at the all simers association western and central washington chapter that's the long name we serve individuals and families from the oregon border to the canadian border of the pacific ocean to the communities of central washington twenty three counties in all about eighty percent or so of the state's population so we run pretty fast so much of what we do is about stories the amazing stories of the individuals and families that we serve on their journeys with also hires and other forms of dementia and it's been a particular pleasure for me to partner with collin on what has become a series of these presentations and readings and signings of his amazing anthology into the storm these are the personal stories of ordinary people doing extraordinary things confronted with situations that nobody prepares for and i'm very pleased to have not only collin but also and have drene who is one of the contributors with us tonight to share their stories so my great pleasure to introduce i took many years ago tonight i'm going to talk about the importance of community and support systems and i have to really give tremendous credit and gratitude to all the members friends loved ones here at the temple they really provide it more than anybody else i would say such a important safety net and support system for lind as our journey begin to enter a very critical phase i'd like to just talk briefly tonight and sure some general reflections about how i came to start this project  really believe is a collaborative effort so i don't take any credit for it and had green as one of twenty three writers who shared their personal stories many of you know this story but for those of you who don't my late wife linda  first began showing symptoms of early onset are now called younger onset alzheimer's at the age of fifty one way back in one thousand nine hundred nine we were traveling together on a trip to france and it was actually here just the sunday before we left for france that linda was in a tizzy because she couldn't find her contact lens solution i remember morris heath came to the rescue one of our resident physicians here but that was the first indication that something was amiss we were on vacation and a number of things linda had forgotten and she was a very meticulous person very very well organized  when we got back several things happened and one day ever sees a phone call from linda's supervisor at seattle city late linda was having some serious problems  remembering appointments and asking her coworkers the same questions over and over again it became apparent that something was was wrong we checked it out with a number of specialists and then we got the bad news that linda had young onset alzheimer's so that was the start of our very long journey why did i write his book well as the royal later on will share with you in greater detail alzheimer's now has become a very serious national and state wide public health epidemic there are now upwards of one hundred fifty thousand people living with alzheimer's here and in the state of washington it's now the third leading cause of death in our state nationwide the figure is higher and by the middle by twenty thirty the figure will double and by the middle of the century or why the figures will triple i was very fortunate when linda developed alzheimer's to reach out to a wonderful organization which i had the pleasure of joining as a volunteer the alzheimer's association so back in two thousand and five as i was beginning to see the seriousness of our dilemma i called the twenty four seven helpline at the alzheimer's association spoke to a very very helpful gentleman house met with us and developed a comprehensive cure plan for linda in addition i joined a alzheimer's support group made up of carrick evers like myself many of whom were in various met once a month and i was moved by the stories and discoveries that i was a just a very life giving situation and so what happened was that about four years it and published a story with his post globe and surprisingly it drew a very wide response and gave me an idea that perhaps it might be some value in collecting were stories from the midwest from the south and also from new england and was the result  i think stories are really important and i was inspired by a number of people to put together the something one of them was professor a that i had back in one thousand nine hundred nine at pacific school of religion  and so it gave me the idea that by compiling in curating collection of stories about character having that this could provide a way of entry for caregivers who are dealing with a number of really difficult issue one of them is isolation when you're a caregiver you are suddenly thrust into a very chaotic very frightening and confusing situation stories help us to see the landscape more clearly as peter schaffer the playwright said stories help us to see more clearly in the dark so stories help us to see our situation and learn how to be more effective caregivers the other thing is that  feel isolated as your loved one begins to undergo behavioral changes begins to wander begins to lose their cognitive ability it becomes really important that you are connected with other people  they did that so i'd like to read a short selection from just one story in this book by reed everest the hand rita is a psychotherapist in seattle she wrote a book called a story i'm sorry called bread for the journey which is taken from her book walking one another home moments of grace and possibility in the midst of alzheimer's i think this is a powerful piece because she talks about the unexpected moments of grace that she encountered in what is otherwise a very challenging and very difficult journey what was curious to me at the outset of mom's disease was that i felt disoriented although i had read volumes on alzheimer's i could find no clear road map no specific timeframe to mark the passages in my disoriented stage i began pondering where am i going how do i get there is only natural then at this soul searching time that i should insist upon asking myself so if there is no clear road map out there rita how will you find your way as companion through the alzheimer's journey i found inspiration from many sources but one book by phil cosa no the art of poker mitch spoke to me most deeply his wise words we can transform any journey into pilgrimage with a commitment to finding something personally sacred along the road she writes only as i open to the sacredness of this image yet i begin to understand the uniqueness and the depth of such a pilgrimage throughout simers pilgrims leave her comfortable every day surroundings to venture at least for a while into challenging and unfamiliar territory often they journeyed to places where a holy presence is felt places credited with healing powers consistently i felt a holy presence when i was with my mother and her tiny nursing home room offered healing at many levels true absurd dilemma's often oros stirring strange and unwelcome feelings in me at such times i would become impatient or preoccupied or even depressed as a witness mom's downward spiral watching someone i love so much fade before my very eyes was not easy and often made me feel as helpless what could i do being helpless seemed pretty much a given in the situation i myself did it help but this much remain clear however i could do nothing about mom's deteriorating condition what i could do something about was my own behavior my attitude towards what we were facing i could bring into your interactions greater love and compassion more patience and flexibility in each given moment this is my call yes we walked one another home faithfully mom and i in our pilgrimage to alzheimer's in to invite our one of our contributing authors and gina come and share from her story northern northern house and as a award winning writer and film producer and she is the author of a brand new book a memoir about her own journey as a caregiver with her mother which will be published in september right and through she writes press it's called her beautiful brain it's my privilege soon bite a it's a pleasure to be here and i thank you all for coming my mother knew that something was wrong when she was about my current age that's a little scary i'm fifty seven and we at the time bluer often said oh mom i'm sure it's nothing this went on for some years and she was tested a few times this was in the early ninety's i think we're better at this kind of thing now she was finally told when she was sixty six arlene we think you have disease and the reason my book is titled her beautiful brain was because she was very brainy and people had actually said that about her she has such a beautiful brain because she was sort of unique she had you know one geometry and trig prizes in high school but she also was an artist and she ended up teaching english at roosevelt high school that was her last stop before she  voluntarily retired because she felt like she wasn't the teacher she wanted to be because of these strange memory problems she was having anyway shout out to the all timers association like kahlan when my mother was diagnosed my one of my sisters and i and mom joined a support group and it was a life saver i learned a lot of things i didn't want to learn at the time i was in my early thirty's i had two young kids i was really not interested in becoming an expert on all timers disease but you know such was my fate although i wouldn't call myself an expert i'm still very much a lay person  my chapter in this book is called northern house is calling mentioned it's not a happy chapter i dedicate it to all the people how they're who are who are angry as much as they're sad about what's i'll just leave it at that a couple things you might want to know before we begin this chapter my mom grew up in butte montana so there are some references to butte which is some of you may know is now a an e p a superfund site after many decades of copper mining have pretty much the town to death and i'm one of six siblings so i have three sisters and i had two brothers one passed away but so that an unusual part of my story too is navigating alzheimers with five siblings our mom was single twice divorced once widowed when she was diagnosed trying to find a home for someone who's done a stint at the seattle gerrard site psychiatric center is like trying to find a home for a paroled sex offender we weren't yet accustomed to thinking of our mother as a parolee an ex con of the dementia world so we were grateful for northern house lynette the gero psych social worker labored hard to find this new address for mom but that didn't mean we didn't notice things like the split level floorplan in a can dreariness of the place the peeling kleenex blue paint the faint lines of ma scraping up the outside walls the cloying floral furniture you wouldn't wish on your most impoverished college age nephew mom loved good woods strong stripes and straight lines she would never have chosen northern house in a million years and yet it was surrounded by tall trees some of them probably one hundred fifty years old big patient second growth doug douglas firs miraculously left standing when the split level developers game came through forty or fifty years ago and it was tucked into a winding ravine in a neighborhood just north of the seattle city limits not too far from the little red ranch house that she and dad bought when they were newlyweds sometimes i took the old highway to get there instead of the freeway and drove past landmarks mom would have loved highland ice arena where she who had grown up skating in butte held out her hands and coaxed us away from the edge of the rink lonny lanes where she dropped off baby lisa and me in the up stairs nursery and i watched her through the big glass window looking so serious as she stared at those pins and then  after the crash of a strike which i still think is one of the best noises in the world the round the clock staff at northern house radiated calm and kindness in tree like patients most of them were from gambia and you got the feeling that taking care of people with brain damage and dementia was a breeze compared to some of the earlier chapters of their lives they had a completely new view of mom the view of people who had never known her any other way before seattle gero sake in her two years at the lakeview retirement community she had gone from hosting illicit wine parties and modeling at the end you'll fashion show to yelling at the staff when they tried to colorado her room for meals and flat out refusing to bathe but the caregivers at northern house had not seen any of that transformation nor had they seen or tied to a wheelchair in the day room they only knew her as the gnomish white haired woman who walked up and down the hallway all day muttering and gesturing but never tiring herself enough to sleep who looked closer to ninety than she did to her real age seventy who had four blue eyed daughters who were impossibly hard to keep straight they didn't wince at having to cut up her food and feed her with a spoon because they didn't know that just a few months before she'd been feeding herself just fine they didn't mind if she yelled through her shower because they knew she'd be calm afterwards soothed by the warm towel and the brush running through her bobbed hair arlene didn't have the old lady hair of the other women a northern house hers was a spine and straight as her many daughters through the looking glass of a disastrous fall followed dose of anti psychotic medication and the slow detox at seattle gero psych mom had slipped into the late stage of alzheimers outings were now too exhausting and overwhelming my sisters and i no longer got to play the role of liberators signing or out for family birthday parties or woks or restaurant meals now we were visitors we brought chocolate and photos and flowers from our gardens we emailed each other constantly comparing notes about when we planned to visit so that mom would have visitors on as many days as possible and then sending updates about how she was doing when we saw her i often came at lunch time because feeding her gave me something to do sometimes she was happy to see me other times she didn't seem to know me sometimes she liked it when i sat next to her on the couch and put my arm around her as if i was a teenage boy and she was my girlfriend sometimes she liked it when i sang songs the oldest songs i could think of songs i remembered her father singing like oh my darling clementine whether she was treating me like a daughter or a stranger on any particular day did not seem to have anything to do with how well she liked my cuddling or my laughable singing or the food i was feeding her she grew tired and cranky if i stayed too long at least that's what i told myself as i watched the clock tick while i saying talked spooned macaroni all the while feeling like some kind of desperate performance artist who just couldn't get the audience to wake up and was now counting the minutes until i could run from the stage hearing boxes without tops is sandals were for clementine maybe my sisters and i should have been so strict about not visiting on the same days but we knew that if we were there at the same time we would be tempted just to talk to each other and ignore mom and also that it would mean she might not get a visitor on another day northern house was not a quick drive for any of us twenty five or thirty minutes each way for carolyn or me an hour and a half each way for lisa or christy and we reasoned it was good for mom in a general sense if the staff knew that one of us might scroll in any old time what we didn't know was how much any of it mattered to mom there are so many kinds of loneliness there's the eerie isolation of being packed into a subway or walking down a crowded street where no one dares to make eye contact or the pressing in of the walls when you're alone in a new town and have no one to call but i've never felt as lonely in all my life as i did when i visited my mother at northern house to sit across the table from the person who was the very first person i loved the very first person to love me to try with all my might to will her eyes to meet mine and then to have to give up to accept her eyes not seeing me and then to have one meaning caregivers comment on how pretty early on looks today her lovely skin her clean white hair i wanted to shout who cares she's gone on can't you see that this is not arlene this is an old woman rag doll who we are all pretending i still a living person can't you see that the reason i have to leave the very minute the clock strikes the hour is not that i have so much work to do which is what i always say but because i have to get in my car and drive down the street until i'm out of your sight and then i can stop and let out this sob i've been strangling on for the last half hour this went on for four years each visit another downhill step another bit of bad news to report she won't stand up straight she won't stand up at all for years from walking and muttering to limp in mute in a wheelchair all connections between brain and muscles severed and during those four years the visits to mom were sandwiched between all the rest of my life just as they were for my sisters and for my brother when he visited from new jersey sandwiched sounds so easy a simple matter of tucking the ham in between the bread and the lettuce but it never was it was never easy to t unknown mood wrecker into the day to know that i was going to get up from my desk get in my car and drive into a wall again and then recover again like the world's most resilient crash test dummy it was never easy to do it not knowing how many months or years i was going to keep doing it which meant i couldn't have a big breakdown every time i just couldn't it wouldn't be fair to my husband or children or friends or work mates so i learned what i needed to do to smother the sadness and get on with the day i stopped for the sob down the block from northern house and then if i had time i did some transitional something between the visit with mom and having to function in the world of my daily life if i had time i went to third place books over the hill from northern house if i felt too wrecked to browse books i would browse magazines in their cafe over a bowl of soup a practice the store graciously allowed there were a few friends i could walk with or have lunch with immediately after visiting mom and i could either talk about her or not but there were many people i felt i could not see or talk to right after seeing her my dad and step mom for example they couldn't help being healthy  youthful it was irrational of me to think of their good fortune as somehow unfair but here they were flying back and forth to phoenix for their tennis and golf and sunshine while mom lived out her shredded life in northern house and here i was that old divorced scar tissue flaming up whenever dad asked how's arlene i knew it made no sense and yet it was true and yet it was true maybe all grave illnesses do this to families bring up old hurts inflame old wounds but all timers disease has its own particularly insidious torture methods one is the open ended miss of it there is no three months six months couple of years if you're lucky kind of diagnosis as you might get with cancer it could be a year or a decade or two decades mom's body was strong so i couldn't afford not to tamp down the sadness after my visits i had to conserve emotional energy another of alzheimers tortures is that once you're you've past a certain point you can no longer talk about it with the person who has it there's no crying together about the awfulness of fate there are no goodbyes if mom was raging against her illness somewhere deep inside we didn't know it she couldn't tell us i wondered often at northern house if she was raging if her pacing and muttering and later in the wheelchair her sudden bursts of incoherent agitation were her ways of trying to say why why can't you get me out of here out of this canyon this cavern why can't someone or something or some drug get in here and clear a path through my brain she was so helpless so lost watching her we were too lost and gone forever dreadful sorry clementine things thank you and we've brought some literature from the outside to prove that provides more detail about services available for a caregivers and their families and now i'd like to invite bob to tell us a bit more about those services and also give us some additional information about the new developments with the national alzheimer's plan act  we believe we are in the business of providing help and hope and we do that in a variety of ways we have a toll free help lying it's professionally staffed twenty four hours a day seven days a week and the folks at the other end of that line answer a variety of questions my husband can't seem to balance the checkbook anymore  i'm not sure what's going on my mom got lost on her way to the grocery store the other day she's been living in the same neighborhood shopping at the same store for thirty years we know something is wrong can you offer any suggestions on where we might go a doctor clinic to get some help my husband is so much bigger than i am i can't get him out of the bath tub what should i do our website contains a wealth of information resources referrals for care and support collin mentioned as did a on our support groups we work with over one hundred across our chapters service area for persons with dementia for their care partners for members of their family we have a number of specialized support groups we have fourteen now specifically for folks in the early stage of the disease and for us early stage means within the first six months of diagnosis so these support groups are open to both persons with dementia and their care partners we also have an expanded program for early stage couples they're really focused on social engagement one of my favorites is a partnership that we have a seattle park and rec every monday morning we have a group of early stage folks that walk the zoo together and they talk to the animals and then they go into the pavilion and talk to one another over coffee and pastries i' had an opportunity to to to walk the zoo with them on two different occasions and it's absolutely uplifting for me and more importantly for them you know on the walk with the animals with one another in the pavilion there's no dimension in the room they're talking about life they're talking about family they're talking about friendships and some of the friendships that are born in our support groups are so valuable and so wonderful and extend far beyond the support group monthly meetings we have a couple of online programs one of them is called all connect where folks get on the web  any hour of the day or night and connect with each other we have a peer to peer program so that folks who have been on their journeys with the disease for a while can connect to folks who are just starting and offer them a particular kind of support to kind of work against the particular loneliness that and described in that all folks with the disease and their care partners feel we have our connections program ongoing specialized care consultation for individuals and families often in their own homes often extending for a period of several months sometimes even longer because one of the challenges with all simers is it's a progressive disease and as the disease progresses needs dynamics challenges stresses change we offer community education for both family and professional caregivers we just offered our twenty ninth annual regional educational conference a couple of fridays ago at the convention center we had almost six hundred people many of them professionals but a good many family caregivers as well coming for some relevant evidence based dementia specific training and education and we're taking that show on the road we've done community conferences for family caregivers since the home ish county we did one in everett last fall and one in lynnwood last month we did our first community conference in burlington last fall for both family and professional caregivers and you know we would have been pleased to have thirty people show up we had one hundred seventeen it's reflective of not only the growing impact of the disease on more and more individuals and families and communities but on the need the interest the almost desperation for help for information for education for connections to other community resources we've had a very exciting time in of all places olympia just at the end of the last session the end of march governor inslee signed a bill that provides authorization for us to begin work on an all simers disease plan for washington state we were one of only six states that had even started work on the plan and what the plan will do is pull together all of the services and supports that are within the purview of state government to provide so we're very very excited about this we're going to begin work on the plan under the auspices of the department of social and health services in early september the also has association is the largest private funder of all simers research in the world over the last thirty years we've awarded more than three hundred million dollars in grants many to innovative projects offered by young researchers several of whom are part of the robust clinical and research community in the greater seattle area so we're involved and engaged in a lot of different ways to help the people we serve and also to simply make people aware that there is help and hope there is an alzheimer's association so with that i'd be happy to answer any questions you might have about about the disease is about the science about the association or the work we do here locally and he questions yes to great question  is a form of dementia it's actually the most prevalent form of dementia but there are probably still more than seventy different kinds of dementias if you think of of the match as a kind of an umbrella term  many folks are dealing with dimensions other than all timers vascular dementia which is often characterized by a series of small strokes l body dementia frontotemporal dementia oftentimes people are dealing with more than one kind of dementia so it's a it's a pretty complex path ology but that's that's the important my aunt my mother's sister back in the eighty's was diagnosed with heart in the arteries because they didn't know what else to call it my mother in the ninety's was diagnosed with dementia she was never diagnosed specifically with all simers my father was diagnosed fourteen years ago with alzheimer's so the science of the disease and the tools for diagnosis and detection have really advanced significantly in the last twenty to twenty five years but it was either hardening of the arteries or senility back in the day well we're learning a lot more about the hereditary predisposition to the disease it in a relative sense it it occurs in the minority but it can have a devastating effect on on individual families we have a wonderful volunteer partner an advocate m marquez who was diagnosed about four years ago she is one of five five siblings four of the five have been diagnosed her father was one of fourteen and nine of the fourteen died of alzheimer's so one of the things that is coming into sharper focus around the genetic predisposition to the  disease is how to really work with these families miriam and others are part of a research project that was funded by the all simers association called the diane study the dominantly inherited awls homer's network and this is a group of families from around the country who are part of the study miriam goes down to u c l a med center every spring for a battery of tests to track the progression of the disease and also the efficacy of the treatment so we're learning more about the causes of the disease certainly about about these genetic anomalies that can dramatically increase an individual's risk so you have of course the first thing to say is that is that no two cases are alike even within a family so trying to generalize about the impact of a particular treatment protocol or a particular drug is very difficult the good news is we have over one hundred drugs in various stages of clinical trials right now and some of them are progressing were cautiously optimistic there are some challenges around the clinical trials process so first of all they take a very long time second they're very expensive and third often they're difficult to populate  we launched a new online tool about three years ago now called trial match where an individual can go online and complete of profile and talk with one of our counselors and  matched to an existing clinical trial or trials obviously the process of moving the trials forward is slowed even more if we can't find enough viable candidates to participate  the other thing that we're learning and it's such a simple thing is that how you live really can make a difference the lifestyle choices that you make what you eat and i always look around for my wife because i'm going to tell you how important it is to eat vegetables but she can never hear me say that because i don't eat them at home you're diets remaining active mentally active physically active socially active you're not going to prevent or cure the disease but what you could very likely do is prolong quality of life for a longer period of time and for folks with this disease buying time is a very important part of the equation so the lifestyle choices that really all of us can make and should make even if we never develop alzheimer's one of the clichs in this line of thought is if it's good for the heart it's good for the brain yes oh my gosh yes collin offered collen offered some statistics we  believe that there are currently about one hundred fifty thousand washingtonians living with either all simers or an another form of dementia there you go the other the other the other part of the yeah that's about right it's a little bit about five point four million but the other thing that's important about it is that is our projections and the impact of the disease on the families so on average there are three caregivers for every person with dementia and most of them are unpaid family members so that means we're talking about roughly three hundred fifty thousand of us that are taking care of loved ones right now with a disease that's a total of a half million people that number is projected to triple by mid century so we really do have a public health epidemic the other thing that's important about this is also timers is also the most expensive disease in america if you look at it in turn those of you who have been involved this caregivers can certainly appreciate this if you look at it in terms of the cost to the federal government the cost of caring for all timers this year is about two hundred  twenty five for but billion with a b one hundred fifty of that is direct medicare and medicaid costs so in the current year in medicare dollars it costs three times more to care for someone with alzheimer's than it does for someone with any other chronic disease in medicaid dollars which is where the focus is really a long term care that ratio is nineteen to one so in very simple economic terms allstars disease in and of itself will bankrupt our health care system by mid century we estimate by mid century the annual cost of caring for all timers in this country exceed one point two trillion dollars well you're absolutely right although it's one of the encouraging signs is the pace at which the science is advancing what what will what will allow us to continue that pace though this is the other part of the funding issue for for every dollar the federal government spends on all timers care they currently invest two and a half cents on all timers research it actually is and if you and here's the other cause and effect if you look at annual federal funding for chronic disease research in the current funding cycle there's over five billion dollars dedicated to cancer research there's about three billion dollars elec headed to hiv aids research there's about two point two billion going to cardiovascular disease research here's the good news when that kind of commitment is made to chronic disease research we're seeing declining death rates in several cancers declining death rates in cardiovascular disease declining death rates and hiv aids so sustained significant investment in research makes a difference the issue for us with all timers disease right now is is we're getting less than six hundred million dollars dedicated all cyrus disease research in the current funding cycle through the national institutes of health that has to change and we're not suggesting it's a zero sum game we're we're not arguing that money be pulled out of cardiovascular disease research so it could be invested and also  research but we've got to we've got to find the mechanism to draw it to drive more money to all sectors research yeah i think i don't yeah i don't get i can't i can't answer that broadly i can't say kind of answer in a roundabout way one of the things that is most important to us is connecting with people sooner rather than later in the disease process so that the person with the disease can actually have a voice and articulate his or her wishes about his or her future yeah there's actually a wonderful new document that was drawn by some local folks at seattle university that is a comprehensive medical power of attorney for folks with dementia and it addresses in great detail a lot of really important issues it is it's a it's a it's a global public health epidemic really it is it's fascinating to see though how it's approached in other countries there are some extraordinary models being developed in europe around what we like to think of as dementia capable dementia friendly communities that will that really will allow people with the disease to stay at home stay in the community longer there are also some some really interesting things in terms of different cultures you know we used to hear for many years that there's no also hires in india there's no all simers in pakistan and it's because they what are in their culture far more inclined to to take care of their own in their homes and not come forward and and ask for help and seek information but this is a this is a global epidemic and it is growing at approximately the same pace across the globe as it is here home well there are and there is certainly research focused in certain areas we talked about the genetics of the disease it has long been widely held that the disease is caused by the accumulation of plaques and tangles in the brain and and one of the breakthroughs in terms of research is is a dye that was actually developed at the all simers disease research center at the university of pittsburgh a few years ago and it's a dye that