July 2024 Newsletter | The Dementia Dilemma
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!
Recently I was asked to talk about the “Dementia Dilemma” by Friends of Health. Some of you have asked for a copy of the talk so here it is. A video will be available on BBH website sometime in the future.
Cynthia Wall LCSW, opened with the following statement: "There is no shame, no blame about dementia! We are bringing dementia out of the shadows so we can see it, talk about it, figure out what we can do about it, and what we need to do about it!" The panel was composed of local experts in the field of dementia including a doctor, lawyer, fiduciary, senior care specialists, hospice providers, care alliances, and more. I was moved, honored, and inspired to be a part of it.
Introduction: I am very happy to be here and work together on unraveling the dementia dilemma. I have worked in our county for 30 years mostly as a psychiatrist and more recently as a brain health coach. When my parents developed dementia many told our family there was nothing we could do, some even doubted that they had dementia, and discouraged us from pursuing genetic testing or other lifestyle changes. After several good cries and finding others in similar situations, I decided to start investigating evidence based practices that could make a difference. The person who helped us the most in the early stages was a coach, who also had parents with dementia. Her direct experience was crucial for our family. She was our family guide who gave us hope and helped with maneuvering dementia’s rocky road. During the 10 years of caring for my parents, I was inspired by many caregivers, coaches, therapists, and providers. There were so many who comforted us with their, questions, care, and guidance. I felt inspired by these people so much so that I closed my psychiatry practice and opened the Brain-Body-Health Program focusing on changing the narrative from ‘there is nothing you can do’ - to there are many possible treatments and strategies and more we are discovering day by day.
As you know my mission eventually became clear: To be the first woman in 4 generations to not get AD. Along my journey, I discover practices that I pass on to citizen scientists like you, and to frankly anybody else who is willing to listen, whether they be on the street, train, having lunch at a restaurant or my preferred place, standing in a long line waiting for the women’s restroom. Always interesting conversations going on there (haha). I’m passionate about people understanding that they have agency to make decisions about this dis-ease called dementia.
Dementia is a dilemma because it’s an epidemic no one wants to talk about.
We are all in this together now changing the narrative one brain at a time.
Remember: Dementia is an umbrella term. It is caused by many different diseases and conditions. The most frequent cause of dementia is Alzheimer’s Disease. We now use the term Alzheimer’s Disease and Related Dementias (ADRD).
Exciting new developments in the field of dementia:
Blood markers of beta-amyloid and tau: This simple blood test measures these pathological levels. It will change the landscape of dementia, enabling us to get earlier diagnosis, treatment, and most importantly monitor levels that will tell us if treatment is working or not. No longer do you need an expensive PET scan and invasive spinal tap. Rather than relying on subjective reports of memory impairment we now have actual objective data that we can measure and follow.
Monoclonal Antibodies (MABs): These are the new players in recent years similar to our own antibodies that have been lab-engineered to recognize and eliminate amyloid and tau. These are the first medications to offer disease modification of ADRD. Prior to this we had only Aricept-type medications that just caused ADRD to progress less rapidly, but did nothing to reduce the disease itself. These medications came about from the amyloid cascade hypothesis, which posit the genesis of AD is due to amyloid. This is controversial since some researchers believe amyloid is not the “bad guy” and may even be the brain’s way of responding to an infectious agent. These MABs are not without side effects and other issues. They can cause brain bleeding and swelling mostly in genetically susceptible (APOE 4 +) individuals; they need to be given IV, and they have a high cost even with Medicare coverage. This brings to the forefront the issue of equity where the economically disadvantaged would be served last because of costs and accessibility.
Hormonal treatment: We know that ADRD begins 20-30 years before symptoms develop. Women make up 2/3rds of population with AD. If you follow that time line a 70- 80 year old woman would start having brain changes around 40-50 years of age. That is smack dab in the middle of perimenopause (which can last 5-10 years before menopause) and has peaked more research into studying the relationship between AD, menopause, and the use of bio-identical hormones, that I wrote about in this BBH newsletter. This study showed APOE 4 + women had hippocampal volume increase with the addition of bio-identical hormones.
