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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.”

 

Part 2 – “The End of Absence” (Michael Harris) Book Review

information superhighway going gentle into that good nightThis is the second of a three-part series of reviews that I am writing on The End of Absence: Reclaiming What We’ve Lost in a World of Constant Connection written by Michael Harris in 2014.

The End of Absence: Reclaiming What We've Lost in a World of Constant Connection by Michael HarrisIn “Part 1 – ‘The End of Absence’ (Michael Harris) Book Review,” we looked at the definition of absence and how it relates to our quality of life.

We discussed how absence gives rise to critical thinking, problem-solving, short-term and long-term planning, concentrated focus, and creativity.

We also discussed the physical, emotional, and mental benefits of absence.

And, finally, we discussed how absence has been eroded by our constant connection to technology to the point that it is virtually extinct in our current society.

We discussed how this has dumbed down society as a whole and how susceptible that makes us to being controlled, manipulated, and deceived by technology.

And, finally, we looked at how much technology and our constant connection to it mirrors the society that George Orwell described in 1984, coming to the conclusion that the frighteningly eerie similarities should compel each of us to consciously choose not to follow the crowd and intentionally limit our connection and ensure a healthy amount of absence exists in our lives individually.

In this post, we’ll take a behind-the-scenes look at what happens with all the data you’re willingly and freely putting into digital technology every time you text on your phone, go to a website, input anything onto social media (including the infamous “like” button on Facebook), do a Google search, buy something online, watch streaming video, and play internet video games.

We’ll also see how being constantly connected to digital technology brings that data back to us and shrinks our exposure to real and complete knowledge (Google infamously does this with their industry-standard data mining and predictive analysis processes, which narrow search results down to what we want to see, based on our input, rather than everything there is to see).

In effect, we are being shaped and manipulated in an endless loop of our own little world of preferences and beliefs with subtle changes and false ideas about value and credibility being implanted along the way.

Our constant connection to technology is literally rewiring and incorrectly programming our brains. This negatively affects – if not outright destroys – our value systems and belief systems.

Additionally, our ability to not only think for ourselves – and change our minds based on that – but also to critically and objectively think, as well as to think outside the boxes of what we know and are familiar with is rapidly being destroyed because we depend on technology to do our “thinking” for us.

Additionally, we’ll continue our look at how our constant connection to technology is essentially creating a virtual life (think the movie The Matrix) that we are being conned into believing is real life, while actual real life, which includes lack and absence, is rapidly disappearing for all but a few of us who are aware of what’s happening and refusing to let it happen to us.

Our lifestyles, which now center around technology, are creating a new kind of lifestyle dementia, and most of us don’t even realize it’s happening. That’s why you need to read this book and that’s why I’m spending so much time reviewing it.

don't surrender you're ability to think to anyone or anything elsePerhaps you think what is being described here is impossible and this is just an alarmist warning that you can blow off because “that’ll never happen.”

It’s already happened and it is happening. I know technology very well from a big-picture and a behind-the-scenes perspective, so I’m speaking as an insider and an expert who has worked and does work with this on a daily basis.

Here’s the reality. Whether you choose to ignore this is immaterial. It’s already well in motion and progressing rapidly and, if we choose to remain ignorant and we choose to continue our constant connection, we will be devastatingly changed in the process.

And the sad part is that, like the society that Orwell discusses in 1984, not only will we not be aware, but we will not care, even if it’s the most destructive thing that can happen to humanity.

One of the ways in which our constant connection to technology has changed us is that now our default choice is to use technology to interact with people and things rather than actually interact with people and things for real. 

Here’s a simple comparative survey of why our brains have been rewired to prefer technological interaction with people and things rather than real interaction with people and things.

With technology, we can ignore or eliminate or limit our time with anybody or anything we don’t want to have to deal with. This can include people and things we find challenging, who disagree with us, who don’t “tickle our fancy,” and who “make” our lives “harder” just by their presence.

With a click of a button, we can unfriend them or unfollow them and turn off their news feeds, or we can avoid those things altogether until they simply no longer exist to us.

What we end up with in the process is an artificial, virtual world that we create to make us feel good. It’s also a shallow and stagnant world that ends up being essentially us looking in a mirror and seeing nothing but our own image reflected, because the people and things that are left after our unfriending, unfollowing, and avoiding are those that never challenge us, always agree with us (even when we’re wrong), and boost our feel-good emotions (as we do theirs).

In real life, those people or things are right there with us and we have figure out the best way to deal with them whether we want to or not, even if that means putting up with our co-workers, friends, and relatives or all the tough things that exist in real life.

In other words, we can’t turn them off (and if we eliminate them, in the case of people, then we go to prison). So it forces us to find creative and workable ways to share the same space with them and it increases our relating-to-humanity-and-things skills and builds traits like patience, kindness, gentleness, understanding, empathy and mercy.

These are character-related traits that cannot be developed in the artificial, virtual world that constant connection to technology enables us to create in our own image.

And our artificial, virtual worlds make demands on us as well, although this dark side is seldom, if ever, on our minds or consciences. They demand our 24/7 attention and presence and because of our acquiescence to those demands, we lose absence. Solitude. Peace. Disconnection.

Absence gives us time alone with our thoughts, alone with ourselves, and alone with our ideas, our dreams, our hopes, and our imaginations. Absence also gives us the ability to regroup and recharge our brains and ourselves. It gives us a chance to get away from all the “noise” of life and have peace and quiet.

