Losing My Mind
Page 7
Over time the cognitive performance of individuals with mild cognitive impairment declined more rapidly than that of the healthy participants and more slowly than that of Alzheimer's patients. However, some patients diagnosed with mild cognitive impairment did not progress to Alzheimer's, suggesting that the mildly impaired group is composed of two subgroups, only one of which is sure to progress to Alzheimer's.
- NATIONAL INSTITUTE ON AGING/nATI ONAL INSTITUTES OF HEALTH, "1999 PROGRESS REPORT ON ALZHEIMER's"
The frightening part of my walk to and from school was getting past the two dogs that waited for me at the top of Nichols Street. To a five-year-old, any barking dog, except your own, is frightening. My parents told me not to run because it excited the dogs, but when I followed their advice the dogs discovered a new way to scare me by nipping my shoes. Sometimes, when the dogs were restrained with tethers, I ran as fast as I could, making the dogs bark insanely as they tried to break their restraints.
My life has not prepared me for any medical ordeal and I am definitely not prepared for Aliheimer's. Before the bad news broke this year, the toughest medical trauma of my adult life had been a runny nose.
THOMAS DeBAGGIO
Although I have written the word "Alzheimer's" hundreds of times in writing this book, I cannot spell the word without looking it up; I often abbreviate it with "AD" or a long scribble. It is a fact that my handwriting, good at one time although not always careful, has begun to fall apart, and my spelling, not always accurate but decipherable, has crashed to the point neither I nor the spell-checker on the computer can divine what I wrote.
Dealing with the diagnosis is one thing; dealing with the friends and well-wishers is another thing entirely and much more difficult.
There was a time in school when I became so frightened that I occasionally wet my pants, or worse. Rather than raise my hand and ask to go to the bathroom in front of the class, I did it where I sat. This trait did not endear me to the woman who drove me to and from school.
The stern nuns in their dark, sixteenth-century habits struck me with fear. Despite their kindness, they were demanding and they permitted no talking or squirming. I went to school there two years and happily transferred to public school in the third grade.
TO FRANCESCO
Do you remember the sweet green grass
we rolled in when you were a diapered lad?
Do you remember your first birthday
with cake on your face i^
The first day in school?
The proud, nervous day you went off to college?
The way you worked with your
grandfather on the job?
And now the proud man,
the careful son,
I see struggling
LOSING MY MIND
with nature and the world,
worried that he may carry the secret clipped gene
like the one that has claimed me more
for sorrow.
Although researchers theorize that antioxidants such as vitamin E may protect against memory loss, studies so far have not supported this theory. Now, new findings provide some evidence that vitamin E may be linked to memory performance. To examine the association between antioxidants and memory, investigators measured blood serum levels of various nutrients and administered health questionnaires, physical exams, and two simple tests of memory recall to 4,809 individuals (age 60 and older).
Those who scored poorly on the memory tests were at least twice as likely to have trouble eating nutritiously— either as a result of money problems or difficulty preparing meals—than those with normal memory scores. Poor memory was associated with low blood levels of vitamin E but not with other antioxidants, such as vitamin C, beta-carotene, and selenium.
The study authors theorize that their results may differ from earlier studies due to the greater ethnic diversity of their study population. Also, this study focused on memory—not on overall cognitive function, which has been the focus of earlier studies. Whether low levels of vitamin E actually precede or follow memory loss, however, requires further research.
- AMERICAN JOURNAL OF EPIDEMIOLOGY, JULY I, 1999
This IS a story of a man surprised by his body and the sudden deterioration of his mind.
THOMAS DeBAGGIO
The woods were deep and came up to the back of our house. Thick hanging vines dangled from tree Umbs, and the underbrush was dense. It was a place almost impenetrable in summer and frightening to a four-year-old. A narrow footpath, hardly discernible from the mass of dark greenery and tall trees, led into the woods.
Forays into the woods were made in the summer at risk. My arms, legs, and face quickly blistered with poison ivy. My parents treated me with calamine lotion. So severe was my reaction to the itchy plant my parents had to use soft cloths to soak up the juices that wept from my open sores.
I learned to stay out of the woods that summer. I waited for frosts to disable the poison ivy before entering the natural dreamland in the leaf-littered forest. It was here my imagination, ignited by the cold silence, played for me as it does still.
Sometimes I go into the kitchen for a drink of water. By the time I get there I can't remember why I am there, but my body ends up at the ice machine. I stand in front of the ice machine and stare at it. From somewhere inside my head comes the message "You are in front of the ice machine because you wanted a glass of water."
At other times I can't remember why I went into the room and my body and mind are no help to me. Sometime later my mind flashes a message and I remember but it is so long ago I am no longer interested.
