Forgetting where your keys are, or forgetting what your keys are?

One of the definitions of Alzheimer’s Disease is that it is normal to forget where you put your keys. It is not normal to find your keys and not know what they’re for.

My father died of Alzheimer’s Disease (AD, also known as SDAT – Senile Dementia of the Alzheimer’s Type) at age 78. He recognized no one around him. My mom, on the other hand, died at age 93. She not only knew who I was, but knew that, since it was Monday, it was my day off and that was why I could be with her all day. The fact that she was dying went unsaid. She died just as it got dark that evening.

How does one die of Alzheimer’s Disease? Forgetfulness goes beyond just “what are these things for?” to forgetting how to chew and swallow. The immediate cause may be dehydration or malnutrition but the ultimate cause is the disease. My father’s autopsy report mentioned cardiac arrest and multiple organ system failure…duh. He died when his heart stopped beating, not really because it stopped beating. He could have remained alive longer with IV fluids and a feeding tube, but to what end? He had made that decision long before, as have I. If you have not done it yet, write an Advance Directive – a document that specifies what care you want (and don’t want) in the event of a terminal condition. I know – you don’t want to think about that. Death happens to other people. Guess what? It happens to all of us. But you’re not old. Guess what? Not everyone dies of “old age”. Ultimately, there is one terminal condition in life – it is birth.

Alzheimer’s is only definitively diagnosed after death, from examining the brain. In his case, they even left that out until we demanded an addendum to the report. They had examined his brain but neglected to include those findings in the report. With research, we may be able to diagnose the disease short of death; maybe even treat, cure, or prevent it.

An aside: you may notice that “cure” is a rarity in medical science. We tend to “treat” disease by administering medications to control symptoms – medications that often must be taken for life and at great cost. We don’t “cure” a whole lot of diseases. The cynical among us may say that there is little profit in cure and a lot of profit in lifelong treatment.

Prevention of SDAT may well hinge on a lot of the same factors as many diseases – eat well, sleep well, stay physically active, control blood pressure (and have the right genes).

The PBS series Nova produced a documentary on the WRAP (Wisconsin Registry for Alzheimer’s Prevention) study. It is an hour well worth your time. There were damp cheeks in the program, on both sides of the screen.

The project enrolls the children of people diagnosed with AD (and a control group of people without a familial history) and follows them longitudinally. Every few years, participants complete a lengthy questionnaire (with another completed about them by someone who knows them well) and complete a lengthy battery of neurocognitive tests. Additional optional studies include MRI, functional MRI, and PET scans; lumbar punctures; and treadmill testing.

As a test subject, some of this is difficult, as it involves testing to failure. How long a digit span can you recite backward after hearing it once? You get longer and longer spans until you fail. How steeply can you walk up a treadmill at a set speed? You go until you can’t.

Can we see changes in brain structure and function before one develops symptoms of the disease? Does cardiorespiratory fitness delay or prevent onset of disease? Can we see biomarkers of disease in the brain or the cerebrospinal fluid prior to recognizable disease onset? If so, can we address those markers and influence the disease path? These are a few of the questions the study aims to answer.

What’s it to you? Research shows the children of those with AD are more likely to contract it themselves. My father, his brother, sister, and mother all died of AD. On my maternal side, I have questions about a couple of aunts. But you’re not me. According to the Alzheimer’s Association, “1 in 3 seniors dies with Alzheimer’s or another dementia. It kills more than breast cancer and prostate cancer combined.” The longer you live, the greater are your chances of developing Alzheimer’s Disease. If you are a woman or person of color, your risk may be higher than if you are a white male. Per 2022 Alzheimer’s Disease Facts and Figures “Structural racism pervades many aspects of life that may directly or indirectly alter dementia risk.”

Maybe a coast-to-coast bike ride will help prevent Alzheimer’s Disease. That would be icing on the cake. For today, I’ll ride my bike through the snow to the library.

It is snowing. It is the day that US taxes are due. Does that have anything to do with why I am writing this today? It was in 1716 that Christopher Bullock wrote “Tis impossible to be sure of any thing but Death and Taxes” (though for the uber-wealthy, even taxes are not a sure thing).

Not just for transportation anymore

Just as “Leinenkugel’s beer ain’t just for breakfast anymore”1, riding a bike ain’t just for transportation anymore.

