How Are You Doing?

 

How are you doing?  We are getting along well.  We are not seeing our grandkids as much as we’d like or traveling or doing other things we enjoy.  But we are doing all right.

 

It’s the country we are worried about.  This is the most important election in our lives.  We have had presidents in the past who lied (Nixon about Watergate, Johnson about Vietnam), but we have never had a president who lies constantly and threatens to destroy our democracy.

 

We urge you to vote, if you have not done so already.  And get your friends and relatives to vote, too.  

 

If you are still undecided, or know someone who is undecided, take a look at the excellent column by Nicholas Kristof (link is below).

 

At the beginning of the primaries, we wrote a blog suggesting that Biden (and Trump, too) were too old to be president.  Joe has shown us to be wrong during the campaign.  Instead of trying to match Trump in vitriol, he has presented a vision of what this country could become by bringing people together.  He speaks powerfully from his experiences.  He knows that more anger and bitterness will not get us anywhere.  Our country has lots of problems.  Joe promises to get to work on them, with our support.  That’s wisdom that comes with age.

 

We hope to tune back in next week to celebrate the end of this long nightmare.

 

 

Link to Nicholas Kristof’s column:

 

https://www.nytimes.com/2020/10/30/opinion/donald-trump-polarization.html?campaign_id=45&emc=edit_nk_20201030&instance_id=23642&nl=nicholas-kristof&regi_id=60761850&segment_id=42887&te=1&user_id=98f3fcf260219e79a11053d8948e41ec

 

Photo:  Fall colors. Frick Park, Pittsburgh

The Vote is in!

                                                                    

Not that vote.  But an important vote in our family.  As a diversion from the corona virus, election and other upsetting stories in the daily news, we have been finding wonderful food that can be ordered on-line.  A few weeks ago we ordered babkas from Zabar’s in New York for ourselves and our kids.  They were wonderful.  Even our grandkids were thrilled.  We had tasted Zabar’s babka in the past, but it has been awhile, and we had forgotten how good they could be.

 

But then the question came up—is the chocolate babka better than the cinnamon babka?  You may remember the Seinfeld episode about babkas.  Jerry and Elaine were standing in line, waiting to buy a chocolate babka as hostess gift for the dinner party they were going to.  But the couple a head of them buy the last chocolate babka.  The baker offers to sell them a cinnamon babka, which Elaine calls “the lesser babka.”

 

We thought a taste test of our own was appropriate.  Jerry and Elaine went to Royale Bakery for a babka, but it has closed.  A New York friend of ours said the place to go when you are bringing a babka as a gift is Green’s Bakery in Brooklyn.  So we placed our order.

 

The vote is in.  The winner is (drum roll)  -- the cinnamon babka from Zabar’s.  The consensus was that Green’s chocolate babka was better than Zabar’s, but Zabar’s cinnamon babka was the best overall.  Not the lesser babka at all.

 

FYI.  The Seinfeld episode, “The Dinner Party,” is Season 5, Episode 13, and is available on Prime Video.

  

What’s in a Name? Could COVID-19 Be too Mild a Name to Gain Compliance with Preventive Approaches?

Why has it been so hard to get people to comply with simple protective approaches that reduce the spread of the COVID-19 virus?  It is a simple matter to wear a mask outdoors and in shops.  It is simple to maintain a safe distance.  Yet go almost anywhere and you see someone with the mask below the nose or hanging below the chin.  Or someone who gets far too close to you.  People complain bitterly that these restrictions are trampling on their freedom. Freedom to infect others?

 

Part of the problem, of course, is due to the politicians, starting at the top, who have minimized risks from the beginning and encouraged people not to take any precautions.  But maybe the problem is partly due to the name, COVID-19 Pandemic.  The word “COVID” does not sound threatening.  It doesn’t carry any meaning.  Would a different name be more motivating for people to take precautions?

 

Looking back in history, plagues had more evocative names.  The Great Plague, also called the Black Death or Bubonic Plague, swept across Europe and Asia several times.  In the 14^th century, the Great Plague wiped out between two thirds and three quarters of the population in parts of Europe.  Those names carry some heft to them.  Likewise, other illnesses that led to widespread infection and death had names that conveyed threat:  Small pox, typhus, typhoid, cholera, malaria.  Or more recent names—Ebola and Zika.  And of course, Human Immunodeficiency Virus (HIV/AIDS).  They sound ominous.  Even “Spanish flu” sounds more serious than just ordinary influenza or H1N1 flu.  

 

And why call it a pandemic?  Plague is more dramatic.  It’s something people react to.  The term “plague” calls to mind all those apocalyptic paintings of victims from the 14^th century and later plague outbreaks.  New York Times columnist Roger Cohen recently quoted Camus, who wrote that the plague “never goes away. It is waiting to exploit stupidity.”  That fits our response. 

