While our genes can't be changed easily, you can avoid some dementia risk factors. Today we discuss dementia and five drugs that may increase risk.

Memory loss appears to come with age, but we're not talking about forgetfulness. Sometimes losing your car keys isn't an indication of dementia. Dementia impairs the capacity to think, remember, or make judgments. Dementia hinders daily tasks.

Alzheimers is the most common dementia. Dementia is not normal aging, unlike forgetfulness. Aging increases the risk of Alzheimer's and other dementias. A family history of the illness increases your risk, according to the Mayo Clinic (USA).

Given that our genes are difficult to change (I won't get into epigenetics), what are some avoidable dementia risk factors? Certain drugs may cause cognitive deterioration.

Today we look at four drugs that may cause cognitive decline.

Dementia and benzodiazepines

Benzodiazepine sedatives increase brain GABA levels. Example benzodiazepines:

• Diazepam (Valium) (Valium)

• Alprazolam (Xanax) (Xanax)

• Clonazepam (Klonopin) (Klonopin)

Addiction and overdose are benzodiazepine risks. Yes! These medications don't raise dementia risk.

USC study: Benzodiazepines don't increase dementia risk in older adults.

Benzodiazepines can produce short- and long-term amnesia. This memory loss hinders memory formation. Extreme cases can permanently impair learning and memory. Anterograde amnesia is uncommon.

2. Statins and dementia

Statins reduce cholesterol. They prevent a cholesterol-making chemical. Examples:

• Atorvastatin (Lipitor) (Lipitor)

• Fluvastatin (Lescol XL) (Lescol XL)

• Lovastatin (Altoprev) (Altoprev)

• Pitavastatin (Livalo, Zypitamag) (Livalo, Zypitamag)

• Pravastatin (Pravachol) (Pravachol)

• Rosuvastatin (Crestor, Ezallor) (Crestor, Ezallor)

• Simvastatin (Zocor) (Zocor)

This finding is contentious. Harvard's Brigham and Womens Hospital's Dr. Joann Manson says:

“I think that the relationship between statins and cognitive function remains controversial. There’s still not a clear conclusion whether they help to prevent dementia or Alzheimer’s disease, have neutral effects, or increase risk.”

This one's off the dementia list.

3. Dementia and anticholinergic drugs

Anticholinergic drugs treat many conditions, including urine incontinence. Drugs inhibit acetylcholine (a brain chemical that helps send messages between cells). Acetylcholine blockers cause drowsiness, disorientation, and memory loss.

First-generation antihistamines, tricyclic antidepressants, and overactive bladder antimuscarinics are common anticholinergics among the elderly.

Anticholinergic drugs may cause dementia. One study found that taking anticholinergics for three years or more increased the risk of dementia by 1.54 times compared to three months or less. After stopping the medicine, the danger may continue.

4. Drugs for Parkinson's disease and dementia

Cleveland Clinic (USA) on Parkinson's:

Parkinson's disease causes age-related brain degeneration. It causes delayed movements, tremors, and balance issues. Some are inherited, but most are unknown. There are various treatment options, but no cure.

Parkinson's medications can cause memory loss, confusion, delusions, and obsessive behaviors. The drug's effects on dopamine cause these issues.

A 2019 JAMA Internal Medicine study found powerful anticholinergic medications enhance dementia risk.

Those who took anticholinergics had a 1.5 times higher chance of dementia. Individuals taking antidepressants, antipsychotic drugs, anti-Parkinson’s drugs, overactive bladder drugs, and anti-epileptic drugs had the greatest risk of dementia.

Anticholinergic medicines can lessen Parkinson's-related tremors, but they slow cognitive ability. Anticholinergics can cause disorientation and hallucinations in those over 70.

5. Antiepileptic drugs and dementia

The risk of dementia from anti-seizure drugs varies with drugs. Levetiracetam (Keppra) improves Alzheimer's cognition.

One study linked different anti-seizure medications to dementia. Anti-epileptic medicines increased the risk of Alzheimer's disease by 1.15 times in the Finnish sample and 1.3 times in the German population. Depakote, Topamax are drugs.

SpaceX's Starship.

Launched last week.

Four minutes in:

SpaceX will succeed. When it does, its massiveness will matter.

Its payload will revolutionize space economics.

Civilization will shift.

