April 29, 2014

"Have You Lost Your Mind?"

That's the title of an article by Michael Kinsley in the current (April 26, 2014) issue of The New Yorker. Kinsley poses the question from the perspective of someone who has lived with Parkinson's Disease for 20 years and who has just gone through a battery of tests to see if he could get an answer to that question for himself.

Kinsley is a political journalist, commentator, and pundit. He became known to television audiences as a co-host with William Buckley on CNN's Crossfire. He later participated in the mainstream media's development of online content as the founding editor of Microsoft's journal Slate.

Born in 1951, Kinsley was diagnosed with Parkinson's Disease twenty years ago at age 43. He had deep brain surgery to ease the PD symptoms in 2006.

Kinsley on  His Fellow Boomers' Competition
The penultimate contest  for our baby boomers (after who lives longer), Kinsley says is "whoever dies with more of his or her marbles." There are two forms of competition in the boomer death-style Olympics. "There's dying last and there's dying lucid."

New Information from Kinsley I Didn't Need to Know
I could have live happily without knowing that neurologists generally believe that Hitler had Parkinson's. Francisco Franco and Mao Zedong both probably did too.

Changes in Thinking about Parkinson's
Parkinson's used to be thought of as basically a "movement disorder." Neurologists now believe that the non-movement defects such as cognition, memory and so on can predate the physical symptoms that lead to the diagnosis.

These non-motor symptoms are not helped by levodopa, the "gold standard" that revolutionized Parkinson's treatment and remains the most common drug used to treat people with Parkinson's (PWPs).But now there is some evidence that levodopa can make the non-motor symptoms worse.

Patrick McNamara, a neurologist at Boston University writes:
Neuropsychiatric disturbances of Parkinson's disease . .. . can be as disturbing as the motor symptoms. . . Up to 85% of PD patients evidence deficits in executive cognitive functions even early in the disease . . . 
Almost half of all patients progress toward a dementing illness that may occur late in the disease. More than half of all patients suffer severe anxiety or depression. Roughly 50% of patients suffer varying degrees and types of apathy, hallucinations, sleep disturbances, and impulse control disorders. . . 
PD patients are impaired . . . They have difficulty making decisions, developing plans . . . and monitoring and adjusting plans and actions. 
Enough already! I'm with Kinsley when he asks: "Is it healthy skepticism or an unhealthy mental defect that makes it hard for me to take some of this seriously?" But at least McNamara does conclude with a little pat on our Parkinson's-afflicted heads. saying: "My own feeling is that PD patients tend to be exceptionally intelligent individuals."

Where Alzheimer's and Parkinson's Differ
Unlike Alzheimer's, Parkinson's does not necessarily lead to mental problems, Kinsley says. Neurologists believe that people who get Parkinson's at an earlier age are less likely to suffer cognitive problems. Unlike Kinsley, I don't find that observation particularly encouraging, since I was diagnosed at age 80. And next month when I turn 85 I'll be constantly reminded of the frequently quoted statistic that   half of those over age 85 end up with some form of dementia.

Another difference between Alzheimer's and Parkinson's is that Alzheimer's tends to start its destruction          in the part of the brain affecting memory whereas Parkinson's starts with what they call executive function which involves analyzing a situation and your options and making a decision.

Cognitive Assessment Tests
Kinsley recounts at some length his decision to take a cognitive assessment test and the results, I skipped over most of this since I have no interest in taking one of these tests

Actually Kinsley doesn't think much of them either. He comments:
Neuropsychologists really believe that wrong answers to a few questions involving the alphabet demonstrate personality traits and mental abilities (or disabilities) that run deep
I would like to say that the whole thing is a fraud.
But one thing troubles him and prompts him to take the test. He can't really explain  why Parkinson's patients and similar groups travel in packs. He explains:
They might have the right answer or they might have the wrong answer, but they have the same answer, and it's different from the answer that most "normal, healthy" people  have. That's weird. .  . So I   have reluctantly concluded that there must be something to all this stuff after all. 

Turns out his scores on the cognitive test were pretty good for the most part but showed some surprising weaknesses on the questions related to executive function. As noted above, that's the area of the brain Parkinson's attacks first.

The politically correct line on intelligence, Kinsley says, is   that it's not a single IQ number but rather a collection of talents and abilities that we all have in different amounts. The current studies of cognition suggest that this is close to the truth. But the   notion that intelligence is a single  number is deeply rooted.

Kinsley concludes with this observation about intelligence not being a single number but a collection of strengths and weaknesses:

People  understand this about physical disabilities. Someone with a broken leg will not, for that reason alone, denied a job that requires him to type.  We are comfortable with the idea that physical health is not just a single number but a multiplicity of factors of factors. That's where we need to arrive about mental problems. As we get older we're all going to lose a few of our marbles.
As the word gets out that Parkinson's Disease is not just  a  movement disorder, there will be people whose careers will be destroyed because on a particular day at a particular time , they can't recite a seven-digit phone number backward.  Allowing someone's fate to depend on some stupid test is just the reducto as absurdum of the meritocratic  machinery that has been pretty good to me (and to you, I suspect) over most of a lifetime.
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This article  is  just one of  a slew of stories I've read lately about Parkinson's and executive function, cognition and other non-motor symptoms of the disease. All of which  has caused me to reconsider the rather dismissive way I've  been reporting on my experience with 5-HTP to treat these symptoms.

More  on this tomorrow.

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