Posted 9/16/24
“For the mountains may depart
and the hills be removed,
but my steadfast love shall not depart from you,
and my covenant of peace shall not be removed,”
says the Lord, who has compassion on you.
“O afflicted one, storm-tossed and not comforted,
behold, I will set your stones in antimony,
and lay your foundations with sapphires.” -Isa 54:10-11
According to a National Weather Service report from a few years ago, we are nearing the 2500th tornado in Missouri since 1950. Spectrum reminds us, as if we needed reminding, that the 2011 Joplin Tornado was the strongest in recorded history in the Show-Me state. I was blessed with the opportunity to serve that wonderful community in the weeks following the tornado at the end of the rescue and into the cleanup stage. Saturday morning I was also blessed with attending the Joplin Walk to End Alzheimer’s. How are these things related? 🙂 This is me were are talking about. 🙂
Spending so much time in Joplin, and thinking back on the tragic tornado, Saturday was an interesting time of reflection. I brought my article shoehorn with me, of course, and it made me think…What causes a tornado? The above video was a very interesting look at the specifics of the weather that fateful Sunday in May. It, though, like the brain, gets confusing quite quickly. I will grant you this, I did get a C in Meteorology at Missouri State University (Tornado Ted was my teacher)…but I never had a college class on the brain in my college days. (Note: Here is an excellent, free college class on dementia: LINK )
So, stepping back a notch, I found a NOAA site called Tornado 101. That may be more my speed. In it, the following is found:
How do tornadoes form?
“The truth is that we don’t fully understand. The most destructive tornadoes occur from supercells, which are rotating thunderstorms with a well-defined radar circulation called a mesocyclone. (Supercells can also produce damaging hail, severe non-tornadic winds, frequent lightning, and flash floods.) Tornado formation is believed to be dictated mainly by things which happen on the storm scale, in and around the mesocyclone. Recent theories and results from the VORTEX2 program suggest that once a mesocyclone is underway, tornado development is related to the temperature differences across the edge of downdraft air wrapping around the mesocyclone. Mathematical modeling studies of tornado formation also indicate that it can happen without such temperature patterns; and in fact, very little temperature variation was observed near some of the most destructive tornadoes in history on 3 May 1999. We still have lots of work to do.” It wisely goes on to mention some tell-tale signs/things to watch for including Inflow bands, specific cloud formations, rear flank downdrafts, and ultimately a funnel.
But you know, many of us like watching storm chasers like Reed Timmer. 🙂 I am an avid fan of Reed and his little dog Gizmo as they take the Dominator into the storm. However, even Reed swings and misses. Sometimes everything looks ripe for a tornado and it doesn’t happen. Other times, like a little tornado that showed up in the Branson, MO area this year during a time when there wasn’t even a siren: VIDEO and VIDEO. People were still golfing. LOL
Summary: Science is hard. We are sometimes very overconfident in our abilities. 🙂
Enter into the discussion: What causes dementia?
First, this is a great question and it is worded very well. Back to the storm analogy. It is not unlike saying What causes a storm? Storms are an umbrella term that show the affects of a bunch of things that do different levels of damage. Within a storm may be severe wind, precipitation, hail, lightning, snow, and other things. These are storm things. Figuring out what is happening and what the conditions around us are doing, we can give it a more specific name. Your basic thunderstorm is probably the most common type of storm, much more common than a blizzard or a derecho, which have very identifiable characteristics and some semi-recognizable characteristics that seem to be causing them. Some characteristics in one type of storm (rain, let’s say) can be present in another type of storm too (hurricane).
Similarly, “Dementia” is defined as a condition that typically causes memory/behavior problems, cognitive struggles, cell death, and a few other things. One dictionary explains it as “mental deterioration of organic or functional origin.”, but even that is challenging for some types of dementia. The temptation (some have suggested it) is to drop the word all together, but it, like “storm”, is entrenched and won’t go away easily. So we will just roll with the term dementia being the big pile-o’symptoms and the types (Alzheimer’s, Lewy Body Dementia, FTD, etc…) showing how each fits.
OK, this is a lot of extra words to say this summary statement: “A lot of things cause dementia”. The brain is very strong and resilient and truly fearfully and wonderfully made. However, even with a hard candy shell (skull), gazillions of cells, and a nifty moat (the Blood Brain Barrier-BBB), things can and do go kerfritz.
OK, then what causes the recognizable conditions that have these umbrella term conditions? This is where it gets harder and where the fairly wonky weather anaology may make a little sense.
Exit science and firm references, enter my humble opinions. 😉 (Granted, that never stopped me before).
