With just $3 million in assets, two employees, no ATM, no website, and no transaction fees, Kentland Federal Savings and Loan is the smallest bank in America, and it’s been around for over 100 years.

You’ve most likely heard of America’s banking giants – JPMorgan Chase, Morgan Stanley, Citigroup, Wells Fargo, and the Bank of America – but what about the smallest fish in the pond, so to speak? Well, at the opposite end, we have Kentland Federal Savings and Loan, officially the smallest bank in the United States of America. Founded back in 1920, by the great-grandfather of its current CEO, this tiny financial institution has only ever had one branch in Kentland, Indiana, and has only offered three services – obtaining a home mortgage, opening a savings account, and opening a certificate of deposit.

“We were the only institution that didn’t close during the stock exchange debacle in the late 1920s,” CEO James A. Sammons told Bloomberg. “People felt secure that their money wasn’t going anywhere.”

But the banking climate in America has changed in the last century, so Kentland Federal Savings and Loan is like looking back in time. Both CEO Sammons and his part-time teller are technology-averse and prefer using mechanical devices like a traditional coding machine to write checks. It is one of the reasons that Sammons believes that his way of doing business might end with him.

“When I am finished—whether it’s regulators pressuring us to be absorbed or me walking away—we will have to be acquired,” the 55-year-old CEO said.

Another reason for the impending demise of the Kentland Federal Savings and Loan is the small profit margins practiced by America’s smallest bank. It has managed to beat the local competition with slightly better rates on savings accounts and mortgages, but this is the only source of income, because the bank does not have ATM fees, no wire fees and no transaction fees of any kind.

Oddity Central

We have all heard the saying, “age is just a number,” but could there be some truth to the idea that certain ages are associated with peak physical attractiveness? According to recent studies, the answer is yes. Scientists have pinpointed the age at which people are considered the most physically attractive, and the results may surprise you.

Physical attractiveness is a subjective and ever-changing concept, but according to recent research, there may be a specific age when people are considered most attractive. Experts in the field have weighed in with their findings.

Age 30!

According to a study conducted by Allure magazine by surveying 2,000 Americans, women are perceived as most beautiful at the age of 30. However, they start showing signs of ageing by the age of 41 and are no longer considered sexy by the time they turn 53. Finally, they are generally regarded as ‘old’ once they hit 55 years of age.

A study published in the journal “Evolution and Human Behavior” found that men and women are considered most attractive in their late teens and early twenties. In addition, the study surveyed a diverse group of individuals from various cultures and backgrounds and found a consensus that people in this age range were considered the most attractive. This is due to the peak of physical maturity and youth-associated cues such as smooth skin, clear complexion, and symmetrical features.

Another study published in the journal “Psychological Science” found that attractiveness also peaks in a person’s early 30s. In addition, the study found that people in their 30s were considered more attractive than those in their 20s or 40s due to the youthful characteristics and the experience and confidence that comes with age.

Frenz Hub

Nigeria’s oil production fell below the one million mark in April 2023.

The production figure fell to 998,602 barrels per day (bpd), a 21.26 percent decline compared to March, when output was 1,268,202 bpd.

The Nigerian Upstream Petroleum Regulatory Commission (NUPRC) disclosed this in its latest crude oil and condensate production data for April 2023.

The volume of production is at its lowest point in the last seven months.

In the previous year, oil production fell below one million bpd in August and September owing to several issues, including oil theft.

According to the NUPRC report, oil production decreased from 1.517 million bpd in March 2023 to 1.245 million bpd in April 2023, with the addition of condensate.

Condensate is a mixture of light liquid hydrocarbons, similar to a light (high API) crude oil. It is usually separated from a natural gas stream at the point of production (field separation) when the temperature and pressure of the gas are dropped to atmospheric conditions.

Speaking about the current oil output, Gbenga Komolafe, chief executive officer (CEO) of the NUPRC, on Wednesday, said oil production is currently about one million bpd below “its technically allowable capacity”.

He was represented by Kelechi Ofoegbu, the executive commissioner for economy, regulatory, and strategic planning, NUPRC, at a host communities sensitisation workshop.

Komolafe attributed the low oil production to a number of issues, including the energy transition’s impact on hydrocarbon funding, a lack of investments, and insecurity.

“While the commission is prioritising efforts towards increasing oil and gas production and ensuring maximum federation revenue through the optimisation of oil and gas value chain, the efforts have been constrained by a myriad of challenges,” he said.

“These challenges range from insecurity, low investment, and de-prioritisation of funding of hydrocarbon development arising from the energy transition.

“Currently, Nigeria has the technical allowable capacity to produce about 2.5 million barrels of oil per day. However, arising from the highlighted challenges, our current production hovers around 1.5 million barrels of oil and condensate per day.”

The Cable

WESTERN PERSPECTIVE

In Bakhmut's ruins, Ukraine says intensity of Wagner attacks growing

A Ukrainian brigade commander fighting in the ruins of Bakhmut said Russian mercenary forces have stepped up shelling and artillery attacks in recent days and were not facing a munitions shortage, despite its chief's claims to the contrary.

Russian mercenary boss Yevgeny Prigozhin has complained for weeks that Russia's army is depriving his Wagner troops of enough ammunition to capture the eastern Ukrainian city, where months of fierce fighting have been dubbed the "meat grinder".

Reuters has not been able to independently confirm the situation on the ground there.

Ukrainian Colonel Roman Hryshchenko, the commander of Ukraine's 127th Territorial Defence Brigade, rejected Prigozhin's claims in an interview by video link.

"They haven't had anything even close to a munitions deficit. In the last few days, the intensity of shelling and rocket artillery has increased," Hryshchenko said.

He said Russian forces were conducting constant assaults in the city - and that Ukrainian troops were beating them back.

"The situation is difficult. The enemy is throwing a great deal of its forces at us, constant waves of assaults," he told Reuters late on Wednesday.

He and the rest of his brigade have inhabited the ruins of Bakhmut for nearly two months, he said.

He messaged shortly after the interview to say the positions where he had spoken from had been set ablaze by a strike.

He said Russian forces were suffering casualties several times higher than his unit, but declined to give numbers.

"(Russia) is losing a great deal of its troops… Bakhmut has already fulfilled its main task, and continues to fulfil it. Here, we are butchering the enemy's manpower," he said.

