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Our Mission:

TO EXPOSE the official lies and cover-up surrounding the events of September 11th, 2001 in a way that inspires the people to overcome denial and understand the truth ...

TO PROMOTE the best in investigative reporting, scholarly research and public education regarding the suppressed realities of September 11th, its aftermath and exploitation for political ends, the toxic air cover-up, and the anthrax attacks ...

TO SEEK justice and redress for those wronged on September 11th, or as a result of the events ...

TO ADVANCE the insight that ending a world in which 9/11-type events dictate the agenda requires the fall of the present system and the rebirth of constitutional and accountable republican institutions ...

TO END, by way of integrity and god-given creativity, the regime and illicit power structures responsible for 9/11 and to replace the system that made 9/11 necessary. We solicit collaboration with others who are committed to achieving these goals by way of peaceful transformation.

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9/11 Facts: The World Trade Center and The 9/11 Attacks | 911Truth.Org

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Our Mission: TO EXPOSE the official lies and cover-up surrounding the events of September 11th, 2001 in a way that inspires the people to overcome denial and understand the truth ... TO PROMOTE the best in investigative reporting, scholarly research and public education regarding the suppressed realities of September 11th, its aftermath and exploitation for political ends, the toxic air cover-up, and the anthrax attacks ...

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Losing a beloved life partner is never easy at any age, no matter the circumstance. The loss can be sudden and totally unexpected - a fatal heart attack, traffic accident or natural tragedy like a flood or earthquake. Or the loss can be long in coming from a progressive illness that gives the surviving spouse weeks, months, even years to prepare for and presumably "adjust" to its eventual inevitability.

Psychologists have long maintained that after a brief period of sometimes intense bereavement, the vast majority of surviving spouses adjust well, returning to their previous work, daily routines and prior state of contentment within a few months to a year - a psychological outcome referred to as resilience. Studies by George A. Bonanno and colleagues at Columbia University as well as others, for example, have found that 60 percent of people who lost a spouse were resilient - satisfied with their lives and not depressed.

But new research is calling this global assessment inadequate to describe the aftermath of spousal loss for many if not most people, suggesting a need for more effective and specific ways to help them return to their prior state of well-being. Someone who ranks high in life satisfaction may nonetheless be having considerable difficulty in other domains that can diminish quality of life, like maintaining a satisfying social life, performing well at work or knowing who can help when needed.

The Jewish faith in which I was raised offers one such source of support, specifying a period of mourning that gives survivors needed time to adjust to a new normal. It designates a weeklong visitation - the shiva - during which friends and relatives gather with the bereaved to express condolences and relate memories of the deceased. It also calls for a 30-day period of readjustment that includes daily prayers.

Indeed, my father, who faithfully abided by this ritual period of mourning, seemed to emerge relatively unscathed when my mother, the love of his life, died after a yearlong battle with cancer. With two children to worry about and provide for, perhaps he had little time for protracted mourning. After 18 months as a widower, at age 51 he remarried a lovely woman who became our loving stepmother.

But when he died suddenly of a heart attack 20 years later, she did not fare as well. She was intensely lonely and seemed trapped in a restricted, relatively joyless existence. Only after she died did we realize that her former joie de vivre had been dampened by a persistent low-grade depression and limited social connections after my father's death.

The new research shows that even those who express overall satisfaction with their lives after the loss of a spouse often experience significant declines in specific aspects of physical and emotional health and well-being. In other words, their resilience is not uniform across all dimensions that most of us would consider important. Scratch the surface and you're likely to find that the surviving spouse who seems happy and well adjusted may have considerable difficulties that are not apparent to a casual observer.

The research was conducted by Frank J. Infurna and Suniya S. Luthar, psychologists at Arizona State University, Tempe, who took advantage of a unique data set gathered annually for 13 years in Australia. It is called the Household Income and Labour Dynamics of Australia Study, conducted from 2001 through 2013 among a nationally representative sample of Australians aged 15 and older who responded via a combination of face-to-face and telephone interviews and self-completed questionnaires.

During the study, 421 participants lost a spouse. The Arizona psychologists analyzed five specific aspects of how they were faring for each of the five years before and five years after they became widowed. Sixty-six percent returned to their pre-loss level of life satisfaction within a year, whereas 34 percent experienced a precipitous decline after the death and had not returned to their prior level even five years later.

