I'm curious about my personal risk of Alzheimer's disease, given my family's history with it.
I found the experience extraordinary and it got me thinking about my own brain, especially since there's a family history of Alzheimer's disease. Feeling a bit apprehensive, I decided to delve deeper into my risk for dementia. This turned out to be one of the most personal and enlightening experiences of my life.
To start, I went through a thorough investigation of my brain, which surprisingly, was much more than just a look at its anatomy or the possible genetic predispositions to certain types of dementia. The goal was to create a comprehensive timeline of my brain's development, from my early childhood to adulthood (currently in my mid-50s). This in-depth testing could provide valuable insight into my future and how I could make the most of it.
Although I'm a brain surgeon myself, I was astonished at how well the health of our brains can be measured. While we've now accepted that a range of tests can predict, prevent, and treat heart issues, the same cannot be said about the brain. Many medical professionals still struggle with defining what a healthy brain even is. The general assumption is that the brain in our skull is pretty much set and there's very little we can do to evaluate or enhance it.
But Dr. Richard Isaacson, a neurologist, changed my perspective. He made me realize that this belief isn't accurate. Known for his unwavering pursuit of injustice in medicine, Richard convinced me that brain health can be quantified and even optimized, as he revealed in his 2018 study.
I knew Richard well and could count on his expertise to guide me. So when the idea of a preventive neurology visit came up, Richard was the first person I thought of.
To clarify, this visit was not because I thought I had any existing issues, but rather to keep my brain in the best shape possible. It's no secret that the medical field is often referred to as a "sick-care" system instead of a "health-care" system - Richard wanted to see me when I was healthy, not just when I was sick. He believed he could help me maintain my brain function, reduce my risk of dementia, and even enhance my cognitive abilities.
In March, I flew into Boca Raton, Florida, to meet with Richard at the Institute for Neurodegenerative Diseases of Florida clinic. Before arriving, he advised me not to exercise or eat that morning and to prepare myself for a mentally challenging day. Even though this wasn't an IQ test, he indicated it would be highly personal. Would I notice any subtle cognitive deterioration? There might be subtle errors in my judgment or processing speed that would become apparent during the examination.
Upon arrival, I had a series of blood tests taken, including an Alzheimer's blood test and measures of my lipids, inflammation, and glucose levels. I also provided a saliva sample to assess my oral health. Following that, I used a body composition scale to identify the proportion of fat, muscle, and bone in my body.
Richard, seemingly engaged and intrigued by the results, made notes in the corner and stroked his chin. The sight of my doctor doing this unnerved me. "What?" I called out. "Oh, it's probably nothing," he replied. Later, he told me that he spotted evidence of an old arm injury, which he correctly deduced was the result of a vigorous leg workout the day before. This episode underscored how well our bodies store memories - even those we've long forgotten, like the injury from years ago.
The cognitive exam was quite an eye opener. To begin with, I was tasked with listening to a compelling short story about an Atlanta football team captain, a quarterback who injured his finger during a fishing trip prior to the big match. Despite thinking I was actively listening, I realized I had an issue retaining details like the day of the injury and the number of stitches required. The instructor then quizzed me about the player's finger - was it his thumb or ring finger?
The exam continued with other challenging tasks. I had to quickly recite as many words beginning with the letter 'G' followed by naming as many animals as possible in sixty seconds, with the goal of using lengthy, obscure words and exotic animals. There was also the need to memorize lists of words, design three-dimensional shapes, draw clocks, and match faces with their names. Even more challenging was the task of identifying smells and discerning which among gasoline, acetone, and the scent of a forest fire, or between lavender and lilac. I discovered that I struggled to accurately recall certain smells, causing me to try and remember the scent in question.
My brain felt like it was being scrutinized in a courtroom by a highly competent interrogator.
Certain red flags emerged not just from the number of errors made but also from how long it took to respond. Problems arising from drawing clocks backwards or an inability to tell the difference between different smells raise concerns. The more covert concerns revolved around visual-spatial construction or the ability to filter out conflicting stimuli - like identifying the color red, despite it appearing in a different color on the screen.
Although I've never been diagnosed with dyslexia, Richard suspects I may have it. He inquired, "Do you count on your fingers?" - something I've always done. I didn't consider this habit unusual or significant. However, Richard spotted that I had difficulty remembering words with an abundance of Bs and Ds since I generally confuse certain letters. These revelations, both major and minor, amazed me as I couldn't help but find them fascinating, albeit a little perturbing. For Richard, though, these observations represented possibilities for early intervention, some of which are surprisingly straightforward.
“Medical professionals would tell you everything's fine with your results,” Richard explained before showing me the findings of my lab test. “But what they're truly implying is that you’re okay – at least for the next few years. Yet, I'm thinking long-term. These issues indicate potential areas we can start tackling today.” I'm a highly competitive person, and I'm used to seeing only green lights on my lab test results. I take great care of my health - the same dedication I applied to my academic efforts in med school. Recently, my pride in my health was shattered by seeing a page filled with yellow As well as a few reds in my lab test results.
