Baldness is a loss of hair either in one spot or over the entire scalp. Some infants are born bald or nearly so and develop a full head of hair during their first two years. Rarely do babies born bald remain bald for life. Other babies are born with a full head of hair. They may remain that way, or their original hair may be replaced by a second and permanent growth. Rarely is hair lost during infancy and never replaced.

Infants commonly rub off a band of hair in the back against the crib or playpen mat. Hair that is rubbed off in this way will grow back. Drawing the hair tightly into pigtails, braids, or ponytails also may result in temporary bald spots. Children with the habit of twisting and playing with strands of hair may also lose hair. Emotionally disturbed children may pull out their hair by the handfuls (trichotillomania); this condition requires treatment of the child’s emotional problems.

Alopecia areata is a condition which results in the sudden appearance of round or oval areas that are totally bare. The bald scalp may be completely normal in appearance or slightly pink. Although temporary, the condition may last for months or years. Rarely is the entire head involved. The cause is unknown.

Ringworm of the scalp produces scattered bald spots. The scalp is scaly, and the bald spots are studded with broken-off stubbles of hair.

Hereditary baldness occurs primarily in males. It causes baldness at the temples or the top of the scalp. Occasionally this type of baldness starts during adolescence.

Teenagers often complain that they are “going bald” when they see loose hair after combing. Usually this condition is merely a normal thinning of the hair that does not worsen.

Malfunction of the parathyroid glands (hyperparathyroidism) may result in scattered baldness. The disease is accompanied by other signs of illness.

Impetigo and other infections of the scalp produce temporary bald spots.

Signs and symptoms

Inspect the scalp closely for signs of ringworm or infection. Look for broken or re-growing hairs. Watch to see if the child is rubbing the head against the playpen or crib, or if the child has a habit of twisting or pulling the hair.

Home care

Alopecia areata is treated with patience and time. Hereditary and congenital baldness (baldness present at birth) are treated with understanding and love; a hairpiece may be helpful.

Precautions

• Do not treat baldness with over-the-counter (OTC) preparations that promise growth of hair.

• Do not consult cosmetologists. See a qualified dermatologist.

Medical treatment

Alopecia areata is sometimes successfully treated with steroids either applied to the skin or locally injected. Hyperparathyroidism must be diagnosed by blood tests; it is treated with prescribed doses of vitamin D and a special diet.

*19/84/5*

Sporting life

Take up a sport, suggests Dr. Goldberg. Almost any sport will do, he says. Recruit some friends to play with on a regular basis. And chances are good that you’ll still be living the sporting life all the way into your seventies, if not beyond.

A team of Swedish researchers studied the effects of regular activity throughout life on the physical ability of 233 men at age 76. The volunteers were asked to describe their involvement in competitive sports, recreational sports, occupational physical work, and household work as well as their means of transportation during five periods of their lives, beginning at age 10. The men who had the highest levels of activity after age 35 were the most mobile at 76. And the best activity for ensuring that you’ll still be brisk at three-quarters of a century is playing recreational sports.

Regular physical activity has been linked to lower rates of high blood pressure, diabetes, osteoporosis, colon cancer, anxiety, and depression. Men who get their duffs in motion for close to a half-hour most days of the week actually have about half the risk for heart disease that sedentary men can expect.

It’s never too late to start. A study of almost 10,000 men found that those who became fit during a five-year period had about half the risk of dying from any cause compared to those who stayed out of shape. “Even making small changes like walking briskly to the bus stop, mowing the lawn without a riding mower, and climbing the stairs at work can make a difference,” says Dr. Goldberg. On the other hand, by choosing absolute inactivity, you can shave almost six years off your life span, according to findings from a study of 27,000 people by researchers in California.

Finally, studies show what we’ve known since the days of the recess bell: Taking time to go out and play can sure take the edge off a stressful day.

Curiouser and Curiouser

Researchers from Menlo Park, California, who conducted a five-year study of 1,118 men between ages 60 and 86, found that those who were still alive at the end of the study had significantly higher levels of curiosity than those who had died during the same time.

Curiosity is not only a driving force that keeps your gray matter stoked, but maintained over time, it can also help you find suitable ways to cope through the myriad challenges that life throws your way as you age, says Gary E. Swan, Ph.D., director of the Center for Health Sciences at SRI International (formerly Stanford Research Institute) in Menlo Park. “Older adults should attend as many continuing education classes as possible because they provide the environmental support for you to solve problems creatively, to try new things, and to listen to new ideas,” Dr. Swan advises.

*13/36/5*

Historically, people have been shockingly bad at determining when their fellow human beings were dead. Things got so bad that in 1896 a group fearful of waking up in their final resting place founded the Association for the Prevention of Premature Burial. Earlier in Russia, savvy sales folk were hawking coffins with a system of flags and bells to summon help should you find yourself buried alive.

The truth is that, until relatively recently, the onset of putrefaction was the only truly reliable sign of death. “Otherwise, you’ve been considered dead when the medical folks say you’re dead,” explains Cyril H. Wecht, M.D., forensic pathologist and coroner in Allegheny County, Pennsylvania. “While that hasn’t changed, thankfully, we’ve developed better ways of determining death these days.”

