Sundowning: severe dementia and bringing on the night

KP-PC k.p.collins at worldnet.att.net%remove%
Sat Mar 29 21:54:41 EST 2003


Touche, John.

Please read on.

"John H." <johnh at faraway.xxx> wrote in message
news:jLbha.177$1h6.8116 at nnrp1.ozemail.com.au...
|
| "KP-PC" <k.p.collins at worldnet.att.net%remove%> wrote in message
| news:Qq2ha.3791$cO3.136567 at bgtnsc04-news.ops.worldnet.att.net...
| > If what you say were 'all there is', then the only 'therapy'
| > necessary would be to assure that  patients' nutritional intakes
were
| > rigorously-balanced - vitamin pills would 'cure' all 'dementia'.

You've snipped my whole discussion, leaving only this tongue-in-cheek
comment. Unacceptable.

| No, I'm not giving the full story here, of course vitamin therapy
won't cure
| the problem.

Clearly, I made no such claim. I was reducing it to the absurd, only
to draw an abstract 'line' between the prior discussion and my
further comments.

| There are many causes at work here,

I agree.

| at present all I'm trying
| to do is make a start at understanding this. Thus Larry's comment
re sensory
| confusion and subsequent anxiety is important and offers another
angle by
| which to approach this problem.

And was in the same ballpark as were my prior comments.

| As does Tony's comments re medication timing.

And was in the same ballpark as were my prior comments.

| Furthermore, no amount of vit D supplementation will overcome the
| deterioration and subsequent release of proinflammatory cytokines
into the
| CNS, I suspect in dementia cases the _chronic_ lack of sunlight is
one
| factor precipitating an increased inflammatory response from an
already
| seriously compromised base that sets the stage for dysfunctional
responses
| to anxiety and stress(a reasonable assumption given recent
demonstrated
| efficacy of bright light therapy in dementia).

There's a lot more in-there. Remember my discussion in the "Pineal"
thread? "Internal 'light'" is 'just' relative TD E/I, and when TD E/I
remails elevated for a prolonged period, the functioning of the TD
E/I-minimization mechanisms that are discussed in AoK [and which are
founded rigorously upon experiment, BTW], become 'overwhelmed', the
result being that their functioning becomes increasingly
desynchronized, which constitutes a circumstance of the destructive
'randomness' that's discussed in AoK.

In the midst of such, the functioning of the TD E/I-minimization
mechanisms becomes increasingly 'abstract' - pertaining increasingly
to the abstract internal problem that the 'randomness'-precipitating
desynchronization constitutes, and pertaining increasingly-less to
external physical reality.

Within this circumstance, the brain literally attacks itself, as it
attempts to achieve TD E/I-minimization with respect to the abstract
desynchronization 'randomness'. The result is the cell-loss to which
you refer in your discussion below [with respect to 'schizophrenia'].

The TD E/I-minimization mechanisms are 'just' struggling to cope with
the abnormally-high TD E/I, but because the functioning of the TD
E/I-minimization mechanisms has become desynchronized, the as the TD
E/I-minimization mechanisms act upon the prevailing
relatively-'random' activation of the desynchronized 'state', they
'attack' each other's 'normally' functional processing as they act to
minimize the desynchronization TD E/I(up).

It's =literally= as if the nervous system 'takes a knife' to itself.

[All of this has also been in AoK all along.]

| Interestingly, old studies on
| the epidemology of MS indicated a very strong association between
sunlight
| and MS, this was later delineated to reveal that it was not
sunlight per se
| but lack of vitamin D (identified by fact that high fish eating
cultures had
| low MS prevalence and fish contain lots Vit D.) Additionally, other
studies
| have suggested a link between sunlight during pregnancy and
incidence of
| schizophrenia. Schizophrenia is now accepted a neurodevelopmental
disorder
| with significant tissue loss in various regions of the CNS.

While I do not discount the fact of genetic deficits, my view on
'schizophrenia' is that it's development derives in the dynamics I've
discussed above - 'normal' stuff'a capacities suffering prolonged
'states' of being overwhelmed, resulting in interanl 'neural wars'.

In addition to integrating the Neuroscience experimental results,
I've  also studied the dynamics tjrough first hand observations -
back when I was integrating the Science, I periodically had to 'take
breaks' in order to 'detune' with respect to the very dynamics I'm
discussing [applying what was becoming NDT within my own experience].
Duing these periods, I'd go for long walks on the streets of
Hartford, becoming familiar with virtually all the 'street people'
who 'lived' within the territory I walked.

I never encountered a single instance in which the etiology of these
folks' circumstances, and behavioral 'eccentricities' were not
traceable right back to the stuff they had had to 'live' through.

There was one fellow, "L.", who was a bit of a poet. He ate our of
garbage cans, and was disheveled and boisterous' - just 'normal'
reaction to the TD E/I(up) inherent other folks' almost-always
'moving away from' from him.

