Quick Search For Posts On The Following Topics:

Thursday, February 28, 2013

SAGE and SLUMS. Take These Dementia Screening Tests Free Today!

OH! They were actually kinda fun.
I highly recommend these 2 tests - the SAGE and the SLUMS. I have taken them both, and they actually were able to identify some cognitive impairment in me. Having bvFTD, I am able to perform in the normal range on most of the tests used to diagnose Alzheimer's. Most people with bvFTD have no difficulty drawing a clock! If you have Alzheimer's drawing a clock is an issue. Many of the people diagnosed with bvFTD who have contacted me through my blog have also performed at or near normal on many of the tests given in a typical neuropsychological exam. Some are profoundly impaired, as I am, but still perform well on the standard tests.

Both the SAGE and SLUMS tests and instructions are available for download free from the following websites. The links to access them are provided below.

SAGE test (Self-Administered Gerocognitive Exam (SAGE))

SLUMS test (Saint Louis University Mental Status Examination (SLUMS))


SAGE is a brief self-administered cognitive screening instrument to identify Mild Cognitive Impairment (MCI) and early dementia. Average time to complete the test is 10 to 15 minutes. The total possible points are 22.
Administration:

The SAGE test is self-administered. There are four forms of the SAGE test. Only one test form should be given. It does not matter which form is taken, as they are all interchangeable. SAGE should be filled out in ink without the assistance of others. Inform the examinee that there are four pages to complete. Calendars and clocks should not be available during the testing. Do not answer specific questions. Just say, "Do the best that you can."

If you decide to self administer, or administer this test for someone you know, you should understand this is an assessment tool and that you are not receiving an official diagnosis of mild cognitive impairment, Alzheimer's, or any one of the eight types of dementia.

If you find the test results suspicious, you should contact your doctor immediately, and ask for a neurological or geriatric consult. These specialists can determine, through a series of tests, whether or not you are suffering from or headed for Alzheimer's disease, or that you have nothing to worry about at this time.

Spoiler alert! Go take the test now before reading any further.

SAGE test (Self-Administered Gerocognitive Exam (SAGE))

SLUMS test (Saint Louis University Mental Status Examination (SLUMS))



I suggest you take the tests before continuing. I am going to write about some of my specific results which may give away some of the answers.

I self-administered the SAGE test. Most of it seemed very easy, and only took a few minutes. My test was scored by a friend, and that is the best way to do it. I would have scored myself higher because I knew what I meant to do. She saw what I actually did. This is an important distinction on a couple of the answers.

One of the questions on the form of the test I took (Form 1) was to copy a figure of a cube. I thought I did just fine, but she correctly docked me a couple points because my lines were not parallel. I thought she was just being picky, but the instructions clearly state she was correct in her scoring.

The test failed to identify the difficulty I had in figuring out the simple arithmetic problems presented. I had to resort to writing the problems in the margin, doing the necessary subtraction with great difficulty, and then again with great difficulty checking my answer before answering the test question. Only a few years ago these problems would have been simple to do entirely in my head without writing anything down. So, though I arrived at the correct answer, and so got the full number of points in the scoring, the test did identify a deficit. The issue was with the methodology, and not the actual test. I do not give myself full credit for getting the correct answer because of the antics I had to use to arrive at it.

Another question has you connect numbers alternating with letters in their proper order. I can do this just fine. I scored the full points. Part of my original neuropsychological exam included a much longer version of this test, but on that exam the task was timed. Though I was able to complete the task without any errors it took me more than 3 times longer than someone without any deficits. I was told this is a more typical result for someone with bvFTD.

After scoring myself hard on the arithmetic problem I am in the range indicating a mild cognitive impairment. Some days are better than others, and I was lucky that day.

I also took the SLUMS test. A version of this test was featured on The Dr. Oz show. Again I ended up in the range of score indicating mild cognitive impairment. That was mostly because I totally missed every part of the last question. It is a short paragraph to read, and then there are a few questions afterwards. I just didn't retain much of what I read. Again this is a huge change from what I was like only a few years ago. My short-term memory is drastically impaired!

UPDATE - I took the SLUMS test again today (3-27-2015). I guess it has been about 2 years since I took it last.  It was administered by a neurologist at The University Of Toledo Hospital's neurology center. My score was almost identical.  I was unable to do the math, and again messed up the last question. I did not lose points on the clock because I remembered from last time to be very precise in drawing the hands.

I suggest you take these tests, and record your results. Then take them again in a year or even 2 years. The SAGE test is especially good for this because there are 4 different forms of the test. That way you can take it 4 times without repeating the exact same form of the test and influencing your results.

This is a great way to measure your progression. A way to keep track of where you are, and how you are doing. It may even be a better way to measure how effective a drug treatment is. I wonder if I would score as well if I were not taking Namenda, Aricept, and Ritilin... probably not!

I want to repeat the cautions one more time because people with bvFTD are often stubborn, and ignore such things. I know this from personal experience. If you decide to self administer, or administer this test for someone you know, you should understand this is an assessment tool and that you are not receiving an official diagnosis of mild cognitive impairment, Alzheimer's, or any one of the eight types of dementia.

If you find the test results suspicious, you should contact your doctor immediately, and ask for a neurological or geriatric consult. These specialists can determine, through a series of tests, whether or not you are suffering from or headed for Alzheimer's disease, or that you have nothing to worry about at this time.

Comments are welcome.

Monday, February 18, 2013

Losing or Misplacing Items Around the House

Misplacing it is the easy part!
Lately I have been thinking about memory, and losing or misplacing items around the house. A couple incidents happened to me recently which brought it to my attention. Nothing really serious, but far enough out-of-the-ordinary for me to notice.

I am not talking about losing my car keys. I try to keep them in the same place, so I rarely ever have to go hunting for them. No. The other evening I could not find the remote control for the TV. Panic! I searched all over the house, upstairs and down. I tried to retrace my steps, looking in all the places I had been. It took me about a half hour to finally locate my remote control. It was sitting in a cast-iron frying pan on the stove. Actually it was right next to the kitchen stove, not on the burner, but close enough.

I had no memory whatsoever of picking it up, carrying it into the kitchen, or setting it in the frying pan. It was kinda funny when I finally found it there, and it was kinda upsetting at the same time. It felt completely different than it does when I misplace my coffee cup.

Within a few days of misplacing the remote control, I misplaced a credit card payment. I know it isn't exactly the same as misplacing an item around the house, but it felt like it was the same. I received a notice that my credit card payment was past due, and I was certain that I had payed both of them on-time as usual. I checked my bank statement, and sure enough both payments were there. I called the credit card company, and after talking to a real person for a while it became apparent what happened. I paid the small payment to the large amount, and the larger payment to the smaller amount. Criss-cross!

Other than losing a bill occasionally, or more likely having my stoner-mailman deliver it to the wrong address, I have never done anything like this before. I have a pretty good system for paying my bills. I keep them all in the same place, and pay online once a month. My budget is so tight that it is easy to keep track of the payments. I keep forgetting to pay the water bill, but I have to do that in person, so it falls outside of my routine. Routine is everything.

