerto, other orchestral works, songs, choral works, chamber music, arangements of spirituals, and probably more piano solos than anything else. According to Performance Today, she is not the most performed female composer in America. And that happened in the 15 years between 2009 and now. I am so glad that I have lived to hear at least some of it. I am listening to one on the radio as I type – her Symphony #3. And it is beautiful.

Share
Jan 102024
 

Yesterday I got a bunch of stuff done – mostly on the computer rather than with physical objects, but it still tired me. I guess whie I was busy, the Appeals Court looked at TFG’s “immunity” claim and apparantly those looks were all askance.

I thought this was kind of nice. I well remember Andy Kim starting on cleanup on that day.

The Theater of War has a new project called “An Enemy of the People,” using the play by Ibsen. “The play tells the story of a doctor who discovers the water supply in his small, rural town has been poisoned by a tannery. Despite his efforts to convey the truth to the public, the doctor fails to save his community from environmental disaster and is ultimately scapegoated for his whistleblowing.” Ibsen didn’t pussyfoot around the truth, as long ago as 1882. This sounds a lot like how Fauci was treated – and in fact Dr. Fauci will be one of the actors (the actors will change from one event to another so if you want to hear what he has to say you will need to checking cast lists.) The first two events are 2/22 and 2/24, and Fauci is scheduled in the 2/24 event but not the 2/22 event. This is the link for 2/24 (it looks like you might be able to scroll from it.)

Here’s my response to the “poop Nazi” telling everyone to get over stuff – stuff like their kids being shot in school:

Share
Sep 022023
 

Yesterday, Mary Trump (Mary L. Trump, to distinguish her from her grandmother) wrote about the Supreme Court, in an essay on Substack she calls “The Lowest Court, Part 2.” She remarks, not just on the ethics issues, but on the contempt shown by the court for the people, which really is reminiscent of France before the Revolution. If you were to tell me that Alito, or Kavanaugh, or even Roberts had said “Let them eat cake,” I’d probably believe it. If you want to look deeper, here’s the link – just remember to look for the “continue reading” and click it.

Cartoon –

Short Takes –

HuffPost – Biden Administration Reveals First 10 Drugs For Medicare Price Negotiation
Quote – All told, the 10 drugs on the list accounted for $50.5 billion in total spending in Medicare’s outpatient prescription drug program for the period between June 1, 2022, and May 31, 2023, according to the Department of Health and Human Services. That’s about one-fifth of what the program, known as Part D, spent on all prescription drugs during that period. The announcement represents the first step in a process set to unfold over the coming year, with the government collecting data and public input, and then exchanging price offers with manufacturers over how much Medicare will pay for the named drugs.
Click through for details. Not surprisingly, the article bears the subtitle “It’s the first step in a process that will mean lower prices in 2026 ― unless the drug industry and its allies find a way to block it.”

The Daiy Beast – How One Citizen Fought Back Against a Cop’s Road Rage
Quote – While driving home in his Ford Mustang, [New Mexico motorist Mario Rosales] legally passed a pickup truck, and the other driver started tailgating him. Road rage can be deadly, so Rosales grew concerned. No matter which way he went, the truck stayed in his rearview mirror. Rosales eventually reached his home in Roswell, New Mexico, hoping the truck would keep going. Instead, the vehicle blocked Rosales in his driveway, and the stranger behind the wheel started yelling and cursing at him. At this point Rosales was not just concerned. He was scared for himself and his family members in the house.
Click through for the story, which has a happy ending – this time – finally. Too many do not.

Food For Thought

Share
Aug 172023
 

Yesterday, I learned that over the weekend, the chyron atop a news outlet’s building in Surgut, a Russian city far from Moscow, read (in Russian) “Putin is huylo and a thief.”Huylo” is NSFW and one translator says, “Think of the worst, most obscene possible expression for a very bad person—and that’s the word you need.” Over recent years Russia has put a lot of money and effort into training hackers. I’m sure Putin never expected his face to be eaten. Also, just so y’all know, I am not going to try to keep up with the Trump** trials here. If there is an earth-shaking annoucement midday I may address it in a comment. But the first video in the cideo thread will always be from a legal expert, which means it likely will be about Trump**. Depending on what’s happening, it may not be the only one.

