Post by Admin on Apr 19, 2021 11:10:09 GMT
The radical impact of seeing Alzheimer’s as a second childhood
psyche.co/ideas/the-radical-impact-of-seeing-alzheimers-as-a-second-childhood
In some times and places, life is seen as a one-way expedition from birth to death. We progress linearly and don’t look back. In other times and places, life is circular, a never-ending round trip. We live, die, and live again.
In Buddhism, this cyclicality is known as Saṃsāra; in Taoism, Lunhui. Both are intricate concepts rooted in ancient theologies and scripts, but one doesn’t need to be religious to appreciate the circularity of life. To many, it’s simply a way of being. It says that, when we fight our way into this world as a crying infant, we know nothing, have nothing, not even an awareness of the self. Over time, we see, we hear, and we learn. We form the concept of ‘I’, what this ‘I’ likes and dislikes, and over time we come to live for this ‘I’. Eventually, we die, or rather our flesh dies. We give back the things we learned, and once again become a clean slate, perhaps reborn in another body.
The idea that existence is cyclical can bring us a certain composure in the face of life’s tribulations and vulnerabilities. It can help us appreciate the words of the ancient Greek playwright Aristophanes that ‘old men are children twice over’, as well as William Shakespeare’s dictum that old age is a ‘second childishness’. As the Taoist thinker Zhuang Zi said: ‘方生方死’ or ‘Fang sheng fang si’ – at the moment of life is death; at the moment of death is life. The beginning is the end; the end is the beginning.
Such ancient wisdom and literary musing find a close translation in modern neurological research into dementia and Alzheimer’s disease: retrogenesis, meaning backward (retro-) beginning (-genesis). It was proposed by Barry Reisberg, a psychiatrist at the New York University school of medicine, as a model to make sense of the progressive decline in Alzheimer’s. In 1999, Reisberg defined retrogenesis as ‘the process by which degenerative mechanisms reverse the order of acquisition in normal development’. In other words, the deterioration of a patient with Alzheimer’s follows, in reverse order, a child’s normal development. What a child learns first in this world, a patient loses last; what a child learns last, the patient loses first. The beginning is the end; the end is the beginning.
This is not just philosophical contemplation. A body of scientific evidence supports the retrogenesis model. In Alzheimer’s, we generally witness the gradual decline of two kinds of abilities: cognitive and functional. The former refers to capacities such as attention, memory, language and orientation. The latter refers to abilities to perform daily living tasks from dressing and eating to shopping and handling finances. Multiple tools have been developed to assess the extent of these skills in patients with Alzheimer’s, such as the mini-mental state exam (MMSE) for cognitive abilities and the interview for deterioration in daily living activities in dementia (IDDD) as a measure of functional decline.
When researchers in 2012 used these tools to compare the cognitive and functional abilities of 148 elderly participants and 181 children, they found much to support the retrogenesis model. Patients with Alzheimer’s who were at the very early stage of the disease obtained cognitive MMSE scores comparable with those achieved by children around the ages of six and seven. As the disease progresses, patients’ MMSE scores gradually dropped to the level of a five-year-old and, then, below that of a four-year-old. As for their functional abilities, patients with mild to moderate Alzheimer’s had IDDD scores comparable with those obtained by children aged seven to four, respectively. Patients with severe Alzheimer’s obtained IDDD scores below the level of a four-year-old.
psyche.co/ideas/the-radical-impact-of-seeing-alzheimers-as-a-second-childhood
In some times and places, life is seen as a one-way expedition from birth to death. We progress linearly and don’t look back. In other times and places, life is circular, a never-ending round trip. We live, die, and live again.
In Buddhism, this cyclicality is known as Saṃsāra; in Taoism, Lunhui. Both are intricate concepts rooted in ancient theologies and scripts, but one doesn’t need to be religious to appreciate the circularity of life. To many, it’s simply a way of being. It says that, when we fight our way into this world as a crying infant, we know nothing, have nothing, not even an awareness of the self. Over time, we see, we hear, and we learn. We form the concept of ‘I’, what this ‘I’ likes and dislikes, and over time we come to live for this ‘I’. Eventually, we die, or rather our flesh dies. We give back the things we learned, and once again become a clean slate, perhaps reborn in another body.
The idea that existence is cyclical can bring us a certain composure in the face of life’s tribulations and vulnerabilities. It can help us appreciate the words of the ancient Greek playwright Aristophanes that ‘old men are children twice over’, as well as William Shakespeare’s dictum that old age is a ‘second childishness’. As the Taoist thinker Zhuang Zi said: ‘方生方死’ or ‘Fang sheng fang si’ – at the moment of life is death; at the moment of death is life. The beginning is the end; the end is the beginning.
Such ancient wisdom and literary musing find a close translation in modern neurological research into dementia and Alzheimer’s disease: retrogenesis, meaning backward (retro-) beginning (-genesis). It was proposed by Barry Reisberg, a psychiatrist at the New York University school of medicine, as a model to make sense of the progressive decline in Alzheimer’s. In 1999, Reisberg defined retrogenesis as ‘the process by which degenerative mechanisms reverse the order of acquisition in normal development’. In other words, the deterioration of a patient with Alzheimer’s follows, in reverse order, a child’s normal development. What a child learns first in this world, a patient loses last; what a child learns last, the patient loses first. The beginning is the end; the end is the beginning.
This is not just philosophical contemplation. A body of scientific evidence supports the retrogenesis model. In Alzheimer’s, we generally witness the gradual decline of two kinds of abilities: cognitive and functional. The former refers to capacities such as attention, memory, language and orientation. The latter refers to abilities to perform daily living tasks from dressing and eating to shopping and handling finances. Multiple tools have been developed to assess the extent of these skills in patients with Alzheimer’s, such as the mini-mental state exam (MMSE) for cognitive abilities and the interview for deterioration in daily living activities in dementia (IDDD) as a measure of functional decline.
When researchers in 2012 used these tools to compare the cognitive and functional abilities of 148 elderly participants and 181 children, they found much to support the retrogenesis model. Patients with Alzheimer’s who were at the very early stage of the disease obtained cognitive MMSE scores comparable with those achieved by children around the ages of six and seven. As the disease progresses, patients’ MMSE scores gradually dropped to the level of a five-year-old and, then, below that of a four-year-old. As for their functional abilities, patients with mild to moderate Alzheimer’s had IDDD scores comparable with those obtained by children aged seven to four, respectively. Patients with severe Alzheimer’s obtained IDDD scores below the level of a four-year-old.