I try to put everything back in its place after I have finished with it. It is a work-around. I never really remember where I put things, but I know where to start looking when I put things away. When something is in the wrong place I know it is a symptom.

About a week or so later something else happened. It doesn't really fit into losing or misplacing things, but rather getting lost. I was driving, having just left a thrift store located in a nearby small town. I had been there many times, and was very familiar with the streets. My friend and I were talking, and all of a sudden I looked around, and had no idea where we were. Nothing looked familiar.  I had been distracted by our conversation, and missed my turn. The thing is that it did not feel like a symptom. It was funny, and we both laughed about it as we figured out the easiest way to get back on-track. Maybe the fact that I am more easily distracted is a symptom, but missing my turn at the stop sign felt pretty normal. My friend said at the time that when I think something is a symptom my voice changes. I have some awareness, or a feeling, when something is a symptom, and when it is just a normal screw-up. I have no way to tell if the feeling is valid, but it exists.

I did a little looking online for some information on misplacing things, and dementia. It is a more common symptom with Alzheimer's than with bvFTD, or so it seems. Of course there is overlap, and every case is different. At least I did not try to blame someone else for putting the remote in the frying pan, and I do not do it frequently. To my credit I did not fry it up, and serve it on toast or anything.

The following is from the DementiaGuide website. They list the following symptoms as being indicative of possible dementia, and I must admit that my behavior falls under some of these descriptions.

 Misplacing or Losing Objects:

    Frequently misplaces common items (e.g. glasses, brush, TV remote, keys)
    Frequently misplaces important items or documents (e.g. money, bills, identification)
    Wanders off with items and leaves them in uncommon places
    Can remember using something but can't remember where they put it
    Puts an item away for safekeeping, then can't relocate the item
    Notices something is not in its place and wonders where it went (e.g. a vase, a clock)
    Can't remember where things go (e.g. their proper place)
    Puts things away in the wrong place
    Puts things away in an odd place (e.g. eyeglasses in the freezer)
    Always looking for something
    Takes longer to locate missing items
    Needs help from others to find missing items
    Forgets what is lost while they are looking for the item
    Hides or hoards items


Misplacing or Losing Objects -a General Description

The neurological pathways that allow healthy people to remember what is lost while we look for something are complex. We must be able to hold an image of what we are trying to locate and why. We must also remember far enough into the past to have the idea of the last time we used it or where we put it. People with memory problems find this difficult. That is because some neurological pathways are damaged, causing trouble remembering the past, or having some sense of the sequence by which past events occurred. The person you care for may be able to remember using an item, but can no longer find that item. They may have forgotten where they put it, put it in an odd place by accident or have hidden it so that no one else can find it. As a result, they may require assistance locating the item. They also may need to be reminded of where the proper place for the item is located. When unable to find an item, they may believe that someone has purposely stolen or hidden it, which may lead to feelings of anger or frustration. Sometimes the person you care for may continuously and compulsively search for an item which they believe to be missing, which may not even exist.

Misplacing objects is of course also very common as people age, and some have well established, life-long histories of losing things. Often, with such people, what is different is that they have no idea where an object might be and no idea of how to efficiently go about finding it. Misplacing objects can also be a problem if it is coupled with suspiciousness, which is also common in Alzheimer's disease. Suspiciousness and misplacing can come together in a few ways to be a difficult problem. One is when the person with dementia has suspects that people might be stealing from them, and therefore hides valuable items, but can no longer remember where the item is hidden. Even worse, they may come to suspect that the item has been stolen, in that sense justifying their fears. Lacking a reasoned search strategy, they might believe that they have searched exhaustively when instead they have simply repeated a failed strategy many times. Even so they will feel suspicion and might even experience the frustration of losing and searching.

Another type of "misplacing" problem is commonly seen in the late mild to early moderate stage of dementia, especially Alzheimer's disease. This is when the person with dementia misplaces common household objects, commonly putting them in odd places. Often this happens with kitchen items, especially the dishes.

Comments are welcome.



Sunday, February 10, 2013

Okay! Okay! I Am Still Doing Okay In 2013 ...mostly.

It has been 3 years now since my Diagnosis of bvFTD. I am still no expert, but I have learned a few things about Frontotemporal Degeneration. I have been unable to work since mid-February of 2010. I was almost immediately diagnosed with some kind of early-onset dementia, and specifically with bvFTD a few weeks, and many tests later.

Some days are better than others!
Once diagnosed with FTD the prognosis is not good. As stated in an earlier post about survival prognosis research and FTD:
"...After the exclusion of 24 “phenocopy” cases, the analysis was repeated in a subgroup of 67 patients. In this latter group, median survival was 7.9 years from symptom onset and 4.0 years from diagnosis. The only factor associated with shorter survival was the presence of language impairment."

According to this study the average is 4 years  survival time from diagnosis if not a phenocopy case. My diagnosis was 3 years ago. So, what does this mean?

Nothing at all!

At the time of my diagnosis the best guesstimate the doctors had for me was about 12 years or so, but they made it clear that it was just a guess on their part. So what does this mean?

Nothing at all!

The real questions are: How am I doing today? What has changed? Is there anything I can do to slow, stop, or even reverse the progression? Probably not.

First, I would like to say a few words about finances. The change from working full time, and going on Social Security Disability and Disability Insurance payments is profound. Overall I make about 60% of what I did when I was working. Of course that does not count bonuses or profit sharing so it is really less than 50%. I burned through my entire 401K paying off expenses from the first year. I was still very lucky. I took Family Leave from work while I was being diagnosed, and my diagnosis went much quicker than many people I have heard from. I was never misdiagnosed as having some form of depression, and pushed back hard when it was suggested early on in my testing. In short, I was still technically working when I was diagnosed as totally disabled with bvFTD, and still had disability insurance through my company. They actually kept me on a "medical-sick-leave" status for about a year after I stopped working. This allowed me to keep my medical insurance at about 20% of the cost it would have been for the first year when most of the medical tests and costs happened. Since I paid the premiums on my disability insurance myself, the monthly payments from it are tax-free. This was not due to any planning on my part, just dumb luck and company policy. In truth, about a month before I was diagnosed I changed my disability insurance from 80% coverage to 60% coverage to save a few bucks. A great case of "Penny wise! Pound foolish!"

Finances are very tight, but I get by. I am very frugal. Sometimes I don't have enough money to put gas in the car, so I don't drive much near the end of those months. I have just enough for my house payment, plenty of food, and all of my bills. Well, most of my bills, anyway. Some months there is nothing left over, and Kroozer doesn't get any Cheeze-Puffs. As long as nothing major happens, like the kitchen stove blowing up, I am getting along.

I will try to self-asses my symptoms. Keep in mind that a common symptom of FTD is a total unawareness that anything is wrong. I do not think this is one of my symptoms, but how would I know if I was unaware of it? Catch-22!

Overall, I think each and every one of my symptoms is just a little worse than they were 3 years ago. bvFTD is a progressive disease, so that is to be expected. That said, overall I am still doing very well - all things considered. The progression of my disease so far seems to be slow.

