A Stroll Down Memory Lane on Washington's 14th Street

Recently, I resolved to get out for some needed exercise by picking one of DC's neighborhoods for a walking tour every week. Let's start with 14th Street and it's contrast between now and then. I did this walk on Tuesday.

But first some history:

14th Street April 1968

On April 4,1968, civil rights icon Martin Luther King, Jr. was assassinated in Memphis. His murder sparked unrest that night in Washington, DC. That was Thursday. Over the next few days, violence, looting and arson enveloped the main commercial centers in the African-American neighborhoods. The 14th Street commercial corridor was hit hardest. Most of the smoke you see in the photo on the left is coming from 14th Street.

Washington has always been two cities -- one black, one white. This separation has begun to dissipate somewhat and today's 14th Street is a prime example of that. But that wasn't the case in 1968, when 14th Street was the black community's main street. It suffered the most damage during the 1968 rioting.

Here's a good example of DC's two cities: On Friday, the day after MLK's assassination, my wife and I decided to go ahead with the annual Georgetown house tour we'd signed up for, mainly because it included the Averell Harriman house with its collection of famous impressionist paintings. We saved that for our last house on the tour.

As we headed down N Street toward the Harriman house, tour officials came by to say the tour was shutting down. Everyone was urged to go home as soon as possible because more rioting was underway and President Johnson had called out the National Guard. The federal and district government offices -- and most businesses -- had shut down. Massive traffic gridlock followed as panicked commuters raced home to the suburbs. 

By the end of Friday night, 13,600 federal troops occupied the city. 

Loneliness: A Killer

If you’re not careful, loneliness might kill you.

Everyone feels lonely at predictable times, like when a special friend or relative dies. But doctors are quick to point out that it’s the continuing, persistent kind of loneliness that carries very real health risks.

In a 2010 AARP survey, 35% of all responders reported feeling lonely. Of those, nearly half said their loneliness had persisted for at least six years. That’s a lot of time for a harmful condition to unleash its dangerous effects.

Here are just a few of the consequences of persistent loneliness:

• Studies suggest that loneliness is more dangerous than packing on some extra pounds. Yet Americans spend billions of dollars on diet products and often make little effort to address their loneliness.
• Loneliness increases the risk of premature death by 14%.
• Loneliness affects not only our current mental health – think depression. One recent study also suggests it increases the risk for dementia later.
• Loneliness often brings fragmented sleep, the choppy kind that seriously affects health.
• Loneliness can increase inflammation throughout the body, which carries its own risks. That inflammation can also exacerbate existing conditions like arthritis and heart disease.

Mother Teresa – the impoverished nun who spent her life helping the poor – described loneliness as the “most terrible poverty.”

More Thoughts about Parkinson's and Robin Williams' Suicide

Robin Williams' suicide affected many people. There has been intense media and internet scrutiny... and speculation. These two commentaries resonated with me.

1) Former Time Warner Chairman Jerry Levin Comes out of the Parkinson's Closet
In an interview last week with Deadline Hollywood, Levin disclosed for the first time that he has Parkinson’s disease. He was diagnosed eight years ago.

What follow are verbatim quotes and paraphrasings of Levin's remarks.

Levin’s “coming out.” The death of Robin Williams led Levin to acknowledge his own PD: 

Basically the reason I really wanted to start talking about it now was, to raise awareness and understanding that there may be a million souls in the U.S. who have Parkinson’s, but there are probably many more who are undiagnosed. There is a lack of research and actually a relative lack of practitioners who are versed in Parkinson’s. Probably one quarter of those who have Parkinson’s are being treated by a specialist. The rest are not. For me, it’s not a question of philanthropy, it’s really a question of awareness. That’s why I think what Robin represents is so critical.  

We see the effects of addiction, we know what clinical depression means, but when you put it together with this debilitating disorder that slowly takes away your ability to function and to express . . . and we haven’t even covered the autonomic impact on your ability to sleep or your ability to swallow. Once the diagnosis is given, there is an enormous psychological shift and you tend to view the world from that prism. It is so hard to distinguish what’s normal anymore, what’s Parkinsonian.

