alzheimers news-doc im having memory issues

ALZHEIMERS NEWS-DOC IM HAVING MEMORY ISSUES

yesterday i was contacted by someone who felt like he was having
memory issues
he is a retired professional who works one day a week
he has noticed that he has problems doing some of the work that
he used to do that involves memory and numbers

this has happened to me a lot over the last 7+years since i was
diagnosed
folks wanting to know what to do

for those of us like him with it in our immediate family
we are always concerned
is it going to happen to us

i was
it did

heres my advice

if you think you have issues
you should have an evaluation done
i read this morning in an article that when folks have memory issues
and
dont recognize them
thats more concerning

losing you keys is not abnormal
not knowing what car keys are for is abnormal
but
as we are finding out
there is a gradation between losing your keys and not knowing
what they are for
where you are on that grade is what you want to know

the first thing i tell folks
make an appointment with your primary care doctor for
only one thing
memory issues
nothing else

dont go alone
take your spouse or significant other
many doctors will want to interview them

if you dont think your primary doctor will listen to you
or do a good job
go to a neurologist

eg i if i was in practice now i think i could do a good initial workup
for memory loss

they are looking for causes that you can treat or do something about

go in prepared

if this individual has alzheimers starting he is real early
some of the memory testing will be normal
like the test called the mini cog
the one a lot of doc use
or
the mmse
trumps test the moca test is more sensitive to early changes

please dont go online and read and take the moca test
it affects its accuracy when you do have to take it for a diagnosis

if you dont do well on the moca test you should have a
full neuropsychological exam

if you are further along some of the previsit paperwork becomes
more important

to be complete
i would have his wife fill out this 21 question alzheimers questionnaire by herself
without his help
here is the link
sometimes spouses notice more things than you do
take that with you even if its normal
it helps the doctor out

then go online and take the sage test
here is the link
fill it out copy and take with you
this also helps the doctor out

if you are early in the disease these will be normal also
i expect his will be
mine were
now my moca test was initially abnormal
his moca test may not be normal

make a list of all your medications and all the supplements
that you take

i now take a lot of supplements
i have cross referenced all of them against each other and
against all my prescription medications

webmd.com has a good one to use to cross reference supplements
some supplements and over the counter meds i cant take
because of these interactions
eg
i have to limit antihistamines use since they interfere with
my aricept (donepezil) that i take for my diagnosis

make a list of your health issues like high blood pressure
high cholesterol diabetes sleep issues anxiety depression etc

make your appointment only for memory loss
bring your online tests
bring your wife
bring you list of concerns of what you have noticed
yes write them down
hand your doctor a copy
it is entered into your medical records
it shouldnt now get ignored
you keep copies of the online tests and the other lists
for yourself

the doctor should take a good history and do an examination
thinking in terms of finding a treatable cause for his memory loss

these are the labs that he should have
a cbc
a metabolic profile like a chem 24 that is commonly done
a tsh for your thyroid levels
a vitamin b12 level

some like me would add
a vitamin d3 level
a homocysteine level which if elevated may be associated with
an increased risk of heart attack stroke and alzheimers disease

then some would had sex hormones like testosterone for males
estrogen progesterone for females

if the b12 or the vitamin d3 or the homocysteine level are abnormal
they are usually easily corrected with daily over the counter supplements
all thrre of these were abnormal on me

then after the history and exam and the lab testing is done
there should be a memory test done
a minicog is not a sufficient one for early disease
a better one is the moca test like trump took
it shows up early symptoms

if the moca test is abnormal he should if his labs and history and exam
are unremarkable have a
full neuropsychological exam
it will show if there is memory loss
these are usually done by a neuropsychologist

if the history and exam or lab shows things like sleep issues or depression
not well controlled or abnormal labs these need to be fixed
before more testing is done

if the neuropsycholigical test is not normal
a mri scan should be done
that will rule out things like old strokes tumors etc

