Aren't we all demented in some way? What really is dementia?

Aren't we all demented in some way, shape, or form? Now that my first Renal System exam is done, I have found some "free time" to learn something I have been wanting to investigate for some time now.  My goal of this post is to educate myself and to hopefully educate my family members about the syndrome and disease that has now taken a grandparent on both sides of my family.
What does the word dementia mean? Dementia is defined as an acquired syndrome of deterioration in cognitive abilities that impairs performance of daily living activities. From latin the meaning of dementia means to be out of one's mind. So family and friends, when you  say that my "_______ has dementia." You are saying that your loved one has declined in their mental capabilities and cannot perform simple everyday tasks. Dementia is basically a very large umbrella term and includes so many diseases that involve the mind that I am only going to focus on one and name a few others you may have heard of. Dementia is a syndrome, not a diagnosed disease.  A syndrome is more of a description of a group of signs and symptoms. A disease is a diagnosed impairment of health or a condition of abnormal functioning. They sound similar, but are not. The most famous disease that falls under the syndrome dementia is Alzheimer's Disease. It is pronounced, "Alls-Hi-Mers" not Altimers or old-timers. Haha. Just to make that clear. Saying words right I swear is half the battle of medical school. Other diseases that fall under the dementia umbrella are Huntingtons Disease, Lewy-Body Dementia, Creutzfeldt-Jakob Disease, Cortical Base Degeneration, Vascular Dementia, and numerous others.

So all dementia type diseases  are based off of the parts of the brain they affect and the chemical signal malfunction that causes the disease. The human brain uses chemical signals, called neurotransmitters,  to communicate information along nerves.  These neurotransmitters are designed to control movement, make memories, modify behavior, control mood, and numerous other functions. Many chemicals have multiple functions. It not very cut and dry what each signal does and does not do. Neurologists have been piecing together the function of these chemicals in our brain and are making drugs that mimic these chemical signals or create higher amounts of neurotransmitters in our bodies. What you need to understand is that we really only know what these neurotransmitters do because when a person has a deficit in these neurotransmitters they do not function "normally."

If I haven't bored you guys yet just hang on. I am getting to the stuff that you can learn to teach your friends so you can humiliate them and make them look stupid in public when they act like they know what they are talking about, but they don't. Haha. Just playing, be nice! I am going to focus on Alzheimer's disease because I feel it is more important to know what that is so you don't confuse it with other terminology. I will organize the main points I feel are important into bullets.  I like to organize and see my information placed in bullets when I study as it keeps my thoughts organized. Disclaimer: What I say is not perfect nor is 100% accurate. Most things are just too complicated to explain in a blog post. So I dumbed it down and generalized a few things.  Don't go looking things up and being like, "well Glen actually...." I will seriously hunt you down and possibly slap you. JK.  After these points I will put up a few pictures that will help you visualize what I may be talking about.

• Alzheimer's Disease
• Where does it affect the brain?
• Medial Temporal Lobe
• The medial temporal lobe, the medial portion of your temporal lobe, is located close to the middle of your brain. The temporal lobes are on the side parts of your brain. So if you slap your hand on the side of your head you are hitting your temporal lobe. In order to reach the medial temporal lobe you would have to take a pencil and put it in your nose and shove it at an angle of about 45 degrees vertical to hit your medial temporal lobe. Don't do that!!!! Sorry to be graphic.
• What does the Medial Temporal Lobe do?
• The Medial Temporal Lobe is in charge of memory storage, formation, and recall. Specifically the medial temporal lobe contains a structure called the hippocampus. This little structure is what forms memories. It is a loop of neurons/nerves that send signals around in a little circle that repeats itself over and over again. While the hippocampus runs in circles, your brain makes decisions on what part of the repeating loop it wants send up to your the rest of your brain to remember. So when you are trying to memorize something, for example the word, "Acetocholine" your hippocampus basically runs around in circles telling your brain that this word is important to remember. The more you say and see the word "Acetocholine" the more times the word runs in this little hippocampus circle and your brains recognizes it as being more and more important and will make it a memory. I hope that makes sense.
• How is the Medial Temporal Lobe damaged in Alzheimer's Disease?
• So when a person begins to have Alzheimer's Disease the hippocampus is damaged and the person cannot form new memories. The damage is caused by a buildup of misfolded molecules called proteins.  These proteins are not just any type of protein you drink from a smoothie, but are proteins which are normally found in a healthy brain that have become corrupted and now harm your brain. Most of your brain is made a little healthy proteins. Proteins can be described as little microscopic chains of chemicals that are linked together. The proteins that cause Alzheimer's Disease are chains that have been broken or bent so they don't link together to form normal brain stuff. They end up forming tangles and knots, called Amyloid Plaques and Neurofibrillary Tangles, that disrupt the chemical signals from reaching their proper destination (see picture below). So in the case of the hippocampus, these proteins would break up the memory loop needed to form new memories. The person with Alzheimer's would then be unable to form memories for simple things, like recent events and instructions. Then as the disease progresses more of the storage system of the brain, which is located around medial temporal lobe, becomes damaged and the older memories are forgotten. I hope this makes sense. 