There are a few symptoms where I have noticed more of a change. My lack of ability to do even simple arithmetic is worse, or at least it seems worse to me. When I try to think of a simple arithmetic problem there is now an initial blank spot. It is like I no longer know what math is. The very concept is missing. I have to really concentrate to bring it back. I can still add a couple numbers in my head, but it is extremely difficult to hold them in my short-term memory. It is noticeably more difficult than it was even a year ago. I can still understand even the most advanced theories and statistics, but could never do the actual calculations anymore. At least I still remember how to do it, and how to use a calculator. I get by!

I am more anti-social than I was a year ago. I have always been very happy with my own company, and I really do not think I have ever been lonely. Now I take it to extremes. I rarely see anyone. When people do come for a visit it is very stressful, and I feel relieved when they leave - no matter how much I wanted to see them, or how much fun the visit was at the time. I also hardly ever answer my phone, but I never really did except when work required it. It is a common symptom with FTD to alienate friends and family. In my case I just lose touch. I am perfectly happy being a hermit. That isn't to say I am all alone. I have a friend who visits often, and we talk on the phone daily. She is the best!

Related to being a hermit is my sense of time. Time flies by, at least in retrospect. A week, a month, or even several is the same as a day to me. I have a lot more of what I wrote about in an earlier post and called "Missing Time". Well, if friends call and leave a message, and don't hear back from me for a couple months or more, they just disappear. I can't explain, and they don't understand.

Another change I have noticed is a greater tendency to procrastinate. This is also related to my sense of time, but there is more going on. It is more difficult to motivate myself to do anything. I can waste a whole day, and not be able to tell you what I did to pass the time away. It is just gone. Poof! What happened to Monday, Tuesday, and Wednesday of this week? I have no idea. Missing time. I didn't really do anything, or go anyplace, or see anyone. (And I was a happy hermit) Thinking about something is just as good as actually doing it.

I have more trouble coming up with the right word. It isn't debilitating yet, but I have noticed a change in the past few months. This symptom worries me more than the rest as it is directly linked to mortality. I also do not write posts as often. It is more difficult to get motivated. When reading my first posts from 3 years ago I see that my recent posts are more linear in thought, and much more simple in construction. I think I see a change in style.

I have become a lot more careful than I have ever been before. I think things over, and when I get an idea to do something, I wait a day or so and think it over. This is a work-around. I have developed this behaviour as a safety-check against making bad or stupid decisions on the spur of the moment due to my judgement being impaired by bvFTD. That, and I procrastinate.

At the end of the day, 3 years into my diagnosis I am doing very well. I can still drive, and can still live independently and maintain a household. Sure! I need some assistance from time-to-time, but that is to be expected. So far - so good!

I credit the medications and supplements I take with at least slowing the progression of my disease. Every case of FTD is different, and some people cannot tolerate some of the medications I take. Officially there are no medications approved for FTD, so anything I take is considered off-label. Nothing has been shown to slow the progress, or be beneficial in any way for someone with bvFTD. That doesn't mean it doesn't work, just that the necessary research has not be completed, or is inconclusive, or the drug company has not yet bribed the FDA into approving it for this purpose. Yes. I am a little cynical whenever our government gets involved. A couple of the medications I take have been shown to make the symptoms of FTD worse in some cases, especially in cases where behaviour is a major issue. I am currently taking the following:
Metformin, I gained weight. Weight-gain is a side-effect of both Namenda, and Aricept, and a symptom of bvFTD. Because I have gained weight, by blood sugar went up, so I am again taking Metformin. I don't like taking it, and am actively trying to lose weight, but it is very difficult.

Namenda 20mg/day. Expensive stuff, but when I don't take it I see a difference in my executive function. I think better when I take it.

Aricept 20mg/day. Nasty side-effects with this one. It has the same effects as Namenda, but works on a different pathway. It helps me think better.

Methylphenidate (generic Ritilin) 20 mg/day. Another expensive one. This was originally prescribed for my ADHD-like symptoms, but it does much more for me. My neurologist thought it might assist me with managing my deficits in short-term memory by helping with attention. Yes. It does help with my memory, but it seems to do more than just that. It helps me to "Do things". When I do not take it I just sit around and don't do anything at all. Master procrastinator! When I am taking it I seem to get a lot more done. I still procrastinate, but not terminally so. It is expensive because I must see a doctor, and get a written prescription for it each month. I tried going without it, but everyone around me noticed the change including me.

A few vitamin supplements. I don't take them every day, but a few times a week on average, and I alternate which ones I take. Antioxidants rule! Vitamin D3, all the B's including Niacin, C, and occasionally a multivitamin and Ginko. My tight budget is my biggest constraint. Pomegranate Juice is expensive, but I try to get a couple bottles each month because it has been shown to clear plaques out of the brain. My brain needs some clearing. It can't hurt!

Homemade pasta! Easy. Fun. Healthy!
I also try to eat healthy, and rarely eat factory-made prepared foods. Many years ago I decided that food dyes and preservatives were not good for anyone, especially me. Now I am wondering about some of the genetically modified foods, too. I try to keep it simple, and use basic ingredients without going crazy-organic-only. I prefer to cook my own meals from scratch. Overall I try to avoid food additives whenever possible. I don't eat much fruit, but do have a salad now and then - several times a week in the summer when the garden is growing. Vegetables have never been my favorite thing in the world, but I try. Kroozer and I share.

I have been unable to afford the Lion's Mane Extract I wrote about previously for about a year, but as soon as I can save a few extra bucks I am going to resume taking it. I think I had slower progression when I took it regularly, but it is difficult to say for sure that this supplement had anything to do with it. On the chance that it did, I think it is worth $50 a couple times a year.

I still make my own beer whenever I can afford the ingredients. What I make is much better than what can be had at the store, and at a fraction of the cost. Sometimes as little as 30 cents a bottle! Technically I make ale, and what is available at the store is mostly lager. Totally different yeast involved.  I also make wine. Right now I have 5 galons of Meade ready to bottle. It started out with about 18 pounds of pure clover honey. It is delicious! There is also a 3 gallon crock of Strawberry wine bubbling away in the kitchen. Fresh strawberries were on sale a couple weeks ago, so I indulged a little. I don't drink much water except as coffee. I keep getting letters from the local water department (2 times in the last year!) saying that the water "failed to meet federal standards for drinking water for the past 3 months", but it is still OK to drink it. Yeah! Right! I don't like water very much anyway. Never did! Now I have a good excuse. Also note that they send the letter out a couple months after the fact so I would have been drinking it already long before they notified anyone. What a system!

And - Yes! I do still enjoy an occasional cigar. Not as often as I used to because a good cigar is an expensive treat. Think of rolling up a $10 bill, and smoking it!  It is also cold outside, and I do not like my house smelling like stale cigar smoke. Lately when cold air hits my skin it gets red, and itchy. My hands and fingers will swell up in just a few minutes. They so swollen that I cannot even bend them. Did I mention that it itches? Even at around 40 degrees my skin will redden and start to itch. Very unpleasant to be outside in this cold weather.

