alzheimers news-i think he had it

ALZHEIMERS NEWS-I THINK HE HAD IT

i know an author who wrote several books about him
says he didnt have alzheimers disease when he was president

reaganlibrary

well
i think
ronald reagan was in the early stages of the disease when
he was president
he had to have been

i read that his doctors back then in the 80s said he showed
no evidence of alzheimers
did he have memory tests like trump had earlier this year
the one i have had several times over the last 8 years
the moca test
no reagan didnt have that since it was developed in 1997
the other one used commonly is the mmse
it was developed in 1975
it could have been given to reagan but i doubt that it was

if you are early in the disease the mmse misses the diagnosis
the moca test usually doesnt

so my guess he was never ever really tested while in office
even by his private doctors

i was a primary care doctor having graduated in 1982
and finishing my residency in 1985
starting private practice in 1985
i will admit i never recall actually diagnosing alzheimers
disease in my career
it was something like cancer you didnt talk about with
patients
it sort of got ignored

my guess is that his symptoms were ignored
and not tested for

ive watched reagan on tv clips since i was diagnosed
and now knowing a lot more about the disease

you can hear it in his speech
you can see it in his face
the stare
if you have had a loved one with this disease
you recognize that stare
you know what im talking about

there are three stages in alzheimers
prealzheimers with normal memory tests and abnormal spinal fluid and a positive amyvid scan
mild cognitive impairment with slightly abnormal memory tests and abnormal spinal fluid and a positive anyvid scan
alzheimers with abnormal memory tests and abnormal spinal fluid and a positive amyvid scan

if trump will develop alzheimers as he ages he would be prealzheimers now
he would be in the white area
i have mild cognitive impairment
i am in the pink area
reagan at the end of his second term probably had early alzheimers disease
he would have been in the grey area




this is the alzheimers graph
the graph of the typical late onset alzheimers patient
it shows the development of symptoms and testing that we
now have available

this graph was developed from data from the large research
study that i was in called the adni 2 study

he died at 93
he quit the presidency at 77
plot those points on the graph
he was first president at 70 years old
plot that point on the graph

if this was his path which it probably comes close to
at 70 he probably had early mci or mild cognitive impairment
if you had done the moca test on him it might have been abnormal
not like the good score trump had

he probably noticed things himself
maybe his wife
probably not others unless they knew him real well
if he had had a full neuropsychological test it would
have been there
its the gold standard memory test
his spinal tap analysis for the bad amyloid and the tau
would have been abnormal
his amyvid pet scan the one for the bad beta anyloid
the hallmark of alzheimers disease would have been
positive
maybe early changes would even been seen on a mri scan

so i think when he was first inaugurated as president
these would have been positive

i have been exposed in the last eight years to a lot
of folks who have mci and real early alzheimers
they function quite well
they work they write they give lectures they drive
they travel they do all their financial stuff
most folks dont even know

when he was first inaugurated
my guess he would have qualified to be
in the aducanumab study that i am in now

wouldnt that have been interesting
if a sitting president was undergoing a novel treatment
for alzheimers disease

it probably would have been the best thing that
could have happened to the alzheimers movement

but none of this was available

my guess is he functioned quite well in his first term
my guess is that he started to have issues in the end
of his last term
issues he noted
his wife nancy noted
his close white house staff really noticed
and
they were able to protect him
he did a good job at the end
but
had his disease been a faster progresser
it might not have been a good ending on that second term

so
i believe
knowing all i know now
that he could have been diagnosed while in office
alzheimers just doesnt pop up one day
its a usually slow gradual process that can take
like in him
30 years to fully develop and cause death

lets dont be ashamed if he did have it while in office

the organicgreen doctor

alzheimers news-what to do

ALZHEIMERS NEWS-WHAT TO DO

last week i spoke for about 40 minutes on clinical studies
in alzheimers disease
i reviewed the theory that beta amyloid accumulates forming plaques
then tau protein unravels and forms tangles
both cause brain cell death

i reviewed the adni 2 study i was in for 5 years
a series of diagnostic tests
four that are usually done to work up memory loss
history and exam  labs  memory testing   mri of the brain
the others arent covered by insurance
genetic tests  
spinal tap for amyloid and tau
glucose metabolism pet scan
amyvid pet scan for beta amyloid
then
i reviewed new drug treatments for alzheimers that are experimental
the alzheimers vaccines like my aducanumab study that i am in
the bace inhibitor pills that stop beta amyloid production
the leukemia drug that slows down parkinsons and may slow
down alzheimers

