alzheimers news-trumps memory test

ALZHEIMERS NEWS-TRUMPS MEMORY TEST

ill be the first to admit
i dont like donald trump
but
lets be fair to him regards his memory test

alzheimers starts in the brain 15-30 years before
any symptoms start
before any memory tests are abnormal

there are subtle things that can happen before the
memory tests become abnormal

sometimes the first thing is spatial things
missing things in your peripheral vision
which can show up when driving
sometimes subtle memory things happen
im speaking from personal experience here
things you notice that others do not

eventually when the time comes
the memory tests become abnormal

first let me say
if you are going to need memory testing anytime
soon
dont be reading whats in those memory tests
it affects how accurate they are

now i have personally been administered the same memory
test he had done more than 15 times over the last 8 years
i have personally administered that particular test to
family members and friends several times
i am quite familiar with the moca memory test

when you go to a doctors office
he might administer one of three tests

one is the minicog test
it involves being told three words to remember
then
you are given a time and asked to draw that time
on a clock

if you dont pass that one
you have memory issues
you need more evaluation

its a quick and simple test
its not sensitive though in picking folks up early
with memory loss

the next is the mmse
multimental state exam
its scored up to 30
get 30 and you might be ok
but
for those like me when i was first tested
it missed me
i got a normal score on the mmse

the third test is the moca
thats the one that trump took
the best score you can get is 30
a normal score is 27-30

when i was first tested in 2010
my score was 25
which was abnormal
its in the mild cognitive impairment range

the moca test is a more sensitive test to pick
up those early changes
like what you see with early alzheimers or mild cognitive impairment

its not a 10 minute test
its a 20-30 minute test

so with a normal result
a 30 score
as of right now
trump probably doesnt have any symptoms of dementia
or short term memory loss
the first thing that usually shows up in alzheimers disease

my scores earlier this year on one of the moca test
was 30
a perfect score

so why did mine get better
medication ie aricept (donepezil)
supplements
correcting things like cholesterol blood pressure weight exercise
stress sleep staying mentally engaged
all helped to make my scores improved

so i have a perfect score on my last moca test
does that mean i dont have alzheimers disease
no
the diagnosis is made on more than just the moca test

they use
family history
past medical history
risk factors
spinal fluid for tau and amyloid
a pet scan for amyloid the amyvid pet scan
genetic tests
serial memory tests
then
the gold standard
the neuropsychological exam
eg mine is abnormal even though my last moca was normal

the neuropsychological exam is more accurate
if there are memory issues it will show up
yes you can have a normal moca and have
an abnormal neuropsychological exam
it take 2-3 hours to do this exam

the moca test is a screening test
it doesnt rule out alzheimers disease

there is a state
called
prealzheimers or prodromal alzheimers disease
the memory tests are all normal
the scans and spinal fluid levels are abnormal
in this stage
you just dont have symptoms yet

so
trump
either does not have alzheimers disease at all
or
he is in that prealzheimers state or prodromal state
a time that can last 10-20 years

so
as a medical doctor
as a family doctor
as someone who has had this test multiple times
as someone who has administered this test multiple times
as someone who reads 10+ articles on alzheimers disease each day
as someone who has lectured on alzheimers disease multiple times
as someone who has been and is now in two of the most
important alzheimers studies ever done
i feel like
i can speak with some authority about alzheimers disease

so
if i was trumps medical doctor
if i had administered the moca test to him
i would tell him
right now there is no evidence that you have memory loss or dementia

i would tell him to correct those other health issues
like
the what i called heart attack levels of the ldl cholesterol
he is just a point or so away from being labeled morbid obese
get more sleep
get more physical activity
greatly improve his diet
let your calcium score on that heart ct be a warning
if a heart attack or a stroke dont get you
demential or alzheimers might in the future


the posting of the moca test for all to read
i think does a disservice to those who may need a moca test
in their workup for memory loss
practicing or reading the tests affects its accuracy
i am not allowed in my studies to have other memory testing
since it causes what they call testing effect

also
this doesnt mean trump doesnt have mental problems
or psychological issues
this moca test this screening test
doesnt check
for anxiety
for depression
for bipolar disorder
for psychosis
for paranoia
for narcissism

those are tested usually by a psychologist or psychiatrist

so
no he dont appear to have active dementia or alzheimers
manifesting itself right now