The past couple of years, especially last Spring, I have noticed a seasonality to my symptoms. They seem to get worse in late winter, and early spring. Then suddenly they got much better when the weather warmed up. It will be interesting to see what happens this March and April. Those months were very difficult for me last year. I lost April altogether. I thought I was ready to be admitted to a long-term care facility because I couldn't function - or at least I thought I couldn't, but then suddenly I got better around May. We shall just have to wait and see what this next year brings.

My friend says I am "beating the odds" when it comes to my progression. I don't really think so. Very little is really known about my disease, and every case is very different from all the rest. The statistics overall are dismal, but statistics do not predict individual outcomes. Today I am feeling pretty optimistic about my individual outcome, but only time will tell, and my sense of time is totally flarged. I am still here.

Okay! Okay! I am still doing Okay! Yay! Some days are better than others.


Comments are encouraged.


Friday, February 8, 2013

bvFTD Research in General

There should be proper review before publication.
This is my opinion about an opinion of mine I published in my previous post to this blog. I made the comment questioning publication of some Memantine research in my previous post regarding a research article published in The Lancet. I was thinking about research in general, and research journals, and change. The internet, and social media, and to some extent even traditional media outlets have changed drastically how research is perceived. The fact that research is perceived at all constitutes a change.

As soon as some study which affords some interest is published in a scientific journal it is picked up by social media, and repeated in many places. I frequently do this on this blog. Within days of an article being published it gets widely circulated. Often, as here in my own blog, the people who are repeating the study add their own interpretation or commentary. Frequently after a studies results are repeated enough times it is accepted as fact by general readers, even though the research is preliminary. Other researchers know better. There are newsletters published online, and distributed almost instantaneously through email, which are published by organizations that by their very name give a perception of legitimacy and truth to any research results they report. This is a great way to get information to those who are interested, but readers must be aware that they are often reading about very preliminary research, and the findings are to be examined, and questioned, but never blindly accepted.

Social media, and the internet, have made the dissemination of research information fast and easy. Unfortunately that is not the way science, and scientific journals, are meant to work. The internet has changed the way research is reported, but the journals have not changed to keep pace. That is just fine because the purpose of scientific publications is not to drive social media. Social media drives itself.

Here is the way I think the process is supposed to work, and how I think it has become broken. It used to be that a study was published in a journal, and about the only people who read it were other researchers in that field. Boring stuff for boring people. These researchers evaluated the published research, and if they were skeptical tried to replicate it, or if they agreed with the findings tried to expand on it. A few large newspapers had technical writers on staff who watched for anything significant to report that was published in the journals, but these were trained and experienced writers who understood the scientific process. In most cases a "scientific breakthrough" was not reported in the mass media until there was a formal press release. This was after the research was tested, reviewed, replicated, and generally believed to be valid.

This process is still going on today. This is what scientific journals are for. They are publications written by researchers in their field for other researchers. They are not, nor were they ever, meant as a vehicle to release information to the masses. Quietly in the background at universities all over the world research is plodding forward as it always has.

Times have changed, even though the research methodology, journals, and their purpose have not. With the coming of "the information age", and the universal influence of the internet along with the proliferation of social media, even obscure articles can be widely distributed. Anyone can add their interpretation to research, and report on it. Anyone on the internet can take a boring article, and sensationalize it. The boring becomes suddenly interesting. It is no longer researchers writing for other researchers, and being read only by other researchers. Now it is researchers still writing for other researchers, but being read by everyone.

So, I wrote all of this because of a comment to my last post made by Cindy. In her comment she agreed with my interpretation of the study on Memantine, and questioned its worthiness for publication in The Lancet. I questioned it myself in the post. That comment really got me thinking about all this. I came to the conclusion that the research should have been published, even though I question the validity of the findings. It is decent research as far as it goes. It is meant for other researchers, and they should know how to interpret it better than I. I do not believe that any competent researcher or doctor in the field would use this study as a basis to discontinue research, or for prescribing, nor to make recommendations or generalizations about the use of Memantine in treating bvFTD.

So, after all that, I guess what I am saying is: No! Journals such as The Lancet should not change their formats because of the influence of social media and the internet. Instead we, as educated consumers, need to learn how to interpret the research that is published, and remember not to go running around shouting, "The sky is falling!", or "The goose just laid a golden egg!", with every new study. Social media, and others writing on the internet, should continue spreading the news about current research to anyone who may be interested, but those interested need to understand exactly what it is they are reading. I plan to continue reporting on any new research I may find of interest, and adding my own interpretations and comments. Anyone with bvFTD desperately wants a cure to be found, and any promising line of research brings optimism and new hope. Some days that is all we have.

Some days are better than others.

(In most of their senses, there is no difference between skeptic and sceptic. Skeptic is the preferred spelling in American and Canadian English, and sceptic is preferred in the main varieties of English from outside North America. This extends to all derivatives, including sceptical/skeptical and scepticism/skepticism. There is an exception, though: In reference to some 21st-century strains of scientific skepticism, writers and publications from outside North America often use the spellings with the k)

Be a skeptic when reading anything about research on the internet.


Comments are welcome.



Tuesday, February 5, 2013

Memantine (aka. Namenda) and bvFTD. Is it beneficial? Maybe


A recent study published February 2013 concludes that, "Memantine treatment showed no benefit in patients with FTD. These data do not support memantine use in FTD."

Stop! Whoa! What does all this mean?

To someone who is not trained in interpreting research, it is obvious from the above statement that if you have FTD Mementine will have no beneficial effect, so you should discontinue using it, or not bother taking it. No! No! No! Please read onward...

My brain on a good day ...sorta!
That is not at all what the above really means. Nobody should use this study as a criteria to determine treatment.

 (I certainly hope that future research is not influenced negatively by this study. Given some of the obvious issues with the methodology - how did it get published in The Lancet?- "The journal is stringently edited and peer-reviewed." ...or at least it was at one time. But I digress, as usual...)

What it really means is that in this particular study, using this particular sample of individuals, using this particular measurement criteria, and this particular method of analysis, the differences between the 2 groups were not statistically significant. A totally different concept.

The only way to really get at this is to look at each of these items individually. This will take a little time, and might get somewhat technical. I think it is worth it because it can serve as an example of how to interpret any research study, as well as this one.

(This abstract of 2013 study, as well as one from 2003, are reprinted at the end of this post because that is where they ended up when I was writing this. If you are totally unfamiliar with this research you may want to read them first, and then come back to the beginning. Hey! I have bvFTD. This is an editorial opinion piece, so I can fail to organize it according to whim. It is very difficult for me to put things in the proper sequence sometimes. I am blaming my Dysexecutive Function. That is my story, and I am sticking to it! Some days are better than others, and today was better than most.)

Lets start with the sample. According to the study: Of 100 patients screened, 81 were randomly assigned to receive memantine (39 patients) or placebo (42 patients). Five (6%) patients discontinued, and 76 completed the 26-week treatment. Enrolment numbers were lower than planned because of many patients' preference to take memantine or cholinesterase inhibitors off-label rather than participate in a clinical trial.

