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Sunday, November 25, 2012

Giving Thanks

Tur-Duc-Hen, aka. Turduckhen aka. Yummo!
One down, and three to go. I am not a big fan of the Holiday season. For me the season officially ends on January 17. I can't wait! At least Thanksgiving is over with. OK, maybe it isn't quite that bad, but almost. Too much stress, and not enough money is not a fun time for Lee.

Thanksgiving was really easy this year because I couldn't afford to do anything much, or go anywhere special. My friend and I just had a nice quiet Thanksgiving dinner here at home. Just the 2 of us. My boys couldn't get time away from work, and couldn't have afforded the trip home even if they could. It worked out because I really was not feeling well enough for a lot of company.

I had always wanted to try a Tur-Duc-Hen. Last year, they went on sale right after the Holidays, and I grabbed the last one at my local Krogers. They were regularly about $70, but I managed to get one marked down to $32. At just over 15 pounds, that is about $2 a pound. Not bad for a boneless duck, and a boneless chicken stuffed inside a turkey along with cornbread and rice stuffing. It looked a little odd - kinda short, and flat, but the directions were easy.

It came in a baking bag, so cooking the bird (s!) was simple. The directions called for 3 hours at 400 degrees. That is a little hotter and longer than usual, but there is a lot of meat in there. The bird(s!) were in the oven by noon.

We spent the time waiting watching Christmas movies on the Hallmark channel. Sometimes ya just gotta keep the woman happy. I must have done something right because she made all of the side-dish trimmings to go with the Tur-Duc-Hen. Dinner was had, and it was delicious. Unlike the picture, I cut our bird in half lengthwise first, then sliced one half of it onto a platter. It was the easiest Thanksgiving dinner I can ever remember. We even had home-made pumpkin pie, and the mashed potatoes were the best I have ever tasted.

And "YES!", I would get another Tur-Duc-Hen, but not at full p[rice. That is what the chest-freezer is for in the basement. The only change I might make next time would be to add a little olive oil through the hole I cut in the top of the bag, and maybe a third of a cup of water too.

Of course I had a Tur-Duc-Hen sandwich for lunch again today, and there is a whole half down in the freezer for later. We certainly won't starve this month.

It was easy not to go shopping on Black Friday. No money to spend, so no sale was good enough. It looks like it is going to be a really sparse Christmas again this year. I'll get by. Who knows, I might even enjoy it!

I sure enjoyed watching Ohio State win on Saturday, and right now the Browns are holding their own at the half. I am doing some work outside today between plays. Pool hoses, and pump put away for the winter, fountain emptied, and who knows, I might even get the Guyzeebo taken down. There were flurries yesterday, and it might snow Wednesday, so I guess it is time.

Other than having to remember to take my medications, I really don't think I thought, or cared, about Frontotemporal Degeneration (FTD) all weekend. That is always welcome. I am simply thankful that I am doing as well as I am.

Comments are welcome.

Friday, November 2, 2012

The Mysterious Cataract. Aricept? Namenda?

It has been almost exactly one year since it happened. I don't know why I haven't written about it sooner except maybe that I didn't want to jinx myself, or I might have been waiting to see if it was going to reoccur. What am I talking about? My cataract.
My cataract covered about 30% of the lower center/left of my lens.

Last October I started to have some blurred vision in my left eye. It got suddenly worse over the course of several days until during daylight it looked as if someone had stuck semi-transparent tape on my glasses lens. At night I had a huge ring of star-like lines or rays coming out of any light source such as car headlights. I was pretty much blind in my left eye.

It happened so suddenly that my first thought was that I had a detached retina. I called my Ophthalmologist, and they wanted to see me right away. They thought the same thing because of the severity of the impairment, and the suddenness of the onset.

I had a complete eye exam. My regular ophthalmologist was not available, but there are several at the clinic where I have been going for my regular eye exams ever since being diagnosed with diabetes about 12 years ago. My eyes were dilated until my pupils were the size of dinner plates, and I was given several different tests. The doctor described in detail exactly what he was seeing in my eye as his nurse dutifully took notes.  In one test they shined a light at my eye, and asked me to read a chart. I could not even see the chart! Anyways, it was good news - sorta. I was not going immediately blind from a detached retina. The bad news was that I had a large and very opaque cataract right in the center of the lens of my left eye.

I was told I was a good candidate for surgery, and to make an appointment with my regular doctor for a final exam, and to go over the surgical options to remove my cataract. About 2 weeks later I was examined by my regular ophthalmologist. The exam did not take quite as long, and he spent more time actually looking in my eye, and mapping the large opaque occlusion in the center of the lens of my left eye. He said it was about as bad as any he had seen, and that I was a good candidate for surgery. Since I could not see out of that eye, I elected to get the surgery as soon as possible.

Before I left that appointment, I had a date set for my surgery, and a date set for another appointment several days before my surgery to get some final measurements taken for the implant and stuff. There is a lot of good information on the Internet about cataract surgery, and I think I read it all before making my choices. My surgery was scheduled for the weekend right after Thanksgiving. My appointment for all the pre-surgery measurements and stuff was on the Monday right before Thanksgiving. I was just a little bit nervous about the whole idea, but I had a couple weeks to get used to it. Things were happening really fast, but the fact of the matter was that I could not see out of my left eye.

I had a date on Sunday with a lady I had been seeing for a couple of weeks. We went to a local BBQ place that is kind of a sports bar as well as a family restaurant. As usual the place was very busy. The food was good. We were seated at a table which allowed me to see a TV screen above the end of the bar, even though we were well into the dining room. The big screen was visable right over my date's shoulder.

It was so great when the Browns football game started. I could pretend to be listening, and look right at my date when she was talking, and still watch the game over her shoulder. It worked! I was a total cad, and loving it. She was having a great time telling me all about sewing, sewing machines, and AppleLumpkins, or something like that.  I was having a great time, and it was one of the very, very, very rare occasions when the Browns were winning! WooHoo!

Then I blew it! I said, "Hey! Honey! I can read the score on the TV over there." I was so surprised when I realized it, that I just blurted it out. In my head, and out my mouth. That is bvFTD all over.

Well, after some laughter, and teasing about watching the game over her shoulder, we really examined what I was seeing. The TV screen was not very large, maybe 42 inches, and was an easy 50 feet away. I squinted, and looked through only my left eye, and could still see it just fine. There was no blurry haze from the cataract.

I was a little disconcerted. I had this feeling like it couldn't be real. Cataracts do not go away by themselves. I kept checking it all day, and I could see just fine. That night driving home I checked again with oncoming headlights, and the huge ring of foggy rays that had blinded me at night had almost completely disappeared. That was Sunday night.

Monday morning, the very next day, was my appointment with the ophthalmologist to take measurements for the new lens to replace the one they were going to remove because of the cataract. I was a few minutes early for my appointment.

The nurse looked at me like I was crazy when I told her something had changed, and that if my vision was going to stay the way it was right then I did not need to have surgery. The doctor came in, and after I told him what had happened at the restaurant with the Browns game, he ordered another complete exam.

I could see! There was no sign of the huge cataract that had been blurring the very middle of my lens. They were throwing around words like, "Miracle!", and said cataracts do not just go away on their own. Especially not ones as severe as mine. Remember, 2 different ophthalmologists, and 2 technicians had all seen it, and measured it.

