One of the most common reasons patients get upset with neurologists is when we tell them they should no longer drive. Most older folks are very independent, and when you take their car away from them, they are not happy. In fact, many become belligerent and act as if you’re personally out to get them.

The most common reasons for prohibiting driving include seizures, Parkinson’s disease, and dementia.

What is dementia? It is very broad term that encompasses all the hundreds of things that can lead to poor brain function. In addition to impairing memory and overall cognitive ability, dementia greatly diminishes reflexes and reaction time, visual-spatial processing, as well as hand-eye-leg coordination. And it is very common.

How common? It’s estimated that 5-10% of the population aged 65 years or older has it. My guess is that amounts to millions upon millions of unfit drivers.The scary thing, however, is that no one is doing anything about it.

The laws are incredibly strict when it comes to punishing and taking away licenses of people who get DUIs (driving under the influence of alcohol). And rightly so, of course. We don’t want them killing us or our children.
But what about the tens of millions of drivers over 65 that are demented? I believe they also represent a major road hazard, and need to have their licenses pulled.

Came across an article on physorg.com that recently notes:

Researchers at the Alzheimer’s Disease Research Center (ADRC) of Washington University School of Medicine in St. Louis and elsewhere have developed a three-hour workshop that trains health care providers to identify potentially unsafe drivers with dementia and to encourage appropriate retirement from driving.

This is all well and good, but the vast majority of primary care physicians are too busy taking care of medical issues to have to worry about this sort of thing, and many are not expert enough in neurological assessment to determine when “appropriate retirement from driving” should take place.

If a state can make laws prohibiting cell phone use while driving, why can’t they make laws subjecting everyone over 65 to another driving test?

Share This Post:

Sometimes, a picture really is worth a thousand words…

(Noever, R., J. Cronise, and R. A. Relwani. 1995. Using spider-web patterns to determine toxicity. NASA Tech Briefs 19(4):82. Published in New Scientist magazine, 27 April 1995.)

Nevertheless, over the next week, I have 2 informative commentaries on caffeine I’m getting ready to post

Share This Post:

As strange as this may sound, currently, there is no good scientific test for Alzheimer’s disease. In other words, there is no specific blood test, spinal fluid test, or brain imaging study (MRI, CT, PET) that can definitely tell whether you have the disease or not.

The diagnosis mainly rests on the neurologist’s clinical impression, which is based on an interview, examination, as well as some blood tests and an MRI of the brain to rule out other conditions which may mimic Alzheimer’s. Many times, especially during the early stages of the disease, physicians are uncertain of the diagnosis. Families are told that more time is needed to observe the patient, to see how the disease process unfolds. This uncertainty can lead to frustration.

The only real way to be 100% certain of the diagnosis is to autopsy the brain, which of course is not a good option in a living person.

Things may have just changed though, as the UCLA School of Medicine has announced they’ve developed a PET scanning technique that seems to offer the promise of a definite answer.

While still experimental, the scan utilizes FDDNP, a radioactive tracer that binds to the plaques and tangles typically encountered in the Alzheimer brain. The PET technique then provides physicians an actual picture of how much and where this tracer shows up in the brain.

I’d say this is significant breakthrough, as we are now much closer to identifying which people are going to develop Alzheimer’s disease years before they become symptomatic (see a related post discussing the early signs of dementia).

Additionally, the new study will enable researchers to more rapidly develop effective treatments, since they’ll be able to more objectively see what drugs are effective and which ones aren’t.

The study was published in the New England Journal of Medicine, December 2006.

Share This Post:

Much Thanks to the International High IQ Society for this ball transformation puzzle:

What is the smallest number of red balls that must be moved to transform the red triangle into the green triangle?

(Puzzle copyright (c) International High IQ Society)

Solution follows below:

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

Share This Post:

People who regularly act out their dreams at night have a disorder called REM sleep behavioral disorder (RBD). Frequently, these patients can injure themselves or their spouses and not even realize it.

During normal REM sleep, the part of the brain that activates movement of the arms and legs is gated closed and silenced, so that your limbs are paralyzed. When this mechanism fails, RBD ensues.

A recent study done by the Mayo clinic indicates that a startlingly large number of people with RBD (two-thirds!) will, within 11 years time, go on to develop a synucleinopathy: a neurodegenerative disease like Parkinson’s disease or Lewy Body dementia.

Share This Post:

This real-world puzzle comes courtesy of www.rinkworks.com:

Why is it better to have round manhole covers than square ones?

Feel free to post the answer in the comments section if you think you know it

Share This Post: