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Hastings Center News

What Makes a Good Life Late in Life? Nobel Prize Winner and Leading Bioethicist Offer Insights

Eric Kandel, winner of the 2000 Nobel Prize in Physiology or Medicine who has done groundbreaking work on the molecular mechanisms of memory, spoke at The Hastings Center on May 22 about the differences between normal age-related memory loss and Alzheimer’s disease, as well as the possibility that exercise might protect or even enhance memory in old age. Following Kandel, Tia Powell, director of the Montefiore Einstein Center for Bioethics and a Hastings Center Fellow, discussed the “substantial ethical challenges” posed by dementia.

Kandel, who is the director of the Kavli Institute for Brain Science at Columbia University, said that treatments for dementia might be more effective if begun early, even before symptoms emerge, than if they are given later on. Routine brain PET scans for adults over age 35, he suggested, might be useful for early identification of amyloid plaque buildup and other signs of dementia, though more research is needed to determine their efficacy. Kandel also presented evidence that osteocalcin, a hormone produced by bone cells, is a “cognitive enhancer.” He said that walking and other forms of exercise that put direct pressure on bones help stimulate the release of osteocalcin from bones into the bloodstream and might also maintain or improve memory, even in old age.

Powell spoke about the ethical dilemmas raised by caring for people with dementia. Family members and physicians often grapple with balancing the values of autonomy and beneficence. For example, caregivers may struggle to determine when an individual with dementia should no longer drive or control his or her own finances. “How do you make that determination?” she asked. “How do you protect the safety of that person, the safety of those around them, without unnecessarily curtailing the rights and dignity of that person?”

She also discussed whether PET scans should be more widely conducted to identify amyloid plaque in the brain. Medicare doesn’t pay for these scans, which cost about $3,000. She said that the cost and effectiveness of PET scans should be balanced against the cost and effectiveness of evidence-based programs that enable people with dementia to remain in their homes for as long as possible.