It's not just me, folks!

When I tell my story, I'm often met with skepticism.  And why shouldn't people doubt me?  The concept in popular culture about Alzheimer's disease is that it is genetic, with a steady, inevitable progress to the grave.  Most people have known someone, likely in their own family, who developed the disease and followed that seemingly inevitable path of memory and cognitive degeneration.  I don't mind telling you that I sometimes wonder myself ... until I recall how my life was in 2015 and 2016.  So, is my story credible?  Am I somehow unique?   

I recently came across this article in the New York Post about two people who claimed to have "reversed" their biomarkers for Alzheimer's disease through changes in diet and exercise.  Sound familiar?  The article references a documentary series on CNN about Alzheimer's disease, which, in turn, highlights research by the well-known diet doctor, Dr. Dean Ornish.  The series is narrated by Dr. Sanjay Gupta.  Ornish has been conducting research in how lifestyle changes can influence the advance of Alzheimer's disease, and he is now publishing his results.  

The key to understanding the evidence (and the skepticism about our experience) is to recognize that the role of lifestyle is only obvious following significant and often difficult changes in lifestyle.  Some people are already living well and/or do not have any predisposing characteristics.  Others have genetic markers and/or have poor habits regarding exercise and diet.  But it's rare to see someone change their lifestyle and record how it affects memory and cognition.

Ornish uses the phrase "for the first time" regarding his research on reversing Alzheimer's disease, without giving due to the FINGER study, which we hope will be confirmed by the US POINTER study.  Of course, as we pointed out in Beating the Dementia Monster, Dr. Dale Bredesen also claims credit for reversing Alzheimer's disease "for the first time."  I won't claim to be "for the first time;" I'll say instead that I have company.  

I'd like to say I have a lot of company, but I don't have enough.  My mission at this point in my life is to encourage as many people as possible to change how they live, hoping they will be happier and more productive.

In Gupta's series, one thing he did was travel to Okinawa where the longest lived people in the world live.  He hoped to find out what in their diet causes their longevity.  He may be wasting his time.  Many people in Hawaii who identify as Japanese are of Okinawan heritage.  After living in American culture for generations, they are consuming as much pizza and McDonald's as anyone.  My wife is of Okinawan ancestry, the youngest of eight.  We visited Hawaii a couple of months ago and spent some time with her oldest brother.  At 91, he still plays golf twice a week.  It seems to me that (if Alzheimer's doesn't interfere) it's genetic makeup causing Okinawans to live long lives.

Exercise and Dementia - A much more complex picture

In Beating the Dementia Monster, we tried to provide a reasonably straightforward understanding of how it was that exercise, especially sustained aerobic exercise, might have such a powerful effect in countering Alzheimer's and some other diseases associated with metabolic syndrome.  The simple narrative was that during exercise, the body generates the brain-derived neurotrophic factor (BDNF) protein that repairs damaged neurons and prompts stem cells in the hippocampus to form new neurons.  While that all appears to be true, it turns out that there's a much more complicated story.  According to some new research, exercise, one way or another, does something in just about every tissue in the body.  And many of these effects make additional contributions to brain health.

Since 2016, the Molecular Transducers of Physical Activity in Humans Consortium (MoTrPAC), has been conducting a 10-year project funded by the NIH Common Fund to further investigate these phenomena.  The results are pretty remarkable.  (But you may want to take a Dramamine before you visit their web site.)

So far, MoTrPAC has produced three peer-reviewed studies.  One paper published in the journal Nature maps molecular responses to endurance training across 18 organs, including the brain and the cardiovascular system.  Another, in Nature Communications, reports that endurance training influences the expression of disease-associated genes.  A third, published in Nature Metabolism, identified sex differences in how fat tissue responds to training.  (It turns out that males burn more fat than females.) 

The most important of these studies was "Temporal dynamics of the multi-omic response to endurance exercise training," published in Nature.  But, well, the study was based primarily on work with rats.  They compared rats who worked out hard on the cage wheel with rats denied access to any way of exercising.  However, the researchers meshed what they learned about rats with other research with humans to draw conclusions about exercise by humans.

