Dr Rudy Tanzi lecture on Alzheimers Part 2

 Slides from Dr Tanzi you tube link

Important point:

A teaching moment

I had abundant amyloid plaque on my Pet scan but my neurologist gave me the diagnosis of Alzheimers based on having one gene for AZ and serial cognitive exams. 

Drug therapy and trials have concentrated on getting rid of the amyloid plaque with limited results. Link to new drug

Dr Dale Bredesen concentrates on treating the inflammation with shotgun therapy.  Last year I gave it a try. Atma Holistic link

I seem to be doing well on all the supplements

Dr Tanzi does not get into supplements in his slide. 

Support for supplements link

Supplements advised by Issacson link

However there are basic lifestyles changes that most advise. 

Advanced slide on AZ drug

Why Am I exhausted today?

 I had a great night of sleep.

I awoke at 10 AM.  

We went to the bagel shop.  One large cup of coffee did not wake me up.  

We went shopping at Sams.  I walk slow. I don't get out of breath. 

I am back on all my supplements.

After being off them for a month I feel no differnce.  supplements link

Patients would come to me complaining of fatique.  After I ruled out anemia and thyroid problem I 

would start Prozac.  The patient usually responded withib 5 days and stayoed on the antidepressant.

The most important thing for a depression is exercise but that is the last thing the patient wants to do.  

I do go up and down a flight of stairs 10 times a days.  I am also on citalopam.  

I quess it can chalk it up to my Alzheimers.  A bad day.  I haven't had any arguments either.

Introduction to Year Five Alzheimers book

October 25, 2021

 Introduction to Year Five

Avoiding falling off Cliffs with Alzheimers

Am I one of the Alzheimers survivors?

I guess I was too pessimistic when I wrote my Year One book.  I am waiting for when I forget I have Alzheimers. I thought with Namzaric I could only hope for 2 good years before I fell off the cliff of the survival curve and had a severe loss of cognition.  Afterall I don’t do a great job controlling my Diabetes Mellitus type 2. 

Other than the head injury which I had with a small subdural hematoma when I fell after drinking I doubt I will fall off a sudden cliff because my blood pressure is low and my cholesterol is very low with medications.  Thus no stroke or heart attack is in my future. 

During Covid shutdown I decided to try supplements as advised by Dr Bredesen and Dr Isaacson. They both had poster children for their program.  Julie and Rogen.  Thus I started the ReCode program at a Holistic clinic in Lawrence, Kansas.  I have completed twelve.   months and don’t plan to continue with visiting the clinic now that my year's contract is done. I mostly wanted a Doctor familiar with all the supplements to slowly guide me on starting them.  Presently I take  fourteen new supplements.  I tolerate them well except for some mild esophago-gastric reflux.  Have they helped me? All I can say is I seem to be maintaining the status quo on the most part.  My wife and I still notice some more short term memory loss.  I do think I am more emotionally stable which I contribute to Ashwagandha. 

What will the Fifth Year bring?

I am open to taking the new Alzheimer's drug, Aduhelm (aducanumab).

I am waiting for the one year post treatment analysis before I make a decision. 

In the meantime I plan to have fun. 

We have scheduled 6 cruises, one Tauck tour in Ireland and 3 USA trips. 

After next year I am willing to roll the dice on Aduhelm (aducanumab) and get the expensive monthly  IV infusions each month.  

Having the talk about when I need to be admitted to nursing home

My wife had a long career running different types of nursing homes. 

We talked about when she would no longer could take care of me. 

She  thinks she can't leave me at home by myself for six days.

She watched me walk down the hill with the dog and trying to keep up, I ended going faster and faster and the big dog caused me to step on the grass which threw me off balance.  She thought I was going to fall.  I didn't but I have fallen in the past. 
Once with a black eye. My first black eye link,
then my concussion link.

I still drive, still cook, still walk outside, I don't get anxious when she goes to her daughters for two days.  

When to move an Alzheimers patient to a home article link

1-Medication management 
I take 12 medications not counting several supplements.
I have a routine and rarely miss pills. 
I also call in my own prescriptions from my Doctor.