Here’s the irony. We need solitude as part of our mental, emotional, physical and spiritual health. There’s no other way to survive life.

Yet, even for those of us born before 1985, from the moment we’re born the emphasis is on socialization.

Society is so insistent on this – my parents often had to drag me kicking and screaming as a small child into social situations because I was always very uncomfortable with them, and as I got into my teenage years and could make my own choices, more often than not, I chose staying home over going somewhere either for a few hours or overnight – that most of us are uncomfortable being alone and being quiet, with nothing to entertain or distract us.

Technology and constant connection ensure that we don’t have to be uncomfortable, and it amplifies the illusion of constant company.

This, by the way, began before digital technology. Before there was the internet, there was television. And before television, there was radio. All of these technologies gave – and give – the illusion of constant company because of the noise and the distraction they provide.

And here’s the reality for humanity now. For those of us who remember absence, we have the constant choice of saying “yes” or “no” to constant connection. For those of us who came of age with constant connection as part of our normal lives, we don’t even know there is a choice. And that is truly sad.

Because our artificial, virtual worlds seem real to us because they’re replacing real life, our brains get rewired in additional ways by the illusion this creates.

One way is that we feel surrounded by people like us, so we feel free to say whatever we want to say however we want to say it. We don’t care how wrong it is, how hurtful it is, or how confessional it is. Constant connection, by subverting thinking, has removed the filtering that normally goes into thinking before we speak.

In this way, the words spewed out on the internet actually mimic one of the tell-tale signs of dementia: the loss of impulse control and ability to know what things to verbalize and what things to keep to ourselves. 

Another way that constant connection to technology rewires our brains is that it promotes the self all the time. With an artificial, virtual world that we have created and are the center of, we can continuously draw all the attention to ourselves.

This self-broadcasting, which shares many traits with narcissism, includes fervent self-documentation consisting of constant tweets, continual status updates, and a never-ending supply of selfies.

In effect, a constant connection to technology makes us incredibly self-centered, self-absorbed, selfish, and it reinforces our belief that “it’s all about me.”

So it’s no surprise that we’re less empathetic, less genuinely caring (caring for someone online takes little effort, engagement, involvement, and commitment while caring for someone in real life takes continual effort, engagement, involvement, and commitment, no matter what circumstances arise), less able to listen and hear what people are saying or trying to say, less understanding, and less able to provide authentic comfort, encouragement and support.

In other words, a constant connection to technology makes us less human.

So why do we do it? Because it’s rewarding online. The more attention we garner, the more we want. If everybody notices us and loves – or likes – us, that is very motivating to continue our self-tracking because it feeds our egos.

A constant connection to technology and self-broadcasting gives us the approval we crave just for living life and doing the mundane things it requires of all of us. Somehow, having a bunch of people like and praise some routine, ordinary thing we’ve done makes us feel extraordinary and accomplished.

It doesn’t happen like that in real life. Most of what we say and do goes completely unnoticed, even though we may say and do a lot and say and do a lot of good, but despite that reality, those of us who are invested in real life just keep going on and putting one foot in front of the other.

A constant connection to technology rewires our brains to stop doing our own thinking and shop it out the the public opinion of the internet.

This costs us far more than we are remotely aware of.

In choosing constant connection and public opinion to do our thinking and decision-making, we choose to abandon the most powerful workshop we have access to, which is our lone minds.

In our lone minds, which only solitude can give us, we can think objectively and critically through things. We can solve problems. We can fill in missing pieces of the puzzles that life inherently has. We can find connections between things that don’t look connected on the surface. And we can innovate and create scenarios and options that point us forward in our lives.

When we abandon our lone minds, we offer ourselves up to indiscriminate information from public opinion, much of which is conflicting, wrong, and worthless.

But because our brains are rewired to believe that’s a valid and real world, we accept all the input we’re given and make the erroneous assumption that it all has the same quality, the same value, and the same veracity.

And that will destroy us, because most of what we get is uninformed, uneducated, and unknowledgeable in the context of being “expert” information.

In addition to this and what most people don’t know is that public opinion is manipulated, especially on the organizational level.

For example, many organizations have people internal to the organization write a lot of positive reviews about whatever their products are to feed the search engines to give them a higher rating of satisfaction.

Data mining cannot analyze quality, only quantity. So the more times a search engine sees a name and sees positive input, the higher it ranks it organically. This is a driving force – and goal – in every organization with an online presence.

There are two types of search engine results, paid and organic.

paid organic search engine results PPC

Paid search engine results (the ones in the example above with AD to the left of the link) are those that organizations pay, often a lot of money, to the search engine for significant keywords to get top-of-the-page (or top-right-side-of-the-page), first-page placement.

This is known as pay-per-click (PPC) advertising. Each time someone clicks on the paid advertisement, whatever that keyword costs is what is charged to the organization. This can get really expensive really fast.

Organic search engine results (in the example above, below the faint gray line, starting with the Alzheimer’s Association’s link) are generated in order by how many times the keyword appears on the site and how much traffic (search engines don’t really care where the traffic comes from, only how much of it there is) goes to the site (this is where social media sharing has really taken center stage in driving traffic to sites). This doesn’t cost anything.

So, it should be obvious why organizations manipulate their data behind the scenes to get higher organic ranking. The most prevalent (and most dishonest) way has become social media sharing and having people internal to the organization physically go to the site as often as they can. More hits equals higher ranking in the organic search results.

