The Second Childhood

The brain is the "3 pound universe within".  However, we don't actually know as much about this 3 pound universe as we would like to.  When stuff goes wrong in there, we can't seem to fix it.  This little 3 pound universe has a mind of its own and refuses to tell us its secrets.

Alzheimer’s disease, in laymen terms is when the neurons in the brain begin to die, which leads to both a diminished mental capacity and diminished memory.  Protein plaque from the dying neurons begin to build up and inhibits blood flow further, which causes more neurons to expire and the 3 pound universe begins to shrink and disintegrate.  It’s like our home planet has decided to go supernova on us.*

There is no cure for this disease. 

Some drugs may be prescribed to slow the dying process, but their effectiveness is questionable.  Other drugs prescribed to Alzheimer’s patients are for behavior modification.  As mental capacity diminishes - illnesses such as depression, schizophrenia, paranoia begin to get more pronounced.  Drugs are prescribed to subdue the patient and make it more manageable for the care-givers.  So really, these drugs are not for the patient’s benefit (and in fact are frequently harmful to the patient), but they continue to be prescribed for the convenience of the care-givers.

An estimated 95% of the occurences are non-hereditary.  They appear to be sporadic occurrences triggered by an unknown combination of environment, lifestyles and other degenerative diseases like diabetes.  It is now believed (though not proven yet) that the culprits that cause the neurons to die out are astrocytes.  Astrocytes were considered to be fillers in the brain and so largely ignored.  They were thought to be like little worker bees that unobtrusively work away at nothing special, and of no real importance. 

Now it appears that if the astrocytes decide, the neuron should die, it will die.  All these years, they've been focusing on fixing the health of the star player neuron, while the astrocyte has quietly been directing the whole show, and we didn't even know it!  In all those whodunits, the killer is always the quiet unobtrusive butler!  Everyone knows that!  Trash whodunnit novellas should be required reading for all serious scientists :)

There is a lot of noise from the pharma industry that claims that stem cell research will yield the answer because it carries the promise of creating new neurons.  To me that's like dropping more soldiers in an area surrounded by the enemy who will just kill them as they killed the previous troops.  Forgive me for being skeptical, but I will believe them when they manage to grow a missing foot or an arm.  When they can successfully regenerate something simple like that, I will believe their claims that they can regenerate a brain with all its complexities.  Until then, they can claim what they want, I just don't believe them. 

Just so my bias is completely clear, I think the pharma industry is out to fleece mankind.  I find their ethics deplorable.  And it concerns me that they churn out more *therapies* than cures.  You see, cures would cure the disease and remove dependence on their product.  Therapies, on the other hand require a lifelong dependence on their product which is financially secure for them.  Their business model is contrary to the benefit of their client base.

Coming back to an Alzheimer’s patient - this is usually someone over 65 years of age, whose brain is shrinking.  What you end up with in the advanced stage is a two year old complete with the tantrums, incontinence issues and delusional flights of fantasy including imaginary friends, wandering issues, limited vocabulary and ability to express, etc.  Unfortunately, this two-year-old is not adorable in the marketing sense, so will not evoke your maternal instincts.  And therefore there is no mother-figure around to teach it again. 

We have a two-year old orphan child who, in the best case scenario, is surrounded by uncaring nannies that dope up the kid, use physical restraint, and in general ignore all social and intellectual needs of the Alzheimer's patient.  In the worst case scenario, the orphan's family cannot care for her at all, so she's left to rot on the garbage heap of their indifference.

As a community, we ought to have orphanages for these abandoned old orphans.  As humane people, we shouldn't let the greed of the pharma industry define how we treat our own.

The hope for these patients is that a normal person actually uses very little of their brain.  So even if they lose parts of it, theoretically, they should be able to just relearn by using another part of their brain.  The basis of this theory is the fact that when brain trauma patients become amnesiac because part of their brain was damaged; they are taught to reintegrate using physical and psych-therapy.  They are taught again how to talk, walk and live.  They learn to make new memories and build a new personality.  Hence the hypothesis that principles of early education delivery designed for children, can in fact be used to teach Alzheimer’s patients also.