The former military prosecutor said only 30% of his brigade, which was originally recruited as a local territorial unit in March 2022 when their home city of Kharkiv was attacked, had previous combat experience but they were now seasoned soldiers.

"They (Russian forces) don't just retreat by themselves. It's a big, arduous task, and we need to work very hard to drive them out," he said. "For every metre, ten metres, section of trench, for every building, we need to try very hard."

He suggested that news from Bakhmut, of an unspecified nature, would be coming "soon", smiling but declining to expand.

"I ask everyone to have a little bit of patience, and you will see," he said.

RUSSIAN PERSPECTIVE

Russian military clarifies frontline situation in Ukraine

Russian Defense Ministry has denied rumors of a large-scale Ukrainian counterattack, noting in a statement late on Thursday that the situation along most of the frontline appeared to be relatively calm, with the only heavy fighting in and near Artyomovsk, also known as Bakhmut.

“Reports by certain Telegram channels of ‘breaches of defenses’ in several places along the line of contact are not accurate,” the ministry said around 11 pm Moscow time. “The general situation in the area of the special military operation is under control.”

According to the Russian military, the last remaining part of Artyomovsk was being stormed with air force and artillery support, while there was an “ongoing battle” to repel the attack of Ukrainian units in the direction of Malo-Ilyinkovka, northwest of the city, with “heavy enemy casualties in lives and equipment.”

Eight Ukrainian attacks and three attempts at reconnaissance in force were repelled on the Donetsk front, the Russian military said. Russian forces continue efforts to take all of Marynka and blockade Avdeevka.

Ukrainian troops attempted two company-sized attacks towards Kremennaya but were repulsed. Three scouting parties were defeated further north, near Kupyansk. The ministry first said there had been no “active operations” on Kherson or Zaporozhye fronts in the south, but later published a list of Ukrainian losses on the Kherson front from Russian artillery, and reported shooting down 12 HIMARS rockets and a Su-25 ground attack jet.

Earlier in the day, multiple military correspondents had reported that the Ukrainian counter-offensive might have started, with a “breakthrough” near Artyomovsk and several attacks all along the frontline. One reporter cited military sources to claim the Ukrainians had used chemical weapons at a stretch of the Zaporozhye front as well.

Kiev has not commented on Thursday’s movements so far. Earlier in the day, Ukrainian President Vladimir Zelensky claimed his military still needed more time to prepare before the long-awaited spring attack.

** US begins passing confiscated Russian money on to Ukraine

US Attorney General Merrick Garland has authorized the first-ever transfer to Ukraine’s state coffers of expropriated Russian funds.

In a statement on Wednesday, the official said the money seized from Russian businessman Konstantin Malofeyev will be sent for the reconstruction of Ukraine, in response to Moscow’s military operation in that country, which began in February 2022.

“While this represents the US’ first transfer of forfeited Russian funds for the rebuilding of Ukraine, it will not be the last,” the Attorney General stated.

Last year, the US Department of Justice charged Malofeyev with sanctions evasion. At the time, prosecutors claimed the businessman had provided financing for Russians promoting separatism in Crimea, the formerly Ukrainian territory that reunified with Russia in 2014.

At the time Garland announced “the seizure of millions of dollars from an account at a US financial institution traceable to Malofeyev’s sanctions violations.”

Washington and its allies have been debating the issue of expropriating Russian funds since last year, arguing over, among other aspects of the scheme, the legality of using such frozen assets to help Ukraine.

The US Department of Justice has launched a dedicated unit called KleptoCapture to help enforce sanctions on Russian government officials and business figures, targeting their yachts, jets, real estate, and other assets.

In December, the US Congress passed a law directing the State Department to award certain proceeds from confiscated Russian assets to Ukraine. The first such transfer was approved in February and involved $5.4 million seized from Malofeyev.

Moscow has called Western attempts to transfer the seized assets to Ukraine “barbarism,” saying that, if necessary, Russia will respond in kind. Moscow has also described the freezing of its assets as “theft,” warning that it violates international law.

Reuters/RT/Tass

The Federal Government spent $112.35m servicing external debt in January 2023. Data from the Central Bank of Nigeria’s Weekly International Payments showed that the amount spent in January was 146.17 per cent higher than the $45.64m spent in December 2022.

This occurred as the Federal Government struggled to boost its revenue base despite its revenue generation efforts.

The Federation Account Allocation Committee shared N750.17bn among the three tiers of government in January 2023.

The figure represents a decrease of N240.02bn compared to the N990.19bn shared in December 2022.

In 2022, Nigeria spent $2.4bn to service its external debt, which was a slight increase from the $2.11bn spent in 2021.

Federal Government deducted over N78bn from allocations made to the states for external debt servicing.

This was according to data from the Federation Account Allocation Committee Disbursement reports published by the National Bureau of Statistics.

The deductions were made in 2022 from the allocations given to state governments from the Federation Account.

The federation account is currently being managed under a legal framework that allows funds to be shared under three major components: statutory allocation, Value Added Tax distribution and derivation principle.

The most hit state by the deductions was Lagos, with about N23.61bn deducted in 2022 for external debt servicing.

It was followed by Kaduna, with N10.25bn deducted, and Cross River with N7.56bn deducted.

The International Monetary Fund recently said the Federal Government projected to spend 82 per cent of its revenue on interest payments in 2023.

According to the IMF, external debt (including that of the private sector) will rise to $121.6bn, with external reserves climbing to $37.5bn.

It disclosed this in a table of projections in its ‘IMF Executive Board Concludes 2022 Article IV Consultation with Nigeria Summary

The projections showed an improvement in the share of the government’s revenue used as interest payment, with interest payment falling from 96.3 per cent in 2022 to 82 per cent in 2023.

It added that interest payment was 86.1 per cent and 87.8 per cent of the Federal Government’s revenue in 2020 and 2021, respectively.

Punch

Sudan's rival forces agree to protect civilians but no ceasefire

Sudan's warring factions early on Friday committed to protect civilians and the movement of humanitarian aid, but did not agree to a ceasefire and remain far apart, U.S. officials said.

After a week of talks in the Saudi port of Jeddah, Sudan's army and rival paramilitary Rapid Support Forces (RSF) signed a declaration that they would work towards a short-term ceasefire in further discussions, they said.

"The two sides are quite far apart," a senior U.S. State Department official said, speaking on condition of anonymity.