When responses to questions about positive feelings like "Did you feel full of life?" "Have you felt calm and peaceful?" "Did you have a lot of energy?" were assessed, only 26 percent had returned to their previous level; 74 percent, who had started at a lower level before their loss, sank even lower at the time of death and never bounced back fully.

With regard to negative feelings like "Have you been a nervous person?" "Have you felt so down in the dumps nothing could cheer you up?" "Did you feel worn out?," only 19 percent were found to be resilient, no worse off after than before their loss.

The participants also reported on their general health and whether they had trouble performing daily activities like carrying groceries, climbing stairs, walking several blocks, bathing and dressing. Thirty-seven percent were resilient in terms of general health, but for 63 percent health was poor to begin with and sank lower with time. Physical functioning declined as well for 55 percent, with only 29 percent showing resilience.

Of the entire group, only 8 percent of the bereaved individuals were in good shape for all five indicators of resilience studied, while 20 percent were not resilient in any of them.

Given that 92 percent of participants experienced declines in one or more areas of functioning, the researchers concluded that it is wrong to define resilience "based on a limited set of measured outcomes." In fact, they added, people who lost a spouse may have difficulties beyond those assessed in this study, like problems at work or general feelings of loneliness.

All told, the findings showed pronounced differences from what has been generally believed about how resilient people are to the loss of a spouse. It depends on the particular aspect of life in question.

Most important to resilience in the face of bereavement were how vulnerable or protected surviving spouses felt and how well they functioned in their everyday roles, Dr. Infurna said in an interview.

He and Dr. Luthar described three factors that influenced overall resilience: 1) Reliable comfort - having someone to confide in or lean on in times of trouble, and being able to get help from other people when needed; 2) Social connectedness - whether their physical health or emotional problems interfered with social activities like visiting friends and relatives and interacting socially with neighbors or groups, and 3) Daily functioning - having difficulties with their normal activities because of emotional problems like depression or anxiety.

Based on their data, the researchers concluded that "it can take two to three years or even longer for some to recover from bereavement" and return "to their pre-loss levels of functioning."

What they found to help most was remaining socially connected and engaged in the usual activities of everyday life and knowing where they could turn for help and comfort and receiving support when they needed it.

Correction:

The Personal Health column on Tuesday, about resilience after the death of a spouse, misstated the length of the Jewish period of mourning for a spouse. It is 30 days, not a year. (The one-year period is for those who have lost a parent.)

A version of this article appears in print on , on Page D5 of the New York edition with the headline: Recovery Varies After a Spouse Dies. Order Reprints | Today's Paper | Subscribe

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When a Spouse Dies, Resilience Can Be Uneven

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Losing a beloved life partner is never easy at any age, no matter the circumstance. The loss can be sudden and totally unexpected - a fatal heart attack, traffic accident or natural tragedy like a flood or earthquake.

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Researchers say that all memories involving laughing and celebration are usually already lost forever by the time an initial diagnosis of dementia is made.

BALTIMORE-Researchers at Johns Hopkins University published a new study this week on the cognitive effects of Alzheimer's disease and other deteriorative brain disorders, finding conclusive evidence that dementia sufferers' fondest memories are nearly always the first to go.

The five-year study, which followed a group of nearly 3,000 individuals diagnosed with dementia, found that as neurons and dendritic connections in the cerebral cortex are degraded by the disease, patients' most positive recollections-such as falling in love for the first time or the overwhelming, indescribable joy of holding one's firstborn child just moments after their birth-are eradicated much more rapidly than other types of memories.

"It appears that the accumulation of abnormal proteins in the brain, which underlies most forms of dementia, first affects the specific memory centers responsible for retaining the subject's most treasured reminiscences," said neurologist David Trapp, who noted that during the earliest stages of the disease, patients typically lose all recollection of their most prized personal and professional successes in life. "At acute risk are memories along the lines of the heart-stopping exhilaration of that first kiss at summer camp those many years ago, as the sun slowly set out over the lake and caught the water in just such a way, almost like the lake was on fire. In fact, that type of memory is erased almost immediately."

"The moment you notice the first signs of dementia in a loved one, you can be certain that the majority of memories that give them any feeling of pleasure, pride, or personal fulfillment have already been forever expunged from their mind."

"And memory loss progresses quickly from there," Trapp continued. "The moment you notice the first signs of dementia in a loved one, you can be certain that the majority of memories that give them any feeling of pleasure, pride, or personal fulfillment have already been forever expunged from their mind."