How do you get ready for bicycling season? First, disabuse yourself of the notion that there is A Season. Any season is a season for bicycling. For some, the winter is for fatbiking. For others, it’s indoor cycling. For still others, it’s cyclocross. For me, it’s mostly for transportation. It’s how I get to work, the store, the library. Riding just for the hell of it is not common except for my New Year Ride.

New Year Ride. If you were sitting at home nursing a hangover, you missed this.

On the other hand, if “just for the hell of it” is not part of most of your rides, it’s time for an attitude adjustment.

Do you need a special pre-season exercise program? No. You ride your bike. Start slow and easy. Gradually increase speed, distance, time. You don’t need to be a slave to numbers. Listen to your body.

For me, spring is the time to feel the wind without the word “chill” attached to it. It is time to explore the back roads and watch for potholes. It is the time to look for the first robin, the first crocus; to listen for the Spring Peepers; to smell the earth and the lakes come to life; to watch the grass turn green and buds appear on the trees; to notice all of the different greens as they appear. Notice that tree flowers are a different green than the leaves. It’s a time to ride with friends again.

Sunday I rode with friends. We chatted. I still needed tights and a jacket. We rode through “The Only Waunakee in the World” to get high on Bong Road. Monday I rode alone, in shorts and a short-sleeve jersey. I rode beyond Hope and into Coffeytown. Was it a week ago that I shoveled snow?

Part of the half-fast cycling club, at the top of Bong Road. It’s all downhill from here.

Do you need a special bike? No, you need the bike you have, if it is well-maintained and fits you. If either of those criteria are puzzling to you, talk with a knowledgeable friend or visit a reputable bike shop (with your bike). I am riding my commuting bike. It reminds me that I’m not in the shape I’ll be in come July. It makes me get into a rhythm to climb hills rather than just charge up them. It is better suited to spring road conditions, with wider, lower pressure tires, and fenders. When I switch to a bike that’s 6 pounds lighter, I’ll feel faster. When I switch to the bike that’s another 6 pounds lighter, I’ll feel ready for a century, or to ride across the country. I won’t be, but I’ll be in that frame of mind.

Which brings us back to paying attention to your body. In these early spring rides, I don’t have a power meter, a heart rate monitor, an altimeter, a speedometer, odometer, or a clock. I ride how I feel. The “goal” is to have a good time. Numbers do not add to that good time. I know my heart is beating. I know when I’m exerting myself. I know the sun is high in the sky so I don’t have to hurry home before it gets dark. I don’t need more data.

Do you need special gear? Depends on the conditions. Bike shorts are a lot more comfortable than jeans, but I wear regular clothes to ride to work. I’ve written extensively on clothes for winter. It’s not winter. Wear a helmet that fits well. Try a few on. Lean forward into the position in which you ride. Can you see under the brim of the helmet? Ask for help in a bike shop if you’re not sure. If they steer you straight to the most expensive helmet, try another shop. On the other hand, even the most expensive helmet is cheap compared to a craniectomy to relieve bleeding on the brain. You might argue that helmets are unnecessary. That may be true until you hit your head. You might argue that folks in the Netherlands ride more than we do in the US and they don’t wear helmets. I’m not in the Netherlands. Yes, I’ve read the study that claims that people ride more dangerously with a helmet on. They had people ride through a course with and without helmets and they rode marginally faster with helmets. Were they riding dangerously, or without helmets were they overly cautious? The study was not clear. Remember that, if you’re going to quote a study’s conclusion and jump to your own conclusions from that, you might want to read it. I know a hill that I can descend safely at 40 mph. I’ve ridden it at 50. Would I ride it at 40 without a helmet? No way. Did I ride without a helmet in the 1970s? Sure, but then I also rode in cars without seatbelts in the 50s.

1 Song lyric from “Guys on Ice”, book and lyrics by Fred Alley.

Don’t go quoting research to me…

unless you actually read it. And I don’t mean an article about it in the popular or the propaganda press. Those articles were clickbait even before the term came into existence. If it’s sensational and it’s new, it gets press. If it’s later debunked by half a dozen other researchers, it gets much less.

Remember cold fusion? (Fleischmann and Pons, 1989, Journal of Electroanalytical Chemistry) A great scientific breakthrough, until it wasn’t.