What does that have to do with us and the end of absence and constant connection to technology? Everything!

We instinctively choose what’s listed first because we connect that with what must be the best. However, because what’s listed first is simply because of manipulation (which we are unaware of) and not because of proven and tested quality, we get duped in accepting things as “best,” “right,” or “most” when in fact there is no proof any of those things are true. It’s all an illusion.

google-logoBecause we have come to believe that Google is always right and if it’s on the internet then it must true and because the answers are alway immediate, we have abandoned the mental processes that time would allow – comparison, analysis, perspective, insight, and wisdom – so that we could be sure we were making the right and best choice. That’s the lack of absence that real life decision-making gives us.

instagram-logoAnd what do Google and Facebook do with all that data you share with Twitter, Facebook, Instagram, and Google (these are just a few – everything you do on the internet gets stored somewhere and is analyzed by software that gets a sense of who and what you are about using predictive analysis, so that what you ask for ends up being things that appeal to or interest you, not everything there is on the subject)?

The next time you do a Google search, log in to your Facebook account afterwards. Look at the right hand side of the screen where the ads are. Odds are good they will be for what you just searched for in Google.

twitter-logoPay attention when you share links on Facebook to that same right hand side of the screen. The odds are good that whatever the content is within the link you shared will be what the advertising is for.

facebook-logoThis is predictive analysis in your face. Most of it is not, but Facebook makes no secret that is what they are doing to try to get you to buy something.

Google’s method is invisible, but much more detrimental and dangerous.

Google uses what is known as a “filter bubble” to generate search results. This gets personalized for each person that uses Google and it is based on our preferences and our activities.

Google keeps meticulous track of our searching history, promoting the same results each time we repeat a search and further personalizing them based on which results we choose to follow through on by clicking on the links Google shows.

Each time we do the search, results are pared down to match our personalization preferences, which in effect means we get exposed to a narrower and narrower view of the universe.

Facebook uses this same algorithm in our newsfeeds. We might have 100 Facebook friends, but we interact with 10 or so almost constantly.

All the statuses of those 10 will always show up in our news feeds. The other 90 friends will randomly show up in our news feeds based on how much we interact with them and they interact with us.

The more interaction, the more likely the statuses will show up randomly – not always – in our news feeds. For friends with whom we have little interaction on Facebook, their statuses disappear from our news feeds altogether.

In other words, the internet is making our worlds smaller, not bigger.

And the personalization that makes our worlds smaller, not bigger has affected every part of our lives. The music we listen to. The suggested content for us to watch on live streaming. How and if we get employed by an organization.

And it seems that our brains are, with their constant connection rewiring, accepting this as being okay and we’ve adopted an “out of sight. out of mind” mentality toward anyone or anything we don’t see regularly or at all.

Here’s what we must understand and realize about how dangerous this is and how much we’re losing in the process.

Personalization is really just the glorification of our own tastes and our own opinions. It eliminates the big picture and a general, broad and comprehensive base of knowledge and understanding while embracing customization, specialization, and a singular viewpoint that takes nothing around it into account (no context).

Personalization cuts off our access to real learning and real knowledge. It cuts us off from the very things – and people – who could help us the most.

Because there is no “surprise” content to challenge us, to think about, to learn from, and to grow and mature in, we stagnate in life.

Stagnation is one step away from the regression to the kind of mindlessness that typified 1984‘s society as a whole. We are not that far from it ourselves.

In the next and last post reviewing The End of Absence: Reclaiming What We’ve Lost in a World of Constant Connection, we will look at the final third of the book, still looking for signs of hope, although the prospects of that are getting dimmer.

Part 1 – “The End of Absence” (Michael Harris) Book Review

internet going gentle into that good night neurological changesThis is the first of a multipart series of reviews that I will write on The End of Absence: Reclaiming What We’ve Lost in a World of Constant Connection written by Michael Harris in 2014.

I have written on the main point of Harris’ book in “Dementia of the Preoccupied: How Multitasking and Being Attached to Technology 24/7 is Creating A Dementia Effect on Society” and “The Quintessential Leader Perspective On the Art – and Beauty – of Silence,” which everybody should take some time now to read.

The End of Absence: Reclaiming What We've Lost in a World of Constant Connection by Michael HarrisI would also highly recommend that everyone read The End of Absence: Reclaiming What We’ve Lost in a World of Constant Connection. At about 200 pages, it is completely doable for the shorter attention spans (one of the side effects, as I’ve noted and Harris notes, of a life immersed in digital technology).

Michael Harris and I, it turns out, are, completely independently of each other, raising the same red flags about the brain that morphs (or is born into) into an existence that resides primarily or solely in a digital, always-connected world.

This post will look at some of the research, statistics, and ideas presented in the first quarter of the book, along with my commentary on them.

Reading should ignite an intense interaction in us that includes questioning, testing, proving, thinking deeply about, and making connections with experience and information we already have in our neurological repository of neurons, interconnected lobes, and synaptic networks.

Reading should challenge us, educate us, and give us a broad and rich knowledge base from which we can glean wisdom and understanding. 

Reading should also spark creativity and original thinking that moves us mentally, emotionally, and even spiritually beyond where we were to begin with.

I seldom see this anywhere anymore.

I think that is directly related to how and what in terms of quality and content we’re reading, if, in fact, we’re reading at all (based on my research and observations, it appears the overwhelming majority of us are either on a steady junk-food diet or we’re starving ourselves in this area of life).