at this point the cause of the memory issues should have been
discovered

for him
he might consider after this
if he wants to know more
to do genetic testing
spinal tap for beta amyloid and tau
an amyvid pet scan for beta amyloid
none of these are covered by insurance
and are expensive

for me
i wanted as much information as i could obtain

so i have
such that i feel like my diagnosis is as accurate as one
can have based on the testing thats available in 2018

also
as i told him
he is a good candidate for research

you can go to clinicaltrials.gov
type in alzheimers
click on the state you live in
a list of all the alzheimers studies available are there

i can tell you though sometimes they dont show up before
they are open
the alzheimers centers in your state will know whats coming
in the future that may not be listed

for him
since he could be early or even in that prealzheimers state
that state where the memory is normal but the scans are not
he would be a good candidate for
some of the new treatments that are being used on folks with
prealzheimers or those with mild cognitive impairment like me

also a new study that is the phase 3 of the adni2 i was in for 5 years
called the adni3 study is starting up in his state. it should be on the
clinical trials website

also you can sign up for the alzheimers associations trial match
on their webpage www.alz.org
they will let you know when a study comes available that you might
match up with

also
if he goes to his doctor and gets the run around
he should go see another doctor
he should make sure he has a complete work up

a history and exam
labs
memory testing
maybe mri
maybe further tests for alzheimers not covered by insurance

he also
after he has had a complete workup
not before
should consider the regimen in dr bredesens article on reversal of cognitive decline
this should never be done without discussing it with your doctor
i reviewed them with my doctor and my neurologist before i started them

does it help
i think it might
but
its hard to prove if this is why im not worse now
or
if its the aricept (donepezil)
or
if its just the course of the disease
waxing and waning for now

tomorrow i will be on an alzheimers panel at a conference
at the huntingtom memorial hospital in pasedena california
sponsored by the alzheimers greater la at www.alzgla.org
answering questions about my story and diagnosis
and
how i feel about being diagnosed
and
how it affects my family and my life
and
what recommendations
i have for other folks

the panel im on at 1030am will be all folks who have
an early diagnosis

its interesting when you are around folks who are early on in the disease
that for many you would have no idea they had memory problems

here is the link to the conference

so
if you have memory issues
get a good workup
some causes can be treated

the organicgreen doctor

top questions you ask me

TOP QUESTIONS YOU ASKED ME
i am always asked a lot of questions about alzheimers
dementia memory loss
and
of course lots of gardening questions and rainwater collection ones
but
mostly today ill address the top three im asked about memory

should i be tested is asked at every presentation i do
i answer it this way

if you are having memory issues
you should seek an evaluation
there are a lot of things that causes memory issues that are treatable
like low thyroid low b12 abnormal electrolytes liver disease
kidney disease depression anxiety stress sleep disturbances
medication abuse of drugs and alcohol poor control of diabetes
blood pressure cholesterol
just to name a few

fix these and your memory might improve

before you go to the visit
if the memory is significant have a family member do
an online questionnaire on you like this one
fill it out and print it to take with you

also write out what memory issues you are having
take them in with you
take someone with you since many providers like to
interview family members also

make the appointment just for memory and nothing else

during the evaluation you should be asked lots of questions
labs should be done
a memory test should be done

if you have an in office one that doesnt take 20 minutes or so
to do then you did not have a good one
they are called mmse or moca tests
they may do one called a clock test or minicog as a quick screen
but on that one you have to be more advanced to flunk it

you may need a neuropsych test and an mri

here is the link to a pamphlet that is a gold standard
for evaluation of memory loss for providers to follow
the link is at the bottom of that page to the pdf file

it soon will be available in a quicker reduced form
you can look at this online pdf file to follow your workup
to make sure a complete evaluation is done

dont get ignored if you do go somewhere else for the evaluation

should i have genetic tests done
i would say no if you are not ready to accept what you find
if you are not ready physically mentally emotionally and
financially to get bad news