Just as we would for a two-year old, we need to provide:

1.  A comfortable and non-hostile environment.  Have you ever tried to manage a two-year old who is over stimulated?  This is how an Alzheimer’s patient will get if there is excess noise, loud shouting and negative feedback from people around her.  Combine this with the fact, that nothing seems familiar to them.  They feel like they are surrounded by strangers.  They are forced to live in an environment that appears to be hostile to them.  They can't seem to be able to successfully run away from it.  Therefore they react in hostile ways.  Instead, if we all can just calm right down.  It’s not a big deal.  Let’s not make it a big deal.  This is what is.  Just accept it and do the best you can.  No point wishing for what is NOT there.  No point crying over it, throwing blame and stressing everyone out - especially the patient.

2.  Plenty of activities designed to fit their limited motor skills and challenge them just a bit.  Activities like gardening, painting, and crafts, which engage some level of abstract as well as rational thinking.  Just because they can't do the things that they once did, doesn't mean that they can do nothing!  Just like a child, they can do plenty.  Unless you can channel their abilities to constructive uses that leaves them with a positive feeling; they will channel it to destructive uses that leaves them with a negative feeling.  They need to feel too.

Destruction seems to come naturally because it is easy.  Construction needs to be learned because it is complex.  It’s up to us to re-teach them the value of construction.  You can't just ignore them because they are no longer functioning at your level.  Just as you won't and shouldn't ignore a two year old.  If you ignore them, they will behave badly to get your attention back on them.  Ignore their negative behavior and applaud the positive.  Just do it consistently and before you know it, they should be learning again.

3.  Loads of physical comfort from people who are familiar to them.  This one is tricky to deliver.  Much like an infant that immediately recognizes an unfamiliar lap and start bawling; these patients shrink away from physical touch from people they do not recognize.  Yet they need that physical touch and the comfort it delivers.  Imagine what it is like to stand in a crowd of strangers just craving to be hugged and loved by someone, and yet refusing to be hugged by strangers or believing that a stranger couldn't possibly love you.  This is how they would probably feel all the time. 

The importance of a primary care-giver is great in this situation.  Someone that they could bond to and trust.  This person would provide that emotional and physical nurturing that could bring them to a safe place where they could begin to relearn again.  You cannot teach a scared and isolated child anything.  The child would be too obsessed with its immediate insecurities to actually learn anything.

4.  Interaction on their level includes buying into their delusions and imaginations.  This actually helps them relate better to reality.  Sit with them and listen to their stories.  Live their stories as they live it.  You can learn more from their stories, than what they can actually verbalize rationally.  Like children, they reach out to connect with their imagination.  If you can connect with their imagination, then they can connect with reality through you. 

This principle is the same as when one would do the airplane act with a spoon full of peas to make it safely land in the airport of a toddler’s mouth.  Use their imagination to deliver a needed reality.  You really can't force a spoon full of peas into a pursed up mouth.

5.  Provide a safe wandering area so they can explore on their terms and enjoy the feeling of freedom and foster independence.  We all need to be alone from time to time.  A kid is no different.  An Alzheimer’s patient is no different.  Being alone is a way to connect back with one's own self.  A centering of emotions.  Enabling of quiet contemplation.  We don’t want to be over-indulgent parents who over-stimulate their children and raise attention junkies who are constantly dependent on others for their stimulation.

We don't just need hospitals and long-term medical care facilities for these patients.  We need drug-free care centers like early-learning educational institutions that provide a safe learning environment to re-teach them how to access the parts of their brain where the neurons are still alive. 

Maybe if they start using the neurons in new ways, the astrocytes may cooperate and rush over blood to the newly activated neurons.  After all, it has been proven that the more we think, the more blood is diverted to the brain, enabling more learning. 

As a hypothesis, this makes more sense to me than confronting the huge expense, ethical questions and effectiveness of stem-cell research and its vague promises of a utopian evergreen and immortal future.  I would rather have a future built by educators and humane helpers, than one built by those blood-sucking pharma industry principles that advocate and create life long therapies which deteriorate the quality of your life even as they extend it.

As environments get more polluted, lifestyles get more self-indulgent, and the population ages into longer but not necessary healthier lifespan - this disease is going to get more pronounced.  It won't be enough to just suppress the symptoms.  We need to think about ways to address the needs of these de-evolved humans who reenter childhood in their twilight years.  We need to integrate them back into our social fabric.  These old but new orphans need love and care too. 

They need a new beginning before it all ends. 

*The definition given up above of the disease, is a simplified understanding that is intended to be true to the effect of the disease.  This definition is meant to convey the effects of Alzheimer’s on a brain using analogies that seem to fit it.  If you are looking for the complete technical definition, then I would encourage you to google for it or talk to someone who works in this field.