Williams' Parkinson's Diaganosis: Turning to the subject of the Parkinson’s diagnosis and its impact on Williams, Levin notes that one of the telltale signs of Parkinson’s is what’s called the Bland Effect; facial expression begins to dissolve into a lack of emotion, no vibrant expression. It’s almost blank and it’s quite noticeable. Your smile is barely discernible and artificial.

Pomegranate for Alzheimer's and Parkinson's?

The continuing saga of pomegranate magic has again lit up the internet over the past few days.

This time, the story focuses on punicaligan -- a polyphenol found mainly in the skin of pomegranate fruits – which scientists at the University of Huddersfield in West Yorkshire, England, think may slow the progression of Alzheimer’s (AD) and Parkinson’s. Their findings were just published in the journal Molecular Nutrition and Food Research.

The report claims that this punicaligan compound could slow down the inexorable progress of AD by inhibiting inflammation in specialized brain cells known as micrologia. That inflammation, when unchecked, enables the continuing destruction of brain cells typical of people with Alzheimner’s… and Parkinson’s, too.

As the buzz reverberates about pomegranate’s anti-inflammatory qualities, Huddersfield scientists have begun a new effort to develop drugs – mimicking the efficacy of punicaligan – that treat neuro-inflammation.

Pomegranante Benefits Not New

Lead researcher Dr. Olumayokun Olajide is quick to tout the benefits of pomegranate. "We do know that regular intake and regular consumption of pomegranate has a lot of health benefits – including prevention of neuro-inflammation related to dementia," he said. 

Olajide -- who became interested in the anti-inflammatory effects of natural products as a med student in his native Nigeria -- says pomegranate has been of interest to Alzheimer's researchers for some time. Previous studies have suggested it can help break down plaque that builds up in the brain and brings on the beginnings of the disease.

There may also be applications for punicalagin compounds to treat conditions that involve general inflammation – not just neuro-inflammation – such as rheumatoid arthritis and even cancer.

Just To Show I Didn't Spend the Weekend in Bed with the Covers Pulled Up Over My Head

After Robin Williams' shocking suicide last week, we learned from his wife that he'd recently been diagnosed with Parkinson's disease.

I wondered if that new information had affected his decision to kill himself. And it made me think more about my own final exit.

Reading those grim thoughts in the blog last week, some of my nearest and dearest expressed concern that I might be speeding into a serious depression.

Not yet. But I'm now looking for a therapist who specializes in end-of-life issues. Even if I didn't have Parkinson's, this 85-year-old thinks it might help to talk with a counselor about these important matters. 

Sunday, Not in the Park, but at the Farmers Market

I love my Palisades neighborhood. On most Sundays, you'll find me here at our farmers market. It's just a five-minute drive from home on familiar streets, one of the few destinations I'll permit myself to get behind the wheel to visit. 

That's Gloria standing with me. She manages the market on Sundays, and serves as a valued caregiver to a friend who's pretty far down the Parkinson's road.

My Final Exit: Suicide by Starvation and Dehydration, or Assisted Suicide in Switzerland?

Into the Parkinson’s disease homestretch, and prompted in part by the recent suicide of fellow Parkinsonian Robin Williams, I spent time this past week thinking about -- and planning -- my final exit.

This disease is idiosyncratic; I could live independently for several more years, or I could take a fatal fall tomorrow. Both my neurologist and my physical therapist recently reported seeing little decline in my physical condition. But I've seen signs that I'm on the verge of dyskinesia, the involuntary movements that tend to occur when the levodopa medication starts to wear off. In addition, my response to this medication has become erratic.

Yesterday, my neurologist suggested I get back on Azilect, the costly medication that can smooth out and extend the performance of the levodopa medication. There’s something else, too: I just saw reports that a particular variety of curcumin – the active ingredient in the Indian curry spice turmeric -- is especially effective here. I’ll report more on this next week.

So… that's my life on the Parkinson's rollercoaster. Up and down and round and round we go.

Parkinson's Disease Progression
Parkinson's symptoms progress idiosyncratically – for some people, fast; for others, slowly. People diagnosed early in life typically see a slower progression. Leon Paparella -- my Parkinson's support group leader -- was diagnosed 27 years ago. Today, at 69, he continues to function well, and has outlived many group members who received their diagnoses at age 60 or beyond… as most PWPs do.

