 and can play an important role in society by delivering a message of the importance of contributing to one's community and taking responsibility for its welfare. In pursuit of this goal, Dr. Whitehouse and his wife, Catherine, have created the Intergenerational School located at Fairhill Center in Cleveland, the only public school of its kind. Older persons, including those who have suffered cognitive deficit, are important part of the learning environment of approximately 100 children in grades K through 4. Its purpose is to contribute, create a learning environment that empowers people of all ages to become lifelong contributors to a democratic society. Attempts at intergenerational collaboration, such as the Intergenerational School, will become increasingly important as we grapple with the difficult problem of allocating societal resources. Dr. Whitehouse will speak to us today on the dementia of Alzheimer's disease and the wisdom of just aging. Please welcome Dr. Whitehouse. Good afternoon. Let me begin my first slide by offering a thanks to this entire community. There are many individuals that I'll mention in a minute who've kind of gotten me here on the podium, but it's really been difficult for those of us who don't know your community to capture what's magic. I've heard that mentioned several times. I'll mention it again. And I think it is this sense of coming together to learn about science and its role in society. To me, as you may learn as I go on, learning is a spiritual activity, and this is a spiritual community. As part of this community, you celebrate learning, so I feel very much at home. I have been accused, including by my wife, of being a workaholic. I try to say I abandoned the difference between work and play about 10 years ago, so maybe I'm a playaholic as well. And what Tim said in the beginning was this is a fun conference, and I think learning is fun. It can be fun. It should be fun. So I really want to thank you for allowing me to join in your learning and your fun. Like Laura, I actually started talking about this conference. I said, Gustavus, with Nobel Conference, I'm actually sharing this experience. And lo and behold, Carrie Gleason, a Gustavus graduate at the University of Wisconsin at Madison. I was just having lunch with her, and he said, oh, I'm a graduate. What do you want to know about Gustavus? And I said, well, tell me a bit about the school. And she told me about Curriculum 2, which is the very innovative seminar approach to learning here. And so they arranged a wine and cheese reception, which we actually had time for as part of this program, and I met with some of the faculty. So from the very beginning, I was drawn to this conference and appreciate that. And I thank Florence Amato for organizing it. I also want to thank Nicole Furstenberg and David Rudeck, who have been my shadows. I think their real job is to keep me out of trouble, but they've done that well, and I've really enjoyed having personal hosts. So thank you so much. That's what it should be for all everybody here. It's a great community. Let me start with some disclosures. Those of you who attended last night heard David Knopman identify his conflicts of interest as a physician. It's very important as we talk about science to let you know the work we have done with industry, and David did that last night. I believe that the relationship between industry and physicians is an exceedingly important ethical topic for medicine, and we need to disclose when the profit motive may play a role in the statements we make to you. I've received a lot of funds over the years working internationally on drug development and Alzheimer's disease, and I'm grateful for that. I have received various grants from other places as well. I don't own any stock or serve on any company board, however. Further disclosures, you know, it's funny for a neurologist to say I believe everything has a biological basis, but you know, there is a biology to everything in the sense that, well, okay, let me back off on that a little bit. There may be some aspects of life where we're still struggling to find the biological basis, but, you know, when they do PET scans on Tibetan monks, I guess they're even trying to find the spiritual manifestations of the biological basis. But I'm going to talk about labels. I'm going to talk about words that we use to characterize biology, and I believe that you can't get rid of people suffering by just eliminating words. But I do believe, and Jay Chansky said, language isn't powerful in science, and it is. We need to attend to our language, and we need to attend to the healing power of stories. So that's what I'm going to be talking about. I'm going to be talking about words and their effects on people. Words like dementia and Alzheimer's disease and wisdom and just aging. And lest you think that the only thing we can do, colorful, in the integrative studies unit that I run, this is our three-dimensional yin and yang symbol that represents our group's activities. So a little colorful word, it's a little colorful symbol. But here's what's really important in this talk, in my opinion anyway, and that is the individual, patient, and their story. This is a gentleman whose photograph I use with his permission and his story I use with his permission. Mr. Kranz is a gentleman who ran the theaters in Cleveland for 40 years. A wonderful man, a major contributor to the vitality of our community. And a man who saw me because of concerns about his memory. So file away Mr. Kranz and his story. We'll come back to him as we move forward. Now my wife said, if you give this talk and explain each one of those words, you'll have essentially given your talk. And there are some pretty difficult words to explain. Dementia, Alzheimer's disease, wisdom, just and aging. But what I want to do is to go through those words and explore them with you and hope at the end that the talk is more than just words, but you do have a sense of a story. Which is a little different than perhaps the story you're used to hearing about age-related cognitive challenges, one of which is Alzheimer's disease. We're here to talk about science, the science of aging. Now science is not one of the words I was going to talk about explicitly, but I think it's really