Trapp added that the happier and more life-affirming a particular memory is, the faster it will be claimed by the neuropathology of dementia. Remembrances of proudly walking through the front door of one's newly purchased home or of triumphantly marching down the Champs-Élysées with the knowledge of having helped defeat the greatest evil the world has ever known are typically lost within a few weeks of being diagnosed with the condition.

According to the study, brain regions associated with memories of love, smiling, accomplishment, unmitigated joy, comfort, interpersonal tenderness, physical pleasure, beloved childhood pets, and self-respect appeared to be the first targeted by memory-destroying neural plaques.

"In fact, just the act of trying to recall the brightest days of one's youth-to recapture some small sense of the profound satisfaction that came from learning and discovering and experiencing new things, of the very essence of what is good about being alive-greatly accelerates the process," Trapp said. "We found that the more subjects attempted to think back to their carefree college years or their childhood escapades with friends over summer breaks, the faster these memories vanished, never to be recalled again."

In addition to decimating those memories most important and sustaining to the patient, the degenerative effects of dementia seemed to spare the vast majority of the humiliating and unhappy moments from its victims' lives, the study found, leaving them fully intact as the remainder of one's store of memories steadily deteriorated and disappeared.

"Even after subjects were robbed of their ability to recognize loved ones and the basic skills necessary to feed and clean themselves, the worst of their memories persisted," said Dr. Emily Braun, a neurobiologist at Columbia University who contributed to the study. "Functional magnetic resonance imaging shows that areas of the brain that retain, for example, the memory of walking in on one's oldest and most trusted friend engaged in passionate intercourse with one's wife or of suddenly being stricken with uncontrollable diarrhea while giving a presentation at a sales conference continue to light up well after the other cortical regions have gone silent."

"And with complex emotional imprints, such as those stemming from a long relationship with one's spouse or children, it seems dementia selectively destroys neural circuitry related to the positive aspects of the memories in question, leaving behind only the trauma, pain, and disappointment related to these experiences," Braun added. "Although more research is necessary, it appears as though the most awful recollections actually become crisper and more vivid to the patient as the disease advances."

As dementia reaches its terminal stages, Braun confirmed that bitter and displeasing recollections begin to erode as well, eventually leaving each individual with only a solitary, recursive synaptic pathway comprising their single most negative memory. This instance is said to be relived in a perpetual loop, to the exclusion of all other high-level cognitive functioning.

"In their final months, it seems that dementia patients are left with just one exceedingly agonizing memory and nothing else," Braun said. "In their mind's eye, the very worst moment of their entire life is the last thing they'll ever see."

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Dementia Study Reveals Fond Memories First To Go

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BALTIMORE-Researchers at Johns Hopkins University published a new study this week on the cognitive effects of Alzheimer's disease and other deteriorative brain disorders, finding conclusive evidence that dementia sufferers' fondest memories are nearly always the first to go.

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English | العربية | 简体中文 | Español

Alzheimer's disease is a brain disorder that slowly destroys memory and thinking skills, and eventually, the ability to carry out the simplest tasks. In most people with Alzheimer's, symptoms first appear later in life. Estimates vary, but experts suggest that more than 6 million Americans, most of them age 65 or older, may have Alzheimer's.

Alzheimer's is currently ranked as the seventh leading cause of death in the United States and is the most common cause of dementia among older adults.

Dementia is the loss of cognitive functioning - thinking, remembering, and reasoning - and behavioral abilities to such an extent that it interferes with a person's daily life and activities. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person's functioning, to the most severe stage, when the person must depend completely on others for help with basic activities of daily living.

Share this infographic and help spread the word about understanding different types of dementia.

The causes of dementia can vary depending on the types of brain changes that may be taking place. Other forms of dementia include Lewy body dementia, frontotemporal disorders, and vascular dementia. It is common for people to have mixed dementia - a combination of two or more types of dementia. For example, some people have both Alzheimer's and vascular dementia.

Alzheimer's disease is named after Dr. Alois Alzheimer. In 1906, Dr. Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness. Her symptoms included memory loss, language problems, and unpredictable behavior. After she died, he examined her brain and found many abnormal clumps (now called amyloid plaques) and tangled bundles of fibers (now called neurofibrillary, or tau, tangles).

These plaques and tangles in the brain are still considered some of the main features of Alzheimer's. Another feature is the loss of connections between neurons in the brain. Neurons transmit messages between different parts of the brain, and from the brain to muscles and organs in the body.