if a positive genetic test gets in your medical record
you will not get life insurance disability insurance
long term insurance possibly professional insurance like
malpractice insurance and in some cases health insurance
which thank goodness for obamacare most people could get
it even with a diagnosis

i have had relatives and friends get genetic tests done
that show the apoe4 double gene
if its positive and its in your record you will have problems
as above

the genes for alzheimers are rare
less than 1%
if its heavily in your family you could have it
if you have the gene you will get the disease

the apoe4 gene double version is the next bad one to have
your odds are increased 10-20 times you will get alzheimers
but it doesnt mean you will
even then it can be hard to digest and accept your risk

that said
i would want to know and i did want to know
so i got tested
granted this was after already being identified as having
memory loss
and
labeled as amnestic mild cognitive impairment
and
having been shown to have abnormal levels of beta amyloid
and tau in my spinal fluid

so as part of a total workup i had it done
probably without symptoms i would not
but
lucky for me i had all of my ducks in a row re insurances
when my diagnosis was made

that said
knowing you have this increased risk sure makes you more
aggressive in taking care of you health
which i think determines how this apoe4 gene will affect
your memory loss

how are you doing
i must say that compared to 4 years ago when i was diagnosed
and
took all my tests and did all those memory tests and
neuropsych tests
i am much better as evidenced by my scores now on those tests
and
based on what i feel and notice myself

i feel like that fog that was hoovering over me for a couple
of years seems lifted some

why
once all this happened i got very aggressive with my health
my blood pressure was always borderline high
it would come and go
so i gave in and got on a blood pressure medicine that keeps
it normal all the time now

my cholesterol was under pretty good control
but i have aggressively got my levels to those that someone
with heart disease or increased risk for heart disease should
have theirs at
specifically my ldl is less than 100 and my triglycerides are less than 100

i stay very active physically mentally socially as much probably
as when i was in practice if not more

i take aricept which could be part of the reason why im better

stop it and i will find out but im not willing to do that though
the problem with aricept is that it interferes with my sleep
i only get 5 hours a night
but
i compensate that with an afternoon nap
and
i now take a nightly herbal medicine that seems to get me back
my 1-2 hours i am loosing to the aricept
usually
but i do most of the time feel rested

that said the aricept causes a lack of energy and tiredness that
usually hits me in the afternoon
hopefully i dont demonstrate that tomorrow afternoon at the movie

luckily usually i am napping and have done most of what i
like to do in the morning

i take b12 supplements and vitamin d3 supplements since both of
these were low when i had blood tests for them

i eat a mostly vegetarian diet about 90%
i eat a morning egg and toast dried nuts and fruits
i do eat meat but its lean meat like turkey and range fed beef
some occasional chicken
i follow mostly a mediterranean diet
but if i go out to eat i eat what i want too

i am not depressed i dont feel stressed i feel happy and contented
i dont get angry it seems

then
i have been following the protocol from the
reversal of cognitive decline study from dr bredesen from ucla
most of which i was doing already

putting all that together
the answer is
i think i am doing better


still alice
the special showing of still alice  with the alzheimers association at 155pm which
will have a panel that includes me and two others to answer your questions
afterwards
is sold out

it is showing several other times that day and at other locations in austin
for you to see it
it is a must see movie for i think everyone
even young folks since i think they need to be thinking about this

for those who got tickets to the q&a session ill see you there

the organicgreen doctor

fate

FATE
i called it fate
she called it as a result of her strong religious beliefs
and an early morning prayer for help that morning

two weekends ago my wife she and i went to the school
to visit the garden fair
its the school where i helped put in the garden in the back
ground of the picture below

note i meet today with another school to help them plan
their school garden
my purpose is to help as many people garden organically
as possible especially kids and the schools

my other purpose is to spread the word about alzheimers disease

that morning we stopped by the garden to see the fair
on my way to doing a q&a with a large group of caregivers
on alzheimers disease

