Searching for signs of dementia

July 26--How do you know if you, or individuals you care about, are beginning the descent into dementia?

Forget about forgetfulness, a group of neuropsychiatrists and Alzheimer's experts suggests.

Sea changes in personality forecast the tempest earlier, the thinking goes.

Last weekend, the panel presented a checklist of 38 probing behavioral questions at the Alzheimer's Association International Conference in Toronto.

The goal was to trump the predictive dementia syndrome M.C.I. (mild cognitive impairment) with the proposed M.B.I. (mild behavioral impairment), a syndrome that theoretically presents Alzheimer's and dementia "stealth symptoms," as one neuropsychiatrist phrased it.

In light of the fact that there's no cure for Alzheimer's once it's taken root, it occurs to me that this squishy early warning system could end up robbing the elderly of their civil right to live as long as possible with their quirky heads in the clouds, oblivious to whatever torments might await them.

In a sense, everyone's at some risk of dementia. Why press the point over eccentric behavior?

Look, I'm not going to downplay the seriousness of dementia. It's a sadistic slow killer, a scourge for victims and loved ones.

Like you, I'm intimately familiar with the sorrows of Alzheimer's. The first column I ever wrote for money was an op-ed for the San Diego Union agonizing over my beloved grandmother's "senility" and the problems it posed for my family.

Back in 1980, "Alzheimer's" was a novel word. Since then, there's been a lot of progress in understanding the chemistry of the disease, but modern medicine remains useless in reversing its course.

Naturally, researchers are going to want to gather all the data possible. What could be better than studying millions of super-early dementia candidates who may or may not want to know what might -- might -- await them?

On a human level, however, it could lead to a dystopian world in which most changes in personality would be presumed to be harbingers of dementia. Gee, Gramps is acting weird. Better get his brain scanned.

In my experience, most people, including really smart people, start behaving differently when they get older.

For one, they tend to act older, which in the company of grandchildren can mean a lot of really outrageous things, including acting a lot younger.

W.B. Yeats, arguably the greatest old poet in any language, wrote, "An aged man is but a paltry thing, a tattered coat upon a stick, unless Soul clap its hands and sing, and louder sing ...."

Wonder how that clapping stick in the tattered coat would fare on the M.B.I. survey?

Probably not well.

Here's an example of the Toronto questions regarding behavior that, if answered in the affirmative, could signal the onset of dementia:

"Has the person started talking openly about very personal or private matters not usually discussed in public?"

Imagine if the decorum question were asked of Joan Rivers, Phyllis Diller or Larry David?

Any comedian old enough for Botox would be called in for brain scans and reservations at assisted-living facilities.

Here's another leading dementia question:

"Has the person become more agitated, aggressive, irritable or temperamental?"

While all those related traits could be alarming to family and friends, they might also construed as reasonable responses to a hostile world.

Dealing with the Kafkaesque health system, for example, would be enough to make anyone "agitated, aggressive, irritable or temperamental."

Paradoxically, research indicates that seniors are wiser and more content than young people, according to Dr. Dilip Jeste, director of the Sam and Rose Stein Institute for Research on Aging at UC San Diego. Wisdom is a natural byproduct of age, Jeste argues, validating white-haired sages everywhere.

But I'd counter that in addition to wise, old people are also inherently defiant, the flip side of wisdom. They do crazy things, not the least of which is trying to work forever, the ultimate rebellion against the status quo.

In between a court change last week, a tennis friend, one of the best 70-and-over players in the country, wondered if dementia could be fought off by varied and difficult work, an off-kilter notion in a society that envisions the ideal retirement as an endless cruise into the sunset.

This physically fit guy was intrigued by evidence showing taxi drivers having healthier brains than bus drivers. The challenge of learning streets and chatting with passengers appears to be a bracing mental workout for cabbies while the brains of bus drivers, who navigate the same route and rarely gab with passengers, don't fare so well in the cerebral department.

We talked about symphony conductors and Supreme Court justices, professions famous for their longevity and brainy vitality. Seriously competitive senior athletes who play every day, we speculated, are working out their wrinkled gray matter as well as their sun-damaged bodies.

Reaping from my ink-stained field, I dug up the memory of Lionel van Deerlin, the grand old man who churned out delightfully idiosyncratic Union-Tribune columns until he suddenly died at 93. Van's last piece appeared on May 15, 2008, two days before his death.

We should all be so lucky. And so crazy.

And don't forget it.

logan.jenkins@sduniontribune.com

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