Byline: Peter J. Whitehouse, MD, Ph.D.
Peter J. Whitehouse, MD, Ph.D., Case Western Reserve University professor of neurology and biomedical ethics who studies age-related cognitive decline, was online Tuesday, August 2, at 3 p.m. ET to answer your questions about the aging process.
From The Post:
Joy . . . or Pain? (Post, August 2)
Whitehouse is Director of the Integrative Studies at Case Western Reserve University as well as professor of Neurology, Psychiatry, Neuroscience, Psychology, Nursing, Organizational Behavior, Cognitive Science and History. He received his undergraduate degree from Brown University and MD-PhD (Psychology) from The Johns Hopkins University, followed by a Fellowship in Neuroscience and Psychiatry. He is also a clinician at University Hospitals of Cleveland.
Whitehouse's research interests include the neurobiology of Alzheimer's disease and related conditions, the development of more effective treatments for individuals with cognitive impairment, including drugs and non-biological interventions, ethical issues and integrative health care systems.
The transcript follows.
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Kensington, Md.: I am 73 years old and am unable to stand up without help by pushing on something (arm of chair or table) to stand up or pulling on something to get out of a car. I have trouble sitting down also. I have knee problems but don't think that's related to my problem. This has been happening for a couple of months and really concerns me. I don't know what's causing this. My friends my age or older don't have this problem. Thanks for your thoughts about this.
Peter J. Whitehouse, MD, Ph.D.: I would seek a neurologist's opinion. This could be a nerve or muscle disease or it could be as simple as needing to improve your exercise program.
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Richmond, Va.: Glad you are here to answer our questions!
I am 40, and have noticed (that like my parents) I am starting to have "liver spots" and brown patches starting to pop up on my skin. Also, those tiny red dots too. Can all these be removed without surgery? How do I slow or prevent them from emerging?
Peter J. Whitehouse, MD, Ph.D.: Sorry. I am a neurologist. Please consult a dermatologist.
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St. Paul, Minn.: My 78-year-old mother has shown a lot of confusion over dates lately. For example, she repeatedly asked how a party went during the weeks and days before the party was given, each time being told when the party was actually scheduled. She also has shown problems playing card games that she used to do well at. Are these signs of normal aging or of Alzheimer's?
Peter J. Whitehouse, MD, Ph.D.: Hello, there is no definitive way of differentiating so-called normal aging from so-called Alzheimer's disease. The label Alzheimer's is applied when a memory problem impairs activities of daily living, i.e. function. How much dysfunction is necessary to make a diagnosis is arbitrary. I personally believe that the label Alzheimer's includes a variety of biological processes that occur in aging and therefore represents severe forms of brain aging. I think the label is problematic for many reasons. Your mother should see a physician in my view.
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Dallas, Tex.: Is memory loss normal at any age?
Peter J. Whitehouse, MD, Ph.D.: Some memory loss is normal. Some quite reversible medical conditions can be caught early.
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Marion, Ky.: My 94-year-old mom who is in outstanding health finds her mind going. What is the latest help in warding off dementia?
Peter J. Whitehouse, MD, Ph.D.: Live a life with purpose; contribute to the lives of others.
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Laurel, Md.: What is the best evolutionary theory for senescence?
Peter J. Whitehouse, MD, Ph.D.: Senescence is hard to incorporate in theories of evolution. Genes care about passing themselves on through reproduction earlier in life. However grandparents are important for raising children and there are plenty of opportunities for passing on your memes in later life.
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Hendersonville, N.C.: How do I get more energy?
Peter J. Whitehouse, MD, Ph.D.: Exercise and think positive. But see your doctor if it doesn't work
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Washington, D.C.: So if someone does have memory loss that is caught early, what can be done to improve the situation? Anything?
Peter J. Whitehouse, MD, Ph.D.: It depends what's causing the memory problem. Getting an evaluation.
Many times the treatment for normal memory concerns is getting a pad of paper, a sympathetic wife or a computer. Turn your attention to gaining wisdom as you age rather than losing your memory.
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Anonymous: Can you please explain if anything can be done to postpone/delay/help out the aging process? What are your thoughts on all of the anti-aging products that are out there? What, in your opinion, are the best ways to help the aging process overall?
Peter J. Whitehouse, MD, Ph.D.: Exercise, keep your mind active, have a purpose in life, eat responsibly, wear your seatbelt, listen to your mother, your wife or any other wise woman in your life.