Surgery was canceled, and they said they wanted to see me back again if anything changed. Other than that, my eyes were fine, and I had very minor changes to my glasses prescription. I kinda got the impression that they wanted me out of there because I had caught them making some kind of mistake.

I do not think that was the case at all. The cataract was there, and I definitly could not see, when they first examined me. Then it was gone!

Did you know that Cataracts are listed as a side affect of Aricept? Did you know that Cataracts are listed as a side affect of Namenda?

I take the maximum recommended dosage of BOTH! Duh!

I continued to take both Namenda and Aricept for most of the past  year. There were a few weeks when I was between insurance coverage when I could not afford them, but my Neurologist helped me past the roughest times. I figured the cataract had come, and gone, and the potential benefits of slowing my progression was worth the risk.

Every case of bvFTD is different. Some people have different side affects than others, and each of us have our own unique and distorted ways of dealing with discomfort. I know of many people who try taking these drugs for a while, and then stop taking them because they just got tired of the side effects, and they "...really didn't see any difference."

"They didn't really see any difference."


If you have bvFTD, and you are taking Namenda and Aricept for a year or more, and you, "REALLY DON"T SEE ANY DIFFERENCE!!!!"  DUH! Something is working, and you can bet it isn't your inherent good looks! Maybe it's the drugs, maybe not. Right now nobody knows for sure. The research goes both ways. That seems to say that they work for some, or under some conditions, but not for others. That is a big part of the reason I decided not to give up on my drug regimen. I still have side affects. Sometimes they can be debilitating, but they go away. They are the worst when I make any change in dosage, brand, or if I forget to take something. (Withdrawal? Oh! Yes!)

Something seems to be working, and other than some POM Juice every other week or so I can't afford to do much else. As long as I don't develop another cataract, I am continuing with both the Aricept and Namenda as long as my insurance will allow.

(Just as a side note, that same lady and I are still dating. That lady must have the patience of a Saint, but then I haven't tried to watch TV over her shoulder ever again either. I figure I was plenty lucky the last time.)

Some days are better than others, but at least I can see today ...when my vision is not too blurry from the Aricept. (Sigh!).

Monday, October 15, 2012

The Meaning Of "Totally Disabled" By bvFTD Hits Home

Slammed by bvFTD, The Meaning Of "Totally Disabled" Hits Home

This past weekend was a minor disaster. I always say, "Some days are better than others!", and this weekend really brought the truth of those words home to me.

This weekend  was smaller with just the white canopy.
I had been doing very well for quite a while, and had assisted my friend with a couple of craft shows. I helped her to set up her vendor booth, and even helped out as a salesperson during the craft shows. Though it was very tiring, and required a few days afterwards to recuperate, I did very well by all accounts. I was feeling pretty confident about things, so I committed to assist with her last outdoor show last weekend. I had also said I would repair a leaky toilet, and replace an outdoor light fixture. I know now that this was a mistake. What was I thinking?

The week leading up to the show was a rough one. I forgot to take my medications a couple of times, and the nerve ganglia on the bottom of my left foot became inflamed. These things may be related, but I am not sure yet. In any case, the whole week was one miserable thing after another. I just stayed home, and avoided people as much as I could. That was pretty easy because I was really broke, and couldn't afford to go anywhere, or do anything anyway. I got through it, and by Friday was feeling better. I packed up for the weekend, made sure Kroozer had plenty of food and water for a couple days by himself, and headed North for the Craft Show.

Set up for the Show was Friday night, and the craft show itself was all day Saturday and Sunday. Friday went well, and the 10 X 10 foot booth was all set up under the canopy well before it was dark. Having attended many trade shows, and organized a few very large ones when I was President of Stellar Games, Inc., I had a lot of experience setting up a booth. My experience told me that the booth looked great, the products were great, but that the location was terrible, and sales would suffer.

A few hours later on Friday night my allergies attacked in force. I was sitting on the couch, and all of a sudden my nose started running, my eyes started itching, my throat started itching, and I sneezed a few times. Within minutes I was all stuffed up, and miserable. I had already been taking antihistamines that day, and took another right away. It did not help at all, and I was unable to sleep Friday night. I spend most of it sitting up on the couch just trying to breathe.

Saturday morning came early. I maybe got 2 hours of sleep Friday night. Got to the craft show, and opened everything up. It only took about an hour to get all of the merchandise out on the racks and tables. Everything looked great when the show opened. Of course because of the lousy location way down at the end of the street blocked by a huge food truck there were very few customers. The fact that it was freezing in the morning, and then cloudy, cold, and rainy all day did nothing to improve matters. Due to the location sales were a little more than 10% of what I would have predicted. After 10 hours out in the freezing cold I was exhausted, and in quite a bit of pain from my foot which wasn't doing well standing on concrete for so long.

At the end of the day my friend went to talk to the show management about a refund of some sort because of the lousy location they had forced on her. She returned with their best offer. No refund, but we could move the booth to a better location, and have 2 spaces because somebody didn't show up. I gotta tell ya that this is a crap offer, but does show that they knew they had really messed up sticking us way out in no-man's land. It would have taken us between 3 and 4 hours to take everything down, pack it up, and then set it all up again in another location. We would have been working well after dark. We really couldn't use the extra booth space because we did not have an extra canopy, and rain was predicted for Sunday.

I left the decision up to my friend as it is her business. I was tired, but figured if she wanted to move I could tough it out for another few hours of labor. She decided it was not worth moving for just the last day of the show. We left.

I got home, and went right to sleep on the couch. My friend woke me up to feed me some dinner, and I went back to sleep again right after I ate. I slept for 10 hours straight. I was exhausted.

Sunday morning, after a comatose night's sleep, I felt better. I had taken some ibuprofen, and antihistamines, and was feeling pretty good. It was much warmer, but windy. It was so windy that when we got to the show the canopy was blowing around, and it looked to me like one of the corner poles was bent a little. Within a few minutes the wind blew all of the clothes racks over for the second time, and tipped over a table. It was nearly noon, and the street was nearly empty of potential customers. My friend decided we should just pack everything up, and leave before the wind did any serious damage to the canopy. I think this was a good decision because the wind and weather got worse throughout the day, and the location also got worse because several of the booths near us had already packed up and left. There was now about 150 feet of empty street between our booth, and the next one towards the main shopping area, and it was still blocked by a huge food truck so nobody could even see we were there. We left, and good riddance!

We spent the rest of Sunday recovering, at least I did. My friend was fine. I was not feeling fine at all. I am spending Monday lazing around the house watching some TV and resting. I need it. I just cannot do this kind of thing any more. I thought I could, but I cannot perform at a normal level of competency consistently. A day here and there I can do just fine, but then I just collapse in a heap afterwards. Problem is that I cannot tell exactly which days will be the good ones, and which will not.