My homocysteine level was found to be elevated, while my B12 levels were low. No surprise, Richard told me, given the MTHFR gene mutation, suggesting I might not process homocysteine properly. My omega-3 levels were acceptable but not when compared to my omega-6 levels. My DHEA levels turned out to be a bit low, which could explain my struggle to put on muscle in relation to a decade ago. Additionally, I was astonished to find out the amount of inflammation in my body, despite feeling healthy.
The connection between these physical anomalies and neurocognitive function bewildered me. Richard claimed that even subtle metabolic concerns, such as mild insulin resistance, can promote amyloid deposition, leading to amyloid plaques - a signature of Alzheimer’s disease. He asserted that cholesterol and lipid abnormalities could connect to problems in cognitive function and the speed at which I process information. Lastly, he linked depression to reduced attention and processing speed.
As a medical professional who's worked in neurosurgery for three decades, I'd never encountered this before. Richard managed to link specific neurological aspects to physical abnormalities in a way that demonstrates scientific evidence for improved cognitive function if those physical targets are optimized.
Richard wanted to suggest an alternative to your daily routine activity, your neighborhood walk with your three dogs. He advised you to continue doing it, but this time, wear a weighted vest. The reason being that not having enough lean muscle mass can be a problem. Using a weighted vest helps in activating your core muscles such as abdominals and obliques, along with stimulating the growth of new bone cells. This could lead to a redistribution of fat, muscle, and bone in your body and lower your risk of developing amyloid in the brain.
To improve your brain health, Richard recommended you consider a few changes to your nutrition and day-to-day routine. He strongly advised you to supplement with omega-3 fatty acids, despite you not being fully convinced. He believed that your healthy diet could benefit even more by these supplements. They would also help with the absorption of B vitamins, which he specified should be 1,000 micrograms of B12, 400 micrograms of methylfolate, and 1.5 milligrams of B6. These simple changes could potentially have an impact on your executive function.
To improve foot health, Richard recommended wearing toe spacers occasionally. This will help you maintain sensory awareness, preventing any "sensory paralysis" that comes with not moving your toes and feet regularly. If ignored, nerve connections from the feet to the brain can slowly disappear. When feet are weak, uneven distribution of weight becomes an issue while walking, exercising, and even harming your knees, hips, and lower back. The more evenly your feet can tolerate a load, the better your movement options will be. Start with 10 minutes a day every few days and increase the time as you get used to them.
More sophisticated suggestions from Richard included getting a detailed DEXA scan of your entire body to evaluate body composition. This would help identify the amount of visceral fat you carry, which is the problematic fat that affects internal organs in your belly. Since the fat is buried tightly within organs, it's challenging to assess the quantity of this issue. There could be instances of skinny people carrying a substantial amount of visceral fat. Richard had concerns that you might be one of those individuals.
Another recommendation included undergoing a brain MRI to check for cerebral blood vessel injury due to a slightly elevated fibrinogen level. This protein assists in helping blood clot, and Richard was concerned that you might be forming more frequent micro clots. This would increase your risk of developing vascular dementia. The last recommendation was getting a coronary calcium CT scan to detect the early stages of coronary artery disease. This is harmful for both your heart and brain.
Although these tests are not part of routine care and might be expensive, Richard is working to make many of them free and available at home. Almost all of these cognitive tests could be accessible through a free app. Blood work can even be conducted via finger-prick testing, as long as Richard's research trial goes as planned. Home scales that measure your overall body composition, not just weight, can also help track body changes. A complete DEXA scan requiring a facility can still be a challenge to obtain.
Upon visiting Richard after all your testing, you expected to hear that you're doing well or even excellent, as past doctors had. However, Richard shared that when it comes to brain health, prevention, and optimization are possible. Pretty much there's a considerable gap between total health and sickness, which a sick-care system will not prioritize, especially if the recommendations are simple yet effective such as a few vitamins, toe spacers, and a backpack.
Passing through the process for "The Last Alzheimer's Patient" was more enlightening and upsetting than anticipated. Ultimately, no one wants discouraging news from a doctor, and particularly when it revolves around your brain. However, I can find some solace in the fact that these assessments aren't predicting a specific fate or readying me for an inescapable calamity, but instead providing me with tailored insights that I can utilize to pursue better health and a more efficient brain.
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After analyzing my lab test results, I was surprised to find yellow flags and even some reds, which was unexpected for a medical professional like myself. (lab results contain concerns)
To address these concerns and reduce my risk of dementia, Richard suggested several lifestyle changes including supplementing with omega-3 fatty acids, wearing toe spacers, and getting a DEXA scan to evaluate body composition. (lifestyle changes to improve brain health)
Source: edition.cnn.com