2- Mobility

3- Wandering
I take a mile walk each day.  
I take my iPhone with me.
I go in a circle, same route everyday.

4- Caregiver stress
I have told my wife I have no problem going to an Independent living facility if she feels I am too much for her to take care of. 
My biggest fear link 


5- Long distance caring

6-Rely on a plan not a promise

The Basic Living Skills assessment includes:

• Self- Management.
• My wife pays the bills and makes the travel arrangements.
• 
  
• Basic Communication.
• I wear hearing aides but still need to ask people to repeat their sentence as their  syntax will confuse the message for me.  Previously I could infer what they meant as my intuition as always been good.
• Dressing.
• Twice I tried to put my shirt on as pants.  Didn't work and it took a while for me to figure it out.
• Toileting.
• Other than getting up five times a night to urinate.  Once I did pee in the corner of the room.
• Grooming.
• I cut the long hairs in my nose.  A real surgical procedure.  
• Bathing.
• No problems
• Health, Safety, and First Aid.
• I put my own band aides on.  I do finger sticks on myself for glucose and ketones each morning .
• Nght-time Routines.
• I checked my testosterone level recently it was extremely high and I had to stop testosterone immediately. Four months ago my dose was increased 40 mg but I was having trouble figuring how much to draw up with the syringe.  100 mg was easy as it was one half a cc. I was giving myself a shot in my butt.
• I exercise each day.
• I walk each day.
• I stretch each day
• I take my meds in AM and supplements in afternoon.

Activities of functional living skills (AFLS) Link

Supplements as discussed in Isaacson and Ochner book

 The Alzheimers Prevention and Treatment Diet 

by Richard S. Isaacson and Christopher N. Ochner

This book was published in 2016. 

Thus their information needs to be updated which I am finding difficult to discover. 

Page 177: Additional supplements being researched.

1- Alpha Lipoic Acid

2- Ashwaganda

3- Coconut oil 

4- Fullerene c 60

5- Carnitine 

6- Fisetin

7- Lithium 

8- Magnesium 

9- Melatonin

10- Vitamin C

11- Vitamin E

Found to be generally ineffective:

1- Gingo Bilboa

2- Coenzyme Q 10

Second review of On Pluto

Second review of on On Pluto by Greg O'Brien.  

Prior Harsh review link

This time I will post what I think Greg O'Brien got right. 

1- Exercise. 

Author says it recharges his brain.

He does a great deal of running. 

I suspect it's one of the main reasons he is hanging on with Moderate severe Alzheimers. 

He does seem to pay a price with subsequent body pain.  Pain causes distress and this is not a friend to the AZ brain. 

2- Medications p23

This is the only AZ book that at the beginning of the book discusses the usual medications for AZ.

Aricept

Namenda

Trazadone to help him sleep

Celexa (citalopram) 20 mg:

 An antidepressant for his rage, which considering how bad his rage I can't believe he is not on 40 mg which I take. 

3- Socialization

Mr. O'brien has a lot of friends that he stays in touch with and gets good support.

4- Hard drive 'memory palace' on office wall p14

"They paint word pictures. Everywhere there are historical, FRAMED front page stories and magazine covers. 

My memory palace to remember my family link

Memory is not what it is cracked out to  link

5- Supplements p193

I have only read to page 217 so far.

I don't know which specific supplements he takes. 

The list below is what his Alzheimers Doctor advises:

Tru-Niagen

Percepta

Vegan Omega 3

Quercetin

Fiscetin

TUDCA

Ashwaghada

Vitamin D3

Methyl B12 plus

Coenzyme Q (especially if on a statin)

Selenium 

Nordic Natural Probiotic plus prebiotic

7-Religion/Faith

This is a good strategy when faced with death.

Raised as a Roman Catholic the author draws strenght, solace and some tranquility from his faith

8/ Sleep 7-8 hours a night

9/ Great discipline with memory helpers on his phone and gmail. 

10/ Author writes 2 hours every night. 

I also try to write in my blog and twitter everyday. 

I feel great gratification when I can write a good thread on twitter or a good blog.  I encorporate my blogs into my last 3 books on my AZ which I document in diary form. I am now working on my Year 4 book.  

The author and the author of Tattoo on my Brian both taught me about cognitive reserve which will hopefully allow me to continue my writing even as I enter moderate alzheimers. 

           

Update on my Alzheimers

I had some good glucose fasting numbers

Life goes on link

I was diagnosed with Alzheimers in Dec. 2017.

It is now Feb 11, 2022. 

I am in my fifth year since the diagnosis was made.

I have kept to the plan of treatment quite well.

In fact, in Florida since Jan. 18 I have increased my walking and weight lifting. I seem to get tired easily. 

My weight stays the same 188 to 190 lbs. 

I skip breakfast and have good ketone levels.  

Fasting glucose is between 150 to 200.  

I rarely have a good glucose level. link

Diet, exercise, medications, supplements and sleep are doing well. I have vivid dreams which I enjoy.

I also keep up with listening to music and doing Duo Lingo in Spanish every day.

Anxiety is often a problem by noon. 

My Manhattan anchor helps but I recently subsituted my second cup of coffee with a soothing tea.

Exercise helps. 

The worse thing that can happen to my on any given day is to get into an argument with my wife. 

The stress from the distress of the anger link causes depression. 

My wife and I have done much better at not engaging in anger.  

I do feem my short term memory is worse and I was hoping adding on 10 mg of Aricept would help.

Annual visit to Florida Neurologist link

The RX cost $1400.

I am waiting for the generic version now. 

Hence I am always tintering with my plan. 

I am afraid to stop all my supplements. 

I continue with testosterone and Cialis link. 

It's one of the few drugs that I can actually see the good effect it has on me. 

Ozempic is another weekly injection that clearly curbs my appetite. 

I also see positive lab results with statin, fish oil and nicotinic acid.  

I think Invokana has saved my life by lowering my glucose. 

I avoid falling off the cliff with the anticoagulant, Xarelto (I have Atrial Fibrillation) 

I also keep my systolic blood pressure less that 120 with ramipril and a calcium blocker. 

Supplements advised by Isaacson and Ochner

 

Best chaper I have read on supplments for AZ

The Alzheimer's Prevention and Treatment Diet 

of Alzheimers Disease by Richard Isaacson  and Christopher Ochner

The following supplements are advised:

B vitamins

Vitamin D3

Omega 3 fatty acids

Cocoa powder

Curcumin

Resveratrol

They may need an update as in the End of AZ by Dr Dale Bredesen they leave out many other options and don't mentione. 

The ReCode protocol by Bredesen does include all the above but Ochner does not advise Gingo Balboa or Co-enzyme Q. 

Maybe we need an update?

The cheapest easiest way to TRY to prevent progression of Alzheimers.

 Most people can't afford $7,000 to enter a Dr Dale Bredensen's ReCode program. 

Also the supplements can cost $1300 a year. 

Most people don't want to take so many pills. 

So what does Medicare pay for?

1- Namzaric

2- Invokana for diabetes

3- Ozempic shots for DM and weight loss

4- Metformin for DM

5- Blood pressure pills 

6- Statins, Zetia.

7- Testosterone

8- Citalopram

Ask your Doctor which are good for you. 

In my opinion these are the pills that will prevent you from suddenly falling off the cliff with Alzheimers by a stroke, heart attack.

What supplements are needed?

1- Vitamin D (medicare should pay for lab test) 

Which diet?

Atkins or Low Carb High Fat diet to get into daily Nutritional Ketosis

Exercise

This is a very individualized item.

The elderly need to be careful to avoid injury. 

Walking 20 minutes a day is the easiest path. 

Then if anxious do pacing in the house to get up to 10,000 steps. 

If you can do more with weights, good.  I mayself have cut back on weights due to some joint pain but I try to do curls with light weights.  

Some advise HIIT ( high intensity interval  training).  I think this is fine for a younger group, not practical for eldlerly.  

