You saw a movie last week and in discussing it with friends simply can’t remember the important parts. Plus you just missed another appointment. Planning to drive to a north suburb, you instead got on the southbound expressway and after 15 minutes of Loop traffic realized your error. You’re mixing up words and forgetting too many names. Reading anything has shifted from pleasure to struggle. You see someone you ought to know but you’re unsure who they are. When you learn it’s someone you’ve known for years, you’re shocked and embarrassed.
And you’re really not all that old. 40s? 50s? Didn’t grandma, now dead after a decade in a nursing home, starting showing signs of senility in her 60s? Many of us lose some of our smarts as we age, but certainly not necessarily. Chicago actor Mike Nussbaum is still taking lead roles at 94. Chicago icon and brilliant polymath Studs Terkel remained as sharp as a tack until he passed away at 96, likely with a martini and cigar at his bedside.
Why the difference and what’s the latest?
Are some of us just doomed to slowly deteriorate mentally while others are blessed with active and inquisitive brains until the end? You can learn a great deal about your brain and how to care for it in what I believe is the most important medical book published this past year, The End of Alzheimer’s, by Dale Bredesen, MD. He’s a UCLA-trained neurologist who has devoted his entire career to understanding mental decline and Alzheimer’s.
Based on microscopic examination of autopsy brain specimens, and more recently PET scans on living people, physicians thought brain deterioration occurred because of an accumulation of a protein called amyloid, which damaged delicate brain cells. They reasoned that if a medication could be developed to dissolve, or at least halt, amyloid production then Alzheimer’s could be cured or slowed down. Unfortunately, after extensive clinical trials, this route met with little success.
Other drugs that are designed to increase certain brain chemicals, like Aricept and Namenda, marginally improve memory but don’t stop Alzheimer’s.
After years and years of study, Dr. Bredesen concluded that researchers were on the wrong track. Amyloid production in the brain occurs when the brain is assaulted by any of several triggers. It’s a defense mechanism gone awry. To some extent, the triggers he describes can cause cognitive decline in just about anyone, but some people are more reactive to these triggers than others. Once assaulted, their sensitive brains pump out amyloid, triggering the fast-forward button of cognitive decline.
There are different manifestations of this decline. The mildest, called subjective cognitive impairment (SCI), means that you yourself notice something’s wrong, but really no one else does. For many of us, SCI feels like just a part of getting older, and fortunately may not lead to Alzheimer’s.
A little more serious is mild cognitive impairment (MCI), noticed by you and others. Again, not everyone with MCI develops full-blown Alzheimer’s, but many do.
Patients with MCI have lower-than-perfect scores on the Montreal Cognitive Assessment Test (MoCA), which can be administered by a physician or psychologist. It’s one of several tests available and for a thorough exam, more than one type of test should be administered.
WholeHealth Chicago patients can schedule these tests with Dr. Janet Chandler. Obviously and sadly, Alzheimer’s patients score poorly on their MoCA and the scores worsen with the passage of time.
Parenthetically, President Trump scored a perfect 30 on his MoCA, but since many of the items are on the order of drawing a clock face or being shown an unlabeled drawing of a camel and being asked to name it, calling himself a “stable genius” is a bit of a stretch.
What’s attacking the brain?
So if amyloid production with subsequent loss of brain function is a brain defense mechanism gone awry, what exactly is attacking your brain, and why yours?
To some extent, though not completely, it’s genetic. SCI, MCI, and Alzheimer’s can run in families, but for many patients there may be no other family members affected. If there is a genetic villain, it’s APOe4. There are actually four APOe genes (labeled 1 through 4). Keep in mind that you get one gene from each parent, and you can get tested to see what you have. Most people carry APOe3/3 and this poses no increased Alzheimer risk. However, APOe3/4 increases Alzheimer’s risk by two to three times. APOe4/4 increases the risk 12 times.
WholeHealth Chicago patients can contact their primary care provider and schedule APOe testing in our lab. Generally, insurance picks it up but always keep an eye on your deductible. Alternatively, order the 23andMe Health + Ancestry Service for $199, which includes this profile.
It’s important to recognize these facts
- You can experience cognitive decline and even develop full-blown Alzheimer’s without any evidence of APOe4 risks.
- If you do have either of the APOe risks, there are important–very important–steps you can take to reduce the risk of your genes manifesting themselves as cognitive decline.
- If you’re already experiencing some cognitive decline, whether it’s subjective or mild, and you have a less-than-perfect MoCA, or even early Alzheimer’s, you can prevent further damage and even reverse this deterioration.
I’ll cover how to best go about doing this in next week’s Health Tip. Dr. Bredesen has dubbed his program ReCODE (Reversing Cognitive Decline) and we at WholeHealth Chicago can guide you through it.
David Edelberg, MD