important to have a sense of what is science. We're kind of trying to explore in our society about what science is. Because science means different things to different scientists. My particular interest is in mind and brain. And so at Case West and Reserve University, we're developing a new department of cognitive science. There are only about six of them in the country. We're also trying to do something which I think you've successfully done here at Gustavus, integrate liberal arts and science. Not create the divide between science and humanities. The two cultures that C.P. Snow talked about. And our president, who's a psychiatrist, wants to create not our university, but our community of 500 acres university circle into the world's most powerful learning environment. I would have used the word empowering, but I'm not empowering, but I'm not president. So I think it's important for us to know that science does exist in a social context, in a social setting, and you're seeing that, living that in this two-day conference. You've already heard from Laura that we're also embarked on reinventing aging. And that will be a focus, that's one of those colorful words I'll get to. And to give you a clue, and you got that clue from Dick in his introduction, we take a lifespan perspective on aging. The president of Brown University, actually he moved on when he wrote this article for the Chronicle of Higher Education, said, Vortran Gregorian said, colleges must reconstruct the unity of knowledge. We spend a lot of time in disciplinary lines, and so as you can tell from my background, I celebrate what we can learn from each other, just as you do at this college. And our new dirt dean of the College of Arts and Sciences, Mark Turner, who came from Stanford in fact, wrote a book called The Literary Mind. This is an English professor who's a cognitive scientist that one of the basic units of thought is stories, and how we change our thinking is through changing stories. So that gives you just a little flavor of why I am so pleased to be here to talk about some of these words. So let's talk about the first one, the dementia of Alzheimer's disease and the wisdom of just aging. Dementia is a word that literally means put into two, DE and mentia means an impaired or a mind or thinking ability. It's a word that shows up in many languages. As I was researching for this talk, there was a long list of languages in the words for dementia, and it happened that we've got the A, B and C's here, and I decided to stop at Chinese because I'm going to teach you a little Chinese later on in the talk. It's guaranteed to enhance your cognitive vitality if you learn Chinese. And this was me at a conference in Beijing trying to explain dementia and Alzheimer's disease to a bunch of Chinese reporters. So we've identified for a long time that unfortunately as we age, cognitive impairment can occur, and cultures have tried to address this in many different ways with different words. The history of dementia in our language goes back to about the middle of the 1800s. An English neurologist by the name of Pritchard kind of took some of our earlier ideas of how the mind and the brain were organized in relationship to the planets and begun to put the clinical description of this notion of a loss of cognitive abilities into the medical literature. And then people like Theodore Meinert, you may never have heard that name. It was interesting to me because the structure I studied was called the Nucleus bacillus of Meinert. He's also known as the person who taught Sigmund Freud all the neuroanatomy he knew. And that's not a joke because Sigmund Freud actually thought originally before he became psychodynamic that he liked to understand how the brain related to emotions. But there was a time about 150 years ago in which we first kind of started using the word clinically. But it wasn't until about 1906 to switch now to the second word that the word Alzheimer's disease entered our medical vocabulary named for a Lois Alzheimer who in 1906 as you heard one of the other speakers gave a talk at a scientific meeting called the Society for Alienists. That's what they called psychiatrists back in that time. And he was not very well received. All the Freudians had an interesting discussion afterwards but his talk was ignored. And Alzheimer was a brain scientist. He used a stain developed by his friend Nissell, well Nissell, he used Nissell stains, he also used silver stains to capture what Dr. Selka already mentioned, the neurofibrillary tangle as well as the senile plaque which I didn't describe previously. But on this slide I want you to try to imagine that there are at least two ways of thinking about Alzheimer's disease. Most of the time when people talk about Alzheimer's disease the first thing they say is that it's a brain condition or a brain disease. That's what many of the definitions start off with. But what I would like to have you start to think about is what it is, and I would even say more fundamentally is an eponym, two words named after a Lois Alzheimer. If Alzheimer hadn't been born maybe we wouldn't have Alzheimer's disease. And actually to be honest we wouldn't have had Alzheimer's disease except for the political ambitions for his boss. Emil Kreplen had a school in Munich that was competing with other German schools. And he decided, even though Alzheimer himself being somewhat more skeptical of the concept and perhaps modest, really wasn't sure that Alzheimer's disease deserved a separate name. But Kreplen, who was competing with all his other German colleagues decided he wanted to have a disease that came out of his shop and then get some fame for that. And Kreplen wrote a very influential textbook through several editions starting in 1910. So Alzheimer's disease started in the brain and in the politics and wording of German science a hundred years ago. So that hopefully gives you a sense of why I'm asking you to think about these things as both biologies and to use the term that Laura mentioned social constructs that we have to agree that these labels are useful. So I mean, I studied the neuropathology of this condition as Dick mentioned. I mean, this is a disease in which there are under the microscope senile plaques, the way Dr. Salko showed you, and