Pat Summit, the pugnacious, and supremely successful, coach of the University of Tennessee Lady Vols basketball team
, just announced that at age 59, she has been diagnosed with early onset Alzheimer's disease
. Pugnacious applies because she wanted to punch out a doctor who was the messenger she blamed for giving her the bad news. On further reflection, she decided to continue her coaching career
for as long as possible.
She will be the new face of Alzheimer's--particularly early onset Alzheimer's--a celebrity face much in the fashion of Michael J. Fox and Parkinson's disease. She will live her new life in the glare of even greater national coverage of her high profile life and high profile basketball team.
She says she wants to coach for at least three more years.
Can she do it?
Is it possible for somewhat with the level of impairment that Alzheimer's brings, pull off such a challenging cogntivie achievement?
Coaching a basketball team requires a high level of management skills, cognitive organization, and physical fitness. Summit says she will increasingly rely on her staff to help her, but will she be anything more than a figurehead? Will she reign in the fashion of the Queen of England, but not rule as a prime minister?
Alzheimer's, as other dementias, come in various shapes and sizes. Obviously, I have no knowledge of her particular situation, but even her treating doctors won't be able to predict with authority her future. Sometimes, dementias follow a long and slow decline. With others, it's like falling off a cliff. With still others, it follows a step-wise decline. You bump along a plateau until you fall down to a lower plateau, and continue down a long staircase into cognitive oblivion.
Beyond Summit's particular case, there are parcels of research that are suggestive of what might help people with this devastating diagnosis--evidence that cognitive engagement similar to coaching a basketball team will delay cognitive decline. But this comes at a price. If you delay Alzheimer's with heavy cognitive involvement, the progression of your disease, once you get it, will be more rapid and precipitous.
Robert Wilson, a researcher at Rush University in Chicago, in a large longitudinal study, looked at the cognitive progress of 1,157 participants in the Chicago Health and Aging Project. At the start of his analysis, the subjects were 65 and older, and were free of cognitive impairments.
Each subject was rated on their involvement with several cognitive activities, such as listening to the radio, watching television, reading, playing games, and going to a museum.
Using this data, they rated each participant on a five-point cognitive activity scale. They found that in a six-year period, among those without a dementia diagnosis, each point on the cognitive activity scale meant a reduction in the rate of cognitive decline.
Unfortunately, and seemingly paradoxically, the reverse was true once participants were diagnosed with Alzheimer's: the average rate of decline per year increased by 42 percent for each point on the cognitive activity scale.
Simply put, Wilson found that cognitive activity may initially slow cognitive decline, but speed up it up--and the associated mortality--once dementia sets in.
Is this good or bad news for Pat Summit?
On the face of it, given the fact that she has a diagnosis, it may predict a rapid decline. It also may mean that she may have developed Alzheimer's at an even earlier age than 59 had she not been so cognitively involved.
Overall, the success of her future coaching aside, this is not necessarily bad. Wilson notes that an involving cognitive life means later onset and less time suffering from Alzheimer's once you develop it.
"We think what a cognitively active lifestyle does is help delay the initial appearance of cognitive impairment in old age and allows a person to have a longer period of cognitive vitality and cognitive independence," writes Wilson. "Then, if the person lives long enough and the underlying disease is progressing nonetheless, when dementia does become clinically manifest, we think that this sort of lifestyle is associated with a slightly less protracted course of the disease. So that at the end of the day, you're spending a lesser proportion of your lifespan in a cognitively dependent, demented state, which I think is what we're all after."
It's not clear yet why this is true. Wilson speculates that mentally stimulating activities may somehow enhance the brain's ability to function relatively normally despite the buildup of lesions in the brain
associated with dementia. However, once they are diagnosed with dementia, people who have a more mentally active lifestyle are likely to have more brain changes related to dementia compared to those without a lot of mental activity. As a result, those with more mentally active lifestyles may experience a faster rate of decline once dementia begins.
In other words, the brain damage of Alzheimer's proceeds at similar rates among both the cognitively involved and the cognitively disengaged. Cognitive involvement masks the organic damage, which is more progressed once symptoms become apparent.
So pick your poison. Do you want to suffer longer with Alzheimer's, but get it sooner? Keep your mind blank. Do you want stave off symptoms longer, but die sooner once you are diagnosed? Keep working those crossword puzzles.
Cognitive exercising aside, other research indicates that physical exercise can also have some positive effects on Alzheimer's.
Several studies seem to show that aerobic exercise may reduce associated effects of Alzheimer's such as the buildup of a chemical associated with the condition, amyloid in the brain, or, more globally, overall brain shrinkage.
In one study, Jeffrey M. Burns, University of Kansas, looked at 121 subjects, age 60 and older. Among them, 57 had early stages of Alzheimer's, and 64 were symptom free.
"People with early Alzheimer's disease who were less physically fit had four times more brain shrinkage when compared to normal older adults than those who were more physically fit, suggesting less brain shrinkage related to the Alzheimer's disease process in those with higher fitness levels," wrote Burns and his colleagues.
This may be good news for Summit, even though she has already been diagnosed, suggests Burns: "People with early Alzheimer's disease may be able to preserve their brain function for a longer period of time by exercising regularly and potentially reducing the amount of brain volume lost. Evidence shows decreasing brain volume is tied to poorer cognitive performance, so preserving more brain volume may translate into better cognitive performance."
Whatever Summit's future, Alzheimer's remains a devastating disease with no cure now, and no cure on the horizon. As a fellow baby boomer, she is only one of projected millions. Alzheimer's and other forms of dementia afflict up to 5 million people in the United States and about 26 million people worldwide. By 2050, there could be 13 million cases of Alzheimer's alone among U.S. baby boomers and the aging Generations X and Y, according to the National Institutes of Health. Some reports have the global prevalence of Alzheimer's growing to as many as 100 million people by mid-century. This year, the national costs for Alzheimer's will approach $200 million. By mid-century, without a cure or effective treatment, we will be spending more than $1 tillion.
Given the state of medicine's overall impotence when it comes to dementia--our current treatments are no more effective than garlic was for the Bubonic Plague--I can do little more than wish Summit well, and applaud her courage.
My book, Nasty, Brutish, and Long: Adventures In Eldercare
(Avery/Penguin, 2009), was a Finalist for the 2010 Connecticut Book Award. Click here
to read the first chapter It provides a unique, insider's perspective on aging
in America. It is an account of my work as a psychologist in nursing homes, the story of caregiving
to my frail, elderly parents--all to the accompaniment of ruminations on my own mortality. Thomas Lynch, author of The Undertaking, calls it "A book for policy makers, caregivers, the halt and lame, the upright and unemcumbered: anyone who ever intends to get old."
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