We don't yet understand how this will affect space and Earth culture. Grab it.

The Cost of Space Transportation Has Decreased Exponentially

Space launches have increased dramatically in recent years.

We mostly send items to LEO, the green area below:

SpaceX's reusable rockets can send these things to LEO. Each may launch dozens of payloads into space.

With all these launches, we're sending more than simply things to space. Volume and mass. Since the 1980s, launching a kilogram of payload to LEO has become cheaper:

One kilogram in a large rocket cost over $75,000 in the 1980s. Carrying one astronaut cost nearly $5M! Falcon Heavy's $1,500/kg price is 50 times lower. SpaceX's larger, reusable rockets are amazing.

SpaceX's Starship rocket will continue. It can carry over 100 tons to LEO, 50% more than the current Falcon heavy. Thousands of launches per year. Elon Musk predicts Falcon Heavy's $1,500/kg cost will plummet to $100 in 23 years.

In context:

People underestimate this.

2. The Benefits of Affordable Transportation

Compare Earth's transportation costs:

It's no surprise that the US and Northern Europe are the wealthiest and have the most navigable interior waterways.

So what? since sea transportation is cheaper than land. Inland waterways are even better than sea transportation since weather is less of an issue, currents can be controlled, and rivers serve two banks instead of one for coastal transportation.

In France, because population density follows river systems, rivers are valuable. Cheap transportation brought people and money to rivers, especially their confluences.

How come? Why were humans surrounding rivers?

Imagine selling meat for $10 per kilogram. Transporting one kg one kilometer costs $1. Your margin decreases $1 each kilometer. You can only ship 10 kilometers. For example, you can only trade with four cities:

If instead, your cost of transportation is half, what happens? It costs you $0.5 per km. You now have higher margins with each city you traded with. More importantly, you can reach 20-km markets.

However, 2x distance 4x surface! You can now trade with sixteen cities instead of four! Metcalfe's law states that a network's value increases with its nodes squared. Since now sixteen cities can connect to yours. Each city now has sixteen connections! They get affluent and can afford more meat.

Rivers lower travel costs, connecting many cities, which can trade more, get wealthy, and buy more.

The right network is worth at least an order of magnitude more than the left! The cheaper the transport, the more trade at a lower cost, the more income generated, the more that wealth can be reinvested in better canals, bridges, and roads, and the wealth grows even more.

Throughout history. Rome was established around cheap Mediterranean transit and preoccupied with cutting overland transportation costs with their famous roadways. Communications restricted their empire.

The Egyptians lived around the Nile, the Vikings around the North Sea, early Japan around the Seto Inland Sea, and China started canals in the 5th century BC.

Transportation costs shaped empires.Starship is lowering new-world transit expenses. What's possible?

3. Change Organizations, Change Companies, Change the World

Starship is a conveyor belt to LEO. A new world of opportunity opens up as transportation prices drop 100x in a decade.

Satellite engineers have spent decades shedding milligrams. Weight influenced every decision: pricing structure, volumes to be sent, material selections, power sources, thermal protection, guiding, navigation, and control software. Weight was everything in the mission. To pack as much science into every millimeter, NASA missions had to be miniaturized. Engineers were indoctrinated against mass.

No way.

Starship is not constrained by any space mission, robotic or crewed.

Starship obliterates the mass constraint and every last vestige of cultural baggage it has gouged into the minds of spacecraft designers. A dollar spent on mass optimization no longer buys a dollar saved on launch cost. It buys nothing. It is time to raise the scope of our ambition and think much bigger. — Casey Handmer, Starship is still not understood

A Tesla Roadster in space makes more sense.

It went beyond bad PR. It told the industry: Did you care about every microgram? No more. My rockets are big enough to send a Tesla without noticing. Industry watchers should have noticed.

Most didn’t. Artemis is a global mission to send astronauts to the Moon and build a base. Artemis uses disposable Space Launch System rockets. Instead of sending two or three dinky 10-ton crew habitats over the next decade, Starship might deliver 100x as much cargo and create a base for 1,000 astronauts in a year or two. Why not? Because Artemis remains in a pre-Starship paradigm where each kilogram costs a million dollars and we must aggressively descope our objective.

Space agencies can deliver 100x more payload to space for the same budget with 100x lower costs and 100x higher transportation volumes. How can space economy saturate this new supply?