these neurofibrillary tangles. The point I would say, though, is these things occur as you heard Dennis describe also in dogs, monkeys, and human beings as they age normally. And normally is a funny word there as they get older, let's put it this way. So it's a certain amount of accumulation of brain atrophy that I showed you in the first slide of plaques and tangles occurs in all of us. And the question that is, what is the advantage of labeling people that achieve some kind of threshold of severity of clinical symptoms and pathologies as having Alzheimer's disease? We'll keep coming back to this theme of words obviously as we go through. And what I want to do is to challenge you to think outside the box, and in order to do that I give you a box that you can be out of. So the box, the standard view is that the dementors are discrete categories of disease that it's not part of the aging process. The genetic approaches are the best way to develop effective therapies that for-profit endeavors, and we'll come back to that theme again, are the most likely ways to lead to generally available affordable treatments where there's a caveat, isn't there? Sometimes say, yeah, we're going to find a cure for Alzheimer's disease and Bill Gates is the only one who's going to be able to afford it. The more important principle here though is we tend to think that we're just caring for people while we're sitting on the edge of the seats waiting for a cure. So we tend, and by the way, cure and cure come from the same root word. But my own view is that look, whatever we do with our medical approaches, we are still going to need to care for each other so that caring ought to be the dominant category that attempts to cure, attempts to ameliorate, attempts to palliate are embedded as secondary phenomena to what needs to be a social commitment to care for each other. So this was a book we did based on a conference in Alzheimer's Family House in 1998. See how we were provocative. We called it concepts of Alzheimer's disease, biological, clinical, and cultural aspects. It was a very interesting conference where many pharmaceuticals bought Alzheimer's Family House and made it into a conference center. And we had molecular biologists and clinicians and sociologists and ethicists coming to talk at this conference and it led to this book, Concepts of Alzheimer's Disease. And what do we mean by concepts of Alzheimer's disease, biological, clinical, and cultural? Well here I'll just read them for you. And I'll play with the pointer here. Biological, a strongly genetic condition with specific neuropathologies related to clinical features of cognitive and behavioral impairment. You heard that, right? Clinically though, it's part of the narrative of the affected individual's life who is linked, if the healer is engaged in this kind of relationship-based care, in a relationship, a healing relationship to support quality of life. And culturally, it is a social construct influenced by the belief systems of particular national and ethnic groups and particularly the strong national group of molecular biologists and geneticists whose ideas about this tend to dominate. So that's what I mean about taking a broader look at it. Another way, fortunately, I think, we've been thinking about this condition that we call Alzheimer's Disease. This picture has been showing up in people's presentations more and I think it's great because Alzheimer got his name on it. The wife of the postal clerk in Germany, who at the age of 51 started with a progressive dementia that Dr. Alzheimer saw clinically and then was fortunate enough to obtain her brain and find those plaques and tangles. So this was the first sufferer of something that became labeled Alzheimer's Disease. Of course, other people had suffered from it prior to that time. It was interesting how the politics of German psychiatrists played out again because my friend and colleague, Professor Maurer, found Alzheimer's Description and we think Alzheimer might actually have taken this photograph. It was in the bowels of the hospital in Frankfurt. Then there was a competition to see if he could find the slides and Alzheimer had moved to Munich, which is where Kreplen was and they eventually found the slides that confirmed that Dr. Alzheimer's right. I guess that's not surprising although sometimes it does occur and actually doesn't get it always the way we now consider it. The first case of Alzheimer's Disease had Alzheimer's Disease and so there was a little bit of competition around the rediscovery of the case just as there was in the first description of it. So to bring the patient, the person suffering from the condition into the fore I think is so important and there are some very, very interesting things that are going on in society now where we respect the voices of those affected but wonder a little bit about what their writings teach us. This is a man, Thomas de Baggio, whose first book there, Losing My Mind, an Intimate Look at Life with Alzheimer's Disease actually became very popular on Amazon.com, competing for times with the 36-hour day, another classic. He describes in excruciating detail and with great eloquence how he can't write anymore and he describes the terror of falling off the abyss. He continues this in his second book and he now has two other books under consideration from his publisher. So as a neurologist, I want to respect this person's story particularly when he writes so eloquently but I want to be a bit concerned about whether this is a typical Alzheimer's patient, clearly most Alzheimer's patients don't even write one book, let alone four and it raises the possibility in my mind particularly when he describes the terror of this disease so eloquently as to whether we've created a space in society around this term Alzheimer's disease that does create a terror, an anxiety. I mean how many people say don't use the A word. So the word Alzheimer's disease has become very powerful in people's lives and it concerns me a bit about when we label somebody as Alzheimer's disease that we put them in a different box, a box that isn't part of the rest of us and if you believe what I believe that we're all addressing brain aging to one degree or another then I'm not sure we should ostracize, stigmatize