Everybody - those with Alzheimer's or mild cognitive impairment as well as healthy volunteers with or without a family history of Alzheimer's - may be able to take part in clinical trials and studies. Participants in Alzheimer's clinical research can help scientists learn how the brain changes in healthy aging and in Alzheimer's.

Many volunteers are needed to participate in the hundreds of active clinical trials and studies that are testing ways to better understand, diagnose, treat, and prevent Alzheimer's. Researchers need participants of different ages, sexes, races, and ethnicities to ensure that results are meaningful for many people. To learn more about clinical trials, watch this video from the NIH National Library of Medicine.

NIA leads the federal government's research efforts on Alzheimer's. NIA-funded Alzheimer's Disease Research Centers throughout the United States conduct a wide range of research, including trials and studies of the causes, diagnosis, and management of the disease. NIA also sponsors the Alzheimer's Clinical Trials Consortium, which is designed to accelerate and expand research and therapies in Alzheimer's and related dementias.

To learn more about Alzheimer's clinical trials and studies:

Learn more about participating in clinical trials. Watch videos of participants in Alzheimer's clinical trials talking about their experiences.

How does Alzheimer's disease affect the brain?

Scientists continue to unravel the complex brain changes involved in Alzheimer's. Changes in the brain may begin a decade or more before symptoms appear. During this very early stage of Alzheimer's, toxic changes are taking place in the brain, including abnormal buildups of proteins that form amyloid plaques and tau tangles. Previously healthy neurons stop functioning, lose connections with other neurons, and die. Many other complex brain changes are thought to play a role in Alzheimer's as well.

The damage initially appears to take place in the hippocampus and the entorhinal cortex, which are parts of the brain that are essential in forming memories. As more neurons die, additional parts of the brain are affected and begin to shrink. By the final stage of Alzheimer's, damage is widespread and brain tissue has shrunk significantly.

Signs and symptoms of Alzheimer's disease

Memory problems are typically one of the first signs of cognitive impairment related to Alzheimer's. Some people with memory problems have a condition called mild cognitive impairment (MCI). With MCI, people have more memory problems than normal for their age, but their symptoms do not interfere with their everyday lives. Movement difficulties and problems with the sense of smell have also been linked to MCI. Older people with MCI are at greater risk for developing Alzheimer's, but not all of them do so. Some may even revert to normal cognition.

The first symptoms of Alzheimer's vary from person to person. For many, decline in nonmemory aspects of cognition, such as word finding, vision/spatial issues, and impaired reasoning or judgment may signal the very early stages of the disease. Researchers are studying biomarkers (biological signs of disease found in brain images, cerebrospinal fluid, and blood) to detect early changes in the brains of people with MCI and in cognitively normal people who may be at greater risk for Alzheimer's. More research is needed before these techniques can be used broadly and routinely to diagnose Alzheimer's in a health care provider's office.

Stages of Alzheimer's disease

Mild Alzheimer's disease

As Alzheimer's worsens, people experience greater memory loss and other cognitive difficulties. Problems can include wandering and getting lost, trouble handling money and paying bills, repeating questions, taking longer to complete normal daily tasks, and personality and behavior changes. People are often diagnosed in this stage.

Moderate Alzheimer's disease

In this stage, damage occurs in areas of the brain that control language, reasoning, conscious thought, and sensory processing, such as the ability to correctly detect sounds and smells. Memory loss and confusion grow worse, and people begin to have problems recognizing family and friends. They may be unable to learn new things, carry out multistep tasks such as getting dressed, or cope with new situations. In addition, people at this stage may have hallucinations, delusions, and paranoia and may behave impulsively.

Severe Alzheimer's disease

Ultimately, plaques and tangles spread throughout the brain, and brain tissue shrinks significantly. People with severe Alzheimer's cannot communicate and are completely dependent on others for their care. Near the end of life, the person may be in bed most or all of the time as the body shuts down.

What causes Alzheimer's disease?

In recent years, scientists have made tremendous progress in better understanding Alzheimer's and the momentum continues to grow. Still, scientists don't yet fully understand what causes Alzheimer's disease in most people. The causes probably include a combination of age-related changes in the brain, along with genetic, environmental, and lifestyle factors. The importance of any one of these factors in increasing or decreasing the risk of developing Alzheimer's may differ from person to person.