Cartoon – 17 0817Cartoon.jpg

Short Takes –

Crooks & Liars – Fight Breaks Out Among Russian Forces That Leaves 20 Dead, 40 Injured
Quote – Around 8:00 p.m. [on Saturday, August 12], in the Central Park area of the village [of Mykhailivka], a verbal altercation took place between Kadyrivians and Dagestanis from another division of the Russian Armed Forces. During the quarrel, one of the occupants opened fire in the air from a small automatic weapon. In the course of the fight, one of the occupiers was inflicted with numerous stab wounds, incompatible with life. This led to an open confrontation between units using underbarrel grenade launchers GP-25 “Koster”, hand grenades and small automatic weapons.
Click through for story. “Friendly fire.” I often go to the original when a story is from a single source, but I thought I would take their word for this information from the Ukrainian government site. I trust Ukraine … but it’s also under attack – and as my intro noted, Russia has hackers.

The 19th – After hottest summer on record, heat-related illnesses are now being tracked nationwide
Quote – “Each year heat kills more people than any other type of extreme weather event, and the heat is getting worse,” said John Balbus, acting director of the Department of Health and Human Services’ Office of Climate Change and Health Equity. Balbus’ department, in partnership with the National Highway Traffic Safety Administration, is responsible for developing and maintaining the dashboard. Balbus told The 19th that the dashboard has been in development for about a year and was initially inspired by a similar dashboard that tracks opioid overdoses.
Click through for details.  I’m glad someone is taking climate change seriously.  It’s sad that this is necessary – but it is.  The highest temperature at which a human can survive is probably lower than you think it is.

Food For Thought

Share
Jul 142023
 

Glenn Kirschner – DOJ changes course, will NO LONGER defend Donald Trump in E. Jean Carroll defamation case

Thom Hartmann – New Hate Group Wants To “Liberate” Your Children

MSNBC – Florida suffers consequences of DeSantis political games with public health

Liberal Redneck – Sound of Freedumb

Chonkiest Tomcat Appears In Woman’s Living Room

Beau – Let’s talk about Tuberville and the Marines….

Share

Everyday Erinyes #375

 Posted by at 4:30 pm  Politics
Jun 182023
 

Experts in autocracies have pointed out that it is, unfortunately, easy to slip into normalizing the tyrant, hence it is important to hang on to outrage. These incidents which seem to call for the efforts of the Greek Furies (Erinyes) to come and deal with them will, I hope, help with that. As a reminder, though no one really knows how many there were supposed to be, the three names we have are Alecto, Megaera, and Tisiphone. These roughly translate as “unceasing,” “grudging,” and “vengeful destruction.”

Deforestation. You’ve all heard of it. We all know it contributes to climate change. But I’ll bet you didn’t know wha else it contributes to – and that is “spillover.”

Spillover is what it is called when a virus or other disease agent leaps from an animal to a human being. Spillover is what caused the Ebola outbreak (and in that case, the outbreak can be linked directly to deforestation.) Spillover is what brought is CoViD-19, and all its variants. And the next spillover may be only one forest clearing away.

Pro Publica, which has the story inas much detail as a non-medical-professional can be expected to grasp, is a Creative COmmons site. Following certain guidelines and attributions (such as include all links but no pictures), it’s perfectly kegal for me to quote a full article from them here. But this is not just one article – it is a three-part series – and any one of the three is too much reading dfoe a Sinday afternoon, and especially on a holiday weekend. So, instead, I am going to share links to all three, in order, with at least one startling quote from each. I am not trying to scare anyone just to be scaring you, no am I trying to make a simple political point – it’s way too complex for that. But some of this information should scare anyone. That’s just how it is.
==============================================================

Part One of the series is “On the Edge.” It details sequences of events in Guinea – specifically in Meliandou, Guinea – where the Ebola outbreak started.

