As planned, I spoke yesterday at the meeting of the Southeast Washington Advisory Council on Ageing and Long Term Care. The title of the talk was "Beating Back Cognitive Impairment from Alzheimer's Disease, What really works?" The talk was very well received.
They said I had 45 minutes with Q&A. I went 53 minutes without Q&A, leaving off some of what I had planned to say. But they distributed the PowerPoint to everyone afterward.
I had an informal Q&A during the lunch that followed. I did get on inquiry about another possible speaking opportunity.
In my book, "Beating the Dementia Monster," I describe what has occurred since 2015 when I first knew I had memory problems. (You can find it on Amazon.com.) I have experienced remarkable improvement, and I’m certain that I can share valuable information with many others. In this second edition I continue my story to 2020 and provide greater understanding of how Alzheimer's advances and why what I did worked.
Saturday, April 20, 2019
Thursday, April 18, 2019
Speaking Engagement, Friday, April 19
Tomorrow morning, I will be addressing a meeting of the Southeast Washington Advisory Council on Aging and Long Term Care. I'm told to expect up to 45 people in attendance. It's a public meeting, held at the TRAC convention center in Pasco, WA. The title of my talk is "Beating Back Cognitive Impairment from Alzheimer's Disease; What really works?" I have two more firm invitations to speak to interest groups later this year and a couple more likelies.
Is the Search for an Alzheimer's Drug Intervetion Over?
In a post of March 25, "Aducanumab RIP," we discussed the shock waves that went through the AD community when Aducanumab was abandoned as a candidate drug intervention. We noted that the failure of the drug had challenged our understanding of how the disease works. Since then, consensus on how to go forward has continued to evolve.
This week, Alzheimer's and Dementia, the journal of the Alzheimer's Association published an article about the changing research paradigm. The article, "Dementia: Paradigm Shifting into High Gear," acknowledges how the failure of the drug has shaken optimism about the future trajectory of AD research. While I didn't pay the $36 necessary to penetrate the paywall and so didn't read it, I did read the abstract. The article doesn't say it in so many words, but the implication could be that there just might not be a "silver bullet" drug intervention for AD, at least not in the foreseeable future. The article suggests that continuing the search for a miracle drug may be misguided, and treatment ideas are complicated by the likely presence of cardiovascular disease in the Alzheimer's brain. We should think about new designs and strategies that consider the concurrent presence of different diseases associated with aging.
What I take from this is that the only treatment that we have now or will likely have any time soon is the multi-domain strategy we discuss in Beating the Dementia Monster: physical exercise, sound diet, good sleep, maintaining social connection, and stress reduction.
This week, Alzheimer's and Dementia, the journal of the Alzheimer's Association published an article about the changing research paradigm. The article, "Dementia: Paradigm Shifting into High Gear," acknowledges how the failure of the drug has shaken optimism about the future trajectory of AD research. While I didn't pay the $36 necessary to penetrate the paywall and so didn't read it, I did read the abstract. The article doesn't say it in so many words, but the implication could be that there just might not be a "silver bullet" drug intervention for AD, at least not in the foreseeable future. The article suggests that continuing the search for a miracle drug may be misguided, and treatment ideas are complicated by the likely presence of cardiovascular disease in the Alzheimer's brain. We should think about new designs and strategies that consider the concurrent presence of different diseases associated with aging.
What I take from this is that the only treatment that we have now or will likely have any time soon is the multi-domain strategy we discuss in Beating the Dementia Monster: physical exercise, sound diet, good sleep, maintaining social connection, and stress reduction.
Tuesday, April 16, 2019
Can Amyloid Removal Accelerate Cognitive Decline?
On April 11, 2019, the New England Journal of Medicine published a report on the abandonment of the prospective AD drug, verubecestat. Not only did it fail to improve cognition, some test subjects experienced worsening cognition when compared to the control group. The findings were summarized this week in ALZForum.
Verubecestat is a BACE1 inhibitor. In June, we reported on the failure of another BACE1 inhibitor which, it was hoped, would have removed amyloid proteins (actually, protein fragments) from the brain. The BACE1 inhibitor drugs may be effective in stopping the formation of new amyloid molecules in the brain, but that has not led to improved cognition in test subjects. If fact, test scores for subjects in the verubecestat test actually worsened. It's not clear why this occurred.
The article quotes a doctor at Mayo Clinic who said, “To be blunt, beta-amyloid lowering seems to be an ineffective approach, and it is time to focus on other targets to move therapeutics for Alzheimer’s disease forward.”