Too many people. Too much responsibility. Too much commitment. It was all just too much for me to handle, and I really didn't have to do anything, or handle anything at all. My friend did all the hard work, and made all the decisions. I was just sorta there taking up space. On a good day I could manage it, but not on one of my not-so-good days. This weekend at the craft show was a cold and damp reminder of just how much bvFTD has affected my abilities. I guess I really am "Totally Disabled" in that I can no longer be consistently competent to work even at a very undemanding task like helping a friend at a craft show. I will say that it is a hard pill to swallow, but I am finally starting to be forced to kinda admit it just a little that I can sometimes no longer do quite everything I used to be able to do as easily as I used to be able to do it ...maybe!

On a side note: I did force myself to fix the toilet, and replace the outside light. The two things together only took a few minutes. That was the easy part. I told my friend that I would not be available to assist with any more outdoor craft shows. I haven't totally made up my mind about the little indoor ones. They have their benefits in getting me out of the house, and talking to people, but they still wipe me out both physically and mentally. We shall see.

Comments are welcome.

Tuesday, October 9, 2012

bvFTD Symptom: Half-Track Mind

I would  like to address a symptom of bvFTD that is mentioned often (at least anecdotally), but rarely explained in terms that relate to a real life situation. Actually, I see it mentioned in personal accounts of people who have been diagnosed with bvFTD, but I really do not see it mentioned or explained in the medical literature. I am talking about my inability to multi-task with bvFTD. I must now take a very single-minded, one-track approach to life. Actually more like a half-track approach. This is life with bvFTD for me.

I used to be able to do seventy'leven things at once, and do them all very well. At least I thought I could, and it seemed to be the case. Now I can only do one thing at a time fairly well sometimes on a good day.

The reason I am addressing this is because it was brought to my attention last evening while watching television, and I want to document the severity of it right now though I really can't see how it could get any worse. Wait! Forget I said that! It can always be worse. It could be raining...

The premier of the TV program "Last Resort" was on, and I was watching it with a friend (who fell asleep on my couch halfway through it!). Near the very end, the lead character, the Captain of the sub whatever his name is, gives a lengthy monologue taped speech broadcast to the world. As he is talking for several minutes while the background images are telling a different story. The images shown while he is talking catch the viewer up on what has happened, and tie up some loose ends. Well, this may be a great creative way to tell a story, but it does not work for me with bvFTD! I really didn't even know about it until I watched it again. One of the advantages of being able to pause and replay live TV.

I watched the whole speech, and listened intently. After all it was his important speech to the world. I thought, subjectively, that I had a full comprehension of what had gone on, and was not aware of how I could possibly have missed anything. That was until my friend woke up and asked, "Why was his wife in a room being shown pictures?"

I said, "What?" I kinda thought she had been dreaming, or was thinking of something she had seen earlier in the show before she fell asleep. She was insistent about what she had seen, and I had no idea what she was talking about. It was like we were watching 2 different shows.

To figure out what was going on, I used the DVR to re-watch the Captain's speech to see what she was talking about. I realized that not a single one of the images had registered the first time I watched it when I was listening to the words of his speech. When I watched the images, I didn't hear the speech! Wow! My mind is really incapable of doing 2 things at once even when I am aware of it, and trying to concentrate on both.

I usually do not notice this symptom in my day-to-day activities. Occasionally a friend will notice that I need to be guided back on-track if I am in the middle of doing something, and get interrupted or distracted. Because of my inability to multi-task I just switch tasks, and continue down a different track until I am reminded of what I was originally doing. I think the reason I don't notice is because I have adapted to it. I structure my time so that I can work on one thing at a time as much as possible, and avoid interruptions.

I also have ADHD-like symptoms, so I now have an unnatural tendency to skip around from one thing and thought to another, but still only one thing at a time. These 2 symptoms together make both of them worse because when I switch tasks or thoughts I tend to stay switched, and not return to what I was doing or thinking for a long time if ever.

I just thought this would be a good time to document this symptom since I noticed such a good example of how it works.

Comments are welcome.

Friday, September 21, 2012

The Hard Facts About bvFTD Nobody Wants To Tell You. Mortality And Progression.

The first question I had when I was diagnosed with bvFTD, (Well, right after, "What the Hell is that?"), was probably something like, "Well, Doc., how long do I have to live?" And then the doctor usually side-steps the question. They gave me some vague guesses, but really didn't answer the way I wanted. After all, plans need to be made!

Following are a couple studies that shed some light on the survival probabilities, or lack thereof. Remember that every case of bvFTD is different, and statistics do not predict individual outcomes. As a case in point, I was diagnosed a little over 2 and a half years ago, so I should be just about dead. Well, I am frakkin-well not dead yet, and not even considering it as an option! Screw'em!

It is interesting that there were 24 out of 91 phenocopy cases in the first study. This seems like a really high percentage to me. Not much is said about the criteria for diagnosis, or inclusion. The numbers are still dismal. The second study seems to do a slightly better job of addressing the non-progressive phenocopy cases of bvFTD, but the numbers are still dismal.
Title: Determinants of Survival in Behavioural Variant Frontotemporal Dementia.

Authors: Beatrice Garcin, Patricia Lillo, Michael Hornberger, Olivier Piguet, Kate Dawson, Peter Nestor, John Hodges

Journal: Neurology


Background: Behavior variant FTD (bvFTD) is a common cause of non-Alzheimer dementia. Little is known about its rate of progression but a recently identified subgroup seems to have an excellent prognosis (phenocopy cases) whereas the pathological cases decline rapidly. Data about natural history are needed to provide the best information to the patients and their families.

Methods: We estimated survival in a large group of bvFTD patients (n=91) and reviewed their demographic and clinical features to determine how they affect prognosis.

Results: Median survival in the whole group of 91 patients was 10.6 years from symptom onset, and 7.3 years from diagnosis. Log rank tests showed that being a female, having a positive family history, language impairment and motor symptoms at first assessment were associated with a significant shorter survival. The estimated hazard ratio indicated that younger age at onset, a higher score on MMSE and ACE were associated with longer survival. After the exclusion of 24 “phenocopy” cases, the analysis was repeated in a subgroup of 67 patients. In this latter group, median survival was 7.9 years from symptom onset and 4.0 years from diagnosis. The only factor associated with shorter survival was the presence of language impairment.

Conclusions: The prognosis of bvFTD is poorer when there are language features at presentation. This study also provides evidence for the existence of a benign subgroup of patients with clinical features of bvFTD.