To give PD patients an idea about the progress of their disease, many doctors use the Hoehn and Yahr scale, which describes the stages this way:

• Stage one: Parkinson's disease symptoms affect only one side of the body.
• Stage two: Symptoms begin affecting both sides of the body, but balance is still intact.
• Stage three: Parkinson's disease symptoms are mild to moderate and balance is impaired, but the individual can still function independently.
• Stage four: People at this stage are severely disabled, but they can still walk or stand without assistance.
• Stage five: The patient becomes wheelchair-bound or bedridden, unless someone is helping him.

I'd place myself at stage 3 now. While there are signs I may be heading for stage 4, there's no way to know the timetable.

I could probably deal with stage 4. But as of today, I'd like to exit before I move into Stage 5.

Electronic Monitoring Gizmos Help Seniors Stay in their Homes

Staying in one’s own home – called “aging in place” – is way up there on seniors’ priority lists, along with “keeping my mind.”

The issue is important to me, and I’ve written about it frequently. Recent posts include:

• Keeping the home safe for seniors
• Three new models to help seniors stay in their homes
• A key reason to avoid nursing homes: antipsychotic drugs

As we might expect -- well into the 21^st century -- a new way to help seniors stay safely in their homes involves "electronic high tech."

A recent article on MSN’s science and technology page outlined the new electronic techniques available to more closely monitor seniors at home. Here are a few of the new advances designed to keep seniors safely in their own homes.

Motion Sensors Around the House

Families and caregivers can place motion sensors in key locations – front door, refrigerator, favorite living room chair, bathroom door – to monitor activity. If there’s little or no activity logged at these key locations after a prescribed interval, the software will send an alert to family, caregiver, and/or nurse.

Sensors under the bed mattress can detect if the senior is sleeping normally. For example, they can monitor pulse and respiratory patterns to keep tabs on a senior’s heart disease… and send appropriate alerts even before the senior knows she’s becoming short of breath. The sensors will detect if a senior is getting out of bed more regularly than normal – raising a red flag for possible urinary track infection.

Did Parkinson's disease or its Meds Play a Part in Robin Williams' Suicide?

Robin Williams' suicide has generated many comments about its possible connection to his long struggle with depression and substance abuse. When his wife discussed Robin's PD diagnosis after his death, a new wave of comments followed.

As a person with Parkinson's, I have some thoughts -- and facts -- to add to the discussion about the role of Parkinson's in his demise.

Parkinson's Disease and Depression
The data on PD and depression are inconsistent. But it's likely that 40-50 percent of people with Parkinson's (PWPs) will have depressive symptoms in their lifetimes. In fact, depression can be a non-motor symptom of PD, often occurring before any of the more typical movement difficulties. I lost my sense of smell -- another non-motor symptom -- more than four years BEFORE my PD diagnosis. But it's depression that occurs most frequently as a non-motor symptom of the disease.

In most cases, the depression is mild to moderate, and treatable with talk therapy, antidepressant meds, or both. In my case, the serotonin booster 5-HTP has kept depression at bay.

Suicide rates among PWPs are low, perhaps lower than in the general population.

Newly diagnosed PWPs experienced higher rates of depression, anxiety, fatigue and apathy than a healthy control group, according to a study published last week in the journal Neurology. Most of those patients were not treated with antidepressants during the two-year study.

What's the Best Age to Be?

At the beginning of my “career” as a blogger, I described 2010 -- my first full year as a newly diagnosed Parkinsonian -- as the best year of my life. Knowing about -- and facing -- this disease gave my life new energy, challenge, and focus. Of course, some of the inevitable effects of the disease are catching up with me these days. But four years ago… well… the Parkinson’s honeymoon was just beginning, and things looked pretty good.

That assessment about happiness at 80 turns out not to be completely odd after all.

An article published August 6, 2014 on FiveThirtyEight.com titled "What’s The Best Age To Be?" got my attention, and reminded me of my pronouncement about 2010.

Here are some of the answers to that question.

It’s 29

A survey of 1,505 Britons by Genius Gluten Free found that – at 29 years of age – people had the greatest number of friends. The more friends we have, the happier we are? I see people on Facebook with more than a thousand friends and they don’t often seem very happy to me.