then i reviewed the healthy things that one can do to slow it down

then i answered questions for 30 minutes running over into the break time
but
folks kept asking questions
afterwards i answered question for even longer
folks want answers
sometimes there arent any yet

should i get tested
yes if you have memory issues

should i get genetic tests
no if you dont understand what they mean
especially the apoe 4 gene thats in the 23 and me tests for genetic diseases
its associated with late onset alzheimers disease
if you get the gene it doesnt mean you will get the disease
you are at a higher risk of getting alzheimers though
how you live your life health wise and environmental factors determine
whether it gets you

so what do i do if its in my family
for now there is no real treatment
but we are close i said

i would do these things
do all the healthy things on this slide
do the  mind diet or the mediterranean diet
consider if you are high risk or if you have memory issues
the reversal of cognitive decline protocol from ucla
its the one i am on

most of it is on that slide above
the rest are supplements
and
checking levels of things like b12
thyroid levels hormone levels vitamin d3 homocsyteine etc
correcting them if they are abnormal

the results from their studies are promising to slow down the
mental decline
but
i doubt that it totally stops the disease
it just slows it down
but
what if you could slow it down for 5 years
thats a lot of time in alzheimers years
enough
to see a love one graduate or get married or have a baby

i attribute my doing well to this regimen
and
to taking aricept (donepezil)

dont just do nothing
most of what you can do is in
your hands
and
your mouth
and
your legs

get going
now

thats what you do to slow this down

the organicgreen doctor

im not really but

IM NOT REALLY BUT
the next time i go see my primary care doctor
im going to say
i feel sad all the time
i cant sleep at night   now that one is true
i feel an impending doom   now that one is partially true
its called alzheimers disease
im having trouble with my appetite   now that one is true also
but thats due to the aricept (donepezil) im taking
i feel tired a lot   now thats true but thats usually in the afternoon
and evening and again thats from the aricept (donepezil) im taking

now when you look at those symptoms they are when put
together some of the symptoms of depression

now i know that most of my symptoms are due to my aricept (donepezil)
and its side effects
side effects who cares about side effects when it comes to aricept
those side effects are nothing compared to whats looming in the
future
so please dont talk to me about side effects i dont care about them

now i get screened on an annual basis for depression when i have
my 2 hour neuropych exam as part of the adni-2 study that im in
thats alzehiemers disease neuroimaging initiative

so i know that im not depressed
i dont really feel depressed
but
if he asked me questions i would answer them truthfully
mostly
because i might just want to take an antidepressant
maybe a ssri selective serotonin reuptake inhibitor

basically it makes the serotonin levels stay high in the brain

now of course i would want a generic one since its cheap
i dont want to increase the profits of big pharma too much
maybe
one like what i use to order first for depression

citalopram
a 10 mg tablet would cost $6.40 for 30 pills at costco
the brand celexa would cost $157 for those same pills
nice profit huh

why in the heck would i fake depression to just get a depression
pill a ssri one called citalopram

it seems that citalopram and the other ssris by keeping the serotonin
levels up in the brain appear to decrease the levels of beta amyloid
that accumulates there

now its the beta amyloid that bad stuff that accumulates forms those
sticky gooey plaques that leads to the cascade of events that
causes tau protein destruction tangles that leads to or causes
the symptoms of alzheimers disease

wait now i thought that new alzheimers vaccine was going to do
that also

why is this 20 cent pill not been looked at before

they just now did it on rats
yep it worked dropped the bad boy beta amyloid down 40%
wow if it only worked in humans

so why not give it to humans and see if it works
they did
gave it to normal folks and the levels in the brain fluid dropped
by over 25%

wow
now the plan is to give it to folks who hopefully are early in the
disease to see if it drops the levels and substands that low level
over time

wow if that works
lets pour the money into more research to find out if it could
be this simple

first the warning from researches well we worry about the side effects
do more study needs to be done

excuse me one minute here

side effects dont talk to me about side effects
have you mr researcher ever taken aricept for a month
then do it and talk to me about side effects

side effects dont talk to me about side effects
im looking down into my future
if i have alzheimers which i personally feel i do
then whats in store for me and my family over the next few years
is nothing compared to any damn side effects
side effects give me a break

then this is the thing that makes me want to vomit this morning

this drug is a generic drug easily manufactured by many companies
its almost as cheap as aspirin
so
there is no big pharma who will finance the research that needs
to be done to see if this works
folks its expensive to do the research

then thanks to the no good congress who struck out all the
big research monies from the budget a few years ago
there is not enough money available for all the research that needs
to be done