Verubecestat is a BACE1 inhibitor. In June, we reported on the failure of another BACE1 inhibitor which, it was hoped, would have removed amyloid proteins (actually, protein fragments) from the brain. The BACE1 inhibitor drugs may be effective in stopping the formation of new amyloid molecules in the brain, but that has not led to improved cognition in test subjects. If fact, test scores for subjects in the verubecestat test actually worsened. It's not clear why this occurred.
The article quotes a doctor at Mayo Clinic who said, “To be blunt, beta-amyloid lowering seems to be an ineffective approach, and it is time to focus on other targets to move therapeutics for Alzheimer’s disease forward.”
Can Naproxen -- or Asparin -- Prevent AD? Or make it worse?
On April 11, research results were published about testing on the (formerly) interesting idea that non-steroidal anti-inflammatory drugs (NSIDs) could prevent or treat AD. The idea was intriguing, and some epidemiological studies had suggested that it might work. Recall that inflammation plays a significant role in the disease process for AD and may be part of the way in which it begins. Therefore, it seemed reducing inflammation would combat the disease.
Does it work? No, and it may make things slightly worse.
What are NSIDs? These are (often) over-the-counter pain relievers, like aspirin, ibuprofen, and naproxen. (Tylenol can reduce inflammation, but it is not an NSID.) NSIDs relieve pain by reducing inflammation.
This week's issue of ALZForum featured an article, "Closing the Book on NSAIDs for Alzheimer’s Prevention." It reported on the early termination of the INTREPAD trial. Preliminary results showed no benefit with respect to AD, but downsides such as causing and aggravating cardiovascular problems.
As we discussed in a post on March 2, 2109, sound diet and exercise are your best weapons against inflammation.
In Beating the Dementia Monster, we commented on reports that anti-inflammatory medications might treat AD. We'll need to make sure that's not in the second edition!
Does it work? No, and it may make things slightly worse.
What are NSIDs? These are (often) over-the-counter pain relievers, like aspirin, ibuprofen, and naproxen. (Tylenol can reduce inflammation, but it is not an NSID.) NSIDs relieve pain by reducing inflammation.
This week's issue of ALZForum featured an article, "Closing the Book on NSAIDs for Alzheimer’s Prevention." It reported on the early termination of the INTREPAD trial. Preliminary results showed no benefit with respect to AD, but downsides such as causing and aggravating cardiovascular problems.
As we discussed in a post on March 2, 2109, sound diet and exercise are your best weapons against inflammation.
In Beating the Dementia Monster, we commented on reports that anti-inflammatory medications might treat AD. We'll need to make sure that's not in the second edition!
Saturday, April 6, 2019
Interesting Content in UW Dimensions Magazine
I just received my pdf copy of Dimensions magazine, Spring/Summer 2019 issue, published by the UW Alzheimer's Disease Research Center. It is chock full of really interesting material. But if you don't have time to read it, here are my takeaways.
Voice Biomarkers
An article on voice biomarkers was especially significant to me. Why? Because I was a participant in some of the research behind the article.
Some time ago I participated in research in which I periodically sent recordings of my voice to be analyzed. They were looking for clues to the emergence of neurodegenerative disease in changes in someone's voice. I had been waiting for a long time to hear the outcome of the research, and the article marked where it's now at.
The goal of the research is to be able to take a recording or series of recordings of someone's voice and reliably find indication of AD, ALS, early Parkinson's, and frontotemporal degeneration -- and be able to distinguish them. They're not there yet, but the researchers are optimistic that, with a lot more voice samples (many more), they'll be able to do this.
I believe this direction of research has basis for optimism. I have always felt that my own voice did begin to change at about the time my disease was diagnosed. My perception is that it has varied over the course of time in ways that I can detect, although no one else seems to notice.
Bilingualism and Neurodegenerative Diseases
There was a brief summary article about research into how disease can affect both first languages and acquired second languages. Researchers would like to know several things, including answering the commonly asked question, does bilingualism confer a protective effect for neurodegenerative diseases, notably AD. The article noted that, so far, the evidence is conflicting,
The actual research did not study AD, but rather something called primary progressive aphasia, or PPA. PPA is a neurodegenerative disorder that impairs language abilities over time, such as speaking and word finding. The main finding so far is that PPA impairs both first and second languages in about the same way.
The article talked about comparing people who's first language is English and their second language is Spanish. I said, "Hey, that's me!" I began learning Spanish on my 59th birthday which was in 2008. My first symptoms of AD (balance problems) probably began in 2012.
