January 2024 Newsletter | Multimodal studies as guides to Precision Medicine
My mission is to be the first woman in 4 generations to not develop Alzheimer’s Disease (AD). On my journey of discovering ways to mitigate my risk, I pass this information on to you in this Brain-Body-Health (BBH) Newsletter.
Hello BBH Citizen Scientists!
10 years ago an important study out of UCLA showed not only the improvement but the reversal of cognitive decline. Yes, I said reversal of cognitive decline. In 2016 there was a follow up report on 9 of those patients who continued their improvement. Many who were struggling at work could return, and their performance on cognitive testing such as the MoCa (Montreal Cognitive Test) reflected this. By 2018, another study followed with 100 people using the same multimodal approach. Led by Dr. Bredesen these 3 studies reflect the need to entertain a multi-pronged approach to understanding AD, rather than solely a pharmaceutical one.
On the international front, the 2015 Finger study again used a multi-treatment program to educate and address the risk of cognitive decline, stressing interventions that would translate into better cognitive health. The results showed improved cognitive health especially true for persons with the APOE 4 gene. What these studies have in common is a multi-oriented approach, targeting several variables affecting brain health with significant improvement.
Neurodegenerative disease (ND), AD, Parkinson’s, ALS, frontotemporal dementia, supra-nuclear paralysis, and macular degeneration have been, arguably, the field of greatest failure of the last century in terms of treatment and disease modification.
Dementia is the main cause of disability worldwide. Sadly, we haven’t made a dent in altering the course of ND diseases. Even with MABs, monoclonal antibody drugs, like Aduhelm and Lecanemab, (the one my brother is taking) these only slow the progression of the disease. Meanwhile, ND diseases have risen to the third leading cause of death. Neurodegenerative decline is a very slow, long (up to 10+ years), and an expensive death at that, landing the bulk of stress on family and caregivers, the majority of which are women. No wonder women make up 60% of all AD diagnoses. Indeed, for women age 60 plus the rate of developing AD is now greater than her chance of developing breast cancer.
Despite all we know about the molecular underpinnings of AD we have failed at treating and preventing it.
By continuing the now greater than 20 billion dollar search for the single pharmaceutical bullet that will cure dementia, we are neglecting these multi-orientated studies that incorporate prevention and lifestyle changes. BTW, you won’t hear mention of these studies on the news or social media because they are not being funded by Big Pharma. This visible neglect and mounting expense reminds me of the definition of insanity: doing the same thing over and over expecting a different outcome?
“This has led some to question whether the approach taken to drug development for AD is an optimal one”
— Dr. Dale Bredesen.
Combining targeted strategies likely has a synergistic approach altering cognitive decline, which is not new. Their positive results have been seen in several chronic illnesses, like HIV, cancer, and even long-term Covid.
In 2016, I knew nothing about these combination treatment studies nor did I recognize my risk of AD. What I did know, was that my mother’s memory was declining. Dr after dr…gave me the same story. “There is nothing you can do” and “you're grasping at straws”. We were slowly losing her to AD. We did what her doctors told us. We started her on Aricept-like meds that were purported to slow the progression of the disease. We did not witness any positive changes. I was curious. Was there a genetic factor operating in our family? Determined to find out, our family decided to go against medical recommendations and get tested for the APOE 4 gene, the strongest genetic link to late-onset AD (LOAD). Understanding the many downstream effects this gene has on metabolic health including cholesterol and glucose regulation, inflammation, vascular health, and the making of amyloid, fueled my frustration, anger, and grief, into action. It was no longer about AD affecting Mom but also our family, our kids, our communities. Soon after this discovery, I began spreading the word about the connections the APOE 4 gene had on metabolic health and the development of AD along with how to mitigate that risk.
We APOE 4 positive brothers and sisters make up 20-25% of the population. We are the ‘canaries in the mine’, and the most likely to develop AD. The bad news is our brains are super sensitive to alcohol, smoking, toxins, insulin fluctuations, heart disease, stroke, and the effects of aging. The good news is according to these multi-targeted studies we may also be the most likely to improve when we reduce these risk factors and integrate brain-healthy practices including SLEDSSS. Reading the literature through the eyes of my canary-like brain🐦 gives me hope for my mission: To be the first woman in 4 generations to not develop AD. 😁
Lessons in Coaching
It was in nursing school when I first learned of the bio-psycho-social-cultural-spiritual developmental framework for health assessments. That is a mouthful but a necessary one for understanding health as a constantly changing state of affairs. The lesson is the care you receive needs to be personalized and individualized to fit you. There is no one-size-fits-all. This is the future of medicine and the foundation of BBH.
BBH coaching is a comprehensive approach to understanding the whole person while assessing your risk of dementia. We recognize how biomarkers, cognitive testing, family history, and lifestyle markers are all significant factors for your health.
Coaching this past month has been steady and rewarding. I primarily work on Wednesdays. Therapeutic conversations have ranged over a wide variety of topics including: prevention measures for diabetes and AD, end-of-life planning, time management and behavioral strategies when caregiving for a loved one, and testing for the APOE 4 gene.
I offer a free 15 minute consult to see if BBH coaching is a good fit for you.
On Caregiving: Being a caregiver is one of the hardest jobs anyone can do. Caring for someone with memory impairment is especially hard. Life suddenly becomes filled with medical appointments, medication management, making sure your loved one is safe, secure, clean, warm, and fed. It is easily a 36-hour day that can quickly become exhausting. Exhaustion sounds the wake-up call alarm. It comes from within with a message…YOU need more support for your loved one and more time for yourself. Coaching can help channel exhaustion into actionable steps for you to get clear about your needs, set boundaries, and limits. May you listen for your call.
On End of Life: Lately, coaching has taken me into homes to help clients and their loved ones who have memory impairment get clear about EOL wishes. Getting clear paves the way to create the best possible outcome for the death you want.
On Grief: The busyness of life often prevents us from experiencing feelings, such as hurt, pain, and grief. Being busy can be a form of denial that keeps us in a place where we can, at least for a while, avoid and hide from uncomfortable feelings. Facing these feelings of loss and grief is uncomfortable, challenging, and certainly one that requires space and time to allow them to come forth.
On changing behavior: I found this article fascinating using the reward chemical dopamine to exemplify what happens when we consciously choose to stop an offensive habit, addiction, or negative behavior.
On APOE 4 testing: Since the hacking of 23andme.org, I’ve been reaching out to various resources to determine where is the best secure testing site. Here are my recommendations:
Rupa Health - blood and maybe saliva. Need MD order
Lab Corp-blood test only. Need MD order
Empower RX- saliva, HIPAA, CLIS certified, direct to consumer.
More information is available Genetic testing and website and on the BBH APOE 4 resource page.
Lessons from Science
BrainSee is an AI-based medical software that analyzes brain MRI data in conjunction with cognitive test scores to generate an accurate objective score predicting the likelihood that a person with amnestic MCI will progress to Alzheimer’s dementia in the next five years with 91% accurate in predicting Alzheimer’s dementia.
This phospho-tau could serve as a disease staging biomarker making memories film.
First Survivors of Alzheimer’s Disease, Dr Dale Bredesen
Film: Memories for life showing the effect of individualized treatment for AD using ReCode intervention.
Lessons from the Poets
Poem Healing time and commentary by Kristine.
To optimized health for all!
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- African proverb
To our optimized health!