Instead, it seems we become the masters of copying and sharing hackneyed and trite little sayings in glancing blows that neither we nor anyone else even pauses at or pays attention to.

This is a result of the end of absence, and it has made us, future generations, and humanity in general poorer. We’ve become slaves to the machines and given up being the captains of our own destinies. In other words, we’ve capitulated to being controlled by technology without even putting up a fight.

I have, over the past couple of years, gradually pulled back from even a semblance of constant connection (I never have been completely connected because I value and need peace and quiet and solitude – all things that “absence” gives us – too much to allow myself to be enslaved by a master that will destroy all that).

I have accelerated that even more in the last few months because I realized I couldn’t function well mentally with the constant and loud cocaphony that it seemed I could never get away from and of all those things that were contributors, this was the one I had complete control over. 

Although I tend to be a Type-A, naturally intense (mainly because I do think pretty seriously all the time and I’ve always found it almost impossible to relax and not be either looking for answers to the questions my thinking brings or for new ways to approach existing problems and dilemmas to resolve or get past them) person, I have seen one source of stress significantly lessen.

And that has helped me clear out some much-needed room in my brain to work on important things, oh, like, life. Even if the answers aren’t here yet and all the problems aren’t solved or behind me yet, at least life in that area is quieter because I’ve consciously and purposefully made it much quieter and much more peaceful.

Peace and quiet can never be overrated.

Before I go further, we need to put digital technology in its proper big-picture perspective. Essentially that is why I write about the dangers and why Harris has written this book. Because there is no proper perspective and no balance. It’s all or nothing and that’s the danger.

But technology is not the source of that danger. We – you and I – are the source of danger. Human beings tend to be polar in their thinking and their behavior by default. If a little of something is good, then nothing but that must be sheer nirvana.

Paper In Fire John MellencampTo quote a line from a John Mellencamp song that resonated with me as much in my very early adulthood as it does today “…we keep no check on our appetites” nor do we recognize that overindulgence in any and all corporeal things will first make us sick, then increasingly unhealthy over time, until at last it finally destroys us.

And that lack of self-control and balance is at the crux of my posts on this subject (as well as the subject of lifestyle dementias) and The End of Absence: Reclaiming What We’ve Lost in a World of Constant Connection.

And I’m very qualified to discuss this because my entire career has been in technology. There are incredibly effective and efficient (in terms of usability, financial feasibility, and operational streamlining – in other words, maximizing value while minimizing overhead) uses for technology and I continually endorse, support, and advocate for those.

One area that I see where technology is best in increasing value and reducing costs is in routine brick-and-mortar operations and organizations.

These include companies that don’t sell tangible products, organizations that don’t promote or support tangible products, governmental regulatory departments (local, state, and federal), and educational institutions.

brick-and-mortar business organizationsBrick-and-mortar operations are extremely costly and offer little in the way of value when considered in the light of new technologies that allow people to connect remotely – as if they were in the same room – face-to-face to meet and do business or get an education.

Buildings cost money. Maintaining them costs money. Furnishing them costs money. Supplying them with utilities and office expendables and technology costs money. Expanding them costs money.

People filling the chairs in-house cost way more than people working remotely (both to the organization and to the employees in terms of transportation, food, clothing, childcare, and time lost with families). 

brick and mortar educational institutionThis is such an inefficient and costly way to work for everybody involved. The benefits are miniscule compared to the costs, which never end and will always encompass the bulk of brick-and-mortar operating capital. 

And here’s the irony that most brick-and-mortar institutions don’t realize or recognize: the true success of any service, business, support, or educational organization is doing more and better in both meeting existing needs and anticipating and growing toward potential needs.

Greater success, progress, and innovation is where the most money should be invested (in other words, a growth model). Instead, most of the money is invested in treading water and going nowhere and having nothing but a lot of unnecessary costs to show for it.

No sane business model would support this, and yet, at least here in the U.S., this is still primarily how most organizations set themselves up.

For someone like me who knows that in most cases this isn’t necessary (and for a fraction of the brick-and-mortar costs, offering better wages and better benefits encourage the best talent), it doesn’t make any sense and I have little patience for all the “oh, we can’t afford that” or “oh, we need more money” when they’re bleeding it out left and right in archaic-based waste.

Another reality of this brick-and-mortar structure is the endless meetings that accomplish next to nothing, but seem to take up the bulk of time. The truth is that most in-house meetings are a waste of time, but remote meetings where participants fly in are both a colossal waste of money and time.

However, there are very few people who want to give up flying somewhere for a few days and “doing business” for a fraction of the time they are there, while spending the bulk of time and money on socializing and entertainment. That’s so antiquated, so ineffective and so incredibly inefficient when compared to its cost and what actually gets accomplished to move forward.

However, some things lend themselves to brick-and-mortar. These are smaller operations that either sell perishable goods (bakeries are a good example) or goods that require an in-person visit to get it right the first time (shoes and clothing are good examples). These, however, are exceptions to the general rule.

Because I’ve been intimately involved with technology all my adult life, I have always been acutely aware of the dangers of constant connection and how it changes the brain.

I will never forget the one and only time that I, in an effort to combat a sleepless night, decided that playing a computer game with lots of motion, flashing lights, and noises at 2 a.m. would be just the thing to make me sleepy and calm me down.

I got sleepy after an hour or so, but every time I closed my eyes, all I could hear was noise and all I could see was flashes of light, and I never got to sleep that night. And I never made that mistake again.

