If you read Beating the Dementia Monster, or if you've heard me speak, you know that I had five MRIs of my brain between 2012 and 2018. The MRIs of 2017 and 2018 found that my brain had atrophied to the point that, among 100 men my age, I would have had the most tissue loss. Under normal circumstances, all brains atrophy, but brains with neurodegenerative diseases atrophy much faster. And mine was going pretty fast. (My first MRI was in April 2012, and it explicitly found no atrophy.)
You will also know from my book that some researchers have found an increase in brain volume among elderly people who began to get more exercise. This could include just exercise from working in the garden -- which can be hard work. This appears to occur when the body generates the brain-derived neurotrophic factor which prompts stem cells to form new brain cells.
What about me? I've gotten a lot of new exercise since my last MRI. Has my brain volume increased?
It would take another MRI to compare to the past, and that's not likely to happen. The insurance company wouldn't pay for it because it wouldn't alter my course of treatment -- it would be for the sake of curiosity. It would be a different story if I were to begin taking Aduhelm, because brain swelling and micro-hemorrhaging are a problem with it, and you get an MRI monthly during the course of treatment. But I'm not doing that. So, unless I'm involved in another drug trial that uses MRIs to assess what's happening in the brain, I won't be getting one.
Unless, of course, an unanticipated medical condition emerges that demands one.
About two weeks ago, I was sitting at the computer when I felt as if a fist or something hit me in the back of my head, kind of hard. I was alone, so it wasn't a fist but rather some event inside my head. It was quite jarring. For the next minute or so, I couldn't coordinate my eyes; they just looked in whatever direction each eye wanted to look. It passed, and things seemed to return to normal. I had a minor headache the next day.
This actually happened once a few years before, and my neurologist and primary care provider scolded me for not going to the ER. So I went this time. The ER people wanted an image of my brain to look for abnormalities, so they gave me a CT scan. The results surprised me.
First, they found no new abnormalities, and they have no explanation for either of the two events. So now, life just seems to be going on as before. A few days later, I had almost four hours of cognitive testing for my annual evaluation, and, as I reported before, I think I may have done better than last year. (I'll find out for sure on Tuesday, July 20.) So, whatever it was that happened, it doesn't seem to have had a lasting effect.
A CT scan is not an MRI, and when I discussed this with the neuropsychologist before my tests, she pointed out that the CT scan has less resolution. Nevertheless, as with all of my MRIs from 2015 and later, the analysis of the CT scan image noted there has been tissue loss. However, on the standard rubric of "mild," "moderate," and "severe," the report classified my tissue loss as "mild." My previous MRIs from 2015 and later noted "moderate diffuse cerebral and cerebellar volume loss." So I've gone from moderate to mild ... maybe.
A question that comes to mind is, if my brain had atrophied enough to put me in that < 1 percentile category, why isn't my volume loss "severe?" I don't know. I'd just guess that, for men my age, the number of men with severe volume loss may be considerably less than 1% of the population of interest -- men my age. There would then be room for men with moderate volume loss who were still in the <1 %.
That this CT scan shows that my brain volume might be increasing is pure conjecture on my part. And my neurologist warns that changes in brain volume don't always correlate with changes in cognition. But it has me wondering what another MRI would show.
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