Right off the bat there is an issue. Nearly 20% of the patients screened elected not to participate because they wanted to continue taking Memantine or cholinesterase inhibitors off-label rather than participate in a clinical trial. Why? I can only guess, but it seems logical that it was because they were working noticeably well for them, and they did not want to risk being placed in the control group, and receiving a placebo.

So, at the very start of this study it seems to have eliminated 20% of the people who were taking memantine, and felt that it was working effectively. This is, of course, only a guess, and any evaluation would necessarily be subjective, but at the sample size used in this study it would only take 1 or 2 of those 19 individuals to totally change the outcome. These may well represent the population of bvFTD patients for whom Mamentine is a very effective treatment! This is not in any way bad research. It is reported up-front, so it can be included in any interpretation of the results. Though 81 individuals were randomly selected for the study groups, another 19 individuals self-selected themselves out of the study in a decidedly non-random manner.

In delving a little deeper into the study groups it turns out that only 29 individuals with bvFTD actually received memantine! (the others either dropped out or had semantic FTD) According to The Family Caregiving Alliance (FCA) as many as seven million Americans may be afflicted with a form of dementia.  Frontotemporal Dementia may account for 2-5 percent or 140,000 – 350,000 cases of dementia and for as many as 25 percent of pre-senile dementias. OK, what this means is that to select a sample for a study with a 95% confidence level (as in this study) and a confidence interval of plus or minus 3, a sample size of 1064 is necessary. Not 100! Not 86! Not 29! More than 10 times the total number actually tested. Again this is not bad research. Sample size is often a result of availability, and cost. The effect on the study is that it is more likely with an undersized sample to miss a valid result. In general the bigger the sample, the more likely it is to see a small difference.

(If you are interested in "delving deeper" into this study follow the link below, and then select the green link on the upper right of the summary page for The Lancet. Scroll down the Lancet page for many figures and tables excerpted from the original study: http://www.ncbi.nlm.nih.gov/pubmed/23290598)

To get back on-track, the sample size was very small, and may have excluded many of the very people that the study was designed to test.

One last thing about the sample. According to the abstract:  Participants met Neary criteria for behavioural variant FTD (bvFTD) or semantic dementia and had characteristic brain atrophy.

The consensus diagnostic criteria for frontotemporal dementia (FTD) by Neary et al.1 are of particular interest because many patients diagnosed with schizophrenia would fit criteria for FTD. All the core diagnostic features of FTD characterize schizophrenia patients with prominent “negative symptoms.” The supportive features of FTD also feature prominently in schizophrenia excepting the physical signs of incontinence, akinesia, rigidity, tremor, and low and labile blood pressure, which occur but infrequently. Primitive reflexes, however, are commonly found. A plethora of studies implicate frontal lobe neuropsychologic impairment as well as both frontal and temporal structural and functional imaging abnormalities in schizophrenia.2 McKenna3 provides the most complete catalogue of the cardinal symptoms and clinical picture of schizophrenia mirroring FTD symptoms.

Since bvFTD is so very difficult to diagnose the criteria used to select the subjects for testing is crucial. It appears that the Neary test developed in 1998 was used in conjunction with some form of brain imaging. As indicated above, the Neary test does not differentiate well between schizophrenia and bvFTD. More recent criteria are available, and many studies now require a PET Scan to determine a diagnosis. The Neary test isn't wrong, but it may not be the best test available today.

Lets move on to the way the researchers measured the changes. According to the abstract:  Primary endpoints were the change in total NPI score and clinical global impression of change (CGIC) score after 26 weeks and were analyzed by intention to treat.

Looking at the last one first - a quick explanation of exactly what "intention to treat" means is probably in order as it is "researcher jargon" for a specific methodology. There is nothing wrong with it, except when a lot of people drop out of a study. In this study 5 people, or about 6% of the sample, quit the study before completing it.

According to my research, an intention to treat (ITT) analysis of the results of an experiment is based on the initial treatment assignment and not on the treatment eventually received. ITT analysis is intended to avoid various misleading artifacts that can arise in intervention research such as non-random attrition of participants from the study or crossover. ITT is also simpler than other forms of study design and analysis because it does not require observation of compliance status for units assigned to different treatments or incorporation of compliance into the analysis. Although ITT analysis is widely employed in published clinical trials, it can be incorrectly described and there are some issues to its application.

Medical investigators often have difficulties in accepting ITT analysis because of clinical trial issues like missing data or adherence to protocol.

To address some of these issues, many clinical trials have excluded participants after the random assignment in their analysis, which is often referred to as modified intention-to-treat analysis or mITT. Trials employing mITT have been linked to industry sponsorship and conflicts of interest by the authors.

After all of that, Intention to treat is a valid, and accepted method of analysis though it has some flaws which can introduce error in the outcome of a study. Just be aware that it may introduce error, so any conclusions are subject to interpretation. In this study the drop out rate was not too large, and any error introduced would probably influence the results by over-emphasizing any differences.

When I first read the abstract for this study, I was a little surprised at the tests that were chosen to measure the results. Here is why. According to the study the total NPI score and clinical global impression of change (CGIC) wre used to measure the results.

As for my own case of bvFTD, and always keeping in mind that every case is different, I would not expect to see any difference in my own personal test score after only 26 weeks, or even 32 weeks. Of course some days are better than others! In fact, I would bet that most people who suffer from bvFTD, and are in the earlier stages of the progression, would show little or no change on these particular tests. But, since the CGIC requires input from a caregiver it effectively eliminates anyone who is in the earliest stages of bvFTD, and able to still remain self-sufficient. Well? Aren't the individuals who are still able to function without a caregiver the ones who have the most at stake in stopping or slowing the progression of the disease? Duh! Sad, but - DUH! The definition of a garegiver, and the severity of the symptoms to start with were not addressed in the abstract, so it is unclear what if any affect this would have on the outcome.

The Clinical Global Impression rating scales are commonly used measures of symptom severity, treatment response and the efficacy of treatments in treatment studies of patients with mental disorders (Guy, W., 1976). Many researchers, while recognizing the validity of the scale, consider it to be subjective as it requires the user of the scale to compare the subjects to typical patients in the clinician experience. (This particular test is probably of little use in determining the affects of Memantine as shown in the results of the 2003 study on Alzheimer's patients which is included at the end of this post for reference.)

The Clinical Global Impression - Severity scale (CGI-S) is a 7-point scale that requires the clinician to rate the severity of the patient's illness at the time of assessment, relative to the clinician's past experience with patients who have the same diagnosis. Considering total clinical experience, a patient is assessed on severity of mental illness at the time of rating 1, normal, not at all ill; 2, borderline mentally ill; 3, mildly ill; 4, moderately ill; 5, markedly ill; 6, severely ill; or 7, extremely ill.

The Clinical Global Impression - Improvement scale (CGI-I) is a 7 point scale that requires the clinician to assess how much the patient's illness has improved or worsened relative to a baseline state at the beginning of the intervention. and rated as: 1, very much improved; 2, much improved; 3, minimally improved; 4, no change; 5, minimally worse; 6, much worse; or 7, very much worse.