lets all move on from this

mudslide update
maybe next week the 101 will be open
no new recoveries no change in the death toll
we saw what seemed to be miles of trucks loaded with mud
and stuff on the freeway waiting to go to a dump place
way north of santa barbara
they are expecting to dump over 20,000 dump truck loads of
stuff in those dump sites

thatcher update
he is awake
playful
tape free
looks like iv free except for the pic line
oxygen free
soon to be moved from icu
you go thatcher

here is his gofundme account
#thatcher strong

the organicgreen doctor

alzheimers news-am i in

ALZHEIMERS NEWS-AM I IN

this last friday
as my wife she and i were driving up to dallas
to the alzheimers center to begin this journey
hopefully
to get a new treatment for alzheimers disease
that may slow it down or if we are all lucky
stop it in its tracks

i did a lot of contemplating as i drove north
thinking back over the last 6 years
when
we made this same journey to the center
then
i was simply volunteering to be in the normal control group
of the large alzheimers study
alzheimers disease neuroimaging initiative phase 2

i was simply going up
to do my part to further our knowledge of what happens
in alzheimers
and
at the same time start a monitoring process for myself
since
it runs so strongly in our family

friday
as i sat in the same damn chair that i sat in
6 years ago when all this happened
i looked out the window
well the blinds were closed

in my reoccurring dream i have about this
there is a large tree growing up to the 4th floor outside
this window
in my dream it is a sycamore tree
i think because my grandparents one who had dementia
had a huge sycamore tree in their yard
and
i use to climb on it as a kid

all that really is there is just the windows of a building

but as i sat down to take the memory test friday
the same tester was giving the test that gave me the first one
i said you know in my dreams there is a big tree out there
she smiled that sweet smile of hers

now 6 years ago
i was broadsided by failing my memory test
ive done the thing so many times now
i know the parts i cant do very well
interesting is
some of the parts i have gotten better at
some i dont do as well

now
this study is called the aducanumab study
by the company biogen
of all the drugs out there right now
it has the most promising chance of being successful

i have had my eye on this study now for several years
well
i have fought hard to get into it
knowing that this could be my last chance to
plug into one of these new drugs
if i wait too much longer
i may to late for them to do any good
so
i know its now or never for me

now i continue to do all the healthy things i should be
doing
the same ones that all of you who read this should be doing
control blood pressure cholesterol weight
do exercise eat right get sleep avoid stress etc

all those no matter what i will keep doing
oh if you are genetically kin to me you should be aggressively
doing the same
since this drug is really meant for those of you
who have no symptoms but are going to get alzheimers

yes i was a little bit nervous
its like a terminal cancer patient
getting this glimmer of hope
from a new research drug
that will slow down the cancer or cure it

this is what this study means to me

so here we go

we arrived there at 930am and left there at 200pm
with no downtime

first
we met with the screening nurse
who went over the lengthy protocol with us
who went over my medical history with us
who took my vital signs weight etc

then
second
they drew some blood
well a lot of blood
i think i counted 10 vials of blood
its 2/3 of a can of soda
now i didnt faint
but
i need to eat a lot of iron foods for awhile to build
my blood back up
its almost like donating a unit of blood

they are testing cbc chemistries ua all kinds of biomarkers
genetic tests dna and rna studies etc
even saving some for perpetuity
in case its needed for more research some day

i realize i have my blood stored all over the place
across the usa

then
third
since i didnt pass out
i was able to proceed to the next testing
the much dreaded memory testing
it took about an hour
i did parts of the mmse memory test
some components of the moca test
and
a new test thats used specifically for this study

to get in this study
i have to be in the upper part of the mmse
but
must have difficulty with parts of the short term memory part
that correlates with mild cognitive impairment amnestic type
the stage right before alzheimers disease

knowing what i know from taking these things
i passed the mmse and will qualify based on how i felt i did
i had difficulty with the parts of the test that is correlating
with what i have noticed in my day to day life
which is what they are looking for

so far after these three things i feel like i am qualifying
for the study

then
fourth
i underwent answering questions on my memory
by a alzheimers center interviewer
comparing what my wife she has told them
to what i say

first question
do you have memory issues
the answer
yes
granted its subtle probably not recognizable to most
folks who know me

then
fifth
i underwent a lengthy neurological history and examination
by the main investigator at the alzheimers center for
this aducanumab study
he was good at picking out the parts of my history and exam
that correlates with my memory loss

so
at the end of the day
how do i feel about my chances of getting past this step
i feel like i met the criteria
unless something is hidden in the labs somewhere