...and an excerp from another study, this one targeted at Phenocopy bvFTD, which shows little or no progression:

Nonprogressive behavioural frontotemporal dementia: recent
developments and clinical implications of the ‘bvFTD phenocopy
Christopher M. Kippsa,b, John R. Hodgesc,d and Michael Hornbergerc,d
Wessex Neurological Centre, Southampton University
NHS Trust, bDepartment of Clinical Neurosciences,
University of Southampton, Southampton, UK,
Neuroscience Research Australia and dSchool of
Medicine, University of New South Wales, Sydney,
Correspondence to Dr Christopher Kipps, Consultant
Neurologist and Honorary Senior Clinical Lecturer,
Wessex Neurological Centre, Southampton University
NHS Trust, Southampton SO16 6YD, UK
E-mail: christopher.kipps@soton.ac.uk
Current Opinion in Neurology 2010, 23:628–632
Purpose of review
The clinical features of behavioural variant frontotemporal dementia (bvFTD) are well
established; however, recent work has identified patients fulfilling diagnostic criteria for
the disease who do not appear to progress clinically. This review describes means of
distinguishing this group at an early stage from patients who are likely to deteriorate.
Recent findings
Despite indistinguishable clinical profiles, studies in a cohort of bvFTD patients showed
a particularly good prognosis in a subgroup of predominantly male patients in whom
initial structural imaging was normal. This could not be explained by differences in
disease duration, and was confirmed by subsequent PET studies. Retrospective review
of clinical data in these groups verified that the current clinical diagnostic criteria are
both insensitive to true progressive bvFTD, particularly in the early stages, and also
poorly specific. In contrast, measures of activity of daily living performance, executive
function and tests of social cognition appear to have better discriminatory value for
patients who show clear clinical progression, with many individual diagnoses verified by
post mortem examination in this group.
It remains doubtful that the nonprogressive group have a neurodegenerative disease.
The implication for the current clinical diagnostic criteria and their proposed revision is

Moreover, a retrospective survival analysis of a bvFTD
cohort [5] showed that those patients with abnormal scans
were largely dead or institutionalized within 3 years, in
line with median survival time in pathologically proven
cases of bvFTD [7 ]. However, patients with scan ratings
in the control range had a significantly better disease
prognosis, with some patients surviving for 10 years or

So, the other question I had right away was something like, "How fast will this disease progress?" Once again the answer was unconvincing. They said that since my onset seemed to be rather slow, the progression should also be slow, so that maybe I had 10-12 years.

But how do you know if you have bvFTD if you are a fast or a slow progresser, or a phenotype case who may not even progress at all? That book I talked about, What If It's Not Alzheimer's?, gives some general guidelines that may be useful. I still highly recommend this book as I use it as a reference, and will repost the post about it if I can figure out how. It should also be available through a link on the sidebar of this blog somewhere - maybe lower left. It is worth the modest price.

According to the book,  losing 2 points per year, as in a declining test score on the MMSE (mini–mental state examination (MMSE) or Folstein test) is about average progression. Four points a year or more would indicate a rapid progression. If you lose 1 or no points you are a slow progresser, or even a phenocopy case. It may take several years to get a good idea of progression, and again: every case of bvFTD is different.

Comments are welcome.

Friday, September 14, 2012

TauRx Therapeutics LMTX® Phase 3 Clinical Trial Begins

..Ummm ...I think these are actually spleen cells, but they look like Pick's Bodies.
A special thanks to "Cherry Blossoms", a reader of this blog who recently posted a comment about this promising new drug and study.

The following is the  TauRx press release in its entirety.

Phase 3 Clinical Trial Begins in Early Form of Dementia

MANCHESTER, England, September 10, 2012 /PRNewswire/ --
Investigational drug study follows earlier study with promising results in mild to moderate Alzheimer's patients
TauRx Therapeutics today announced the initiation of a global Phase 3 clinical trial in a type of Frontotemporal Dementia (FTD) also known as Pick's Disease. The announcement, which immediately follows The 8th International Conference on Frontotemporal Dementias, held 5-7 September in Manchester, England, underscores the need for new treatments for this form of dementia that is similar to Alzheimer's Disease, except that it tends to damage different areas of the brain and affects people as early as 40 years old.
The study focuses on a type of FTD known as behavioural-variant, or bvFTD, which can cause early changes in personality and loss of empathy. A large percentage of these patients have a specific pathology that involves abnormal collections of tau protein in the brain.
The study drug, LMTX®, targets a process in the brain whereby a normal form of tau protein begins to self-aggregate due to binding neuronal waste-products. Once the process has started, the aggregates are able to propagate themselves indefinitely, using up normal tau protein and converting it into the toxic aggregates. After destroying the nerve cells where they are initially formed, the aggregates go on to infect nearby healthy neurons, progressively spreading and accelerating the destruction throughout the brain. LMTX® stops this aggregation process in its tracks and releases the trapped tau protein in a form which can be easily cleared by nerve cells.
In a pilot series of cases, LMTX® was found to arrest the progression of the disease. LMTX® has been found to act in a similar way on the aggregation of TDP-43 protein. Tau or TDP-43 aggregates each account for about 50% of patients with this early form of dementia.
Speaking to patients and caregivers at the FTD conference in Manchester, Professor Bradley Boeve of the Mayo Clinic in the U.S., one of the investigators of the study, said: "Clinicians devoted to FTD clinical trial development have been refining the measures to use in an experimental trial in FTD spectrum disorders for years, and frankly have been waiting for a promising agent. The basic science data for this agent, particularly in the tauopathies, looks sound and the excitement among investigators and among families is high."
The Phase 3 double-blind placebo-controlled study is designed to evaluate the safety and efficacy of LMTX®, the second-generation Tau Aggregation Inhibitor (TAI) developed by TauRx. The study aims to confirm the results first seen in the pilot cases in a larger controlled clinical trial in bvFTD patients over a 52-week timeframe. Participating study sites are located in Canada, U.S., U.K., Germany, The Netherlands, Australia and Singapore. Because the condition is relatively rare, TauRx was granted Orphan Designation for LMTX® in 2010, which provides a basis for more rapid approval for marketing if the trial is successful.
"This is an important step forward in our quest to find an effective treatment, with a goal to actually arrest the progression of the disease," said Professor Claude Wischik, founder and CEO of TauRx Therapeutics and Professor of Old Age Psychiatry at the University of Aberdeen. "We are building on over thirty years of research, and the encouraging results from our previous Phase 2 clinical trial in Alzheimer's Disease, which is also correlated with abnormal tau aggregates in the brain."
TauRx previously tested rember©, the first-generation TAI on which LMTX® is based, in a Phase 2 clinical trial involving 321 patients with mild and moderate Alzheimer's Disease in the UK and Singapore. This study found a 90% reduction in the rate of disease progression over two years in Alzheimer's Disease. Professor Wischik and his team have spent nearly 24 years investigating the structure and role of Tau tangles in the development of Alzheimer's disease, FTD and other neurodegenerative diseases. They were the original discoverers of the Tau protein pathology of Alzheimer's.
"It's very exciting news that a treatment is being tested for FTD in a clinical trial," said Penelope Roques of the Frontotemporal Dementia Support Group in the UK. "This is encouraging progress in a disease where there is currently no treatment available." The group has about 1,000 members across the UK, ranging from FTD patients, caregivers and family members.
If successful, this will be the first investigational drug that is able to arrest the progression of this disease. TauRx Therapeutics, a Singapore-based company spun out of the University of Aberdeen, developed the novel treatment based on an entirely new approach which targets aggregates of abnormal fibres of tau protein that form inside nerve cells in the brain. The TauRx team have since discovered that LMTX® could also have beneficial effects on other proteins which aggregate abnormally, including TDP-43 in FTD and synuclein in Parkinson's disease. In FTD, the frontal and temporal lobes are affected first, which impacts behaviour and emotion. As the disease progresses, other parts of the brain are affected, eventually producing a global dementia.
Patients and caregivers are invited to sign up for future updates as more news is available at http://www.PicksDementiaStudy.info.
About Pick's Disease:
According to the Association for Frontotemporal Degeneration (AFTD), bvFTD - or Pick's disease as it was originally known - can cause early and progressive changes in personality, emotional 'blunting' and loss of empathy. A person with the disorder may have difficulty controlling their behaviour, which can result in socially inappropriate responses or actions. Language may also be impaired after behavioural changes take place, as well as neurological symptoms such as movement and coordination difficulties. Over time, these symptoms worsen. The bvFTD form of the disease is particularly aggressive and progresses faster than Alzheimer's disease.
About TauRx:
TauRx Therapeutics was established in Singapore in 2002 with the aim of developing new treatments and diagnostics for a range of neurodegenerative diseases based on its technology platform. The TauRx team includes highly skilled and internationally recognised pharmaceutical experts in drug discovery and development. The company's Tau Aggregation Inhibitors (TAIs) include rember® and LMTX®, the second-generation drug that is being studied in Phase 3 clinical trials in Alzheimer's and FTD. TauRx is headquartered in Singapore with primary research facilities in Aberdeen, Scotland.
SOURCE TauRx Therapeutics

