Cognitive Enhancer: Protctive Factors

Carers of people with dementia

Providing care for a person with dementia is stressful and demanding, and carers of people with dementia have poorer physical and mental health than do carers of people with other conditions.1 Carers who find caring a stressful experience are at higher risk of mortality than are non-carers.2 Social aspects of burden include loss of relationship with the recipient of care and reduced social network owing to stigma or lack of opportunities to socialise. In addition, chronic illness can result in family conflicts that reduce the available emotional support, and family and friends may "distance" themselves physically or psychologically from carers. Carers can feel lonely, and loneliness has been associated with increased mortality and physical and psychiatric morbidity.

In the United Kingdom, one to one social support is commonly provided through voluntary sector based befriending services. Britain has a long tradition of voluntary action, and the emphasis on partnership in recent government policies has given voluntary, community, and users’ organisations a more central role in the delivery of services.3 4

We could identify only one published trial of befriending for family carers of people with dementia; it evaluated the provision of a short term (eight week) peer support intervention that showed no significant impact.5 We may anticipate that friendships take time to evolve, and therefore befriending should be evaluated over the long term. In this paper, we describe the clinical outcomes of the befriending and costs of caring (BECCA) multi-site randomised controlled trial of a long term voluntary sector based befriending intervention.6

All participants and recipients of care received usual care as provided in their area by health, social, or voluntary services. Typical services included community psychiatric services, day hospitals, day centres, home care or personal care, respite care, and carers’ information or support groups.

We assumed that the HADS, PANAS, MSPSS, and loneliness scores followed a normal distribution, on the basis of summary statistics and plots. We initially used a two sample t test with pooled variance to test for a difference in means between groups. We used a general linear model to compare groups while adjusting for baseline scores and by stratification variables (that is, kinship and population density). We constructed confidence intervals for unadjusted and adjusted (least squares) mean differences. We used the log-rank test to test for a difference in median time to institutionalisation between the two groups.

Most participants were white, female, above retirement age, and living with and usually married to the person with dementia. Almost all were providing daily assistance. The mean age of carers was 68 (range 36-91) years, and the mean duration of caring was just under four years. The mean age of the people with dementia was older, at 78 years. One in five (17%) carers reached case levels of depression (HADS depression score 11).

Source: BMJ, doi:10.1136/bmj.39549.548831.AE (published 27 May 2008)






Smoking has consistently been found to be inversely related to the risk of endometrial cancer, but cancers of the breast and colon seem unrelated to smoking. Inverse associations with venous thrombosis and fatality after myocardial infarction are probably not causal, but indications of benefits with regard to recurrent aphthous ulcers, ulcerative colitis, and control of body weight may well reflect a genuine benefit. Evidence is growing that cigarette smoking and nicotine may prevent or ameliorate Parkinson's disease, and could do so in Alzheimer's dementia. A variety of mechanisms for potentially beneficial effects of smoking have been proposed, but three predominate: the ‘anti-estrogenic effect’ of smoking; alterations in prostaglandin production; and stimulation of nicotinic cholinergic receptors in the central nervous system.

John A. Baron, British Medical Bulletin 52:58-73 (1996), Beneficial effects of nicotine and cigarette smoking: the real, the possible and the spurious
www.oxfordjournals.org




Increasing age, fewer years of education, and the apolipoprotein E 4 allele were significantly associated with increased risk of Alzheimer’s disease. Use of nonsteroidal anti-inflammatory drugs, wine consumption, coffee consumption, and regular physical activity were associated with a reduced risk of Alzheimer’s disease. No statistically significant association was found for family history of dementia, sex, history of depression, estrogen replacement therapy, head trauma, antiperspirant or antacid use, smoking, high blood pressure, heart disease, or stroke. The protective associations warrant further study. In particular, regular physical activity could be an important component of a preventive strategy against Alzheimer’s disease and many other conditions.

Lindsay J, Risk Factors for Alzheimer’s Disease: A Prospective Analysis from the Canadian Study of Health and Aging, Epidemiol 2002, John Hopkins Bloomberg School of Public Health, www.oxfordjournals.org






Cognitive Enhancer


............The report fails, however, to recognize the urgent need for research to develop better cognitive enhancers. Progress on developing effective cognitive enhancers, and on understanding their long-term effects, is hampered by a shortage of focused research in this area. In general, the potential of enhancement medicine has yet to be fully appreciated.

Prevailing patterns of medical funding and regulation are organized around the concept of disease. Every pharmaceutical on the market with alleged cognitive-enhancing effects was developed as a treatment for some pathology. Its good effects on healthy adults' brains were discovered as fortuitous side effects. This disease-centred framework impedes the development of safe and effective enhancing medicines and has several consequences.

First, it makes funding hard to come by; it also makes it difficult to obtainregulatory approval for enhancement drugs. The result is that those who wish to research cognitive enhancement must often mask their work under the guise of addressing some 'respectable' disease.Second, in order to gain access to the benefits of a cognitive enhancer, the user must first be classified as sick. This leads to the expansion of diagnostic categories and the invention of new pathological conditions - sometimes to cover cases that in earlier times would have been regarded as within normal human variation.

Nick Bostrom cited in James Martin School:
http://www.21school.ox.ac.uk/blog




Access (and skill in accessing) online information sources, software tools and mental training can likely achieve far larger effects. Recent developments of computer training of working memory and fluid intelligence suggest that cognition enhancement can be done without chemicals: the ethical and social challenges remain largely the same, but the enhancement would be outside of any drug policy.

Anders Sandberg




There is an ‘in principle’ restriction too. Measurement involves interactions: a system must be disturbed, ever so slightly, in order for it to affect the system that is our measurement device. We are forced to meddle and manipulate the natural world in ways that render uncertain the precise state of the system. This has two consequences. First, measurement alters the state of the system, meaning we are never able to know the precise premeasurement state (Bishop [2003], section 5). This is even more pressing if we consider the limitations that quantum mechanics places on simultaneous measurement of complementary quantities. Second, measurement introduces
errors into the specification of the state. Repetition does only so much to counter these errors; physical magnitudes are always accompanied by their experimental margin of error.

Brit. J. Phil. Sci. 56 (2005), 749–790
Randomness Is Unpredictability, A. Eagle






The Transparent Disposition Fallacy

The transparent disposition fallacy asks us to beleive two doubtful propositions. The first is that rational people have the willpower to commit themselves in advance to playing games in a particular way. The second is that other people can read our boy language well enough to know when we are telling the truth. If we truthfully claim that we have made a commitment, we will therefore be believed.

If these propositions were correct, our world would certainly be very different! Rationality would be a defence against drug addiction...............


Complete Information

Information is perfect when the players always know everything that has happened so far in the game. Information is complete when everything needed to specify a game is common knowledge among the players - including the preferences and beliefs of the other players.

In the Prisoner's Dilemma, the players need know only that hawk is a strongly dominant strategy in order to optimize, but changing th epayoffs only a little yields the game of Chicken, in which we certainly do need complete information to get anywhere.

When is it reasonable to assume that information is complete?

John Hersanyi's theory of incomplete information is a technique for completing a strategic structure in which information is incomplete. The theory leaves a great deal to the judgement of those who use it. It points a finger at what is missing in an informational structure but doesnt say where the missing information is to be found. What it offers is the right questions. Coming up with the right answers is something that Harsanyi leaves to you and me.

Ken Binmore, 2007, Playing for Real, OUP