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For Dementia

digital calendar for the dementia patient
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I know I'll need this eventually. My research says simplicity is best for the sufferers of dementia. This is a flat screen monitor that hangs on the wall, displays the day of the week. and one reminder. Keep it simple. Someone else has to input the data in advance of course so it will display automatically. Today is Friday, October 16

You have an appointment with Dr. Smith at 2:00.

This is meant for an elderly person who wants to continue living independently, but has other help, such as a driver, meals prepared and nursing assistants that check in throughout the day.

I have looked online and can find only the date and time digitally available. there are also recorded messages. But a dementia patient will not likely be able to push buttons for messages.

dentworth, Oct 18 2015

Digital Photo Frame connected to Internet https://www.pix-star.com/
I use this for remotely adding family photos etcetera. For my father. [AusCan531, Oct 22 2015]

Microsoft Hololens http://www.microsof...soft-hololens/en-us
Reality-augmenting devices can add virtual annotations to physical objects. [Cuit_au_Four, Oct 23 2015]

Preimplantation Genetic Diagnosis https://en.wikipedi...n_genetic_diagnosis
Fertilize in vitro and snuff out genetic defects in the test tube [Cuit_au_Four, Oct 23 2015]

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       Hi [dentworth] ) remember me?
xandram, Oct 19 2015
  

       Wife's grandmother, who is in stage 6 of 7 and can't remember exactly how many kids she has sometimes, would react with 'Who is Dr. Smith, and why did he put this thing on my wall?"
RayfordSteele, Oct 19 2015
  

       Yes xan of course I remember you. You're the lady who flew the space craft to my house last night!   

       I have elderly parents, one already had the worst dementia imaginable and true enough if I'd put this up on his wall he'd have ask who is dr. smith. But this would best suit early stages of memory loss. I found a product in the UK costs about $500. Which does this.
dentworth, Oct 19 2015
  

       //$500// !!   

       You could surely set this up using an old computer? Just have the display on the wall, and the computer itself somewhere out of site.
MaxwellBuchanan, Oct 19 2015
  

       good suggestion Maxwell, we've been looking for a calendar app that might do the job.
dentworth, Oct 19 2015
  

       You could, in fact, just create each day's screen using Word or a graphics package.   

       It wouldn't have the automation of a calendar app, but it would be a good deal more flexible. If there was nothing scheduled for that day, you could put up a picture that meant something to him.
MaxwellBuchanan, Oct 19 2015
  

       Hi [dentworth], remember me? I'm the lady who flew a space craft to your house last night. Ehem...not really, just jealous.   

       Anyways, about this idea a little information that most of you probably don't know; I now work in an Alzheimer's Memory Center, on the evening shift. It is difficult and challenging, but I'm where I am needed the most. Hence I am pretty much an objective expert at this point and would love to offer my input.   

       What you say is true. In the early stages, (1-5), this would be an excellent adjunct to other reminding devices. Later stages would respond very much to what [RayforSteele] suggests. Also at that stage, things on the wall tend to get taken off the wall, and put in strange places.   

       I'm assuming through your comments that this, then, is for your mother who is suffering mild to moderate memory loss. Be that the case, please accept my heartfelt concern, and reach out to me, if there is anything I can do.   

       So good to see you here. Several old baker's have wandered in lately. Great to see you back.
blissmiss, Oct 19 2015
  

       I like the sound of the Ementia. Especially if they have those plugin dongles because I have had it with gas pumpers; don't even wipe your windows and then stand around expecting a tip. Here's a tip - get a shave! Used to be three of them came out in sharp uniforms and they would pump up your tires too, if you needed it. Now that was worth a tip. I used to drive a Ford; a Manchego I think. Bought it cash and drove it off the lot. It had that rich leather that Spaniard from Fantasy Island liked so much - the tall one. But that midget - do they call them midgets now? - he did his part too. I think that was what made the whole thing work. They were a good team, those two. Or was that some fancy cheese, now?
bungston, Oct 20 2015
  

       don't limit it to the date and a reminder. old photos of the patient's past and interests could illuminate their life in more ways.
po, Oct 20 2015
  

