Music and dementia

My mother's elder sister died ten years ago, at the age of 90, after a long, slow, tragic decline from Alzheimer's disease.  I remember my Aunt Florence as a bright, intelligent woman, who loved to read, had a whipcrack sense of humor, and could beat just about anyone around at Scrabble.  The first symptoms were a gradual descent into what my mom called "fogginess," but it was accompanied by worry, anxiety, and paranoia.  She lost more and more of herself to this horrible disease, and during the last few years of her life she was immobile, unresponsive, with no apparent awareness of her surroundings.

My cousin, her eldest daughter, and her family cared for Aunt Florence with a diligence and selflessness that borders on heroism.  Even after she no longer knew where she was or who was in the room with her, they talked to her, made sure she was kept warm and safe, and was hugged and shown affection every single day.

To me, dementia is one of the scariest things out there.  I can't imagine anything more fundamentally terrifying than to lose one's memory and sense of self, to have a damaged mind trapped in a withering body, to be totally dependent on others for my care.  No one should have to endure that.  I'm hopeful that research in Alzheimer's will one day find a therapy or medication that slows down the progress of the disease, or perhaps cures it entirely.

In the meantime, there's been some interesting research into palliative care.  Just last week, the American Association for the Advancement of Science announced some research that will be published this month in the Journal of Prevention of Alzheimer's Disease, done at the University of Utah, that considers using music as a way to alleviate the horrible anxiety that comes along with the early and middle stages of the disease.

Researchers found that the part of the brain that mediates our emotional response to music is relatively undamaged by Alzheimer's (for reasons as yet unknown).  They investigated the possibility that even people whose memories were largely gone might remember, and be comforted by, hearing familiar music.  And their results were striking.

Jace King, lead author of the study, said the response was obvious.  "When you put headphones on dementia patients and play familiar music, they come alive.  Music is like an anchor, grounding the patient back in reality."

[Image licensed under the Creative Commons Evdokiya, EscportalW Music transparent, CC BY-SA 3.0]

The researchers placed the test subjects in an fMRI machine, and monitored brain activity while playing one of three things through headphones -- a selection from the patient's music collection, the same music played backwards, and silence.  The familiar music triggered dramatically increased activity in the cerebrum, and a spike in functional connectivity.

The previously quiet parts of the brain were once again talking to each other.

Norman Foster, senior author of the paper, was encouraged by these results.  "This is objective evidence from brain imaging that shows personally meaningful music is an alternative route for communicating with patients who have Alzheimer's disease," Foster said.  "Language and visual memory pathways are damaged early as the disease progresses, but personalized music programs can activate the brain, especially for patients who are losing contact with their environment."

It's not a cure, or even a treatment, for the disease, but anything that can alleviate the horrific anxiety that comes along with it is a blessing.  "In our society, the diagnoses of dementia are snowballing and are taxing resources to the max," study co-author Jeff Anderson said.  "No one says playing music will be a cure for Alzheimer's disease, but it might make the symptoms more manageable, decrease the cost of care and improve a patient's quality of life."

Which is tremendous in and of itself.  Considering how much music affects me emotionally -- I'm the guy who wept the first time I heard Ralph Vaughan Williams's Fantasia on a Theme by Thomas Tallis -- it's fantastic that there is a way to bring some of that emotional depth back to people who are becoming progressively disconnected from their world.

So if, heaven forfend, I ever descend into that deep, dark pit that is Alzheimer's, please give me a temporary reprieve by playing some of my favorite music.  You could start with Stravinsky's Firebird.

After that, use your imagination.  I'll be thankful, even if at that point I may not be able to say so.

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This week's featured book is a wonderful analysis of all that's wrong with media -- Jamie Whyte's Crimes Against Logic: Exposing the Bogus Arguments of Politicians, Priests, Journalists, and Other Serial Offenders.  A quick and easy read, it'll get you looking at the nightly news through a different lens!

A panacea for aging

As a relatively healthy 55 year old, I don't spend a lot of time thinking about aging.  I've got creaky knees sometimes, but still run regularly.  I have a few minor issues -- mild high blood pressure that is completely in check with meds, eyesight that used to be better than it is now, a little bit of tinnitus.  But I'm well aware that I've been lucky.

