Sunday, June 30, 2013

From Costa Rica to ... Dementia

Roberto was a funny guy.  During one conversation, he said, "oh, wait, what is the name of that German guy? A big time doctor?"  After a momentary pause, he resumed, "Oh, yes, Alzheimer."

We laughed.  Hey, I like a good joke.

The vacation is over, and Costa Rica seems more and more distant in the rear view mirror.  As I returned to my regular reads, it turns out that two of my favorite publications had something significant to offer me about Alzheimer's.

This article (sub. reqd.) in the New Yorker notes:
In the United States alone, roughly five million people suffer from Alzheimer’s, a figure that is expected to more than double by 2050. The annual cost to the nation for treating the disease may then approach a trillion dollars; the cost in suffering is incalculable.
Yet three decades of Alzheimer’s research has done little to change the course of the disease.
Way back, when I was barely thirty years old, I decided that I ought to make clear to wife and daughter my preferences for medical treatment.  I didn't want any big time life supporting machines to be hooked up to me.  Donate my body to a medical school. At a dinner table conversation, I told the attorney friend that my greatest worry was that I would end up with dementia. With Alzheimer's.

Dennis laughed.  "Alzheimer's won't be your problem at all, but somebody else's."  And he looked at my daughter.

As one who loves living the life of the mind, and with thinking as my profession and hobby, I shudder to think that I could lose it and then be in a state of being around without actually being around.  I have been waiting for some kind of a development that would nuke Alzheimer's before it actually begins.  A preemptive strike.  It is all the more important for societies all across the world to understand, and not merely because Sriram is worried about it, because of our longer and longer lifespans.
Current surveys show that, of the population over eighty-five, roughly a third of people worldwide have Alzheimer's. ... "If we lived long enough, would we all become demented, with plaques and tangles?  Is Alzheimer's just another name for aging?"
Doesn't take much to imagine the complexity involved.  Taking care of an Alzheimer's patient is no easy task for a caregiver.  If one decides to outsource this care-giving, the expense quickly adds up.
A recent study in the New England Journal of Medicine estimated that caring for an Alzheimer's patient costs forty-one thousand to fifty-six thousand dollars a year.
This piece in the Economist, also on Alzheimer's, puts the cost figures thus:
In America in 2010, the cost of treating those with dementia was $109 billion. That exceeds the cost of treating those with heart disease or with cancer. The RAND Corporation, a Californian think-tank, reckons this cost will more than double by 2040.
That comes across as a low estimate, compared with what the New Yorker suggests: "more than a trillion dollars a year by 2050."

Let's hope that the drugs that are in the trial stages will work out.

Here is to hoping that my constant worries will help in preemptive strikes against those crazy proteins that trigger the Alzheimer's.  If not, my daughter needs to be warned that Oregon's Death with Dignity won't extend to Alzheimer's patients--how can it when they cannot rationally think and decide for themselves!


Ramesh said...

You've raised one of the most difficult of topics. Every disease is a horror, but those like Alzheimer's and Parkinson's, or even plain dementia, are one of the most awful. Is it worth living when one's mental faculties are destroyed. Millions have been poured into research, for these are "rich man's diseases", but the cure is very elusive, because we are just scratching the surface of the complexities of the brain.

Switzerland allows assisted suicide for terminally ill people. There have been cases like this with huge ethical and moral issues.

I know you are an atheist, but my own position is a prayer to God, not necessarily to spare me the horrors, but to give me the strength to bear them, if they come to me.

Sriram Khé said...

I have been thinking about this for a number of years, Ramesh. Decades, I think. Longevity is as much a curse as it is a blessing. It is one of those that is a wonderful example of "be careful what you wish for."

A few years ago--maybe ten years ago--one older woman--a friend/relative of my father's--whom I was meeting for the first time ever, said something like this: "science has increased the number of years we live. But the quality of life is horrible. Why do we need then these long lives?"

I suspect that she merely vocalized what many people think. Not only in India, but all over the world. Of course, the longer one lives, the probability of various kinds of sufferings and disappointments and pain and everything else also goes up.

And the longer we live, the more we become candidates for ailments like Alzheimer's. And here is the worst part of Alzheimer's: the patient kind of slips into an ignorant bliss. So, your prayers for strength to bear the disease should be directed more in favor of the ones who have to care for you because they are the ones who will experience and feel everything. Which is why my friend Dennis cracked the joke that it won't be my problem.

And if you look at the economics of aging ... the longer we live, the more we suck up the resources that otherwise families and society will allocate for the future. For the kids. For public infrastructure. For R&D. But, instead, aging becomes an expensive need to meet. And an unproductive investment in that.

Right from when I was a teenager, it has scared the heck out of me that I could live way too long. And, dammit, I haven't picked up any wrong habits either. I tell ya, it is one awful nightmare for me.

Out of politeness, families do not discuss these issues. As a society, we dare not discuss these issues. Which means we are all living in some collective denial ...

BTW, both the articles point out that despite the urgency, not enough money has been invested into understanding Alzheimer's and dementia and such ... I would think that we have, as a contrast, invested way more into viagra and breast implants! We humans are messed up in our preferences and no god can help us ;)

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