The Alzheimer's Association today announced the launch of a $20 million U.S. two- year clinical trial to test the ability of a multi-dimensional lifestyle intervention to prevent cognitive decline and dementia in 2,500 older adults with no current cognitive symptoms but who are at increased risk for later cognitive decline. The announcement was made at the 2017 Alzheimer's Association International Conference (AAIC 2017) in London.
The large U.S. study to PrOtect through a lifestyle INTErvention to Reduce risk (US POINTER) will include physical exercise, nutritional counseling and modification, cognitive and social stimulation, and improved self- management of medical conditions. Recruiting for the study will begin in 2018.--Press Release AAIC 2017

Preventing Cognitive Decline and Dementia: A Way Forward
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RCTs are the gold standard in evidence generation but require large investments of money and time. Moreover, while they are particularly effective for testing single-intervention solutions, the apparent complexity of the pathophysiology underlying cognitive decline and dementia suggests that a multifaceted approach may be most effective.  

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As many citizens can attest, the U.S. is a great place to get sick, but a terrible place to stay well. This requires a shift in the way both doctors and patients approach health maintenance and disease prevention.--Rob Wittman

In many respects, our medical systems are best suited to diseases of the past, not those of the present or future. We must continue to adapt health systems and health policy as the burden of disease evolves. But we must also do more. Diseases can never be reduced to molecular pathways, mere technical problems requiring treatments or cures. Disease is a complex domain of human experience, involving explanation, expectation, and meaning. Doctors must acknowledge this complexity and formulate theories, practices, and systems that fully address the breadth and subtlety of disease.--NEJM Jones et al.

Disease is always generated, experienced, defined, and ameliorated within a social world. Patients need notions of disease that explicate their suffering. Doctors need theories of etiology and pathophysiology that account for the burden of disease and inform therapeutic practice. Policymakers need realistic understandings of determinants of disease and medicine's impact in order to design systems that foster health. The history of disease offers crucial insights into the intersections of these interests and the ways they can inform medical practice and health policy.--NEJM

Modern neuroscientific knowledge makes the idea of Gage’s recovery all the more plausible. Neuroscientists once believed that brain lesions caused permanent deficits: Once lost, a faculty never returned. More and more, though, they recognize that the adult brain can relearn lost skills. This ability to change, called brain plasticity, remains somewhat mysterious, and it happens achingly slowly. But the bottom line is that the brain can recover lost functions in certain circumstances.--Slate

Because we are bombarded by media accounts of amyloid deposits in the brain being the potentially causative agent in Alzheimer's disease we may fail to see the forest through the proverbial "tangled and globby" trees. ​Neurodegenerative diseases all seem to have a protein problem. Alzheimer's has tau and amyloid--not to be outdone, frontotemporal dementia is known for TDP-43 (also in ALS), and Parkinson's disease α-synuclein. All present in some capacity in the "normal" brain as well.

Paula Wolfert and the complex questions of dementia...

Thus, the so-called bulletproof coffee she makes every morning and the squares of dark chocolate she eats after lunch, in the belief they will bolster her brainpower. In between, she eats a carbohydrate-free diet built on salmon, berries and greens, along with extracts of turmeric, cinnamon and eggplant.

The gripping narrative traces the arc of her career, from her Brooklyn childhood to her adventures in the farthest corners of the Mediterranean. Anecdotes and adventure stories come Paula's extensive personal archive, from over 50 interviews with Paula herself, and from dozens of interviews with food writers and chefs whom she influenced and influenced her—from Alice Waters and Thomas Keller to Diana Kennedy, André Daguin, and Jacques Pépin.--unforgettablepaula.com

...I say hello to myself and to break the terror of nonexistence I restore my self to existence whatever the consequence-- Excerpt from To Infinite Eternity by Edwin Honig ​

Since Honig was a poet, Berliner felt it was important to honor his cousin's memory by making the film an exploration into the life of a poet, and his film was conceived in poetic terms. "Poets' lives are not arbitrary," Berliner states. "For poets, it's all or nothing. They are the translators of human experience. They're the people we turn to in order to put words and images to the feelings, emotions and experiences we don't understand or know how to deal with. He even says at one point in the film,

​'What you're doing is like writing a poem. You're changing what people are thinking and making them think what you want them to think.' So I felt challenged to make a work of cinematic poetry because of who Edwin was. And not only do I believe that Edwin was a poet right through his last day of life, but I realized Edwin was experiencing what might otherwise be called 'A Poet's Alzheimer's.'