It’s Before 25

A highly unscientific commentary in the “Onion” suggested that a group of retirees reported making the most important or life-changing memories before age 25. That’s another bizarre definition of happiness.

It’s 28 for the Ladies

Clairol Perfect 10 – a hair color brand – commissioned a study of 4,000 women. The results?

• At 28, women are most happy about their sex lives.
• At 29, women as most happy about their careers.
• By 30, women are happiest with their relationships.

Hmmm. Sex, work, and relationships. All important stuff. But markers -- by themselves -- for happiness? Again, way too simplistic.

It’s 34

In a ridiculously unscientific and wacky review on Gawker, Tom Scocca rated all ages up until age 40. His conclusions? Thirteen was the worst, and 34 the best. But let’s move on.

It’s 37

A collection of deodorant manufacturers asked 2,000 Britons about the issue. Results? Age 37 was the average age by which the study subjects felt they would have achieved their important life goals.

Here’s what that graphic looked like:

Judith Viorst, "Unexpectedly Eighty"

I had planned to share some thoughts about Robin Williams' suicide and the role his Parkinson's diagnosis may have played in it. But I soon realized the issues were too complex, and that I needed more time to sort things out.

So I turned to my queue of posts. Here's one of my favorite's.

Judith Viorst has lived in Washington since 1960. An amazingly prolific author, she's written science fiction books, picture and poetry books for children, adult fiction and nonfiction (including the best seller Necessary Losses) and three musicals.

She has also written best-selling books of  poetry for adults. First came Suddenly Sixty, followed by I'm Too Young To Be Seventy. Now we have Unexpectedly Eighty. Here are a few samples of her wise and witty poems:

<>  <>  <>  <>  <>  <>  <>

Revelation?
When I awoke this morning
The world was radiant with newness.
Indoors and outdoors, all had been scrubbed clean.
The sky had achieved a blue it seemed beyond blueness.
Whites were whiter than white, greens greener than green.
And the edges of everything,
Windows
Walls
Tree trunks
Blades of grass,
Stood apart from the edges of everything else
With exquisite clarity.

How can I explain this? Revelation?
No – – successful cataract operation.

Enabling Seniors to Remain in Their Own Homes: Three Models

Last month, I wrote about the scourge of over-using antipsychotic drugs in nursing homes. I mentioned that this practice – common in facilities for the elderly to make them more “manageable” – is one of many reasons why I want to stay in my own home as long as possible… here in the Palisades neighborhood I’ve loved for almost 60 years.

In June, the National Aging In Place Council (NAIPC) held its annual meeting in Washington. As described in a June 16, 2014 article by Liza Kaufman Hogan carried by Forbes.com, the NAIPC focused on this one question:

If 90% of adults over 65 want to remain in their homes as long as possible, as a 2011 AARP study suggests, why do so many wind up in retirement communities, assisted living facilities and nursing homes?

At that meeting, presenters offered three different models to address the issue. It’s a big issue, too: projections suggest that by 2030 there will be 89 million Americans over 65, and 20 million over 80 (the country’s fastest growing segment).

The Technology Model

Dr. Allan Teel created his for-profit telemedicine support program – Full Circle America -- for the oldest residents in his own home town, Damariscotta, Maine. They didn’t want to leave their homes for assisted living or nursing home environments; even if they did, many of them didn’t have the means to do so.

Teel identified a way to keep his fragile and proud neighbors in their own homes by thoughtfully combining several elements:

• Digital medical tools to track their health
• Paid caregivers
• Family members
• Volunteers

Full Circle America members receive a kit that includes a web camera, blood pressure cuff and stethoscope to monitor their health. Those tools enable doctors and family members to keep an eye on their patients and loved ones without always being physically present.

Miracle on the Mall: My Incontinence Disappears!

In yesterday’s post, I described sharply increasing my fluid intake this past week. I'd learned that dehydration might be a factor in a series of recent symptoms. While outside on warm days, I'd sometimes get dizzy or feel very listless. I noticed that my blood pressure (BP) underwent sharp drops, too.

While I've only been on this hydration project a few days now, I've noticed results. The big surprise? My long-standing incontinence issues have abated dramatically. Research shows that drinking more usually means peeing less. 

Who knew? Not me.

