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Confabulation, Alcohol Abuse, and Alcohol-Related Dementia

Confabulation breaks trustOne of the lifelong struggles we, as human beings, do – or should be doing – battle with is being consistently honest both with ourselves (I submit this may be the hardest part of this battle because our capacity for self-deception seems to have no limits) and with others.

I have written here before about the interconnected relationship between honesty and trust. When we are dishonest with someone, we break their trust. Continue reading

The Ever-Increasing Connection Between Diabetes and Dementia

3D Image of Brain in ColorGoing Gentle Into That Good Night has and will continue to discussed the connection between lifestyle choices and an increased risk of developing dementia. Some of these lifestyle choices include alcohol abuse and addiction, prescription drug use, abuse, and addiction, illegal drug use and addiction, and “smart drug” use and abuse.

So maybe you’re reading this and thinking, “Well, I don’t make any of those risky lifestyle choices, so I don’t have to worry about neurological damage and developing dementia.” And you would be wrong. Continue reading

Comfortably Numb or All Jacked Up: Prescription Addiction May Lead to Developing Lifestyle Dementia

Uppers and Downers and Lifestyle DementiaPrescription addiction is a national problem in the United States. Although there has been some public acknowledgement of its existence in general terms recently, the real scope of how deep and pervasive prescription addiction is in this country is still mostly hidden from public view.

Because of this, Big Pharma and the medical profession still pushes the two classes of drugs – central nervous system (CNS) depressants (“downers”) and central nervous system (CNS) stimulants (“uppers”) – at the core of prescription addiction insistently and without restraint. Continue reading

“Smart Drugs” (Nootropics) – A Precursor to the Development of Lifestyle Dementia?

Nootropics (smart drugs, brain enhancers, mental magic) fundamentally alter brain chemistry and may be a precursor to developing lifestyle dementiaThis blog has discussed the use of drugs designed for specific kinds of attention-deficit disorders being used by people without an attention-deficit disorder for cognitive enhancement and the risk such usages portends toward an eventual development of lifestyle dementia.

Anything that alters brain chemistry (legal or illegal) introduces the risk of dementia down the road. We must understand that. It seems, however, that we – both the medical community who blithely prescribes these legal brain-altering chemical compositions and we the people, who decide for ourselves and choose to take both legal and illegal brain-altering chemical compositions because they seem to promise a short-term benefit (or because we want to numb our brains and not deal with life as it is and comes) – don’t understand that. Continue reading

Technology and Neurology – A Perfect Storm For A Lifestyle Dementia

Technology can have devastating effects on the brainIn my book review of The End of Absence by Michael Harris, we see how an increasingly constant interaction with, reliance on, and addiction to technology is creating devastating effects on us neurologically.

Among these effects are dementia-like symptoms: loss of short-term memory, easy distraction, lack of focus, loss of critical thinking skills, and loss of executive functions.

These effects are happening to people all around us just like you and me. The effects don’t discriminate: even the very young are affected just as profoundly as others of varying ages.

In Nicholas Carr’s The Shallows: What the Internet is Doing to Our Brains, a book everybody should read, the discussion centers on the neurological effects of 24/7 technology connection in the actual composition of the brain.

The research and the science is sobering, especially in light of how it points to the emergence of another lifestyle dementia that is already beginning to affect people, and will increasingly affect vast numbers of people at earlier and earlier ages.

Lifestyle dementias are dementias we choose because we adopt or don’t control or eliminate the lifestyle factors that cause the dementias.

Alcohol abuse and addiction is one of those lifestyle choices. How we treat our bodies (food, exercise, etc.) is another lifestyle choice. The quality and quantity of our sleep is yet another lifestyle choice.

And our relationship with technology presents even one more lifestyle choice. A recent Pew Research Center survey revealed that 20% of Americans report that they are online almost constantly.

That is 1 in every 5 people here in the United States. It is not surprising to me, but it is disturbing to me for many reasons. 

Because my whole career has been intricately involved with technology, I’m uniquely qualified to discuss this since I’ve always made choices to limit my exposure, instinctively, I suppose, realizing the dangers, and I continue to do so because my brain, for better or worse, is the best asset I have and I don’t want my choices to be the reason I lose any functionality it has.

The neuroplasticity of the brain is negatively changed by overexposure to technologyOverexposure to technology completely rewires our brains (neuroplasticity) and not in positive ways. It literally changes our neural pathways, eliminating the ones we don’t use and creating new ones.