What did they find?  Exercise provoked an incredible array of molecular changes across the entire body. Some were shared across tissues, suggesting common responses, while others only happened in one or a few organs.  Some of these molecular responses rose or fell as endurance training progressed.  While all tissues showed changes in response to exercise, some showed more change than others.  Blood, brown and white fat, adrenal gland, and colon cells changed dramatically, while there were only small changes in the hypothalamus, cortex, testes, and vena cava.  For proteins, the calf muscle, heart, and liver experienced the biggest effects.  And, of course, they confirmed what we said about BDNF in Beating the Dementia Monster. 

The ALZFORUM concludes, "Researchers have long puzzled over whether the benefits of physical activity on cognition and memory might be due to a direct effect on the brain, and/or to improvements in other tissues, such as the cardiovascular and immune systems.  [MoTrPAC] could help them tease apart these effects, and point to the most optimal exercise interventions."

So ... more research is necessary.

That online test and ... chocolate!

Last time I wrote, I talked about the online cognitive test from LANGaware.  The first time I took it on April 23, I came up as cognitively impaired.  I took the test two more times since then and came up normal.  However, my "normal" had some deficits.  In my post of April 23, I shared the map of my cognition, showing those of my strengths and deficits that had been measured.  I took one more test after that showing a wider range of strengths, but still substantial deficits.  Still within normal.

The obvious question is "the practice effect."  Did I do better simply because I had practiced their test?  All I can say is that, with each test, they based their results on largely differing measures.  I presume that helps with the practice effect, since I studied the results for each test to understand where I'd been short before taking the next test.  So ... who knows?

But I also came across a very reassuring video reinforcing my joy in eating dark chocolate!  Now I've sworn off milk chocolate since its sugar content surely causes more problems than it helps.  But dark chocolate contains flavanols, polyphenols, and catechins that are powerful antioxidants.  Maybe even more than blueberries.  These are great for both heart health and brain health.  (The neurologists always say, "What's good for the heart is good for the brain!")

In the video, the neurologist describes the benefits of eating dark chocolate, noting that chocolate with too much sugar won't help you.  (So no milk chocolate.)  If fact, you should verify that it is 70% or more cacao

I noticed that brands like Lindt and Ghirharde can be a bit pricey.  However, Sam's Club at Walmart, 72% cacao, is reasonably priced.  For a while, we could get Jojo's Dark Chocolate Bars at Costco, but they have been discontinued.  That was my favorite.

I love chocolate, so the warnings that come with this dietary recommendation from the experts can be discouraging.  Only one or two pieces a day.  Otherwise, they say, you negate the positive effects with the amount of sugar you will be consuming.

A free, online test for cognitive impairment

A friend told me that he had taken some online tests for depression and cognitive impairment.  He is almost as old as I am and was curious about what the tests would find.  They found that he was not depressed, and he was not cognitively impaired.  Had they asked me, I'd have told them the same.  The test uses AI to analyze your discussion of a picture to find markers for cognitive impairment.  I know there has been a lot of research in this area.  In fact, I've participated in some.

The idea was intriguing, so I thought I'd give it a try too.  It's provided by a company called LANGaware, and no referral or medical review is required.  They claim, "LANGaware is a clinically validated cognitive health screening tool powered by AI and patented machine learning.  Analyzing language and speech patterns, LANGaware offers insights into your brain health, delivering probability results for cognitive health conditions."

You take the short test, the AI robot interprets it, and you get the results in a few minutes.  If you're disturbed by the results, it's up to you to take it to your medical provider.  What could be easier?

I am tested by researchers at the University of Washington's Harborview Medical Center every week, and I feel well about how I do on those tests.  So I wondered what this AI robot would find.  

Well, it said I am in the middle of the cognitively impaired range.

In taking the test, the first thing I did was inadvertently take a test on depression.  Not surprisingly, it found that I'm not depressed, but ... was part of the test to see if I could follow instructions to get to the right test?

The cognitive test was actually familiar to me, although I never knew how I was evaluated.  Since 2015, I've had comprehensive cognitive testing every year or two, although we are currently skipping two years before my next test.  In this test, I was shown a picture and was told to explain verbally what I saw going on in the picture.  The picture was familiar, and I could recall what I'd seen in the same picture different times over the years.