A text of the declaration released after the talks said the two factions "commit to prioritizing discussions to achieve a short-term ceasefire to facilitate the delivery of emergency humanitarian assistance and restoration of essential services."

A U.S. State Department statement said the parties would focus on reaching a deal for an effective ceasefire of up to about 10 days.

Negotiators working with Saudi and U.S. mediators will next discuss specific security measures for safeguarding relief supplies, the U.S. official said. The State Department statement said measures "will include a U.S.-Saudi and international-supported ceasefire monitoring mechanism."

Saudi Foreign Minister Faisal bin Farhan said in a post on Twitter that the talks and the commitment to protecting civilians were a first step, and "other steps will follow".

"The most important thing is to adhere to what was agreed upon, and the Kingdom will work until security and stability return to Sudan and its brotherly people," the Saudi minister said.

The army and RSF said in their agreement that they would schedule "subsequent expanded discussions to achieve a permanent cessation of hostilities."

The U.S. official said it would be a long process to move from a temporary ceasefire, once agreed, to a permanent cessation of hostilities. But Washington hopes the two sides' willingness to sign Friday's declaration will build momentum.

Civilian groups are expected to participate later in the talks, the U.S. official said. The Forces for Freedom and Change, a coalition of political parties supporting democratic rule, called the declaration "an important first step towards ending the war" and urged the forces to abide by it.

Clashes rocked Halfaya, an entry point to the capital Khartoum, on Thursday as residents heard warplanes circling over Khartoum and its adjoining cities of Bahri and Omdurman, but the fighting appeared calmer than on Wednesday.

In public neither side has shown it is ready to offer concessions to end the conflict that erupted suddenly last month, threatening to pitch Sudan into a civil war, killing hundreds of people and triggering a humanitarian crisis.

Previous ceasefire agreements have been repeatedly violated, leaving civilians to navigate a terrifying landscape of chaos and bombardment with failing power and water, little food and a collapsing health system.

ALLOW DEAD TO BE BURIED

The senior State Department official said the declaration signed early Friday seeks to improve the flow of humanitarian relief and begin restoration of water and electricity services.

Mediators hope it will be possible "to arrange for the withdrawal of security forces from hospitals and clinics, and to perform the respectful burial of the dead," the official said.

The World Health Organization has said more than 600 people have been killed and more than 5,000 injured in the fighting. The Health Ministry said at least 450 people were killed in the western Darfur region.

Many have fled Khartoum and Darfur, uprooting 700,000 people inside the country and sending 150,000 as refugees into neighbouring states, according to U.N. figures.

Western countries condemned abuses by both sides at a human rights meeting in Geneva, but Sudan's envoy there said the conflict was "an internal affair".

Reuters

It started like a grudge match. Africa’s richest man, Aliko Dangote, was dealt a bad hand in a failed transaction. Later, he vowed revenge. Not in a pound of flesh, but by venturing to make his own success where he had been ambushed. 

At issue was the decision of the government of Umaru Musa Yar’Adua in 2007 to reverse the sale of the Port Harcourt and Kaduna Refineries (two of Nigeria’s moribund refineries) to Blue Star, the Dangote-led consortium. 

Blue Star had paid about $670million for the plants in the twilight of the Obasanjo administration, and gone away thinking it was a done deal. It wasn’t. 

Even though the refineries were producing at about 20 percent of their capacity at the time of sale, the Yar’Adua government, egged on by labour, insisted the “national patrimony” were under-valued and underpriced. The sale was reversed.

Dangote walked away bruised, but unbowed. Six years later he announced plans to build a private refinery in Lagos with a capacity of 650,000 bpd – over 200,000 bpd more than the installed capacity of Nigeria’s four refineries combined. 

It sounded like a crazy idea. So crazy, Nigeria’s Central Bank Governor Godwin Emefiele said on Tuesday, that on account of it, the U.S. lender J.P Morgan threatened to expel Nigeria from its Government Bond Index for Emerging Markets.

After unforeseen delays, including cost reviews (from the original $12-$14billion to $19billion) not to mention energy transition concerns, the glut in global supply caused by Covid-19 and spooky markets caused by the Russia-Ukraine war, the refinery is now set for official commissioning on May 22. 

One source told me on Monday that perhaps the most significant recent reason for the delay was the need to sychronise power supply to the Fluid Catalytic Cracking Unit (FCCU), which has now been significantly completed by General Electric. 

Apart from an estimated 250,000 direct and indirect jobs that the refinery would create, the refinery is also expected to spin off other business opportunities, a story that Dangote loves to share in a country with 33 percent unemployment. 

S&P Global reported two months ago that early commencement of the Dangote Refinery would not only benefit Nigeria, but could also benefit Africa currently suffering a shortage of diesel as a result of the closure of three of five refineries in South Africa. 

The continent imports about 700,000 bpd of diesel. Diesel is one of the four quality Euro-V products expected from Dangote Refinery. Others are gasoline, jet fuel and polypropylene.

But how does Africa’s richest man propose to deal with the growing resonance of the global green army?

He was once outspoken on global warming and its predations. At a fundraiser hosted by the Lagos State government for victims of a major flood disaster in 2011, Dangote said, “All over the world, nature is reacting. We are having extreme weather conditions…as managers of the city, our responsibility is to share knowledge with our people to prepare for the worst and hope for the best.”

That was before he started building his refinery. For Nigeria and much of Africa, where energy resources, renewable and otherwise, remain considerably underutilised, the choice seems to swing between managing emissions, already among the lowest in the world, and expanding industrial processes required to meet rising energy demand.

Dangote Group said it was not in denial of the dilemma it faces from green campaigners. The Group Executive Director, Strategy, Capital Projects and Portfolio Development, Devakumar G. Edwin, said five years ago that the group was dedicated to producing “efficient and clean fuels by investing in processes that meet European standards of gasoline.”  

Edwin tracked back to why the refinery was started. “Primarily,” he said, “Nigeria exports raw materials and imports finished products. When you import the finished product back, you are essentially importing poverty into the country. 

“We have always focused on import substitution. It’s what we are doing in sugar and what we’ve done in cement. So, we decided to adopt the same strategy for petroleum refining.”

Apart from the economic implications, an NGO, Stakeholder Democracy Network, reported on its website that the quality of the stock of imported fuel could also potentially undermine air toxicity, and cause other environmental problems.