people with this label. So the question that you've heard discussed yesterday and I'm going to raise again what is the relationship between Alzheimer's disease and normal aging, the biological process of aging. I asked Dr. Ensoco that question and I think he was honest and said it's a tough question and we don't yet, we can't yet say this is the one precise thing and I guess what I'm saying is I want to keep open the possibility we never will. Would we all develop Alzheimer's disease if we live long enough? Dr. Ensoco showed numbers that about 28.5% by the age of 90. There are numbers that are a little higher than that. The Centenurian studies suggest Ron Peterson at the Mayo Clinic and their experience close to home here where the incidents keep going up. So we're not sure about whether there are people that would escape if they live long enough. You can't do that experiment of course. But I think we have to keep an open mind about the relationship between brain aging and the dementia. See Alzheimer's disease is only one of the conditions we label as a dementia. You've heard about Parkinson's disease and vascular dementia last night particularly the differential diagnosis of this. I'm being perfectly honest and we'll see if Dennis might disagree with this. Frankly in the last 20 years I've been practicing our ability to differentiate some of the dementias particularly vascular dementia or stroke related dementia from Alzheimer's disease has gotten more uncertain. There are mixed cases. I think there are lots of brain aging processes that are going on and there are putting people into an Alzheimer's box or a vascular dementia box or a different box is more challenging. Here's a Minnesota product, if you will, mild cognitive impairment. This is the stage that Ron Peterson and his colleagues Dave Nottman who some of you heard last night have been talking about a lot. What is this term mild cognitive impairment? It's a label that we've invented literally in the last few years and if you think about inventing this label and the challenges of that you will think about the labeling process in general. There have been innumerable scientific conferences including one a couple of weeks ago where I was with Ron talking about what is mild cognitive impairment and the Mayo Clinic has Ron as a book and he also worked with the American Academy of Neurology to identify what we call practice parameters so mild cognitive impairment is coming into the clinical arena and the question is, is it a useful concept or not? What is it? Well, it's not dementia in the sense that people if they had the dementia would be labeled mild Alzheimer's disease or stroke or something else and the differentiation between somebody who has what Dr. Peterson would call Alzheimer's disease or mild cognitive impairment is the function the intactness of their ability to go about daily life. You notice the word relatively there I personally think that in the future our computers will diagnose first as having mild cognitive impairment because the highest order instrumental activity of daily living is how we relate to our computers and so it's a matter of degree it's a matter of degree and I'll show you another very high instrumental activity of daily living and you'll see the pun in just a minute it's also defined statistically if you send the person to a psychologist and they do a test we talked about that a couple of times in this meeting and Laura showed you some more data if somebody performs at a certain level below normal typical normal elderly mild cognitive impairment so you get labeled if you're running to a doctor who uses the term if you have some memory problems on a test but you don't have relatively intact function the problem with this term clinically is that it means different things depending on where you go I will tell the people who are from Rochester, Minnesota that if you've got the label mild cognitive impairment go down to see my friend John Morris Washington University in St. Louis he doesn't use the term clinically so if you go to different places people will use the term differently because it means several things it means for some people well they really have Alzheimer's disease because you heard last night that on average about 10 to 15% of people each year with mild cognitive impairment will go on to get Alzheimer's disease so it's a risk factor but just think for a minute if you add 10 to 15% a year for a few years when do you get to 100% that's not a test question so it means to some people the doctor doesn't have the courage to tell me I have Alzheimer's disease it's too mild but you know I really do have it and if you look inside the brains you'll see those plaques and tangles for some people they will say oh I don't have Alzheimer's disease after all he didn't label me as having Alzheimer's disease for some people it means they may get it or for some people it means they will get it depending on the study there are studies that show that some people with mild cognitive impairment get better so they had a bad testing day or they were a little depressed and they didn't do as well and they got better so you can see the challenges of using a label like mild cognitive impairment where depending on where you go it can mean all these different things and for the partner what does it mean because we've invented another category of people in our society the caregivers with Alzheimer's disease and I respect those of you out there and there are many I'm sure who have been caregivers for people labeled with Alzheimer's disease and it is a challenge and there is suffering for both of you however there is an opportunity to look at that relationship in a different way a couple is caring for each other and they should continue to care for each other regardless of what stage of the illness they're in to the extent of their abilities and for mild cognitive impairment what does it mean are you caring for somebody are you a caregiver at that point is this a disease is this a condition if you listen to doctors talk about mild cognitive impairment sometimes they say it's a disease sometimes they don't say it's a disease we're not sure what to call this thing and for societies it means we'd have more impaired elderly last night I heard a new term for