So I was surprised when I found that I hadn't done well.  There was a discussion of eight different parameters, and I figured I was evaluated using them.  When I read about each one, I concluded that I hadn't spoken formally enough, not using complete sentences with good grammar, etc., and that's why I had scored poorly.  You're allowed to take the tests as often as you like, so I took it again.  This time I was careful to use my very best diction and grammar.  (In Beating the Dementia Monster, we discuss how the practice effect can confound cognitive testing.)

The second time, I scored in the normal (not impaired) range, but I noticed that the results evaluation showed me different parameters used for evaluation.  I'm guessing I was actually evaluated on even more parameters, but, for some reason, these were the most interesting for this taking of the test.  So while my overall score put me in the "normal" range for cognition, I was graded down on "lexical variation," "reference pointers," and "duration of speech."  Only "reference pointers" was mentioned in the first test.  When I was graded down, a score was marked as, "a participant with significant cognitive decline."  Ouch.

On the other hand, the second AI robot may have taken a different approach to evaluating me.  This might be why it got a different result.  But I don't know.

Here's a graphical representation of my first test:

If you can see it, the largest colored area is healthy people.  The purple triangle in the middle represents some cohort of patients with cognitive impairment.  I'm the green; more OK than the patients with cognitive impairment, but a long way from the healthy cohort.

I'm thinking I'll take the test again tomorrow.  No telling what I'll find.

Early exposure to a "western diet" impairs memory function. Uh oh.

Yes, it's been more than two weeks since I last posted. I've had plenty to keep me busy; I'm not just running out of gas.  I hear from some of you who worry about me.  But I'm OK.

I came across some recent research with implications for the diets of children and later memory loss.  But there's no real news.  Saturated fats, refined sugar, refined flour, and otherwise processed foods are still bad.  Very bad.  What's new in this research is that the negative effects begin with children when they are on what they referred to as a "western diet."  You know, pizza, red meat, fast food, and other processed foods.  (According to the late Dr. Martha Clare Morris, in her book Diet for the Mind, pizza seems to be the very worst thing for your brain that you can take in...)

The research was published in the journal Brain, Behavior, and Immunity.  The article was "Western diet consumption impairs memory function via dysregulated hippocampus acetylcholine signaling."  The researchers claimed to find causes and effects in several areas we've discussed before, both in Beating the Dementia Monster and in this blog.  For example, the western diet is hard on the gut microbiome that has such an important regulatory function for the brain.  Also, the western diet disrupts processes in the hippocampus that are so vital to memory.

Now, to be fair to McDonald's, the research was conducted with rats, not people.  And we've discussed before how brain research results from rodent models applied to people has sometimes been discredited.  In this case, the researchers wanted to know what would happen if rats ate a western diet during their juvenile stage of development, 26 to 56 days after their birth.  The rats were fed cafeteria-style, giving them the opportunity to choose whatever (junk) food they wanted.

I'm thinking this age may correspond, in people years, to when I began to earn enough money to begin eating fast food on my own.  Fast food became my regular diet at a fairly young age.  So maybe diet in my juvenile years has something to do with why I'm where I'm at today.  But I'm confident that generally following the MIND diet over the past seven or eight years has contributed to my present well-being.

Intermittent fasting causes heart attacks and makes cancer worse?

There is rather stunning news about research on intermittent fasting.  A team of American and Chinese researchers say that they found a 91% increase in cardiovascular death among those on an 8/16 fasting regimen -- those eating in an 8-hour window each day!  Not only that, they said that they found it made cancer worse, and they found no improvement in life expectancy among those fasting.

So what do we make of this?  As a minimum, if I had issues with cardiovascular disease or cancer, I would definitely not be fasting, at least not until we know more.  (I'm grateful to have a very low risk of cardiovascular disease, and I have no known cancer.)  

The authors of the study (and others in the world of research) are quick to point out that these results are preliminary and have not yet been subject to peer review.  It may well be that peer review will find significant flaws in the study.  But a 91% increase?  Where there's smoke, there's fire.