this research on this cheap medicine citalpram was sponsored by
the national institue of health nih and the alzheimers association
yes
that money that you and i paid in taxes
and
you and i donated to the alzheimers asscoiation

now ive stepped down off my high horse
calmed down some

i think i call dr b today
i think i need a medicine for depression
could i maybe try citalpram

hopefully he doesnt read this blog

the organicgreen doctor

tytw

TYTW

the year that was
in alzheimers disease research 2012

the following is my review from the
alzheimers disease information networks (adin) 
january monthly e newsletter
from the alzheimers disease cooperative study

the study im in the alzheimers disease neuroimaging initiative
adni-2 is part of this cooperative study
much of the data from this study is used in the reported studies

i am in the early mild cognitive group and have had serial
neuropsychological exams, blood tests, blood biomarkers,
genetic tests, whole human genome analysis, spinal tap fluid
tests for beta amyloid and tau protein, volumetric mris,
pet scans for glucose metabolism, and pet scans for
beta amyloid

four genes are known to be associated with late onset
alzheimers disease-the apoe 4 genotype is the one that carries
the largest risk for the disease
thats the one i have with the double version
new ones found that have letters in their names are ms4a, cd2ap,
cd33, abca7, epah7

a new gene trem2 was discovered that causes you to be susceptible
to alzheimers disease

all are being looked at closely as they may be the site for treatment
one day

an international group of researchers are starting a preventative study
on a large group of people who carry the gene for early onset
alzheimers disease who are young and in their 30s to see if a new
drug can prevent them from getting alzheimers disease
this gene causes most of them to get in in their 40s
if it works this is important
youll be able to treat people who will get the disease before
symptoms start

a new gene mutation was discovered this year called the app gene
amyloid precursor protein gene mutation
if you have this gene mutation it prevents you from getting alzheimers

this gene is located on the 21st chromosome
downs syndrome patients have three 21st chromosomes instead of two
if they carry the app gene without the mutation they have a 50%
increase in the chance of getting alzheimers disease

if the extra 21st chromosome they inherit doesnt have the app gene
they dont get alzheimers

the new alzheimers vaccine studies results were back and were
mostly disappointing
however there was a subset group that showed that the drug did remove
beta amyloid from the brain and it was found in the spinal fluid

(in alzheimers disease the beta amyoid levels decrease in the
spinal fluid as the disease progresses as the beta amyloid gets deposited
in the brain)

a segment of these patients showed an improvement on their
cognitive or mental status tests

a new study looking at this particular group is starting this year

(my theory is that we are trying these things in folks who are more
advanced and the likelihood of them working are decreased
think advanced cancer vs very early cancer)

(this is why the study mentioned above is so important as its
using the drug in folks who dont have the disease yet)

then one of the most important events was the release of the
new amyvid pet scan for beta amyloid
(beta amyloid is thought to be the product that get deposited in
the brain that is thought to be the end result of the alzheimer
disease process. the theory is if you got a lot of this stuff in
your brain youve got alzheimers)

ive had one of these beta amyloid pet scans and have one
scheduled in april of this year
however i dont ever get to see the results of these scans
so if i want to know if ive got beta amyloid upstairs
i will have to have it done in the private world

this folks i plan on doing this year
i want to know all i can about where im at

so
yes folks
there is
hope for the future

the organicgreen doctor

neurology appointment

Walk to End Alzheimers
click here to donate or join 
the organicgreendoctor.com team

click here to find your local walk 

NEUROLOGY APPOINTMENT
today i am going back for my almost 2 year follow up
since i was diagnosed with mild cognitive impairment 
amnestic type that stage right before full blown alzheimers
disease takes off

today i went back and read some of my blogs about that
time period
here are the links to those blogs

last day thanks
the dreaded doctor visit
the neurology visit

since that time i have retired and am on medical disability 
for my diagnosis because of the risk of making a medical
error because of my short term memory loss

i know from testing that i carry the apoe 4 genotype which makes
these symptoms likely to be from alzheimers disease
i also have an indeterminate testing results for tau protein 
and beta amyloid in the spinal fluid
(those are the two biomakers that are abnormal in this 
alzheimers disease thing)
i have a normal mri normal glucose metabolism pet scan 
normal screening labs 
and a consistently abnormal neuropsychological exam
ive had eight of these since the beginning of all of this 
and one was an eight hour one 
(thats the one that convinced the disability insurance to 
pay on my claim)