i struck a conversation with this lady standing by the rainwater
tank that was on display
ill talk all day about rainwater just like i will on alzheimers disease
and on organic gardens

she and her husband was interested in putting in a system so
i gave her my card with my email address and my blog address
and my twitter link
i told her to email if she had any questions

later as my wife she and i were in front of the garden
i wanted a picture of us so i saw this lady again
so i asked her would you take our picture sure she said
then
my wife she and i went on to the seminar which was successful
i think based on the response

this lady emailed me this week
that day when
she went out to her car to leave
as she sat in her car
thats when fate kicked in

she flipped over my card which says
this blog is about my journey with possible early alzheimers disease
please feel free to follow me along this path

i called it fate she called it an answer to her prayers
she said she got cold chills down her spine

she has agonized over this for months
her husband in his early 50s has seemed to develop memory loss
that is affecting his work and his life
she was at loss at what to do

as i emailed her back i decided to write my answer in this blog
so others in this situation may benefit from this blog today

first if you notice there is a problem or he notices there is a problem
or others notice there is a problem
then
there is a problem
dont ignore it

yes you can get early onset alzheimers although it represents less
than 10% of the cases
there is concern that since his mom had alzheimers disease that
this is what it could be

since he is young the same age my brother was when he was
diagnosed i recommend that he get an aggressive evaluation of
his memory loss

yes it can be a slow gradual onset that can be years in the making
the disease itself starts 20-30 years before the diagnosis is made

it is important that all other causes of memory loss be ruled out

like high blood pressure high cholesterol diabetes anxiety stress
depression sleep disorders like insomnia sleep apnea restless legs
etc low thyroid activity low vitamin b12 chronic infection
electrolyte problems  liver disease medication side effects drugs
alcohol old head trauma etc

many of these things can be treated

go to this link and answer the questions on your husband
my guess is that he will score a 5 or greater which will be abnormal
copy this off and take with you when he goes to the doctor

remember even if his score in in the normal range he needs
an evaluation

make an appointment with his primary care doctor
go with him
go in the room with him
write out a list of medications and a list of things that you
have noticed
make a copy to hand to the doctor

when you make the appointment dont make it for anything
but for memory loss

a good workup will include meeting with you and him then
just you and then just him

here is a link to the clinical parameters for evaluation and treatment
for someone with memory loss
the gold standard in the state of texas for this evaluation

if you are not pleased or if you are put off by the doctor i will
send you the name of a neurologist to see for evaluation

remember you are looking for treatable causes

he should have

a good history and examination looking for causes

labs like cbc metabolic profile b12 foalate tsh-thryoid level ua
maybe hiv hep c syphilis tests

a good screening in clinic memory test like the mmse or moca
then based on what this all shows
he may need a neuropsychological test which will tell if there
is memory loss or not
he wont like that one
i do it every year in fact i have to do
one next week and i dread it

then he may need a mri scan of the brain looking for abnormal
things that would explain his memory loss like strokes old head
trauma cyst tumors brain shrinkage etc

then there are new tests that may or may not be done based on
the history
spinal tap for beta amyloid and tau or the amyvid pet scan

the younger the patient the more aggressive the workup
your husband meets that category

remember some people develop memory loss that becomes
stable and never changes the rest of their life
they can still have a meaningful life
many can continue working

what you need is an answer as what is the cause of all this

also remember
he knows he has a problem
he may be scared to know

i hope this is helpful
please free to contact me if you have a question

you may want to look at this blog on tests and links

wishing you the best

the organicgreen doctor

crs

CRS

thats what people frequently say to me
i cant remember stuff anymore
usually they are grey headed but sometimes they are younger