The Misconception: You make rational decisions based on the future value of objects, investments and experiences.
The Truth: Your decisions are tainted by the emotional investments you accumulate, and the more you invest in something the harder it becomes to abandon it.--David McRaney, You Are Not So Smart 

Some people see a focus on basic research as insistence on wastefully pursuing knowledge for its own sake. That assessment is false. Basic research provides the underpinnings for any understanding of disease, so we need to reassess how we spend our precious funds for development of therapies. 
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The wisest investment in many cases may be to understand disease biology first and move into clinical trials second, only after we have conceived a rational plan for how to treat a disease. Otherwise, clinical trials risk continuing to be shots in the dark, costly and frustrating not only for scientists but also for patients who badly need new treatments.--Thomas C. Südhof professor of neurosurgery, psychiatry, neurology, and molecular and cellular physiology at Stanford University. He received the 2013 Nobel Prize in medicine.

The animals we eat--domesticated or wild--contain PCBs, hormone disruptors, and radioactivity, the fish has too much mercury, the tap water tastes of chlorine and contains copper, some tap water from fracking areas catches fire, buildings have toxic indoor air, we breathe in dust and nitrogen oxides, and there's too much ozone near the ground but tool little up in the stratosphere where it should be. The oceans are going acidic. Temperatures have gone off the charts. Forests are burning and fertile soil is getting depleted, eroded, or drought stricken. The entire atmosphere seems to have caught some kind of fever, which is gradually infecting the oceans. The lament and complaints over nature's disruptions go on and on. The earth and the sky have now become full of seemingly meaningless symptoms and suffering.-What We Think About When We Try Not to Think About Global Warming

Today is the designated World Alzheimer's Day. Held  on September 21st of each year, organizations and advocacy groups focus efforts on raising awareness--advocacy speak for marketing and fundraising.

"Although advocacy groups have some legitimate interests in common, industry is the one with the deep pockets, usually much more than these organizations can raise from individuals or foundations. ​Therefore advocacy organizations have increasingly been shown to advocate for clinical guidelines, drugs, and policies that are not in the best interests of patients--but more in line with industry sponsors."--from book proposal Alzheimer's Disease: The Brand

“We are the world’s leading voluntary health organization in Alzheimer’s care,
support and research.”—Alzheimer’s Association

Organizational learning is a process of detecting and correcting error. Error is for our purposes any feature of knowledge or knowing that inhibits learning. When the process enables the organization to carry on its present policies or achieve its objectives, the process may be called single loop learning. Single loop learning can be compared with a thermostat that learns when it is too hot or too cold and then turns the heat on or off. The thermostat is able to perform this task because it can receive information (the temperature of the room) and therefore take corrective action. 
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If the thermostat could question itself about whether it should be set at 68 degrees, it would be capable not only of detecting error but of questioning the underlying policies and goals as well as its own program. That is a second and more comprehensive inquiry; hence it might be called double loop learning. When the plant managers and marketing people were detecting and attempting to correct error in order to manufacture Product X, that was single loop learning. When they began to confront the question whether Product X should be manufactured, that was double loop learning, because they were now questioning underlying organization policies and objectives. -- Double Loop Learning in Organizations by Chris Argyris Harvard Business Review 1977

Hand in Hand--Couple Fights Alzheimer's Together

Even when one is diagnosed with an illness, it should not define them.
Photographer Allison Hess

Physician Understanding and Ability to Communicate Harms and Benefits of Common Medical Treatments

To make educated decisions, patients must understand harms and benefits of treatments. Unfortunately, patients consistently overestimate benefits and underestimate harms of medical tests and procedures.(Hoffmann  and Del Mar)   Likewise, physicians are poor at assessing treatment effect size and other aspects of numeracy.-- Krouss, Croft, and Morgan