It might be that luck that makes me avoid thinking of things like knee replacement surgery, cataract surgery, heart valve replacements, prostate enlargement.  Worse still, dementia, strokes, cancer.

So put simply: I don't mind aging, I just hate all the stuff that can come with it.

[image courtesy of photographer Chalmers Butterfield and the Wikimedia Commons]

That's why I've watched with interest the research regarding anti-aging therapies.  What we know of the mechanisms of aging has been expanding exponentially; we now have a lot of understanding of the role of telomeres (caps on the ends of chromosomes that shorten as you age, providing a sort of biological molecular clock), apoptosis (pre-programmed tissue death), and oxidative stress (chemical damage from diet and naturally-produced toxic byproducts in the body).  Of these, the telomeres have received the most attention, especially when it was found that reactivating telomerase -- the enzyme that in the young prevents degradation of the telomeres -- doesn't simply halt aging, it can reverse it.

So it was with considerable interest that I read an article that was sent to me by a loyal reader of Skeptophilia yesterday.  Entitled, "First Gene Therapy Successful Against Human Aging," it tells us about a researcher who has performed the first trial of a genetically-based anti-aging therapy -- by testing it on herself.

Elizabeth Parrish, CEO of the gene tech firm BioViva USA, injected herself in September 2015 with two of her company's experimental anti-aging compounds.  One was designed to slow down muscle mass loss, the other to reverse the stem cell depletion that is connected with a whole host of age-related disorders.  The test was ostensibly to demonstrate the safety of the procedure.  But when Parrish was tested in March 2016, it was found that her telomeres had lengthened an amount corresponding with a reversal of aging of about twenty years.

I had to read that part twice, just to make sure I'd read it right.

Parrish, understandably, was elated.  If these results check out, she could well end up a multi-millionaire, if she doesn't end up with a Nobel Prize in Physiology.  "Current therapeutics offer only marginal benefits for people suffering from diseases of aging," Parrish said in a statement. "Additionally, lifestyle modification has limited impact for treating these diseases.  Advances in biotechnology is the best solution, and if these results are anywhere near accurate, we've made history."

Indeed.  Of course, anti-aging therapies open up a whole new realm of ethical problems.  First, how much will they cost?  If the precedents set by the pharmaceuticals industry are any indication, they'll be out of the reach of any but the 1%.  Will they be paid for by insurance?  Unlikely; as much as one could argue that reversing again would, in the long run, save insurance companies money, insurers have not exactly been at the forefront of preventative medicine.  I remember vividly being more than a little outraged when I was preparing for a trip to Southeast Asia, and was told that my health insurance wouldn't cover anti-malarials.  The drugs themselves weren't that expensive -- the issue for me wasn't really the money.  "Don't they see," I fumed, "that paying thirty bucks for a bunch of anti-malaria pills is smarter and far cheaper than paying for combatting an actual case of malaria for the rest of my life?"

But no.  Apparently they didn't see that.  So there's no way, at least at first, that insurance companies are going to spring for anti-aging therapies.

Also, let's suppose that we could slow down aging, to the extent that human life expectancy would be doubled.  From what we know about the mechanisms of aging, what that would mean is that we could expect a much longer period of virtual stasis -- a 120 year old might well look more or less the same as he did at 40.  If this sort of thing became widespread, it'd likely have a serious effect on the world population -- especially when you consider that although women would probably still go through menopause in their forties (the mechanisms of menopause are probably not related to the other factors involved in aging), men would stay fertile for much, much longer.  Unless something went wrong with the plumbing, a 130-year-old guy could well still be fathering offspring.

Then, there's the problem of the economic impact.  What about retirement?  If I at 55 still felt like I did when I was 25, I probably wouldn't be ready to retire from the work world.  But to spend the next sixty years still teaching the same thing in the same school?  I love my job, but for me that falls into the category of "Just shoot me now."  So people would probably have multiple careers, not to mention be much more likely to go back to school to be retrained to do something completely different.