       Beautiful addition, [po].
blissmiss, Oct 20 2015
  

       We have an electronic picture calendar that displays today's day and date, digitally. No reminders on it though.
RayfordSteele, Oct 20 2015
  

       Assuming someone has the time to update it manually (as in [Max]'s suggestion), it might be better to use something old and familiar like a chalk board. Maybe get a routine where the last person to help get the person ready for bed goes over the next day's schedule and updates the chalk board with tomorrow's date and activities. Or do it in the morning. I assume the person being cared for would benefit more interacting with or at least observing the person updating the chalk board rather than having them spend that time sitting at the computer in the other room updating the display.
scad mientist, Oct 20 2015
  

       Trust me, when you have an elderly parent who is no longer the owner of a full deck, anything as complicated, loseable and removable as a wristwatch is not somewhere you want to go.
MaxwellBuchanan, Oct 20 2015
  

       [Blissmiss] Thanks for the info, I imagine you can identify the stages now just from experience. It's tough watching them fade away, some do it less sweetly and calmly than others. And no, if you've experienced this [bigsleep] you'd see changes that would convince you it's not just giving up, there are brain changes that can only be identified in an autopsy. Unfortunately.   

       Two great ideas [po] with the photos and [scad mientist] a chalk board, or a white board has also been suggested. Unfortunately [beauchamp] any addition to the body, any changes will set badly demented persons off into anxiety. I think at this point a nice happy daily reminder is best.   

       Thank you for some great suggestions!
dentworth, Oct 20 2015
  

       //I'm still curious as to whether dementia is caused by people giving up on a fundamental level.//   

       No. It is true that people who enjoy life and remain mentally active can delay the onset of Alzheimer's, just as an athlete will remain physically mobile longer than a couch potato if they both have a muscle-wasting disease.   

       But Alzheimer's is primarily a disease of organic origin. The popular theory is that it's caused by the aggregation of a few types of protein, forming so-called "plaques" that, in some way, are meant to kill the cells. And some variants in the genes for these plaque-forming proteins are protective against Alzheimer's. However, nobody really knows what is the primary cause - it may be just randomly-triggered protein aggregation. It may be oxidative stress or something else triggering the aggregation (my wife worked on prion diseases, and there are parallels). Or it may be something else. It may even (just possibly) be some unknown, virus-like thing. And nobody knows quite how the protein aggregates kill the cells, either.   

       It really is something that ought to be treatable and curable. If protein aggregation really is the key step, it ought to be possible to find small molecules that will inhibit it (and there is some progress in that direction).   

       Ultimately, though, the solution lies in genome editing. We know that some natural mutations give complete protection against Alzheimer's, so the most direct solution is to edit the genome (of adults; not just of embryos) to give them that variant.   

       The same goes for many, many diseases - we know genes that can prevent them, but at present it's just tough shit if you don't have those genes. (Plug: I've recently set up a biotech company to do precisely this kind of genome editing in adult humans.)
MaxwellBuchanan, Oct 20 2015
  

       Awesome link/product [Beauchamp] not sure I wanted to have the calendar on the web unless that gets me remote access?
dentworth, Oct 20 2015
  

       Hi [Bungston]. channeling Grandpa Simpson?
dentworth, Oct 20 2015
  

       My 80 yo father lives by himself on the opposite side of the world from me. He doesn't have dementia but is definitely very non-technical. I've paid for his house to have WiFi then bought a digital picture frame for him (Pixstar). It rotates through the date and time, weather and photos.   

       All that I, or other friends and family, have to do is email photos to a certain email address for new photo to appear in the rotation. I can remotely curate the photos and so on. Dad likes the day and date function most of all as it's easy for him to lose track otherwise. It doesn't have the reminder function but that is a relatively small tweak. [LINK]
AusCan531, Oct 20 2015
  

       On the good side, I recently heard somewhere that 3 cups of coffee a day decreased the odds of Alzheimer's. (For real, this is no reference to 2 cups, not related at all.)
blissmiss, Oct 21 2015
  

       // Could it be that the same process exists in the brain, but the waste products don't get cleaned up as well// It's still an open question. All we know for sure is that some proteins aggregate to form plaques, and the cells die.   