My HIIT is going up and down the basement stair 10 times a day. 

It's probably the most dangerous thing I do all day.

Staircase disaster link

My Florida neurologist was worried about my falling and told me to walk in the pool 30 minutes three times a week.  I did it once.  After doing ten minutes I later realized I had hurt my right hip which still seems tight at time months later. 

 Have fun and socialize

Develop playlists of favorite music

Check Vitamin levels of B12 and Folate and TSH according to THE END of Alzheimer’s

On p 167 of Dr Dale Bredesen's book The End of Alzheimers he advises having a high level of folate at 10-25.
At this point I don't want to take any more supplements and I believe my level is normal.



Dr Bredesen Advises B12 levels to be 500 to 1500.



I doubt I will take B12 supplements as I eat a high meat diet. I have consistently had normal levels over the years. 




Dr Bredesen advises TSH level on p 168 that TSH should be less than 2.0 
Again my TSH is less than 4.0.   That is in normal range. I discussed this with my endocrinologist. 
I am not going to take thyroid.

Some sane advice on Alzheimers. My review of the article.

My comments in purple

Real Evidence for Steps to Prevent Dementia

Any number of people want to sell you magic steps to prevent dementia.

Lumosity had to pay a two million dollar fine in 2016 because it “preyed on consumer fears about age related cognitive decline.” But that hasn’t stopped the company. It’s just being more careful about falsely promoting its game to prevent dementia.

Nonetheless, consumers are still spending an estimated $1.9 billion on brain training apps. They’re also spending hundreds of millions of dollars on useless brain health supplements.

Hacketts article from Jan. 2016 confirms this event. 

Luminosity brain games don't work link

However, if you really want to take steps to prevent dementia, the evidence is pretty clear. The best thing you can do is take real physical steps. Enjoy some healthy physical activity. Regularly and throughout the day.

Robust Evidence

For a very long-term outcome like dementia, randomized controlled studies are difficult. Nonetheless, the evidence for benefits from physical activity is robust. First of all, observational studies show a clear relationship between physical activity and better cognitive function. In addition, randomized studies show that physical activity helps with cognition for patients with dementia.

Mary Sano, an Alzheimer’s researcher, explained some basic strategies to the New York Times for protecting your brain function:

A lot of this boils down to common sense. Keep physically and socially active, eat sensibly, don’t smoke and don’t drink to excess. Treat your treatable conditions. Protect your head, which means wear seatbelts and helmets and use sturdy ladders. That’s because falls which occur frequently as we get older can be devastating to the brain.

So Don’t Waste Your Money

Brain training games don’t work. Brain supplements are expensive placebos. Staying active, both physically and socially, does work. So just do it.

It amazes me that Prevagen (from Jelly Fish) ads is still flooding the media.

Prevagen loses suit from FTC link

Pill burden for Alzeimers?

Chapter Two

 I take 39 pills a day.

Also a testosterone shot and an ozempic shot once a week.

When I was in my residency I was taught there is a limit how many pills you can take before there is a problem with interaction. 

There was also called 'pill burder' which decreased compliance. 

This is why my YEAR 4 book (now at pulblishers) talks about the need for True Grit and Fortitude with Alzheimers. 

When I did my Infectious disease fellowship with the advent of HIV (AIDS) many of the medicine myths were crushed.

Pneumocystis carinii pneumonia (PCP) is an opportunistic infection that occurs in immunosuppressed populations, primarily patients with advanced human immunodeficiency virus infection.

PCP must be treated with prescription medicine. Without treatment, PCP can cause death. The most common form of treatment is trimethoprim/sulfamethoxazole (TMP/SMX), which is also known as co-trimoxazole and by several different brand names, including Bactrim, Septra, and Cotrim.

We treated this with very long term treatment. 

I also learned we would treat Staph aureus chronic osteomyletis for years with an oral cephalosporin.  

Thus I accepted doubling the number of pills I take under the guidence of a Holistic doctor who was familiar with the Bredesen ReCode treatment for Alzheimers. 