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The effect of curcumin (turmeric) on Alzheimer's disease: An overview

This is the first a few research articles I found while following up on a comment left by a reader of this blog. It is not the most exciting reading, but it appears to very important information. Here it is without any editing.

The effect of curcumin (turmeric) on Alzheimer's disease: An overview

Ann Indian Acad Neurol. 2008 Jan-Mar; 11(1): 13–19.
doi:  10.4103/0972-2327.40220
PMCID: PMC2781139
The effect of curcumin (turmeric) on Alzheimer's disease: An overview
Shrikant Mishra and Kalpana Palanivelu
Author information ► Article notes ► Copyright and License information ►
This article has been cited by other articles in PMC.
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This paper discusses the effects of curcumin on patients with Alzheimer's disease (AD). Curcumin (Turmeric), an ancient Indian herb used in curry powder, has been extensively studied in modern medicine and Indian systems of medicine for the treatment of various medical conditions, including cystic fibrosis, haemorrhoids, gastric ulcer, colon cancer, breast cancer, atherosclerosis, liver diseases and arthritis. It has been used in various types of treatments for dementia and traumatic brain injury. Curcumin also has a potential role in the prevention and treatment of AD. Curcumin as an antioxidant, anti-inflammatory and lipophilic action improves the cognitive functions in patients with AD. A growing body of evidence indicates that oxidative stress, free radicals, beta amyloid, cerebral deregulation caused by bio-metal toxicity and abnormal inflammatory reactions contribute to the key event in Alzheimer's disease pathology. Due to various effects of curcumin, such as decreased Beta-amyloid plaques, delayed degradation of neurons, metal-chelation, anti-inflammatory, antioxidant and decreased microglia formation, the overall memory in patients with AD has improved. This paper reviews the various mechanisms of actions of curcumin in AD and pathology.
Keywords: Alternative approach to Alzheimer's, beta amyloid plaques, curcumin, curcumin and dementia, epidemiology, turmeric
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Alzheimer's disease

Alzheimer's disease (AD) is a progressive neurodegenerative disease. It is characterized by progressive cognitive deterioration together with declining activities of daily living and behavioral changes. It is the most common type of pre-senile and senile dementia. According to the World Health Organization (WHO), 5% of men and 6% of woman of above the age of 60 years are affected with Alzheimer's type dementia worldwide.[1] In India, the total prevalence of dementia per 1000 people is 33.6%, of which AD constitutes approximately 54% and vascular dementia constitutes approximately 39%. AD affects approximately 4.5 million people in the United States or approximately 10% of the population over the age of 65, and this number is projected to reach four times by 2050. The frequency increases to 50% by the age of 80 years. Every year more than $100 billion is spent for health care in the U.S. to treat AD in primary care settings alone.
Neuropathology of AD:

The neuropathological process consists of neuronal loss and atrophy, principally in the temporoparietal and frontal cortex, with an inflammatory response to the deposition of amyloid plaques and an abnormal cluster of protein fragments and tangled bundles of fibres (neurofibillary tangles). Neurotic plaques are relatively insoluble dense cores of 5-10 nm thick amyloid fibrils with a pallor staining “halo” surrounded by dystrophic neuritis, reactive astrocytes and activated microglia. There is an increased presence of monocytes/macrophages in the cerebral vessel wall and reactive or activated microglial cells in the adjacent parenchyma.[2,3] The main protein component of amyloid in AD is the 39-42 amino acid (beta) amyloid peptide (A-beta) [Figure 1].
Figure 1
Figure 1
Neuritic plaques are one of the characteristic structural abnormalities found in the brains of Alzheimer patients

Curcumin (Curcuma longa - Haldi) is the source of the spice Turmeric [Figure 2] and is used in curries and other spicy dishes from India, Asia and the Middle East. Similar to many other herbal remedies, people first used curcumin as a food and later discovered that it also had impressive medicinal qualities. It has been used extensively in Ayurveda (Indian system of Medicine) for centuries as a pain relieving, anti-inflammatory agent to relieve pain and inflammation in the skin and muscles. It has also proven to have anti-cancer properties.[4,5] Curcumin holds a high place in Ayurvedic medicine as a “cleanser of the body,” and today, science is finding a growing list of diseased conditions that can be healed by the active ingredients of turmeric.[6]
Figure 2
Figure 2
(2a) Turmeric, (2b) Turmeric plant, (2c) Keto and enol form of curcumin
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The Plant

Botanical name: Curcuma longa; Family: Zingiberaceae, the ginger family. Turmeric is a sterile plant and does not produce any seeds [Figure 2]. The plant grows up to 3-5 ft tall and has dull yellow flowers. The underground rhizomes or roots of the plant are used for medicinal and food preparation. The rhizome is an underground stem that is thick and fleshy ringed with the bases of old leaves. Rhizomes are boiled and then dried and ground to make the distinctive bright yellow spice, turmeric.
Turmeric History:

Probably originating from India, turmeric has been used in India for at least 2500 years. It is most common in southern Asia and particularly in India. Turmeric was probably cultivated at first as a dye and later on it was used as cosmetic and as an auspicious and aromatic food substance. It possesses antiseptic, anti-inflammatory detoxifying properties as well as carminative properties. Turmeric has a long history of medicinal use in South Asia and was widely used in Ayurvedic, Siddha and Unani systems. It is thought to be a hybrid selection and vegetative propagation of wild turmeric (Curcuma aromatica), which is native to India, Sri Lanka and the eastern Himalayas and some other closely related species.
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Curcumin and Alzheimer's Disease

Worldwide, there are over 1000 published animal and human studies, both in vivo and in vitro in which the effects of curcumin on various diseases have been examined. Studies include epidemiological, basic and clinical research on AD.
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Bio Chemical properties
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Epidemiological Studies

Various studies and research[9,10] results indicate a lower incidence and prevalence of AD in India. The prevalence of AD among adults aged 70-79 years in India is 4.4 times less than that of adults aged 70-79 years in the United States.[9] Researchers investigated the association between the curry consumption and cognitive level in 1010 Asians between 60 and 93 years of age. The study found that those who occasionally ate curry (less than once a month) and often (more than once a month) performed better on a standard test (MMSE) of cognitive function than those who ate curry never or rarely.[10]
Mechanism of action of curcumin on Alzheimer's disease:

The process through which AD degrades the nerve cells is believed to involve certain properties: inflammation, oxidative damage and most notably, the formation of beta-amyloid plaques, metal toxicity [Figure 3]. There have been several studies on effects of curcumin on AD. Outlined below are some of the studies and their conclusions.
Figure 3
Figure 3
Different mechanisms of action of curcumin in AD
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Effects of Curcumin on Macrophages

A study conducted at UCLA found that curcumin may help the macrophages to clear the amyloid plaques found in Alzheimer's disease. Macrophages play an important role in the immune system. They help the body to fight against foreign proteins and then effectively clear them. Curcumin was treated with macrophages in blood taken from nine volunteers: six AD patients and three healthy controls. Beta amyloid was then introduced. The AD patients, whose macrophages were treated with curcumin, when compared with patients whose macrophages were not treated with curcumin, showed an improved uptake and ingestion of the plaques. Thus, curcumin may support the immune system to clear the amyloid protein.[11]
Curcumin on glial cells:

Recent histological studies reveal the presence of activated microglia and reactive astrocytes around A-beta plaques in brains from patients with AD. The chronic activation of microglia secretes cytokines and some reactive substances that exacerbate A-beta pathology. So neuroglia is an important part in the pathogenesis of AD. Curcumin has a lipophilic property and can pass through all cell membranes and thus exerts its intracellular effects. Curcumin has anti-proliferative actions on microglia. A minimal dose of curcumin affects neuroglial proliferation and differentiation. Its inhibition of microglial proliferation and differentiation were studied and researched by the University of Southern California Los Angeles (UCLA). Researchers[12] using doses of 4, 5, 10, 15, 20 microM concentration of curcumin in C-6 rat glioma 2B-clone cells, a mixed colony of both neuroglial cells in a six- day trial, showed that curcumin dose dependently stops the proliferation of neuroglial cells, by differentiate into a mature cell or undergo apoptosis. It inhibits neuroglial cells proliferation dose dependently (i.e.) higher the concentration, the greater the inhibition. It has shown to decrease the glutamine synthetase (GS) assay, a marker enzyme for astrocytes. In the same study, curcumin was shown to increase CNP (2′3′- cyclic Nucleotide 3′-phosphohydrolase), a marker enzyme for oligodendrocytes. The overall effect of curcumin on neuroglial cells involves decreased astrocytes proliferation, improved myelogenesis and increased activity and differentiation of oligodendrocytes.
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Curcumin as an Anti Inflammatory in Alzheimer's

One of the important pathogenesis in Alzheimer's disease is the chronic inflammation of nerve cells. Several studies have demonstrated the associated inflammatory changes such as microgliosis, astrocytosis and the presence of pro-inflammatory substances that accompany the deposition of amyloid-β (Aβ) peptide. Patients with the prolonged use of certain nonsteroidal anti-inflammatory (NSAID) drugs such as ibuprofen have been shown to have a reduced risk of developing the symptoms of AD; however, the chronic use of NSAID can cause a toxic effect on the kidneys, liver and GI track. Curcumin has a potent anti-inflammatory effect. Through its various anti-inflammatory effects, it may have a role in the cure of AD. Curcumin inhibits Aβ-induced expression of Egr-1 protein and Egr-1 DNA-binding activity in THP-1 monocytic cells. Studies have shown the role of Egr-1 in amyloid peptide-induced cytochemokine gene expression in monocytes. By inhibition of Egr-1 DNA-binding activity by curcumin, it reduces the inflammation. The chemotaxis of monocytes, which can occur in response to chemokines from activated microglia and astrocytes in the brain, can be decreased by curcumin.[13,14]

Curcumin is found to inhibit cyclooxygenase (COX-2), phospholipases, transcription factor and enzymes involved in metabolizing the membrane phospholipids into prostaglandins. The reduction of the release of ROS by stimulated neutrophils, inhibition of AP-1 and NF-Kappa B inhibit the activation of the pro-inflammatory cytokines TNF (tumor necrosis factor)-alpha and IL (interleukin)-1 beta.[15,16] Overall, curcumin decreases the main chemical for inflammation and the transcription of inflammatory cytokines. Curcumin inhibits intracellular IL-12 p40/p70 and IL-12 p70 expression. The exposure to curcumin also impaired the production of pro-inflammatory cytokines (IL-1, IL-6 and TNF-). These studies indicate a potent inhibitor of pro-inflammatory cytokine production by curcumin and it may differ according to the nature of the target cells.
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Curcumin as an Anti-oxidant

Curcumin inhibits the activity of AP-1, a transcription factor involved in expression of amyloid, which is linked to AD. Curcuminoids are proven to have strong antioxidant action demonstrated by the inhibition of the formation and propagation of free radicals. It decreases the low-density lipoprotein oxidation and the free radicals that cause the deterioration of neurons, not only in AD but also in other neuron degenerative disorders such as Huntington's and Parkinson's disease.[16] In one study, curcuma oil (500 mg Kg(-1) i.p.) was given 15 min before 2 h middle cerebral artery occlusion, followed by 24 h reflow in rats. This significantly diminished the infarct volume, improved neurological deficit and counteracted oxidative stress.[17]

A study conducted at Nanjing Medical University (China) showed that a single injection of curcumin (1 and 2 mg/kg, i.v.) after focal cerebral ischemia/reperfusion in rats significantly diminished the infarct volume, improved neurological deficit, decreased mortality and reduced the water content in the brain.[18]

Curcumin has powerful antioxidant and anti-inflammatory properties; according to the scientists, these properties believe help ease Alzheimer's symptoms caused by oxidation and inflammation.[19] A study conducted at Jawaharlal Nehru University (India) demonstrated that the administration of curcumin significantly reduced lipid peroxidation and lipofuscin accumulation that is normally increased with aging.[20] It also increased the activity of superoxide dismutase, sodium-potassium ATPase that normally decreased with aging. In another study, curcumin has been shown to protect the cells from betaA (1-42) insult through antioxidant pathway.[21] Curcumin protects brain mitochondria against various oxidative stress. Pre-treatment with curcumin protects brain mitochondria against peroxynitrite (a product of the reaction of nitric oxide with superoxide) a potent and versatile oxidant that can attack a wide range of cells in vitro by direct detoxification and in vivo by the elevation of total cellular glutathione levels.[22]
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Curcumin on Haemoxygenase Pathway

Natural antioxidant curcumin has been identified as a potent inducer of hemoxygenase, a protein that provides efficient cytoprotection against various forms of oxidative stress. By promoting the inactivation of Nrf2-keap1 complex and increased binding to no-1ARE, curcumin induces hemoxygenase activity. The incubation of astrocytes with curcumin at a concentration that promoted hemoxygenase activity resulted in an early increase in reduced glutathione, followed by a significant elevation in oxidized glutathione content.[23–25] Glutathione is an important water-phase antioxidant and essential cofactor for antioxidant enzymes protecting the mitochondria against endogenous oxygen radicals. Its level reflects the free radical scavenging capacity of the body. GSH depletion leads to tissue damage due to lipid peroxidation and oxidative damage.
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Beta-Amyloid Plaques

The most prominent characteristic feature in AD is the presence of beta-amyloid plaques. These plaques are basically an accumulation of small fibers called beta amyloid fibrils. Because the deposition of beta-amyloid protein is a consistent pathological hallmark of brains affected by AD, the inhibition of A-beta generation, prevention of A-beta fibril formation, destabilization of pre-formed A-beta would be an attractive therapeutic strategy for the treatment of AD. The levels of beta-amyloid in AD mice that were given low doses of curcumin were decreased by around 40% in comparison to those that were not treated with curcumin. In addition, low doses of curcumin also caused a 43% decrease in the so-called “plaque burden” that these beta-amyloid have on the brains of AD mice. Surprisingly low doses of curcumin given over longer period were actually more effective than high doses in combating the neurodegenerative process of AD.[26] At higher concentration, curcumin binds to amyloid beta and blocks its self assembly. The key chemical features in amyloid beta are the presence of two aromatic end groups and any alterations in these groups has profound effect on its activity.

