Struggling to Remember

    You're at a party or a dinner with friends, the conversation getting lively, the subjects popping up and bouncing with such rapidity that you want to jump in but there's no opening; then there's a moment of pause and you can speak but...you forgot what you were going to say.  It's gone, as quickly as it came and as desperately as you try to remember, it's gone.  There was an old concept of this, that by going backwards to the "main line" you can retrace your steps and thus remake the connection, the old "what were we talking about" question serving as a trigger for your "ah-ha" moment and suddenly you're back on track.  But for many, there is no going back...it is simply gone.  I witness this almost daily at my mother's care facility, one woman in particular always smiling and always happy to see me and always, always wanting to engage me in a conversation; but then she begins and within seconds --seconds-- her chain of thought is gone.  It's sad for me to watch, as much as it is frustrating for her, for I can see her bright smile almost instantly fade into one of exasperation.  She seems to know that whatever she wanted to say is either not there any longer or she is once again unable to get it out, things she wants to say likely appearing as clearly to her as a hallucination, visible right in front of her but only to her alone.  We laugh about "senior moments" in our younger ages, those brief thoughts of forgetting, but when one is exposed to a deeper level of this, it becomes a bit scary...for that may one day be us.  But for those like my mother's friend, it is likelier even more scary as you become aware that your memory is leaving, ebbing out of you daily as surely as a leaky faucet.

    Taking a slightly different tack, here's what Bloomberg Businessweek reported back in 2014 on the drug that accounted for the highest amount of Medicare prescription spending, the heartburn drug Nexium: Spending on Nexium was $2.53 billion in 2013, the Centers for Medicare and Medicaid Services said Thursday...The data cover beneficiaries of Medicare Part D, the privately run, publicly funded prescription drug program for the elderly...Nexium lost U.S. patent protection in 2014, and an over-the-counter version is also available.  Omeprazole, a generic heartburn medication, was prescribed more widely, and accounted for $643 million of Part D spending.

Graph from Bloomberg Businessweek 4/30/15

    Why would this matter?  As it turns out, new data is showing that such usage may possibly lead to an increase in dementia.  Said one report from Scientific American, the claim was being made that: ...Routine use of proton-pump inhibitors (PPIs)—drugs such as Nexium and Prilosec, used to treat heartburn, gastroesophageal reflux disease or peptic ulcers—may cause or accelerate dementia in elderly individuals...A direct link between PPI use and dementia remains unproved, but the association is plausible and warrants further investigation given the debilitating nature of dementia and lack of effective treatments for it...During the course of seven years, 29,510 participants developed some form of cognitive decline, ranging from unspecified dementia to Alzheimer's disease.  After adjusting for age, sex, potentially related conditions such as stroke or depression, and use of other prescription drugs, the team found that dementia diagnoses were more common in individuals with regular PPI prescriptions.  On average, participants who filled a prescription for a PPI at least once every three months were more than 40 percent more likely to develop dementia than their PPI-free counterparts, according to the paper published online in February in JAMA Neurology...The results are potentially worrisome considering the number of elderly individuals who take PPIs (recent studies estimate more than one quarter of U.S. nursing home residents use them) and the devastating, difficult-to-treat effects of dementia, says University of Pittsburgh epidemiology researcher Lewis Kuller, who was not involved in the study.

    My neighbor (now doing cardiology research) told me that her experience is that people seem to break down into those willing to view the long term lifestyle changes vs. those wanting immediate relief, even if small.  Explaining further, she mentioned about some possible heartburn solutions such as changes in diet or staying upright after a meal or increased exercise or reducing acidic or irritating drinks...or, taking a heartburn pill.  Something similar emerged in a piece from Scientific American Mind when their lead article was titled "How to Prevent Alzheimer's" (that piece also showed excerpts from the possible proton-pump inhibitor/heartburn drug link); there was hope, said the article's author, David Bennett of the Rush Alzheimer's Disease Center in Chicago: We have also found various factors later in life that can buy more years of healthy living.  Among them is something commonly called purpose in life, a measure of well-being that refers to our psychological tendency to derive meaning from life's experiences and to have clear intentions and goals.  Neuropsychologist Patricia Boyle in our group at Rush measured this trait in more than 900 participants in the Rush Memory and Aging Project, the majority in their 70s, 80s and 90s, using a scale based on the work of psychologist Carol D. Ryff of the University of Wisconsin-Madison.  During up to seven years of follow-up, we discovered that those who scored higher on purpose in life were 2.4 times more likely to have avoided an Alzheimer's diagnosis, compared with those with lower scores.  Relatively higher scores were also associated with slower rates of cognitive decline.  In a similar analysis, Wilson found that higher levels of conscientiousness --one of the classic "big five" personality traits, characterized by organization, self-discipline, dependability and a drive to achieve-- also offered some protection: participants in the Religious Orders Study scoring in the 90th percentile in conscientiousness had an 89% reduction on risk for developing Alzheimer's.

    A drive for life.  Good advice for us all of us.  But for many staying in places such as where my mother is  (or for those caring for family members at home), such stimulus might prove to be the most difficult challenge in their life, to pull such drive and determination from within, to defy the odds when another movie is put on the tellie or another round of bingo begins, to realize that you've been "parked" and forgotten in a sense, even by your memory; all of it could be enough to give one heartburn thus reinforcing the cycle.  Long-term view or short-term relief?  For many of us, it might be a good time to start thinking of the path we want to follow for as the saying goes, time --and apparently as we're discovering, memory-- waits for no one.