And we'd have to.  No way could the retirement and social security systems, in the United States at least, support a whole bunch of retiring 60-year-olds for the last eighty-odd years of their lives.

There are some upsides.  When an expert individual dies -- a scientist, doctor, researcher, teacher, historian, musician, artist, writer -- that represents an irretrievable loss of information.  People who were making unique contributions to society could do so for much longer, and have much longer to train the next generation.

So the whole thing would turn society upside down.  On a personal level, I won't lie; it's tremendously appealing.  I figure that sooner or later, my luck's bound to run out, and I'll end up with some sort of age-related nonsense to deal with.  We all do, eventually.  But if I could forestall that by another hundred years -- well, all I can say is, sign me up, ethical issues be damned.

A win for the good guys

I find it discouraging, sometimes, how often the hucksters win.  We still have homeopathic "remedies" on pharmacy shelves.  Selling supplements of dubious benefit and largely unknown side effects is still a multi-million dollar business.  Throw in all of the purveyors of woo who every year bilk thousands of people out of their hard-earned cash, and it all adds up to a pretty dismal picture.

But still, every once in a while, the good guys come out on top.

This  happened just this week with the announcement that the creators and marketers of the "Lumosity" brain-training games are being ordered to pay $2 million in reparations to customers who fell for their "unfounded claims that Lumosity games can help users perform better at work and in school, and reduce or delay cognitive impairment associated with age and other serious health conditions."

The selling points were attractive, with the aging population becoming increasingly (and justifiably) spooked by the specter of Alzheimer's and other age-related dementias.  I can understand the fear; I watched my aunt, my mother's older sister, outlive both of her siblings, finally dying at the age of 90 after spending the last ten years of her life essentially unresponsive and needing 24-hour care due to the ravages of Alzheimer's.  It's my worst nightmare, really.  The idea of having my body go on long after my mind is gone is absolutely terrifying.

So the claim that you could stave off dementia by playing some computer games was appealing.  So, too, were there other claims -- that you would improve your performance at work, at school, and on the sports field, feel more alert, perform cognitive tasks more quickly and accurately.  A direct quote from their advertisements said that playing their games three or four times a week would help users to reach "their full potential in every aspect of life."  With that kind of claim, it's understandable why people fell for their sales pitch.

[image courtesy of the Wikimedia Commons]

The problem was, it had no basis in fact, and the Federal Trade Commission is requiring Lumos Labs, the company which created and marketed Lumosity, to refund money to their customers because they were participating in "misleading health advertising."

"Lumosity preyed on consumers’ fears about age-related cognitive decline, suggesting their games could stave off memory loss, dementia, and even Alzheimer’s disease," said Jessica Rich, Director of the Federal Trade Commission’s Bureau of Consumer Protection.  "But Lumosity simply did not have the science to back up its ads."

In fact, it wasn't simply a lack of evidence; there is significant evidence against their claims.  A 2014 joint statement from Stanford University and the Max Planck Institute said that "The strong consensus of this group is that the scientific literature does not support claims that the use of software-based 'brain games' alters neural functioning in ways that improve general cognitive performance in everyday life, or prevent cognitive slowing and brain disease."

But flying in the face of scientific evidence wasn't the only problem.  The FTC found that "...the defendants [failed] to disclose that some consumer testimonials featured on the website had been solicited through contests that promised significant prizes, including a free iPad, a lifetime Lumosity subscription, and a round-trip to San Francisco."

So promoting falsehoods for profit + paying people to give you good reviews = a $2 million penalty.  Which is exactly as it should be.

It's high time that the FTC crack down on these spurious claims.  You have to wonder how long it'll take before they can get the supplement-and-remedies cadre to stop hiding behind "This product is not intended to diagnose, treat, or cure any human illness" as a catch-all disclaimer and general Get Out of Jail Free card.

In any case, I find the whole thing heartening.  I do believe in the principle of caveat emptor, but we sure as hell wouldn't have to invoke it quite so often if the powers-that-be would pull back the reins on the false advertisers.