Yet, the Energy Transition Plan (ETP), a green playbook by the government to achieve carbon neutrality by 2060, is an indication that Nigeria recognises the urgency of sustainable carbon footprint.

The ETP comes on the heels of the Petroleum Industry Act, finally ratified in 2021. The law is supposed to introduce stability, transparency and accountability to an industry that has long resisted reform. 

The ETP anticipates a scenario in which increased investment in the sector would lead to an uptake in the use of gas as a “transition fuel” and also help accelerate the move toward decarbonisation. 

The divergence of opinions surrounding what methods to implement and what outcomes to project has in some way come to define the conversation on sustainability, with a number of developing countries even canvassing such ideas as “energy justice!” 

Large industrial projects like Dangote Refinery, which covers 2,635 hectares, are infamous for environmental challenges they present to the local ecosystem, often causing long-term damage and increased risk of displacement. Already, local populations have called attention to the disruptive effects of the refinery to the environment and their livelihood.

The continent faces what could well be Hobson’s choice: how to overcome widespread energy poverty while at the same time not ignoring global concerns about the deleterious effects of converting its rich deposits of hydrocarbon resources. Nigeria, like many commodity-rich countries on the continent, is at a crossroads. Is there a bridge?

Maybe. And Africa’s richest man is poised not only to fill a vital supply gap but also to do so as a business, keenly aware of all the bad habits that ruined the state refineries. Reuters quoted him as saying he was focused on starting production at the end of the third quarter of 2022 and to reach full capacity by early 2023 – a dream now deferred.

Dangote Refinery is not Nigeria’s first experience in private refining. To plug the supply gap, previous governments issued dozens of licences for “modular refineries.” 

As a result of price caps and other regulatory hassles, however, only two of them with a combined capacity of 10,000 bpd are currently producing. Yet their combined output, even with those of rogue refineries that dot the oil-rich Niger Delta region, still fall far short of the estimated daily consumption of 72million litres daily, an estimate still viewed with suspicion in some circles. 

One and a half decades after Dangote’s Blue Star misery, the mood in official circles has changed. In 2021, the government gave state oil firm, NNPC Limited, approval to buy a 20 percent stake valued at $2.76billion in Dangote Refinery, indicating a significant shift in government attitude. 

Dangote told The Economist that the refinery would save Nigeria up to $10 billion in foreign exchange and generate approximately $10 billion in exports. The country’s perennially opaque petrol demand and supply chain could also be re-written. While the location of the Refinery could bring benefits of lower freighting costs, pump prices would still be largely determined by the markets.

Nigeria imports 80-90 percent of all domestically consumed petroleum products. According to the Observatory of Economic Complexity (OEC), Nigeria imported $11.3 billion in refined petroleum products in 2021, becoming the 18th largest importer of the products in the world, while refined petroleum was the first most imported product in Nigeria.

Whatever the world may be saying about fossil fuels, carbon footprint and spooky markets, the hundreds of thousands of unemployed Nigerians cannot wait for the relief that the commencement of the refinery promises, even if it’s indirect.

As Kudirat Oyefeso, a trader in Ajah, Lagos, about eight kilometres from the site of Dangote Refinery said, “It is the person who is alive and has something to do that can worry about climate change.”

Looking back in his quiet moments 16 years after he felt hard done by the Blue Star experience, Africa’s richest man might perhaps sometimes pinch himself as he recalls how what started as a grudge match has ended up feeling like the parable of the rejected stone.  

** Ishiekwene is Editor-In-Chief of LEADERSHIP

Nigeria’s Under 17 team, Golden Eaglets have crashed out of the ongoing Under 17 African Cup of Nations (AFCON) in Algeria. The team lost 1-2 to their Burkina Faso counterparts in the quarter finals of the event at the Nelson Mandela Stadium on Thursday.

The result means that Nigeria could not secure a ticket to the 2023 FIFA Under 17 World Cup in November, after failing to reach semi finals of the ongoing AFCON.

In the match, Aboubacar Camara put the Burkina Faso team in the lead, at the 45th minute of play, following a defensive error from Tochukwu Ogbiji.
Nigeria’s goalkeeper Richard Odoh made an effort to block the ball aiming for the back of the net, but without much power in that attempt, the ball fell at the penalty area and needed Ogboji to clear but an indecisive attempt gave Camara the chance.

Ogboji also adjudged to have fouled Lassina Traore in the 18 yard box and penalty was given against Nduka Ugbade’s tutored side at the 57th minute.
Camara converted to increase the goal tally for his side.

Nigeria however responded 10 minutes later via a tap in by Abubakar Abdullahi to reduce the goal deficit for the home team.
Abdullahi’s effort was not enough to see the Golden Eaglets through as the game finished in favour of their opponents.

Meanwhile, Morrocco, Mali, Senegal and Burkina Faso have all booked places at this year’s World Cup.

The Guardian

Kevin Rodrigues was great at math.

He could look at a room and tell you its square footage. Then he'd calculate precisely how much carpet, tile or other material you would need to cover it. That's what made him so good at his job selling commercial flooring ― that and his charismatic personality.

"He was like a magnet," his wife, Tina, said. "You just gravitated to him, you know? He had the most amazing smile, the greatest laugh. … He could just go into any room and just start talking to people."

Then in 2012, Kevin miscalculated a job. It wasn't like him, but he messed up the numbers. His family shouldered a significant cost.

There were more inconsistencies after that, and he failed to meet his sales expectations.

In 2014, Kevin lost his job.

He started looking for a new employer, but never really told Tina the details of what was going on. He started to misplace things, to forget why he’d gone to the store.

Tina didn't think much of it at first. A few months later, she started working at the Arizona Alzheimer's Association. She had conversations and trainings about dementia and learned about the disease's 10 warning signs: memory loss and difficulty performing familiar tasks, among others.

That's when she grew concerned. She was seeing some of those signs at home in her husband.

Figuring out whether her concerns were a reality wouldn't be easy. In some ways, Tina's occupation would mean the family had a best-case-scenario shot at getting Kevin a diagnosis and treatment if he did have Alzheimer's. But there would still be a difficult road ahead, made worse by the stigma around the disease.

As many as one in nine Americans over age 65 already have Alzheimer's disease, the most common type of dementia, according to the Alzheimer's Association. That's not including other types of dementia, like early-onset, vascular and Lewy body dementias. But despite the prevalence of these conditions, diagnosing them is still often complicated and costly. There are few options available to slow the progression of Alzheimer's and dementia. And there is still no cure, nothing that can halt or reverse it.