My neurologist at Harborview was one of the credited researchers for this study, and she wrote the article for the magazine.
Busting Myths about Alzheimer’s Treatments and Diets
The myth-busting article goes very well with the article I cited in my March 11 post about the FDA going after supplement snake oil salesmen. Consistent with what I wrote in Beating the Dementia Monster, people will be attracted to supplements when there is a terrible problem, but medical science has so little to offer. But, as noted in the 2019 Alzheimer's Association Facts and Figures Report, no supplement has been shown scientifically to reverse, stop, or even slow the advance of AD.
The article began by discussing what can go wrong when a hypothesis is accepted before it's properly tested. It recalled how, in 1965, some scientists found that injecting rabbits with a aluminum salts could produce some of the physiological changes associated with AD. Subsequent research found that human uptake of aluminum could not be correlated with an increased risk of developing AD, but nevertheless there was great anxiety about using aluminum in cooking utensils and other applications. These included, for example, body deodorants. Even today, aluminum cookware sometimes carries warnings about a link between aluminum and AD.
In 2013, a researcher at the UW Harborview Brain Wellness Center had some of his research published in the New England Journal of Medicine correlating blood glucose levels with risk of dementia. This finding was a motivator behind a New York Times best seller, The Grain Brain. But The Grain Brain seriously distorts the research. It infers that you can control AD risk by controlling dietary intake of gluten-heavy grains that tend to have a higher glycemic index than fruits and vegetables. Grains would therefore produce larger changes in blood sugar, and eating more grains will increase your risk for dementia. The researchers who originated the data reject this conclusion, but The Grain Brain is still a best seller on Amazon. Medical experts are concerned that the erroneous conclusions will lead people to remove beneficial foods from the diet for invalid reasons.
The neurology researchers went after the coconut oil fad, pointing out that it can actually increase AD risk, not help. This occurs because coconut oil is is a highly saturated fat, and saturated fat consumption is associated with higher risk of AD. (The MIND diet pretty much eliminates saturated fats.) The researchers noted that moving from a diet heavy with saturated fats to one with unsaturated fats can provide a benefit for blood pressure equal to starting on a statin drug. Bottom line: throw out your coconut oil and use olive oil.
The article had an interesting discussion of the Keto diet, which has been touted as good for brain health. And maybe it is, but not necessarily across the board. If you're interested, you should read the article. Apparently there are some scenarios in which the Keto diet can help, and others in which it may hurt. But the article concludes that it's such a difficult diet to maintain, that you should try other options.
The article ends with a plea for common sense. Eat a balanced diet free of what we know is junk and get plenty of exercise. The Mediterranean and MIND diets fill that bill for diet. The Mediterranean diet has us eating what we know is good, and the MIND diet seems to improve on that. But -- the jury is still out on the MIND diet. The article noted that there is a major study on the MIND diet, but we won't see results until April 2021. It then goes on to emphasize the importance of exercise. It contrasts the contradictory evidence around diet and brain health with the unambiguous connection between an active lifestyle and brain health.
Voice Biomarkers
An article on voice biomarkers was especially significant to me. Why? Because I was a participant in some of the research behind the article.
Some time ago I participated in research in which I periodically sent recordings of my voice to be analyzed. They were looking for clues to the emergence of neurodegenerative disease in changes in someone's voice. I had been waiting for a long time to hear the outcome of the research, and the article marked where it's now at.
The goal of the research is to be able to take a recording or series of recordings of someone's voice and reliably find indication of AD, ALS, early Parkinson's, and frontotemporal degeneration -- and be able to distinguish them. They're not there yet, but the researchers are optimistic that, with a lot more voice samples (many more), they'll be able to do this.
I believe this direction of research has basis for optimism. I have always felt that my own voice did begin to change at about the time my disease was diagnosed. My perception is that it has varied over the course of time in ways that I can detect, although no one else seems to notice.
Bilingualism and Neurodegenerative Diseases
There was a brief summary article about research into how disease can affect both first languages and acquired second languages. Researchers would like to know several things, including answering the commonly asked question, does bilingualism confer a protective effect for neurodegenerative diseases, notably AD. The article noted that, so far, the evidence is conflicting,
The actual research did not study AD, but rather something called primary progressive aphasia, or PPA. PPA is a neurodegenerative disorder that impairs language abilities over time, such as speaking and word finding. The main finding so far is that PPA impairs both first and second languages in about the same way.
