{"id":10925,"date":"2018-05-05T08:27:28","date_gmt":"2018-05-05T13:27:28","guid":{"rendered":"https:\/\/wholehealthchicago.com\/?p=10925"},"modified":"2022-03-21T15:51:26","modified_gmt":"2022-03-21T20:51:26","slug":"10925","status":"publish","type":"post","link":"https:\/\/wholehealthchicago.com\/blog\/2018\/05\/05\/10925","title":{"rendered":"Reversing Mental Decline and Preventing Alzheimer’s"},"content":{"rendered":"\n

Reversing Mental Decline and Preventing Alzheimer\u2019s, Part 1<\/strong><\/p>\n\n\n\n

You saw a movie last week and in discussing it with friends simply can\u2019t 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\u2019re 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\u2019re unsure who they are. When you learn it\u2019s someone you\u2019ve known for years, you\u2019re shocked and embarrassed.<\/p>\n\n\n\n

And you\u2019re really not all that old. 40s? 50s? Didn\u2019t 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<\/a> is still taking lead roles at 94. Chicago icon and brilliant polymath Studs Terkel<\/a> remained as sharp as a tack until he passed away at 96, likely with a martini and cigar at his bedside.<\/p>\n\n\n\n

Why the difference and what\u2019s the latest?
<\/strong>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\u2019s<\/em>, by Dale Bredesen, MD<\/a>. He\u2019s a UCLA-trained neurologist who has devoted his entire career to understanding mental decline and Alzheimer\u2019s.<\/p>\n\n\n\n

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\u2019s could be cured or slowed down. Unfortunately, after extensive clinical trials, this route met with little success.<\/p>\n\n\n\n

Other drugs that are designed to increase certain brain chemicals, like Aricept and Namenda, marginally improve memory but don\u2019t stop Alzheimer\u2019s.<\/p>\n\n\n\n

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\u2019s 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.<\/p>\n\n\n\n

There are different manifestations of this decline. The mildest, called subjective cognitive impairment (SCI), means that you yourself notice something\u2019s 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\u2019s.<\/p>\n\n\n\n

A little more serious is mild cognitive impairment (MCI), noticed by you and others. Again, not everyone with MCI develops full-blown Alzheimer\u2019s, but many do.<\/p>\n\n\n\n

Patients with MCI have lower-than-perfect scores on the Montreal Cognitive <\/a>A<\/a>ssessment Test  (MoCA)<\/a>, which can be administered by a physician or psychologist. It\u2019s one of several tests available<\/a> and for a thorough exam, more than one type of test should be administered.<\/p>\n\n\n\n

WholeHealth Chicago patients can schedule these tests with Dr. Janet Chandler. Obviously and sadly, Alzheimer\u2019s patients score poorly on their MoCA and the scores worsen with the passage of time.<\/p>\n\n\n\n

Parenthetically, President Trump scored a perfect 30 on his MoCA<\/a>, 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 \u201cstable genius\u201d is a bit of a stretch.<\/p>\n\n\n\n

What\u2019s attacking the brain?<\/strong>
<\/strong>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?<\/p>\n\n\n\n

To some extent, though not completely, it\u2019s genetic. SCI, MCI, and Alzheimer\u2019s can run in families, but for many patients there may be no other family members affected. If there is a genetic villain, it\u2019s APOe4.<\/a> 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\u2019s risk by two to three times. APOe4\/4 increases the risk 12 times.<\/p>\n\n\n\n

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<\/a> for $199, which includes this profile.<\/p>\n\n\n\n

It\u2019s important to recognize these facts<\/strong><\/p>\n\n\n\n

  1. You can experience cognitive decline and even develop full-blown Alzheimer\u2019s without any evidence of APOe4 risks.<\/li>
  2. 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.<\/li>
  3. If you\u2019re already experiencing some cognitive decline, whether it\u2019s subjective or mild, and you have a less-than-perfect MoCA, or even early Alzheimer\u2019s, you can prevent further damage and even reverse this deterioration.<\/li><\/ol>\n\n\n\n