Because of my knowledge and experience, I’ve always been consciously careful to make sure to maintain an offline life and an online life as balanced as possible because I have always recognized that I need both of them equally in my life.

One of the things that Harris talks about in his book is the divide between those of us born before 1985, who knew a world of solitude, peace, quiet, boredom, disconnection for extended periods of time, and the resulting creativity and problem-solving associated with that, and those born after 1985 who came of age in a digital world and have known nothing else.

There were two quotes from Harris’ book that struck me as I considered this divide:

“Every revolution in communication technology – from papyrus to the printing press to Twitter – is as much an opportunity to be drawn away from something as it is to be drawn toward something.”

“As we embrace technology’s gifts, we usually fail to consider what they ask from us in return – the subtle, hardly noticeable payments we make in exchange for their marvelous service.”

For those of us who knew a world at one time that was mostly offline and have transitioned full-tilt into an online world, we should ask ourselves what worthy and healthy things we have sacrificed to do so. 

It has never ceased to amaze me that people can’t go anywhere, even into a church service or funeral, without their cell phones (being on).

Our parents didn’t have cell phones (they didn’t even have answering machines until we were teenagers, if then). If there was an emergency while they were in church services or at funerals (most cell phone calls and texts, by the way, are not emergencies, despite the fact that we’ve elevated the mundane to a level of importance it doesn’t deserve), they didn’t know until hours later when they were home and could answer the phone or play the answering machine.

The world didn’t end with that lapse of time. So what has changed that we think it will now?

We’ve changed. Technology and being constantly connected to a digital world has given us a distorted and unrealistic, but frenetic and immediate, view of the natural rhythm and flow of communication, of life, and, even, of death. 

We’ve surrendered the beauty and serenity of an offline life that we had more control over to a 24/7 online life that controls us 100% of the time. We’ve become mere puppets to a puppetmaster that is constantly pulling our strings in every which way but loose.

Harris’ book urges us to bring back the offline life we knew and find a balance between it and our online life, because what we’ve given up by surrendering our offline lives is costing us dearly and in ways we don’t even realize.

As I’ve been reading this book, 1984 by George Orwell just kept going parallel in my mind because we’ve become the society that Orwell describes in that novel.

Those of us few who are aware of the danger are like Winston Smith, the novel’s protagonist, and the outcome for us is as grim as it was for him: either we will eventually and under great duress and pressure capitulate and become mere shells of our former selves or we will be destroyed because of the threat we pose.

We’ve surrendered our entire lives to technology. We’re not even aware that this has happened. But, as Harris says, “the sheer volume of time we devote to our devices means we are carving ‘expendable’ time away from other parts of our lives.” In other words, instead of enhancing our lives, technology instead becomes our lives and our experiences.

“Ceci tuera cela.” This line from Victor Hugo’s The Hunchback of Notre Dame is apt for the impact of technology on humanity in terms of absence: “This will kill that.”

smartphone-text-messagingHere are a couple – at least for me – of surprising statistics just about kids and adults and text messages.

Kids send and receive an average of 4000 texts a month.

Adults send and receive an average of 746 texts a month. (I was not surprised that I’m not even close to being an average adult here, since I can count the average number of texts I send and receive in a month on less than one hand).

The volume boggles my mind for both kids and adults. Who has that kind of time? And who’s got that much to say? It’s beyond my comprehension.

But what happens neurologically is even more drastic. We become more comfortable with technology than we do with each other. Texting simplifies and reduces the quality of our relationships and increases our emotional distance.

Friends are replaced with contacts. We pretend that complete strangers are our new best friends and the people in our lives who choose less technological connection or are unable to have it fall off of our radars for good.

In other words, we abandon something for nothing.

And our brains form new neural pathways that make this not only okay, but the new normal for how we live.

It is very similar to the same mechanism – and the overarching demand it exerts – that is behind addiction: we crave “quick hits” and “fast fixes” and our lives are consumed with getting the next one.

Anything that requires investment, focus, concentrated attention, and thinking we ignore and turn away from.

It is the same reaction that an addict who doesn’t want to stop using has when they are confronted with rehab.

Neurologically, this becomes totally acceptable for us as technology literally changes the way our brains are connected and what our brains expect.

The changes to the brain, though, go even deeper than connections and expectations. Constant connection causes us to either abandon our memories (based on our actual existences) or subdue them in favor of what we come to believe are memories (stored in brain) but are actually reminiscences (found in an external source).

In other words, our brains are totally reprogrammed in terms of information: how we get it, whether we have to keep it, and whether it means anything or not.

It becomes a simple passive action of processing something outside us and our experiences, instead of the active action of finding, keeping, doing that builds unique records of our actual experiences in our brains.

An example of a reminiscence is doing a Google search for something we should know the answer to. If we don’t remember the answer, we Google it instead of taking the time to work with our brains to search and find the answer and all the original ancillary information and memories that are associated with that answer.

So let’s look a little more closely at what happens in the brain, where it happens, and what the implications are with constant connection to technology.

Digital technology reorganizes the brain. Because the frontal lobe of the brain (which handles decision making, problem solving, control of purposeful behaviors, consciousness, and emotions) is primarily involved in response to digital technology, new neural pathways get formed there.

Changes become evident (much in the same way as frontotemperal dementia) in areas of executive functioning. We become more fragmented, more unorganized, more unfocused, and more easily distracted and bored.