can be injected into the bloodstream and when it gets into the brain into fixes itself to the plaques and tangles and so  through a series of tests over a period of time you can actually track the progression of the disease in terms of the continuing growth of the plaques and tangles in the brain you can also again use this as a way of tracking the efficacy of the treatments pharmacological and otherwise it's not widely available because it's quite expensive at this point but it but it is an example of how the research is really moving in the right direction  and fairly quickly a tangle is yeah it's just a tangle like your ponytail on a bad day of neurons in the in the brain yeah and  the thing about all simers which is unique among the dementia is is is that what all timers does over time is it is kill brain cells and when it's killed a sufficient number of brain cells the person with the disease loses the ability to do certain basic things and mentioned you know the the deterioration in her mom to the point where she she couldn't stand up one of the last things that happened in this was my father died a month ago and he couldn't swallow he in women yeah right now if you're a woman if you're a woman in america age six year old or your chances of developing all simers are twice that of developing breast cancer well it is it is for both men and women yeah yeah there's also some some significance attached to the prevalence it's far greater in respect all simers and particularly for caregivers and caregivers are really a focus of our work because it is it is so very very stressful for those of you who have been caregivers you know what this is like and far too often it's the caregiver who is the first to die you know one one of i think the hand outs and we have in the back is called know the ten signs and it'll it'll just give you some examples and without being flip if everybody loses their car keys if you don't know what to do with them when you find them or you find them in the freezer  may be a sign of something more serious and what you need to do then is go talk to your doctor and if he's not able to give you the that you need ask him to refer you to someone who can and if he can't do that call our help line yes you know in terms that we were talking about lifestyle and things that you can do i write i think writing things down keeping a journal a lot of the folks that we work with who are living with the disease in the early stages are avid journalists  and writers and poets we have a couple of of wonderful early stage individuals who are poets one of them one coles actually had a book of his poetry published recently so it's about staying in gauged in ways that that that that feel good but that also challenge you a bit some of them are pretty simple if you're right handed try doing things left handed for oh yeah yes i would say i would say overall the curve is going up if you're age sixty five in america well but i'll get right to it if you're a sixty five in america your chances of getting all timers are  if you're eighty five your chances are almost one in two so age is a certainly a relevant predictor of the disease but it's not that simple there first of all the fastest growing cohort in our population is eighty five and older people are living longer so more of them are going to live in to their eighty's and not develop alzheimer's you can develop alzheimer's much earlier in life we work with a number of people colleen mentioned linda was was diagnosed at age fifty one or at least started showing signs of the disease at age fifty one we we lost a dear friend just the other day who was diagnosed i think in her forty's also we're learning more about the likelihood that people may have the disease for years before any symptoms manifest so it's complicated me my my father was ninety eight and with the exception of his hearing loss which is actually quite profound he was really good health and he he lived for over fourteen years after diagnosis but about i know that he had the disease in fact i my my mom lives for about fourteen years after her diagnosis and my father you know mom died about six weeks before their sixty second wedding anniversary and pop was by god going to take care of her i know that had to have exacerbated the progression of the disease in him but at the time i think i really thought it was the stress of of caring for her you know every waking moment every ounce of energy and and if he lost a word or a thought it was easy for me to say well who wouldn't be forgetful you know with the stress that he's living under so but you're right and one of the ironies is it we're seeing that often when the disease is it manifests and is diagnosed in someone younger it progresses more quickly that we've worked with families where  the spouse is taking care of husband or wife for over twenty years with i can't say much really to your vegetables but really i can't say much for to reasons again every diseases treatments be easier to say if this isn't working maybe you should try that i will say that a whole mark of the of the funding for research that they also have is a cessation does we really do look for those innovative projects that are sort of in the gaps not necessarily in the main mainstream with the really popular prevalent theories around the disease and we look for those other opportunities that are very legitimate and very promising but but are getting funding otherwise project is an example of that and this is a relatively new development in the science we thought for years and years and years that once you reach a certain age you couldn't generate new cells and the reality is you can't in your brain  all right anything else and the other questions or comments thank you very much you've offered some great questions you certainly kept me mentally engage