 

What, then, should we call it that would better get attention?  President Trump started calling it the China Virus, which everyone saw as just another attempt to divert attention from his incompetence in letting the virus spread in the US, even as much of the world was implementing shutdowns and other efforts to control the virus. Such as wearing masks.

 

But it is not just that COVID-19 originated in China.  Viruses have regularly been making the jump from animals to humans in China.  The source is believed largely to be markets where wild animals are sold for food.  For years, the US and other countries have been talking with China about closing these markets, and there is some indication that they may be willing to do so. That would be an important step that could reduce the annual flu epidemic and prevent other novel viruses such as COVID-19.

 

To further that goal, we thought that COVID-19 should be re-named for one of its animal hosts, bats.  Bats are ugly.  We use their images for decorations for Halloween.  But Bat Virus is not strong enough.  Bats play an important role in eating mosquitoes in this country, and, after all, they are not responsible for the virus.  So we propose instead that COVID-19 be renamed the Bat Shit Plague.  There’s nothing nice or comfortable about that.  The bat isn’t being blamed directly.  And the name conveys how terrible the virus has been.  Maybe people unwilling to take precautions for COVID-19 will take steps to avoid the Bat Shit Plague. It’s a thought.

 

 

  

  

In the Midst of the Covid19 Crisis, Ageism Raises Its Ugly Head

Ageism been there all along during the COVID pandemic.  There was the quote a few months ago from Dan Patrick, the Lieutenant Governor of Texas, “Lots of grandparents would rather die than see health measures damage the US economy.”  It was only a matter of time before a national politician would raise that argument.  And there it was last week.  President Trump passed along a tweet claiming that only 6% of all deaths attributed to COVID 19 were actually due to the virus, and “the other 94% had 2-3 other serious illnesses & the overwhelming majority were of very advanced age.”  So they don’t matter.  The figures are, not surprisingly, also wrong.  But the truth is that many people are willing to write off the deaths of older people.

 

This is particularly the case of older people from disadvantaged groups.  Scholars who study age prejudice often talk about “double jeopardy,” that ageist beliefs and behaviors have an even greater impact on minorities.  Infections and death rates are higher among African Americans.  That’s not surprising, given long-standing disparities in income and access to health care.  African Americans are also more likely to hold jobs that could expose them to COVID 19 and less likely to be able to work remotely.

 

It’s not only despicable politicians and social media trolls who are saying ageist things.  Ageism has been part of the response to COVID 19 in the mainstream media, as documented in a recent article by Bronwen Lichtenstein in The Gerontologist.  Examining the media in the US, United Kingdom and Australia, she found that the vulnerability of older adults was frequently described with name-calling, blame, and “so-be-it” reactions.  There was also considerable debate in the articles she reviewed herd immunity.  Like the Lieutenant Governor of Texas, proponents argued that the herd immunity approach was the best way to support the economy, even though it would likely increase mortality substantially among older people.

 

The country that went full speed ahead to try to reach herd immunity was Sweden.  Their approach of minimizing restrictions had the expected effect of higher rates of illness and mortality, with older people paying a disproportionate price.  Drawing on recent data in the Washington Post, Sweden has a death rate of 575 deaths per million people in the population.  That compares to 610 deaths per million in the UK (which also took a herd immunity approach initially but has since pulled back on it), 545 deaths per million in the US, 111 deaths per million in Germany, and 9 deaths per million in Japan.  Likewise, Sweden is at the high end of countries for deaths in care homes.  Forty-seven percent of all deaths in Sweden occurred in care homes, compared to 45% in the US, 39% in Germany and 14% in Japan.  

 

But despite the expectation that the economy would not suffer if businesses and social interactions continued as usual during the pandemic, Sweden’s economy is not doing particularly well, and certainly not better than its Nordic neighbors, which have much lower rates of infections and mortality.  For example, Denmark has 623 total deaths (107 deaths per million), Norway has 264 deaths (48 deaths per million), and Finland has 335 deaths (60 deaths per million).  

 

The throw away attitude toward older people is most apparent in the death rates in care homes.  Basic procedures for containing infection were woefully inadequate in some facilities in the US and in other countries.  And then there is Japan, which stands out for its very low rate of deaths in care facilities.  It’s not because of a smaller proportion of the population in care facilities. Japan has a universal long-term care insurance program and the number of people in care facilities has grown steadily, and is now about equal to the US, according to the Washington Post article.  The article went on to speculate on what led to the low rates of deaths in care facilities.  One factor was that rates remained low in the population as a whole.  Beyond that, three other factors played a role:  implementation of stronger measures to prevent infections, higher standards of hygiene, and perhaps not surprisingly, the traditional importance of elders in Japanese culture.  

 

Photo:  We found the graffiti message on this old viaduct to be intriguing.  Is it a comment on our times?