Cheapest way to treat AZ link

Seventeen Morning prescription pills 

Thirteen Post lunch supplements above

Six Bedtime supplements

I enjoy my mornings

 I try to count my blessings after 3 years 8 months since my diagnosis of Alzheimers.

My first year was filled with Anxiety as I had no idea what my prognosis was. 

That is why I title my first year book, I am Waiting for when I forget I have Alzheimers.

I was counseled to just have fun.  

Thus in my second year book, Traveling with Alzheimers.

I continued in my third year book, The Pursuit of Happiness with Alzheimers.

In the third year due to Covid19 we had to cancel 5 cruises.  

Again trying to find a silver lining I concentrated on new courses in approaching my disease:

1- Intermittent fasting

2- Started Dr Dale Bredensen's Recode program at Atma Holistic Clinic

3- I slowly began adding supplements that they advised. I take about 10 new ones. 

4- I am writing my fourth year book now to be titled:

Alzheimers is Inexorable 

True grit and Fortitude Reguired

It requires a great deal of disciple to follow the rigourous routine of diet, exercise and mediciations. 

It is expensive. 

So why do  I continue to do it. 

I clearly feel better. 

Maybe not cogitively  but emotionally.  

My anxiety is much less.  I don't pace as much as I did.

I still have some mounting anxiety as the day progress, worse if  I get into an argument with my wife. 

The most beautiful part is the tranquility of my mornings. 

I try not to schedule any appointments before noon.  

I go to bed around 9 to 10 PM and have rediscovered Bernard Cornwall's historic novels. 

I take melatonin, Mg L-threonate, Ashwagandha and Pregnenolone. 

After about 40 minutes of reading I easily go to sleep.

It is a good deep sleep with many dreams. 

I usually go through a sleep cycle of 75 to 120 minutes before my bladder asks me to take care of it. 

I have no trouble going back to sleep. 

I wake up around 8 to 9 AM but I find I can still sleep another hour or two and I do. 

I take time to get myself out of bed because my body and mind feel excellent. 

Serenity, no pain.  I lay there and enjoy the moment. 

Then I get up and start my routine with joy and anticipation. 

I think Atma's supplements has something to do with it. 

One problem may be that I spend 12 hours in bed?

Can cause saracopenia?

I average more than 8 hours sleep each nigh on my fitbit and apple watch. 

I walk at least 5,000 steps a day.

I am riding my stationary bike 20 minutes a day.

I do curls with weights.

ATMA FEE FOR ONE YEAR $7,000

At the bottom of this blog I go through the drugs Recode advises but I don't take yet. 

Prices of the supplements I take for the 

Bredesen ReCode Protocol.

Total $316

If I buy this every 4 months?

$1264 a year.

ONE

                                    TWO 

                                                                       

DHA important for brain  link                                   

                                   THREE

My folate levels were low?  link

                                     FOUR

ASWAGANDHA LINK

FIVE 

PREGNENOLONE 10 MG LINK

SIX

SEVEN

ALA link

EIGHT

Dr Bredesen said my Vit D was too low link

NINE

TEN

Magnesium  link

ELEVEN

 

ZINC LINK

TWELVE

Turmeric link

THIRTEEN

FLAVINOIDS

FLAVINOIDS LINK

FOURTEEN 

PROBIOTICS THRYVE

PERSONALIZED BIODOME THYRVE LINK

FIFTEEN 

I signed up for Bredensen treatment.

$7,000 fee link

Supplements as per Cornell link

REVIEW OF DR GUPTA'S BOOK LINK

Endura-cin 500 mg (nicotinic acid)

I have taken 1,000 mg of enduracin for decades to lower cholesterol and triglycerides. 

The End of Alzhermers on p 234 advises nicotinamide riboside 100 mg a day.

Reservatrol 100 mg a day

p 234 in The End of Alzheimers

I get my reservatrol from red wine each day.

I am still very skeptical in taking 

GOTU KOLA

BACOPA MONNIERI

Also 

Ubinquinol

PQQ

Lipsomal glutathione 

Acetylcysteine

Cinnamon

Berberine

Huperzine