    I\u2019ll cover how to best go about doing this in next week\u2019s Health Tip.  Dr. Bredesen has dubbed his program ReCODE (Reversing Cognitive Decline) and we at WholeHealth Chicago can guide you through it.<\/p>\n\n\n\n

    Be well,
    David Edelberg, MD<\/em><\/p>\n\n\n\n

    Reversing Mental Decline Part 2: Tests for Alzheimer\u2019s Prevention<\/a><\/strong><\/p>\n\n\n\n

    Last week I explained the current thinking about cognitive decline, whose worst manifestation, Alzheimer\u2019s disease, occurs because a protein called amyloid accumulates in the brain, destroying delicate brain cells. Focusing on clearing out amyloid as a treatment of Alzheimer\u2019s has been unsuccessful. The answer is prevention.<\/p>\n\n\n\n

    In his important book The End of Alzheimer\u2019s: The First Program to Prevent and Reverse Cognitive Decline<\/em><\/a>, Dale Bredesen, MD, a UCLA-trained research neurologist, shows that amyloid appears as a reaction to any of several threats to our brain. He divides these threats into three groups.<\/p>\n\n\n\n

    Three main threats to the brain<\/strong>
    <\/strong>The first, and most important, is chronic inflammation.<\/u> You\u2019ve probably read a lot about inflammation. We eat more fish for its anti-inflammatory omega-3s and we take baby aspirin or turmeric for their anti-inflammatory effects.<\/p>\n\n\n\n

    There are two forms of inflammation, one that helps us and one that harms. Brief episodes of inflammation are described as acute. These include your body\u2019s elegant, normal response to any attack, whether by a bacterial or viral infection or to a foreign body, such as a splinter in your thumb. In medical vocabulary, adding \u201c-itis\u201d to a body part indicates an inflammation is taking place. Think appendicitis or dermatitis.<\/p>\n\n\n\n

    Chronic inflammation is the harmful version, now known to be the villain behind heart disease, autoimmune disease, and some cancers. Last week I mentioned that individuals carrying a specific gene–APOe4–are especially susceptible to brain inflammation and subsequently to Alzheimer\u2019s. But susceptibility isn\u2019t the same as inevitability. Certainly not all APOe4 carriers get Alzheimer\u2019s (or any form of cognitive decline) and plenty of Alzheimer patients do not carry the APOe4 gene.<\/p>\n\n\n\n

    Dr. Bredesen has compiled an extensive list of triggers that create the chronic inflammatory state capable of igniting the smoldering fire of cognitive decline and Alzheimer\u2019s. These include chronic infections like chronic Borrelia (Lyme disease), Herpes simplex (cold sores), chronic sinusitis, and even gingivitis (gum disease).<\/p>\n\n\n\n

    Equally risky triggers for inflammation in susceptible people are dietary (gluten grains, trans fats, sugars, dairy). Gluten, for example, can inflame the lining of your intestine, rendering it more permeable to a variety of other inflammatory foods, a condition called leaky gut. Too much sugar or too many simple carbohydrates (such as white bread), which convert to sugar, can cause your body to become resistant to the sugar-lowering effect of insulin. This is insulin resistance, which we now know can increase amyloid deposition.<\/p>\n\n\n\n

    How much inflammation you have in your body and discovering what\u2019s triggering it can be established with lab tests, part of a diagnostic protocol Dr. Bredesen dubs a cognoscopy, sort of a colonoscopy of your brain.<\/p>\n\n\n\n

    Atrophic threats.<\/u> Keeping in mind that amyloid appears as a reaction to any of several threats to our brains, Dr. Bredesen describes this second risk group using the medical word atrophic, meaning gradual decline in function due to neglect or underuse<\/em>. This, too, occurs more often among APOe4 carriers.<\/p>\n\n\n\n

