Bad year to be a celebrity: Walter Cronkite dies of unclear causes

Another celebrity, Walter Cronkite, dies of nee urological causes.

While we are all saddened for his family, the death of this 92 year-old (I believe, right-handed) white man, allows us to discuss major neurological issues.


This will, hopefully, raise several advocacy issues:

1. In most reports, it states that he died of cerebrovascular disease (some have termed it cerebral vascular disease), while it seems that according to his son, he died from complications of dementia.

So, how do we reconcile these two possibilities?

Cerebrovascular means that it affects the vasculature of the cerebrum (brain), just as cardiovascular means that it affects the vasculature of the heart.

A CVA (cerebrovascular "accident") is also called a stroke (it is sometimes called a brain attack -- to emphasize its urgency, much like a heart attack). Stroke is the third most common cause of death in the United States and is usually ischemic in nature. Ischemic strokes are caused by a process that reduces blood flow (and hence oxygen and other nutrients) to an area of the brain. This can be caused by thinning of the diameter of the arteries (and other blood vessels) where blood can flow through, caused by atherosclerosis (often because of cholesterol build up), blockage from a clot originating in the heart or other blood vessels (usually arteries, but sometimes from veins through a patent foramen ovale). Less commonly, a stroke also means bleeding in the brain (hemorrhagic stroke). This may be caused by high blood pressure (hypertension), cocaine use or a disease called cerebral amyloidosis (cerebral amyloid angiopathy).

Bleeding in the brain is much more fatal than ischemic strokes. if a patient survives the initial stroke, the chances are that they will not die directly from the stroke (but can from its complications -- such as swallowing difficulties, leading to food going down the breathing tubes and causing infection).

As the baby-boomers age, dementia is becoming a growing epidemic and is set to be a major public health crisis. Dementia (memory loss) may lead to complications, such as infections medication side effects and, most alarmingly, abuse by caretakers.


We do know that "Uncle Walter" was ill at least a month prior to his death on Friday night July 17th, 2009, because of the various reports (which were denied by his aide at the time and CBS gave "no comment" -- isn't that a comment in itself?) and by Katie Couric's recent statement reflecting that.


So, how do reconcile his family's statement and the overwhelming reports by online pundit/bloggers/writers?

There are several possibilities:

1. Someone is reporting inaccurately (the Anchorman would not be proud)
2. He had vascular (multi-infarct dementia)
3. He had cerebral amyloidosis


Multi-infarct dementia is a process whereby serial small strokes lead to a step-wise decline in memory (dementia). Just like Multiple Sclerosis (MS), strokes can happen in different parts of the brain and this may lead to memory difficulties (although the cognitive problems in MS are different from those in multi-infarct dementia).

Cerebral amyloidosis or cerebral amyloid angiopathy is a pathological process where amyloid gets deposited in brain, and can lead to bleeding in the brain (a form of cerebrovascular disease) and dementia.

[For more information on stroke and dementia, please visit http://www.neurologique.org/ and my National Library of Medicine reviews of these topics (go to "Links" section of website.]


2. Walter Cronkite received individualized care at his home. This sort of care will personalized not be possible through the nationalized healthcare system (if healthcare reform goes through). Instead of bringing doctors and their patients closer together, this reform will turn medicine further into an industry and remove the Art of Medicine. As doctors are rushed even more to see more and more patients in less and less time, the relationship and partnership between doctor and patient will further erode (this is why we offer housecalls).


Hopefully, even in death, Walter Cronkite can inspire all of us to reach for the stars (as he cared for the space missions so much) and advocate for improvements (not financial or political programs) in the quality of life of all Americans.



--
Daniel Kantor, MD BSE
Medical Director
Neurologique

info@neurologique.org