I want to share the results of an interesting field experiment I undertook just yesterday.

  

A Trip to the Mall

Next April will mark the 60^th anniversary of my arrival in DC, and I loved the town right from the start. I've seen dramatic changes here. It has changed from what President Kennedy termed  "a city of Southern efficiency and Northern charm" to one that Forbes Magazine  put at the top of its 2014 list of America's "coolest cities."

But one thing has remained a constant -- the city's sweltering summer heat and humidity... until this year. 2014 has brought the most pleasant summer weather I can remember.

On my recent Norwegian  cruise, I found I could still get out and (slowly and at my own pace) tour cities, despite my age and advancing Parkinson's. While abroad, I resolved to get out and about more when I got home.

So yesterday -- with a pleasing forecast of temperatures in the low 80s -- I decided it was a perfect time to act on that resolution.

Hydration: Easy, Cheap, Effective Remedy for Two Big Problems

For a while, I've become dizzy -- close to fainting -- after spending time outside in midday heat. After those episodes, I've noticed big dips in my blood pressure (BP), often below 100 systolic.

At first I thought it was "orthostatic hypotension," the BP drops people sometimes experience when they change from sitting to standing positions. While positional changes didn't cause my dizziness and low BP, I still figured my problem was connected to orthostatic hypotension (OT), since that condition typically affects the elderly and people with Parkinson's.  

Neither my internist nor my BP specialist bought my OT diagnosis.They suggested some remedies -- wearing an abdominal binder that elevates blood pressure among them (I bought the "corset" but haven't used it) An on-line search produced other suggestions such as using salted pretzels to elevate blood pressure. These lists of suggestions no doubt included "drink more fluids" somewhere.  But. that recommendation appears so often in general healthcare lists, I gave it little notice.

When I'd be out and about on warm days during my Norway cruise, I started to carry salt packets -- the kind fast food joints offer. I'd pop the contents into my mouth around 11am on warm tour days, and the simple remedy seemed to work for me. No sinking spells.

The Breakthrough
Last week, I had my first physical exam with my new internist. As we talked, my mouth got so dry I could barely speak. I asked for a glass of water. I drank it, but she didn't seem especially curious about an elderly man's sudden and urgent need for hydration.

Prior Authorizations: Insurance Companies: "Yes!" Doctors: "Ugh!"

An op-ed piece from a doctor in the August 3, 2014 edition of the New York Times opened my eyes about a well-intentioned practice that apparently burdens our country’s already out-of-control healthcare costs: “prior authorizations.”

Here’s how it works: in an effort to keep the lid on costs – a worthy goal – insurance companies regularly send letters to doctors in an effort to make them rethink a costly treatment they’ve prescribed and to choose instead a cheaper alternative.

On first blush, it’s hard not to support the practice. If there’s any healthcare theme we see repeated ad nauseum in the media, it’s unnecessary costs.

But in fact, according to the op-ed letter’s author, Dr. Danielle Ofri, prior authorization “is a wasteful administrative nightmare, a cavalcade of recurring paperwork, lengthy phone calls and bureaucratic battles.”

Dr. Ofri cites a recent study that offers this conclusion: prior authorizations drain about 20 hours per week from every medical practice in America:

• 6 hours of clerical time
• 13 hours of nurses’ time, and
• 1 hour of doctors’ time

The Doctor Almost Loses It
Ofri describes one case – she calls her patient Mr. V – that apparently precipitated the NYT piece. Mr V had high blood pressure that had been very difficult to control pharmaceutically without exacerbating the side effects from his diabetes, kidney disease, and valvular heart disease.

After years of experimenting, Dr Ofri and her her patient finally came upon a combination of four different blood pressure meds that worked for him. Both of them surely thought the solution a major cause for celebration.

Then, Mr V changed insurance carriers, and a rep from the new company sent Ofri a letter challenging her prescribing him 90 pills of a particular medication every month.

"Freud's Last Session" and Reflections on His Assisted Suicide

Last month, just before my Norway cruise, I saw a revival of the play Freud’s Last Session at Theater J in DC’s Jewish Community Center. The two-character drama is based on an imagined meeting between Freud and C. S. Lewis in which they debate God’s existence. The conversation takes place a few weeks before Freud’s assisted suicide.