Different parts of the brain are stimulated with how we receive information.

Images light up a different area of the brain than words do. Technology lights up a totally different area of the brain than either images or words do.

Which area of our brains get lit up the most often is the part of the brain that becomes dominant and we use the other parts less and less.

Brain cells (neurons) that don't get used die permanently.With disuse, those parts we don’t use begin to die at the cellular level, eventually creating the same kinds of synaptic gaps that are common among dementias.

The brain is the only organ in which there is no cellular regenation. Once the cells in the brain die, they’re gone for good. With time, this cellular death becomes widespread and we experience dementia.

The problem with our increasing interaction exclusively with technology (smart phones and tablets have definitely made this easier) is that technology is purposefully designed to stimulate the part of the brain that deals with emotions.

Because of the emotional stimulation that technology elicits, it consistently bypasses logical, analytic processing of information and the desire and ability to discern between what’s true and false, what’s right and wrong, and what’s valuable and what’s not.

The effect on us is that we are unaware of what’s happening tethered-to-technology-going-gentle-into-that-good-nightbehind the scenes to our brains as we’re tethered to technology, so we don’t realize we’re not logically and analytically processing information coming in and that we’re rapidly losing the desire and ability to discern between what is true and false, what is right and wrong, and what is valuable and what is not.

It is simply disappearing without our awareness that we’re losing the very things that make us unique as humans and which are the most precious gifts we have been given.

The end result is that in the short term we become shallow (gullible, unthinking, ignorant, and imprisoned in a shrinking world that is simply a mirrored reflection of our narcissistic selves) and in the long term that we lose our cognitive abilities altogether.

It’s not to late for most of us to turn this around and do everything in our power to make choices that will stave off this lifestyle dementia. 

But each of us has to make the choice for ourselves. Some of us won’t. Some of us don’t believe this is happening. Some of us don’t care.

However, for those that will, that do believe this is happening, and that do care, here are a few ways to get started:

  1. Unplug from everything at a set time every day and stick to it. Replace the time that you would have spent with technology with an activity that involves the other parts of your brain. These can include hobbies, reading, putting together jigsaw puzzles, playing board games or cards with other people, crossword puzzles, sudoku, and other types of brain-intensive puzzles.
  2. Don’t stay plugged in all day. Do what you need to do (check social media, email, texts, etc.) at set time-delimited times each day (I generally check mine early morning, noon, and 6 pm, giving myself 15 minutes each time and no more). Otherwise, I’m off the grid and working on other productive things.
  3. Unplug completely for 24 hours each week. No phone, no internet, no social media, no nothing. And do something else entirely away from it all. This may, especially if we’re addicted to technology, be quite uncomfortable and unsettling at first (generations before us lived this way and they not only survived just fine, but I suspect they were happier and better off), but eventually you will absolutely crave your unplugged 24 hours and it may lead you to more complete unplugging than that in time.

We only get one brain in our lives. Everything we do supports it or destroys it. Once destruction happens, it’s permanent and it can’t be undone.

Let’s make sure we’re doing everything in our power with our choices to support our brains and not destroy them.

The Layperson’s Guide to Alcohol-Related Dementia

pouring-shots-alcohol-related-dementia

In “Lifestyle Dementia: Underdiscussed, Overlooked, But a Very Real and Present Danger,” and “Is the Precipitous Rise in Dementias and Alzheimer’s Disease Over the Last Twenty to Thirty Years Linked to Lifestyle?,” we see that certain lifestyle factors and choices can make the likelihood of developing dementias and Alzheimer’s Disease more probable.

Two lifestyle factors that can contribute to the development of dementias and Alzheimer’s Disease – and the onset of these is usually before age 65 – are chronic, long-term alcohol abuse and alcoholism. This type of dementia is called alcohol-related dementia and can manifest itself in various forms.

This post will take a look at how chronic, long-term alcohol abuse and alcoholism affects the brain and what the behaviors and symptoms of the dementia looks like.

We all know that drinking enough alcohol at one time impairs the brain. Common symptoms include slurring words, exhibiting general motor impairment, including stumbling and walking off-balance, making poor decisions (like driving, for example), being less able to hear sound at a normal volume, experiencing vision problems, and being unable to think clearly. 