the first time and I'm sorry the slide is fuzzy I took it from the screen last night pre mild cognitive impairment before mild cognitive impairment before Alzheimer's disease I think I'm going to have to keep up with this game there'll be pre pre mild cognitive impairment in fact there already is it's called aging associated memory impairment so believe me experts can make up all kinds of labels the original one in 1962 was benign senile forgetfulness kind of has a more gentle flavor to it but the issue is dementia experts suffer from a kind of hardening of the categories it's a serious disease in Japan and the Alzheimer's disease international meeting in Japan is occurring just next week my friend Akira Houma who I did part of my sabbatical with says they're trying to invent a new term for dementia in Japan so this is straight from his email obviously they're looking for a Japanese term I guess that makes sense corresponding to cognitive impairment mindfulness, illness of memory, memory impairment or corresponding to Alzheimer's they find the word dementia to an Alzheimer's disease too challenging but here's the ringer and this ringer will bring us from the end of my first part of my talk about dementia of Alzheimer's disease to wisdom and just aging the ringer is that meeting in Beijing I told you about where I'm puzzled about how to express some of these thoughts to a Chinese audience and this is Professor Xu is a major opinion leader in China and helped organize this meeting and he like many Chinese are a little reluctant well actually he was less than reluctant he wanted to do this but they were not sure about what this Western concept of mild cognitive impairment was all about and so at least some of my friends in Japan and in Asia were a little concerned well here's why I got concerned the back translation into English of mild cognitive impairment so you take mild cognitive impairment I said I teach Chinese well there they are it's up there in Chinese I can't pronounce it but the back translation into English is loss of wisdom do you know how many people in China would lose their wisdom if we apply the label mild cognitive impairment to them it's a lot older Chinese so this was kind of the as an illustration of the power of labels and whether we want to go around using this label particularly when it translates in this way but it is a bridge to the more positive aspects of aging which I would like to now move to wisdom what on earth is wisdom you've heard it used a few times actually my favorite my favorite humorous one let me put it that way was Laura's of a little mouse with a helmet approaching the mouse trap by being older and a little wiser I think I'll remember that one but from a psychologist's perspective wisdom is difficult to define but we're taking that on and Laura's taking that on in her work a bit as well they're what we call executive functions with a special dose of emotions and values so it's some kind of an integration of the kinds of thinking abilities we celebrate as human beings where we have a purpose in life we can make a plan, we can monitor whether that plan works and it's heavily involved in the kinds of things that Laura was talking about motivations and emotions it's also heavily involved in a psychological ability we call attention whether you pay attention to something or not something distracted by really can affect what your ability to think deeply about a matter the point I would like to make about wisdom though is academics don't like to talk about it it's kind of not a topic that has been talked about in our management school in our leadership training in our philosophy programs it's a word that seems to have dropped out and I want to bring it back so I want to ask you to think about that word and it has been used in this conference in addition to Laura's talk about wisdom but I think what's important to recognize is wisdom is not should not be viewed in my opinion anyway maybe this is an unwise perspective as rare something that that Confucius had that Socrates had it's unattainable it's rare I think what's important is collective wisdom is how we as communities can address the challenges we face as human beings particularly in this troubled world so I like to think that everybody has it to one degree and that it's something that we can enhance in each other and in ourselves through the process of learning and celebrating the kind of activity we're embarked upon here so my baby steps in this regard were to work actually with the president of our university I mentioned for Ed Hundred the psychiatrist who is trying to create a world's powerful learning environment and we completely redone our undergraduate curriculum to approach called Sages the seminar approach to general education and scholarship which is why I was interested in meeting with your faculty and Ed came and talked to our class about his book on on knowledge and values and we went to the art museum we tried to take full advantage of the university circle we also developed a program where the Case Western Reserve undergraduates developed a learning module on wisdom to teach to the kindergarteners through fourth graders that Dick mentioned were in our intergenerational school because there's nothing like thinking about wisdom in the abstract and then doing something practical with the youngsters let me say I also as part of that course gave a talk on the neuroscience of wisdom the possibility of a wisdom pill and this is the closest I found so just hang on to your seats this is the experiment in high instrumental activities of data living this was our pilot project with pilots and a flight simulator so there's nothing like studying how pilots would behave in a flight simulator as a measure of the ability of medications to affect their ability to to perform in that complex situation and we use a medicine that had been developed to treat people with Alzheimer's disease because we knew that even in these 53 year old pilots they would have some of the same brain changes we thought they would that you see to a more severe extent in Alzheimer's disease where this medicine was tried and this is a very small pilot experiment in about 18 people but it was randomized double blind it was 5 milligrams of the medicine for a month