Either I hadn’t known or had forgotten how Freud ended his life. I made a note to research the topic when I got back from my trip, and I did this weekend.

Freud's Last Session

It’s September 3, 1939. Freud is 83 and suffering from advanced oral cancer. Germany has just invaded Poland. Freud has summoned C. S. Lewis -- still a a young, little-known professor and author -- to his London home. Freud wants to know how such as an intelligent man could suddenly abandon his atheism and turn to religion... or as Freud puts it, “embrace  an insidious lie.”

For 80 minutes (longer than the standard therapy session), they engage in a wide-ranging theological debate that eventually turns personal. Their conversation is punctuated by radio news bulletins -- like Neville Chamberlain’s declaration of war against Germany -- and an air raid scare.

Freud’s Last Session, written by Mark St. Germain, opened Off-Broadway in the summer of 2010. It enjoyed an unusually long run, perhaps because (it was said) every psychiatrist in New York went to see the show.

Home Sweet Home: Garden Photos and Travel Reflections

On the Norway cruise, I met several travelers my age who go from one cruise to another. I couldn't do that. Two weeks away from home, three max, is enough for me. I enjoy my life at home too much to spend a lot of time on the road (or on the ship).

With that in mind, I decided to make this a two-for-one post, alternating photos of my July-August home garden with some reflections on my recent trip.

The New Kindle
I didn't pack it because I hate it. As so often happens these days, the powers-that-be added so many new bells and whistles that it's now difficult for a klutz like me to use the device.

"7 Simple Ways to Prevent Alzheimer's" Really?

#1. Who Knew?

<>  <>  <>  <>  <>  <>  <>

Like me, you’re probably skeptical about lists that “experts” share. You’ve seen them: the special things you can do and eat to enjoy perfect health until you’re 110.

So, here’s a new one I saw in what I consider a pretty reputable info source: the August 3, 2014 edition of "Alzheimer's & Dementia Weekly." The title of the story? “7 Simple Ways to Prevent Alzheimer’s.” It’s written by the online magazine’s medical correspondent, Dr. Manny Alvarez.

If preventing AD were really that easy, networks would have interrupted their regular broadcasts to trumpet the news. The internet would have been buzzing like never before. Phones would have been ringing off the hook all over the world, with people eager to share the astonishing headline with family and friends.

To be sure, we need to take these headlines with a grain of salt.

In this list, however, I saw recommendations familiar to me after years of following the latest medical and healthcare news, especially about the two chronic diseases I have – Parkinson’s and prostate cancer… and a disease I don’t have but fear more than any other – Alzheimer’s.

After seeing most of these recommendations over and over through the years, I’m already doing most of them. I could eat more cinnamon, drink more apple juice, and do a better job of protecting my eyes. 

Otherwise, I feel pretty good about the choices I’m making. I should – and could -- exercise more; I’m surprised that important recommendation didn’t make Dr. Alvarez’s list.

The idea, of course, is to prevent any kind of dementia from developing.

Here are Dr. Alvarez's recommendations to keep Alzheimer's at bay:

Travel Health Issues for this 85-Year-Old with Parkinson's

I thoroughly enjoyed my recent vacation: two weeks cruising up and down the coast of Norway, and a couple days in Copenhagen, where the adventure began and ended. Nonetheless, my time away had its health issues, too; no surprise in light of my age and my Parkinson's disease.

I brought with me the same ailments I have at home, of course. But I got some new insights, too.

Jet Lag, Insomnia, and the Blue Pill
Insomnia is nothing new to me. I’ve wrestled with it for years; just enter "insomnia” in the search box at right. The serotonin booster supplement 5-HTP has kept the problem at bay these past five years since my PD diagnosis. It has also helped with the other two typical Parkinson’s side effects: depression and constipation.

But insomnia resurfaced when we arrived in Copenhagen. During earlier travels, I used (and abused) Tylenol PM and other acetaminophen products. Before I left this time, a friend recommended Unisom (generic: doxylamine succinate).

I took Unisom for the first few days in Europe and again when I got home. But I'm not going to do what  formerly did and continue using the little blue pill. I'll do anything to avoid another "summer from hell" -- a horror story from several years ago when I abused sleeping pills.