It's not for want of trying. In 2014, the National Institutes of Health provided $562 million to research Alzheimer's and related dementias. This year, federal funding will be over $3.7 billion, according to the Alzheimer's Impact Movement.

Much of that research has long been focused on one predominant hypothesis: that the disease is caused by amyloid plaques, distinctive proteins that show up on brain scans and in spinal taps and are one of the most definitive ways of diagnosing the disease. And recently, a couple of drugs targeting amyloid plaques have made a bit of headway, including one — lecanemab — that gained accelerated approval from the Food and Drug Administration amid some controversy about its benefits and risks.

However, some experts think there might be more to the story than amyloids. Studies have demonstrated that some people who have a significant amount of amyloid plaques never develop the symptoms of Alzheimer's or dementia. Some researchers think there might be other elements that contribute to the disease and better areas in which to intervene. Genetics, diet, lifestyle, environmental exposures, prior infections, the microbiome and several other factors might also be at play.

Some researchers are now deviating from the focus of the past few years. They're collaborating with scientists who study other parts of the body. They're thinking about prevention in addition to treatment. They're working on methods for earlier, easier and cheaper detection. And they're calling attention to better types of care that can improve quality of life later in the disease.

It's all research that, as it advances, will likely also improve conditions in congregate care settings like assisted living facilities and nursing homes. As the nation's population ages, it will be necessary to support more loved ones in the future.

And it's something Tina lived firsthand as she stood by Kevin's side, as they tried to understand what was happening to him.

The challenges of diagnosis

Tina thought she could see some signs of Alzheimer's, but Kevin was also relatively young, in his 50s, and he'd just had a big life change. Socially, he was fine. His personality hadn't really shifted much. When he finally went to a doctor in 2015, the doctor attributed Kevin's symptoms to the stress and depression of being unemployed and prescribed him an antidepressant.

Over a two year period, the medication didn’t seem to be working. Kevin was still forgetful, still having trouble with tasks he used to do all the time. He would get hired at new jobs ― at least six, by Tina's count ― and then let go.

By 2016, it had grown harder to ignore: Something was wrong. Nothing was changing. They went back to the doctor, and the doctor referred Kevin to a neurologist for a cognitive exam in November 2016.

The neurologist gave Kevin five words and asked him to repeat them back. He couldn't remember them.

Next, the neurologist asked him to draw the face of a clock that read 2:00 in the afternoon. He couldn't do it.

Then Kevin had to identify images of animals: rhinoceros, lion, camel. He couldn't name them.

"You're sitting there as the spouse and you want to scream out what the words are because you don't want them to get it wrong," Tina said. "It knocked me over. … I was so stunned by how poorly he did on this test."

The neurologist said they would need an MRI and additional cognitive testing. Between the MRI and the next round of tests, the neurologist prescribed Aricept, a drug used for dementia and cognitive decline.

Tina and Kevin still didn't have their answer, but now they had a prescription. Tina thought that meant things must be pretty serious.

She asked the neurologist if they could all meet to discuss the diagnosis, but he told them to wait until after the next round of cognitive tests, which would be administered by an outside company. Tina was upset and uncomfortable. Why were they being shunted from test to test without ever having a conversation about what might be happening to her husband?

Part of the problem was the challenges of diagnosis. Dementia often initially shows symptoms shared by many other conditions, including anxiety and depression, both of which have been on the rise in recent years.

Dr. Jordan Karp, professor and chair for the department of psychiatry at University of Arizona, knows this from his clinical experience. Karp described one patient, an academic, whom he had diagnosed with and was treating for anxiety but who didn’t seem to be getting much better. He initially showed a newfound fear of driving, but was so high functioning that he was still going to work and scored well on basic cognitive screens.

Karp said things didn't click for him until he met the patient's wife, who described more of the changes she was seeing at home. Eventually, he realized the patient had likely become scared of driving because of changes to his visuospatial perception and had been going to work but had not been accomplishing much there.

"Often we see behavioral and psychiatric symptoms as the presenting reason why people are brought to the doctor and they seek medical care," Karp said. "Their brains are changing and behavior comes from the brain. It's what is first brought to attention."

But if the patient behaves the same, a doctor might not spot the changes. That's a problem called diagnostic overshadowing, and it's commonly seen in individuals with intellectual and developmental disabilities, said Liz Carr, a clinical director who has worked with those with intellectual and developmental disabilities for many years and also trains other caregivers in the field.

Diagnosis is like playing 20 questions, she said, except there are hundreds of possible answers and nobody playing knows the answers.

For older adults with and without disabilities, she said, there are other conditions common to aging that mimic the signs of dementia: dehydration and malnutrition; metabolic disorders; urinary tract infections; vitamin deficiencies; and sensory impairments, among others.

So how do doctors actually diagnose dementia? Cognitive tests are a start, but doctors often need a brain scan or a spinal tap to confirm the presence of amyloid plaques, the clumps of proteins that build up between nerve cells and are a hallmark of Alzheimer's disease and some other dementias.

Those tests are expensive right now and out of reach for most patients, said James Fitzpatrick, a director of advocacy with the Alzheimer's Association. PET scans, for instance, cost thousands of dollars and are usually not covered by insurance. Spinal taps are costly and invasive, which discourages their use in most cases. And specialized tests and clinicians are also especially hard to access for those who don't live in major cities.

All of that means several clinical, technical, geographical and financial hurdles are working against early and accurate diagnosis of dementia.

And the stigma around mental illness can be detrimental to those experiencing dementia symptoms, said Dr. Anna Burke, chair for dementia and director of the Alzheimer's and Memory Disorders division at Barrow Neurological Institute.

"We need to be very careful about equating dementia with mental illness, because that is one of the stigmas that actually leads people to shy away from early diagnosis and from treatment and really impedes their access to care," Burke said.

Lori Reynolds, who spent many years as an assistant clinical professor of occupational therapy at Northern Arizona University and has a doctorate in gerontology, agrees. She said it's important to clarify the relationship between mental health and dementia. While dementia can appear to cause mental health conditions ― for instance, dementia patients also often experience anxiety ―that's not the same as someone having had clinical anxiety their whole life. Instead, it's a direct effect of the changes happening in their brain as a result of their degenerative brain disease.

"Diagnosing dementia is a multifaceted process," she said. "It's not a one and done."