Because of the lipophilic nature of curcumin, it crosses the blood brain barrier and binds to plaques. Curcumin was a better A-beta 40 aggregation inhibitor and it destabilizes the A-beta polymer. In in vitro studies, curcumin inhibits aggregation as well as disaggregates to form fibrillar A-beta 40. A Japanese study showed that using fluorescence spectroscopic analysis with thioflavin T and electron microscopic studies, curcumin destabilizes the fA-beta(1-40) and fA-beta(1-42) as well as their extension.[27] Curcumin-derived isoxazoles and pyrazoles bind to the amyloid beta peptide (Abeta) and inhibit amyloid precursor protein (APP) metabolism.[28] Curcumin given to APPswe/PS1dE9 mice for 7 days crosses the blood-brain barrier as demonstrated by muliti-photon microscopy and reduces the existing senile plaques.[29] In another study, curcumin has been shown to increase the phagocytosis of amyloid-beta, effectively clearing them from the brains of patients with AD.[30]
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Metal Chelation

Studies showed that metals can induce A-beta aggregation and toxicity and are concentrated on Alzheimer's brain. Chelators' desferroxamine and cliquinol have exhibited anti-Alzheimer's effects. A study at Capital University Beijing demonstrated the toxicity of copper on neurons. A greater amount of H2O2 was released when copper (2)-A(beta)-40 complexes were added to the xanthene oxidase system. Copper was bound to A(beta)1-40 and was observed by electron paramagnetic resonance spectroscopy. In addition, copper chelators could cause a structural transition of A(beta). There was an increase on beta sheet as well as alpha-helix when copper was introduced.[31] Another study reveals that copper and zinc bind A-beta inducing aggregation and give rise to reactive oxygen species. There was a conformational change from beta sheet to alpha helix followed by peptide oligomerization and membrane penetration, when copper (or) zinc is added to A-beta in a negatively charged lipid environment.[32] Brain iron deregulation and its association with amyloid precursor protein plaque formation are implicated in the pathology of AD.[33]

Curcumin, by interaction with heavy metals such as cadmium and lead, prevents neurotoxicity caused by these metals. The intraperitoneal injection of lead acetate in rats in the presence of curcumin was studied microscopically. The results show lead-induced damage to neurons was significantly reduced in rats injected with curcumin.[34] A study at Chinese University of Hong Kong showed that by using spectrophotometry, the curcumin effectively binds to copper, zinc and iron. In addition, curcumin binds more effectively with redox-active metals such as iron and copper than the redox-inactive zinc. It is suggested that curcumin suppresses inflammatory damage by preventing metal induction of NF-kappa.[35,36]
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Cholesterol Lowering Effect

High-fat diets and increased blood cholesterol are linked to increased amyloid plaques by the intracellular accumulation of cholestryl esters.[37] Researchers believe that by inhibiting cholesterol formation and decreasing serum peroxides, curcumin might exert beneficial effects on AD.[38]
Oral bioavailability:

Curcumin has poor bioavailability. Because curcumin readily conjugated in the intestine and liver to form curcumin glucuronides.[39] In a clinical trial conducted in Taiwan, serum curcumin concentrations peaked one to two hours after an oral dose. Peak serum concentrations were 0.5, 0.6 and 1.8 micromoles/L at doses of 4, 6 and 8 g/day respectively.[40] It is also measured in urine at a dose of 3.6 g/day. Absorption is poor following ingestion in mice and rats. 38% to 75% of an ingested dose of curcumin is excreted in the feces. Absorption appears to be better with food. Curcumin crosses the blood brain barrier and is detected in CSF.
Side Effect

No apparent side effects have been reported thus far. GI upset, chest tightness, skin rashes, swollen skin are said to occur with high dose. A few cases of allergic contact dermatitis from curcumin have been reported.[41]

The chronic use of curcumin can cause liver toxicity. For this reason, turmeric products should probably be avoided by individuals with liver disease, heavy drinkers and those who take prescription medications that are metabolized by liver. Curcumin was found to be pharmacologically safe in human clinical trials with doses up to 10 g/day. A phase 1 human trial with 25 subjects using up to 8000 mg of curcumin per day for three months found no toxicity from curcumin.[42]

Curcumin is said to interact with certain drugs such as blood thinning agents, NSAIDs, reserpin. Co-supplementation with 20 mg of piperine (extracted from black pepper) significantly increase the bioavailablity of curcumin by 2000%.[43]

Curcumin is not recommended for persons with biliary tract obstruction because it stimulates bile secretion. It is also not recommended for people with gallstones, obstructive jaundice and acute biliary colic. Curcumin supplementation of 20-40 mg have been reported to increase gallbladder contractions in healthy people.[44,45]
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Epidemiological studies have shown that prevalence of AD is 4.4 lower amongst Indian Asians as compared to people of western origin.[9] D ementia incidence in western countries (P < 0.21) and East Asian countries were lower than that of Europe (P < 0.0004).[49]
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Experimental studies: Statistical significance

Clinical -Vivo: Blood from six patients with AD and three healthy controls was taken and the macrophage cells were isolated. After treatment of macrophages with curcuminoids, Aβ uptake by macrophages of three of the six AD patients was found to have significantly increased (P < 0.001 to 0.081).[11]

Five animal and two human studies showed statistically significant P values.
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Based on the main findings detailed above, curcumin will lead to a promising treatment for Alzheimer's disease. The clinically studied chemical properties of curcumin and its various effects on AD shows the possibility to do further research and develop better drugs based on curcumin for treating AD. The recent review paper of John Ringman also supports some of the abovementioned properties of curcumin in AD;[50] however, large-scale human studies are required to identify the prophylactic and therapeutic effect of curcumin.

Several unanswered questions remain: What is the one main chemical property of curcumin that can be exploited in treating AD? What is the role of curcumin in other neurological disorders such as Parkinson's, Huntington's and other dementias? How does curcumin interact with neuronal plaques? Is it effective only as a food additive? Would it be effective when used alone or with other anti inflammatory drugs?
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Source of Support: Nil

Conflict of Interest: Nil
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Friday, September 7, 2012

Can a bvFTD Symptom be an asset? An anecdote.