TD E/I(up) -> internal desynchronization.

As 'time' went by, I had to return to work, and, since there was a
noontime Mass nearby, I attended 'daily'. "L." started coming to
Mass. He was very 'disruptive', literally shouting stuff in the midst
of the Mass.

But the folks at Mass just 'accepted' "L.", and as 'time' went by,
his behavior at Mass tended toward 'normal'.

Folks not 'moving away from' him because of his appearance, etc., or
because of his outbursts, were like a 'hug' that had allowed his TD
E/I-minimization mechanisms to get a toehold on the 'randomness'
that'd been overwhelming them.

Our Saintly Priest often allowed "L." to read some of his poetry at
the end of Mass. "L." gave me some carefully hand written copies of
some of his poems.

I saw stuff like this =routinely= within the existences of 'my'
street-people. One cannot miss seeing what the actual wellspring of
their 'difficulties' is - 'ignorance' with respect to how nervous
systems process information on the parts of others who almost always
subject street folks to 'moving away from' behaviors, with the result
that TD E/I soars within the street folks' nervous systems.

So I'm not 'making mud-pies', John :-]

I've seen it all with my own eyes.

| What I need to do is deepen my understanding of this condition,
have a much
| closer look at the types of dementia where sundowning is more
pronounced,
| and relate this to the known aspects of the types of damage caused
by
| various types of dementia.

It's as I said in my prior post. Hyper-TD E/I, desynchronized, and
the TD E/I-minimization mechanisms operating abstractly with respect
to TD E/I's "inner light". Within such, stuff that's 'normally'
configured with respect to 'sleep consciousness' is configured into
'waking consciousness', and impacts within the driving of behavior.

Same thing happens, in a much 'safer' way, when kids divide their
attention between the TV or stereo and their homework - non-maximal
TD E/I-minimization that leaves an 'abnormal' degree of 'randomness'
in-there [when I've got a lot of typos in my post, it's usually
because, for whatever reason, I'm 'watching' TV while I'm typing my
comments - a lot, recently, because of the Sorrowful War coverage].

My 'point' in my prior post was with respect to the fact that the
helping Professions are 'oblivious' to all of this stuff because
they've not had access to NDT's synthesis of the Neuroscience
experimental results. The result is that, often in ways that are
actively prescribed within their Professions, they subtly act in ways
that 'move away from' the folks who they're trying to help - and the
result is like the same-stuff in "L.'s" case, above - augmenting TD
E/I that exacerbates the patient's TD E/I-minimization difficulties.

| Thus, I would expect that frontal lobe dementia
| _should_ be more vulnerable to sundowning problems.

My view is that 'dementia' is a product of whole nervous system
[mal]function. There can, of course, be an initial organic focus, but
the progression is always a whole-system thing, and it's at this
'level' that understanding how brains process information is not only
helpful, but mandatory, because, due to the brain's awesome
redundancy and plasticity, there's always stuff that can be worked
with - but folks have to understand how brains work to implement
therapeutic strategies that invoke redundant and plastic capacities.

Instead, the emphasis is on 'slam-the-door-shut' 'diagnoses' that's
tantamount to condemnation of salvagable Lives.

| But as I have long ago
| learned, there are no simple answers in this bloody game. To be
honest,
| contrary to you, I empathise with researchers, therapists and
carers.

There is no greater Empathy than to give one's Life to the
development of the understanding through which others can work, and
to work to lift them up in such understanding [does require a bit of
'daring', though, because such tends to be negatively-sanctioned in
proportion to folks' Professional 'level' :-]

| It's easy to be on the outside and proffer solutions,

I wouldn't know about 'being on the outside'. My way is to 'dive
rightr into the midst' of any problem that I'm working on. I 'get my
hands dirty'.

| but as anyone who deals
| with the mentally ill knows all too well, what's in the books and
theories
| often aint in the world.

I understand. Why do you think I gave my Life to doing what obviously
need to be done?

| We take small steps, we continue to try, you may
| wish to barrage the general research and therapeutic community with
| criticisms,

That's not what I'm doing, John. What I'm doing is, after trying for
more than twenty years to do it in slightly-more-gentle ways, just
lifting folks up in understanding. I'm presenting a Gift of
understanding. Hardly the stuff of 'barrages'.

If you want to take that line, tell me what a man should do when he
has completely verified Science, but no one will even allow it to be
published.

I hope you'd do what's necessary, which is all I'm doing, no?

Yup.

| I'd prefer to focus my attention on ways to help.

Giving the necessary understanding, so that it can supplant the
absence-of-understanding that's prevailed, is a way that helps.

| Accordingly, I
| intend to approach some residential care units to seek their
observations
| and ideas concerning this phenomenon.