and this is the flight simulator at Stanford at Laura's place where Jerry Savage a friend of mine who is a pilot has a flight simulator and he's putting the effects of a variety of drugs so the interesting conclusion from the data was that there were a couple of areas where they did do better statistically on the active medicine rather than the placebo handling emergencies and landing intention intensive tasks where you really have to be using good judgment using executive function not suggesting we have a wisdom but I am suggesting that the full range of thinking about how we can enhance cognition should include appreciation that there's a biology to these things this work got featured in both scientific American and business week in the same about a year ago because there's this whole focus now on not only talking about people on the continuum of cognitive aging where you're worried about decline but also worried thinking about how can we enhance thinking abilities how can we enhance flying how can we enhance performance in a variety of tasks but the business week question is okay well if we can develop these pills you know who's going to be able to afford them and the whole ethical issues are very complex so wisdom I want to bring back into the conversation because in many ways it's a word that we associate it with aging it's we associate it with life experiences and perhaps we need to look for opportunities to enhance wisdom in all of us as we age now let's talk about just aging what do we when I say just aging the the reporter on the radio about an hour ago said what do you mean do you mean justice just aging in the sense of morally right or do you mean just in the sense of well only aging or just exactly what is designated I meant both and I want to just take you through both those meanings of the word by the way that reporter also informed me that her parents have been going to this this Nobel conference for years and years as well I won't embarrass them by mentioning the name but you know everywhere you go people know about this conference it's wonderful so let's just talk about bioethics for just a minute now bioethics is a discipline that does focus on issues of justice and autonomy and beneficence and medical issues it's a term that was invented by a man by the name of Van Menzelier Potter who was from South Dakota and spent his entire life as a faculty member at the University of Wisconsin a wonderful wonderful warm human being who wrote his first book called bioethics a bridge to the future and he saw it as a bridge between the science and the humanities just like what we're doing here an interdisciplinary profession but it's emerged to be something different I want to express my concerns about that basically bioethics has become very close to medicine it's become concerned about genetics technology and to my mind it's not looking at the broader issues that Van Potter wanted bioethics to the way he conceived it to look at in this second book that he did in 1988 he dedicated to Aldo Leopold Aldo Leopold a man who wrote the San County Almanac a man who invented the science of game management a man who invented the concept of a land ethic so Potter was very concerned about the global issues in bioethics that focused on sustainable environments and quality of life he was very intent on trying to use bioethics as a way of exploring the necessary wisdom that we as a species should have around survival on this planet and he was a great guy when I first met him he drove up in his 1984 Subaru station wagon had quite a bit of rust on it that time I had a 1984 Volvo station wagon which at that time I was rusting too that was one of the problems with those old Volvos and it had his license plate said yes, ZPG so this was a guy who was concerned about population growth who was concerned about the quality of the environment who was concerned about having doctors in our healthcare system pay attention to these broader issues of environmental and public health so he was a man who was ahead of his time and somebody from this area of the country so I think as we look to issues of ethics and medicine considering whether we should have a gene that will allow us to live 500 years or whether we should with accosted drugs all these kinds of issues are very important issues we need to take a global perspective on these issues be concerned about social justice be concerned about our kids as well as our older Volvos and bioethics is changing bioethics is under a significant degree of criticism the president Bush's bioethics panel has been a challenge for many bioethicists because it's taken a political bent to its activities and maybe that's not unexpected as a presidential but it has taken on, this is their first report beyond therapy, biotechnology and the pursuit of happiness so they are actually thinking about a memory pill, what if we develop a pill that would have us live much longer so these issues are of concern to the bioethics community let's just talk about what I mean by just aging though, the kind of second definition exact or opposite or approximate it seems like whenever we talk about aging we always want to put a modifier on it so these are the terms you'll hear most frequently successful aging or productive aging well I'm not sure that doesn't limit us a bit yeah I want to be successful yeah I want to be productive but in aging there are words like conscious aging and natural aging and a spiritual process to aging as well so we don't want to commodify we don't want to necessarily think of aging only in terms of our role as economic creatures or as people constantly thriving in life as successes or perhaps we want to broaden our conception of what we mean by successful aging Thomas Cole, a wonderful writer wrote a book called The Journey of Life a Cultural History of Aging in America in which it's very clear that through time, through the centuries what we mean by aging has changed and as he describes in the book as we come closer to our time we have medicalized a lot of aging we have given I think too much responsibility over to the medical model the physician model and this Tom Perkwood you heard is a friend of Jay's from the University of Newcastle where actually I was raised I wrote a book called The End of