       We don't even know, really, whether the plaques are (a) causing the cells to die (b) completely irrelevant by-products of something else that _is_ causing the cells to die or (c) part of the [ineffective] defences of a cell that has something else wrong with it.   

       All we know for sure is that if you've got gene variants X, Y and Z you won't get Alzheimer's. Same goes for lots of other things, and we're finding more all the time. Within the human population, there are probably gene variants that protect against most illnesses, including most cancers.   

       The problem is that we can say "Hey, this lucky guy won't get Alzheimer's because he has genes XYZ!", but the guy with genes PQR is screwed. My company wants to be able to edit PQR to XYZ, not in cultured cells or in human embryos, but right now and here for the poor sods whose taxes pay for the research.
MaxwellBuchanan, Oct 21 2015
  

       It's possible, but unlikely.   

       Basically, the human body is as good as it needs to be - there's no point putting rustproofing on a WWII fighter with a life expectancy of a few weeks. It's only a problem now that we're no longer at war and want to keep'em flying.
MaxwellBuchanan, Oct 21 2015
  

       It's possible, but unlikely.   

       Basically, the human body is as good as it needs to be - there's no point putting rustproofing on a WWII fighter with a life expectancy of a few weeks. It's only a problem now that we're no longer at war and want to keep'em flying.
MaxwellBuchanan, Oct 21 2015
  

       I didn't say I agree (at least, I don't think so). Basically, the way it works is:   

       (1) However fit you are, your risk of death is a few percent per year (until a few millennia ago).   

       (2) Therefore evolution selects for people who breed before the age of 20.   

       (3) Therefore, evolution cannot have any say in the ageing process - once you're past 30, your body is just coasting.   

       There are some additional complexities (such as the possibility of grandparents helping out, which helps to propagate genes that let you live longer), but basically we evolved for a world where every year could be your last. That's one of the reasons that it's relatively easy to extend lifespan - we're not trying to do better at something that evolution has already tried.   

       //Several old baker's have wandered in lately.// They were probably looking for their hearing aid and, now that they're here, they can't remember why they came.
MaxwellBuchanan, Oct 21 2015
  

       //the human retina has evolved to last around about 80 years // That's a good point, but sadly complete bollocks.   

       The human retina hasn't evolved to last 80 years, any more than a Lancaster bomber was designed to last 80 years. The retina evolved to last _at least_ 30 years. If it keeps going beyond that, it's not thanks to evolution.
MaxwellBuchanan, Oct 21 2015
  

       I suppose it hinges on how you define the word "to".   

       If you meant "in order to", then alas my testicular verdict stands.   

       If you meant "The human retina has evolved in such a way that, by good fortune, it lasts 80 years", then fine.   

       It's a bit like saying "The human thumb has evolved to allow easy texting."
MaxwellBuchanan, Oct 21 2015
  

       //I don't think cures for short straws sold on the open market will lead anywhere.//   

       OK, so you're saying that, if you had a gene set that guaranteed you'd get Alzheimer's; and if I said I could swap out those genes for a set that was just as good but would also protect you from Alzheimer's; you wouldn't go for that? That's interesting.
MaxwellBuchanan, Oct 21 2015
  

       My Mom is pretty much totally demented now. We have the clock with the day of the week, time and date. I don't even know if she knows what the clock is anymore. :(   

       Still a good idea for someone who has early stages of dementia...
xandram, Oct 22 2015
  

       [xandram], My heart goes out to you. I am so sorry that you are going through this. It must be extraordinarily hard. The residents we have that are in stage 6, do not know what a clock is, or a calendar.   

       We can point it out, state the time even, but the neurons in their brain are not responding, to what we are saying and looking at. It simply does not register. Nor does the appearance of the room, or the people within it.   