As part of that process, advocates like Fitzpatrick hope scientists and researchers will advance the available options for early diagnosis. He dreams that one day a biomarker blood test or an eye scan could make it easier and cheaper to confirm that a patient has dementia.

Those ideas are still on the horizon; Fitzpatrick thinks they might be coming in the next few years. But for those grappling with the possibility of a dementia diagnosis now, the challenge continues.

Tina eventually made the difficult decision to confide in her colleagues at the Alzheimer's Association about what was going on with Kevin. With their help, she looked for a new neurologist. While she was doing that, Kevin faced his next cognitive test — a six-hour ordeal.

He had to go in by himself. Tina would remain outside. The test required him to perform seemingly easy tasks, like counting money. Things Kevin had once done with ease. Things he found himself now unable to grasp.

About halfway through the testing, Tina got a call from the proctors. Kevin was finished, they said. He didn't want to do any more testing.

"It was really hard for him, I think, because he was still in a place where he knew something was wrong, but he wasn't able to do some of the things that they were requesting him to do," Tina said.

The new neurologist sat down with Tina and Kevin to look over the results of the latest cognitive testing. On paper, he said, he would have thought Kevin was at least 70 years old ― a contrast to his actual age, 53.

A lumbar puncture (commonly known as a spinal tap), which allows doctors to remove a sample of the cerebrospinal fluid found in the lower back, confirmed what the neurologist suspected.

Kevin had early-onset Alzheimer's disease.

They left the office, sat in the car, and cried together.

How Alzheimer’s progresses in the brain

By the time Kevin and Tina got their answers about Kevin's diagnosis, Kevin had progressed into the moderate stages of the disease.

That meant he would be unable to enroll in any clinical trials, because most clinical trials require patients in the early stages of Alzheimer's. They need to be able to report back on themselves, and Kevin was already unable to do that.

Some trials also asked patients to undergo successive lumbar punctures. When Kevin had his spinal tap to confirm his Alzheimer's diagnosis, Tina said, air got caught in the equipment and caused Kevin tremendous pain. He never wanted to do that again, ruling out any trials that used spinal taps. Even if he had wanted to, he could no longer pass the cognitive tests to get those opportunities.

But that first spinal tap had detected what was going on in Kevin's brain the whole time: beta-amyloid proteins, the hallmark of Alzheimer's disease.

That buildup, and the inevitable progression of the disease, is something that scientists have known about for decades and have been trying to halt or reverse. Right now, the outlook is grim. Nobody survives Alzheimer's disease. It just keeps going.

To understand that better, you have to zoom way in, to the cells that make up your brain.

In between every two brain cells is a gap called a synapse. That's how everything in your brain is wired together. And like electrical wires, there are junctures where two ends meet.

When your brain is working normally, signals travel electrically through a cell and chemically between cells, through the release of molecules called neurotransmitters at those junctures.

That happens over and over again, trillions and trillions of times. That's how you get up in the morning, how you brush your teeth, play basketball, write an essay or tell someone you love them.

As you age, the connections at those synapses start to wear out. Eventually, nerve cells in those areas start to die and the tissues degrade.

Scientists aren't entirely sure why that is, but they think it might be related to beta-amyloid plaques (a clumpy buildup of protein pieces that come from the fatty membranes surrounding nerve cells) and tau tangles (a malfunctioning of other types of proteins that help transport materials to your brain cells).

It's still unclear whether the plaques and tangles are actually causing the degeneration of the brain in those areas, or whether the plaques and tangles are a byproduct of degeneration that's happening because of something else.

In any case, with Alzheimer's, brain degeneration, plaques and tangles start to occur.

It often happens first in the hippocampus, the memory center of the brain, and the frontal lobe, which is associated with thinking and planning.

That can happen as early as 20 years or more before the onset of any symptoms.

In mild and moderate stages of Alzheimer's, the damage spreads to other parts of the occipital, parietal and temporal lobes, which can affect speech and proprioception (your body’s ability to understand where you are in relation to your surroundings).

Eventually, severe Alzheimer's degrades the whole brain, changing a person's personality, ability to access memories, and physical capabilities.

But the changes that occur might not only be in the brain, said Diego Mastroeni, an associate research professor at the ASU-Banner Neurodegenerative Disease Research Center. He and other researchers are interested in the possibility that changes in the microbiome ― the colony of viruses, bacteria, and other microscopic life forms that inhabit your gut and other organs ― might create inflammation that may lead to Alzheimer's disease and exacerbate it once it has already taken hold.

"I don't really believe in one particular biological mechanism that drives these kinds of diseases," he said. "I think it's many different things."

To investigate those possibilities, Mastroeni and his collaborators are examining cerebrospinal fluid and samples from the gut, liver, blood, brain and other tissues to get a more holistic look at the changes associated with Alzheimer’s.

Mastroeni suspects there's more going on than just the development of plaques and tangles, and that factors like genetics, environment, prior brain injuries, diet and lifestyle may all play a role in the onset of dementia. He described a study he worked on concerning identical twins who were both engineers. One had a desk job and one worked in the field, where he was exposed to higher levels of chemical pesticides.

The twin who worked in the field developed Alzheimer's, while the twin who worked the desk job did not.

Mastroeni is not alone in thinking there may be more to the puzzle than just plaques and tangles. Reynolds cited a study on nuns in which one remarkable woman, Sister Mary, scored highly on cognitive tests up until her death at age 101 ― despite having abundant plaques and tangles, the hallmarks of Alzheimer's. Reynolds believes most recent evidence suggests that lifestyle factors including lasting social bonds, consistent exercise and a healthy diet may all potentially prevent the body from developing Alzheimer's in ways that we don't yet fully understand.

Other researchers are making headway on hypotheses relating latent viral infections with the development of Alzheimer's. Dana Cairns, a researcher at Tufts, is examining miniature models of human tissues to study how HSV-1, an extremely common herpes virus that stays in the body indefinitely after initial infection, may eventually lead to inflammation and the development of amyloid plaques.

One of Cairns' mentors, Ruth Ithzaki, wrote an op-ed in November 2022 about how her attempts to pursue a viral theory of Alzheimer's were dismissed by a steadfast group of researchers intent on pursuing the theory of amyloid plaques.