What the Internet is Doing to Our Brains: The Shallows by Nicholas CarrThe thinking process changes as well. We become what Nicholas Carr has described in The Shallows: more capable of “shallow” thinking and less capable of “deep” thinking. Therefore our interests turn to things that don’t require us to think and we studiously and consciously avoid things that would give us no choice but to think.

As thinking is disrupted continually and systematically within the brain, eventually it becomes altogether too difficult, and we abandon it completely.

This is where we become completely vulnerable and susceptible to external programming (whether that comes through people or technology), much like the society that Orwell describes in 1984.

We parrot opinions, beliefs, ideas that are fed to us, but we don’t have any knowledge, proof, or investment neurologically behind them to back them up. In other words, we become simply somebody’s “yes” people.

If we’re looking carefully, we’ll see the world around us is pretty much already like this. Thinking has become too hard and too time-consuming in the face of constant digital connection where we don’t have to think because all the answers are already there when we need them and the answers are right because Google said so, so what’s the point?

And yet that is the point. I would far rather have somebody who’s thinking deeply disagree with me and tell me why so we can put our heads together and reach a more comprehensive understanding or perspective on something (even if we still disagree on some aspects, which is okay) than to be surrounded by “yes” people who don’t have a clue or people who just don’t care.

And, quite frankly, I’ve observed, as Harris has observed in his book as well, that the latter two – the no-cluers and the don’t-carers – are the majority now.

And that’s tragic for humanity on a personal level, on a community level, and on a species level.

We are quickly disintegrating into a unconscious and complete embrace of in-and-out emotional processing (which is not reason and thinking based on logic, knowledge, and facts) and total abandonment of the gifts that are unique to us – that make us human.

These gifts are the ability to reason, to critically think, to test everything, to prove everything, to know because we’ve done the time-and-labor intensive personal work of testing and proving what is true and what is not. What is right and what is wrong. What is good and what is bad.

We will not be able to have any kind of meaningful life without these gifts. Without a framework, without a moral compass, without the ability to think, we will simply exist, unhappily, in increasing fear as well as mental, emotional, and spiritual poverty until we don’t.

No one in their right mind would bring children into this kind of bleak existence, so if time goes on long enough, we as a species will simply die out, if we’re don’t all destroy each other first.

In the next post on The End of Absence: Reclaiming What We’ve Lost in a World of Constant Connection, we will look at the next section of the book and see if Harris is any more hopeful than I am in anticipating what the future of humanity left to its own devices and constant connection looks like.

 

 

Dementia of the Preoccupied: How Multitasking and Being Attached to Technology 24/7 is Creating A Dementia Effect on Society

lifestyle dementia technology multitaskingNeuroscientist and author Frances Jensen, in describing what normal life has become for most of society, calls what happens neurologically dementia of the preoccupied.

It’s an apt term. It’s also the brain mimicking dementia symptoms, because our brains aren’t wired to do continual rapid attention/task shifts nor is it wired to multitask.

Despite a lot of evidence that a 24/7 connection to technology (produces a neurological condition, which includes changes to the structure of the brain, known as digital dementia) and multitasking are not only damaging the brain long-term, but they also reduce productivity dramatically (the effect neurologically is exactly the same as staying awake for 24 hours or more or smoking marijuana), a 24/7 connection to technology and multitasking are still seen as badges of honor and are highly prized both professionally and personally.

The problem with multitasking is that we can’t really multitask. Neurologically, we are wired to focus all our attention on a single task and to complete it before moving on to something else. When we try to force our brains to do something they aren’t designed to do, we end up doing more harm to ourselves than good.

One harm is simply forgetting what we were doing, leaving it unfinished, or forgetting to do something we needed to do altogether.

smart phone dementia lifestyleAs a result, at the end of a day, which is when we finally put that phone down, turn the digital devices off, and turn off all the rest of the technology we have going (until we open our eyes the next morning), all we have is a random, disjointed mess of incompletion. In other words, we have little to nothing concrete or finished to show for being awake for 14-16 hours.

That increases anxiety, which is damaging to the brain. It also increases stress, which is damaging to the brain.

tablet dementia lifestyleAnd because we’re not getting anything accomplished, we’re constantly behind and getting further behind until we’re completely overwhelmed to the point of just quitting, so that most of what we set out to accomplish as far as things that actually mean something and are important never get done.

The modern world, if we choose to follow the crowd, is bad for our brains. I suspect that we will see more dementia-like symptoms emerging sooner in the general population in the not-too-distant future because of our addiction to multitasking and being connected 24/7 to technology.

I also expect the longer-term outcome of our multitasking and 24/7 connection to technology to be another kind of permanent lifestyle dementia among the general population.

But, as with all lifestyle dementias, we can make choices that can prevent dementia of the preoccupied, digital dementia, and the real possibility of early, permanent dementia.

But it means that we have to be willing to go in a different direction from the crowd of society, and most of us, it seems, get more short-term satisfaction from following the crowd and being part of it than we do from the conscious effort of taking care of ourselves and making changes and choices that are neurologically – and physically and emotionally – healthy.

We’re already paying dearly, in ways we may not be aware of, for the choices we’re making. The cost will only get steeper with time.

It will not only affect us in dramatic and negative ways, but also our loved ones who will end up either taking care of us because we are unable to take care of ourselves or will be forced to have someone else take care of us because they can’t meet the demands of caregiving.