The basics of Alzheimer's disease

Scientists are conducting studies to learn more about plaques, tangles, and other biological features of Alzheimer's. Advances in brain imaging techniques enable researchers to see the development and spread of abnormal amyloid and tau proteins in the living brain, as well as changes in brain structure and function. Scientists are also exploring the very earliest steps in the disease process by studying changes in the brain and body fluids that can be detected years before Alzheimer's symptoms appear. Findings from these studies will help improve our understanding of the causes of Alzheimer's and make diagnosis easier.

One of the great mysteries of Alzheimer's is why it largely affects older adults. Research on normal brain aging is exploring this question. For example, scientists are learning how age-related changes in the brain may harm neurons and affect other types of brain cells to contribute to Alzheimer's damage. These age-related changes include atrophy (shrinking) of certain parts of the brain, inflammation, blood vessel damage, production of unstable molecules called free radicals, and mitochondrial dysfunction (a breakdown of energy production within a cell).

Alzheimer's disease genetics

In most cases, Alzheimer's does not have a single genetic cause. Instead, it is likely influenced by multiple genes in combination with lifestyle and environmental factors. Changes in genes, called genetic variations, may increase or decrease a person's risk of developing the disease.

Scientists currently know of more than 70 genetic regions associated with Alzheimer's. Of the genetic variants associated with Alzheimer's so far, only three are known to cause the disease. Although it happens rarely, when someone inherits an altered version of one of these genes - APP, PSEN1, or PSEN2 - they will likely develop Alzheimer's before age 65 and sometimes much earlier.

People with Down syndrome also have a higher risk of developing Alzheimer's earlier in life. Down syndrome results from having an extra chromosome 21, which carries the APP gene that produces the amyloid precursor protein. Too much of this protein leads to build-up of beta-amyloid plaques in the brain. Estimates suggest that 50% or more of people living with Down syndrome will develop Alzheimer's with symptoms appearing in their 50s and 60s.

Another genetic variation, in the APOE gene, which has several forms, is known to influence the risk of Alzheimer's. Specifically, APOE ε4 increases a person's risk of developing Alzheimer's and is also associated with developing Alzheimer's earlier in life for certain populations. APOE ε2 may provide some protection against Alzheimer's.

Changes in different genes, along with other biomedical, lifestyle, and environmental factors, play a role in potentially developing Alzheimer's. Still, it is never known for certain if any individual will or will not develop the disease.

For more about Alzheimer's genetics research, see NIA's Alzheimer's Disease Genetics Fact Sheet.

Health, environmental, and lifestyle factors

Research suggests that a host of factors beyond genetics may play a role in the development and course of Alzheimer's. There is a great deal of interest, for example, in the relationship between cognitive decline and vascular conditions, such as heart disease, stroke, and high blood pressure, as well as metabolic diseases, such as diabetes and obesity. Ongoing research will help us understand whether and how reducing risk factors for these conditions may also reduce the risk of Alzheimer's.

A nutritious diet, physical activity, social engagement, and mentally stimulating pursuits have all been associated with helping people stay healthy as they age. These factors might also help reduce the risk of cognitive decline and Alzheimer's. Researchers are testing some of these possibilities in clinical trials.

How is Alzheimer's disease diagnosed?

Doctors use several methods and tools to help determine whether a person who is having memory problems has Alzheimer's.

To diagnose Alzheimer's, doctors may:

Ask the person and a family member or friend questions about overall health, use of prescription and over-the-counter medicines, diet, past medical problems, ability to carry out daily activities, and changes in behavior and personality.

Conduct tests of memory, problem solving, attention, counting, and language.

Order blood, urine, and other standard medical tests to help identify other possible causes of the problem.

Administer tests to determine if depression or another mental health condition is causing or contributing to a person's symptoms.

Collect cerebrospinal fluid via a spinal tap or order blood tests to measure the levels of proteins associated with Alzheimer's and related dementias.

Perform brain scans, such as CT, MRI, or PET (positron emission tomography), to support an Alzheimer's diagnosis or to rule out other possible causes for symptoms.

These tests may be repeated to give doctors information about how the person's memory and other cognitive functions are changing over time.

People with memory and thinking concerns should talk to their doctor to find out whether their symptoms are due to Alzheimer's or to another cause, such as stroke, tumor, Parkinson's disease, sleep disturbances, side effects of medication, an infection, or another type of dementia. Some of these conditions may be treatable and, possibly, reversible.