       My boss made a pretty good analogy and it has stuck in my head. "Every day, every hour, every moment, is similar to an Etch-A-Sketch. Shake it, and the memories dissolve every time. Never to return again.   

       It's a horrible disease to bear witness to for the family. The blessing is those afflicted don't seem to know how much they have declined, unlike some other diseases, like Parkinson's and Lou Gehrig's.
blissmiss, Oct 22 2015
  

       //I guess if these types of cures were cheap enough. I was just imagining people with average income faced with a bill of millions.//   

       In theory, they could be very cheap. However, as with all "drugs" (though this won't be a regular pharmaceutical), the actual cost doesn't depend at all on the cost of manufacturing and administering it; it depends on how much money the company can charge for it, until the patents run out in 25 years. Not that any of this is any help for people with Alzheimer's today.
MaxwellBuchanan, Oct 22 2015
  

       The risks aren't (or at least shouldn't) be associated with the delivery vector.   

       The main problem with gene editing (and with gene therapy), is off-target effects. If your system hits the right target 99.9% of the time, that still means trillions of cells in which it hits the wrong target. 99.999% of the time that won't matter (the cell either won't care, or will die), but then that still leaves a significant risk of jump-starting a cancer in one cell.   

       Howevertheless, it is possible. After all, most of our cells merrily repair and replicate their own genomes repeatedly, and this only rarely leads to cancer. So it's not at all unreasonable to imagine an agent that can do a spot of editing with acceptably low risks.
MaxwellBuchanan, Oct 22 2015
  

       // but then that still leaves a significant risk of jump- starting a cancer in one cell.//   

       But we're getting pretty good at cancer. Especially if you're deliberately watching for it. I'd say to hell with the risk..
bs0u0155, Oct 22 2015
  

       //But we're getting pretty good at cancer.// True. But we're still not great at it.   

       Howevertheless, genome editing is where I'm heading for the next few years. Keep 'em crossed.
MaxwellBuchanan, Oct 22 2015
  

       "Keep 'em crossed?" Mine's in a double helix already, and my thanks to you not to unravel 'em.
lurch, Oct 22 2015
  

       Is there some specific chemical that is produced during sleep that causes individuals to forget their dreams shortly after they wake up? Maybe dementia patients are constantly over-producing that chemical.
Cuit_au_Four, Oct 23 2015
  

       //How do you magically rewrite DNA in all existing cells without a teleportation system that has on- the-fly editing ?//   

       It's not easy. The actual editing system is hard enough, but the problem you're thinking about is how to get that system into every cell.   

       There are virus-like systems (ie, you package your components into empty viral shells). You can also do it using lipid vesicles (basically, tiny droplets surrounded by what looks like a cell membrane) - these can fuse with the cell membranes to deliver their contents. Even naked DNA can get into cells (assuming that your editing system is a DNA machine). None of these is easy (especially for brain cells - the brain is pretty well isolated), but it's doable.   

       The general aim (Alzheimer's aside) is to be able to make your genome a read/write system as opposed to the read-only system which it is at the moment.
MaxwellBuchanan, Oct 23 2015
  

       //How do you magically rewrite DNA in all existing cells without a teleportation system that has on- the-fly editing ?//   

       It's not easy. The actual editing system is hard enough, but the problem you're thinking about is how to get that system into every cell.   

       There are virus-like systems (ie, you package your components into empty viral shells). You can also do it using lipid vesicles (basically, tiny droplets surrounded by what looks like a cell membrane) - these can fuse with the cell membranes to deliver their contents. Even naked DNA can get into cells (assuming that your editing system is a DNA machine). None of these is easy (especially for brain cells - the brain is pretty well isolated), but it's doable.   

       The general aim (Alzheimer's aside) is to be able to make your genome a read/write system as opposed to the read-only system which it is at the moment.
MaxwellBuchanan, Oct 23 2015
  

       So... you can't actually change a cell, but you can change its offspring... ?
FlyingToaster, Oct 23 2015
  

       //alterations, possibly permanent and even heritable, through radio penetration.// No. At least not by any means that we can even think of imagining to begin to start to conceive of at present.   