If you really want to study it, get yourself 'committed' and/or
'imprisoned'. You'll get data enough.

| I'm only starting, your approach seems
| to be that you already have all the answers.

I've worked devotedly for thirty-one years, John. How could I not
have some answers? [And I've never claimed to have "all the
answers" - perhaps you interpret my just stating my position without
making 'excuses' in that way, but all I'm doing is stating my
position without making 'excuses' - hoping that someone'll just take
up the discussion.

| Reminds me of H L Mencken, "For
| every human problem there is a simple solutions - simple, stupid,
and
| wrong."

It shouldn't so "remind" you, because the verification is given in
AoK, and the refs cited in AoK, isn't it?

Yup.

| Unlike yourself I prefer empiricism to theory,

Ho, ho, ho - not with respect to =you=, but with respect to
'challenging' NDT on the basis of it's, supposedly, being 'theory
unverified via experiment' - you're 'trashing' a lot of work done by
Neuroscience, John, because it's all in NDT, tightly-integrated.

| I assume my ignorance
| and do the hard yards, the reading and thinking, rather than
extrapolating
| from what I believe to be true.

Me too.

| I started this topic to seek input from
| people who have some experience in dealing with this condition and
already
| some (Tony & Larry) have helped. You will note that rather than
relying on
| ethereal notions about brain function they have provided concrete
| information.

So have I, and if you're not just on a 'fishing' expedition with
respect to NDT, that you cannot see it is solely due to your not
having done the "hard yards" with respect to what's been in AoK all
along.

| > Of course there can be inbred metabolic deficits, and at least
some
| > of these could be 'show-stoppers' [until retroactive gene therapy
| > might address such].
| >
| > But the biggest 'problem' remains the absence of understanding
with
| > respect to the way nervous systems actually work, on the parts of
the
| > 'helpers'.
| >
| > As a result of the 'ignorance' they carry into the 'therapeutic'
| > setting, the 'helpers' fail with respect to, "First, do no harm."
| >
| > They 'intervene' in ways that only impose more dis-order within
| > nervous systems whose main 'problem' is that they have descended
into
| > the dis-order that is what relatively-high TD E/I is.
|
| Your criticisms of carers are unjustified because:

They were my just stating the verified facts, John, in my continuing
efforts to lift folks up in the understanding.

| No-one knows what causes sundowning. No-one enjoys locking people
away,
| therapists would be delighted to find a remedy to many problems
associated
| with dementia. Your explanations offer no significant insight into
the
| condition.

Ho, ho, ho :-]

| As a psychiatrist once told me, 'we treat conditions, we don't
| cure them'. Not yet anyway, but only through perseverance will
further
| progress ensue. Bees to honey, I'd rather help than berate.

Me too, but it's been thirty-one years, John, and 'time's getting
ever-shorter. Is there anything more worthy of being "berated" [to
use your term] than is an instance of verified Science that folks
won't allow to be published?

| I suggest you
| adopt the same attitude and desist from lamenting humanity. That
lament has
| been echoed through the ages and does nothing to solve the
problems, it is
| often little more than masked arrogance because it is predicated on
the
| belief of the accusers that they somehow are above the problem and
those who
| cause it. I prefer the attitude exemplified by the philosopher Karl
 Popper,
| "We may differ in what we know but in our infinite ignorance we are
all
| equal."

I did the work, John. It stands verified. It can lift folks up. All
that remains is the communication

"Still it moves." [supposedly 'immovable' "human nature"]

| > What's necessary is to develop treatement strategies that focus
upon
| > re-establishing internal order - that, in effect, temporarily
| > externalize TD E/I-miniization.
|
| In severely damaged brains the probability of restoring 'order' is
| effectively nil, one can only hope to ameliorate the condition, not
cure it.

I cannot respond because "severely damaged" is open to subjective
interpretation. Care to cite a published case?