Or send me $100; so I can join the many people were trying to take your money in exchange for some magic pill.
The magic is in you; live well.
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Arlington, Va.: What are the symptoms of early onset Alzheimer's? Is there any age that's too young for this to develop? Is it hereditary? Thank you.
Peter J. Whitehouse, MD, Ph.D.: Memory problems can occur at any age and need to be evaluated.
Some people unfortunately suffer from premature brain aging that leads to severe impairment in activities of daily living. Genetic forms of Alzheimer's disease usually come on in the 40s and 50s.
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St. Augustine, Fla.: What role does heredity play in age-related declines in cognitive function?
Peter J. Whitehouse, MD, Ph.D.: Some forms of dementia do run in families. They are rare.
Aging also tends to run in families - in fact in all families.
In today's modern medicine too much emphasis is placed on genes.
Go out there and help clean up our environment. Get rid of the lead that still impairs the learning of our young children in our cities.
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Baltimore, Md.: Dr. Whitehouse, I enjoyed reading the article with your research-based input. Still, I was disappointed to see how the article treated the subject of calorie restriction with optimal nutrition for life extension. Is this not the ONLY scientifically demonstrated means of extending baseline lifespan in mammals? No, it has not yet been proven in humans, but I believe that the other remedies offered pale in comparison. We all know that smoking and excessive drinking are detrimental, while moderate alcohol consumption may be beneficial (although the article did not mention resveratrol, which is only in red wine). Exercise is, of course, a positive thing for overweight Westernized societies, but it will never effectively combat the standard American diet. Calories and nutrition should have been the first and most prominent factor.
Peter J. Whitehouse, MD, Ph.D.: I absolutely agree with you. I would not have written the article so enthusiastically about caloric restriction, at least in humans. Have a glass of red wine tonight and toast the calories you eat each day! Then go out and take a nice walk after dinner.
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Richmond, Va.: Most of the recommendations you make for successful aging are not new to me, and they make great sense. However, one of my husband's family members did just about everything you suggest but still has dementia. Her mother also had it, but her father did not. How much of late-onset dementia is inherited, or do we know that yet?
Peter J. Whitehouse, MD, Ph.D.: I'm sorry to hear about your relative.
Serendipity plays a more important role in our lives than genes.
There are genetic factors in late life dementia, like ApoE 4 (google it).
Environmental factors play a role as well.
Avoid being hit by an SUV - let's not blame "being hit by a bus" as we usually do to explain chance events. We need more buses and fewer SUVs.
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Bowie, Md.: From what I have read, exercising your brain is as important as exercising your body. What are your top five exercises for the brain?
Peter J. Whitehouse, MD, Ph.D.: First I'm not good at crossword puzzles and therefore don't do them.
However my wife loves them and I'm sure she will age better cognitively than I do.
Seriously I've only going to give you one example but it incorporates many of the recommendations I make in one package. My wife and I started a country's first and only intergenerational public-school. In this school we celebrate lifelong learning and service to community. Urban city children from Cleveland, college students and older adults read, produce multimedia products, garden and have fun learning together. Even older people with memory problems participate in our programs. Such activities keep you physically and mentally active and contributing to community with a sense of purpose.
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Washington, D.C.: If someone says "you'll end up just like your ... mother, father, grandmother, etc." when talking about your personality at an old age, is this entirely true or could it be?
Peter J. Whitehouse, MD, Ph.D.: Like most things in life it's partially true.
I also like most things in life it's up to you.
Do you like the way your parents aged? Follow their footsteps.
Do you think you can improve on it? Take a different path.
Genes are not all that they are cut out to be, besides they're yours.
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Arlington, Va.: Why have you suggested thinking positive as a way to get more energy? I'm not disagreeing, but am wondering if there's any scientific evidence that suggests thinking positively could actually improve one's body?
Peter J. Whitehouse, MD, Ph.D.: Reread the article section on Be happy and Google Seligmans' Authentic Happiness.
Being happy of mind, helps your body. And even if it doesn't, you still think it does!
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Annandale, Va.: In the article "joy or pain," there are partially contradictory statements made about women and the benefits of alcohol. It says it's good in moderation for the cognitive capabilities, yet then it says that it raises your chances of getting cancer, even with moderate consumption. While I realize that one is the mind and one is the body, the two are so interconnected that the research on the subject has led me to conclude I'd feel safer without any alcohol in my life, because of its addictive properties. Why can't the researchers do a better job of displaying the gigantic risks along with the mild benefits?
