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The brief screening test for dementia: why it doesn’t help that He passed (His father died of Alzheimer’s Disease.)

photo by Oleg Gamulinsky courtesy of (notice the left eye and the left side of the mouth– he’s questioning whether to believe He-who-must-not-be-named)

The reason “He who must not be named” needed to take the screening test for dementia is that His father died of Alzheimer’s Disease (AD.) This disease runs in families to a very large extent (see below for explainer.)

The reason He brags about it is that he misunderstands or chooses to misinterpret the reason he had the test. I think that fundamentally, he misunderstands for two reasons: he wasn’t told the truth about why he was given the test, and/or he doesn’t have the intellectual capacity to make the distinction between dementia and personality disorder.

He doesn’t admit that dementia has nothing to do with his mental “problems”– his problem is what we call personality disorder, meaning there’s something wrong with his personality. What’s wrong? He has sociopathy and malignant narcissism, which are the problems causing the decline of our country.

Not to mention the deep roots of sadism, misogyny, xenophobia, and racism, which go along with his identification with the Republican Party and its nativist wing. I’ll set those things aside today and concentrate on dementia and personality disorder.

Let us not forget Ronald Reagan, who had AD while he was president and died of it. His entire staff knew that he was losing it, but they covered it up because he pushed the right buttons when it came to policy.

What is sociopathy? In basic terms, it’s the lack of a conscience, that thing inside you that makes you do right when other people aren’t looking or don’t stand in your way.

What is malignant narcissism? It is the concentration of your entire being on yourself and the complete absence of interest in anything other than yourself. Other people are only of concern to the extent that they validate you by praising you and doing what you want.

Every subject is of interest only to the extent that it reflects on your glory and your complete mastery. Nothing can be allowed to get in the way.

To a malignant narcissist, anyone who questions or criticizes is automatically an enemy to be destroyed. There is never any sense that one might be wrong or imperfect, or if there is, it must be immediately negated by praise from another or complete destruction of the critic.

To diagnose sociopathy and narcissism, there is the Minnesota Multiphasic Personality Inventory, but He wouldn’t take it– it’s way too long. Instead, one can make these diagnoses on the basis of spontaneous statements and behavior outside of the exam room, as His niece Mary Trump has done.

The “Goldwater Rule” would normally prevent a professional from discussing diagnoses, especially mental, outside of the exam room and without the patient’s consent. There is another doctrine, the “duty to warn” if there is a danger to “self and others.” In this case, anyone who realizes how bad things are has a duty to tell everyone because this patient can be very dangerous.

G-d help this country if this man is re-elected.

Explainer: the causes of dementia, specifically Alzheimer’s Disease.

First, the symptoms: The most common early symptom is difficulty in remembering recent events. As the disease advances, symptoms can include problems with languagedisorientation (including easily getting lost), mood swings, loss of motivation, not managing self-care, and behavioural issues.

(references for symptoms: British Medical Journal,  2009 Feb 5;338:b158. doi: 10.1136/bmj.b158. World Health Organization fact sheet.)

Second, the causes: the chance of inheriting (heritability) of AD is estimated between 49% and 79%. This means that AD is caused by problems with your metabolism that you are born with. Your chances of getting AD are less, even if you have metabolic problems, if you exercise (both body and mind) and eat a diet low in animal fat.

Most AD is called “sporadic” because it has not been identified in the patient’s relatives. If He were found to have AD, we would say it was inherited because His father has it.

In sporadic cases as well as inherited ones, the risks are higher with high cholesterol, fatty diet, inactivity, obesity, and lack of mental exercise. Sound familiar? All of these risk factors fit He-who-must-not-be-named.

Luckily for Him, risks are probably less with cholesterol-lowering drugs, which He is taking– but the risk is NOT eliminated just by taking a pill.

A small percentage (roughly 0.1%) of AD is caused by a dominant mutation on regular chromosomes (not X-linked.) These are interesting cases because they are traced to mutations in genes for amyloid precursor proteins (more on these below) or “presenilins” (proteins that sit in the cell membrane and control how calcium crosses into the cells– important in nerves that sit in the hippocampus, a brain region that controls memories.)

In most sporadic cases, like the inherited forms, there is an apolipoprotein called apo-E4 present. It is involved in cases of atherosclerotic heart disease as well as AD. This fat-binding protein is part of fat metabolism in the body and brain, but it may cause heart disease in different ways than it causes brain disease and AD.

In the brain, apolipoprotein E helps to break down amyloid deposits called plaques. When the E4 type malfunctions, especially when body cholesterol levels are high, these deposits can damage nerve cells. Over a lifetime, amyloid plaques that build up eventually kill nerve cells. This has a lot to do with AD, but it’s not the whole story.

Those amyloid precursor proteins mentioned above also play a role. These proteins, when broken down into amyloid beta, accumulate in sheets called amyloid plaques. These are metabolized and removed in the brain by apo-E. Certain types of amyloid beta are harder to break down than others– leading to more and bigger plaques and, eventually, brain damage… thus, AD.

There is actually a known mutation in amyloid precursor protein that protects against AD by reducing breakdown into amyloid beta. The “amyloid precursor proteins” play many physiological roles that are still being evaluated (see the Wikipedia article on these proteins.)

That’s enough science for one post. It all comes from Wikipedia, which is almost 20 years old and getting bigger by the day. I just gave them $5.35 because I was ashamed that they only asked for $1.75 …

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