Friday, September 29, 2017

A passion for words

Throughout middle school and especially high school, I tended to be an underachiever. Both of my parents were teachers, so I couldn’t claim that I didn’t have the resources in the home to enable me to do well. With the exception of my senior year, when I failed to make the cut for the basketball team, I was engaged in a sport in every season. And, not coincidentally, when I failed to make the cut for the varsity basketball team, I became more focused on my classes. The book that triggered my transformation was 1984, George Orwell’s famous dystopian novel in which love and intimacy are regarded as crimes against the state.
Urged on by my high school football coach, I tried out for the Western Washington University team as a defensive back, but from day one I sensed that I was out of my league. The Western Washington football team was no powerhouse in those years, but many of those young men were huge. And when a flamboyant wide receiver burned me on a long pass completion during a scrimmage, the receiver shouted, Hey, Coach! Hey, Coach! I just burned your DB! I just burned your DB!”  Yes, I got burned on that pass route, and that was certainly a blessing. If my history of injuries in high school was any guide, it seems likely that I would have gotten hurt frequently on the college team. And even after a summer of weight training, I weighed only 150 pounds.
I quickly redirected my energies. Unlike in high school, when I was often indifferent to my grades, now I took my grades seriously—maybe too seriously. Every academic quarter I looked forward to going to the university bookstore to buy my textbooks. Astronomy, to gaze into a dark winter night and contemplate the vastness of the stars? Rocks for jocks? Boring? How so? The fossil record intrigued me. How cool! Or, should I say, how molten? To have a sense of how old the earth is? And the eons before history, the small-brained reptiles, devoid of mother’s milk.  And at the end of this is us, homo sapiens, humanity.
The significance of the wheel. The mute, inscrutable pyramids. Socrates imbibing the hemlock. The misnamed “dark ages.” And then, Columbus, not just reaching a new land, a new continent, but carrying with him an old-world collection of microbes, from which the native populations had no defense. Lust for Mexico’s gold. Martin Luther, fracturing western Christendom, leading to thirty years of religious war. Plimoth Plantation, suffering deeply, almost to extinction. The Declaration of Independence. Gettysburg. Chlorine and mustard gas. The Great Influenza of 1918. Stalingrad. Hiroshima. Stalemate in Korea. Quagmire in Vietnam. The American century.
My vocabulary, meanwhile, was rapidly growing. In my reading, I made a point to write down unfamiliar words. In the summer after my freshmen year, I chose to read Moby-Dick. Melville’s themes went over my head, but I liked the action scenes. One of my favorite words I learned from Melville was ostentatious. He applied this to the whale itself, and its terrible flukes. Elsewhere in that capacious book, I learned about cetology, the science of whales. Sometimes, I would use words egregiously. I accused my dad, during an argument, of being fastidious—which, decidedly, he wasn’t. And also in Moby-Dick, I first encountered the word audacity—a more elegant version of “boldness.”  While reading a newspaper account of a Vietnam veteran, I learned the word premonition, a hunch that something bad was about to occur. Then the bomb went off.
Within this framework, I began to think for myself. And, in doing this—to acquaint myself with history and literature and philosophy in my college years—I apparently developed a partial prophylactic effect that has helped me forestall Alzheimer’s progress. The term for this is  “cognitive reserve,” and it remains somewhat of a mystery. There are two facets to this. Idea density reflects the ability to pack a lot of information within a small space, a useful skill for journalists, in particular. A related phenomenon is syntactical sophistication. If you’re familiar with the prose styles of Earnest Hemingway and William Faulkner, you can infer that Hemingway’s prose reflected “idea density,” and Faulkner embodies “syntactical sophistication.”
Why this information is worth repeating is that it appears to protect the brain to a significant extent, particularly among people with high levels of formal education. Why this is true is still something of a mystery. Perhaps age twenty is a key period for brain development. It is now known that brain development continues into one’s mid-twenties or later. Unfortunately, cognitive reserve won’t protect people up to a ripe age. The phenomenon is finite.