The article talked about comparing people who's first language is English and their second language is Spanish. I said, "Hey, that's me!" I began learning Spanish on my 59th birthday which was in 2008. My first symptoms of AD (balance problems) probably began in 2012.
My neurologist at Harborview was one of the credited researchers for this study, and she wrote the article for the magazine.
Busting Myths about Alzheimer’s Treatments and Diets
The myth-busting article goes very well with the article I cited in my March 11 post about the FDA going after supplement snake oil salesmen. Consistent with what I wrote in Beating the Dementia Monster, people will be attracted to supplements when there is a terrible problem, but medical science has so little to offer. But, as noted in the 2019 Alzheimer's Association Facts and Figures Report, no supplement has been shown scientifically to reverse, stop, or even slow the advance of AD.
The article began by discussing what can go wrong when a hypothesis is accepted before it's properly tested. It recalled how, in 1965, some scientists found that injecting rabbits with a aluminum salts could produce some of the physiological changes associated with AD. Subsequent research found that human uptake of aluminum could not be correlated with an increased risk of developing AD, but nevertheless there was great anxiety about using aluminum in cooking utensils and other applications. These included, for example, body deodorants. Even today, aluminum cookware sometimes carries warnings about a link between aluminum and AD.
In 2013, a researcher at the UW Harborview Brain Wellness Center had some of his research published in the New England Journal of Medicine correlating blood glucose levels with risk of dementia. This finding was a motivator behind a New York Times best seller, The Grain Brain. But The Grain Brain seriously distorts the research. It infers that you can control AD risk by controlling dietary intake of gluten-heavy grains that tend to have a higher glycemic index than fruits and vegetables. Grains would therefore produce larger changes in blood sugar, and eating more grains will increase your risk for dementia. The researchers who originated the data reject this conclusion, but The Grain Brain is still a best seller on Amazon. Medical experts are concerned that the erroneous conclusions will lead people to remove beneficial foods from the diet for invalid reasons.
The neurology researchers went after the coconut oil fad, pointing out that it can actually increase AD risk, not help. This occurs because coconut oil is is a highly saturated fat, and saturated fat consumption is associated with higher risk of AD. (The MIND diet pretty much eliminates saturated fats.) The researchers noted that moving from a diet heavy with saturated fats to one with unsaturated fats can provide a benefit for blood pressure equal to starting on a statin drug. Bottom line: throw out your coconut oil and use olive oil.
The article had an interesting discussion of the Keto diet, which has been touted as good for brain health. And maybe it is, but not necessarily across the board. If you're interested, you should read the article. Apparently there are some scenarios in which the Keto diet can help, and others in which it may hurt. But the article concludes that it's such a difficult diet to maintain, that you should try other options.
The article ends with a plea for common sense. Eat a balanced diet free of what we know is junk and get plenty of exercise. The Mediterranean and MIND diets fill that bill for diet. The Mediterranean diet has us eating what we know is good, and the MIND diet seems to improve on that. But -- the jury is still out on the MIND diet. The article noted that there is a major study on the MIND diet, but we won't see results until April 2021. It then goes on to emphasize the importance of exercise. It contrasts the contradictory evidence around diet and brain health with the unambiguous connection between an active lifestyle and brain health.
MIND Diet and Boredom
There are two separate topics for this post -- boredom and the MIND diet. I'm not bored with the MIND diet.
Boredom is good
In Beating the Dementia Monster, I described how I would sometimes sit on the sofa, completely uninterested in speaking with anyone or engaging in most any activity. Different thoughts may have been running trough my head, but I wasn't interested in engaging with anyone or any thing. You would think that this might indicate boredom, but I was definitely not bored. I was too dulled by the disease to be bored.
That was then, this is now.
Retiring from my engineering and teaching careers has left me with quite a bit of time on my hands. And so I have been keeping this blog, preparing a new edition of Beating the Dementia Monster, taking pictures, working at the food bank, getting to the gym, reading classics, meeting with friends, maintaining a couple of web sites, and other activities. But these don't fill all of my time. So I occasionally become bored, quite bored. At least, nowadays.
It occurred to me the other day that the return of my ability to experience boredom is a relatively recent phenomenon. It occurred to me that boredom, at least for me, arises out a sort of frustration with a lack of engaging activities. But if I'm ambivalent about life, I'm not frustrated, and I'm not bored.
It seems to me that the ambivalence I was experiencing before was a product of AD. Therefore, the more recent tendency to boredom indicates a retreat by the disease.
I don't like being bored, but it looks like the ability to be bored is a very good thing!
