welcome to the organic green doctor blog

i am a family physician who was diagnosed with
early mild cognitive impairment(mci) amnestic type on december 21, 2010
this is a precursor to alzheimers disease
because of this diagnosis i have opted to stop practicing medicine
this blog will be about my journey with this disease
please feel free to follow me along this path
i will continue blogging on organic gardening, green living,
solar power, rainwater collection, and healthy living
i will blog on these plus other things noted to be interesting

Friday, April 19, 2013

alzheimers symposium part 3

i will present a talk on my story with possible alzheimers
at the alzheimers symposium at the mayborn center in temple texas
on tuesday april 30, 2013

here is the the link to register for the event

part 3
the alzheimers disease neuroimaging initiative

i was on the aricept (donepezil) for three months and was stable
so i was allowed back on the alzheimers disease 
neuroimaging initiative study in the early mild cognitive study group

this study called the adni study is the largest alzheimers study 
and the most important one that has been done so far
its a large multicenter study 
when the data and results are collected and processed the
information is available to researchers all over the world

hundreds of research articles have been published using 
this data

during this study we have multiple tests done
i am not able to see my results of the tests as this is a blind study

here is the list of the tests we have done

the neuropsychological test is done
although i dont get the official results i know when i take the 2+
hour evaluation where i am with my memory loss
i have not changed in the last two+ years

then we have blood work done thats similar to the blood work
i had done when i saw the neurologist

the next test is the blood biomarkers and genetic tests

the two blood biomarkers are beta amyloid and tau protein and
the other proteins that they are trying to use to develop a protein
profile from the blood to be able to predict whether someone
has or will get alzheimers disease
in a recent study the test may be 88% accurate
its not available yet
but in the future you will go to the doctor and get this blood test
and find out whether you will get alzheimers disease

the genetic tests are testing for the genes for alzheimers
if you have the genes you get alzheimers
these are  rare and represent a very small percentage of the
alzheimers cases

then there is the apoe4 gene that is associated with an increased risk
of developing alzheimers disease
15% of the patients with alzheimers carry this gene
the apoe2 version tends to protect you
the apoe3 version tends to give you a mild case of alzheimers
the apoe4 version gives you the increased risk
if you have the apoe4/apoe4 double version you have a 15x increased
chance of developing alzheimers disease in your lifetime
if you are having symptoms and carry this double gene you have
a 60-90+% chance of developing alzheimers disease in your lifetime

i was able to have my genes done at a private lab
and i carry the double apoe4/apoe4 genotype
the sucky combination
so i have a 15x increase in my chances of having alzheimers
and with my symptoms i have a 60-90% chance that i have alzheimers

the next test we have done is the mri scan of the brain
of course they are looking for the same things that i mentioned before
to explain any symptoms
but they are also especially looking at the underneath surface of the brain at
the hippocampal area where alzheimers starts
they can detect subtle changes in the volume in this area early on in the
disease process

my mri scan as reported earlier was normal

the next tests we have done is a spinal tap analysis for beta amyloid and
tau  protein
the theory is that beta amyloid accumulates in the brain and causes a
sticky gooey substance that eventually forms plaques then later the tau protein
which forms the microtubules in the brain cells and nerve cells that carry
nutrition get damaged

the tau proteins as they are damaged become unwound
the body sticks phosphorus on the end of them
they form tangles and eventually inflammation and oxidation occurs
as the brain cells die

the tau proteins leak into the spinal fluid and can be measured

the beta amyloid protein is normally found in the spinal fluid
it goes to the brain
bathes the brain
is filtered through back to the spinal fluid
some people think the filtering mechanism gets messed up
some think there may be an overproduction of beta amyloid
whatever the cause it accumulate in the brain and the amount
in the spinal fluid decreases

so in a normal person like some of you
you have a normal amount of beta amyloid in your spinal fluid
and a low level of tau proteins there also

but in a person like my younger brother who is in the later
stages of alzheimers disease their beta amyloid level in the
spinal fluid will be low since its being deposited in the brain
and the tau protein levels will be high since the tau proteins are
being destroyed and leaked to the spinal fluid

so here is an graph where these result can be plotted out

in the upper left portion of the graph someone like you who are normal
with a normal amount of beta amyloid and a low level of tau protein
will plot out in the area not consistant with alzheimers disease

in the lower right portion of the graph someone like my younger
brother with alzheimers disease with a low level of beta amyloid
(its being left in the brain) and a high level of tau protein will
plot out in the area consistent with alzheimers disease

i was able to send my spinal fluid to a private lab and see the
asterisk in the middle that is my results
in the indeterminate range
this is consistent with my early diagnosis

these results along with my positive apoe4 double genotype makes
my diagnosis of possible alzheimers disease more likely

the next test we have done is the glucose metabolism pet scan
of the brain

we are given a radioactively labeled glucose in an iv
wherever in the brain that there is glucose being used by the brain
it will show up as increased activity

in alzheimers disease as the cells are being damaged they cant
utilize glucose well

so a normal patient will have increase uptake throughout the brain
while an alzheimers patient will have areas where there is decreased
or no glucose uptake

some people think that alzhiemers disease is a form of type 3 diabetes
there is resistance to the insulin so that the glucose cant be easily taken
up by the brain cells

studies are being done to use nasal insulin
the insulin travels up the olfactory nerves to the underneath surface of the
brain where alzheimers starts and where memory is processed
the patients are being evaluated for
improvement in their memory after using the nasal insulin

here is an example of the glucose metabolism pet scan
the one on the left is on a normal patient
you can see there is diffuse uptake ie red areas throughout the brain

the scan on the right shows a mild alzheimers patient
you can see on the sides of the brain there is no uptake
of glucose ie no red areas

my glucose metabolism test is normal
which is consistent with my early diagnosis

then the last test we have done is the
beta amyloid pet scan of the brain
amyvid is the only commercially available fda approved one

i have had two of these done with the study

in this study an iv material is given that will bind to beta amyloid
in the brain and will show up as high lighted areas

the amyvid pet scan is now commercially available in the dallas houston
san antonio areas
its expensive
it cost $3000-$6000
its not covered by health insurance or medicare or medicaid
there are $500 vouchers available at some sites

here is an example
the top scan is of an elderly control person who does not have
alzheimers disease
you can see that there is no red areas so no beta amyloid is  present

the bottom scan is of an alzheimers patient
see the red areas diffusely in the brain
that is beta amyloid
the hallmark sign of alzheimers disease

i plan on having one done at the austin radiological association in
austin texas next month

i expect mine to be positive

so now we have new tests available to possibly diagnose alzheimers disease
most of these are or will be commercially available some time in the future

next friday april 26
i will blog on
part 4
the alzheimers graph and what can be done

the organicgreen doctor

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