Friday, September 15, 2017

Is Namenda ‘neuroprotective’?

A couple of years before I was diagnosed with Alzheimer’s, one of my doctor’s, a gerontologist—I was 53 at the time—prescribed Aricept. The clinical name is Donepezil, and it’s likely that my gerontologist strongly suspected that I already had Alzheimer’s or some other emerging form of dementia. In the ensuing months, I underwent  a neuropsychological examination and, despite my eroding short-term memory, my neuropsychologist pronounced that I was functioning at a high cognitive level. When she asked me to discuss a current event (this was the early soring of 2014) I chose the Putin regime’s meddling in the Crimea—the region that Russia and other great powers have vied for influence for centuries. I didn’t say it quite that way—I would have been more articulate in writing—but the doctor pronounced that I was “functioning at a high cognitive level.”
My relief was significant but premature. What the doctor was subtly conveying was that despite my weak short-memory, I was otherwise doing quite well. Later I learned about “cognitive reserve,” the phenomenon that benefits some people with Alzheimer’s, particularly among people with high levels of formal education. While cognitive reserve can be helpful, it can’t confer much protection in the short-term memory sphere, which is typically the first realm of the brain to show decline. A few weeks before I was diagnosed, I had a premonition. I was discussing something with my editor, and I was struggling to grasp what he wanted me to do. I didn’t quite formulate my thought this way, but the sense was, this is what dementia is.
The gerontologist delivered the bad news a few weeks later. That she had prescribed Aricept, the most widely prescribed medication for Alzheimer’s, before I was diagnosed, spoke to her confidence that I already had the disease. But Aricept did not sit well with me. Perhaps I didn’t give Aricept a chance. But after having an intense nightmare that had an almost psychedelic quality to it, I decided to leave my Aricept in the medicine cabinet. For a time I took the drug at a reduced dose, but I decided to go down a different road. By now, I’d learned that regular daily exercise—in my case, swimming, vigorous walking and cycling—could help slow down the disease’s pace. And, no longer employed, I have time to exercise. The exercise, in turn, led to good sleep habits. Sometimes I disturb Paula’s sleep, but that’s another story, still in progress.
A couple of weeks ago, though, my gerontologist noted that another Alzheimer’s drug—memantine—has shown some efficacy in clinical trials. The brand name is Namenda. According to the website drugs.com, Namenda “reduces the actions of chemicals” in the brain that may contribute to the symptoms of the disease. But if you have the patience, there is a little nugget waiting to be exhumed. The paragraph begins discouragingly, pointing out that there is scant evidence that this drug can help people still in the mild or moderate stage of the disease. But there is a “very small but statistically significant effect” from Namenda over six months involving cognition, according to the study. The basic question remains whether Namenda can help people in the early and middle stages of the disease.
 According to a study with 431 participants, there was “no substantial benefit” by taking Namenda. If this is progress, I must be blind to it. But there is at least one thing in Namenda’s favor, at least for me: In the two weeks since I’ve been taking Namenda, I’ve continued to sleep well. That was not the case with Aricept. Nor have I experienced significant dizziness, said to be a common side effect of Namenda. But to be honest, I am not optimistic. Researchers have been studying Namenda since at least 2003, and there is yet no hard evidence that people like me can benefit from this particular drug. It’s a stretch to call that “progress.”

Friday, September 1, 2017

Is football in decline?