These behaviors occur because alcohol depresses the central nervous system , causing it to slow down its responses and reactions. The brain stem (made up of the Pons, Medulla, and Midbrain), which regulates breathing, heart rate, lifestyle dementia alcohol related going gentle into that good nightand consciousness, as well all other areas of the brain are affected by alcohol:

  • Frontal – involved in movement, problem-solving, concentrating, thinking, mood, behavior, and personality
  • Temporal – involved in hearing, language, and memory
  • Parietal – involved in sensation awareness, language, perception, attention, and body awareness 
  • Occipital – involved in vision and perception
  • Cerebellum – involved in posture, balance, and coordination of movement

Chronic, long-term alcohol abuse and alcoholism have even more devastating – and permanent – effects on the brain, eventually leading to alcohol-related dementia.

Usually the first noticeable symptoms of chronic, long-term alcohol abuse and alcoholism are cognitive. Memory loss is common, but a unique feature of memory loss with people who are chronic, long-term alcohol abusers or alcoholics is confabulation.

Confabulation occurs when, instead of recalling accurate memories because of the damage to the brain, the person distorts, makes up, and misinterprets memories about themselves, others, and the world around them.

As difficult as it is to believe for those on the receiving end of confabulation, there is no conscious intent to be dishonest. It is simply the result of extensive neurological damage.

One of the most challenging aspects of people who confabulate is that although they are giving blatantly false information, the information can appear to be coherent, internally consistent, and relatively normal.

People who confabulate have incorrect memories that run the gambit from slight, almost imperceptible changes to the most outlandish made-up stories you can imagine.

The maddening thing about this is that they generally very confident – to the point of arguing down anyone (because they know the memory is fabricated) who tries to correct or challenge them – about their recollections, despite overwhelming concrete evidence that contradicts them.

Other signs of alcohol-related dementia emerge as:

  1. Inappropriate behavior, including words and actions
  2. Loss of executive function, including organizing and planning
  3. Slowed thinking, reactions, and speaking
  4. Garbled speech
  5. Trouble executing basic skills functions like adding, subtracting, multiplying, and dividing
  6. Decreased ability to concentrate
  7. Decreased ability to complete tasks
  8. Trouble with balance
  9. Diminished hearing

With alcohol-related dementia, as with all other dementias, the person who has alcohol-related dementia loses the self-awareness that anything is wrong, both neurologically and behaviorally.

Most cases of alcohol-related dementia involve global neurological deterioration. Everything is affected.

However, two very specific types of alcohol-related dementia, Wernicke encephalopathy and Korsakoff syndrome (known together as Wernicke-Korsakoff Syndrome), which are the result of a vitamin B1 (thiamine) deficiency, have key features specific to them. There can be some reversal of symptoms with B1 (thiamine) therapy, but there is still permanent neurological damage and concurrent alcohol-related dementia.

Wernicke encephalopathy (commonly known as “wet brain”) causes damage in the thalamus and hypothalamus. Its symptoms include:

  • alcohol-related dementia Wernicke encephalopathy going gentle into that good nightSevere confusion and decreased mental activity that can lead to comas and death
  • Loss of muscle coordination (ataxia) that can cause tremors in the legs
  • Vision deterioration including abnormal eye movements, drooping eyelids, and persistent double vision

As symptoms of Wernicke encephalopathy disappear, Korsakoff syndrome symptoms appear. These include:

  • Loss of ability to form new memories
  • Moderate to severe loss of all memories
  • Confabulation
  • Visual and auditory hallucinations  

Malcolm Young, the 61-year-old co-founder and guitarist for the band AC/DC, has been moved to a nursing home and his family has confirmed that he has dementia (he’s unable to remember any of the band’s songs).

Young’s addiction to alcohol is well-known. Although he sought rehabilitation treatment for alcoholism during the band’s tour in 1988, it appears that he malcolm young ac/dc dementia going gentle into that good nightrelapsed (the statistics on the efficacy of alcohol rehab are grim: from 50 to 90% of people who’ve been through treatment relapse, often, over a period of time, habitually consuming even more alcohol than they did before entering treatment) and never sought treatment again.

In April of this year, Young was hospitalized with what was described to the media as a stroke (chronic alcohol abuse has very detrimental effects on blood, including causing the platelets to clump together and form clots, and these clots, when they travel to the brain are responsible for strokes), so this would be entirely consistent with what we know about Young’s lifestyle. 

There are systemic physiological effects of chronic, long-term alcohol abuse and alcoholism, including nerve damage in the arms and legs (peripheral neuropathy), liver damage (cirrhosis), heart damage, and kidney damage.

