Lessons from my (nearly) centenarian mother

#1

Tomorrow is my mother’s birthday: she will be 99. She is deep into AD, living in her apartment with full time caregivers (for which I am deeply grateful). She would not have lived this long but for their attentive care, and being in her own home. Though her mind is gone, she is remarkably healthy: walking around quite soon after a hip replacement (she does have severe osteoporosis), and her appetite is better than ever. As far as the Alzheimers: I worry about that, but I feel quite sure that she did it to herself: she was extremely anxious, OCD, controlling, narcissistic, all the years I was growing up, anorexic in her youth, in short, pretty messed up. And she took a continuous dose of meds such as Elavil (amytriptoline), Miltown, valium, librium. I don’t know how she got her hands on them. She paid no attention to the warnings that she needed to get off them. She was always very thin, but “skinny fat”, apple shaped body. Her diet was terrible- – no fruits or vegetables, but prodigious amounts of steak-- she said she felt she needed the meat, and she probably did, for the amino acids – and also a lot of sweets, ice cream and pastries. Here too, she accepted no guidance.

So here she is, and she is not a good advertisement for living long.

We have been estranged for years. But watching what happened to her, and knowing I share some of her tendencies, has made me resolute about understanding as much as I can, working out as hard as I can. All the more so now, as I recently did a scan that showed: low body fat (22%), low metabolic rate (900 calories per day), most likely because I too have the apple body tendency, skinny fat, and little muscle. I have spent so much time getting the lipids and glucose where they need to be that I have not faced into what for me is probably the biggest threat: sarcopenia and frailty.

So, time to wean off metformin, start imeglimin, creatine, leucine, work with a trainer to lift heavier weights, eat more protein and drink more water.

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#2

Well, it seems that you have some pretty good longevity genes, given her other eating and lack of exercise habits. And we have much more information on how to prevent or delay the medical issues she does have, so it seems likely you are on the path to a good, long life.

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#3

At what age did your mother’s AD start?

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#4

Hard to pinpoint when exactly it started, but approximately her early eighties.

#5

My wife’s step-grandmother, who was often sick and seeing doctors regularly for various illnesses, developed AD. Not long after she was in the advanced dementia stage, she seemed to be much healthier, and previously reported illnesses disappeared. Were her previous illnesses psycosomatic? Don’t know, but it seemed odd. I don’t remember how old she was when she died, but she lived with Alzheimer’s for a long time.

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#6

Very unusual in AD. Often it’s the opposite, and people in the prodromal stage of AD have loss of appetite (and subsequent weight loss). This is sometimes also connected to deficits in the senses of smell and taste.

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#7

Yes it is unusual. I think she just “mindlessly” eats all that her caregivers set in front of her --and they do a good job: salmon, spinach and far fewer treats than she habitually ate.

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#8

My wife recently died from fronto-temporal dementia. It was thought to be AD initially but as it progressed, it became more evident that it was FTD. With FTD, and its effects on the frontal lobe, disinhibition becomes more evident and part of that disinhibition is loss of inhibition to stop eating when full. I cared for her and prepared her meals, and she had a healthy appetite until her last few weeks… Weight loss was not a problem.

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#9

I’m so very sorry for your loss.

#10

mchasemd, thank you for that information, and, so sorry for your loss.

My mother was never tested so I don’t know if she has AD or FTD or even something else. She did go through a frantic/violent stage, calling the police, attacking her caregiver, (who stayed through it all, thankfully). But mostly it just amplified her worst anxieties and paranoia,

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#11

low body fat (22%), low metabolic rate (900 calories per day), most likely because I too have the apple body tendency, skinny fat, and little muscle.

I’m pretty similar. Cycling on and off rapamycin has definitely helped, as has creatine and eating more protein. Last fall, I added working with Kaatsu bands after listening to a podcast Doug Lucas did about using them for osteoporosis. Around the same time, I got a Body Pod bioimpedance scale to track changes. Happy to report that within months, I went from my chronic low weight of 105 to 112, and my scale confirmed that the weight gain was due to increases in muscle and skeletal mass. This has not happened with previous strength training. I’ll be repeating a DEXA next month to see if it has improved my osteoporosis.

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#12

I personally think it’s unconscionable to include anxiety and OCD in the same sentence with “she did this to herself”. We are certainly born with some distance from the line of either or those… some of us with our toe on the line and others miles away from it. We can learn to cope and get help etc but have a little grace about actual mental illness/ disease and dietary lifestyle choices.

#13

Change is very hard. You can go to all of the cognitive behavioral therapy you want.
There are some things that seem to be inborn and are impossible or nearly impossible to change.

Quoted lines are from Caude Opus 4.6

“Psychiatric literature identifies several personality disorders as especially resistant to treatment, though the field has evolved its thinking, moving away from calling anything truly “untreatable” and toward “difficult to treat.” Here’s what the evidence shows:”

“Antisocial Personality Disorder (ASPD) and Psychopathy stand out as the most treatment-resistant. ASPD is considered among the most difficult personality disorders to treat, partly because individuals with it often lack sufficient motivation to change and may simulate remorse rather than genuinely committing to the process — they can be charming and dishonest, manipulating staff and fellow patients during treatment. Wikipedia The picture is even more stark with psychopathy specifically: a review found that only 3 of 8 studies showed treatment could be beneficial for offenders with psychopathy, and in one case treatment actually had the opposite effect.”

Probably what we call “bad eggs,” “evil twin,” etc.

The Cluster B disorders as a group — antisocial, borderline, narcissistic, and histrionic — have historically been considered the most difficult to treat among the ten personality disorders described in the DSM-5. PDAN

Borderline Personality Disorder, despite its notorious reputation for treatment resistance, actually has surprisingly hopeful long-term data. A 10-year prospective study funded by NIMH found that over 90% of patients achieved remission lasting at least two years, though around 30% of those subsequently relapsed."

My personal observation is that Borderline Personality Disorder reputation as “notorious reputation for treatment resistance” is well deserved; it may be treatable to some extent, but it is never cured.

Narcissistic Personality Disorder is one of the more common clinical considerations here. A person can be intellectually brilliant but emotionally stuck at the developmental stage where everything revolves around their own needs, image, and sense of specialness. The hallmark is a striking gap between cognitive sophistication and emotional maturity — they can reason at a high level but respond to criticism, rejection, or frustration the way a teenager might, with rage, withdrawal, or contempt. They often lack genuine empathy despite being perfectly capable of understanding others intellectually.

We often describe these people in layman’s terms: he was born bad, she’s such a diva, etc.

What we have to accept and appreciate is that people are the way they are, and not much can be done about it. When we accept this and adapt to people with personality disorders, including friends and relatives, they are much easier to get along with. You know the ones that you will never win an argument with or change their minds. So, why bother arguing with them? Accept that your aunt Harriet is almost always going to be rude and that she doesn’t really mean anything by it.

My life is so much more peaceful when I accept people for who they are and say to myself, “Who am I to judge?” I think it became much easier as I got older.

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