This has been a tough year for my cat, Sabina. We took her to the vet to have her teeth cleaned. What we thought was a routine procedure turned into a nightmare. Along with cleaning her teeth the vet decided to remove a tooth without telling us. When we came for the cat, she had been traumatized, apparendy the victim of improper use of sedatives. She nearly died, but she eventually pulled through. Now she cannot hear and only knows of your presence through vibrations in the floor, touch, or by sight. Some of her
dd
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usual habits changed. She is frightened when you approach her from behind and touch her. More pecuHar, however, she began to jump away from me as I approached her when she was looking at me. At first I thought my shoes upset her, but she had the same reaction when I approached with bare feet. Six months later, the Alzheimer's diagnosis was given and I wondered if Sabina sensed a change inside me and saw I carried death within me now.
Previous research has suggested higher levels of education may protect against cognitive decline later in life. Known as the "reverse" hypothesis of brain aging, this theory suggests that education—or what it measures—provides the brain with extra reserves that enable it to defend against the damage of dementia. Researchers in a new study theorized that if the reserve hypothesis is correct, then cognitively normal people with higher education levels may have evidence of extensive age-related brain changes without the usual accompanying dementia. For evidence of such changes, they took magnetic resonance imaging scans of 320 older, non-demented individuals (age dG to 90).
Each year of education was associated with an increase of approximately 1.77 mL in peripheral cerebrospinal fluid volume. But despite the fact that peripheral cerebrospinal fluid volume is a marker of atrophy in the context of the brain, the subjects did not have dementia. Why education levels may help preserve cognitive function is unclear. But by studying brain structure, researchers hope to forge a greater understanding of possible causes of, and protective measures against, dementia.
- NEUROLOGY^ JULY 13, 1999, JOHNS HOPKINS WHITE PAPERS
THOMAS DeBAGGIO
Some days I am frightened to sit down and write, a task I have loved for forty years. I have also become more cunning and wary, characteristics I did not know three years ago. The disease is not visible to anyone but me, but I live with it and I am conscious of it in many ways. I find ways around the
misspellings that litter my manuscript. At any moment I may lose my train of thought and end up losing another neurotransmitter and the story that went with it.
^^
It is now several months after I was diagnosed with Alzheimer's. During much of that time I have focused on my own shaky emotional state. It has been a time filled with tears and uncontrollable emotion. My throat still catches when I tell someone about my illness and what a slender chance of cure I have. I hope a bright researcher will create a cure soon enough to benefit me. I get angry, too, when I hear someone talk about this disease as if it were brought on by improper diet or behavior. I love kind souls who offer me books but this is a disease transmitted through genetic abnormalities and, as yet, it is without cure.
What I have overlooked is the effect of my illness on those around me, especially Joyce, even at this early stage when I appear quite normal. Joyce is on the edge of tears more often than I know. She is as frustrated as I am and as angry at the fates.
I have purposely stayed away from Francesco as much as possible, although it hurts me. Every time I have talked to him about how I feel and what we can do to transition the business to him, I end up choked with emotion and wet-eyed. He has to be cleansed of my emotion. He will have to take care of his mother, as well as himself and Tammy, after I die. I am afraid I may have passed the genes for this disease to him, as I think my mother or father may have unknowingly passed them on to me. The thought of having transmit-
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ted this hellish disease to someone you love is almost more than anyone can bear and it fills my eyes with tears.
Here is what life taught me. You can do all the healthy stuff touted as a way to extend your life, and you can believe in the 200-year-old human, but do not forget you had parents, men and women who were the results of centuries of genetic swapping. Some of those important codes on some of those genes can become damaged. Although it feels light, every morning you wake up with the weight of your genetic history. It is not your fault you have a battered gene that will kill you, but it is your burden now. Smugness in the pursuit of health is a risky attitude.
In summer when I was small, my family visited Eldora, Iowa, where I was born. My family stayed in an apartment above my grandfather's restaurant. My grandparents lived upstairs, too, in a separate apartment. One night I awoke to find smoke in the room and my parents hustling to get Mary Ann and me ready for a quick exit. Smoke was thick and in darkness I was disoriented and afraid. Frightened, at five years old, I wanted someone to comfort me, but there was no time; lives were in danger.
The stairway to the street was narrow, steep, and unfamiliar. I was terrified in the dark and refused to walk; I wanted to be carried. My mother had Mary Ann in her arms and my father was loaded with suitcases. It was not a time for a tantrum. My grandparents were already going down the stairs.
The smoke came from a grease fire in the kitchen of the restaurant. There was not much damage, but the smell of grease smoke lingered. For the rest of the week left of vacation, my family slept at Grandmother Davis' house a few blocks way. It was large and had a second floor with three big bedrooms.
It is a common misconception that tens of thousand of
THOMAS DeBAGGIO
brain neurons die each day. Even if this notion were true, concerned individuals fail to take into account just how many cells the brain contains: approximately loo billion. Even a loss of 100,000 neurons per day would still only represent a small percentage of mental reserves by age 70. In actuality, negligibly few neurons appear to die over a person's lifetime; however, they do shrink, which could explain some of the general slowing of mental functioning that occurs in middle or old age. Serious memory problems arising from cell death occur only when whole clusters of neurons are destroyed by major disorders such as a stroke or Alzheimer's disease.
