Getting "Worked-up" for Alzheiner's Disease

A few months ago I noticed that my memory wasn't as sharp as it had been and that I had to pull a book off the shelves more frequently to confirm facts that I once could rattle off quicker than a contestant on Jeopardy's Tournament of Champions. Thinking this to be nothing more than an "annoyance of aging," I mentioned it in passing to my neurologist. This apparently set off a warning, because I was soon undergoing a full medical "work-up" because mild memory loss known is to be associated with early Alzheimer's disease (AD, aka "Old Timers' Disease").

The reasoning behind this course of action works out something like this:

I had what is known as a diffuse hypoxic brain injury. This means that the entire brain was affected, to one degree or another, during a period of time in which it was deprived of adequate oxygen. This is different than a traumatic brain injury, where the damage is mechanical (force-related), and more or less restricted one area. The question to be addressed is whether or not those with a hypoxic injury are at a greater risk of AD than the overall population.

As my neurologist explained, "There aren't a whole lot of people that survive an injury as extensive as yours, much less survive intellectually intact; probably like one in ten thousand. Because of that, we're not sure what to expect as far as your future goes, but every little bit of data might go a long way in helping someone else that's in the same situation."

It sounded like a good plan to me, probably because I looked at it from a different perspective: I get to donate my brain to science without having to die (to the chagrin and disappointment of my former spouse).

Now, a medical "work up" for memory loss of any cause includes the following tests / examinations (my results):

Blood work, the usual stuff plus:

Thyroid Panel (normal)

Vitamin B-12 level (normal)

C - reactive protein (elevated, bit not grossly I have heart and peripheral artery diseases, so no big deal)

Neurology-specific examinations:

EEG (diffuse "slowing" consistent with post-hypoxic injury, unchanged from previous exams)

Magnetic Resonance Imaging, aka "MRI Skull and Contents" (obvious scarring and minimal but obvious volume loss, no significant changes from previous exams)

Neuropsychological Testing (trust me, this one deserves an essay of its own. I'll get back to it in another posting)

Many people outside the medical community tend to think of AD as something that "robs you of your 'Golden Years;'" as a disease of aging. This is not necessarily the case. As an example, research has conclusively linked what is known as "repetitive mild closed head trauma" to AD.

Although "Repetitive Closed Head Trauma" is often thought of as being related to the sport of boxing, such that saying "so and so is 'punch-drunk,'" and that there is a known relation to Parkinson's disease, the results of long-term studies demonstrate that AD occurs with greater frequency among former athletes from body-contact sports such as rugby, soccer, and football. Fortunately, the preliminary results of other ongoing studies indicate that a single episode of head trauma (such as a concussion) does not lead to a future increased risk of AD.

It's also been known for years, although not necessarily outside the medical community or the patients' families, that those born with Down syndrome (Trisomy 21) have as much as five times the risk of developing AD as the overall population. Furthermore, those with Down develop AD symptoms at a much earlier age (in their 30s and 40s) that those born without the condition. The reasons for this early occurrence are not well understood although one hypothesis suggests that, since the "extra" genetic material present in those with Down is also known to cause rapid aging (their "body" age is often much higher than the "calendar" age), this may account for the much higher incidence of AD. Other theories hold that the also well-known fact the Down patients frequently have abnormalities of their immune systems and that this could "pre-dispose" to AD. Although not everyone agrees about the cause, everyone agrees that AD appears more frequently in Down.

In my next posting, I'll give you a rundown on what to expect from a "neuropsych" evaluation.

Until then, shalom.