i tell them
if you occasionally forget an appointment then remember later
if you make occasional errors balancing a checkbook
if you occasionally need help with the settings on a microwave or
recording a television show
if you get confused occasionally about what day it is but figure
it out later
if your visual changes are due to cataracts
if you sometimes have trouble finding the right word
if you make a bad decision occasionally
if you misplace things from time to time then are able to eventually
retrace your steps to find them
if you sometimes feel weary of work family or social obligations
if you develop very specific ways of doing things and become irritable
when a routine is disrupted

then
you have normal aging behavior

if its more than this i refer them to this link
at the alzheimers association at www.alz.org
that has the 10 early signs of alzheimers

things like repeating questions over and over again
being unable to follow a simple recipe or taking care of monthly bills
driving to a familiar place
forgetting where you are
having trouble judging distance or color contrast
having trouble following a conversation
putting things in unusual places
making poor judgement with money
removing yourself from social activities
easily getting upset outside of your comfort zone

then you may have a problem

again go to the link and read more

then if you or your family think there is a problem take
one of the online quizzes at this link
or the ad8 test at this link
or a family member can go to this link and answer
the 21 question test at this link

then if there seems to be a problem
you should get evaluated

remember there are a lot of treatable causes for memory loss
like b12 deficiency thyroid issues depression high blood pressure etc

when you go to a provider take the online quiz results
and your concerns
usually its good to take a spouse or loved one with you
the provider may want to interview them also

remember dont let the provider ignore your symptoms

get a good history
an exam
probably some labs
a good mental status evaluation like the mmse or mocha test that
is commonly used in the providers office

if indicated a full neuropsychological evaluation
if indicated an mri of the brain

remember the most important test is the history and exam

you are looking for an explanation for your memory loss

if the primary provider doesnt seem interested go to someone
who is interested in memory loss patients
a good source is an alzheimers research center like the one i go to
at ut southwestern medical center in dallas
every state has them
they wont ignore you and will do the workup thats needed

hopefully that answers that question
when someone asks me about crs

the organicgreen doctor

reversible, video update

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

click here to find your local walk 

REVERSIBLE

in dementia and alzheimers weekly this last week 
they reviewed some reversible casues of memory loss

these are things ive mentioned before that we look for
when someone presents with memory loss

we are looking for things to treat to make the 
memory loss better

these things were screened on me when i presented 
for my first evaluation 
also these tests are repeated at the visits for the adni
alzheimers disease neuroimaging initiative study that 
i am in 

medications such as antihistamines notable are benadryl
or meclizine or the long acting ones we all take for 
our allergies
also sleeping pills and pain pills are on the list

alcohol and illicit drug use
excessive alcohol can affect the b vitamins and both can
affect the brain 

stress especially emotional stress can cause memory loss
to the extreme is psychogenic amnesia where the patient 
can forget who they are and can wander around lost
it usually resolves on its on 

depression is common with aging and can affect memory 
treatment usually improves memory 
i get screened for depression at each visit

thyroid problems either underactive or overactive can interfere
with remembering things

sleep deprivation can cause memory loss
whether its from stress insomnia or sleep apnea

nutritional deficiencies of vitamin b1 and b12 can affect memory 
loss and is easily replaced with a pill or shot

another cause of memory loss and confusion is normal 
pressure hydrocephalus in which there is increased pressure
in the fluid in the brain
this is usually detected by ct scan or mri of the brain 
its easily treated with a shunt to relieve the pressure
and the recovery in these patients is remarkable
there are stories of patients who are in a nursing home who 
after shunt surgery become near normal again driving and 
living back at home

my last year of practice i discovered a patient with this 
who was having problems with walking and who had 
gotten confused
the dementia or memory loss work up was done and the normal 
pressure hydrocephalus was discovered
after having the surgery the recovery was impressive

with dementia work ups this is what we are looking for
treatable reversible causes

as we all know 
alzheimers is not treatable 
it can only be slowed

VIDEO UPDATE
also the video on my story is now on 
the national institutes of healths website 
and was referenced in 
the last alzheimers weekly

the organicgreen doctor