The viral idea is not without controversy, and researchers are far from a definitive answer on which theory or theories may be most promising. Burke, of Barrow, noted that scientific research often occurs in waves or cycles of interest. The "sexy" thing in research now might be anti-amyloid treatments, she said, but that doesn't mean there isn't a wide range of possible routes to investigate.

Meanwhile, patients who already have dementia contend with their disease, slowly slipping away from what little knowledge we do have about what is happening to them.

As Kevin's brain and body changed, his behaviors began to change. Where he had once been worried that he wasn't working, he became content to just leave the house, go mountain biking and forget about what his responsibilities had once been.

He became a compulsive shopper. He began obsessively buying items from bike stores ― he got fixated on tubes and rims, bike lights, backpacks and toolkit bags. He was more impulsive, now. And where he had once been sleeping frequently ― a sign that suggested depression to his first doctor ― he became busy all the time. Kevin was agitated; he couldn't sit still.

The last year saw the most changes. It was during the height of the pandemic, in 2020, and Tina said the isolation worsened the progression of his disease. Kevin's communication slowed down. No longer his charismatic self, he stopped striking up conversations and answered questions in just a couple of words.

And he started getting angry.

The promise and futility of medications

Kevin's outbursts were mainly directed at men, which Tina says most often affected their sons or sometimes strangers at the grocery store or on the street.

He would puff up his chest and walk toward someone to start a confrontation.

"It was unnerving," Tina said. "It was very different. That's just not who he was."

He would hit his hand on his leg or his head, but Tina could usually keep him calm. "I was kind of his beacon, his lighthouse," she said. "As long as he could see me, everything was fine."

On Christmas Eve 2020, their son Jacob, who was 21 at the time, came into the house. Like his father, Jacob was charismatic and had a big personality. On this occasion he came in quickly, announcing that he had candy for Kevin (at the time, Kevin had become fixated on sugar and wanted as much of it as he could get).

That set Kevin off.

Tina wasn't sure whether it was Jacob's demeanor that triggered it. You had to come in slow and gentle and explain things to Kevin. You "couldn't just come in hot," Tina said. In any case, this time Kevin's anger and agitation reached a boiling point.

Tina heard the confrontation from upstairs and knew from the tone that she needed to break things up. She rushed into the room and ran to put herself between her husband, who was puffing up his chest again, and their son.

It was a painful episode, among some others that Tina would prefer not to share because of the stigma they might engender.

"(People with dementia and Alzheimer’s) can't change how their brain is deteriorating," she said. "I think it's on us to meet them where they are … to keep them in a calm space and keep them happy."

Eventually, to do that, Kevin's doctors put him back on antidepressants, more specific to his condition than what they had prescribed early on when they didn't know about his Alzheimer's diagnosis.

There are a few medications that can help manage Alzheimer's symptoms, but there is no cure. Some drugs may be prescribed for the early to middle stages of the illness to boost alertness, memory and judgment, but they don’t do anything to slow or stop the progression of the disease.

That's long been a goal for scientists, and recently a couple of medications have made headlines as potential steps in that direction. The FDA recently granted accelerated approval for lecanemab, an anti-amyloid drug, because patients in clinical trials showed a reduction of beta-amyloid plaques compared with a placebo group.

Dr. Alireza Atri thinks this is a foundational step for the field. The director of the Banner Sun Health Research Institute and a cognitive neurologist who studies Alzheimer's, Atri has served as a consultant for government agencies, foundations and pharmaceutical companies, including those focused on an amyloid approach to the disease.

If Alzheimer’s is a wildfire that spreads through the brain, Atri said, he hopes that drugs like lecanemab – especially if they’re administered early enough – can play a significant role in slowing the burn well before patients reach a turning point when the damage becomes too great.

Patients in clinical trials who received lecanemab, on average, progressed less by about half a point on an 18-point dementia severity scale of cognitive and daily function. But Atri said that's not just statistically significant, it is also clinically meaningful. If a patient benefits by half a point, he said, that could mean, over the 18 months of the study, the equivalent of 5-6 months of more time recognizing a loved one or being able to continue a cherished hobby.

But the drug isn’t without controversy. Some users experience side effects – the medication includes a warning label about brain swelling – and some scientists who have examined available evidence have linked the drug to the deaths of three patients who participated in clinical trials, according to reporting from Stat Newsand Science.

Eisai, one of the developers of lecanemab, responded to a request for comment with official statements that said, “Outside of scientific papers in peer-reviewed journals or scientific conferences, it would be inappropriate to provide additional information about specific patients or comment on information that was provided by other sources.”

It remains to be seen whether lecanemab will get traditional approval from the FDA this summer.

As a result, the promise of the drug has been tempered by caution. Madhav Thambisetty, a physician with the National Institutes of Health, said he thinks the difference the drug makes might be too small to be noticeable by patients or their caregivers — meaning that the risks, to him, outweigh the benefits for now.

While anti-amyloid drugs are exciting because they could potentially slow the disease if they work, Thambisetty thinks more research will be required to determine whether that's actually happening, a question connected to research on whether amyloid plaques are even causing dementia in the first place.

Thambisetty says in the meantime, there are many other routes scientists and drugmakers hope to explore on their way to finding medications to treat dementia. Those include testing existing drugs for other diseases — drugs that have already been proven to be safe in clinical trials — to see if they have any effects on the progression of dementia.

It also includes using medications to manage the symptoms of the disease even as it progresses, like, for instance, Kevin's antidepressants.

It's not uncommon for dementia patients to be prescribed antidepressants, anti-anxiety medications and antipsychotics, and while non-pharmacological interventions might be preferred initially, doctors have to weigh the risks and benefits of medications to keep patients from harming themselves or others and to decrease the patient’s internal distress or delusions, said Karp, of UA.

In addition, many in congregate care settings, even those without dementia, struggle with their mental health and sometimes take medications for it. About a quarter of Arizona nursing home residents reported feeling down, depressed or hopeless in the third quarter of 2022, according to data from the Centers for Medicaid and Medicare Services.

When it comes to medications, those responsible for elder care for the general population could learn from the intellectual and developmental disabilities population, Carr says. Whenever someone with an intellectual or developmental disability is prescribed medication, the care team has to work methodically, because medications can have different effects in that population than in the average person. Because several care providers might be involved with one person, they need to coordinate in order to make sure they’re all on the same page.