By 2013, a village had bloomed where trees once stood — 31 homes, surrounded by a ring of forest and footpaths that led to pockets residents had cleared to plant rice. Their children played in a hollowed-out tree that was home to a large colony of bats.

Nobody knows exactly how it happened, but a virus that once lived inside a bat found its way into the cells of a toddler named Emile Ouamouno. It was Ebola, which invades on multiple fronts — the immune system, the liver, the lining of vessels that keep blood from leaking into the body. Emile ran a high fever and passed stool blackened with blood as his body tried to defend against the attack. A few days later, Emile was dead.

On average, only half of those infected by Ebola survive; the rest die of medical shock and organ failure. The virus took Emile’s 4-year-old sister and their mother, who perished after delivering a stillborn child. Emile’s grandmother, feverish and vomiting, clung to the back of a motorbike taxi as it hurtled out of the forest toward a hospital in the nearest city, Guéckédou, a market hub drawing traders from neighboring countries. She died as the virus began its spread.

On average, only half of those infected by Ebola survive; the rest die of medical shock and organ failure. The virus took Emile’s 4-year-old sister and their mother, who perished after delivering a stillborn child. Emile’s grandmother, feverish and vomiting, clung to the back of a motorbike taxi as it hurtled out of the forest toward a hospital in the nearest city, Guéckédou, a market hub drawing traders from neighboring countries. She died as the virus began its spread.

*******

But looking back, researchers now see that dangerous conditions were brewing before the virus leaped from animals to humans in Meliandou, an event scientists call spillover.

The way the villagers cut down trees, in patches that look like Swiss cheese from above, created edges of disturbed forest where humans and infected animals could collide. Rats and bats, with their histories of seeding plagues, are the species most likely to adapt to deforestation. And researchers have found that some bats stressed out by habitat loss later shed more virus.

Researchers considered more than 100 variables that could contribute to an Ebola outbreak and found that the ones that began in Meliandou and six other locations in Uganda and the Democratic Republic of Congo were best explained by forest loss in the two years leading up to the first cases.

It is now clear these landscapes were tinderboxes for the spillover of a deadly virus.

Part Two of the series is “Seeding Hope.” It deals with events and lessons learned in Madagascar, one of many areas in the world which have rainforest problems – because they are disappearing.

The following year, representatives from each of those villages gathered in a soccer field to watch as their chiefs pressed inky thumbs onto paper, signing an agreement that affirmed their communities would stop encroaching on the forest. In return, Health In Harmony began providing affordable health care through mobile clinics and teaching residents how to grow more food and support themselves without cutting down more trees.

Founded in 2006 to save rainforests and combat climate change, Health In Harmony may have stumbled upon a way to help prevent the next pandemic.

Researchers have shown that deforestation can drive outbreaks by bringing people closer to wildlife, which can shed dangerous viruses. Scientists found these dynamics can explain several recent outbreaks of Ebola, including the largest one nearly a decade ago in Guinea, which scientists believe started after a toddler played in a tree that was home to a large colony of bats. The child may have touched something contaminated with saliva or waste from an infected bat, then put his hands in his mouth, inadvertently giving the virus a foothold.

The moment in which a virus jumps from an animal to a human is called spillover. Though we now know more than we ever have about why, where and how these events happen, global health authorities have failed to make preventing them a priority. Instead, they’ve focused resources on fighting outbreaks once they begin.

Many see stopping deforestation as an intractable problem that would eat up the scarce money set aside to combat pandemics. Experts convened at the request of the World Health Organization last year argued that the “almost endless list of interventions and safeguards” needed to stop spillover was like trying to “boil the ocean.”

