A shot to replace exercise?

Back when I was first investigating exercise to address my disease, I came across this article in Scientific American that discussed what was going on in the brain during physical exercise that might help the brain.  It did not mention by name the brain-derived neurotrophic factor (BDNF) that we discussed in Beating the Dementia Monster, but it described its effects, such as prompting stem cells in the hippocampus to form new neurons ... among other benefits.  The article proposed that it might be possible to artificially replicate the healing environment which appears in the brain during exercise.

What would be the benefit of that?  Hey, you could pop a pill and not need to go to the gym anymore!  What more could you ask!

A recent article in SciTechDaily.com reported on research for a possible way to just do that.  The article was entitled "Brain Gains: Scientists Discover How To Replicate the Cognitive Benefits of Exercise," and it reported on research conducted at the University of Queensland and published in the journal Nature Communications.  The journal article was entitled "Platelet-derived exerkine CXCL4/platelet factor 4 rejuvenates hippocampal neurogenesis and restores cognitive function in aged mice."  (Mice again.)

Some music to our ears: the researchers underlying understanding was that physical exercise is one of the strongest enhancers of adult hippocampal neurogenesis, and older adults who perform regular physical activity are more likely to maintain their cognitive ability.  (Neurogenesis is the generation of new brain cells from stem cells.)  

They must have read Beating the Dementia Monster. 

So what's the concept here?  The idea is that during exercise, blood platelets excrete a specific "exerkine" that has the power to prompt stem cells in the brain to form new neurons ... among other benefits.  The researchers acknowledged that this is a similar effect to BDNF, and the presence of BDNF in an exercising brain could confound research results.  But mice brains don't produce BDNF.

According to this article, exerkines are defined as signalling molecules released in response to acute and/or chronic exercise, which exert their effects through certain pathways.  A multitude of organs, cells, and tissues release these factors, including skeletal muscle, the heart, liver, white adipose tissue, brown adipose tissue, and neurons.  Not mentioned in this definition is blood platelets.  But it does help illustrate why exercise has such a great benefit for so very many aspects of your health! 

What the Australian researchers found was that "the systemic administration of the platelet-released exerkine PF4 in an adult hippocampal neurogenesis-dependent manner" could reproduce the cognition-enhancing benefits of exercise in aging mouse brains.  Basically, they extracted the exerkine PF4 from the platelets of exercising mice and injected it into veins in the tails of aging mouse subjects.  They tested the mice for their ability to learn and then evaluated changes in brain volume.  This treatment improved cognitive ability and increased brain volume.

That was with mice.  Will the same thing happen with people?  The research paper didn't address application of this method on human subjects.  However, the researchers made some brief statements to the journalists with SciTechDaily.  They said that the next step is to study the effect of administering exerkines to diseased mice, since the initial research was with healthy mice, both young and aging.  After that would come some sort of human trials.  Throughout the research paper and interviews, the researchers stayed away from suggesting that this treatment will actually replace exercise.  So keep your gym membership current.

Dementia-Friendly Communities Conference

I am again this year on the planning committee for a conference about how to make our cities and communities more accommodative to those with dementia.  We had a similar conference two years ago, and I think it was quite profitable to those who attended, at least those with a stake in the life of someone with dementia.  The conference is primarily for people in Washington State, but I believe the material and topics last time were useful to people and organizations in other states.  This is especially true if your state has a nascent program for making your communities dementia-friendly, and you're looking for ideas. 

The conference will be a 2-day virtual event, 9 a.m. - 12 p.m. Tues/Wed September 19-20, with a pre-conference virtual “happy hour” from 4 – 5 p.m. on Monday September 18.  

The conference is for anyone who wants to take action to make their community more dementia-friendly, including people with dementia, caregivers, and people who work or volunteer in a variety of public settings: aging and senior services, arts and culture, chambers of commerce, city government, community centers, cultural associations, faith communities, libraries, neighborhood groups, parks and recreation, service clubs, social or health care services.  Whether you joined us for a previous conference or are attending for the first time, you’ll take away plenty of practical ideas and helpful tools!

Topics include: 

Overview of the Dementia Friendly America model and resources 

Culturally-celebratory dementia-friendly programs and initiatives 

How to start a Memory Café program in your community 

Using the Dementia Friends program for dementia awareness, including a tailored approach for Indigenous communities 

Engaging faith communities in the dementia-friendly movement 

Launching a dementia-friendly chorus: the Giving Voice model 

And more! 

Sliding scale $0 - $40 registration fee.

REGISTER HERE: https://depts.washington.edu/mbwc/events/dfc

The event is organized by the University of Washington Memory and Brain Wellness Center, on behalf of the Washington State Dementia Action Collaborative, with primary funding from the Aging and Long Term Support Administration, and with a planning committee made up of advisors from across the state.

It's here -- a consumer-level blood test to measure Alzheimer's disease risk

We have been waiting for some time for a simple blood test for Alzheimer's disease.  And now there is one.  It's said to measure disease risk ten years before first symptoms, and you don't even need an order from your doctor to get it.

The test is being offered by Quest Diagnostics, and it costs about $400.  It's called A-D Detect.  While it's sort of an over-the-counter consumer product, it's not quite so simple.