So providers use a specific system to track behavior related to any medication. They log exactly when the person takes the medication every day and then chart behaviors in response to that medication several times throughout the day. At the end of a week or a month, they have a systematic collection of data that they can use to determine the effect of the medication, whether it's working and what might need to be done to adjust the care plan.

All health care facilities, for those with intellectual disabilities or not, are required to keep medication administration records. But caregivers for those with intellectual and developmental disabilities are specifically trained to monitor medication effects to ensure the person is able to participate in life to their fullest potential. It's a model that emphasizes strengths, not deficits; one that ensures medications don't end up being used as chemical restraints.

That's a relatively easy thing to do for anyone, Carr says, but she doesn’t think it's been applied to the general population of dementia patients because there's no mandate for it. If there's no requirement, it won't happen.

Kevin stopped responding to all the medications the doctors put him on. As a result, he started behaving more aggressively toward Tina, not just toward men or their sons.

Why do medications sometimes stop working? Scientists have some information about the brain's chemical interactions with certain drugs, but the question of why exactly the brain can become habituated to medications is "a Nobel Prize kind of question," Karp said.

Like much of the science of the brain, it remains out of reach, inside the black box that so infrequently gives up its secrets.

Meanwhile, people like Kevin suffer and are hospitalized. Kevin went to a psychiatric hospital to have his medications adjusted. There he was infected with coronavirus.

He went into acute kidney failure and was transferred to a different hospital. Tina couldn't see him until he recovered from COVID-19, but he lost his ability to walk and talk after that. The words that came out of his mouth were gibberish. Every so often Tina would catch a word or two that made sense, but most of the time he was unintelligible.

Tina, who continued to be his primary caregiver, needed to sort things out for his new needs. They lived in a two-story house, and now that Kevin couldn’t walk, she needed to rearrange their living space. And she needed time to get organized and prepare to help Kevin in the final stages of his disease.

So for a few months, Kevin would stay in the memory care unit of an assisted living facility.

The first day after he was taken there from the hospital, Kevin heard their son Jacob talking.

Almost out of nowhere, Kevin said, “Is that our baby?”

That, Tina said, was the best thing for Jacob to hear. They had spent so much time with him, around the clock at home and in isolation during the pandemic, and so much of that time had been filled with Kevin's agitation and anxiety.

But for a fleeting moment, he had recognized his son.

Caregiving until the end

Gradually, Kevin's agitation eased. The new medications seemed to be helping. He was happier and more cheerful, though he was still losing his cognition day by day.

The first thing Tina did when he entered memory care was to write Kevin’s story on a piece of paper — that he loved country music, his favorite singers, where he'd worked — so he "wasn't just this man in this room that couldn't talk to you."

Then she made herself a fixture at the facility. She visited every day and got to know the staff and the people working with her husband.

She quickly realized that the caregivers, though well-intentioned, didn't always understand why Kevin would yank their arms or how he needed them to explain what they were doing, slowly and carefully, the way Tina always had.

Tina said she noticed that the staff rotated in and out so fast that it was hard to keep track of who'd had the lessons that made them better equipped to do their jobs.

She clearly remembered one woman who kept moving the furniture around in her room, which frustrated the caregivers. Tina asked the caregivers what she used to do before she was in the facility; they said she was a facilities manager of some sort. Tina told them that she thought the woman just wanted to clean. She was moving the furniture because it made her feel like she was doing her job.

When the staff started letting the woman do that, she settled down. Tina realized maybe she had the tools to help. So she offered to set up free training for the staff from the Alzheimer's Association, where she worked.

The nursing director agreed, but only five caregivers showed up on the day of the training.

Taking care of people with dementia is both a science and an art, but some caregivers never receive the most basic training that would better equip them for their jobs.

Reynolds, the gerontology expert, thinks education is sorely needed for both formal and informal caregivers and hopes educators will prepare students effectively.

There are factors in a person’s living environment, for example, that must be considered:

Loud noises from a squeaky medicine cart, laundry machine, kitchen or paging system could startle someone with impaired cognition.

Seemingly mundane objects can quickly become weapons for confused, threatened or otherwise disturbed dementia patients. Examples from police reports in Arizona include a shoe horn, a pill crusher, a coat hanger, a porcelain toilet tank cover, an electric hair trimmer and a metal pipe.

Other residents or caregivers can trigger a patient with their behaviors, speech, noises or other actions, such as wandering into their room or simply trying to pass by one another in a tight space.

Karp said when behaviors escalate to the point of causing violence, it "speaks to the need for the late-life health care workforce to be trained in identifying, diagnosing and managing behavioral and emotional symptoms and behaviors of older adults, especially those with psychosis, with dementia. … And it speaks to the need for our lawmakers to put more money toward the training of a late-life behavioral health workforce.”

Tina, as both Kevin's caregiver and as an employee of the Alzheimer's Association, agreed. "My biggest goal for Kevin in this whole thing was that he always felt safe, loved and cared for, you know, and happy," she said.

"I think for the most part, he did. But I think even in facilities, that's a huge missing piece, like a memory care facility," she said. “It's unfortunate they don't educate their staff in the way that they should about Alzheimer's."

Kevin was only in a care facility until Tina could take him home. They set up their bed in the dining room, on the first floor.

"As a caregiver, you are basically living in fire," Tina said. "Especially at the end. It's such a hard place to be, to try to manage."

Early-onset Alzheimer's moves even faster than its later-onset counterpart, and Kevin's disease progressed quickly. Faster than she ever could have imagined, Tina had to say goodbye.

On Dec. 21, 2021, Kevin died of Alzheimer's disease.

Tina thinks he would have noticed that date ― 12/21/21. He liked numbers.

Tina still cherishes the memories she has with her husband: training to be a river raft guide with him until she became pregnant with her first child. Hiking, fishing, camping, mountain biking. Watching his smile.

And she knows what she’s lost: One of their older sons taught the youngest to tie a tie when he was a freshman in high school, not Kevin.

She tells his story because she hopes it will help others. And this is the reality of Alzheimer's disease and dementia. However much funding is poured into research, however much more scientists learn about the brain and the body and their intertwined demise, it's too late for the people being diagnosed with the disease now.

Many researchers hope that will change. They dream of the day when the puzzle will fall into place, when they will know exactly what causes the brain to deteriorate and find a way to stop or reverse it.

But for now, loved ones of those with dementia can do little more than rely on the system of doctors, nurses and caregivers that's already in place.

And that system is still not enough.

USA Today