A couple of centuries ago, long before the magic of medical technology, just having fainting spells could send you to your grave, recounts Kenneth V. Iserson, M.D., professor of surgery at the University of Arizona College of Medicine and director of the Arizona bioethics program, both in Tucson, and author of Death to Dust. “Many diseases like syncope (a condition that causes people to faint or suddenly lose consciousness) and typhoid could easily be mistaken for death in those times.”

As recently as 1926, medical texts were advising doctors to look for “signs of life,” using uncertain techniques such as placing an ice-cold mirror close to the person’s mouth to check for breathing, and cutting an artery to see if the person would still bleed.

They eventually discovered more advanced ways to determine death, based largely on the idea that when your heart stopped, you were dead, Dr. Wecht says. “But then CPR (cardiopulmonary resuscitation) began reviving people whose hearts had stopped. And in 1968, a South African doctor further complicated things by performing the first heart transplant,” he says. That’s when the folks at Harvard Medical School declared and promoted the idea of “brain death criteria.” When your brain has stopped working, that’s absolutely the end, explains Dr. Wecht.

Today, doctors have several surefire methods for determining when the brain dies, ranging from the simple (testing the person’s ability to breathe on his own and blinking in response to touching the cornea) to the high-tech (hooking the person to an electroencephalograph machine to monitor brain activity, electrocardiograph to measure the heart’s electrical activity, and nuclear medicine brain scans). “No one has ever failed all these tests and still regained consciousness,” Dr. Iserson says.

*24/36/5*

There is no doubt in any doctor’s mind that stress plays a crucial role in many of today’s illnesses, both physical and mental, though just how big a role stress plays in any particular disease is difficult to assess. Undoubtedly the link between ‘type A’ behaviour (competitive and aggressive) and heart attacks is real enough and the links between stress and high blood pressure, certain bowel disease, asthma, eczema, migraine and many other conditions are all too obvious to many people.

Each of these eight headings points to what the preventive medical world calls ‘risk factors’. If you want to reduce your chances of getting a particular disease, or indeed of being unwell at all, you have to be aware of what you personally are at risk from. Only by knowing what your risk factors are can you understand the causes and set about possible risk-reducing activities.

Risk appraisal generally depends on the study of probability tables. The Robbins-Hall method of risk-factor analysis (probably the best devised so far) looks at the top twelve to fifteen causes of death, because between them they account for about two-thirds of all deaths. By comparing treated and untreated groups of people in any specific disease category a doctor can find out which intervention produces results, and can work out a ‘health appraisal’ age to compare with the patient’s actual chronological age. Let’s look at an example.

Take a 41-year-old man with a blood pressure of 180/94 mmHg and a cholesterol level of 220 mm/dl who is overweight by 15 per cent and is a non-diabetic. He also smokes twenty cigarettes a day, has eighteen drinks a week, drives 15,000 miles a year, wearing a seat-belt 75 per cent of the time, and exercises moderately each week. He has no family history of heart disease and his parents are both over 60 years old. Using the Robbins-Hall method this man’s total personal risk is 9,680. This means his chances of dying during the next 10 years are 9,680 in 100,000.

If he stops smoking, has his mild blood pressure treated and cuts his drinks to six per week, he can reduce his risk from 9,680 to 4,992. This large reduction is possible because by changing his behaviour in this way he can reduce his risk of heart attack considerably. It would also reduce his risk of cirrhosis, lung cancer, stroke and car accidents.

This man’s total personal risk before he starts his personal preventive programme translates to a risk age of 46.5 years compared with his actual age of 41 years. By using personal preventive measures he can reduce his personal risk age to 40. The Robbins-Hall printout would show that this man’s level of high blood pressure elevates his risk of heart attack by 150 per cent, and that his smoking plus his raised blood Pressure increase his stroke risk. His drinking increases his chances of both liver cirrhosis and of having a car accident.

*19/72/5*

Many people have enjoyed gardening during their life and will retain certain basic skills, physical problems permitting. A small area of garden in which simple flowers or vegetables can be grown may provide a lot of stimulation. As well as the need to plant and sow and then to tend the growing plants, it can be an interesting focus of attention on other occasions. A short stroll into the garden, especially if it is sunny, can be very soothing. It can also be used as a diversional activity to be returned to at times of stress or agitation.

If an outdoor plot is, or becomes, impractical for any reason, consider creating an indoor garden with plants in pots or trays on the windowsill, in a conservatory, or elsewhere. It is best to use unbreakable or inexpensive materials and to grow simple plants. These could be purely decorative, grown only for interest, or productive such as mustard and cress, beansprouts, and even indoor tomatoes if the space allows.