Diabetes type 3: The relationship between diabetes and AD has been known for more than a decade. So much so that Alzheimer’s has been called diabetes type 3. Diabetes increases with age, weight gain, stress, family history, etc. It’s also why I have devoted the last three BBH newsletters to tackling the subject.
Decrease Neuroinflammation: Targeting the macrophages or janitorial cells of our brain, called microglial cells, have given scientists a bird’s eye view into another area of growing interest: neuroinflammation increases with age! One reason for this is the microglial cells begin to malfunction, not keeping up with sweeping out the dust bunnies and debris, like senescent cells that damage brain tissue. Age is the biggest risk factor for AD, debunking the myth that if you don’t get AD by 90 or 100 you won’t get it. Sorry to say, the older you get the more likely you will develop memory impairment. This should make us even more invested in our health span rather than life span.
What may make the biggest difference in our Brain Health, like Dorothy said, could be found in our very own backyard.
It turns out there are changes in our own personal daily habits that can make a big difference giving us a longer runway for a journey to a longer health span.
There are several studies supporting lifestyle changes that have made a difference in cognitive health. The most well know and one of the largest with 1200 people is the Finger study done in Finland where people improved cognition and cardiovascular health with multi-domain lifestyle interventions. Dr. Dale Bredesen’s program has showed a reversal of Mild Cognitive Impairment (MCI) in his book describing personal stories called, "The First Survivors of Alzheimer’s". Recently, CNN featured "Last Alzheimer’s Patient" with reversal of AD symptoms in a 55-year-old man, secondary to lifestyle changes and health optimization using Richard Issacson’s preventive neurology program. Dean Ornish, who was first to show reversal of heart disease, now has a study showing reports of reversal of MCI in a small study.
I hope you are getting the message there are many disciplines of science exploring how we can prevent, modify, and possibly reverse dementia. Being citizen scientists, we have to be careful to not provide false hope. The studies above are showing improvement and reversal of mild cognitive impairment and some cases of mild dementia. There is no clear agreed-upon program at this time that is the most beneficial. We are still working this out, collecting scientific evidence from upcoming studies. What is clear is that the earlier we start treatment for cognitive impairment the better chance we have of improvement, and possibly, even reversal.
Genetics and Epigenetics are central players in the Dementia Dilemma.
Genetics: We know about the highest risk gene called the APOE 4. It is a cholesterol transport gene that 20-25% of the world population has. In other words, 1/4 of the people in this room have an increased risk for AD. If you have 1 copy of the gene (like me) you have 3x the risk of the general public. If you have 2 copies like my brother, you have 8-13X the risk. Genes do make a difference, but they are not the whole story. In Africa, the APOE 4 rates are the same or higher than the US, but the population risk for AD is less. The same is true for the Bolivian Tsimane tribe of South America. They also have a high degree of APOE 4+ members with low rates of AD and cardiovascular disease. Is there something about western society that predisposes us to AD? These are interesting questions science and citizen scientists are talking more about.
Epigenetics: We used to think genes were written in stone; enter the field of epigenetics which is the study of factors that can modify genes. Take the risk for type 2 diabetes. You may have genes that are postive for this disorder. Those genes are modifiable, for instances, if you increase exercise, get 7-8 hours of sleep, eat a low carbohydrate diet, etc. . . you can reduce the impact of those risky genes. We’ve discovered many ways to reduce diabetes and other diseases like dementia along with epigenetic modifiers. Science is uncovering additional genes that increase risk of dementia while investigating epigenetic modifiers that reduce the risk. These are what I base my BBH program on.
SLEDSSSS: Sleep, Learning/Laboratory Optimization, Exercise, Diet, Socialization, Stress reduction, Sensory health (eyes/ears/nose/sexual), Spirituality/Purpose. These epigenetic factors, when optimized, are backed by scientific evidence that supports improvement in cognitive health.