The Clinical Global Impression - Efficacy Index is a 4 point × 4 point rating scale that assesses the therapeutic effect of the treatment as 1, unchanged to worse; 2, minimal; 3, moderate; 4, marked by side effects rated as none, do not significantly interfere with patient's functioning, significantly interferes with patient's functioning and outweighs therapeutic effect.

My basic issue with using this as a measure is that for those of us with bvFTD every day is different. There are some days when I cannot function at all, others where I can barely get by, and many more where I appear to be within the broad range of what is considered normal. The clinician only sees the patient on a few days, and for only a few hours, and talks to them on the phone a couple times during the study period. With all of the variance in symptoms from day-to-day I question the validity of this type of subjective observational measurement. A less subjective measure, and one not as prone to be influenced by daily fluctuations in symptom severity would be preferred - at least by me. (Wouldn't a study comparing PET Scans over 2 years be WAY better!)

The other measure used to asses any changes is The Neuropsychiatric Inventory (NPI), but even then the symptoms, their severity, and their impact are reported by the caregiver so are also subjective. The NPI was developed to assess psychopathology in dementia patients. It evaluates 12 neuropsychiatric disturbances common in dementia: delusions, hallucinations, agitation, dysphoria, anxiety, apathy, irritability, euphoria, disinhibition, aberrant motor behavior, night-time behavior disturbances, and appetite and eating abnormalities. The severity and frequency of each neuropsychiatric symptom are rated on the basis of scripted questions administered to the patient's caregiver. The NPI also assesses the amount of caregiver distress engendered by each of the neuropsychiatric disorders. A total NPI score and a total caregiver distress score are calculated, in addition to the scores for the individual symptom domains. Content validity, concurrent validity, inter-rater reliability, and test-retest reliability of the NPI are established. Different neurologic disorders have characteristic neuropsychiatric manifestations and distinctive NPI profiles. The NPI is sensitive to treatment effects and has demonstrated the amelioration of behavioral symptoms in Alzheimer's disease by cholinergic agents. The NPI is a useful instrument for characterizing the psychopathology of dementia syndromes, investigating the neurobiology of brain disorders with neuropsychiatric manifestations, distinguishing among different dementia syndromes, and assessing the efficacy of treatment.

So, they take the difference in total scores on a test that measures delusions, hallucinations, agitation, dysphoria, anxiety, apathy, irritability, euphoria, disinhibition, aberrant motor behavior, night-time behavior disturbances, and appetite and eating abnormalities. I can tell you right now I don't have most of these symptoms, and as for the ones which I think I do have I would not expect to see any change in only 6-8 months (Fingers crossed!). At this time, though I do have some outside assistance, I do not have a caregiver. I can be apathetic. I can be irritable (and irritating!). I do not sleep well, and I have gained about 35 pounds in the past year, but not in the past 6 months. The thing is that if you were to look at these criteria a year ago, and compare them to today, I doubt you would see any difference. That, and my total symptoms account for less than half of the total score, so this test really does not measure me very well. I think it is much better suited to more advanced stages of Alzheimer's and other forms of dementia rather than the early stages of bvFTD.

I spent a lot of time writing about the measures because I really question whether these particular tests would pick up on any real difference if it were actually there. These are not bad tests, and they are widely accepted as research measures. In my opinion they are more likely to only identify very large changes, and to totally miss all of the subtle changes in daily living, cognition, and social interactions that occur in a person with bvFTD.

So, in my opinion what this study says is that in this particular study, using this particular sample of individuals, using this particular measurement criteria, and this particular method of analysis, the differences between the 2 groups were not statistically significant. So, if you were a participant in this particular study who received Mamentene you should not expect to see any benefit in taking it that can be measured by the tests used. For all of the rest of us who did not participate in this study, including those who declined to participate, it means absolutely nothing, and more research will be necessary.

Nobody should use this study as a criteria to determine treatment. Mamentine (Namenda) may or may not work for you. If it works, Great! If not... keep looking.

Personally I take both Memantine and Donazepel at about the maximum recommended dosage. It seems to be working for me, at least something seems to be working. I am pretty damn pleased that 3 years after my diagnosis I can still write this post. (Was that an example of disinhibition?)



Here is the abstract of the study:

Lancet Neurol. 2013 Feb;12(2):149-56. doi: 10.1016/S1474-4422(12)70320-4. Epub 2013 Jan 2.
Memantine in patients with frontotemporal lobar degeneration: a multicentre, randomised, double-blind, placebo-controlled trial.
Boxer AL, Knopman DS, Kaufer DI, Grossman M, Onyike C, Graf-Radford N, Mendez M, Kerwin D, Lerner A, Wu CK, Koestler M, Shapira J, Sullivan K, Klepac K, Lipowski K, Ullah J, Fields S, Kramer JH, Merrilees J, Neuhaus J, Mesulam MM, Miller BL.
Source

Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA. Electronic address: aboxer@memory.ucsf.edu.
Abstract
BACKGROUND:

Memantine has been used off-label to treat frontotemporal lobar degeneration (FTD). A previous 26-week open-label study suggested a transient, modest benefit on neuropsychiatric symptoms as measured by the neuropsychiatric inventory (NPI). We aimed to determine whether memantine is an effective treatment for FTD.
METHODS:

We did a randomised, parallel group, double-blind, placebo-controlled trial of 20 mg memantine taken orally daily for 26 weeks in patients with FTD. Participants met Neary criteria for behavioural variant FTD (bvFTD) or semantic dementia and had characteristic brain atrophy. Use of acetylcholinesterase inhibitors was prohibited. Individuals were randomly assigned to receive either memantine or matched placebo tablets (1:1) in blocks of two and four patients. All patients and study personnel were masked to treatment assignment. Primary endpoints were the change in total NPI score and clinical global impression of change (CGIC) score after 26 weeks and were analysed by intention to treat. This study is registered with Clinicaltrials.gov, number NCT00545974.
FINDINGS:

Of 100 patients screened, 81 were randomly assigned to receive memantine (39 patients) or placebo (42 patients). Five (6%) patients discontinued, and 76 completed the 26-week treatment. Enrolment numbers were lower than planned because of many patients' preference to take memantine or cholinesterase inhibitors off-label rather than participate in a clinical trial. Memantine treatment had no effect on either the NPI (mean difference 2·2, 95% CI -3·9 to 8·3, p=0·47) or CGIC (mean difference 0·0, -0·4 to 0·4, p=0·90) after 26 weeks of treatment. Memantine was generally well tolerated; however, patients in the memantine group had more frequent cognitive adverse events (six patients) than those in the placebo group (one).
INTERPRETATION:

Memantine treatment showed no benefit in patients with FTD. These data do not support memantine use in FTD.
FUNDING:

Forest Research Institute.


And here is another abstract from a study in 2003 to take a look at. Though not specifically targeted at bvFTD it shows some interesting results, and most importantly regarding cognition - a criteria not measured in the current study! This study shows a benefit in the effect of memantine (20 mg/day) for patients with moderate to severe Alzheimer disease on cognition and functional  but not in the clinical impression of change. Interesting that the tests selected to measure the effects in the current study do not measure cognition, and do include the clinical impression of change.