 

Source of Statistics for the Nordic countries:  Statista:  https://www.statista.com/statistics/1113834/cumulative-coronavirus-deaths-in-the-nordics/

 

Washington Post, Japan Has the World’s Oldest Population. Yet It Dodged a Coronavirus Crisis at Elder Care Facilities.  https://www.washingtonpost.com/world/asia_pacific/japan-coronavirus-elderly-death-rate/2020/08/29/f30f3ca8-e2da-11ea-82d8-5e55d47e90ca_story.html

https://www.boomlive.in/world/donald-trump-endorses-false-claim-that-cdc-cut-covid-19-death-toll-9580

 

 

A New Diagnostic Tool for Alzheimer’s Disease: What Does It Tell Us?

You may have read recently about a new, more accurate test for identifying people with Alzheimer’s disease (AD).  Finding a reliable marker of the disease has long been a goal of researchers.  The ability to confirm diagnosis would help improve research of all kinds, but especially drug trials, because there would be more certainty that participants in the trials had Alzheimer’s and not another form of dementia.  An early marker of AD would also be enormously helpful for designing prevention studies.  We know, however, that many stories about Alzheimer’s disease in the media exaggerate or misinterpret the findings of studies. So we decided to take a look at the article about the new diagnostic tool, which has been published on-line in JAMA.

 

The paper reports on findings from three studies of people with and without Alzheimer’s.  The goal of the three studies was to test how well a marker found in blood samples, P-tau217, distinguished between people with a confirmed diagnosis of Alzheimer’s disease and people without the disease. Tau, as you may know, is a protein normally found in nerve cells that can become twisted, forming one of the primary markers of Alzheimer’s disease, neurofibrillary tangles.  P-tau217 is a marker of those abnormal cells.  

 

Study 1 consisted of people with and without dementia who had volunteered to be followed over time until their death.  Plasma samples of P-tau217 were obtained prior to death and compared with postmortem findings in the brain as well as with prior diagnosis.  

 

Study 2 was part of a large Swedish study that was following people with Alzheimer’s Disease and other neuropathological disorders and well as persons without dementia.  Amounts of P-tau217 were compared to other markers of the disease as well as to diagnosis.

 

Study 3 used a sample from an ongoing study in communities in Colombia, where many people have an autosomal dominant gene for Alzheimer’s disease that leads to the disease at early ages, typically when carriers of the gene are in their 40s.  Blood samples were obtained from people with and without the gene who were part of the study.

 

What did they find?

 

Across the three studies, P-tau217 from blood and plasma differentiated between cases of Alzheimer’s disease and non-disease subjects better than or as well as other markers, including findings from PET and MRI scans and samples of P-tau217 from cerebral spinal fluid.  P-tau217 was highly correlated with the amount of tau (tau density) found in the brain at autopsy in Study 1 and with estimates of tau in the brain from PET scans in the other two samples.  In Study 3, people with the dominant gene for Alzheimer’s disease began showing increased P-tau217 in their mid-20s, or about 20 years before symptoms typically occur.

 

What are the implications?

 

            The main take away from the study is that P-tau217 is a reliable marker of Alzheimer’s disease and of one of the main pathologies in AD, neurofibrillary tangles.  The blood test for P-tau217 is easier to administer and less painful than tests using cerebral spinal fluid, and more readily available and less expensive than PET scans, but just as accurate for determining diagnosis as either of the other methods.

 

            But does P-tau217 predict Alzheimer’s among people who are not symptomatic?  Here the media loudly proclaimed that P-tau217 could detect AD up to 20 years prior to symptoms.  This was based on the finding that people in their 20s in the Colombia sample who carried to dominant gene for AD and could expect to become symptomatic in their 40s had elevated levels of P-tau217.  It remains to be determined higher levels of P-tau217 are found years before onset of symptoms only in certain genetic variants of the disease, or if they can be detected early across most or all cases of AD.  That’s a big “if.”

 

Is P-tau217 ready for widespread use for diagnosis?

 

            No.  There are two hurdles that are by no means easy to overcome.  First, there needs to be a reliable cut-off score, that is, how much P-tau217 indicates a disease process.  The cut-off used in this research worked well in differentiating people already characterized as having AD from controls without the disease, but whether that score would work as well in community samples where people may have early symptoms remains to be seen.  Every effort to push diagnosis earlier in the disease process runs the risk of increasing false positive diagnoses.    

 

            The second hurdle is how far ahead can P-tau217 reliably predict AD.  P-tau217 may predict in a sample with a strong genetic determinant, where we know that people holding the gene will develop the disease, but may not do as well as a predictor for other forms of the disease.  Studies to determine how far ahead a P-tau217 score might predict symptoms would take considerable time to conduct—doing the test today and waiting a few years or more to find out who gets the disease and who does not.

 

Do you want to know your risk for Alzheimer’s?