*102\138\2*

Many carers feel extremely isolated when the immensity of the task ahead dawns on them. Some have struggled on for years before realizing that many people are in a similar position to themselves. The isolation is not just psychological, but also physical. Some sufferers with dementia require almost constant attendance, twenty-four hours a day. This gives little opportunity for a carer, particularly an elderly spouse who may have physical problems of his or her own, to get out and meet other people, other than the occasional short trip to the shops. Social activities often take second place to what appear to be more essential daily tasks. The situation is often compounded by embarrassment at the behavioural abnormalities that so frequently occur. If the doctor or other professionals are found to be caring, supportive, and understanding of the carer’s predicament, they may themselves help to break the feeling of isolation and at the same time point a carer in the direction of additional forms of help.

Many people find themselves in a situation where it is the very person to whom they would have turned for help that has developed the dementia. This can be a particularly cruel predicament and it is essential that a carer in this situation makes contact with others, either through a support group, or day hospital, or day centre, or via family and friends. In particular, discover what type of day care and sitting-in services are available in your area, which will enable you to break free and meet other people.

*80\138\2*

These invaluable members of the health care team are often part of the supporting system for families caring for people with dementia and for the many demented elderly people who are living alone at home despite their illness. They are trained psychiatric nurses and many have also trained in general nursing and can therefore appreciate and understand the physical as well as the psychiatric problems. In some areas they are based in a hospital, attached to a psychiatrist’s team; in others they are attached to health centres. Sometimes they operate from both. The CPN liaises across all the different services – social services, geriatric service, psychiatric service — and may have to work closely with the general practitioner. Many of them have close links with the voluntary bodies in the locality. They do not carry out physical nursing tasks; these are the province of the district nurse. A CPN will usually become involved after the general practitioner has referred a patient for assessment to a psychiatric clinic or asked a psychogeriatrician to make a visit to the person’s home. In some areas, a general practitioner can himself initiate the CPN’s involvement.

The CPN has a wealth of experience and knowledge, will be able to give practical advice about coping with routine problems, may be able to arrange attendance at a day hospital or day centre as appropriate, and can alert others if the need arises.

*58\138\2*

Although diagnosis is often most easily made with the help of a brain scan, the outwardly discernible character of the disease provides many clues to its presence.

As discussed, the disease will often have an abrupt onset and there will be gradational deterioration with a fluctuating course; although a person with multiple infarct dementia will suffer from an intellectual decline that is in many ways similar to that associated with Alzheimer’s disease, to begin with the disease will pick out different areas of intellect, resulting in a rather patchy intellectual loss compared with the steady and relentlessly progressive deterioration that is seen in most of the other conditions that cause dementia. Personality is often preserved until quite late in the disease, as is insight, and this can result in severe depression. People with MID are often very unstable emotionally.

There is often evidence of an underlying medical condition that puts the patient at particular risk of having strokes, such as high blood pressure or heart disease. If some of the small strokes have affected the part of the brain controlling the face or the limbs, there will be signs of this when the subject is examined by a doctor. The following account describes a fairly typical case history.

Mrs Brown

Mrs Brown was sixty-eight when her husband took her along to their general practitioner because he was worried about his wife’s forgetfulness. It was clear that she had been becoming more and more forgetful and that this had started suddenly, after she had experienced a ‘dizzy turn’ on Christmas Eve. Although she had never lost consciousness, she had had several more funny turns after most of which she was a little confused for a day or two. The doctor knew that Mrs Brown suffered from diabetes and needed to take tablets, so he checked the level of sugar in her blood. This was normal and she didn’t have any of the other symptoms of high blood sugar. He therefore examined her carefully and discovered that she had a high blood pressure. He treated this with the appropriate medicines.

When he saw her again a month later, Mrs Brown was still very forgetful, had some difficulty with her speech, and needed a little help with dressing. This was only a little better than her condition when he had seen her a month previously.

A further year passed during which Mrs Brown was seen on several occasions by her doctor, who ensured that her blood sugar level and her high blood pressure were properly treated. During this year she only had one further dizzy spell, after which she had again become a little more confused. Although there was some recovery over the ensuing two or three days, she was a little more muddled than before.

In summary, Mrs Brown had some of the characteristic features of multiple infarct dementia and careful attention to the underlying risks — the blood sugar level and the high blood pressure – had probably slowed down the rate of intellectual deterioration.

*36\138\2*

Dementia provides two important diagnostic challenges. The first of these is the need to establish whether what appears to be an exaggeration of the normal mental changes of ageing is really dementia. The second involves determining the nature of the underlying illness if the diagnosis of dementia is confirmed.

This chapter will provide an outline of the procedures involved and will also give some information about many of the more important conditions, both treatable and untreatable. As Alzheimer’s disease and multiple infarct dementia are the two most common causes, and much is known about them that will be of interest to those caring for sufferers, each has a chapter of its own and is not discussed in detail here.

It is probably unnecessary for most readers to refer to the sections dealing with each of the different underlying illnesses – it may be less confusing to refer only to that condition which is affecting the person for whom they are caring. Professional carers – those working in old people’s homes, nursing homes, or with patients in their own homes – may find it helpful to read this section in its entirety, or to refer to it from time to time as necessary.

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