all this information is sent to the biogen folks
to review
they make the final decision

if they say ok
then
i have an mri of the brain
if i pass that one
i have a amyvid pet scan for the bad beta amyloid
the test that is missing from all that i have had done

the one
that i feel will give me my final answer
the one
that will provide me with what i need to plan
the rest of my life

fingers crossed

the organicgreen doctor

alzheimers symposium part 2

ALZHEIMERS SYMPOSIUM PART 2
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 2
neurology visit

so i went to dallas to the neurology appointment with my wife
they asked that i get the following labs before i came to the appointment

labs to be done
cbc complete blood count
metabolic profile with electrolytes liver function tests kidney function tests
and glucose
vitamin b12 level
syphilis antibody test
hiv antibody test
tsh for thyroid function
urinalysis
mri scan of the brain
depression screen
neuropsychological testing or a good mental status exam
good history and physical

this is the list of lab tests and exams that you need to have done if you
are being evaluated for memory loss or dementia
anything less is not acceptable

a cbc complete blood count checks for anemia or a low white count

a metabolic or chemistry profile checks the electrolytes for a low or high
sodium or potassium which can cause memory loss
abnormal liver tests
abnormal kidney tests the bun and creatinine which is elevated
if you have kidney failure

a glucose which can detect diabetes

a vitamin b12 level
if you have a low b12 level you can have problems with memory

syphilis antibody test
you can have latent syphilis that shows up as later in life in the
central nervous system and cause dementia

hiv antibody test

tsh for thyroid function
thyroid stimulating hormone will detect hypothyroidism or low thryoid
which can cause depression and memory loss

urinalysis to check for blood or protein in the urine

a depression screen
depression can cause memory loss

a mri of the brain
this is looking for increased fluid in the brain shrinkage or atrophy of the brain
brain tumors or masses or cancer old scar tissue evidence of stroke
aneurysms or white matter hyperintensities which can be associated with
an increased incidence of dementia
they are looking for something treatable

a neruopsychological test the gold standard for evaluation or a
good mental status evaluation in the office as  a screening test
the mmse test misses me but a mocha a more involved test picks up
some subtle changes on me that would make a physician want to do more
testing with the gold standard neuropsychological test

then a good history and physical examination looking for something in the
exam that would explain the memory loss

so i saw the neurologist who looked at my neuropsychological test and
my lab tests and mri scan that were done and did a history and exam

she said
dr nash
you have early mild cognitive impairment amnestic type
(short term memory loss) that is earlier than what we usually see
and it may be due to alzheimers disease

here why
you had a normal mental status exam three years ago with your long term
care insurance and now using the same test you have an abnormal result
and other short term memory tests are abnormal

your labs and scans show a normal evaluation for other treatable causes of memory loss

you have a very strong family history of alzheimers disease
mother father brother cousin aunts and uncles grandparents

you put this all together and it says possible alzheimers disease
(later other tests done point towards this diagnosis also)

i think you should consider getting on the medication aricept (donepezil)
i had read enough about my diagnosis and knew thats what i wanted to do

aricept (donepezil)
is an acetycholineterase inhibitor
it raises the acetylcholine levels in the brain and makes the brain and nerve
cells work better

it does not treat slow down or prevent the disease
it only delays the symptoms

one neurologists told me that 1/3 get better on it
1/3 stay the same
1/3 dont get better

so 2/3 of those that start it stay the same for a while or improve
near 100% of those who dont take it dont get better

the earlier you start the aricept (donepezil) the longer it seems to work
it however will get to the point where it doesnt work any more
as the disease just marches on

the side effects of the medicine is related to the elevated acetylcholine
the first month you take as i found out is when the side effects are the worst
they get better however over time

i have had most of the side effects
i get insomnia that is worse if i take it before bedtime
my brother took his however at bedtime and never had any sleep problems
i take it in the morning after breakfast to counter the nausea that occurs
and to help with the insomnia
i also snack some in the morning to keep the nausea at bay

i have the most vivid dreams those aricept dreams
the kind when you wake up you want to go back to sleep so you
finish them
they are never bad ones just pleasant ones

i have restless sleep
i get restless during the morning not long after i take it
which gets better as the day progresses as does the nausea

i get severe leg cramps when i sleep
the kind that get you up out of bed
they are worse if i have done a lot of exercise