i have a strong family history of alzheimers disease
my mother died in the final stages of the disease
my father may have had the disease 
my younger brother now has the disease and is in 
a long term care facility

i am on aricept (donepezil) for the possible alzheimers disease
its really the only thing that helps
but it does not affect the progress of the disease
just the symptoms 
maybe
its all there is for now

i am staying active mentally and physically 
i dont let this drag me down 
at least im alive and healthy and am doing a lot of things
that i am enjoying
except of course im not practicing medicine which is what 
i enjoyed the most 

there is a test that may give me the definitive answer
its the beta amyloid pet scan
ive had one already and will have another next year with the 
study that im in 
the (adni) alzheimers disease neuroimaging initiative

but they dont give me the results
it would be the piece of the puzzle that im missing

the test is now available commercially in some areas
the amyvid pet scan
they inject a radioactive substance that attaches itself to 
any anyloid deposited in the brain 
if amyloid is present it will show up as red highlighted areas

if i have no amyloid present then there is a good chance that 
my symptoms are not from alzheimers
not definite but as definite as you can be

if amyloid is present that doesnt mean you have alzheimers but
it implies that you might

i want the test to add to what i already know

now we just need a treatment to stop or slow this disease down
if my test is completely normal i might have a chance if this 
disease shows up later for that treatment that is coming

otherwise my generation has missed out on the cure or treatment

but at least i will know 
i want to know

its like having metastatic cancer
theres no treatment 
but i want to know if its metastasizing
so i can speed up my planning for the rest of my life

i want to know

the organicgreen doctor 

was born too soon

WAS BORN TOO SOON

if you have a family member or friend with alzheimers

or have a strong family history of alzheimers then 

you might want to read this

yep think i was born too soon 

wished i was born 15 years later

why

the studies on alzheimers showing promising findings

is starting to steam roll

although im participating in one of the biggest and

most important studies on alzheimers ever done

i wish i were younger so that i could some day 

benefit from these findings

at least those of you are younger than me and my kids

and my nieces and nephews and one day my grandkids

will all benefit

those who would have gotten alzheimers will actually 

be dying from something else since treatments will be

available to prevent and treat this disease

nothing we have available does this except we are

getting close

ivig (intravenous immunoglobulins)-they take the plasma 

from plasma donors and remove all the immunoglobulins that

fight inflammation disease and infections including antibodies

against that on bad sticky stuff beta anyloid and it is given in 

a vein as an infusion

you know some of you when you were younger in college

needed money so you donated at a plasma center 

thats where this stuff comes from

its not new and is actually available now

its used now against certain neurological diseases as 

multiple sclerosis myasthenia gravis some demylinating 

polyneuropathies eg

its not approved by fda for use in alzheimers

the supply is limited

and its very very expensive 

they gave this ivig to patients with alzheimers then followed them 

for several months and those who received the higher doses

got good results

with alzheimers when you have it and show symptoms the decline

is noticeable over 3 years

everyone in this study showed a noticeable decline in progressive

symptoms

those who received the higher doses did not have any 

worsening of their alzheimers  in 3 years

if you have anyone in your family who has alzheimers you know

this is an important result

my mother went from driving her car although she shouldnt have 

to being unable to care for herself in three years

the same happened to my younger brother

now the problem is this stuff is available now

it can be given to someone and they may not progress in their

disease

they dont get better but they dont get worse

on the horizon and in the final stages of studies are at least three

infusions that contain either man made antibodies or something 

that induces the patient to make antibodies against beta amyloid

those results will be published soon so well 

know whether this approach will work against alzheimers

the ivig study implies that it will

if i have alzheimers i would be a good candidate for use of one of

this iv infusions since im so early in the process

and only a small amount of damage has been done so far

the progression of the disease could be stopped and i would

not develop full blown alzheimers

another important study is the genome project

luckily i am one of 800 people in this study 

using dna obtained in the adni study that im in

basically they will take blood and will do a whole genome

sequencing (all 6 billion letters in my dna) that will take 4 months to do 

they will basically map out all of my dna and genes

they then will take this information and compare it to my 

neuropsychological exams my mris my beta amyloid pet scans

and other tests done in the study

and scientist all over the world will use this information for 

research 

this genome project may end up creating a world without 

alzheimers according to one researcher

we  sure hope so

yep born 15 years too early 

the organic green doctor

more hope, nba

MORE HOPE

this is a picture of my wife she and i with hook em
the mascot from the university of texas
just before the baylor ut football game in november 2010