       //you can't actually change a cell, but you can change its offspring... ?// No, you can change the cell itself. There's one caveat: if the cell has irrevocably committed to something (like differentiation to form, say, a muscle cell), you won't really be able to change it into something else. Or if it has already made plaques of aggregated protein, it may not be easy to disrupt those plaques. But if the cell is making, say, a protein which _will_ eventually form plaques, you'll be able to replace the gene for that protein with one which makes a non-plaque-forming variant.   

       (sorry - bit of a tangent here). Despite all the hoo- ha over genomics, there's not much we can actually do, directly. You can figure out that certain gene variants cause certain problems, and then maybe try to find fixes (downstream of the genes) for those problems, but it's very difficult. And you can edit an oocyte to produce a person free of those problems, but that doesn't help you or I. Genomics at the moment is a read-only technology - it's a bit like a spell checker that only tells you where you need to apply the Tippex.   

       In 10 years time, all of current genomics will be seen as just a minor pre-amble; actually fixing things at the genomic level will be the important stuff.
MaxwellBuchanan, Oct 23 2015
  

       In my lab[1] we have some experience with genomic editing of bacteria. If I may, I'll give you a quick overview:   

       The way we do it is to first create a copy of the region we want to change with the alteration in the middle. This is placed in a special vector (a plasmid) which we can select for (with antibiotics) and against (it produces an enzyme which kills the cell in the presence of sugar). Setting this up takes at least a few weeks.
We describe the plasmid as a 'suicide vector', because it carries the DNA we want into the cell, but can't reproduce inside the cell. (We grow it up inside other cells where it can replicate.) So we introduce the plasmid to the bacteria we want to change and select for it. What we're hoping for is 'homologous recombination' which integrates the vector into the genome at the place we're targetting. After making sure it's in (by killing off the other cells), and checking it's in the right place, we grow up many cells and select for excision (by plating on sugar, which kills cells which still express -make protein from- the sacB gene).
What we're hoping for is a second homologous recombination which removes the vector. The result is either a strain with the change we want, or a revertant which is the same as the parent strain. Or, something else which we don't want, like a random deletion which happens to remove the sacB gene. So we screen the resultant colonies for what we want, and then can move on, and try to remember why we were doing this in the first place.
  

       So this takes _ages_, and there's a lot of checking involved. It does have the advantage that we can make large alterations (big insertions or deletions), but remember that we're doing this to individual cells in large populations. There are other methods which can make very minor changes (like changing one base to another in a specific sequence - and that's largely what changing human alleles would be about) and can even be run in parallel, but again they need a population and screening for the result (and IIRC the process in a paper I read introduced more mutations than deliberate changes).   

       Of course eukaryotes have vastly larger genomes - which are typically in two copies to complicate matters. Maybe there are tools to be had from retroviruses, but my expectation is that in the medium term the best we can hope for is the ability to modify germ-line cell's genomes (egg or sperm essentially). Culturing and modifying spermatogonia (which become sperm) might be a basic approach, because they grow and divide. (I haven't looked; I assume people are working on that.)
We can of course screen and select embryos already. The main issue is the legal aspect of doing so.
  

       [1] In the sense of the one I work in; I'm not the boss.
Loris, Oct 23 2015
  

       " We've already tried it -- ethyl methane sulfonate is an alkylating agent and a potent mutagen -- it created a virus so lethal the subject was destroyed before we left the table."   

       " Then a repressor protein that blocks the operating cells."   

       " Wouldn't obstruct replication, but it does give rise to an error in replication so that the newly formed DNA strand carries a mutation and you've got a virus again... but all this is academic... you are made as well as we could make you."
normzone, Oct 23 2015
  

       //in the medium term the best we can hope for is the ability to modify germ-line cell's genomes//   

       I disagree. It has already been shown, for example, that the approach I'm following can cause modification of a large percentage (not all, yet) of cells in a whole, intact, living and breathing mouse. The tools that they used to do that are _not_ precise enough (there are off-target effects), but there are closely related tools which _are_ precise enough already. (I'm being a bit cagey here because this is what my company is doing.)   

