Archive for June, 2014

There are two types of risk factors that are associated with the development of dementing conditions as we age.  First, there are factors that we cannot control.  The strongest risk factor for becoming demented is not directly controllable, age.  If you live to be in your mid-80s or older, the risk is near 50%.  There are other associated risk factors that are correlated with cognitive decline with aging such as apolipoprotein gene carrier status (Apoe4 has the greatest risk whereas Apoe2 has the least), Mild Cognitive Impairment, cancer (there is an inverse association between cancer and cognitive decline), and sex (women are at greater risk than men). Second, there are also factors over which you have at least some degree of control.  These include history of head injury (hence the desire to wear seatbelts and helmets), blood pressure at midlife […]


The “amyloid hypothesis” of Alzheimer’s disease postulates that Alzheimer’s is caused by the accumulation of a protein named beta-amyloid that produces the “gunky” deposits called plaques in the brain.  Despite the evidence that this is not the root cause (may be an effect of the brain changes in Alzheimer’s rather than a cause), the theory has become scientific orthodoxy, dogma and accepted on faith rather than evidence.  It has dominated research aimed at slowing or reversing Alzheimer’s disease leaving little funding for other approaches.  But there is a kink in the armor.  There is accumulating evidence that treating amyloids is not the solution.  For example, six new drugs that decrease beta-amyloid reached phase II and III clinical trials in 2012.  Three of the studies were discontinued because concerns about safety or lack of efficacy.    Furthermore, we know that the brains […]


Notwithstanding many technological advances, there is still no fool-proof method for diagnosing Alzheimer’s disease, (avoiding the fact that the brain changes occur decades before symptoms).  There is no blood test or imaging technique that is definitive.  Even autopsy diagnosis has its problems.  Diagnosis of Alzheimer’s disease remains a clinical diagnosis based on history, symptoms, patterns, and clinical judgment.  The criteria for a diagnosis of possible Alzheimer’s disease: The afflicted individual must be demented – disabled by the decline. Symptoms appear gradually over months to years There is progressive worsening of cognition The initial and cardinal deficit is short-term memory (i.e., new learning) Less commonly language deficits (e.g., word-finding) appear early There are deficits in other skills such as planning, reasoning, judgment, sequencing The diagnosis of possible Alzheimer’s disease: There is sudden onset of symptoms Progression is not gradual There is […]

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