If the diagnosis is Alzheimer's, beginning treatment as early as possible in the disease process may help preserve daily functioning for a while. An early diagnosis also helps families plan for the future. They can take care of financial and legal matters, address potential safety issues, learn about living arrangements, and develop support networks.

In addition, an early diagnosis provides people with more opportunities to participate in clinical trials or studies testing possible new treatments for Alzheimer's.

For more information, visit How Is Alzheimer's Disease Diagnosed?

How is Alzheimer's disease treated?

Alzheimer's is complex, and it is therefore unlikely that any one drug or other intervention will successfully treat it in all people living with the disease. In ongoing clinical trials, scientists are developing and testing several possible treatment interventions.

While there is currently no cure for Alzheimer's, medications are emerging to treat the progression of the disease by targeting its underlying causes. There are also medications that may temporarily improve or stabilize memory and thinking skills in some people and may help manage certain symptoms and behavioral problems.

Additionally, people with Alzheimer's also may experience sleeplessness, depression, anxiety, agitation, and other behavioral and psychological symptoms. Scientists continue to research why these symptoms occur and are exploring new medications and non-drug strategies to manage them. Research shows that treating these symptoms may make people with Alzheimer's feel more comfortable and also help their caregivers. Antidepressants, antipsychotics, and anti-anxiety drugs may be helpful for some people with Alzheimer's, but experts agree that these medicines should be used only after other strategies to promote physical and emotional comfort, such as avoiding stressful situations, have been tried. It's important to talk with a doctor about what treatment will be most effective in your situation.

For more information, visit How Is Alzheimer's Disease Treated?

Clinical trials on Alzheimer's disease treatments

Volunteers are needed for clinical trials that are testing ways to treat Alzheimer's. By joining one of these studies, you may help scientists discover new Alzheimer's treatments and contribute useful information to help people living with Alzheimer's disease.

Support for families and Alzheimer's disease caregivers

Caring for a person with Alzheimer's can have significant physical, emotional, and financial costs. The demands of day-to-day care, changes in family roles, and decisions about placement in a care facility can be difficult. NIA supports efforts to evaluate programs, strategies, approaches, and other research to improve the quality of care and life for those living with dementia and their caregivers.

Becoming well-informed about the disease is one important long-term strategy. Programs that teach families about the various stages of Alzheimer's and about ways to deal with difficult behaviors and other caregiving challenges can help.

Good coping skills, a strong support network, and respite care are other things that may help caregivers handle the stress of caring for a loved one with Alzheimer's. For example, staying physically active provides physical and emotional benefits.

Some caregivers have found that joining a support group is a critical lifeline. These support groups enable caregivers to find respite, express concerns, share experiences, get tips, and receive emotional comfort. Many organizations sponsor in-person and online support groups, including groups for people with early-stage Alzheimer's and their families.

For more information, see Alzheimer's Caregiving.

For more information about Alzheimer's disease

NIA Alzheimer's and related Dementias Education and Referral (ADEAR) Center
800-438-4380
adear@nia.nih.gov
www.nia.nih.gov/alzheimers
The NIA ADEAR Center offers information and free print publications about Alzheimer's and related dementias for families, caregivers, and health professionals. ADEAR Center staff answer telephone, email, and written requests and make referrals to local and national resources.

Alzheimers.gov
www.alzheimers.gov
Explore the Alzheimers.gov website for information and resources on Alzheimer's and related dementias from across the federal government.

This content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date.

English | العربية | 简体中文 | Español

Share this infographic and help spread the word about understanding different types of dementia.

Scientists continue to unravel the complex brain changes involved in Alzheimer's. Changes in the brain may begin a decade or more before symptoms appear. During this very early stage of Alzheimer's, toxic changes are taking place in the brain, including abnormal buildups of proteins that form amyloid plaques and tau tangles. Previously healthy neurons stop functioning, lose connections with other neurons, and die. Many other complex brain changes are thought to play a role in Alzheimer's as well.

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What is Alzheimer's disease, what causes it, what are the symptoms, and how is it treated? Get answers to these questions and more in this NIA fact sheet.

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Rob Pudim is a contributor to Writers on the Range, the opinion service of High Country News. A writer in Colorado, he says his friend died while in hospice care on June 16.

The West seems to have a different attitude about life and death than other parts of the country. Of the five states that allow medical aid in dying, known as MAID, four are west of the Mississippi - Oregon, Washington, California and Colorado. The fifth is Vermont and, although it is not a state, the District of Columbia.

