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Brain Failure and Brain Fitness: A Farewell to Dementia?

A dread­ed diag­no­sis, that dimmed and doom­ing dilem­ma. Feared, some­times fought, too often for­got­ten. It is the grayest, ghastli­est ele­phant in the room: demen­tia.

What is demen­tia? I, like many oth­ers who ded­i­cate their pro­fes­sion­al efforts to its study and treat­ment, have no good answer. I believe we are lost in our lex­i­con, try­ing to define a brain state so vex­ing and elu­sive it dri­ves us out of our minds.

I hope we can do bet­ter, and I am not alone. In a sen­si­tive and for­ward-look­ing edi­to­r­i­al enti­tled Demen­tia: A Word to be For­got­ten, Drs. Tra­cht­en­berg and Tro­janows­ki of the Uni­ver­si­ty of Penn­syl­va­nia argue that alter­nate terms are more appro­pri­ate for research, clin­i­cal, and every­day set­tings. From sci­en­tif­ic and bio­log­i­cal per­spec­tives, demen­tia is unspe­cif­ic and sub­jec­tive. With­in the walls of the physician’s office, deliv­er­ing the diag­no­sis of demen­tia can erect unin­tend­ed walls around patients and fam­i­lies; vul­ner­a­ble indi­vid­u­als, assum­ing that the “cru­el con­no­ta­tions in the lay lan­guage” actu­al­ly apply to them, are unnec­es­sar­i­ly iso­lat­ed. The authors recount a patient and care­giv­er expe­ri­ence upon first hear­ing the term applied:

An imme­di­ate epiphany occurred, and sud­den­ly the poten­tial dan­ger and threat­en­ing sen­tence of the word became man­i­fest. It was fright­en­ing that some­body might say it to her while she was still able to ful­ly grasp and sense its tox­ic effect and that it would has­ten and seal her fate in the man­ner of a self-ful­fill­ing proph­esy. (Archives of Neu­rol­o­gy 2008;65(5):594)

Words to Live by

Idiot, midget, lunatic, and many oth­er pejo­ra­tive terms have thank­ful­ly been excised from clin­i­cal and polite dis­cus­sion. The result­ing advan­tage goes beyond con­for­mi­ty to stan­dards of social­ly-accept­able dis­course. It enables the pro­duc­tive con­sid­er­a­tion of lim­i­ta­tions which should not be dis­missed or ignored. In the case of cog­ni­tive and behav­ioral dis­or­ders of aging, many resist con­fronting their con­cerns, pre­fer­ring self-con­scious group chuck­les sur­round­ing “senior moments.” What’s more, prac­tic­ing physi­cians have few incen­tives or resources to probe for late-life neu­ropsy­chi­atric con­di­tions. While nihilism pre­vailed for some time, atti­tu­di­nal change has tak­en hold. Proac­tive peo­ple are arriv­ing at spe­cial­ty eval­u­a­tion cen­ters with mild cog­ni­tive symp­toms, well before one would ever con­sid­er drop­ping the D-bomb. Con­se­quent­ly, we need to employ alter­na­tive con­cepts to sig­ni­fy the pres­ence of poten­tial­ly seri­ous brain dys­func­tion.

Wit­ness Brain Fit­ness

Sharp­Brains read­ers young and old already know that Brain Fit­ness is an achiev­able goal. Increas­ing pub­lic aware­ness and diverse tools and venues for pur­su­ing suc­cess­ful brain aging now exist. Use­ful start­ing points for dis­cus­sion are emerg­ing, many reflect­ing the con­cept of pos­i­tive cog­ni­tion. But what do you call that ghast­ly gray ele­phant?

Brain Fail­ure describes the loss of Brain Fit­ness, and fit­ting­ly refers to the state of men­tal degen­er­a­tion and depen­dence expe­ri­enced by mil­lions. Of the many more aging indi­vid­u­als who are threat­ened to endure such a fate, the rea­son­able approach is to con­front the pos­si­bil­i­ty of Brain Fail­ure by pur­su­ing Brain Fit­ness. Nihilists and slack­ers are of course wel­come to slip down the bliss­ful slope toward Brain Dis­as­ter. Those who per­ceive signs of Brain Fail­ure should seek help in iden­ti­fy­ing the bio­log­i­cal and envi­ron­men­tal deter­mi­nants of their symp­toms. Cog­ni­tive and behav­ioral dis­or­ders are com­mon in aging, and are now rou­tine­ly detect­ed and treat­ed at ear­li­er stages than ever before. When med­ical and neu­rode­gen­er­a­tive diag­noses are com­mu­ni­cat­ed, there is no ben­e­fit in evok­ing stig­ma or sound­ing the death knoll. Regard­less, if I had to choose an obso­lete and hurt­ful label, I’d rather be senile than dement­ed. Every­one famil­iar with Brain Fail­ure under­stands it can be unremit­ting and cru­el; we must also rec­og­nize that is reme­di­a­ble. Brain Fit­ness is still the goal, even in the throes of Brain Fail­ure.