    The neglect list can be pretty long, but it\u2019s manageable. Neglect includes an unhealthful diet; vitamin deficiencies such as low B-12<\/a>, vitamin D<\/a>, and vitamin E<\/a>; smoking<\/a>; homocysteine levels; and lower-than-normal levels of virtually every hormone our bodies manufacture (thyroid, adrenal, estrogen, progesterone, testosterone, pregnenolone).<\/p>\n\n\n\n

    The underuse list can pretty much be summed up by the phrase \u201cuse it or lose it.\u201d Challenging your brain constantly keeps it vital and healthy. Sitting slack-jawed in your recliner binge watching and binge eating is risking trouble. Dr. Bredesen recommends a variety of brain exercise websites, such as BrainHQ<\/a>, and let me also remind readers that uncorrected hearing loss has been associated with early dementia<\/a>.<\/p>\n\n\n\n

    Toxic threats.<\/u> Bredesen\u2019s third Alzheimer\u2019s threat occurs more frequently in carriers of the fairly common APOe3 gene rather than APOe4. This type of Alzheimer\u2019s is less common and usually begins earlier, in the late 40s and 50s. It often starts after a period of physical or emotional stress. The initial symptoms may be difficulty with spelling, reading, word-finding, or simple arithmetic. Significantly, people in this group have blood-test abnormalities in tests not normally performed as part of a dementia diagnostic work-up.<\/p>\n\n\n\n

    Among these are low levels of zinc<\/a>, high levels of copper, adrenal gland abnormalities, and a history of excessive exposure to toxins like mercury or black mold (mycotoxins). Here\u2019s a page that shows good food sources of zinc.<\/p>\n\n\n\n

    Do I need a cognoscopy?<\/strong>
    <\/strong>You might reasonably ask who really should get tested for all this. Who really needs Dr. Bredesen\u2019s cognoscopy?<\/p>\n\n\n\n

    First, if there\u2019s dementia in your family start with APOe testing. Obviously you\u2019ll not be thrilled if you learn you\u2019re carrying the APOe4\/4 gene, but knowing you\u2019re at risk means you can start taking preventive steps immediately. If you have a positive test result for APOe4\/4 or APOe4\/3, further tests can be individualized according to your age, gender, and lifestyle.<\/p>\n\n\n\n

    Second, if you\u2019re experiencing cognitive decline, either the subjective form (you sense it but others don\u2019t notice) or the mild type (noticed by you and others), step right up and get a thorough battery of tests (Bredesen\u2019s cognoscopy).<\/p>\n\n\n\n

    If you\u2019re uncertain about the status of your brain, schedule testing with our psychologist Dr. Janet Chandler<\/a> or try an online self-test<\/a>.<\/p>\n\n\n\n

    Next week, I\u2019ll discuss the specific tests in a cognoscopy and the steps you can take to normalize them. When members of our WholeHealth Chicago staff read Dr. Bredesen\u2019s book, the general consensus was \u201cHey, this is us. This is what we do!\u201d So we\u2019re here if you need help.<\/p>\n\n\n\n

    Be well,
    David Edelberg, MD<\/em><\/p>\n\n\n\n

    Reversing Mental Decline Part 3: Tests for Alzheimer\u2019s Prevention<\/strong><\/p>\n\n\n\n

    Dale Bredesen, MD, author of The End of Alzheimer\u2019s: The First Program To Prevent and Reverse Cognitive Decline<\/em><\/a>, refers to the tests you should undergo if you\u2019re concerned about brain health as a \u201ccognoscopy,\u201d sort of a colonoscopy for your brain. Perhaps thinking back on your own colonoscopy, it\u2019s reasonable to ask, \u201cDo I really need a cognoscopy?\u201d<\/p>\n\n\n\n

    There are three groups of people I recommend give these tests serious consideration. (And at least a cognoscopy doesn\u2019t require a laxative.)<\/p>\n\n\n\n