       As for timescale and complexity, what you describe is the whole process of setting up an homologous recombination (ie, from planning to making the constructs, to actually applying it to bugs and validating the result). In the case of, say, replacing a beta-amyloid gene in humans to prevent Alzheimer's, we are talking about creating a single construct (or, to account for existing variants, a handful of constructs), once and for all. This will be a little like the development of any pharmaceutical, with the important difference that treatments for other diseases can follow a very similar model (whereas pharmaceuticals tend to be one-offs).   

       The actual treatment involves a series of either injections or infusions, at most requiring a few very short appointments. It's not going to be tablet-izeable, but it's about as simple as it can get.
MaxwellBuchanan, Oct 23 2015
  

       Damn. That's fascinating stuff. You can certainly see the risk/rewards model the company has to deal with.
normzone, Oct 23 2015
  

       For my investor pitches I wear a tie.   

       The last one went badly, though. I may have to add trousers and a shirt.
MaxwellBuchanan, Oct 23 2015
  

       Never ask me if I'm sure. I'm always sure.
MaxwellBuchanan, Oct 23 2015
  

       (in reverse order)   

       //As for timescale and complexity, what you describe is the whole process of setting up an homologous recombination (ie, from planning to making the constructs, to actually applying it to bugs and validating the result). In the case of, say, replacing a beta-amyloid gene in humans to prevent Alzheimer's, we are talking about creating a single construct (or, to account for existing variants, a handful of constructs), once and for all.//   

       Sure - I was just trying to explain the whole process for other people. The immediate bladerunner response suggests it was a wasted effort, but still, the intent was there.   

       //... The tools that they used to do that are _not_ precise enough (there are off-target effects), but there are closely related tools which _are_ precise enough already. (I'm being a bit cagey here because this is what my company is doing.)//   

       If you have a better strategy then get on and patent it already, then licence for molecular work ASAP. I neeeed it!
Of course, if you're trying to make medical treatments, there are other problems (which I mentioned, obliquely). If you had a treatment ready to go *today* then what's the earliest point at which it would be through clinical trials and cleared for widespread use? I'd be rather surprised if you're already at that stage but keeping it quiet[1], but I would be astounded if your first treatment was for Alzheimer's, rather than, say, cystic fibrosis.
So you can see the science barely gets a look-in before I think we're looking at treatments for future generations - even if you're highly optimistic overall.
  

       [1] Quite apart from the Miracle Breakthrough, where the hell did you -as a small company- get funding for clinical trials without leaving stealth mode?[2]   

       [2] ...Perhaps you mortgaged Buchanan palace?
Loris, Oct 23 2015
  

       No, I'm nowhere near even testing this in anger. And yes, it'll take as long as (or longer than) any other treatment. But hey, gotta start somewhere.   

       Also, there's no guarantee that the current system of clinical trials will continue indefinitely. If I have a treatment, and if someone doomed to Alzheimer's is willing to take the risk, who's to stop me?   

       And yes, CF would be a better target, given that CF would be a treatment of active and life- threatening illness rather than a prevention.
MaxwellBuchanan, Oct 23 2015
  

       // CF would be a better target, given that CF would be a treatment of active and life-threatening illness rather than a prevention.//   

       And it's got a known and clear-cut mutation causing disease.
And the primary target is in an easily accessible tissue.
And it's recessive, so you have two targets per cell, of which you only need to hit one.
And you don't even need to modify every target cell, maybe even one in ten would do it.
  

       That just makes it merely very difficult.
Loris, Oct 23 2015
  

       This is almost certainly a stupid idea, but until a cure is found, aren't we just trapping patients into our memory-based society, and we get distressed by their inability to fit in with our system. How about a time-free place, with patients of similar condition get to live free of us?
not_morrison_rm, Oct 24 2015
  

       Yes, but that depends on how you do things.
MaxwellBuchanan, Oct 24 2015
  


 

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