Age Why Everything About Aging is Changing so as Laura said she's part of the same revolution to think about the word aging in different ways we can reinvent aging there's one way I would recommend that we avoid doing too much fantasy about aging I mean certainly the work John Hayflick has described is absolutely fascinating in terms of understanding aging and I agree with him we need to understand more about the fundamental basis of the biology of aging but taking these claims too far to anti-aging medicine is where I think we go to run the risk of perhaps taking our science too far too quickly or perhaps taking non-science too far too quickly I think there's a group of people that were meeting at the gerontology society and I won't for lack of time describe this cast of characters but the one with the long beard there has written about how we can live for thousands of years if we're not hit by, well he said a bus I would prefer to say SUV just to be politically more forward thinking so the people who think we can live a long time if we don't have accidents and there's actually an academy of anti-aging medicine that will refer you to a physician now this is not certified by regular accreditation bodies for medical specialties but there is this kind of what shall I say desperate hope about aging and stopping aging and reversing aging that this kind of group wants to try to address somebody will tell me, I'm sure after I show this slide there's a museum in Minnesota where they have medical devices that made extravagant claims this one is the nematron the rings were placed around the ears to regenerate brain cells it was also good to cure acne so I mean only in Minnesota I think we also have to be careful about claims about curing Alzheimer's disease if Alzheimer's disease is brain aging or intimately related to brain aging or largely brain or largely, Dennis said it's largely a disease you can see that there's a fair amount of controversy on this table I'm at least opening up the possibility that in fact there are more fundamental relationships so is curing Alzheimer's disease ten amount to curing brain aging both some speakers have referred to this vaccine that Dennis has been involved in his company's been involved in developing exciting science but I think we run the risk of creating expectations that we will take a while if ever to meet let me end then by bringing you back to my home which is Fairhill Center this is a former merchant marine hospital yes Cleveland is on the North Coast of the United States and that main building is shaped like an anchor as you can see I think and on that campus we're programs for the elderly and now we've got schools and nursing homes and a whole variety of programs in fact in that main building it's great for me my wife and I started the school with others it's on the second floor our research programs are on the second and third floor our clinic is on the third floor the Alzheimer's Association is on the first floor we've got a variety of lifelong learning adventures also on the first floor so this is our integrative studies focus with the focus on intergenerational activities this is Mark Freeman who's from San Francisco who wrote a book prime time how baby boomers will revolutionize retirement and transform America by the way I don't think we have to wait for the baby boomers for those of you that may feel you're out of that that category and we certainly expect generation X's and Y's to contribute to this dialogue in society about transforming aging he runs a group called Civic Ventures and so he is he thinks of the secret and I think it's one of the secrets is to keep engaged in your community and we've done a series of programs and I'll just go through quickly to give you a flavor of what I mean about the power of stories electronic reminiscence our NIH funded book club and the school electronic reminiscence involves taking folks with memory problems and collecting their archives kind of like the way you hear people do at the 50th anniversary of their parents because as our memories get a bit more weaker we can use computers we can use information technology to save not only the still photographs but the videos and the music that people enjoy later in life so we've got a project to use computers to try to enhance storytelling one of my patients we learned what used to do theater at the chagrin valley outside of Cleveland and just as an illustration there's so much of that person as a character emerged not only for us but for his family as we began to put these things together by hook or by crook and I won't describe exactly how we actually developed a little project where we followed folks for four years and tried to measure whether the number of books that they read could contribute to cognitive vitality in a study in which the outcome measure was whether they developed dementia or not I mean after all if you think about it drugs act on neurotransmitter systems often just one or two books act on multiple neurotransmitter systems and they have long lasting effects so if you want we could develop a biology of reading books so everything has a biology but perhaps keeping your mind engaged by reading books about how to improve your memory or how to engage in community perhaps that would be a way of generating stories that keep you cognitively vital and last the intergenerational school this is as Dick mentioned a public school we actually now are K through 6 but we include learners of all ages in this school including those as Dick mentioned with cognitive challenges by that I mean people labelled with myocardial impairment in this case we're doing music therapy with young kids who walked to a nursing facility right near the school to work with people who had quite severe dementia we celebrate real life learning in community we celebrate the notion that all of us have age related cognitive challenges so one of those children may have attention deficit disorder and they may be on medicines one of our older adults may be on have a memory problem and be on a medicine but what we're celebrating in this community that everybody is learning all the time and I did add last part because it's just recently come out in our plane dealer we were grateful to be designated as the only school