Joshua R. Steinerman, M.D. Dr. Joshua Stein­er­man wrote this arti­cle for Sharp­Brains. Dr. Stein­er­man is Assis­tant Pro­fes­sor of Neu­rol­o­gy at New York’s Albert Ein­stein Col­lege of Med­i­cine, where he directs the Neu­rode­gen­er­a­tive Dis­ease Clin­i­cal Tri­als Program.  He is the found­ing sci­en­tist of ProG­evi­ty Neu­ro­science.

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4 Responses

  1. jane says:

    Yes, good doc­tor you are on tar­get Unless you have expe­ri­enced a par­ent with demen­tia, you would not ful­ly under­stand what lies with­in the lack of brain function…yet, in my eyes, we need to address the brain func­tion which is still alive…one which says..what is wrong, I am sor­ry for act­ing this way..violent and inco­her­ent and scared all wrapped up in one breath…it is the live brain that is the prob­lem at this point Amer­i­ca is begin­ning to come to terms with this ill­ness. But, to insti­tu­tion­al­ize? NO that is not the answer. We need trained indid­i­uals to help with home care…the hos­pice team to reco­gog­nize this it ter­mi­nal. Maybe not soon enough for them, but it is a fatal dis­ease; one in which they do not die from. The brain will stop the heart or kid­neys first and the death will be ill… I can go on…but the ones deal­ing with the patient are the ones who are trou­bled. Please write about that …the family..the search for help, the inablit­ly to pay high prices for good …and i mean good nurs­ing care… help those of us who are try­ing and tak­ing on two help one ill demen­tia patient who still has a liv­ing part of her brain and is in distress..thanks jane

  2. Paul says:

    Instead of Brain Fail­ure, I sug­gest Brain Insuf­fi­cien­cy or Brain Dys­func­tion

  3. stark says:

    i think you make a ter­rif­ic point here that what we choose to call it, and what con­no­ta­tions that evokes for suf­fer­ers and their fam­i­lies, is a tremen­dous­ly impor­tant issue in this dis­ease. and i applaud you for open­ing a dis­cus­sion of the issue. i am in this sit­u­a­tion now with my grand­moth­er, who recent­ly stopped being able to live inde­pen­dent­ly. i find myself at a loss with how to cope with my own sad­ness at what she’s going through, which is mak­ing me even less able to help her — espe­cial­ly since i dont have a men­tal image of how, and i think that has a lot to do with the fram­ing of “demen­tia” cul­tur­al­ly, as basi­cal­ly syn­ony­mous with “doom.”

    i will agree with the poster above that “brain fail­ure,” for me a as a non-med­ical­ly trained per­son, is not necce­sar­i­ly help­ful to me in approach­ing what’s hap­pen­ing to my grand­ma. while i under­stand the anal­o­gy to “heart fail­ure” — the word “fail­ure” still sounds just as doomed in every­day par­lance, where­as i know its more spe­cif­ic and pre­cise in med­i­cine.

    what would you think about a term i haven’t heard used in a long time, “sec­ond child­hood?” or a vari­a­tion on that some­how. because, child­hood isnt some­thing you cure, which for me as the fam­i­ly mem­ber, i cant do for what my grand­ma is under­go­ing. but, depend­ing on how oth­ers treat you, you can have a hap­py child­hood or an unhap­py one.

    what do you think?

  4. Margo says:

    The arti­cle is help­ful. My great-grand­moth­er lived at home with Alzheimer’s until 89, then into a nurs­ing home for the last two years of her life. ‘Sec­ond child­hood’ cer­tain­ly sounds warmer, and hope­ful­ly more opti­mistic than dement­ed or senile. I par­tic­u­lar­ly appre­ci­ate the con­cept that we can work with peo­ple hav­ing demen­tias and con­tin­ue to engage in mean­ing­ful care. Good news, indeed!

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