More on the MIND diet
In Beating the Dementia Monster I minimized the importance of diet in dealing with AD after reading that some researchers believed that the link between brain health and cognition may simply indicate that people who eat healthy diets also get exercise. The idea was that research was inadequately controlled for exercise, and exercise is responsible for the better brain health of people with good diets. I still said that diet was important, but it wasn't anything like the powerful solution that exercise was.
In my December 17, 2018 post on the FINGR study, I noted the disappointment that a correlation could not be established between either the Mediterranean diet or the DASH diet and improved cognition. The study acknowledged that there was such a thing as the MIND diet, but it did not evaluate it. The study is important and seems to be forming a baseline for research on diet and brain health. It seemed to me that this was helping confirm my minimization of diet as an important solution to AD.
On March 6 of this year I reported on an Australian study that actually compared cognitive improvement outcomes with the Mediterranean diet and the MIND diet. The study found no correlation between the Mediterranean diet and brain health, but it did find a surprisingly strong correlation with the MIND diet. I was surprised, but didn't think much of it initially.
Over the past month I've been thinking about this more and more. Maybe skipping the butter, cheese, and red meat, then adding all of the blueberries, strawberries, and almonds actually is making a significant difference.
The University of Washington Alzheimer's Disease Research Center publishes a quarterly magazine, Dimensions. I will review the current issue in another post, but I want to note a specific article there on diet. The article discusses the MIND diet, and notes that there is a large study of the MIND diet in progress right now that may more clearly define its true worth in brain health. It should be completed in April 2021. Yes, that's a long way off, but maybe this will be the definitive study that answers most of our questions on the relationship between diet and Alzheimer's disease.
Boredom is good
In Beating the Dementia Monster, I described how I would sometimes sit on the sofa, completely uninterested in speaking with anyone or engaging in most any activity. Different thoughts may have been running trough my head, but I wasn't interested in engaging with anyone or any thing. You would think that this might indicate boredom, but I was definitely not bored. I was too dulled by the disease to be bored.
That was then, this is now.
Retiring from my engineering and teaching careers has left me with quite a bit of time on my hands. And so I have been keeping this blog, preparing a new edition of Beating the Dementia Monster, taking pictures, working at the food bank, getting to the gym, reading classics, meeting with friends, maintaining a couple of web sites, and other activities. But these don't fill all of my time. So I occasionally become bored, quite bored. At least, nowadays.
It occurred to me the other day that the return of my ability to experience boredom is a relatively recent phenomenon. It occurred to me that boredom, at least for me, arises out a sort of frustration with a lack of engaging activities. But if I'm ambivalent about life, I'm not frustrated, and I'm not bored.
It seems to me that the ambivalence I was experiencing before was a product of AD. Therefore, the more recent tendency to boredom indicates a retreat by the disease.
I don't like being bored, but it looks like the ability to be bored is a very good thing!
More on the MIND diet
In Beating the Dementia Monster I minimized the importance of diet in dealing with AD after reading that some researchers believed that the link between brain health and cognition may simply indicate that people who eat healthy diets also get exercise. The idea was that research was inadequately controlled for exercise, and exercise is responsible for the better brain health of people with good diets. I still said that diet was important, but it wasn't anything like the powerful solution that exercise was.
In my December 17, 2018 post on the FINGR study, I noted the disappointment that a correlation could not be established between either the Mediterranean diet or the DASH diet and improved cognition. The study acknowledged that there was such a thing as the MIND diet, but it did not evaluate it. The study is important and seems to be forming a baseline for research on diet and brain health. It seemed to me that this was helping confirm my minimization of diet as an important solution to AD.
On March 6 of this year I reported on an Australian study that actually compared cognitive improvement outcomes with the Mediterranean diet and the MIND diet. The study found no correlation between the Mediterranean diet and brain health, but it did find a surprisingly strong correlation with the MIND diet. I was surprised, but didn't think much of it initially.
Over the past month I've been thinking about this more and more. Maybe skipping the butter, cheese, and red meat, then adding all of the blueberries, strawberries, and almonds actually is making a significant difference.
The University of Washington Alzheimer's Disease Research Center publishes a quarterly magazine, Dimensions. I will review the current issue in another post, but I want to note a specific article there on diet. The article discusses the MIND diet, and notes that there is a large study of the MIND diet in progress right now that may more clearly define its true worth in brain health. It should be completed in April 2021. Yes, that's a long way off, but maybe this will be the definitive study that answers most of our questions on the relationship between diet and Alzheimer's disease.
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