(this is a few days before i had my eventful trip to the
ut southwestern for my initial neuropsychological exam
to enter the adni 2 study
little did i know what was coming
it was also the day rg3 stuck it to the longhorns)

inside that mascot uniform is a special person
(youll see him in this uniform on espn this fall on some commercials)
that has it
you know it when you see it
this kid has it

he is the son of friends of ours
hes graduated from the mccombs business school this month
and will be working in finance at a non large bank company
in new york
he was asked to fix the financial mess while he was there
he said he would work on it for me

we went to his graduation party and met several of his friends
who had also just graduated
they all had jobs already
thats better statistically than the average graduate today

after spending time with these students i must say
that our future is in good hands

yes there is
hope for the future

NBA
dang i love watching nba playoff basketball
watched lebron go off on the pacers on sunday
what an athlete

then theres the plodding along spurs just getting it done
and no ones paying much attention
its either duncan or the coach or both as they are
always there without any flash

i decided what they need to do is just get rid of the regular
season and just have the playoffs
they play half a season anyway in the playoffs and
the players really dont  play real hard until the playoffs
and do they get chippy with each other or what

by the 7th game of a series they are usually tired of
playing each other

spurs vs okc
plodders vs the gazelles
then who knows what will happen in the eastern division
should be a good next few weeks of games

the organicgreen doctor

what if, adni 2 follow up

WHAT IF
the theory is that alzheimers disease is caused by the accumulation
of a sticky gooey substance called beta amyloid that attaches itself
to the brain and as a result the brain nerve cells die and what the end
result is
alzhiemers disease
thats the theory that is about to be finally tested in a clinical trial in
columbia
why columbia and not the us

in columbia there is an extended family of over 300 people who
get full blown alzhiemers disease in their mid 40s
they have a genetic mutation that predisposes them to get the
disease

there are people here in the us that have the same mutation but they
are not in the same family and in the same area of the country
like the family is in columbia

the new drug being tested is called crenezumab
its an injectible drug that induces the body or it is an anitbody that
attaches itself to this goey sticky beta amyloid and starts to remove
it from the brain

instead of giving it to people who have full blown alzhiemers
the drug will be given to people who dont have any symptoms yet
but who most certainly will get the disease within 10 years

if the beta amyloid gets removed as its produced and these people
who are destined to get alzheimers dont get alzheimers then the
theory that the beta amyloid is the cause of alzheimers disease
is proven and we then will have the first real medicine that can be
used to prevent alzheimers disease from occurring

thats the treatment america and the world is waiting for
i know if it was available and it works i would be first in line
to volunteer to get it
similar drugs as ive mentioned before though do not work as
well in patients like me who carry the apoe 4 gentotype
so if it works it may not work as well in me and others who
carry this genotype

could we have a cure or preventative treatment coming soon
the goal is a cure by 2025
i of course dont have that much time to wait

ADNI 2 FOLLOW UP
yesterday i went for my one year follow up for the adni 2 study
alzheimers disease neuroimaging  intiative phase 2
i had tons of blood drawn in special tubes that are sent off to
the adni central location i think in uc san diego

i had a neuropsychological exam done again
yes the torture test
this was a little shorter yesterday as it was only an hour long
next year i have the lengthy one done of 2-21/2 hours
dont look forward to that one

i had another neurological exam done by a neurologist and
a lot of questions were asked about how i was doing

my wife she also has to go with me
they ask her lots of questions about me and she
has to fill out a lengthy questionnaire on how im doing
she was real good this time and didnt get faintified

then finally i had a special volumetric mri of the brain done without
contrast that also takes extra views of the area of the brain
where alzheimers usually starts
this volume of this area will be measured and any subtle
changes in its size will be detected on this mri
this mri although read locally will be sent to the research central
area i think again at uc san diego to be officially read for the study

as a part of the deal i dont get the results of these studies

however when i take the neuropsych exam i know personally how
i am doing
i still have short term memory problems that are noticeable when
i take the test and have been persistent
they do correlate with things i notice but others dont notice
in my everyday life
none of this interferes with what i am doing now but
would have interfered with my practice of medicine

this does seem stable however and has not really worsened in a
year and a half since i had my first neuropsych exam done

my wife she and i did a video for the alzheimers research center
they did over 4-5 hours of filming and made a 5 minute video

ive reviewed it and although its hard to watch for me i know
that its a good video that hopefully will encourage people to get
evaluated  if they are having symptoms or to volunteer for an alzheimers
research study

i should be able to post it on my blog and it also will be available
on the azheimers research centers website and possibly other
national websites soon

i will post where it can be viewed when its available

the organicgreen doctor