Peter J. Whitehouse, MD, Ph.D.: Research is not the be-all and end-all to answer all our questions. We would never have enough money to do studies on all the questions we would like to ask, let alone answer. Besides as anyone who reads the Washington Post everyday realizes - one day's breakthrough is another day's disappointment. Don't put scientists on pedestals. Too often the research is biased by personal theories or even worse personal pocketbooks. Science is a great profession, do not get me wrong. It is a very bad religion.
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Washington, D.C.: My grandmother is 85 years old. That said, she is always saying "I'm 85 years old and I can say whatever I want." And she absolutely does. She has really no "filter," which can make for some interesting stories ... She is, however, sharp as a tack, too. What is it with the mind that she can seem to lose her sense of what may be appropriate and what may not be, yet still be witty as ever and up on everything? Is this something going with her mind with age, or could it simply be a personality trait/development? And thank you!
Peter J. Whitehouse, MD, Ph.D.: Hi, can you arrange a date for me with your grandmother; she sounds like fun?
One off the advantages of getting older is that you can take more risks and ask the question what is appropriate? What is appropriate today may not be appropriate tomorrow. I would argue that many of the things were doing to our natural environment are not appropriate. Grandparents can point out the foolishness of youth and even the foolishness of mature adults.
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Washington, D.C.: I am 45. I have always had very poor memory when it gets to remember names or certain facts (f.e. never remember names of films, actors and celebrities, even though I like them), which makes me a very boring or bad conversationist. But I've also found out that I may have a better than average memory of "visual" images of places, works of art, etc. I dread the idea of loosing my memory when I get even older. Which leads to my two questions: 1. Do people like me have a greater chance to develop Alzheimer's ? 2. Is visual memory different or evolves differently than language memory? Thank you very much.
Peter J. Whitehouse, MD, Ph.D.: We have many different kinds of memories in our brain - visual, verbal, motor, olfactory, short-term, long-term etc. Each of us starts off with a different brain and a different set of cognitive abilities. Aging adds to the variability. My advice to you is don't worry about it too much. There may be more anxiety caused by the fear of Alzheimer disease than Alzheimer's disease itself. Besides Alzheimer's disease is just a particularly severe form of brain aging.
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Arlington, Va.: Are there things with the mind that improve with age? Or only decline?
Peter J. Whitehouse, MD, Ph.D.: Wisdom - or at least the opportunity to learn from experience.
Seek wisdom and you shall find it; find it and you shall not.
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Sterling, Va.: Yesterday, the state of Maryland gave my 83-year-old father a driver's license without a road test, even though I had asked them to do so. I am terrified that he will kill someone.
I am not worried because of his age. I am worried because he is not able to handle things, and driving in the D.C. area requires quick thinking.
My father is very confused all the time -- he forgets what what he is doing while we are doing it (for example, on the way to Sat breakfast at the same place each week, he will ask repeatedly where we're going and what we're doing.) He does not know who Pamela Anderson is when he is looking at her on the cover of a magazine, even after being told who she is he draws a blank. Basically, he remembers WWII pretty well but most things after are sketchy at best.
This confusion was very evident during our three hours at the DMV, but the person helping us did not seem to have the authority to approve my request that he be given a road test. I was given a phone number to 'report him anonymously,' but that avenue is still at the descretion of the state of Maryland (they will decide if a road test is warranted.) I have placed that call.
Am I wrong to be concerned? Can a person who is so confused be a safe driver?
Thank you.
Peter J. Whitehouse, MD, Ph.D.: You are correct to be concerned about both your father and others. Perhaps you should work with other family members to take away the keys. Persist in your efforts please.
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Washington, D.C.: How many people in the U.S. - statistically speaking - get some form of Alzheimer's disease?
Peter J. Whitehouse, MD, Ph.D.: Well now that's an interesting question, particularly because you said some form of Alzheimer's disease. How many forms are there? I think there are as many forms as people will grow old and have some memory problems. That makes it about a quarter billion in the US. Unfortunately some people grow old and have more severe memory problems. Then the number depends on how severe you must be before you get labeled as having Alzheimer. Some clinicians are trying to promote the concept of mild cognitive impairment (MCI). If you add it in to the pot and considerate it early Alzheimer's, then there are tens of millions of people's labeled with an age-related memory problem. Let's not label too many people as sick please.
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Peter J. Whitehouse, MD, Ph.D.: A blank question - should promote us all to reflect deeply on our own aging.
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