You don't just get it done at your local pharmacy.  First, your application for the test needs to be evaluated by Quest's medical staff, and they'll figure out if it's appropriate for you.  Then you'll need to make an appointment at one of Quest's 2,100 test sites.  (The nearest site to me is 62 miles away in Yakima.). So you actually do need an order, just not from your own physician.

The test measures the ratio of two types of amyloid in your blood, AB42 and AB40.  A lower ratio of AB42 to AB40 indicates a higher risk of Alzheimer's disease.  They say that this is not measuring the presence of the disease, but rather your risk for developing it.

So why would you take this test?  To find out whether you should consider Leqembi or one of the other new monoclonal antibody treatments.  If you're going to be spending that much money on a treatment (~$24,000/year), you want to know it's probably treating the actual cause of your memory loss.  Of course, it also might tell you to start implementing The Dementia Toolkit of Beating the Dementia Monster! 

Where are Alzheimer's disease rates highest in the US?

The Alzheimer's Association International Conference 2023 was held (again) in Amsterdam and ran from July 16-20.  You may recall that it was entirely on line in 2020, and I attended the whole thing for free.  But this year, I'd have had to pay for the same level of access.  So I picked off interesting information from news releases and stories. 

The value of attending the conference is finding out first hand about the most exciting recent breakthroughs in Alzheimer' research from around the world.  The headline for the conference this year was the ongoing success in trials of donanemab, a new generation monoclonal antibody.  Apparently phase 3 trials have gone well, and FDA approval may be on the horizon. 

We've been writing about donanemab since 2019.  But something else I saw that was interesting was a breakdown of which localities in the United States have the highest rates of Alzheimer's disease.  Which will lead to a question of why the rate in some region might be higher than in another.  The research was published in the journal, Alzheimer's and Dementia; Journal of the Alzheimer's Association.

First, the states with the highest rates of people over the age of 65 living with Alzheimer's disease were Maryland, New York, and Mississippi.  Then, to break things down further, the counties with the highest rates were Miami-Dade County in Florida, Baltimore city in Maryland, and Bronx County in New York.  In each of these, about 16.6 percent of senior residents had the disease.  The next highest was Prince George’s County, Maryland, with 16.1 percent.

What was important here is that the locations with the highest rates had minority populations.  This points to the fact that we need a population of study subjects that has a much broader representation of the general population.  The current population is mostly white baby-boomers.

That insomnia cure...

So my brother reminds me that I need to update you on my experiment with sleep restriction cognitive behavior therapy for insomnia.  I last posted about it on July 9, but I've been slow with followup reports on its progress.  Long story short, it hasn't been the silver bullet I hoped for.

They warn you not to try it on your own.  You should have a coach, which I believe is necessary to maintain discipline in the process.  You will recall that the process is quite unpleasant.  But, then, they also point out that there are very few sleep coaches out there, and I didn't find one locally.  

Would things have gone better if I'd worked under the supervision of a coach?  Probably. Should I give it another shot?  Maybe, but not now.

Early on in the process, I believed that it was going reasonably well, and I felt I had some latitude with the protocol.  I had been trying to go to bed at midnight and wake up naturally at 5 a.m. for a week, but I couldn't really keep that up.  And I wasn't able to sleep all the way to 5.  So I was getting about four and a half hours of sleep a night, and the protocol forbids naps.

I decided to call it good enough for the first week of the protocol, and so moved my bed time to 11.  That kind of worked out OK, and I would sometimes get a reasonably continuous five or six hours.  I was supposed to do that for a whole week, but I shifted to a 10 o'clock bed time in less than a week.  And I actually protracted things by going off and on the protocol a time or two due to circumstances.

I did hit a point where I thought I had made a lot of progress, but then we had a trip to the East Coast ... three time zones away.  If that wasn't bad enough, Amy and I both managed to get covid on the trip, causing further disruption in my sleep schedule.

The whole concept behind cognitive behavior therapy for insomnia is to teach your brain habits about when to go to sleep and when to wake up.  If your schedule shifts three hours two times in one week, well that confuses the training.  

I may have mentioned before that when I got covid during the summer of 2022, it actually worked out to my benefit.  It was a very mild case (for me ... not so much for Amy), but it caused me to have three nights in a row of uninterrupted sleep.  I woke up each morning feeling great, and I only dealt with a mild fever the three afternoons. 

So this time, when Amy got it (probably in an airport), and it was clear I'd be getting it too, I thought I'd have a replay of 2022.  Well, not quite.  While it was still a relatively mild case, it was very disruptive to my sleep, especially since it fell right into the time when I was trying to adjust for the time zone changes.

I'm still trying to stabilize my sleep schedule from our trip.  My neurologist suggested a higher dose of melatonin, which I've been trying.  In Beating the Dementia Monster, we noted that both my sleep doctor and the well known sleep researcher, Dr. Matthew Walker, consider melatonin to be a placebo with respect to insomnia.  My extensive experimentation with it seemed to confirm that.  But using the higher dose recommended by my neurologist seems to help a little on some nights.

We have a trip to visit family in Hawaii later this month, and that's three time zones in the other direction.  We'll be there two weeks before returning home.  So how's that going to work out?

I'm hoping that when I'm over the repercussions of our trip and the covid infection that I'll get back to some reasonable sleep schedule, even if it involves two or three periods of sleep each night.  If that happens and remains stable for a while, maybe I'll try the sleep restriction therapy again.  Maybe.