Cochrane Database Syst Rev. 2003;(3):CD003154.
Memantine for dementia.
Areosa SA, Sherriff F.
Update in

    Cochrane Database Syst Rev. 2004;(4):CD003154.

Abstract
BACKGROUND:

Alzheimer's disease, vascular and mixed dementia are the three commonest forms of dementia affecting older people. There is evidence that the excitatory activity of L-glutamate plays a role in the pathogenesis of Alzheimer's disease and in the damage from an ischaemic stroke. A low affinity antagonist to N-Methyl-D-aspartate (NMDA) type receptors, such as memantine, may prevent excitatory amino acid neurotoxicity without interfering with the physiological actions of glutamate required for memory and learning.
OBJECTIVES:

To determine the clinical efficacy and safety of memantine for people with Alzheimer's disease, or vascular or mixed dementia.
SEARCH STRATEGY:

Trials were identified from a search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 15 April 2003 using the terms: memantin*, D-145, DMAA, DRG-0267. All major health care databases and trial databases within the scope of the group are searched regularly to keep this Register up to date.
SELECTION CRITERIA:

Double-blind, parallel group, placebo-controlled, randomized and unconfounded trials in which memantine was administered to people with dementia.
DATA COLLECTION AND ANALYSIS:

Data were extracted, pooled where possible, and weighted mean differences, standardized mean differences or odds ratios were estimated. Intention-to-treat (ITT) and observed cases (OC) analyses are reported, where data were available.
MAIN RESULTS:

Effect of memantine in patients with moderate to severe Alzheimer's disease: analysis of the change from baseline at 28 weeks gave statistically significant results in favour of memantine for 20 mg/day on cognition (MD: 6.1. 95% CI 2.99 to 9.21, P=0.0001) activities of daily living (MD 2.10, 95% CI 0.46 to 3.74, p=0.01) and in the global clinical impression of change measured by the CIBIC-Plus at 28 weeks (MD -0.30, 95% CI -0.58 to -0.02, p=0.04), in all cases the analysis was the ITT-LOCF population (Reisberg 2000). There were no significant differences between memantine and placebo for the number of drop-outs and total number of adverse effects, but a significant difference in favour of memantine for the number who suffer agitation. Effect of memantine in patients with mild to moderate vascular dementia: analysis of the change from baseline at 28 weeks gave statistically significant results in favour of memantine ( 20 mg/day ) for cognition (MD -2.19, 95% CI -3.16 to -1.21, P=less than 0.0001) but there was no benefit for the clinical impression of change, or for global measures of dementia (MMM300, and MMM500). There were no significant differences between memantine and placebo for the number of drop-outs and total number of adverse effects, but a significant difference in favour of memantine for the number who suffer agitation. Effect of memantine in patients with Alzheimer's disease and vascular dementia at 12 weeks: there was no statistically significant difference between memantine (10 mg/day) and placebo in activities of daily living. There was a benefit in favour of memantine (10 mg/day) compared with placebo at 12 weeks, for the numbers improved in terms of clinical impression of change (60/82 compared with 38/84 - OR 3.30, 95% CI 1.72 to 6.33, P=0.0003) (Winblad 1999). Effect of memantine in patients with vascular dementia, Alzheimer's disease and dementia of non-specified type at 6 weeks: there were beneficial effects on cognition (Ditzler 1991), activities of daily living (Ditzler 1991, Pantev 1993), behaviour (Pantev 1993) and global scales (Gortelmeyer 1992; Pantev 1993; Ditzler 1991) and in global impression of change (Gortelmeyer 1992; Ditzler 1991). There were no significant differences between memantine and placebo for the number of drop-outs and total number of adverse effects, but a significant difference in favour of placebo for the number who suffer restlessness
.REVIEWER'S CONCLUSIONS:

There is a beneficial effect of memantine (20 mg/day) for patients with moderate to severe Alzheimer disease on cognition and functional decline but not in the clinical impression of change. Patifor patients with moderate to severe Alzheimer disease on cognition and functional decline but not in the clinical impression of change. Patients with mild to moderate vascular dementia receiving memantine 20 mg/day had less cognitive deterioration at 28 weeks but again this effect was not clinically discernible. There is a possible beneficial effect on cognition, function and global scales for memantine at 6 weeks in mixed populations. The drug is well tolerated and the incidence of adverse effects is low. More studies are needed.

That's my interpretation. My analysis. My opinion. There ya have it!
Comments are encouraged.

Saturday, February 2, 2013

Snowface! Kroozer Day Pictures 2013

Kroozer did NOT see his shadow on Kroozer Day 2013. Spring is just around the corner anyway! Yay!

Kroozer is already back in his warm little bed snuggled up sound asleep. Kroozer  seemed to enjoy his  little excursion into the snow this morning. Even though the snow was almost nose-deep on him, he didn't seem to mind it at all. What a skunk! Did he see his shadow?

Judge for yourself in the pictures below.


Snowface! Yes! There is a Kroozer under there.

No matter how hard he looked, there was no shadow to be seen.

"I make all this snow look good. Still no shadow."

Nope! Not my shadow, just a leaf! Darn!

























"OK! My feet are getting cold. I'll meet you back in the house. I am outta here!"


...and so it went. Kroozer looked really hard. He gave it his fat li'l skunk best, but there was no shadow to be seen.

According to legend if a Groundhog does not see his shadow, he stays out because Spring is starting. Well, Kroozer would be the first to tell you that he is not just some stupid old marmot, and that when it is only 15 degrees out and he has snow on his face, it is time to go back to bed. Let those stupid marmots freeze. Kroozer will be all snug in his bed until Spring arrives ...in about 6 weeks as always.

Happy Kroozer Day 2013!


























Happy Kroozer Day 2013! Did This Fat Skunk See His Shadow?

Happy Kroozer Day 2012!!!

Happy Groundhog and Kroozer Day 2013!

"This is one time where television really fails to capture the true excitement of a large squirrel predicting the weather."              ~Phil Conners from the movie Groundhog Day

Groundhog Day is my favorite holiday. When I say this people invariably give me a strange look and ask me "Why?". If you are new to this blog you are probably asking the same thing. I shall explain. No, this is not a symptom of dementia, and is not related to bvFTD. It has nothing to do with Pick's Disease, or Frontotemporal Lobal Degeneration. If you are looking for something like that, you will be disappointed. If you are wondering why someone with dementia is writing about a furry little marmot, read on. Groundhog Day is, and always has been, the best holiday ever.

Here is why:
First, nobody important like a President or anybody died on Groundhog Day.

Second, it isn't some crazy religious holiday to start a war, or kill anybody, or blow anything up over.

Third, no wars have been started, won, or lost, on Groundhog Day.

Fourth, nobody controversial was born on Groundhog Day.

