Smell test - fail

In an earlier post, I wrote about an incident where my husband was clearly not experiencing his sense of smell the way everyone around him was.  I wondered whether the inability to smell was tied to MCI / Alzheimer's.

Well, according to WebMD, studies do not support the idea of a smell test for Alzheimer's.

Resist cognitive decline

While aerobics exercise is good for your heart; resistance training is good for the brain.  Studies have shown resistance training gave participants a 13% greater boost in cognitive abilities. compared to those who did only aerobics. 

For the drunkard and the glutton shall come to poverty: and drowsiness shall clothe a man with rags. ~ Proverbs 23:21

AMYVID Pet Scan locations

Here are the current and planned radiopharmacy locations for AMYVID PET scans as of
June 2012.  Ughh, you'd think they'd offer it in the Washington, D.C. area....but I guess not yet.  Until the scan is covered by Medicare/Medicaid, I suppose there won't be a big push to roll it out...

Oh, and BTW, the Amyvid is $1,600, the PET scan is $5,000 - for a total of $6,600 cost for the test. Yikers!

At last - an Alzheimer's Disease diagnostic scan!

I am ecstatic!   I have been waiting 2 years for the FDA approval of Amyvid – a PET scan tracer that shows AD pathology in the brain.  And it’s finally happened!

FDA Approves Amyvid™ (Florbetapir F 18 Injection) for Use inPatients Being Evaluated for Alzheimer's Disease and Other Causes of CognitiveDecline

Watch video here.

This is such good news for families who are dealing with cognitively impaired loved ones.  Hopefully, very soon, family physicians will be able to send their cognitively impaired patients to get this PET scan.  It will not eliminate the need for the other tests (blood tests, CAT scan, and the dreaded neuropsychological tests), but it will give the answer to the questions that everyone asks after a diagnosis of Mild Cognitive Impairment:  What does this mean?  Does this mean I am going to have Alzheimer’s disease?

The press release states:
Because Amyvid loses over half of its radioactivity every two hours, Amyvid must be distributed directly from a radiopharmacy to the imaging centers where it will be administered within several hours. Beginning in June, a limited number of radiopharmacies will be distributing Amyvid with the goal of making the product available in more areas as soon as possible.

I am going to call Monday to find out where we can get this scan when it becomes available in June.  Then I will talk to the family physician and ask him to order one for Dan.

We’ve been managing well lately – I always said if I could get Dan’s rages under control – I could deal with anything else.  Praise God for answered prayers – his rages are mostly gone!  But there are still two issues that are always hanging over my head:

Should he be driving?  Will he hurt himself or others because I did not force the issue?

Should he be working?  Will others lose their jobs because Dan loses customers – when he should have retired?

This PET scan can answer the overriding question:  Should I even be worrying about these things?

My voice shalt thou hear in the morning, O LORD; in the morning will I direct my prayer unto thee, and will look up. ~ Psalms 5:3

How sweet it is

I am confused. 

I read a recent news release entitled Brain Insulin Resistance Contributes to Cognitive Decline in Alzheimer's Disease which states:
Researchers noted that three insulin-sensitizing medicines are already approved by the FDA for treatment of diabetes. These drugs readily cross the blood-brain barrier and may have therapeutic potential to correct insulin resistance in Alzheimer's disease and MCI. "Clinical trials would need to be conducted to determine the impact the drugs have on Alzheimer's disease and MCI in non-diabetic patients," said Dr. Arnold.

So I Googled “insulin-sensitizing” drugs and came up with:

• pioglitazone (Actos)
• rosiglitazone (Avandia)
• metformin (Fortamet, Glucophage, Glumetza, Riomet)

Further digging showed me that the first 2 of these drugs have already struck out in clinical trials for Alzheimer’s. See here , here , and here.  That leaves metformin, which is in a Phase II trial for Mild Cognitive Impairment (results expected September 2012).  So, why didn't the news release include the bad news about 2 out of the 3 drugs?  It was published by a leading research center.  I think I’ll drop them a line and ask…

I am definitely excited at the possibilities of this line of research – the connection between insulin and Alzheimer’s.  I, and many other caregivers, have noticed a “sugar” aspect to this condition. 

My husband almost never ate sweets.  Just did not do it.  No cakes, no pies, no cookies, and very little candy.  He was always a salt man.  Loved chips – the saltier the better – and would actually sit and eat a tomato or a hardboiled egg with a salt shaker in hand, sprinkling every bite.

Now he eats sweets like crazy!  He will eat HUGE slices of cake.  He eats those golf ball sized lollipops all night every night.  He stops at 7-11 on the way to church and picks up a pack of cookies to eat.  My son and I marvel when my husband often wants to eat again, sometimes just 20 to 30 minutes after a very large meal.

I think my husband’s new dietary habits must have come about for a reason; his brain must be telling him it needs more sugar.

Wouldn’t it be wonderful if an effective treatment were found in an existing drug like Metformin? 

Update:  I contacted one of the researchers and he very kindly replied with a very thorough response.  I believe Dan’s blood sugar was near the top end of normal on his last physical, so I am going to see if I can get him to agree to a fasting blood sugar test. (fingers crossed)

Here is the bulk of Dr. Talbots’ reply for those interested:

Before answering the questions you asked, I should clear up a misconception that is being spread by press releases on our paper and provide some background on diabetes. What we found is that the brain of Alzheimer cases is less responsive to insulin than normal even in cases that have no history of diabetes. This condition called brain insulin resistance may be due to a similar condition that develops outside the brain, where it is called peripheral insulin resistance since it is seen in peripheral tissues like muscle, liver, and fat tissues. Peripheral insulin resistance increases over a number of years before people develop the most common form of diabetes (i.e., type 2 diabetes). The pancreas initially compensates for this by secreting more insulin to overcome resistance of the body's cells to insulin's actions. One of those actions is to trigger cellular uptake of glucose. When peripheral insulin resistance persists and becomes strong, the pancreas is unable to secrete enough insulin to overcome resistance to its actions, and the number of pancreas cells making insulin declines. Under these conditions, elevated blood glucose levels after meals remain high (a state known as hyperglycemia), because glucose is only being taken up slowly by cells of the body.  When a person becomes hyperglycemic due to insulin resistance, a diagnosis of type 2 diabetes is made. When a person becomes hyperglycemic simply due to loss of insulin producing cells of the pancreas, a diagnosis is made of having type 1 diabetes, a condition largely found only in children. In both types of diabetes, patients lose their ability to keep their blood glucose within normal limits.

Since hyperglycemia has many deleterious effects on the body, diabetics need to take care not to eat foods that cause a sudden large increase in blood sugar. Putting someone on a low sugar diet naturally increases an appetite for sugar, but an increase in that appetite when on a normal diet does not indicate that cells of the body are hungry for glucose. From what you mention, I assume your husband is not diabetic. He may, however, have have elevated peripheral insulin resistance, a condition known as prediabetes that increases with age and develops years before blood levels of glucose are high enough for a diagnosis of diabetes. Your husband's responsiveness to insulin in peripheral tissues can be determined from simple blood tests under fasting conditions. Your doctor can arrange those tests if they have not already been run.

If your husband is diabetic or prediabetic judging from blood tests, it is possible that those conditions are accompanied by brain insulin resistance and thus to the symptoms of MCI. Treating those conditions with approved antidiabetic medications could potentially reduce his symptoms. Of the available antidiabetics, I do not recommend rosiglitazone or pioglitazone for various reasons, including safety. Safer and more promising are metformin and especially a class of drugs known as glucagon-like peptide 1 (GLP-1) analogues. Two of the GLP-1 analogues have been approved by the Food and Drug Administration (FDA) as antidiabetics and have shown great promise in the treatment of AD pathology and memory problems in experimental animals. Those GLP-1 analogues are exendin-4 (marketed as Byetta) and liraglutide (marketed as Victoza). These drugs are now in clinical trials for treatment of MCI and AD. One of those trials, one is being run in the U.S. by the National Institute on Aging (NIA), specifically on Byetta.

Don't forget to brush!

My husband was furious with me last week.  While I was leaving the dentist office, I asked the receptionist if she would call my husband and ask him to make an appointment.  I’ve been trying to get my husband to the dentist for years.  I thought that if a nice lady called and urged him to come in, that might help get the ball rolling.  And it did.  But he sure wasn’t happy about it!

Dan:  Why did you tell them to call me?!!!!!! [picture a volcano erupting]

Me:  Because you need to see the dentist.

Dan:  I would never call and make an appointment for you!  What makes you think you can do that?!!!! [now that volcano is spewing molten lava]

Me:  I didn’t call and make an appointment for you.  I just asked them to call and remind you that you needed an appointment.

A few years ago, Dan’s rage would have frightened me to death.  I’m happy (or sad) to report that now I can mostly just ignore it, stay calm myself, and as the old Dragnet officer, Joe Friday said – just stick to the facts. As an aside, Dan’s rages have been more infrequent for the last year or so, and as a matter of fact, he is often very sensitive to his own bad temper, and has even said, “I hate when I act like that.”  I really cannot say where his self awareness has come from; I am just pleased as punch that it arrived.

I am not sorry I pushed the dentist issue.  It turns out that Dan’s gum health is so poor that the dentist could not even clean his teeth.  He was well on his way to gum disease.  He was told to get a water pick and use it for a few weeks and then to return for the cleaning.  He sheepishly admitted to me that when he looked at the dental reminder card that he kept on his desk, the date was 2008.  I guess he, too, is now happy I pushed the issue.  I’m dreading the thought of what the bathroom will look like with a water pick in Dan’s hands, but that will be a small price to pay for his healthy gums J

Simple grooming activities can be difficult for a person with cognitive problems.  Dan’s shaving precision has seriously diminished; he often leaves patches of bristles.  That is a problem I just let slide, as he has not been very receptive to my observations that he missed a few spots.  But one’s oral health can have a big impact on one’s overall health, so that I can’t disregard.

Make a joyful noise unto the LORD, all ye lands.
Serve the LORD with gladness: come before his presence with singing.
Know ye that the LORD he is God: it is he that hath made us, and not we ourselves; we are his people, and the sheep of his pasture.
Enter into his gates with thanksgiving, and into his courts with praise: be thankful unto him, and bless his name.
For the LORD is good; his mercy is everlasting; and his truth endureth to all generations.

~ Psalm 100

A step forward in diagnostics?

I have previously blogged about my frustration with the current diagnostic procedures for MCI / Alzheimer's.

Here is something I wish I’d had available to me before seeing the family physician to discuss Dan’s cognitive problems.  It is an “Alzheimer’s test.”

“The 21-question test distinguishes between normal absent-mindedness and the more sinister memory lapses that may signal the early stages of dementia. The questions are designed to be answered by a spouse or close friend. The Alzheimer’s Questionnaire, which is almost 90 per cent accurate, measures mild cognitive impairment – the slight memory lapses that can be a precursor of the disease.”

I do not know what Dan’s score would have been 2 years ago when our troubles began – today it is 15.

This tool could be very useful to confirm, or relieve, concerns about a spouse.  If it confirms concerns, it could be bought to the doctor’s office to open a dialogue.  I’d like to see it replace that silly Mini-mental test.  Of course the medical community would have to spend decades studying it.  Maybe we could bypass that process, and just start using it ourselves.  Spread the word.

O LORD, thou hast searched me, and known me.

Thou knowest my downsitting and mine uprising, thou understandest my thought afar off.

Thou compassest my path and my lying down, and art acquainted with all my ways.

For there is not a word in my tongue, but, lo, O LORD, thou knowest it altogether.

Thou hast beset me behind and before, and laid thine hand upon me.

Such knowledge is too wonderful for me; it is high, I cannot attain unto it.

Whither shall I go from thy spirit? or whither shall I flee from thy presence?

If I ascend up into heaven, thou art there: if I make my bed in hell, behold, thou art there.

If I take the wings of the morning, and dwell in the uttermost parts of the sea;

Even there shall thy hand lead me, and thy right hand shall hold me.

If I say, Surely the darkness shall cover me; even the night shall be light about me.

Yea, the darkness hideth not from thee; but the night shineth as the day: the darkness and the light are both alike to thee.

For thou hast possessed my reins: thou hast covered me in my mother's womb.

I will praise thee; for I am fearfully and wonderfully made: marvellous are thy works; and that my soul knoweth right well.

~ Psalms 139:1-14