| OCR Text |
Show years, millions of Americans been getting the short end the medical stick. They're the elderly who experience cognitive troubles failing memory, difficulty in concentrating and thinking clearly, even outright confusion. To a large extent, those troubles have been considered virtually inevitable accompaniments of aging, a kind of medical Today that picture is changing. Research in medical center, university and pharmaceutical laboratories has begun to intensify. About 25 years ago came the first psychotropic agents tranquilizers and other compounds for schizophrenia and other severe psychic illness making treatment, instead of mere institutional warehousing, possible. Now we appear to be witnessing the beginnings of what could be another striking development of noagents speotropic cially aimed at cognitive problems. And at a growing number of special programs at major medical centers, elderly volunteers with such problems are joining investigators in dozens of projects to evaluate innovative treatment measures. In its first half dozen months, the Senior Citizens Treatment Program at Medical Long Island lewish-Hillsid- e Center, New Hyde Park, N.Y., has worked with more than 200 elderly volunteers. At New York University's Geriatric Study and Treatment Program in New York City, more than 500 volunteers with cognitive problems have been participating in studies. And similar programs are operating at Boston State Hospital and University of California at Los Angeles Medical Center, with others expected to open. For ThePnMem by Lawrence Galton 0. 4-- 4-- (mind-activatin- She is 72, confused, apathetic, withdrawn, taking no interest in anything. Hopelessly senile? No. Her prob- lem: mental depression. Devastating at any age, depression can be especially so for older people, in whom it may go unrecognized. It is a common cause of cognitive troubles and seeming senility. Treatable? Many antidepressant drugs are available and effective for younger people and for some of the aged. One brought dramatic improvement for this woman in a month. For many of these elderly, however, available antidepressants have undesirable effects on the heart when a heart problem is present. In some cases, they may cause confusion. Many new experimental antidepressants are being developed for older people. One under study right now in the UCLA program directed by Dr Lissy jarvik is called Trazodone. Early indications are that it may be at least new area has been the with discovery that some opened hormones have effects on learning and behavior. ACTH is a hormone from the pituitary gland at the base of the brain that stimulates other glands. At the University of Utrecht in the Netherlands, Dr. David de Wied split the hormone and Tests with got a fragment, ACTH animals followed. He trained rats to go through a maze, then electroshocked them to disrupt their memory. He gave some others injecinjections of ACTH tions of inert material. The latter had to learn to get through the maze all reover again; those receiving membered immediately. Many older people have difficulty with memory retrieval. In the Long has reIsland program, ACTH cently shown a promising effect in facilitating retrieval. And Dr. jonathan Cole of Boston State Hospital has found volunteers reporting another effect: they feel a good deal better after even one injection. An exciting Research goes on Unlike these women, many elderly fail. For them, wide research with live in a haze as mental faculties mind-activati- older antidepressants without their side effects. Other new agents being studied at the various centers include Vivalan and Mianserin. Actually, when their depression is recognized, some elderly may not need drug therapy. At UCLA many respond to group psychotherapy. A newer, simple cognitive therapy, in use in the Long Island program, addresses itself to two tendencies of many depressed elderly people. One fs to talk to themselves things: saying negative . stupid. ." Con''You're old sciously unaware of what they are doing, they can't deal with the thoughts that reinforce depression. The other is selective forgetting. Where most of us in a day experience pleasant, unpleasant and routine moments, many depressed elderly people remember only the unpleasant. In cognitive therapy, they keep a diary, record pleasant and unpleasant daily experiences and note any automatic negative thoughts. In weekly hour-lonsessions, patient and therapist analyze the record, and little by little the patient becomes aware of what he or she has been doing to selfas effective as y, g produce misery. agents holds hope. "Often, without need for anything else, cognitive therapy produces marked improvement within three to four months," says Dr. Allen Willner, who directs the Long Island program. Vasodilator drugs Vasodilator drugs, such as Hyder-gin- e and Cyclospasmol, have been used in older people to dilate blood vessels. It's hoped this increases nourishing blood flow to brain tissues. There have been reports of benefits to at least some patients improvements in confusion, mental alertness, memory, sociability. Yet, curiously, the benefits from some of these drugs did not always correlate well with increased blood flow. It now appears that not all vasodilators are alike and that dilation may be only one effect. There are indications that some may improve the brain's use of oxygen and nutrients and that some may help restore a proper chemical balance needed for normal nerve transmission. Newer drugs of the vasodilator lass are being developed with the hope they will have definable effects useful for more patients. One being evaluated at several centers is Praxilene. Many other drugs are, or soon will be, under investigation in one or more of the centers. Choline, a compound found in vitamin B complex, is used by the body to produce a neurotransmitter, a chemical needed for nerve impulse transa drug often used for mission. also can be converted shaking palsy, the an into by body important neurotransmitter. At New York Universitys center, studies with both agents are under way, supported by the National Institute of Mental Health. Investigators there, says the center's director, Dr. Steven Ferris, see reason to believe that some patients with cognitive problems may have a deficiency in that choline or neurotransmission could help. Also scheduled for study at New York University is the drug Piracetam, in Belgium. Piracetam developed seems to be related to GABA, a natural body compound involved in nerve transmission. Finding answers to cognitive problems in older people is not simple. The highest functions of brain and nervous system are involved. Some of the new, experimental measures under study may prove of benefit. Some may fall by the wayside. What is more significant is that there is now a burgeoning effort in a area. Mental decline in older people is no "We are longer a to keep looking hard," says going UCLA's Dr. jarvik. "I am sure we will find rewarding treatments." long-neglect- 20 PARADE AUGUST 13, 1978 |
