Volume 61, Number 1 - Winter 2010

 

By Steve Osborn

By the time I finish writing this editorial, my brain will be several hours older; of this there can be no doubt. What is in doubt, however, is whether I will be older but wiser—or merely older and more cognitively impaired.

I am of an age—56—where I am starting to forget the names of old friends and recent acquaintances, making for occasional awkward moments at holiday social gatherings. “So good to see you,” I say to an acquaintance at a New Year’s Eve party, desperately raking the few remaining embers in my memory banks for any sign of a flame. Is it Bill, Bob or Brian? And what does he do, anyway?

“Likewise,” comes the equally amnestic reply. “It’s been a long time.” Saved by our lack of specificity, we fall into generic conversation. If I’m lucky, a chance phrase will reignite the dormant flame, and I’ll remember that he is indeed Bob the electrician, last spotted one year ago in an identical milieu.

Memory lapses are the wrinkles and gray hair of the aging brain. In this issue of Sonoma Medicine, local physicians and other health professionals examine that process, from the innocence of memory lapses to the ravages of Parkinson’s and Alzheimer’s. The overarching message is one of hope. While physicians have not yet mastered the intricacies of the aging brain, they are making progress in treatment, prevention and detection.

We begin with news of a possible breakthrough in treatment. Dr. Lynne Love describes the results of a brand-new study finding that the MAO-B inhibitor rasagiline slows the progression of Parkinson’s disease. While urging caution, she offers helpful advice for using these medications with appropriate patients.

Dr. Sue Stephenson details the many risk factors for dementia, including vascular disease, obesity, smoking and stress. The good news here is that prevention may delay onset. “Healthy lifestyle,” writes Stephenson, “is paramount for dementia prevention.”

Early detection of Alzheimer’s disease could lead to better preparation and treatment. In “Biomarkers for Alzheimer’s Disease,” Dr. Allan Bernstein describes genetic, chemical and imaging markers for AD that are becoming increasingly refined and accurate.

Our exploration of the aging brain ends inside a “brain gym” at Primrose, a Santa Rosa dementia care facility. Myra Mayesh gives an overview of the computer games and other tools used at the gym to stimulate brain activity and enhance cognition. 

Writing a daily journal enables us to capture our thoughts before they get lost in our memory banks. Few daily journals are as filled with such captured thoughts as the journals of Charles Darwin, whose record of his journey to the Galapagos Islands eventually led him to the theory of evolution. Retracing Darwin’s steps, Dr. Ted Hard offers his own daily journal of a recent visit to those lands. “I have come back,” he writes, “to better understand what happened here.”

Like journals, automobiles can also be a repository for memories. Dr. David Pompa has spent the last four years restoring and vastly improving the Chevrolet Chevelle his father bought in 1966. The car, which his father used to woo his mother, contains a lifetime of experiences for the entire Pompa family, including the grandchildren.

Poetry is yet another aid to memory. In “The H1N1 Influenza Blues,” nurse practitioner Jessica Flinders records a week of misery contending with the pandemic among her patients. “I’ve had this awful feeling,” she writes, “I’m sure you’ve had it too.”

H1N1 isn’t the only worldwide malaise. In “A Transatlantic Malaise,” Dr. John Toton reviews the proceedings of a recent conference on “physician disempowerment.” American physicians have much to complain about in the nation’s health care system, but their colleagues across the Atlantic may have it even worse, at least according to the conference participants.

Diagnoses of the malaise afflicting our health care system are many and varied, not unlike the diagnoses of “medical mysteries” that elude even the most expert specialists. Readers intrigued by such mysteries will want to read Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis, reviewed here by Dr. Rick Flinders.

We close with a call to action by SCMA President-Elect Dr. Catherine Gutfreund, who explains how physicians can “get into the game” and influence policies at the local, state and national levels.

Your comments on all the above are more than welcome. Just remember to tell me your name.

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