Not in financial terms. Overall revenue for the 2016 NFL season was around $13 billion. That’s about $3 billion more than the second-most lucrative North America sport, major league baseball. And major-college football, especially in the Midwest and below the Mason-Dixon line, continues to draw enormous crowds as well as lucrative sponsorships.
What I’m most interested in is football’s appeal at the grass roots. When I was growing up in the seventies, 90 miles north of Seattle, organized team sports were basically limited to the big three: football, basketball and baseball. I played all three. Hockey was a club sport. There were signs, however, by the late seventies that soccer, the most popular sport globally, was establishing a beachhead. A coach and teacher at my middle school, Dominic Garguile, went on to a highly successful run coaching the women’s soccer program at my alma mater, Western Washington University, putting soccer on the local sports map.
A friend of mine, a football teammate for seven years, dislikes soccer. He once complained that soccer was siphoning off potential football players. I understand his grievance, but I don’t share it. Like my friend, I have a deep, if ambivalent, attachment to football. As a seven-year-old, watching Super Bowl III, in January 1969, I was moved to tears when the great Johnny Unitas couldn’t rally the Baltimore Colts against the upstart New York Jets and their “mod” quarterback, Joe Namath, the first quarterback celebrity. A few years later I hitched my wagon to the Pittsburgh Steelers, which were just emerging from roughly 40 years in the NFL wilderness. In the seventies, the Steelers turned the tables in a big way, winning four Super Bowls in six years.
By that time, I’d earned a bit of football glory for myself, playing a significant role in our football victory over our rival high school, boosting my confidence to the extent that, if I remained disciplined, I might achieve something substantial with my life. My aim was to establish myself as a prominent journalist. A few years later I took a left turn, abandoning my career in journalism to devote myself to the writing of fiction. For a year or two ahead of the millennium, I barely watched any football at all—not even the Super Bowl. But living in the Boston area, how could I resist the alchemy between Bill Belichick, a dour football genius, and Tom Brady, likely the most poised athlete on the face of this earth. Throughout our young century, the Patriots have won almost unceasingly: Five Super Bowl victories, while almost always qualifying for the playoffs.
But football, as we’ve learned in recent years, has a dark side. I can’t prove that my diagnosis of Alzheimer’s is connected with head trauma. But given the lack of evidence of Alzheimer’s in my family tree, it seems probable that a serious childhood concussion, followed by seven years of organized football at a time when head trauma was not nearly as well-understood as it is now, accounts for my diagnosis.
It may be instructive to view football through a Red state-Blue state lens. Certainly football is especially popular below the Mason-Dixon line, the fault line of American politics going back well before the Civil War. On the other hand, the birthplace of football—Ohio—is in the north. A more accurate gauge might be the nation’s roughly 3,000 counties. In affluent, more educated counties, I suspect, parents are likely to be less eager to expose their children to football’s hazards—especially what we now know about the consequences of untreated concussions. Of course, football isn’t the only sport to spawn concussions: thanks to youth soccer’s popularity, many young soccer players are suffering concussions as well.
And if you are my age or older (I’m 56), you may recall that heavyweight boxing—particularly the bouts between Joe Frazier and Muhammad Ali in the 1970s—made for great sports theater. Part of the allure was Ali’s magnetism, but there was a panoply of other boxers who had large followings. Without resorting to Google, the only contemporary boxer I could think of was Floyd Mayweather. But going back to the 1930s, when my dad was a teenager, young men in many communities were expected to have basic boxing skills. And we’re not talking about the streets of Brooklyn. This was Bellingham, Washington, not a particular tough place to grow up in, either in my era or my dad’s.
Here in Massachusetts, the city of Brockton’s moniker is the “City of Champions.” The name alludes to two famous boxers who grew up there: the heavyweight champion Rocky Marciano, who died in a plane crash in 1969, and “Marvelous” Marvin Hagler, who dominated the middleweight class throughout most of the 1980s. Further buttressing the city’s sports legacy is that Brockton has won many state football championships over the decades. But in recent decades, Brockton has struggled as a community. According to data from my former employer, the Massachusetts Municipal Association, Brockton was behind only 28 cities and towns in the category of “income per capita,” a key statistic to gauge a community’s wealth or poverty. And being well-known for football or boxing isn’t likely to make much of a dent, in local economic terms.