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.
As I said previously, I'm on the planning committee for a conference on making our communities friendly to people suffering from dementia. In fact, on the second day I will be in a panel discussion with two authorities on dementia. It's a virtual conference, so if you have access to the Internet, you can participate.
I'm posting here now, because another member of the committee made this short video explaining what it's about. I'm posting here to invite you to take a look.
Before covid closed my gym, I was there on the treadmill 50 minutes a day, and I usually did various forms of resistance training every second day. I went 4.0 mph at a 15 degree incline. I went 4.3 mph for a couple of years, but my stamina seems to have fallen off a little.
But then they closed the gym. Fortunately, Amy has a pretty good consumer level treadmill, and I was able to use it at home. But, unlike the commercial treadmills in the gym, the deck is not cushioned, so running harder sends shock waves up my spine. This causes some pain in my lower back, so I lowered my speed to 3.8 mph. Also, when I raise the deck, the ergonomics of the machine change, so I can't comfortably raise it past 5 degrees of incline.
Initially I worried that reducing the challenge would reduce the effect of exercise on my cognition, so I measured my heart rate while exercising. I found that even with the reduced pace and lower incline, my heart rate was still comfortably within the target zone that we discuss in Beating the Dementia Moster. But just to make sure, I extended my daily time commitment to the treadmill by five minutes. But I also started to drag a little, so I take a break after 30 minutes and drink a pint of water. (I usually drink a pint before I start as well.) I also feel comfortable about reducing my pace to 3.0 mph during two 5-minute spans in the second half of my routine.
We discussed previously research showing that the optimal amount of exercise time per week is five to 6 and a half hours. So 55 minutes per day, six days a week keeps me in that zone. The discussion of the research addressed how long participants exercised but didn't say much about how strenuously they worked out to produce their results. Focus was on how long they went at it, not how hard. And other research we discussed previously found that increases in brain volume can be measured from people getting exercise simply by working in their gardens. So I'm uncertain regarding how intense the exercise needs to be.
Amy doesn't have any resistance machines I can use, so I try to do pushups and sit-ups every second day. This type of exercise is not known to improve cognition, but it does strengthen your core muscles. This helps prevent falls in the elderly.
So while I have reduced the intensity of my workout, I have also increased the time a little. And I am confident that this has not reduced the effectiveness of exercise with respect to my cognition.
For some months now, I've been working with people from Harborview Medical Center in Seattle on a conference about creating dementia-friendly communities. Here's the conference web site. It's intended to be an opportunity for leaders to come together and explore ways that communities can be more hospitable to people with dementia. For example, what should first responders consider when they are called to a situation involving someone elderly and erratic? How have grocery stores prepared their workers for someone unable to properly navigate a simple purchase? How do we prepare our communities for these scenarios as our elderly population grows?
As with all conferences in The Age of Covid, it will be virtual -- September 29 and 30. Cost is $15 for community members and $40 for professionals. (We're still trying to refine how to distinguish the two...) As initially planned, it would have been held in a conference center in Tukwila, and it would have been pretty Seattle-centric. But now anyone can attend from anywhere in the country!
The conference will feature Meredith Hanley, project director for Dementia Friendly America.
On day two (September 30) at 9:15 Pacific Time, I will participate in a panel discussion with two thought leaders. So if you're interested, you can see me then. (You will, of course, need to register.)
We have been working very hard to make this an interesting and beneficial event, and I am quite excited about it. We designed it to benefit the following people:
As it turns out, I'm also working on planning for another conference with the Alzheimer's Association in November. So stay tuned for that one.
I continue to experiment with intermittent fasting, having been pretty strictly on a 20 hour/day fast since February. There are so many cross-currents in what I've been doing, that I have no way of seriously assessing what it has done for my cognition. Nevertheless, I'm pretty certain that fasting has helped with my arthritis, and I really do sense that, overall, my body is in now in significantly less discomfort from the ravages of aging. I'm now 71. This improvement is likely due to an anti-inflammatory response in my body produced by fasting. At least, that's what I conclude from what I've read.
I recently came across an article in the online magazine Inverse about a Japanese study of intermittent fasting. The article is a bit dated and actually predates the article in the New England Journal of Medicine that we discussed previously. But it gave me some new insight. Unfortunately the research looked at people who were fasting from 34 to 58 hours -- a bit more ambitious than what I have been doing. It also evaluated only four test subjects. (These were the only people they could find who were willing to go so long without eating. No surprise there.)
According to the researchers, the most serious effects of fasting kick in at about 34 hours and continue to 58 hours and beyond.
A major feature on Alzheimer's disease is inflammation. Therefore, we avoid foods that cause inflammation, and we consume anti-inflammatory foods to reduce inflammation. But fasting seems to encourage inflammation -- so why would this be helpful? Apparently, the body responds to a fast by producing a larger anti-inflammatory response. This comes through "metabolites."
When your body metabolizes a nutrient, say a lipid (a fat), it breaks it down into component substances. These are called metabolites. They have their own metabolic properties, and some are anti-inflammatory. So, apparently, on balance, there is more to counter inflammation than cause it during fasting. At least if you fast long enough.
Prior to the study, it was understood that there were 14 beneficial metabolites produced during fasting. But the study identified 30 more that had not been previously understood. Perhaps this is because this study looked at people who were fasting for longer periods of time than earlier studies. The study found that the blood concentrations of some of these metabolites rose to as much as 60 times normal after 58 hours of fasting.
One research conclusion was, "these findings provide the first support for the notion that increased antioxidative defense is a significant physiological response during fasting." The researchers also concluded "Collectively, fasting appears to provoke a much more metabolically active state than previously realized."