a charter school community school in Ohio that managed to have an impact on kids that allowed to the rating of excellence so we've been doing this for five years and it is in many ways my most exciting experiment let me tell you about some of the activities there we have a collection of intergenerational literature Sunshine Home is about a young man who leaves his grandmother in a nursing home for the first time and his grandmother is crying and his parents are crying and he brings them back together and there is some rapprochement when I'm old with you another similar positive experience between a young child and her and her grandfather we have 30 reading mentors we're just about to expand that Mrs. Atwood again a name I use for permission sitting on the left there has two sisters in a nursing home and she has been diagnosed and she's reading and getting a tremendous amount of positive energy about continuing to contribute because when you get a label like myocardium impairment when you get a label like Alzheimer's disease it's kind of like what do you have left to do well this lady is doing a lot we have we did a story where we enacted out this kids book this children's book quite a famous book and that's what a memory was because Mrs. Brown one of her friends he overheard her parents saying she was losing her memory and so he went around to some of his older friends and they said well look here's a feather here's an egg let me tell you about a memory so he linked memories and objects so what we did was we took kids and older adults in a nursing facility and the kids brought in an object a teddy bear, a book, an award and the older adults brought in an object and they shared memories about their community and about their lives together they made a quilt out of this that hangs in the long-term care facility we used multimedia approaches with kids particularly around natural topics so the older adult and the younger kid were paired to do a PowerPoint presentation on Lake Erie let me bring you back now to Mr. Krantz and his story and end up with just one other approach that we're using so Mr. Krantz and his wife who also came to see me about concerns about her memory largely due to the stress of caring for her husband participated in our intergenerational time slips and here's Ann Davis basting and here's my friend Rick Moody who are facilitating this time slips is a program developed by Ann to help celebrate creativity even in the depths of Alzheimer's disease so she runs groups of people with Alzheimer's disease and shows them an ambiguous photograph and has them share a story about that photograph there's no right answer, there's no right story it's just celebrating storytelling so what we did was we did this in an intergenerational way this is Ann introducing our group to the photograph that they had to tell a story about for those of you who can't see it it's a young girl hugging an elephant we thought it was an older looking elephant and so we thought this had an intergenerational theme and it might stir on our conversations about aging and so here we have Mr. Kranz and his wife and some of our kids and Sally Alton from the Alzheimer's Association and Sid Katz a very distinguished geriatrician who lives in Cleveland sharing, creating stories together so we have people of different ages as well as different cognitive abilities and then they came back and they shared their stories in a group about what that photograph stirred in their minds about aging and about their own individual lives so that's an example of the creative process of storytelling and a good time was had by all so let me end up by coming back to the dementia of Alzheimer's disease and the wisdom of just aging what I've asked you to do is to think about every one of those words as we've gone through that age-related cognitive challenges are with us and are going to be with us for some time to come but we have to be really careful about what boxes we put people into even the box Alzheimer's disease and there is another side to aging getting older is not just worrying about every time you forget something that you're getting Alzheimer's disease it's about seriously thinking about what the purpose of your life is what you want to contribute with the time you have remaining I personally believe as Laura does and I'm not sure anybody would disagree it's kind of a silly point in some way in the sense but there's so much of the medicalization of aging that makes this talk about loss and when Laura started sharing those graphs with aging we know that we have the opportunity to add wisdom to that list and we know that as we think about our aging we have to think about it in terms of just aging as well that we don't want to set expectations that everybody ages differently and as we age we have our responsibilities to our communities at heart so I want to thank these folks for thinking wisely and I think that in this talk you may have noticed that both President Peterson and the invocation from your chaplain use the word wisdom in fact your chaplain used the word wisdom several times and I think it's important in some sense as we come to the close of this meeting that we recognize that wisdom is something that scientists can study that I believe we ought to measure it but not all aspects of wisdom not all aspects of quality of life perhaps can be included in the rubric of science and that in this community of learners we look at wisdom and aging in this kind of broader perspective so let me end with an overstated and provocative conclusion I had the word nasty on here but I tell you I tone this down a little bit because I was referring to the dementia of experts the most important cognitive challenge is to recognize that experts may divide the world into boxes that have the potential to terrorize people they have the potential to help too perhaps the wisest solution is to appreciate that Alzheimer's disease and other forms of dementia are related to brain aging maybe a form of brain aging which to one degree or another affects us all and that we must all work on rewriting or writing our individual stories to include these very important positive aspects of aging and to appreciate as we do that the limits that we face as human beings on this planet thank you