Fifth, this is the big one, so get ready. It is all about a cute, cuddly little animal predicting the coming of Spring. No pressure on the animal because Spring will come in 6 weeks no matter what. At the end of the day, unlike Thanksgiving where the star of the holiday gets to be dinner, the fat little groundhog gets to go back to bed and cuddle up all warm and cozy until Spring. How kool is that?

So that is why I love Groundhog Day. It looks to the future. It signals the end to these awful Ohio winters. Well, a couple years ago we had a blizzard on this day. This year it is snowing like crazy today after a high of 63 degrees a couple days ago, and has piled up a few inches already this morning.  ...yet. After all, this is Ohio, and that could change again in the next few days let alone weeks. Well, Kroozer and the groundhogs don't care! Neither do I. Spring will be here in 6 weeks because this is the day halfway between Winter and Spring. Duh! What a coincidence!

Anyway, the Groundhog, also known as a Woodchuck, Whistle Pig, Marmot, and "Frakkin Varmint", isn't the only critter who can predict the weather. In "Jolly Old England" it was usually bears or badgers who did the dirty deed. Groundhogs are native to the United States, so we can thank the German immigrants to Pennsylvania for carrying on the tradition. I did a little research on the history of this wonderful holiday, and want to share a little of what I found. Hopefully I will convince at least a few to elevate the importance of this great day. Hey! I have dementia. What do I know?

Anyway - The groundhog and badger were not the only animals that have been used to predict spring. Other Europeans used the bear or hedgehog--but in any case the honor belonged to a creature that hibernated. (I nominate a certain Skunk!) Anyway, the animals emergence symbolized the imminent arrival of spring.

Traditionally, the groundhog is supposed to awaken on February 2, Groundhog Day, and come up out of his burrow. If he sees his shadow, he will return to the burrow for six more weeks of winter. If he doesn’t see his shadow, he remains outside and starts his year, because he knows that spring has arrived early.

Well - Duh! Spring always arrives on or near March 21, so whether the groundhog decides to return to his den or remain above ground, the fact is spring will always come in six more weeks.

The Roman-Catholic Church borrowed the holiday and called it Candlemass. Candlemas occurs 40 days after Christmas. Traditionally the Western term "Candlemas" (or Candle Mass) referred to the practice whereby a priest on 2 February blessed beeswax candles for use throughout the year, some of which were distributed to the faithful for use in the home. In Poland the feast is called Święto Matki Bożej Gromnicznej (Święto, "Holiday" + Matka Boska, "Mother of God" + Gromnica, "Thunder"). This name refers to the candles that are blessed on this day and called gromnicy, since these candles are lit during (thunder) storms and placed in windows to ward off the storm.

The following is supposed to be related to the whole Groundhog seeing his shadow thing which seems to have gotten way out of hand in one certain town in Pennsylvania. I wish I would have stopped in there when I was Elk Hunting, but we were tired, and it was an hour out of our way. This is translated from English (chuckle) from around the year "really a long time ago".

As the light grows longer
The cold grows stronger
If Candlemas be fair and bright
Winter will have another flight
If Candlemas be cloud and rain
Winter will be gone and not come again
A farmer should on Candlemas day
Have half his corn and half his hay
On Candlemas day if thorns hang a drop
You can be sure of a good pea crop

More importantly it is a gauge on how one should ration the Winter food stores. If you have less than half of your food left today, you are going to be really hungry before the snow melts. I don't really like peas very much, so I don't care about that part and am not going out to check any thorns. Last time I planted peas in my garden the rabbits ate them as soon as they came up. Good bunnies! Saved me from having to eat peas! Har!

So, way before all of that there was was this Celtic Goddess Brigid. Goddess! She is one of the "Old Ones", and of course she was sainted in human form as St Briged by those crafty-Catholics. Just remember no matter how cute that Groundhog looks, she was here first. Her British and continental counterpart Brigantia seems to have been the Celtic equivalent of the Roman Minerva and the Greek Athena, goddesses with very similar functions and apparently embodying the same concept of 'elevated state', whether physical or psychological. (Minerva is especially kool, and a sexy  Heinlein computer/woman too!)

Brigid is the goddess of all things perceived to be of relatively high dimensions such as high-rising flames, highlands, hill-forts and upland areas; and of activities and states conceived as psychologically lofty and elevated, such as wisdom, excellence, perfection, high intelligence, poetic eloquence, craftsmanship (especially blacksmithing), healing ability, druidic knowledge and skill in warfare. In the living traditions, whether seen as goddess or saint, she is largely associated with the home and hearth and is a favorite of both Pagans and Christians. A number of these associations are attested in Cormac's Glossary.

Saint Brigid of Kildare or Brigid of Ireland (Brigit, Bridget, Bridgit, Bríd or Bride) or Mary of the Gael (Irish: Naomh Bríd) (c. 451–525) is one of Ireland's patron saints along with Saints Patrick and Columba. Irish hagiography makes her an early Irish Christian nun, abbess, and founder of several monasteries.

A Scottish Gaelic proverb about the day is:

    Thig an nathair as an toll
    Là donn Brìde,
    Ged robh trì troighean dhen t-sneachd
    Air leac an làir.

    "The serpent will come from the hole
    On the brown Day of Bride,
    Though there should be three feet of snow
    On the flat surface of the ground." 

Pity the serpent who pokes his head out today!

Brigid is said to walk the earth on Imbolc eve. That is tonight! She is gonna be really, really cold! Anyway - Before going to bed, each member of the household may leave a piece of clothing or strip of cloth outside for Brigid to bless. The head of the household will smother (or "smoor") the fire and rake the ashes smooth. In the morning, they look for some kind of mark on the ashes, a sign that Brigid has passed that way in the night or morning. The clothes or strips of cloth are brought inside, and believed to now have powers of healing and protection.

Those silly neo-Wiccans have tried to make this a holiday all about women, which they do to just about every holday, so who cares about them. Kinda cracks me up to think some might be dancing naked in circles around a sputtering fire this cold and snowy night. To each their own.  Groundhog Day is unisex. Groundhog Day is non-denominational. Groundhog Day is just for fun. Groundhog Day rules!

Kroozer is not a happy li'l skunk this morning, and probably thinks Groundhogs are just fat stinky marmots too stupid to stay in bed anyway. It is another snowy Kroozer Day for him.  He is still a little sleepy, but churred and purred when I woke him up to take him outside for his now annual excursion.  Now if you were paying attention above, you would have noticed that any animal that hibernates will do as a substitute for the original Badger or Hedgehog. Did you know that skunks hibernate? Kroozer has been trying, but so far this winter he has been wide-eyed, and bushy-tailed ...literally. I have not had to wake his fat butt up so I can feed him even once this Winter. Even though it has been a very warm winter until the last half of January, he has been out and about the house most days. The past few weeks it has been consistently below freezing but he doesn't seem to mind. Of course he is snug as a bug inside a big warm house unlike his cousins outside sleeping in a frigid burrow somewhere. He is one lucky li'l skunk ...until today! 


So, we went for a short walk in the backyard. In the snow! He has a fur coat. I don't!  Did Kroozer see his shadow????


Click here to see if he did.



Comments are welcome.