We should all know the great autism/vaccine hoax. It was first proposed that autism was caused by the MMR (measles/mumps/rubella) vaccine. (Wakefield, The Lancet, 1997 – later retracted). When that was debunked, it was proposed that it wasn’t the MMR vaccine but thimerosal in vaccines that caused autism.

While it is true that mercury (thimerosal is metabolized to ethylmercury and thiosalicylate) is toxic (mercury was used in the production of felt for hats -hence the term “mad as a hatter” and the character The Mad Hatter in Alice’s Adventures in Wonderland), autism continued even after thimerosal was eliminated from many vaccines.

Then it was proposed that vaccines in general cause autism, and the rise in the autism diagnosis was posited to parallel the rise in mass vaccination in the 1950s and ’60s. Somehow that was proposed as proof. Conveniently left out of that argument is that the first treatment center for autism was established in 1953 and the first epidemiological study of autism was published in 1966 (The Foundations of Autism, Bulletin of the History of Medicine, 2014). The reason the diagnosis increased in the 50s and 60s is that it was accepted as a diagnosis and studied beginning at that time. (Also see Publichealth.org “Vaccine Myths Debunked”)

I could argue with equal fervor that autism was caused by the Cold War. I could construct a compelling argument that the childhood fears brought on by “duck and cover” drills and the fear of nuclear annihilation caused mass psychosis that we came to know as autism, but it would be a waste of my time and yours because, no matter how compelling, I just made it up. Correlation does not equal causation, and two things happening in similar times don’t have to have anything to do with each other.

So no, reading an article about an article, and one intended to sell ads, is not reading or understanding science.

And I don’t mean that if you read the abstract you know what you’re talking about. The British Medical Journal published “Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials” (2003). The abstract indicates that no randomised [the article uses the British spelling] controlled trials were found. Their literature review found that “The perception that parachutes are a successful intervention is based largely on anecdotal evidence. Observational data have shown that their use is associated with morbidity and mortality, due to both failure of the intervention1,2 and iatrogenic complications.3 In addition, “natural history” studies of free fall indicate that failure to take or deploy a parachute does not inevitably result in an adverse outcome.4” [Look at all those citations! It must be credible!]

In plain English: we think parachutes work because we’ve heard they work, but in our literature review we found that some people who use parachutes die and some people who don’t use parachutes survive.

As a result, a randomized controlled trial was undertaken. In 2018, the same journal published “Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial” (Yeh, et al BMJ, 2018). [For some reason, these authors used the American spelling.] From the abstract:

Intervention: Jumping from an aircraft (airplane or helicopter) with a parachute versus an empty backpack (unblinded).

Main outcome measures: Composite of death or major traumatic injury (defined by an Injury Severity Score over 15) upon impact with the ground measured immediately after landing.

Results: Parachute use did not significantly reduce death or major injury (0% for parachute v 0% for control; P>0.9). This finding was consistent across multiple subgroups.

Conclusions: Parachute use did not reduce death or major traumatic injury when jumping from aircraft in the first randomized evaluation of this intervention.” [Yeh, et al, 2018]

I could write a sensational article based on that abstract. Or I could read farther: “However, the trial was only able to enroll participants on small stationary aircraft on the ground, suggesting cautious extrapolation to high altitude jumps.”

In case any doubt remains, here is a photo from the article (copyright 2018, BMJ)

The article isn’t merely a joke […though as a joke, it is great. I recommend the article to anyone who reads scientific literature on a regular basis. It uses all the lingo you’re accustomed to and includes statistical analysis of the findings. It analyzes the strengths and weaknesses of the trial in apparent seriousness. If you like British humour, read it. Available at pubmed.org without a subscription. Search by title. I didn’t link to it, in order to make you do some work.]. It warns that: “When beliefs regarding the effectiveness of an intervention exist in the community, randomized trials might selectively enroll individuals with a lower perceived likelihood of benefit, thus diminishing the applicability of the results to clinical practice.”

The crux of the issue: “The PARACHUTE trial satirically highlights some of the limitations of randomized controlled trials. Nevertheless, we believe that such trials remain the gold standard for the evaluation of most new treatments. The PARACHUTE trial does suggest, however, that their accurate interpretation requires more than a cursory reading of the abstract. Rather, interpretation requires a complete and critical appraisal of the study.” (Yeh, et al, 2018) (Emphasis added)

Note: Any relationship between this posting and current COVID-19 hoax and conspiracy claims is purely intentional. Be careful out there!