We don’t have control over the external factors – and nobody really knows or will ever know what all of those are – that cause dementias and Alzheimer’s Disease. We don’t have control over genetic factors that give us a greater risk of developing these degenerative neurological diseases.

But we do have control over the choices we make in our lives that put us at greater risk for developing dementias and Alzheimer’s Disease.

It is my hope that we will all choose to take that control and use it wisely.

 

 

Alcohol-Related Dementia: A Lifestyle 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 this week 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 Early-Onset Dementias

There are several types of common early-onset dementias. Early-onset dementias are categorized as dementias where the onset of symptoms is prior to age 65. These dementias can occur as early as the 30’s, but more typically become symptomatic in the 40’s and 50’s.

Early-onset dementias, unfortunately, are still off the main grid for medical staff – a classic instance of fixed expectations that dementias won’t be an issue for a person until after age 65 – and our loved who are diagnosed with early-on dementias face challenges that our older loved ones who are suffering with these diseases don’t face. These include:

  • Difficulty getting a correct diagnosis
  • Loss of employment and income
  • Difficulty getting Social Security Disability Insurance, Medicaid, and other employment-related disability insurance
  • Loss of health insurance and high-out-of-pocket costs for medical care
  • High out-of-pocket costs for long-term care
  • Lack of appropriate medical care, residential care, and community services (all of these are geared toward an older population)

Early-onset dementias typically are harder to diagnose because other than the dementia systems, sufferers are usually healthy, active, and aware there is a problem.

Additionally, the symptoms of early-onset dementias usually don’t have memory impairment as the predominant feature. Most often, behavioral and personality changes occur first, so usually the first type of treatment is psychiatric instead of neurological.

The causes of early onset-dementias fall into three categories: random, genetic, and lifestyle.

Random early-onset dementias are just that. There’s no concrete link to a cause. My opinion is that few of these in this category are actually random, but the causative issue(s) have not been identified yet.

Genetics plays an important role in certain early-onset dementias (and, although the scientific community has overlooked or disregarded the familial aspect of elder-onset dementias, it appears very likely, from observation, that if there’s a family history of elder-onset dementias, there may be a genetic predisposition for development of elder-onset dementias in subsequent generations).

Three genes are known to have mutations in the case of some sufferers of early-onset dementia, Alzheimer’s type (symptoms related to these genetic mutations usually begin in the 30’s and 40’s):

  • Amyloid precursor protein gene (APP) on chromosome 21
  • Presenillin-1 (PSEN-1) on chromosome 14
  • Presenillin-2 (PSEN-2) on chromosome 1 

We’ve talked extensively here about lifestyle dementias with regard to management of health (blood pressure and blood sugar) and substance abuse, as well as with regard to what we eat and how we live daily life. Some of the early-onset dementias we will talk about here can be directly attributed to lifestyle.

There are several types of early-onset dementias.

At least 1/3 of all sufferers diagnosis with early-onset dementia have Alzheimer’s Disease (remember that Alzheimer’s Disease is a type of dementia, but is not inclusive of all types of dementia, just as all photocopiers are not Xerox photocopiers and all facial tissues are not Kleenex facial tissues).

Onset symptoms include progressive and episodic memory loss, as well as visuospatial and perceptual deficiencies, but intact language and social functioning.

early-onset dementia, Alzheimer's type, Pat SummittThis type of early-onset dementia is more common in women than men. Once symptoms appear, the duration of the disease averages eight years.

A recent example is the 2011 diagnosis of former University of Tennessee women’s head basketball coach, Pat Summit, who was diagnosed with early-onset dementia, Alzheimer’s type, at age 59. Coach Summitt stayed with the team one more season, but was not actively coaching that season.

Coach Summitt retired in 2012 and has begun the Pat Summit Foundation to raise Alzheimer’s Disease awareness.

"Still Alice" by Lisa Genova - early-onset dementia, Alzheimer's typeThe novel, Still Alice, written by neuroscientist Lisa Genova, gives a scientific, compassionate and compelling look from the inside out of a 50-year-old Harvard psychology professor as early-onset dementia, Alzheimer’s type enters and progresses through her life.

Since the publication of Still Alice in 2007, Genova has continued her work with bringing the neuroscience of all types of dementias in the same compassionate and compelling style of her first novel through subsequent books and through documentaries produced with her husband, who is a filmmaker.

MRI-vascular-dementia-diffuse-white-matterThe second most common type of early-onset dementia is vascular dementia. Vascular dementia can occur because of:

  • Multiple cortical infarcts (small areas of tissue that have died from the lack a blood supply) that are most often caused by transient ischemic attacks (TIA’s) or silent strokes and characterized by stepwise deterioration of cognitive function
  • Small-vessel disease, resulting in a more subtle decline of cognitive function
  • Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)
    • Rare cause of early-onset subcortical strokes and dementia
    • Caused by a mutation of Notch 3 gene on chromosome 19
    • MRI shows diffuse white matter lesions on the cerebral hemispheres, especially in the anterior temporal lobes and external capsules

With early-onset vascular dementia, there are usually lifestyle factors involved such as uncontrolled or undetected high blood pressure and an unhealthy diet. Recent scientific research has also linked high cholesterol levels with the development of vascular dementia.

frontal and temporal lobes function FTD early-onset dementiaThe third most common type of early-onset dementia is frontotemperal dementia (FTD), also known as Pick’s Disease, which affects the frontal and temporal lobes of the brain. FTD usually has an onset between the ages of 45 and 65. Its average duration is eight years. 