- "JOHNS HOPKINS WHITE PAPER, I999," JOHNS HOPKINS WHITE PAPERS
The nearness of death sometimes brings about introspection and the desire to set things right with an apology, even small things long forgotten. My sister, Mary Ann, came halfway across the country to see me soon after she learned I had been diagnosed with Alzheimer's.
We grew up in the same houses, four years apart in age, but we have seen and heard from each other infrequently over the last thirty years. We remember who we are but we do not know each other anymore. Her three-day visit was an attempt to get in touch once more. Knowing we could never be close again, if we ever really were, I think she wanted to have one shared time that we could all remember with happiness. It turned out well but it had a surprise for me.
After her arrival with her husband, Charles, she told Joyce she wanted to see a display of photographs at the Smithsonian National Portrait Gallery in Washington, DC. The show illuminated the life of Ernest Hemingway through photographs. He was an author I was surprised to learn interested Mary Ann. Joyce thought it would
LOSING MY MIND
be fun for all of us to go together, but Mary Ann wanted to have a day with me alone while her husband looked at investment property. This request added an unexpected sense of mystery to the visit after Mary Ann told Joyce that she wanted to be alone with me because there "were some issues that needed resolution."
Saturday morning was full of work, and as the afternoon began, Mary Ann and I were alone in the house, hunting for a morsel of food to eat before leaving for the exhibit. She stood by the stove in the kitchen, her body blocking one of the windows facing the used-car lot next door. She began to talk about long-ago events and suddenly she began apologizing to me for what happened when she was a teenager. She remembered taking my father's side against me. I no longer remembered her taking any role at all and listened politely. I remember almost none of the details except that it was during a tumultuous time after I left college a week or two after reaching the University of Arizona. I returned home, jobless, without prospects, hugging a copy of The Catcher in the Rye.
My father was the first person in his family to go to college and he became a lawyer. He had plans for me, always a difficult situation for a sibling, and my best hope at the time was to use my wits and ability with the English language to cause as much trouble as I could in the world. I stayed up late writing short stories and listening to clear-channel radio stations hundreds of miles away, the Hound Dog in Buffalo, New York, and especially storyteller Jean Shepherd in the Big Apple.
Every morning a copy of the Washington Post classified ads was on the kitchen table with large circles drawn around jobs he thought promising. It was a tough time for all of us and all our stomachs were awash with adrenaline most of the time. Eventually I found a job in a military uniform store. It provided enough money for me to leave home.
The second thing my sister wanted to apologize for was a dinner we had in her house thirty years ago. She intended to prepare the meal, but was late coming home. As it got later, Joyce and I, baby
THOMAS DeBAGGIO
Francesco, and my mother all got hungry. In an effort to speed dinner's arrival, I began preparing it from the food I found in the kitchen. When my sister arrived she was not pleased—to put it mildly.
There were probably occasions I could have cited where I slipped and made Mary Ann's life miserable but I thought these confessions were often deathbed behaviors, necessary to make amends before shutting off the lights.
In the little Italian town of Romans de Varmo, in Friuli where my grandfather was born, the family name was Di Biasio. The birth certificates and military documents, written with flair in dark, wiry lines and with official stamps, were carefully stored in his grandfather's safe-deposit box to preserve a bit of the past. When my great-grandfather and his son, Enrico, landed on Ellis Island, an immigration officer, hearing their last name and paying no attention to their documents, wrote their names as Di Biaggio. In keeping with tradition they accepted this new appellation as their "American" name.
When Enrico, called Harry in America, became a naturalized citizen he signed the p
apers De Biaggio. He later "Americanized" his name, as he used to say, by eliminating the "i" between "B" and "a" in DeBiaggio. Many "American" names migrated this way.
Events that create a large emotional impact are usually the ones that are best remembered later. In a new study, researchers explored the connection between emotional memories and the brain's limbic system, which governs the most basic urges and emotions. They showed lo volunteers a series of pictures: some to elicit strong emotions (both good and bad), some that were emotionally neutral, and some that were intellectually, but not emotionally, interesting. The subjects were monitored by PET scans during the viewing. Four weeks later, they were shown more pictures and asked to identify the ones they had seen.
LOSING MY MIND
The PET scans revealed more activity in the amygdala when the emotionally powerful images were seen again, and these images were more likely to be recognized four weeks later. These findings suggest that the amygdala is activated by emotional stimuli and that it in turn stimulates the adjacent hippocampus—the major part of the brain involved in long-term memory formation.
- NATURE NEUROSCIENCE^ MARCH I 999, JOHNS HOPKINS WHITE PAPERS
I
My parents tried to instill in me a loathing for name-calling and described it to me as the verbal equivalent of spitting on someone, and I have tried to adhere to their dictum. I have recently discovered I have become a different kind of name-caller and it has come as a result of memory loss. My ability to remember words is diminishing rapidly and I can often see the subject but its name eludes me, and this makes me angry and frustrated.