It has also been pointed out that the research is based on anecdotal evidence which can be tricky to interpret.  And while the they found a correlation between fasting and cardiovascular deaths, they did not establish causation.  You have likely heard the saying among researchers, "correlation is not causation."  So much remains to be clarified.  But a 91% increase in deaths??

I will certainly be waiting to hear more on this.  Speaking for myself, I don't plan right now to change my eating habits.  I think it's likely that fasting has played a role in my amazinly good current cognitive abilities, and I'm reluctant to rock the boat.  According to my cardiovascular scoring, I have no cardiovascular disease and a very low probability of developing it in the future.  Ninety-one per cent of a very low number is still a low number.  And I don't have any known cancer to be made worse.  But this could all change, and I will be paying close attention.

Good news/Bad news

I haven't posted for a while.  This isn't because things have begun going badly, it's just a fair amount of effort to keep writing content I think people will find interesting.  In 2015, when they diagnosed me in Seattle, one thing they told me was "reduce your stress."  Keeping content flowing on the blog takes some effort.  

So how has that reduce-stress thing gone?  Well...  as an elder in our church, that's kept me busy, and we're presently in Hawaii helping my wife's sister and husband move into a senior living situation.  At least, I think we're helping.  But we're not going to the beach.

Researchers from the Alzheimer's Disease Research Center at Harborview in Seattle continue to study me.  Not uniquely, I'm just one subject among many in several ongoing studies.  One is the Clinical Core Study, and another is the UW Memory Tracking Study.  The tracking study involves a weekly 8-minute test of my memory that I take on line.  It was supposed to last one year and, in any event, be done by September 30, 2023.  However, I volunteered to participate in an extension of the study, and I've been beyond my one year by six months or so.

A weekly test involves some topic, like jellyfish species.  Flags of Caribbean nations and national parks are two other topics they've used to test me.  I'm shown a picture of a jellyfish along with it's name.  Then I'm asked to identify the picture in later screens in a multiple choice format.  First I learn two (usually) and then they build to perhaps 15 different species.  My perception is that this is simply testing short-term memory and perhaps measuring damage to the hippocampus.  

I've been doing this for about 18 months.  I rarely get them all right, but I feel well about how I do.  (The protocol doesn't permit them to share their assessment of how I'm doing.)  I know they score me on how fast I respond to each prompt, and I can tell that I'm pretty quick.

But they threw me a new twist last week.  The topic was knots, but I did that one before, maybe six months ago.  So did they teach me the knots all over again?  Nope.  They wanted to know what I remembered from the previous lesson.  In other words, they were now testing my long-term memory.

When I started, I was disturbed (very) that they weren't teaching me the knots, but they were testing what I could pull back from my test six months ago.  But I was actually quite surprised at what I was able to remember.  Not perfect, but much better than I thought I'd do when I first saw I'd need to remember from to old test.

So the good news is that I continue to do extremely well in the area of memory and cognition.

The bad news is that my balance continues to deteriorate, and my sense is that the deterioration is accelerating.

You will recall that, last summer, I saw a new neurosurgeon to evaluate me for hydrocephalus.  After reviewing all of my MRIs, test results, and other of my records, he concluded that I have both Alzheimer's disease and cerebellar dysfunction ataxia.  He commended me for what I've accomplished in holding off the Alzheimer's disease, but he was not optimistic about the ataxia.  He believed that it was a separate neurodegenerative disease, and it would simply continue.  I'm having a hard time just giving in to that.

So I was surfing YouTube a couple weeks ago and came across a lecture by another neurologist in Seattle who specialized in cerebellar dysfunction.  He spoke as though there were many things that could be done for ataxia, and so I decided I'd like to go see him.  My neurologist gave me a referral to see him, and I have an appointment for July.

Does this new guy have a portfolio of treatments that my current care team didn't consider and would heal me?  On close examination of their web site and listening carefully to this other neurologist's lecture ... maybe not.  He's very positive, but my sense is that he's interested in enrolling subjects for clinical trials for new drugs.  We'll see what happens in July.