I'm out of the woods, but news on declining dementia rates

First, I want to thank those of you who sent messages of support during my recent adventure with sepsis and kidney stones.  It appears that this week my doctors and I will be wrapping it all up.  Life goes on.

And something else interesting has come across my screen regarding how it is that dementia rates are declining as we discussed in Beating the Dementia Monster.  Spoiler alert: New research has partly supported some of the speculation in my book.

In the very last section of the second edition, "Good news/Bad news," I said that Alzheimer's disease rates in Western countries has actually been declining over the past 25 years despite an aging population.  I said that perhaps this was due to placing a lot of emphasis on reducing cardiovascular risk factors.  We noted that doctors like to say, "What's good for the heart is good for the brain."  And so there has been a significant reduction in cigarette smoking and an increased use of drugs to control blood pressure.  I'd like to say that people have lost weight, are eating better, and are exercising more, but that may not be true.  Nevertheless, the incidences of both cardiovascular disease and dementia have fallen together.

There is a new study on this published in the February 20 edition of JAMA Neurology, "Trends in Postmortem Neurodegenerative and Cerebrovascular Neuropathologies Over 25 Years."  The study examined the 25-year trends in incidence of dementia and trends in cardiovascular disease, confirming their consistency.  But they came to a conclusion a little different from mine.

I speculated that it was Alzheimer's disease that was declining, when they concluded that it was dementia that was declining.  Even when members of the cohort of 1,540 subjects had less dementia, they still had no decrease in the amyloid plaques and tangles that characterize Alzheimer's disease.  This was determined through autopsies of all test subjects.  (We said in Beating the Dementia Monster, the final confirmation of Alzheimer's disease is in the autopsy.)

So what's the takeaway here?  If you're like me, and you're told that you have Alzheimer's disease, you can still stave off dementia through lifestyle changes.  You will likely still have Alzheimer's disease, but you can at least delay the accompanying physical and mental decline of dementia.  These are lifestyle changes that fight cardiovascular disease and metabolic syndrome (including diabetes).  This is exactly what we designed The Dementia Toolkit to do.

I'm not out of the woods ... but what's with them nuts, anyway?

So I'm off of the antibiotics, but an ultrasound and a CT scan tell us that I still have two large kidney stone fragments to deal with.  One is in the ureter and will likely come out when they remove the stent.  (Yes, there's still a stent in there.)  The stent is sized to allow the fragments to pass around it while urine passes through it.  The largest of the two fragments is trapped between the outer wall of the stent and the inner wall of the ureter.  The other fragment is still stuck up in my right kidney.

So Wednesday I go back in for surgery with general anesthesia.  The plan is to pull the stent and then send up a laser to zap the fragment that's still in the kidney.  Then they'll put a stent back in to allow the fragments to pass.  What's on my mind is the possibility that more invasive procedures invite more infection.

This all began with over-consumption of spinach and almonds.  Both are good for your brain, but both also contain lots of oxalate.  The oxalate is the material of the type of stone that got me.  So my doctor said don't eat that stuff.  I stopped both, but with some substitutions.  Broccoli, asparagus, cucumber, tomato, blueberries, strawberries and avocado are reasonably low in oxalate, and so these go into much of the vegetable portion of my diet.  

But what about the nuts?  Is the oxalate problem the same for all nuts, or is it peculiar to almonds?  From what I read, almonds are a particular problem for oxalate, but walnuts are not.  I like to mix walnuts with blueberries and eat them like a dessert.  I feel comfortable with this.

But how good are walnuts for brain health?  Are they as good as almonds?  We know that tree nuts are good for the brain.  What does the research say about almonds vs. walnuts?  Turns out there's a brand new study to help answer this question.

The study is called "Impact of Nut Consumption on Cognition across the Lifespan," and it was published in the journal Nutrients.  Here's a summary article from News-Medical.net.

What the researchers set out to do was measure the influence on cognition of nut consumption prenatally, on younger people, and on the elderly.  They did this by performing a meta-analysis of 15 peer-reviewed papers on the influence of nut consumption on cognition.  The analysis also sought to discern which nuts had the most positive effect.  They found that nuts in general were helpful, but walnuts were the best.  However, not all the papers found a positive effect from nut consumption, and the effect was sometimes weak in those that did.  I didn't see any explicit mention of almonds at all.  They concluded:

"While limited and inconclusive, available evidence suggests a possible role for nuts in the maintenance of cognitive health and prevention of cognitive decline in individuals across the lifespan, particularly in older adults and those at higher risk.  Walnuts, as a rich source of the plant-based polyunsaturated omega-3 fatty acid alpha-linolenic acid, are the nut type most promising for cognitive health.  Given the limited definitive evidence available to date, especially regarding cognitive health biomarkers and hard outcomes, future studies are needed to better elucidate the impact of nuts on the maintenance of cognitive health, as well as the prevention and management of cognitive decline and dementia, including Alzheimer disease."

So it appears that walnuts are even better for brain health than almonds.

A tough couple of weeks...

Most of you haven't heard from me recently because I've been pretty much out of commission.  You know that I had a kidney stone procedure, but I subsequently was hospitalized with sepsis.  Last Wednesday, I really thought I was going to die.  I'm thinking one or more of the medical professionals attending me thought the same.  I had plenty of prayer support from friends and family, and the medical professionals did a wonderful job with modern technology.  So I'm still here.

Unfortunately, this seems to have come about by my injudicious application of the MIND diet.  I think I overdid it on the spinach and almonds, two of the worst things for kidney stones.  But I'd never had a kidney stone before, and I didn't anticipate this kind of problem.  So walnuts are now doing fine for my tree nuts, while asparagus, broccoli and other green, leafy vegetables can fill in for the spinach.

I was hospitalized for seven days, coming home on Tuesday.  The infection was from a very nasty, highly resistant bacteria called enterococcus.  

I continue to take antibiotic infusions at home 3X/day.  They ran what they call a PICC line from my upper arm to a vessel near my heart.  Then they have an IV arrangement like in the hospital for the medication to drip down to the line.  It drips about a drop/second, taking about 45 minutes for one dose.  This should continue at least until the 10th.

The problem is that we're not done.  They blasted the jumbo (17mm) kidney stone back in mid-December, but there were still some pretty large stone fragments.  They said that I should be able to pass anything up to 6mm, but then one fragment came out that I measured 8mm.  But it turns out that there are more.

When they did the first procedure in mid-December, they inserted a stent.  The stent provided a pathway for urine from the kidney to the bladder, while stone fragments would be able to pass around the stent.  But not many did.  So they pulled the stent out in mid-January, and we got a large flow of stone fragments.  But a CT scan showed that not all  came out, including one big one.

So they put me out again and put in a new stent.  The infections seems to have arisen from that procedure.  We are breathing a sigh of relief that this infection is over, but we remain anxious about going back in to recover the second stent.  That's currently scheduled for February 22.