But this Portland, Oregon-based nonprofit, with an annual budget of just $5.3 million for programs in three countries, is demonstrating how working creatively across health, agriculture and the environment may be the key to prevention.

******

In 2019, Health In Harmony launched its program in Madagascar. An island nation off the southeast coast of mainland Africa, Madagascar is a biodiversity hot spot with hundreds of mammals and birds that can be found only there. Researchers say the extensive range of unique animals makes it a more likely place for a novel virus to emerge. Madagascar fruit bats, which roost in the Manombo reserve, can carry coronaviruses, filoviruses (the family of viruses that includes Ebola) and henipaviruses (the family that includes the brain-inflaming Nipah and Hendra viruses). Rats and fleas in parts of the country carry the bubonic plague….

“I have learned that the forest, humans and animals are interdependent,” Jocelyn said, “and if the forest is sick, then the animals will be sick, and animals will surely impact humans’ health too.”

Part Three of the series is “The Scientist and the Bats.” Set in Gympie, Australia, it examines the work of Peggy Eby – the latest in a line of research scientists stretching back centuries who have continued their work despite being denied serious consideration (and serious funding.)

Dressed head-to-toe in protective gear, Peggy Eby crawled on her hands and knees under a fig tree, searching for bat droppings and fruit with telltale fang marks.

Another horse in Australia had died from the dreaded Hendra virus that winter in 2011. For years, the brain-inflaming infectious disease had bedeviled the country, leaping from bats to horses and sometimes from horses to humans. Hendra was as fatal as it was mysterious, striking in a seemingly random fashion. Experts fear that if the virus mutates, it could jump from person to person and wreak havoc.

So while government veterinarians screened other horses, Eby, a wildlife ecologist with a Ph.D., got to work, grubbing around the scene like a detective. Nobody knew flying foxes, the bats that spread Hendra, better. For nearly a quarter century, she’d studied the furry, fox-faced mammals with wingspans up to 3 feet. Eby deduced that the horse paddock wasn’t where the bats had transmitted Hendra. But the horse’s owners had picked mandarin oranges off the trees across the street. The peels ended up in the compost bin, where their horse liked to rummage. “Bingo,” Eby thought. Flying foxes liked mandarins. The bats’ saliva must have contaminated the peels, turning them into a deadly snack.

Eby, however, longed to unlock a bigger mystery: Could she, with the help of fellow scientists, predict when the conditions were prime for Hendra to spill over from bats, before it took any more lives? What if they could warn the public to be on guard — maybe even prevent the virus from making the leap? It would be painstaking work, but it wasn’t a pipe dream; Eby was already spotting patterns as she crawled around infection sites.

But when she pitched her research to a government funder the following year, she got a flat no. She proposed starting small, gathering basic data on flying foxes that could be used to figure out when and why they spread the virus. Her work, she was told, wasn’t considered a “sufficiently important contribution.”

******

In a world still scarred by the COVID-19 pandemic, Eby’s dogged success exposes a global scientific blind spot. It’s not that trendy science involving the latest AI wonders isn’t worthy of research dollars. It’s that it should not be funded at the expense of the sort of long-term, shoe-leather work that allowed Eby and her colleagues to solve the mystery of a deadly contagion, Vora and other public health experts say. “All of these actions are important if we want to save as many lives as possible from infectious diseases,” Vora added.

==============================================================
Alecto, Megaera, and Tisiphone, I don’t like stories that make me think, “Oh, God, here we go again,” or “Oh, God, I’m glad I’m old.” But of course those are the stories that the world most needs to hear – and also to act on. People have been saying for hundreds of years that “An ounce of prevention is better than a pound of cure” (Benjamin Franklin first used it in writing in 11735, but it can’t have been new, and the concept goes back at least to Aesop), but we still don’t seem to get it.

The Furies and I will be back.

Share