K. P. Collins

| > It's why I'm not actually 'sorry' that during the course of my
| > working to bring NDT's stuff forward, 'ignorant' folks reacted to
my
| > efforts by throwing me into a 'psychiatric' institution, and
twice
| > imprisoning me. As a result, I was able to study the dynamics
that
| > occur within such places first hand.
| >
| > In all three instances, all there was was 'ignorance' posing as
| > 'authority', doing more harm than good.
| >
| > If anyone wants to actually address the 'problem', =this= is
where
| > they must actually begin.
| >
| > It's 'humanity' as a whole that's certifiably 'insane', but
which,
| > through 'blindly'-automated TD E/I-minimization that derives in
| > noting more than repetition of merely-'familiar' consensual
'rules',
| > declares itself to be 'sane', and woe to anyone who tells it
plain,
| > that the "emperor has no clothes".
| >
| > And it's 'hilarious' - NDT has been out-there for decades
already,
| > and all folks've done with respect to it, in ways that're
inversely
| > correlated to individuals' adherence to 'coersed-consensus'
stuff, in
| > 'move away from'.
|
|
|
|
| > It's all 'inside-out, upside-down, and backward' with respect to
| > Truth, but who cares? "We've got all of our so-and-so's saying
| > such-and-such, and we're safe in our understanding, as long as we
| > look to such."
| >
| > And 'the beast', "Abstract Ignorance" [ the absence of
understanding
| > of how nervous systems process information via
'blindly'-automated TD
| > E/I-minimization within nervous systems that, nevertheless, do
| > process information via 'blindly-automated TD E/I-minimization]
is
| > 'rolling on the floor laughing.
| >
| > It's got so many 'helpers' - so many folks who work with-it to
| > sustain the dis-order that is Ignorance, why shouldn't it
'laugh'?
| >
| > I 'cry', though. I 'cry'. There exists no greater Tragedy - that
| > Humans Love ['move toward'] Ignorance, and Hate ['move away
from']
| > Understanding - even imposing such upon the Children, in ways
that,
| > literally, constitute sacrificing them to 'the beast'.
| >
| > I 'cry'.
| >
| > "Still it moves."
| >
| > K. P. Collins
| >
| > "John H." <johnh at faraway.xxx> wrote in message
| > news:mwWga.236$Sa5.8255 at nnrp1.ozemail.com.au...
| > | Just now a friend of mine advised that in nursing homes vitamin
D
| > deficiency
| > | is a real problem(think this was on the Aus sci program
Catalyst
| > just last
| > | week). Vitamin D maintains tranforming growth factor beta which
| > helps
| > | modulates the immune system. In dementia patients interleukin 1
is
| > usually
| > | if not always elevated in the brain, tgf b can play an
important
| > role in
| > | modulating the release of il 1. il1 plays a key component in
the
| > stress
| > | response vis a vis my previous comments re nore. Some
concordance
| > with your
| > | remarks re sensory input and subsequent perceptual
disorientation.
| > |
| > | Your comments re a totally dark room are interesting,
supporting
| > your idea
| > | that low light and subsequent sensory loss may initiate a
confusion
| > state,
| > | leading to anxiety ... . Interesting point. Thanks.
| > |
| > | Light therapy probably relates to tgf b more than circadian
jazz,
| > still
| > | can't see how it could help in relation to this particular
issue.
| > |
| > | My friend in the nursing home advised that yes in the night
these
| > patients
| > | really do go on a bender. Strange thing.
| > |
| > | John H.
| > |
| > |
| > | "Larry Brash" <lbrash at ozemail.com.au> wrote in message
| > | news:3E841E89.AF3E7298 at ozemail.com.au...
| > | > "John H." wrote:
| > | > >
| > | > > Recently a friend of mine starting working in a dementia
ward
| > for
| > | severely
| > | > > demented individuals. She was advised by other staff that
to be
| > careful
| > | > > after sundown because many of the patients become violent
and
| > extremely
| > | > > difficult to control. I'm mystified by this, just wondering
if
| > anyone
| > | else
| > | > > has noticed this in severe dementia and\or if they have any
| > ideas re the
| > | > > same. I did note a few months ago a report stating that
bright
| > light
| > | therapy
| > | > > proved beneficial for some dementia patients but this
doesn't
| > account
| > | for
| > | > > the above observations.
| > | >
| > | > This phenomenon occurs in delirium, e.g. post-op delirium,
DTs
| > etc.
| > | > There is always a clear worsening in the evening. Delirious
| > people seem
| > | > almost lucid in the daytime and off the planet at night.
15-20%
| > of
| > | > general hospital patients are delirious at any point in time.
| > | >
| > | > It seem to be due to the reduced sensory (mainly visual)
input
| > that
| > | > occurs at sunset. The degree of reduction in light between
full
| > day
| > | > light and a well light room at night is actually massive (at
| > least
| > | > hundred fold difference). A dimly light room is the worse. A
| > totally
| > | > dark room is actually better.
| > | >
| > | > Of course, the intact brain copes with this easily, but the
| > impaired
| > | > brain (i.e. delirium) does not cope and starts to experience
| > sensory
| > | > distortions (illusions) and hallucinations (mainly visual).
| > Disturbed
| > | > behaviour may then result in response to this.
| > | >
| > | > Dementia patients, who are in care, are usually well advanced
and
| > | > experience delirium very easily. Urinary tract infection,
| > constipation
| > | > being some of the more common mundane triggers for this.
| > | >
| > | > Delirium literally means "out of (de) the furrow (lirium)"
| > [Latin].
| > | > Dementia means "out of one's mind" and originally referred
more
| > to
| > | > psychosis than organic impairment.
| > | >
| > | > I don't know if Light Therapy would work but it is an
interesting
| > thought.
| > | >
| > | > --
| > | > Larry Brash
| > |
| > |
| >
| >
|
|





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