Incontinence
I've dealt with this issue for several years -- not all that unusual for an 85-year-old who had his prostate removed 20 years ago and received his Parkinson’s diagnosis five years ago.

I worked with the physical therapist a year ago, but haven't been very faithful doing the Kegel exercises. On this cruise, I spent lots more time with other people than I do at home, and the incontinence became a more embarrassing problem.

Incontinence is a big -- and under-discussed -- issue for many seniors, particularly women. I'll explore the issue in a future post.

Are Commonly-Prescribed Anticholinergic Drugs Increasing Your Risk of Cognitive and Physical Decline?

If you take an anticholinergic drug – widely prescribed (and available over the counter, too) to treat conditions like asthma, high blood pressure, insomnia, dizziness and diarrhea – you may be risking cognitive and physical decline… especially if you’re a senior.

These drugs reduce the brain’s production of acetylcholine, a neurotransmitter -- the first ever identified -- that plays a key role in attention, arousal, and muscle function. Typical of so much in healthcare treatments, the drug’s positive effects typically carries negatives, too.

In the case of these anticholinergics, the side effects are scarier than those we often see. In addition to the risk of cognitive and physical decline, the drugs can also cause sedation, confusion, and delirium. See the "Antocholinergic Pocket Guide" below. It lists many of drug with anticholinergic properties, and the ailments / conditions for which physicians prescribe them.

Over 60,000 Cases Reviewed
A team from the UK's University of East Anglia and the Indianapolis-based Regenstrief Institute recently reviewed 46 different studies that followed 60,944 patients who had taken anticholinergic drugs for up to ten years. The results of that extensive study indicate that these drugs could be a cause of cognitive and physical decline in the elderly.

Dr Chris Fox, lead researcher from UEA's Norwich Medical School said, “This is the first research to show a significant decline in physical, as well as cognitive, function. This means patients could become less and less able to carry out everyday activities like walking around, feeding themselves, washing and getting dressed.”

Fox suggested that the drug's blocking effect of the neurotransmitter acetylcholine is clearly the culprit. He also indicated that seniors are more at risk because of increased “blood-brain permeability,” or the ability of the drug to successfully transfer from bloodstream into the neurons.

It seems as if seniors -- as a result -- may get a heartier dose than younger people -- another difference that underscores

• the necessity for study leaders to include more seniors (and women) to future drug trials, and
• the need for the FDA to consider supporting drug prescription dosage variations for seniors and women.

"So How Was Your Norway Fjords Cruise?"

That's the map showing the route of our 15-day cruise on the Crystal Symphony. 

See those life boats? Our two staterooms (7088 and 7090) were right below the first lifeboat. We were warned that our rooms had a "partially obstructed view." But itt wasn't as bad as we'd feared.

Actually, we were happy to be well-positioned if the ship had needed to lower lifeboats during the Oslo terrorist threat. We thought about charging admission to our staterooms.

Copenhagen

I'll confess: this lovely picture comes from Google, not my camera.

Our cruise started and ended in Copenhagen. We enjoyed three days there before the ship sailed, and another day at the end of the cruise.

Oslo, Norway: Personalized Cab Tours -- Better, Cheaper, and Safer than the Ship's Group Tours

Our ship -- the Crystal Symphony -- heads into the Oslo harbor, our next-to-last stop on the cruise. Oslo is the capital of Norway, considered one of the world's most expensive cities, and thought to have the highest quality of life of all European cities.

Terrorist Threat
As we headed into port, the city was on its highest security alert, as authorities reported credible evidence of a planned attack by an extreme Syrian Islamic group. The Royal Palace, City Hall, and Jewish museums were all closed. Twelve soccer teams stayed home rather than participate in the Norway Cup games scheduled to begin that weekend.

The ship's officers just announced -- without details -- that passengers might face tightened security when disembarking. News of the threat spread quickly, as passengers got emails from concerned family members. Some changed their planned city excursions and stayed on board.

Living in Washington, DC, where security alerts are not uncommon, I decided long ago not to let rumors about terrorism affect my plans. Besides, the two places I wanted to visit -- the Vigeland Sculpture Park and the Holmenkollen ski jump -- seemed less likely targets for terrorists than the harbor filled with cruise boats and probably military ships and installations as well.