• Interesting fact: Emotional memory, which is the ability for a person to recognize and express emotion, is the last type of memory to be affected by Alzheimer's Disease. So people with Alzheimer's are able to understand and express emotion until the very end stages of the disease. If you are around a person with Alzheimer's disease that individual will notice and respond to when you are getting frustrated, angry, sad, or happy even if they can barely talk, walk, or act "normal". Alzheimer's patients respond very well to stimuli that evoke emotion. For example, bringing a baby to an Alzheimer's patient can stimulate feelings of joy in that patient's brain, and you can see in the patients face that they remember that babies make them happy even though they might not even know how to say the word "baby" or even know who that baby is. Pretty cool!
• How is it diagnosed? It's complicated!

•  The picture above show a brain scan of 3 people. The colors reflect the action happening in the parts of the brain. Red is highly active and blue is less active.  The middle of the brain is more like relay center rather than a hard working factory like the rest of the brain so it appears blue. The middle portion is probably the most important part of the brain and just because it is blue doesn't mean it isn't working less hard. If you look at the blue part on the scan on the far left that is the two halves of of the medial temporal lobes. That is wear memory is formed and relayed to the rest of the brain. So as Alzheimer's progresses that part of the brain shuts down and becomes that black hole on the far right and that person loses all those memories and their brain fails to make sense of pretty much everything.
• Brain scans can be used to diagnose Alzheimer's,  but the scans only take a snapshot of what is happening in the brain at that moment. So in order to really diagnose Alzheimer's with brain scans a person would need to go get brain scans often to show the disease progression.  This is extremely expensive and most insurances won't cover this because imaging the disease will not really change the outcomes of the disease. Insurance feels if we can't cure it then why do we need to keep imaging it. In real life, if doctor's suspect Alzheimer's then usually it is just a wait and see what happens type of thing. 
• Alzheimer's can only be officially diagnosed in two ways. The first way is by basically ruling out all the other possible forms of dementia through expensive imaging and then doing strict mental tests that often upset the patient before an official diagnosis can be made.  The second and more accurate, quicker way of diagnosing Alzheimer's is through autopsy. Yes, only after you die can we say, "Yep you had Alzheimer's." That doesn't do much good, so most people opt not to have their family member get their brain removed after they die and just say what is done is done. 
• How can we treat Alzheimer's Disease? It depends, and its complicated!
• Here are the top two FDA approved drugs that are "proven", I use that term loosely, to help with Alzheimer's and what they do:
• Donepezil/Aricept: well we don't know exactly how it helps Alzheimers, but I will explain what we think it does. The main chemical signal used in the hippocampus, the memory loop thingy, is called Acetocholine. The name is not important, just know that Acetocholine is what makes the hippocampus memory loop thingy go round and round.  People with Alzheimer's don't have enough Acetocholine in the hippocampus because it is getting destroyed by overactive proteins called enzymes.   Donepezil goes in and shuts off the enzymes that break down Acetocholine and therefore let the hippocampus run in circles to form memories. Wow I hope you guys can make sense of this!!! After a while though the damage from Alzheimer's gets bad enough to where it doesn't matter how much Acetocholine you have, the loop is broken so the drugs won't help.
• Rivastigmine: is basically a manufactured form of Acetocholine that gets transported from your gut, into your blood, and then to your brain to keep your Acetocholine levels high.

I hope this was educational and interesting. Send me questions if you have any. If you guys are curious about other diseases and medical things let me know and I will try to find answers.  I have a ton of resources not many people have and I know google is great, but it often times isn't the best resources for current issues.  I hope to check in every month and write about a few topics I have been curious about. I think next I want to talk about what to do when babies are sick and how to tell if it is serious or not. I think many people would enjoy that. 

A Summer for the Bennion History Books

This post was meant for August and I totally forgot about it. But here it is!

This summer started off with a bang! After finishing my first year medical school and passing all my classes, Hailey, Olive, and I look forward to a summer full of adventures and bonding time. When we look back upon the school year, we realized we really missed out on a lot of family time so this summer was going to be the time when we can make that up! However, this summer was going to be something we would never forget for both good and bad reasons!

I will first make a record of all the trying times we have had the summer. Unfortunately, most of these unfortunate incidences revolve around my car. Her name is Diabla! The bad luck with Diabla started one beautiful sunny Sabbath morning here in Yakima Washington. The summer had just started as I had been out of school for only a few weeks. Our family got to church about five minutes before starting and we parked Diabla facing Terrace Heights Drive. After sacrament meeting we decided it would be best to take Olive home as she was teething, screaming, and needing to go down for a nap. As Hailey was getting Olive into the car she noticed that there was a bunch of glass on the two front seats. Then she looked at the windshield and saw that a rock about the size of a fist had been thrown at our windshield and shattered it. Long story short, we found out that a kid was throwing rocks from the other side of the road attempting to hit cars. A witness saw the kid throwing rocks and told him to stop, but the witness did not realize he had already struck our car. After finding out our car window was shattered I left church to clean the car and to call the insurance. We later replace that windshield that week for about $200. 