Before Starship, NASA supplied heavy equipment for Moon base construction. After Starship, Caterpillar and Deere may space-qualify their products with little alterations. Instead than waiting decades for NASA engineers to catch up, we could send people to build a space outpost with John Deere equipment in a few years.

History is littered with the wreckage of former industrial titans that underestimated the impact of new technology and overestimated their ability to adapt: Blockbuster, Motorola, Kodak, Nokia, RIM, Xerox, Yahoo, IBM, Atari, Sears, Hitachi, Polaroid, Toshiba, HP, Palm, Sony, PanAm, Sega, Netscape, Compaq, GM… — Casey Handmer, Starship is still not understood

Everyone saw it coming, but senior management failed to realize that adaption would involve moving beyond their established business practice. Others will if they don't.

4. The Starship Possibilities

It's Starlink.

SpaceX invented affordable cargo space and grasped its implications first. How can we use all this inexpensive cargo nobody knows how to use?

Satellite communications seemed like the best way to capitalize on it. They tried. Starlink, designed by SpaceX, provides fast, dependable Internet worldwide. Beaming information down is often cheaper than cable. Already profitable.

Starlink is one use for all this cheap cargo space. Many more. The longer firms ignore the opportunity, the more SpaceX will acquire.

What are these chances?

Satellite imagery is outdated and lacks detail. We can improve greatly. Synthetic aperture radar can take beautiful shots like this:

Have you ever used Google Maps and thought, "I want to see this in more detail"? What if I could view Earth live? What if we could livestream an infrared image of Earth?

We could launch hundreds of satellites with such mind-blowing visual precision of the Earth that we would dramatically improve the accuracy of our meteorological models; our agriculture; where crime is happening; where poachers are operating in the savannah; climate change; and who is moving military personnel where. Is that useful?

What if we could see Earth in real time? That affects businesses? That changes society?

Believe what you see, what people say

It’s sad that we never get trained to leave assumptions behind. - Sebastian Thrun

Many problems in software development are not because of code but because developers create the wrong software. This isn't rare because software is emergent and most individuals only realize what they want after it's built.

Inquisitive developers who pass the yellow cat test can improve the process.

Carpenters measure twice and cut the wood once. Developers are rarely so careful.

The Yellow Cat Test

Game of Thrones made dragons cool again, so I am reading The Game of Thrones book.

The yellow cat exam is from Syrio Forel, Arya Stark's fencing instructor.

Syrio tells Arya he'll strike left when fencing. He hits her after she dodges left. Arya says “you lied”. Syrio says his words lied, but his eyes and arm told the truth.

Arya learns how Syrio became Bravos' first sword.

“On the day I am speaking of, the first sword was newly dead, and the Sealord sent for me. Many bravos had come to him, and as many had been sent away, none could say why. When I came into his presence, he was seated, and in his lap was a fat yellow cat. He told me that one of his captains had brought the beast to him, from an island beyond the sunrise. ‘Have you ever seen her like?’ he asked of me.

“And to him I said, ‘Each night in the alleys of Braavos I see a thousand like him,’ and the Sealord laughed, and that day I was named the first sword.”

Arya screwed up her face. “I don’t understand.”

Syrio clicked his teeth together. “The cat was an ordinary cat, no more. The others expected a fabulous beast, so that is what they saw. How large it was, they said. It was no larger than any other cat, only fat from indolence, for the Sealord fed it from his own table. What curious small ears, they said. Its ears had been chewed away in kitten fights. And it was plainly a tomcat, yet the Sealord said ‘her,’ and that is what the others saw. Are you hearing?” Reddit discussion.

Development teams should not believe what they are told.

We created an appointment booking system. We thought it was an appointment-booking system. Later, we realized the software's purpose was to book the right people for appointments and discourage the unneeded ones.

The first 3 months of the project had half-correct requirements and software understanding.

Open your eyes

“Open your eyes is all that is needed. The heart lies and the head plays tricks with us, but the eyes see true. Look with your eyes, hear with your ears. Taste with your mouth. Smell with your nose. Feel with your skin. Then comes the thinking afterwards, and in that way, knowing the truth” Syrio Ferel

We must see what exists, not what individuals tell the development team or how developers think the software should work. Initial criteria cover 50/70% and change.

Developers build assumptions problems by assuming how software should work. Developers must quickly explain assumptions.