This article has me thinking, especially since this year's cognitive tests were less than what I'd hoped for. I've been pretty disciplined with the 20 hour fast, but a 34 hour fast, and especially a 58 hour fast looks like a bridge too far. While my weight has stabilized after an initial loss, I worry about losing too much weight during a fast. And then, how long am I willing to forego the pleasure of eating -- that very great pleasure? But I'm thinking about this...
The Lancet Commission is a group commissioned by the Lancet to analyze dementia prevention, intervention, and care. As we've said before, the Lancet is one of the oldest and most prestigious medical journals in the world that publishes peer reviewed research. In 2017, the commission published the results of their work, concluding that 35% of dementia cases were preventable.
But at this year's Alzheimer's Association International Conference (which we discussed extensively two weeks ago), the commission updated their conclusion to estimate that 40% of dementias are preventable. What changed? They added excessive alcohol consumption, air pollution, and traumatic brain injury (TBI) to their list of preventable causes. We have previously addressed alcohol and air pollution as causes of dementia in this blog, and we discuss TBI in Beating the Dementia Monster.
The commission provided an interesting but somewhat cryptic graphic to show the role of each of twelve known and suspected potentially modifiable risk factors for dementia. What's interesting about the graphic is how they show the influence of the factors based on the stage of life in which they occur. Educational achievement in early life is an important factor with the potential to eliminate 7% of cases, while there are five factors in mid-life and six factors in later life.
Some people at the conference were confused by the percentages assigned to each factor. According to the commission, the numbers corresponded to the per cent reduction in cases if the factor is eliminated. You can read more here.
On August 7, Biogen announced that they had received notice from the FDA that they had accepted Biogen's application for approval of aducanumab, and that it will be fast-tracked. This means the review process will be cut from 10 months down to six.
We are all anxious to see this move along. We discussed previously how we got here and what the prospects are for an approved, effective pharmacological treatment for Alzheimer's disease. We just don't know what the FDA will make of the application.
On the one hand, we are so desperate for a medication that will actually slow the progress of the disease that the FDA will be encouraged to approve it, warts and all. On the other hand, its effectiveness remains in question, and it's known to sometimes cause micro-hemorrhaging in the brain. In the best of outcomes, it only slows progress of the disease, it does not reverse or even stop it.
So let's say that the FDA approves it. Biogen has put a LOT of money into research and development, and they will want return on their investment. So how much will it cost? And then, this will not be a pill. You will need infusions by needle once or twice (I believe) per month. I'm not sure how long that would go on for, but likely for the rest of your life. And with the micro-hemorrhaging, the patient will need frequent MRIs to watch for the development of problems.
The buzz in the medical field is that the lifestyle changes we discuss in Beating the Dementia Monster will remain our best bet for treatment of the disease for quite a while to come.
According to my doctors, the two factors that have been impeding my progress on cognition for the past year or so are sleep problems and stress. Getting the second edition of Beating the Dementia Monster out the door has helped a lot with the stress, but the insomnia remains a challenge. I do think I've been making progress.
The insomnia has steadily worsened over the past year and a half. It is only once every two or three weeks that I sleep all night, since I invariably awaken at about 3. I cannot get back to sleep. I consistently go to bed at 10 with the goal of making it to 5. But that doesn't happen any more.
I said before that I picked up a white noise machine on Amazon, and that seems to have helped a little. Maybe. But I'm still up at 3.
On the other hand, I have improved things a lot. When I wake up, I try not to lie in bed longer than 20 minutes (based on advice I've read) and then get up. Rather than do my devotional time at 5, I do it at 3:30 or whenever it works out. This takes me an hour to an hour and a half, and then I go back to bed. Generally, after going back to bed, I can then fall back to sleep. Often I'll sleep until 7:30 or as late as 8:30. I will then feel well when I get up for good.
I've discussed this before, but lately it has become even more the norm. If this continues it will be a good thing, because I feel rested when I do get up. I discussed this with my neurologist in June, and she was positive about it. We noted that recent research found that interrupted sleep is inferior to uninterrupted sleep for fighting Alzheimer's disease, but it's better than the alternative.
In 2012, the Nobel Prize in Physiology or Medicine was awarded to John B. Gurdon and Shinya Yamanaka for their discovery that essentially any mature specialized cell can be reprogrammed to become stem cells capable of developing into all tissues of the body. These are called "human induced pluripotent stem cells" (iPSC). So, in principle, you can grow new brain cells from mature skin cells. This has application in Alzheimer's disease research, and my brother-in-law (Leonard) sent me this article about its promise from Nature Molecular Psychiatry.
When I started reading the article, I thought it might point to reprogramming any cell to produce new neurons in the brain. Unfortunately, it was only about reprogramming cells in vitro -- in a test tube -- so that they can be used to study the disease. From the best of our understanding, most of the success I've had in battling Alzheimer's disease has related to the ability of the brain derived neurotrophic factor to prompt stem cells in the hippocampus to form new brain cells. (We discuss this in Beating the Dementia Monster.) Research I've read suggests that you can run out of stem cells, which may stop the recovery process. So I'm nervous.
The article goes into a great deal of detail regarding what we know about Alzheimer's disease, and I was gratified to note that we cover pretty much everything they discussed in either this blog or in the new edition of Beating the Dementia Monster. Our version of the facts is just easier to understand. However, the article did present a broader picture of all of the different types of brain cells that should be studied due to their role in Alzheimer's disease. Since development of the process for generating new cells, laboratories around the world have now developed lines of all kinds of brain cells with all kinds of varying genetic profiles. The article does not go beyond discussing their potential in research, although it does go into detail on how they might be used.
In this blog and in Beating the Dementia Monster, we discuss three types of cells in the brain whose failures are part of Alzheimer's disease. These are:
The article highlighted three additional types of brain cells that are being cultured to study Alzheimer's disease. We have not discussed these previously.