The Future is Hopeful
The vast majority of people diagnosed with memory impairment already have significant pathology in their brains. Remember this disease starts in the brain 20-30 years before symptoms so all of us are at risk. Stats are that by age of 85, 1/3-1/2 of us will have memory impairment, so the earlier we start the better. According to the AAIC (Alzheimer’s Association International Conference) 50% of people who actually have AD do not receive treatment for symptoms. The blood test for amyloid and tau will improve the accuracy of diagnosis and pave the way for earlier treatment. It should be offered in primary care settings soon but it is already available via direct-to-consumer labs (no doctor signature needed via quest). Now, that we know there are possibilities for earlier diagnosis and treatment we no longer need to fear knowing if we carry the APOE 4 gene. Matter of fact the Reveal study showed people who find out they are APOE 4+ become more proactive knowing they carry the at-risk gene for AD. For instance, knowing you are APOE4+ and you have elevated amyloid and tau in your blood, you and your PCP will determine ways to target your brain-body-health precisely. Most likely that would involve multimodal treatment with a combination of SLEDS,S,S,S,- lifestyle interventions, medications, hormones, antivirals, supplements, etc…
An even better and earlier approach is to ask for a Cognoscopy, proposed by Dr. Dale Bredesen. It is an annual in-depth look at your cognitive health and risk for dementia.
Finally: We need to change the narrative and vision of dementia from the villain and something we fear to a teacher that is creating citizen scientists who are posied to unravel this dementia dilemma. Dementia and aging are teaching us about what our society needs for a sustainable future. First and foremost, we need to protect our brains, educate our young about brain health, form circles of support and care, address equity, and have honest conversations about living and dying. I believe AD is teaching us basic facts about what it is to be human. We all will become sick and vulnerable at some point in our lives. We will need to rely on another person, preferably a circle of many. Maybe dementia is pointing out that we need each other more now than ever.
Lessons in Coaching:
Brain-Body-Health coaching practice is focused on navigating memory impairment from the asymptomatic stage to the end of life. Using scientific-based practices the BBH program uses a personalized approach for preventing and mitigating memory impairment.
Begin early
Know your risk: Everyone is at risk for dementia. The following list puts you at greater risk:
Age
Family history of AD-
Carrier of one or 2 copies of the APOE 4 gene- highest risk gene
Hypertension
Type 2 diabetes or gestational diabetes- diabetes type 3.
Head injury -
Sedentary lifestyle
Smoking
Loneliness: lack of social support
Take Action: I use the acronym SLEDSSSS, which stands for scientifically validated interventions. Sleep, Learning/Laboratory Optimization, Exercise, Diet, Socialization, Stress reduction, Sensory health (eyes/ears/nose/sexual), Spirituality/Purpose.
S= what doctors told President Biden he needed more of - Getting oxygen to the brain is paramount!
L= We know that learning something new daily, like a language, musical instrument improves cognition. Research is showing we need at least 30 min 5 days/week. Have regular laboratory work to make sure labs values are optimized. Screen for APOE4 and toxins: we can use specialized test to measure toxins now. Forever chemical test.
E= Exercise in your aerobic zone minimum 150-300 min/week. Heart rate needs to be above 100. Most proven method for increasing oxygen to the brain and volume to hippocampus memory centers. Most important wear a helmet to protect your brain!
D= Everyone's diet is different and should be moditored depending on your lab values.
S= Stress reduction- increase parasympathetic activity with relaxation, mindfulness, Qi Gong, Tai Chi, etc. . . .
S= Socialization- Isolation and loneliness are dementia risk factors.
S= Spirituality and purpose- church, synagogue, or groups with a focus on connection, compassion, and community.
S= Sensory and Sexual Health- Regular eye, ear, and nose evaluations. Prevent and monitor for UTI’s.
I offer coaching sessions to help navigate and improve brain health for you or a loved one. Contact me to schedule a session.
Lessons from Science:
References:
Landmark study links microplastics to serious health problems. People who had tiny plastic particles lodged in a key blood vessel were more likely to experience heart attack, stroke or death during a three-year study.
Dean Ornish study 2024 showing improved congitive health with a plant based program and lifestyle changes.
Film: Memories For Life: Reversing Alzheimer’s Disease, based on Dr. Dale Bredesen’s program.
MET-Finger study: in UK, Sweden, Finland- is in phase 2 testing combination of lifestyle changes used in the original Finger study with the addition of metformin. I’m looking forward to seeing the results of this one!
In women with the APOE4 gene, HRT was associated with better memory and larger brain volume, with the greatest effect seen in those who started HRT earlier.
To our optimized health!
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“If you want to go FAST, go alone. If you want to go FAR, go together."
- African proverb
To our optimized health!