When a development team's assumptions are inaccurate, they must alter the code, DevOps, documentation, and tests.

It’s always faster and easier to fix requirements before code is written.

First-draft requirements can be based on old software. Development teams must grasp corporate goals and consider needs from many angles.

Testers help rethink requirements. They look at how software requirements shouldn't operate.

Technical features and benefits might misdirect software projects.

The initiatives that focused on technological possibilities developed hard-to-use software that needed extensive rewriting following user testing.

Software development

High-level criteria are different from detailed ones.

• The interpretation of words determines their meaning.

• Presentations are lofty, upbeat, and prejudiced.

• People's perceptions may be unclear, incorrect, or just based on one perspective (half the story)

• Developers can be misled by requirements, circumstances, people, plans, diagrams, designs, documentation, and many other things.

Developers receive misinformation, misunderstandings, and wrong assumptions. The development team must avoid building software with erroneous specifications.

Once code and software are written, the development team changes and fixes them.

Developers create software with incomplete information, they need to fill in the blanks to create the complete picture.

Conclusion

Yellow cats are often inaccurate when communicating requirements.

Before writing code, clarify requirements, assumptions, etc.

Everyone will pressure the development team to generate code rapidly, but this will slow down development.

Code changes are harder than requirements.

Startup entrepreneurs assume what risks when pitching?

Last week I signed four NDAs.

Four!

NDA stands for non-disclosure agreement. A legal document given to someone receiving confidential information. By signing, the person pledges not to share the information for a certain time. If they do, they may be in breach of contract and face legal action.

Companies use NDAs to protect trade secrets and confidential internal information from employees and contractors. Appropriate. If you manage a huge, successful firm, you don't want your employees selling their information to your competitors. To be true, business NDAs don't always prevent corporate espionage, but they usually make employees and contractors think twice before sharing.

I understand employee and contractor NDAs, but I wasn't asked to sign one. I counsel entrepreneurs, thus the NDAs I signed last week were from startups that wanted my feedback on their concepts.

I’m not a startup investor. I give startup guidance online. Despite that, four entrepreneurs thought their company ideas were so important they wanted me to sign a generically written legal form they probably acquired from a shady, spam-filled legal templates website before we could chat.

False. One company tried to get me to sign their NDA a few days after our conversation. I gently rejected, but their tenacity encouraged me. I considered sending retroactive NDAs to everyone I've ever talked to about one of my startups in case they establish a successful company based on something I said.

Two of the other three NDAs were from nearly identical companies. Good thing I didn't sign an NDA for the first one, else they may have sued me for talking to the second one as though I control the firms people pitch me.

I wasn't talking to the fourth NDA company. Instead, I received an unsolicited email from someone who wanted comments on their fundraising pitch deck but required me to sign an NDA before sending it.

That's right, before I could read a random Internet stranger's unsolicited pitch deck, I had to sign his NDA, potentially limiting my ability to discuss what was in it.

You should understand. Advisors, mentors, investors, etc. talk to hundreds of businesses each year. They cannot manage all the companies they deal with, thus they cannot risk legal trouble by talking to someone. Well, if I signed NDAs for all the startups I spoke with, half of the 300+ articles I've written on Medium over the past several years could get me sued into the next century because I've undoubtedly addressed topics in my articles that I discussed with them.

The four NDAs I received last week are part of a recent trend of entrepreneurs sending out NDAs before meetings, despite the practical and legal issues. They act like asking someone to sign away their right to talk about all they see and hear in a day is as straightforward as asking for a glass of water.

Given this inflow of NDAs, I wanted to briefly remind entrepreneurs reading this blog about the merits and cons of requesting investors (or others in the startup ecosystem) to sign your NDA.

Benefits of having investors sign your NDA include:

None. Zero. Nothing.

Disadvantages of requesting investor NDAs:

• You'll come off as an amateur who has no idea what it takes to launch a successful firm.

• Investors won't trust you with their money since you appear to be a complete amateur.

• Printing NDAs will be a waste of paper because no genuine entrepreneur will ever sign one.

I apologize for missing any cons. Please leave your remarks.

How to reframe irritation and go forward

“… before you can figure out where you are going, you need to know where you are, and once you know and accept where you are, you can design your way to where you want to be.” — Bill Burnett and Dave Evans

“You’ve been here before. But there are some new ingredients this time. What can tell yourself that will make you understand that now isn’t just like last year? That there’s something new in this August.”