When our brain has physical things wrong, it can manage… until it cannot manage. Lisa Genova and others call this a “Tipping Point” (and she/they is/are infinitely smartererer than me). See, there is not a neat, easy cause of dementia in most forms that we study. Alzheimer’s, the most common (single) cause of these dementias, seems to have a bunch of issues happening. The ever-discussed Beta Amyloid plaques and the Tau neurofibrillary tangles are like, say, rain in a severe thunderstorm. We thought for a long time that they were the absolute CAUSE because they seemed to be the hallmark thing present. There isn’t always, 100% of the time, rain hitting the ground when a severe thinderstorm happens…and the rest of the stuff may or may not be worse anyway (sorry to those who die of floods, a bigger number than those killed by tornadoes). However, moisture does factor in and if you remove it, the storm changes and/or weakens. Same in dementia, especially with the BA plaque. If we remove it, it delays/slows the progression of the disease. Therefore it matters, and probably a bunch. Two of the three newest drugs Leqembi and Kisunla do a darn good job removing the rain from the cloud, if you will. Whether they use diaper stuffing (See the Twisters movie for the science there), or choose to use a nuclear bomb (See one of the Sharknado movies for that one?) will determine how much is removed and whether there will be damage.
The biggest question, perhaps, is what things are causing this dementia thunderstorm and what can we safely remove/fix with as little harm as possible to keep these umbrella items from crossing the tipping point? What are the “Inflow bands, specific cloud formations, rear flank downdrafts, and ultimately a funnel” of things and will removing a few of these tip the scale back in our favor? The plaques and tangles are important. We know this, especially of the former, because when you remove it, progression slows or stops at least for a time and to a degree. Other things may factor in but are less important by themselves. If you removed, say, mosquitos from a thunderstorm, you didn’t do much if anything to stop it. It might be a good idea, but you didn’t fix the problem. 🙂 This is a science/clinician issue. I do dozens and dozens of clinical study guinea pig sessions to that end. However, there are other things that we can do to push back too. These are risk factors and many of them are in our control to fix/modify: LINK Here are some more: LINK
Whether it is a severe thunderstorm or a tornadic brain storm, think of it this way:
- We work on the things we can work on. We study. We prepare. We build our shelters, buy weather radios, etc… In dementia, we take care of our heart because that helps the brain. We sleep enough, we manage stress, we protect our noggin and we eat right and exercise. (LINK)
- Science/data teaches stuff that we can apply. Tornadoes happen mostly in the spring and summer (because there are more of the conditions that are ripe). We have a higher risk of dementia as we age because the list of factors are probably getting worse (we sleep less, our blood flow may be compromised more than wearlier in life, we exercise less).
- There are outliers everywhere. Tornadoes in Branson with little warning. My otherwise healthy mom getting diagnosed at 65 while doing most everything right health-wise.
- There are combos… Storms sometimes have terrible lightning, floods, high winds, and hail. Dementia may have multiple types in one person. My mom had vascular dementia and Alzheimer’s. She had blood vessel issues hurting her brain and the many possibl;e causes of Alzheimer’s too..
- Sometimes we can learn a lot by watching what happens, but that is a cruddy time to do so. For many decades we only diagnosed Alzheimer’s in an autopsy. Not the best time to work on treatments for us, to say the least. Progression works that way too. My mom, when her hypothalamus was stricken, started getting temperature regulation all out of whack. She wore gloves in theheat of the summertime while on walks. (Hence why I wore gloves in my June event this year). Watch behaviors and symptoms and more orten than not the part of the brain affected becomes clear.
- Big Data may help someday. The more times we gather lots of data we learn and grow in our understanding.
- There is a lot we don’t know. We have to have a semi-loose grip on dogma on what we believe and don’t in dementia. Just becuase one Beta Amyloid removal drug didn’t make cognition better doesn’t mean the idea is wrong. It was proven later to be a good step in the right direction. However, finding a silver bullet pill or a surefure tornado prediction tool is too lofty for now. We learn more and more about the conditions surrounding the situation and worik on what we can. There is no room here for arrogance.
- Snake oil salesmen/witch doctors are always out there offering simple solutions.
- We need to help others! Tens of thousands of folks helped after the Joplin Tornado. Millions are already helping with dementia and we need more.
- These topics make me look forward to heaven. 🙂 No Dementia-nados there…
I hope my meandering around this topic makes sense. We don’t know the exact thing that causes most dementias, but we know a lot about the conditions present. Is this satisfying? For now, anything more is a stretch.
Thank you for endulging me. 🙂
#EndALZ
Next week in my Tour d’Walk I will attend the Lake of the Ozarks Walk to End Alzheimer’s. The next week after that is my hometown Springfield Walk. 🙂
Here is my link in case you want to donate and/or join my team:
https://act.alz.org/site/TR?pg=personal&px=14575499&fr_id=17740