Other states have come close. Montana courts have found that there is no public policy against assisted death, and New Mexico briefly allowed it in 2014 before overturning it in 2015. In Arizona, the Legislature will not let the bill out of committee even though most Arizonans are said to favor it.

Most Westerners, I think, believe that allowing people to obtain medical aid to die is a simply a matter of choice that should not be a decision made by the state, a state legislature, a medical association, a religion or any other person. Maybe it has to do with the independence of people or geographical distance from each other, or the knowledge that we sometimes have to depend on only ourselves. A lot of us believe that each person has the right to decide about our life or death, and whether life is worth living when a condition is incurable and the future filled with pain.

Granted, we all have the ability to commit suicide but generally that choice is not pleasant - jumping off Golden Gate Bridge, guns, death by police or an auto crash.

If you assist or encourage someone - and there was a recent controversial case of a young woman encouraging a boyfriend to commit suicide - you can be charged with being an accessory to murder. Medical help in dying, however, is neither suicide nor murder, and most cases of a loved one helping another to die are dismissed.

In 1996, the 9th Circuit Court of Appeals ruled: "Those who believe strongly that death must come without physician assistance should be allowed to follow that creed, whether they be doctors or patients. But they should not be free to force their views, their religious convictions or their philosophies on all other members of a democratic society, nor should they be free to compel those whose values differ from theirs to die a painful, protracted and agonizing death."

Briefly stated, it's your life. It's your death. It ought to be a personal and private choice.

A dear friend I have known for more than 50 years has an incurable, progressive disease that will kill him. He is educated, alert and rational, and right now feels no pain or anxiety because a hospice manages his discomfort. Yet he does not like being tethered to an oxygen line while he slowly suffocates. He wants his life to be over but is too incapacitated to do anything about it. At one point he asked me if I could get him a gun.

According to the Colorado referendum, two physicians have to agree that a person's medical condition is incurable and the drug cocktail has to be self-administered. It sounds simple.

Nothing is simple.

What if your doctor has religious beliefs that preclude assisted dying, or has a literal interpretation of the Hippocratic Oath, which states that before anything else, do no harm? What if your doctor's beliefs require you to live out whatever life has dealt you? What if the pharmacist thinks the same way and refuses to issue the prescription?

What if the hospital does not have the correct protocols in place or the legal boilerplate necessary to allow a patient to die by choice? What if the hospital is run by a church? What if you are physically unable to take the drugs you need to end your life?

According to Compassion & Choices, a national organization that pushed medical aid in dying in Colorado, 10 prescriptions have been filled so far, but it is not known how many have ever been used. Advocates say about 1 in 3 patients who receive the drugs fails to take them. They may have just wanted the option available.

My old and dear friend has been facing this. He could move to another state and establish residency, which could take at least six months, or is it a year? He does not have the time or ability to do this, though paradoxically he has a lot of time - to lie in bed and think about his future.

In Colorado, lawmakers put $44,000 into the budget in May to help doctors with patients who might ask about receiving aid in dying. Republican State Sen. Kevin Lundberg says tax payers should not support the practice: "This is not the job of a doctor, it's certainly not the job of the government."

Well, whose job is it when you're stuck in a bed with tubes and wires attached to you? And what if this happened to you?

Note: the opinions expressed in this column are those of the writer and do not necessarily reflect those of High Country News, its board or staff. If you'd like to share an opinion piece of your own, please write Betsy Marston at betsym@hcn.org.

Read more

More from Writers on the Range

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Death and dying are different in the West

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Rob Pudim is a contributor to Writers on the Range, the opinion service of High Country News. A writer in Colorado, he says his friend died while in hospice care on June 16. The West seems to have a different attitude about life and death than other parts of the country.

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Timeline: Key Dates in the End-of-Life Debate

Issues surrounding the end of life have been debated since long before New York became the first state to explicitly outlaw assisted suicide in 1828. This timeline looks at major events on the topic in the U.S. since the 1960s.

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Issues surrounding the end of life have been debated since long before New York became the first state to explicitly outlaw assisted suicide in 1828. This timeline looks at major events on the topic in the U.S. since the 1960s.

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There is some truth to the old saying, "There are only two things you can count on in life: death and taxes." Everyone experiences death. Death and dying are an inevitable part of human life.