My coach paused. I sighed, inhaled deeply, and considered her question.

What could I say? I simply needed a plan from her so everything would fall into place and I could be the happy, successful person I want to be.

Time passed. My mind was exhausted from running all morning, all summer, or the last five years, searching for what to do next and how to get there.

Calmer, I remembered that my coach's inquiry had benefited me throughout the summer. The month before our call, I read Designing Your Work Life — How to Thrive and Change and Find Happiness at Work from Standford University’s Bill Burnett and Dave Evans.

A passage in their book felt like a lifeline: “We have something important to say to you: Wherever you are in your work life, whatever job you are doing, it’s good enough. For now. Not forever. For now.”

As I remembered this book on the coaching call, I wondered if I could embrace where I am in August and say my job life is good enough for now. Only temporarily.

I've done that since. I'm getting unstuck.

Here's how you can take the first step in any area where you feel stuck.

How to acquire the perspective of "Good enough for now" for yourself

We’ve all heard the advice to just make the best of a bad situation. That´s not bad advice, but if you only make the best of a bad situation, you are still in a bad situation. It doesn’t get to the root of the problem or offer an opportunity to change the situation. You’re more cheerfully navigating lousiness, which is an improvement, but not much of one and rather hard to sustain over time.” — Bill Burnett and Dave Evans

Reframing Burnett at Evans says good enough for now is the key to being happier at work. Because, as they write, a designer always has options.

Choosing to believe things are good enough for now is liberating. It helps us feel less victimized and less judged. Accepting our situation helps us become unstuck.

Let's break down the process, which designers call constructing your way ahead, into steps you can take today.

Writing helps get started. First, write down your challenge and why it's essential to you. If pen and paper help, try this strategy:

• Make the decision to accept the circumstance as it is. Designers always begin by acknowledging the truth of the situation. You now refrain from passing judgment. Instead, you simply describe the situation as accurately as you can. This frees us from negative thought patterns that prevent us from seeing the big picture and instead keep us in a tunnel of negativity.

• Look for a reframing right now. Begin with good enough for the moment. Take note of how your body feels as a result. Tell yourself repeatedly that whatever is occurring is sufficient for the time being. Not always, but just now. If you want to, you can even put it in writing and repeatedly breathe it in, almost like a mantra.

• You can select a reframe that is more relevant to your situation once you've decided that you're good enough for now and have allowed yourself to believe it. Try to find another perspective that is possible, for instance, if you feel unappreciated at work and your perspective of I need to use and be recognized for all my new skills in my job is making you sad and making you want to resign. For instance, I can learn from others at work and occasionally put my new abilities to use.

• After that, leave your mind and act in accordance with your new perspective. Utilize the designer's bias for action to test something out and create a prototype that you can learn from. Your beginning point for creating experiences that will support the new viewpoint derived from the aforementioned point is the new perspective itself. By doing this, you recognize a circumstance at work where you can provide value to yourself or your workplace and then take appropriate action. Send two or three coworkers from whom you wish to learn anything an email, for instance, asking them to get together for coffee or a talk.

Choose tiny, doable actions. You prioritize them at work.

Let's assume you're feeling disconnected at work, so you make a list of folks you may visit each morning or invite to lunch. If you're feeling unmotivated and tired, take a daily walk and treat yourself to a decent coffee.

This may be plenty for now. If you want to take this procedure further, use Burnett and Evans' internet tools and frameworks.

Developing the daily practice of reframing

“We’re not discontented kids in the backseat of the family minivan, but how many of us live our lives, especially our work lives, as if we are?” — Bill Burnett and Dave Evans

I choose the good enough for me perspective every day, often. No quick fix. Am a failing? Maybe a little bit, but I like to think of it more as building muscle.

This way, every time I tell myself it's ok, I hear you. For now, that muscle gets stronger.

Hopefully, reframing will become so natural for us that it will become a habit, and not a technique anymore.

If you feel like you’re stuck in your career or at work, the reframe of Good enough, for now, might be valuable, so just go ahead and try it out right now.

And while you’re playing with this, why not think of other areas of your life too, like your relationships, where you live — even your writing, and see if you can feel a shift?