How Madness Shaped History by Christopher J. Ferguson

Author:Christopher J. Ferguson
Language: eng
Format: epub
Publisher: Prometheus
Published: 2019-12-26T00:00:00+00:00

Skull demonstrating bone destruction caused by untreated syphilis. Photo: Joseph Bryant and Albert Buck.

Like it or not, advanced age inevitably brings on some level of cognitive decline. That’s why, when we see a centenarian, we tend to remark how “sharp” or “alert” they are so long as they can put on their own pants or stir their own coffee. I’m not trying to be ageist (I’m getting there, too!), simply noting that we all have an awareness that some decline in some cognitive skills is a natural part of aging. Normal cognitive decline is predicted by some factors including genetics, smoking, lack of exercise, and lower B-12 vitamins. However, the effects of these predictors are generally quite small, so I’m not sure I’d pound the B-12s just yet.3 As we age we tend to lose little bits of reaction time, new memory formation, processing speed, and novel learning, but, hey, we get wisdom in return. Given that this makes us more alert to what we’re losing in all the other realms, this hardly seems like a fair trade but whatever. One centenarian, upon being asked the benefits of advanced age replied, “much less peer pressure,” which is not only wise but perhaps one of the funniest observations of all time.4

Dementia refers to cognitive declines that are atypical for the person’s age. These can result from neurodegenerative illnesses such as Alzheimer’s disease or Parkinson’s disease or more acute damage such as from strokes. Some infections can cause dementia. Untreated syphilis can bring on dementia, as can HIV. Prions, little errant proteins that make copies of themselves while destroying brain tissue in the process, are responsible for dementia due to Creutzfeldt-Jakob disease. In most cases, this is genetically inherited but can be transmitted by contact with brain or spinal tissue (including from other animals such as with mad cow disease or “zombie deer” chronic wasting disease). A particularly vicious variant, fatal familial insomnia, mainly attacks the thalamus region of the brain, which is responsible for sleeping. As the name suggests, these poor souls lose the ability to sleep—even sedatives don’t help—and they effectively die from exhaustion within months or a few years at the outside. Fortunately, this is rare, appearing more common in Italian families (good news if you’re not Italian, not-so-good news if you are).

Dementia can also be inflicted through repeated injuries to the brain. Famously, chronic traumatic encephalopathy (a fancy way of saying getting hit on the head a lot) has been found to be common in high-impact sports such as boxing and football.5 Certainly, chronic substance use, such as drinking alcohol, can bring on variants of dementia such as Wernicke-Korsakoff syndrome.

Dementias, particularly those due to neurodegenerative diseases or stroke, are more common during the elderly years. However, rarer forms of dementia can strike at any age, including childhood. Leukodystrophy, which damages the myelin coating around the axons of neurons, can appear in childhood.

In many cases, dementia can develop slowly, becoming obvious only after symptoms reach a state of advancement.

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