There are three types of FTD: behavioral variant FTD, semantic dementia, and primary progressive (also known as progressive nonfluent) aphasia.

In about half the cases of FTD, there is a positive family history for the disease, indicating a probable genetic link (although researchers have not yet identified the genetic mutation).

FTD can co-occur with motor neuron diseases (ALS, also known as Lou Gerhig’s Disease, is an example of a motor neuron disease), but only about 10% of sufferers of only motor neuron diseases develop dementia, resulting in a very aggressive course of the illness.

FTD presents differently from early-onset Alzheimer’s Disease and early-onset vascular dementia because the first symptoms involve changes in personality and social conduct while memory, perception, and visuospatial skills remain unchanged.

The most common indicators are:

  • Behavior disturbances
  • Personality changes
  • Decreased motivation
  • Reduced empathy
  • Impaired planning
  • Impaired judgment
  • Speech and language difficulties

As FTD progresses, other symptoms become apparent:

  • Difficulty behaving appropriately in new and unfamiliar situations
  • Loss in inhibitions (disrobing is not uncommon)
  • Loss of social skills
  • Emotional outbursts
  • Impulsivity
  • Executive function deficits
  • Decreased verbal fluency
  • Compulsive or repetitive behavior
  • Lack of insight
  • Self-neglect
  • Inappropriate sexual behavior

The semantic dementia form of FTD includes symptoms of:

  • Difficulty with correctly naming objects (people, places, and things)
  • Impaired understanding of the meaning of words
  • Inability to understand substitute words

However, in this form of FTD, speech remains fluent and cognition remains intact. MRI scans show more atrophy of the anterior temporal lobe than the posterior temporal lobe.

The primary progressive (progressive nonfluent) aphasia form of FTD is characterized by:

  • Progressive decline in all language skills, with no other cognitive deficits
  • Increased difficulty with speech and speaking (by the end of the disease, most sufferers don’t speak at all)
  • Speech and speaking is not fluent and requires a great deal of effort

MRI scans show predominant atrophy of the left perisylvian region of the temporal lobe.

The fourth most common type of early-onset dementia is Lewy Body dementia. I’ve included the link to my post about Lewy Body dementia for a full description, but will include a brief summary of the dementia’s Lewy Body Protein - Lewy Body dementiaprimary symptoms:

The fifth most common type of early-onset dementia is Wernicke-Korsakoff Syndrome (alcohol-related dementia). This is a lifestyle dementia, brought on by long-term, heavy alcohol consumption.

wernicke-korsakoff dementia (alcohol-related dementia)

Characteristics of Wernicke-Korsakoff Syndrome include:

  • Damage to the limbic structures and frontal lobes
  • Memory impairment
  • Executive functioning impairment
  • Autobiographical memory is frequently affected resulting in confabulation (making up stories)
  • Memory loss stops where it is when drinking stops (damage already done remains)

As shown by the MRI scan above, there is general cortical atrophy along with damage to the frontal, parietal and cingulated regions of the brain, with the majority of the damage occurring in the frontal lobe.

There are two other less common types of early-onset dementia that we’ll discuss.

One is Huntington’s Disease. As this genetically-inherited disease progresses, dementia develops.

MRI Huntington's DiseaseEveryone is born with this gene. However, in Huntington’s Disease, an inherited mutated copy of this gene (on chromosome 4), produces a defective form of the huntingtin protein that causes degeneration and death of the neurons, especially in the center of the brain. 

Because this gene is a dominant gene (as opposed to a recessive gene), everyone who inherits the mutated copy of the gene will, at some point, develop Huntington’s Disease.

Symptoms typically appear between ages 30 and 50, but it can begin at a very young age or appear in the very elderly. Primary symptoms include:

  • Lack of muscle coordination in the arms, legs, head, face and upper body
  • Progressive decline in thinking and reasoning skills, including memory, concentration, judgment and the ability to plan and organize
  • Mood disturbances, including depression, anxiety, anger, and irritability
  • Obsessive-compulsive behaviors

The last type of early-onset dementia, which is extremely rare, is Creutzfeldt-Jakob Disease (CJD). CJD is characterized by rapid neurological degeneration. It is always fatal, and death usually occurs within six months to a year of onset.

CJD belongs to a class of human and animal diseases called transmissible spongiform encephalopathies (TSEs), because the infected brain looks like a sponge. The average age of onset for CJD is 60.

“Mad Cow Disease” is the bovine equivalent of CJD (although it tends to affect younger people, with the average age of onset being 26). 

There are three types of CJD:

  • Sporadic (no known cause) – accounts for about 90% of cases
  • Inherited (family history of the disease) – accounts for 5-10% of cases
  • Acquired (transmitted by exposure to brain or nervous system tissue, usually through certain medical procedure) – accounts for less than 1% of cases

Creutzfeldt-Jakob Disease MRIThe symptoms of CJD include:

  • Rapidly progressive dementia
  • Problems with muscular coordination
  • Personality changes, including impaired memory, judgment, and thinking
  • Impaired vision
  • Insomnia
  • Depression
  • Lethargy

As CJD progresses, mental impairment becomes severe. Sufferers often develop involuntary muscle jerks (myoclonus), and they may go blind.

Eventually, they lose the ability to move and speak and become comatose. Pneumonia and other infections often occur as well, and they generally end in death.