i get blurry vision about 2-3 hours after i take it but that goes away
fairly quickly
it was worse the first month but now is better

warning
if you or a family member is on this medicine dont abruptly stop it
without talking to their doctor
eg if i were to discontinue this medicine i might drop down to the level
i would have been without the medicine and if i restart it
i might not ever return back to the same cognitive level i was at

other drugs used in alzheimers are
exelon which works similar to aricept
it also comes in a patch form which helps with the nausea

namenda works differently that the other two
its usually used as an add on medicine when things start getting worse or if
there is problems taking the other two

recent studies have shown that using the aricept and namenda together at
the beginning of the diagnosis may be helpful
eg
pat summitt started on those two meds when she was first diagnosed

so she wrote that prescription for aircept and handed it two me
a surreal moment as i had just 24 hours before written the same prescription
handed it to a patient and his daughter and reviewed those same side effects

i was not accepted in the normal control group of the
alzheimers disease neuroimaging initiative study
but was told after i was on the aricept (donepezil) for 3 months that i
could reenter the study in the early mild cognitive impairment group

i never returned to work
i went on short term disability then later on long term disability

once i was diagnosed i became uninsurable
no life insurance no disability insurance no health insurance no long term
care insurance no malpractice insurance

luckily i had those all in place before the diagnosis was made

so put a lot of thought into getting this evaluation
you need to be ready
soically psychologically and economically ready
if you are not ready it can be devastating

next friday april 19 i will blog on
alzheimers symposium part 3
the alzheimers disease neuroimaging initiative

the organicgreen doctor

what to do, tomater star

WHAT TO DO
this is a question i get a lot especially recently maybe because of
the holidays
these questions come in on email, texts, facebook, this blog and in
personal phone calls or conversations

what do i do if i think i have short term memory problems or if a
relative has short term memory problems

its simple get it checked out
sometimes these things are treatable
sometimes what you are worried about is just normal aging

what happened in my situation was different
i did not go in looking for an evaluation or complaining of a problem

i had a normal mental status evaluation for long term care and passed
then 1 year later while volunteering for a alzheimers research study as
a normal volunteer i underwent a neuropsychological evaluation that
showed i had short term memory problems greater than expected
for my age and my degree of education
thus the mess i am in now was discovered

if you think you have a problem whether some one else notices it or
not you should get evaluated
the goal is to look for treatable causes-anemia, depression, low thyroid,
b12 deficiency, stroke, sleep problems etc
you want these things and not the big A

go to your primary care provider or neurologist or psychiatrist
and talk to them
if you think theres a problem dont take dont worry about it for an
answer

you need a complete neurological history and physical examination
looking for abnormalities
evaluate any history of drug or alcohol abuse or head trauma or
family history of the big A

you need some type of mental status evaluation
-mmse (this one is not as thorough and is commonly used)
(it misses my deficits), its done in the doctors office
-moca test is more thorough in picking up a problem (it picks up my problem)
it is also done in the doctors office and
-a neuropsychological examination if there is still a question you should
have it done by a psychologist or neuropyschologist
the neuropsychological examination is the gold standard to use to evaluate
short term memory loss

you should be screened for depression
you should make sure there is no sleep disorders such as sleep apnea

here are the labs that are usually done
complete blood count, complete metabolic profile (electrolytes, glucose,
kidney functions, liver function tests), vitamin b12, syphilis screen, hiv test,
tsh (thyroid test for low thyroid function), urinalysis
these are looking for some of the treatable causes of memory loss

then if these are all normal you should have a mri of the brain to rule out
stroke, tumors, aneurysm, increased fluid, and shrinkage of the brain

if all these are normal and the mental status exam confirms a problem with
short term memory then it is possible that you are dealing with the big A

you and your doctor will need to look at all the information and make a
clinical decision on whether this is what you have-the big A

soon you will be able to get biomarkers done on blood, in the spinal fluid,
and beta amyloid pet scans to get a more definitive answer
i had some of those done

if it appears to be the big A
would recommend you start treatment as early as possible
it gives you time with your family that youll lose if you dont
it gives you time to prepare for the future
even though it wont cure you most people opt for treatment
i did

TOMATER STAR
my wifes shes tomato she has at her school will become a tv star
this weekend on klrus central texas gardener at 1200 noon and
at 400 pm
ive told the story of that tomater before
will leave it to the tv show to do the complete job

cant wait to plant one of these weird ones this spring in the garden
and see what grows

the organicgreen doctor