N Engl J Med 2001;344:1111-6 Survival after Dementia

James Michael Howard jmhoward at sprynet.com
Sun Apr 15 07:15:19 EST 2001


Thank you for your response.  I was connecting dementia of the vascular type
and of the Alzheimer's type with reduced DHEA.  The findings of the NEJM
article simply fit the data regarding DHEA and these two types of dementia.
That is the reason I posted here.

James Michael Howard

On Sun, 15 Apr 2001 01:55:02 -0400, Brian <wistar_rat at hotmail.com> wrote:

>I haven't read the article but I saw a report on the news about it.  One
>criticism put forward was that the mean age of people they studied was
>around the low to mid 80s.  People of that age would be expected to have
>a shorter lifespan anyway compared to previous studies of dementia which
>studied much younger people. The fact that this group found a shorter
>lifespan for people with dementia than previous studies doesn't say that
>previous studies were wrong or inaccurate.  What do you think?
>James Michael Howard wrote:
>> I just sent the following to the New England Journal of Medicine regarding,
>> "A Reevaluation of the Duration of Survival after the Onset of Dementia,"
>> which is in the most recent issue
>> (http://www.nejm.org/content/2001/0344/0015/1111.asp ).  I thought you might
>> be interested in reading it.
>> "I suggest the findings of Wolfson, et al., represent excessive loss of
>> dehydroepiandrosterone (DHEA).  It is my hypothesis that DHEA evolved to
>> optimize transcription and replication of DHEA and cortisol evolved as the
>> chief antagonist to DHEA.  This follows from my hypothesis that nervous
>> tissue uses DHEA more than other tissues.  Loss of DHEA would undermine
>> maintenance of the nervous system while continued, or increased cortisol,
>> would exert antagonistic effects on the nervous system.  (It is known that
>> continued, high levels of cortisol damage nervous tissues.)  Since the brain
>> is most sensitive to levels of DHEA, the maintenance defect, called
>> dementia, represents severe loss of DHEA.  This is directly supported in
>> vascular dementia and dementia of the Alzheimer's type in the levels of DHEA
>> and the ratio of DHEA to cortisol.  "By comparison to vascular dementia,
>> patients with Alzheimer's disease exhibited the highest cortisol
>> concentrations throughout the 24h.  …The serum DHEAS levels were
>> significantly lower in elderly subjects and even more in demented patients
>> than in young controls.  Consequently, a significant increase of the
>> cortisol/DHEAS molar ratio was evident when going from young controls to
>> healthy elderly subjects and to demented patients."  Exp Gerontol 2000; 35:
>> 1239-50.
>> I suggest shorter survival times in the study subjects, who exhibited
>> dementia of the Alzheimer's type or vascular dementia, represent severe
>> reduction of DHEA."

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