Just about a month ago, our poor car ran into another tragic event.  Diabla was taken advantage of, violated, and carnapped! We had planned to take a family trip with the Harlan's up to Vancouver British Columbia. We followed Hailey's younger sister and her choir up to see them perform a concert and then did sightseeing in Vancouver, BC. We stayed at a nice hotel just outside of Vancouver. Hailey and I drove our car and followed the Harlans up to Canada. Once we got to the hotel we parked her car in the parking garage and transferred Olive's car seat and essentials either to the hotel room or to the Harlan's car. During our trip to Vancouver we saw the city of Vancouver, we visited a fun suspension bridge, and visited the Vancouver, British Columbia temple. The trip was amazing, at least thus far.
 The morning we planned on leaving, we packed up our room and I took the bags downstairs. I met the Harlans in the parking garage as they were coming back from McDonald's to bring us breakfast. We looked to the side of their car, supposedly where my car should have been parked, and they asked me if I had moved my car in the past night. I told them I had not. I dropped my bags and began to think. So we believed that my car for some reason have been accidentally towed by the hotel. The hotel monitored the parking garage and required us to pay a parking fee so maybe I thought they had made a mistake and towed my car. I went to the front desk and asked if they had towed my car, and the front desk lady said, "We do not tow vehicles here. I am so sorry, I will call the police." I could not believe what I was hearing. My car had been stolen! After about a 2 to 3 hour ordeal we filed a police report and I began my insurance claim with my insurance. I actually have footage of the vehicle being stolen. Maybe I will upload that sometime. To make matters worse I called around to every rental car company in Vancouver to find out that all international vehicles are sold out so we could not make it across the border in a rental car. After I was able to gain my composure and after realizing my car hds been stolen due to poor security by the hotel, I realized that the hotel should have done something to compensate for my difficulties. Also, I forgot to mention that the Harlan's room had been infested by bedbugs, luckily ours had not, and therefore that was another reason to complain about our stay! Honestly, the hotel was amazing. The beds were comfortable and the amenities and staff were great. But that was still was not enough to make up for the bedbugs and my stolen car! I headed up to the front desk and asked to speak to a manager. I spoke with the manager and he was the most kind and understanding manager I've ever spoken to. He refunded our stay, bought the Harlan's new luggage, and even help pay for a rental car when we finally made it across the border. For a brief little while I regained my faith in humanity after having our car stolen by some selfish lowlife.

So after getting things squared away with the hotel, we squeezed all our belongings into the Harlan's car and luckily had just enough room to drive out of Canada to make it to the nearest city in Washington. We picked up a rental car and continued with the rest of our travels. We were able to travel with the Harlan's to visit the grave sites of Hailey's great grandparents and her grandma Carol. Dave was able to dedicate their graves and leave the ashes of Hailey's great grandma in the hands of the mortuary. These two events were the main goals of our trip with the Harlan's on top of our trip to Vancouver.  

After visiting with a few family members in the area, we headed back to Yakima. Two days later we received news that our car had been found. After paying the deductible we had the car towed to Yakima. Yesterday we were able to see the damages that have been done. The thief had attempted to steal the stereo leaving damage to the dashboard. He smashed up the backseat attempting to get to my aftermarket speakers. He ripped out my amp in the trunk. He stole four temple bags and our portable crib. He ripped out the ignition and shoved a screwdriver in it to start the car. Other damages include nicks and scratches on the interior of the car as he was vomiting through the vehicle. Since the car is been stolen our anger had died down, but after seeing what the thief had done to our vehicle we once again felt violated and angry. It is very hard to understand the mindset of an individual who would take advantage of our little family, especially when we do not have the money lying around to have events like this occur. 

To top the summer off with an even better ending I also lost two of my grandparents, Grandpa Bennion and Grandma Allen. Because of our planned trip to Canada and the obligations we had made with the Harlan family, I decided not to go to Grandpa Bennion's funeral. I was sad I could not make it, but was able to see pictures and listen to the audio of the funeral. I was grateful for the taking the time this past Christmas to visit him with Olive and Hailey. I love my Grandpa Bennion. He was always so happy and always had a funny joke to share. He was proud of my accomplishments and made me feel important and loved. I will miss him. Both Grandpa B and Grandma A had been battling a long struggle of Alzheimer's Disease.  I was fortunate to be able to know them before the disease took over the majority of their faculties, especially in the case of Grandma Allen.  I know that they are in a better place and will miss them dearly.