 

            This is, of course, the key question.  Would you want to know?  One reason to consider the test is if one of the rare, dominant gene forms of AD runs in your family.  In that case, getting a genetic test would be more definitive than the P-tau217.  For cases that occur in later life,  60+,  the APO E4 allele has been linked to AD.  The APO E4 is not a dominant gene so having one copy of it does not mean you will get AD, and even having two copies may not result in AD.  Genetic tests can identify if you have one or two copies of the APO E4 allele. 

 

            The other reason to consider the P-tau217 test is if you think you are having symptoms.  Having occasional memory lapses is not reliably a symptom of AD.  Everyone forgets.  But if memory and other cognitive abilities seem to worsen, then the P-tau217 test could help clarify what is behind the cognitive problems. 

 

            But the question still remains – would you want to know?  If you tested positive for a gene associated with AD or for P-tau217, what would you do differently?   What changes would you make in your life?

 

            Growing older has been described by our friend Bo Malmberg as “sooner or later.”  Sooner or later, something bad will happen.  The implication is to live a full life now.  

 

            

 

Reference:  Palmqvist, S., et al. (2020).  Discriminative Accuracy of Plasma Phospho-tau217 for Alzheimer Disease vs Other Neurodegenerative Disorders.  JAMA, doi:10.1001/jama.2020.12134 (published on-line with free access).  

 

 

 

 

            

 

 

 

 

 

 

Celebrating National Chocolate Chip Cookie Day

 

You may have missed it but Tuesday, August 4, was National Chocolate Cookie Day.  What a wonderful idea!  Our grandson Sam was spending the day with us, and Judy decided that some Grandma-Grandson baking was in order.  They had great fun and the cookies turned out perfectly.  The bowl they were using is the same one Judy used with the kids when they were young, too.  And as you can see in the photos, Sam and Judy were able to be safely masked during the baking.  Just so you know he wasn’t left out, Steve was also safely masked during the cleanup.  

 

Cooking and baking are ways we have connected with our grandkids.  They all like to help out, and they all love eating the results.  

 

While helping Sam, Judy realized she has been making this recipe for chocolate chip cookies for 53 years.  The only change has been to use better quality ingredients which she couldn’t afford or weren’t available when she was young—Penzey’s Vanilla, Kerrygold Irish butter, and Guittard chocolate chips.  Our kids have their favorite recipes from when they were growing up, and that led Judy to put many of the family favorites on her cooking blog.  Steve also makes a few recipes from his mother, including a very tasty Poppy Seed Biscuit.  Making family favorites for our children and grandchildren helps us convey something about the past to our family. 

 

You can find the recipe for chocolate chip cookies on Judy’s blog at http://jzcooks.blogspot.com/2012/09/   The recipe follows the section on baking and cooking measures.  Or browse through for other recipes for cookies and brownies.

 

Is the Pandemic an Opportunity for Improving Support to Caregivers

 

The New York Times recently ran an opinion piece titled “Biden’s Quietly Radical Plan.”  The column by Bryce Covert describes plans announced by Mr. Biden that would provide universal pre-school and improve long-term care services for older people.  

 

The COVID pandemic has brought into the open how important caregiving is to our society, whether it is care for young children or for older adults.  As COVID restrictions were gradually being lifted, parents of young children could not return to work because child care and pre-school programs remained closed.  With the school year approaching, parents are facing the dilemma of what to do with their school age kids if their schools go to remote learning.  

 

For older adults, the pandemic revealed how poorly prepared many nursing homes and other residential facilities are for protecting the health of residents.  But trying to keep someone at home where they may be safe poses its own problems, particularly, difficulties finding and retaining qualified caregivers who are virus-free to help out in the home.  Mr. Biden’s proposal would improve wages for home care workers and also improve their work situation.  

 

We need to remember that life before the pandemic was already hard and getting harder for many people.  Needs such as affordable child care and services to support older people to remain at home are routinely addressed in almost all other advanced economic countries, but the US has remained mired in outdated beliefs about care.  There was a time when most women didn’t work outside the home and could care for children or parents at home.  And that was a time, too, when most people did not live to advanced age, so there were not as many older people who needed care.  The idea that families should do it all is as antiquated as a statue of Robert E. Lee. 

 

So maybe we have an opportunity.  The impact of the COVID pandemic and the utter incompetence of the Trump administration have made people more aware of how backward our country has become in so many ways.  This can be the time when we start taking the steps to make caring for young and old more manageable and humane.  We are not likely to become Denmark overnight, but there is much that we can borrow from the Danes and other countries about providing for basic needs for children and older adults and other individuals with special needs.

 

You can find Bryce Covert’s article, “Biden’s Quietly Radical Plan,” at this link:

https://www.nytimes.com/2020/08/02/opinion/biden-child-care.html?action=click&module=Opinion&pgtype=Homepage