Concurrent with all of that is the irreversible neurological damage to the brain that results in alcohol-related dementia, which can emerge as early as 30 years of age, but more commonly begins emerging after the age of 50 in chronic, long-term alcohol abusers and alcoholics.

Drinking alcohol in moderation is fine. But I urge you to take an honest look at your drinking patterns and behavior. If you find that you are a chronic, long-term alcohol abuser or an alcoholic, then it’s time today to find a way to stop drinking alcohol for good.

But no one else can do that for you. Only you can make the choice to stop drinking alcohol and then follow through with actually doing it for the rest of your life. 

And here’s the key: until the rest of your life becomes more important than alcohol, you will be unsuccessful at choosing and taking action to stop drinking alcohol.

Because you are the only one who can take the action, every time you drink alcohol, as a chronic, long-term alcohol abuser or an alcoholic, you show yourself and the rest of the world the choice you’re making and you show yourself and the rest of the world what the most important thing in your life is.

And no one can change that but you.

The Layperson’s Guide to Traumatic Brain Injury (TBI) and Chronic Traumatic Encephalopathy (CTE)

Closed Head Injury Traumatic Brain Injury

Our brains are very soft organs that are surrounded by spinal fluid and are protected by the hard outer covering of our skulls.

Under normal circumstances, spinal fluid cushions the brain and keeps it from crashing into the skull. However, if our heads or our bodies are hit hard, our brains can slam into our skulls and result in traumatic brain injuries (TBIs). TBIs are also caused when the skull is fractured and the brain is directly damaged by outside force.

BrainAlthough concussions, which we’ll discuss later, are sometimes referred to as mild TBIs, the reality is that no injury to the brain is mild and repeated injuries will lead to neurological degeneration that includes dementia.

TBIs are complex neurological injuries that result in a wide variety and severity of symptoms and disabilities.

The least severe symptoms of TBIs – and these may not happen immediately and, in fact, may occur some time after the injury, can include:

  • Temporary loss of consciousness
  • Dizziness
  • Headache
  • Slurred speech
  • Confusion
  • Temporary memory loss
  • Grogginess and sleepiness
  • Double vision or blurred vision
  • Nausea or vomiting
  • Sensitivity to light
  • Balance problems
  • Slow reaction to stimuli

The most severe symptoms of TBIs can include:

  • Extended loss of consciousness or coma
  • Permanent and severe brain damage
  • Partial or complete motor paralysis
  • Death

Going Gentle Into That Good Night TBI CDC Annual StatisicsThe most common causes of TBIs, according to the Centers for Disease Control, are:

  1. Falls (40.5%)
  2. Car accidents (14.3%)
  3. Head/body collisions with people or things (15.5%)
  4. Assaults (10.7%)

In the category of TBIs from falling, most of the falls occur disproportionately in the very young (55% of falls among children occur in children between the ages of 0 and 14) and the very old (81% of falls among adults occur in adults who are 65 or older).

Most of the TBIs in the Other category (19%) are from personal firearms and military weapons.

What CTE Does to The Brain

Courtesy of Sports Legacy Institute (http://www.sportslegacy.org/)

A type of TBI that is more frequently in the headlines today is Chronic Traumatic Encephalopathy (CTE). CTE is brain damage that occurs as a result of repeated concussions (a concussion is defined as injury to the brain from a direct blow to the head or from the head or upper body being violently shaken).

The first identified variant of CTE was described in 1928 by forensic pathologist Dr. Harrison Stanford Martland as pugilistic (from the Latin word pugil, which is translated as “boxer” or “fighter”) dementia. The symptoms included tremors (Parkinsonism), slowed movement, mental confusion, and speech difficulties.

In 1973, the neuropathology of pugilistic dementia was discovered and described by a team of pathologists led by J. A. Corsellis who documented their findings after performing thorough autopsies on the brains of 15 deceased boxers.

Going Gentle Into That Good Night Muhammad Ali BoxerFormer boxing heavyweight champion Muhammad Ali began boxing in Kentucky when he was 12 years old.

By the age of 18, he had boxed his way to the heavyweight gold medal at the Olympics (1960).

A few months later Ali began his professional boxing career. He quickly gained national prominence because of his skill in the ring and his trademark quote: “Float like a butterfly, sting like a bee. The hands can’t hit what the eyes can’t see.” He boxed professionally until his retirement in 1981.

In 1984, Ali was diagnosed with Parkinsonism (the tremors of pugilistic dementia) and his neurological health has deteriorated steadily to include all the advanced symptoms of Muhammad and Lonnie Ali 2014this variant of CTE.

His wife, Lonnie, is his caregiver and contributed to a moving article that AARP published last year about what she and Ali deal with on a daily basis as a result of the neurological degeneration that CTE has caused.

CTE has increasingly become a major health concern in the high-contact sports of professional wrestling, ice hockey, soccer, and football as more and more current and retired athletes are showing symptoms consistent with CTE.

NFL Football CTE going gentle into that good nightIn recent years, football – and especially professional football – has become the focal point for a closer examination of CTE. Not only has this sport become more violent in terms of how the game is played, but how concussions are treated – or not treated – has also come under greater scrutiny.

Joseph Maroon, Pittsburgh Steelers Team Doctor CTE Overexaggerated Rare March 18, 2015

Joseph Maroon, Pittsburgh Steelers Team Doctor

Although NFL team doctors assert that CTE is “rare” or “overexaggerated,” the hard scientific neurological and physiological evidence proves that these doctors are simply paid hirelings who care more about their paychecks than they do about the overall health of the players.

Let’s examine the facts. In a 2014 landmark study by the largest brain bank in the United States, 76 of the 79 brains of deceased NFL players that pathologists examined had TBI, and specifically, CTE.

A class action lawsuit has been filed – and a tentative agreement reached with the NFL – by retired NFL football players and/or their families (some of the players have already died from neurodegenerative causes) which claims that players were not (a) adequately protected from suffering concussions, (b) medically treated properly following concussions, and (c) provided adequate medical compensation to treat the burgeoning costs of CTE as it progresses.

This gist of this lawsuit is that the NFL used – and abused – these players to fabulously guild the seemingly-endless coffers of the NFL, often forcing the players by intimidation or fear to get back on the field as soon as they could after suffering a concussion (often in the same game), and then abandoned their responsibility to their former employees (as part of their contractual agreement) as soon as the employees began costing them money instead of making them money.

Even more damning to the NFL is the actuarial report accompanying the lawsuit that indicates that at least 1/3 of NFL players will suffer CTE.

If there is a silver lining in all of this, it is that the younger NFL players have a much greater awareness of the relationship – and their increased risk – between professional football and CTE.

They are aware of the very real probability that they will be one of the 1 out of every 3 players who develops CTE.

And they’re choosing their long-term health, including their brain health, over temporary fame and fortune.

Jake Locker Retires at 26 An unprecedented number of younger – and in-their-prime in the professional football world – NFL players have already retired before the 2015-2016 season begins.

They include:

  • Cortland Finnegan – Age 31
  • Jake Locker – Age 26
  • Jason Worilds – Age 27
  • Chris Borland – Age 24

While Finnegan, Locker, and Worilds did not publicly cite CTE as a factor in their premature retirements from the NFL, there can be no logical reason to doubt that the mounting evidence was a factor in their decisions.

Chris Borland, on the other hand, made no secret that the high probability of CTE was the reason for his decision to retire.

Chris Borland Retires from San Francisco 49ers Age 24Borland just finished his rookie season (2014-2015) with the San Francisco 49ers, but he revealed after the season that he suffered a concussion in training camp last fall. Instead of reporting the concussion, Borland covered it up so that he could continue to practice and win a starting position on the team.

This is the kind of competitive pressure that gets put on these young players by the NFL (yes, Borland made the decision and he bears the responsibility for it, but had he reported the concussion, he would have been replaced and lost the starting spot and may not have played all season).

Fortunately, though, Borland came to his senses and realized how much he had jeopardized – and would continue to – his neurological health.

As he said on the March 16, 2015 edition of ESPN’s Outside the Lines, “”I just thought to myself, ‘What am I doing? Is this how I’m going to live my adult life, banging my head, especially with what I’ve learned and knew about the dangers?'” 

We can only hope that more athletes in high-contact sports will know the higher risks of TBIs they face, not just in the professional leagues, but at the amateur levels, and they will choose to walk away from certain neurological damage.

In the meantime, we have a better understanding just in our daily lives of how TBIs can happen and what the results can be, so I hope that we’re a little more observant and attentive after falls with our little loved ones and our older loved ones, especially those already going through the journey through dementias and Alzheimer’s Disease, as they are even more prone to falling than the general elderly population.

As Sergeant Phil Esterhaus says at the end of every roll call on Hill Street Blues (a favorite TV show of mine during my high school and college years), “Hey, let’s be careful out there.”