If you are offended by some raw language now and then, now would be a good time to go read something else. I have bvFTD so foul language comes naturally to me on occasion, but most of the time I don't use foul language in my posts, but every now and then... well every now and then I just have to call an asshole what he is!

...and this little bastard garden-raider is next. You lookin at me?
I mentioned in an earlier post that my friend and I had several booth spaces at the local Corn Festival. Sales were good, and our booths were busy most of the time. It was a long and tiring day, but it was worth it. We had fun, and I enjoyed talking to people. Who knew I could sell aprons, purses, and tote bags?

My bvFTD was in the background most of the time. My friend and I actually spoke of this afterwards, and she said that when she noticed I was doing something, and got distracted, she gently guided me back on-track. She is good at it because I wasn't even aware she was doing it.

Sales work is a natural for someone with bvFTD (if they could actually ever do it and not just think about it and not yell at their boss or scream at their customers and get to work regularly and ... and ... but you know what I mean). One of the symptoms of bvFTD is a lack of self restraint. I am not shy about talking with anyone. I do not think it is possible to intimidate me. When I am not being a hermit, and locking myself up behind closed doors away from everyone, I am downright sociable!

Well, she turned me loose on the local population with good solid high quality products to sell, 20 years of marketing experience, a Master's Degree in Business, and bvFTD. They didn't stand a chance! We all had fun.

and then...

I kinda had a symptom, but it worked out for the best, and I can rationalize it all over the place, but at the end of the day it was a direct result of my bvFTD, and a symptom. I just gotta warn all of the other total assholes out there that the person you are dealing with just might have bvFTD and will not put up with any of your crap.

So, here is what happened. We had a slow period mid-afternoon, and Cindy went for a walk. She needed a break, and I encouraged her to go check out the other vendors and stuff at the festival. She is a hard worker. While she was gone I made a few sales. Then things got really slow in the booths.

I noticed a man standing right in front of our booth spaces with his back to me. He had several small children lined up on either side of him effectively forming a wall blocking access to our booth. No big deal. I figured maybe he was just waiting for someone ...until ...a customer came up to our booth to look at something and he blew smoke in her face. She promptly left the vicinity in a huff. To me this was a potential sale, and from what she was interested in it meant about $25 or so. I was suddenly more interested in this gentleman. Did I mention that I have bvFTD?

I walked right up to him, and before I could even ask him if I could help him with something, he turned to me, blew some smoke at me, and said kind of menacingly, "You got a problem?" I think he maybe was some kind of small-town hick bully used to intimidating people. He had no idea! Did I mention I have bvFTD? I can get really pissed-off for no reason in less than zero-point-seven-six seconds, and this bozo had just given me a reason. I was seething!

But, I am also very aware of my bvFTD symptoms sometimes, or at least I try to convince myself that I have some insight into my feelings in spite of my condition. So with great restraint I smiled at him, and asked If I could help him with something.

And then he said, being as rude as he possibly could, "Can't you see I had my back turned to you. If I wanted any help ...mumble ...mumble..." as he turned away.

Well, I did not grab him by his dirty overalls (Yes! He was wearing overalls!), and kick his smelly ass all the way across the creek. I did not shove that cheap cigarette up his nose. I did not yell at him to move his fat-fucking ass somewhere else and take his ugly-assed kids with him! Nope! I was good. I was aware of my symptoms, and stifled all of those urges ...though just barely. He was one lucky asshole.

Instead I said, "Well! Then! I guess you are not shopping, and you are bothering my customers. Move it, or lose it!"

I suppose I could have been a little more polite about it, but considering the circumstances and the  alternatives I was on my best behavior. Did I mention that I have bvFTD? I think I may have been moving towards him as I said it, but I don't exactly remember. I know I really wanted to choke the smoke out of him. He moved. Fast! Gone! Nothing left of him but a bad smell, and a cloud of smoke, and a memory. Kids too.

"Bye! Come again when you can't stay so long!"

I turned around to see 3 women standing there right behind me. They had probably heard most of what had transpired. They were giggling. I gave them a big smile, and welcomed them into the booth. What could I say? Turns out it was the woman the asshole had blown the smoke at with a couple of her friends, or maybe her grown-up kids. In any case they came right into the booth now that the asshole had moved on, and shopped around. They didn't mention anything about what transpired, but they bought a few things. I don't remember exactly what. Maybe some dip mixes.

But here is the thing. I enjoyed it! It was great fun to unleash my bvFTD on this boorish asshole. Somehow it was very satisfying. Deep-down satisfying. Exhilarating! And even better, I was able to control my symptoms, and use restraint. Maybe that is part of why it was so enjoyable. I used my bvFTD to my own advantage, maybe for the first time ever! Now, how kool is that?

I told Cindy about it when she got back from her break, but without the bvFTD connections. That asshole was probably very lucky that she wasn't there. She is a huckster! She does not have bvFTD. She would probably not have used restraint. He would probably be trying to figure out how to remove a cigarette from a left nostril right about now.

Yes it is sometimes difficult. I try to have some fun with it now and then. The alternative is all doom and gloom. It isn't going away. Fun is better.

Some days are better than others.

Comments are welcome.

Friday, August 31, 2012

What happened to April 2012? A really bad month.

This tree in my front yard is flowering six weeks early.
Something changed drastically in late March of this year. I was doing well through the Holidays, and spent a great Christmas with friends and family. The post-holiday transition went well, and the decorations came down. Things were back to my normal comfortable routine. Things were going along as usual until about midway through March. Then everything changed for the worse, though at the time I did not really see it that way. I lapsed into what I can best describe as a type of "bvFTD Survival Mode."

First off, I remember almost nothing of this time period. It is what I refer to in another earlier post as "Missing Time." I do remember that I informed the woman that I had been dating for 6 months I did not want to see her for a while. When pressed by her for how long, I arbitrarily chose the date of May 9th. This had been my Mother's birth date, and was the first thing that came to mind as a date about a month away in May. I closed the doors, and some days did not open them. I did not want any visitors. When friends called, if I answered the phone at all, I just said I was busy, or had other plans, and discouraged company. I only went to the store when I absolutely needed something, and kept it short. The car remained parked in the yard for a week or more at a a time. I was a hermit. I removed almost all outside stress from my life.

All of my symptoms were suddenly much, much worse, and I had no idea why.

Yes, I was aware something was wrong. I was very afraid I was nearing (had reached!) a time when I needed to be in a care facility of some kind, or have some kind of outside help at home. Yes! It was that bad.

Instead, I dealt with it instinctually. I basically shut myself away until I got better. I did have some outside contacts and activities. I went every Friday night for a nice long walk in the park well after dark continuing with the volunteer work counting frogs which I had been doing for something like 12 years. A few times I felt better, and spent some time with old friends, but it did not last, and was just a day or so now and then.

None of my friends or family ever really suspected anything was wrong. After all ...I sounded just fine when I talked to them.

I met with my doctors, and discussed what was going on with me. My Neurologist and I developed a theory. I made some changes ...and I got better! Just like that! Almost overnight ...I was back to my simi-normal self.

So! What did we come up with? What did we do?

This, I suppose, is front-line applied medical research of a type the major drug companies, our bloated government, and the AMA abhor. But in reality they have failed us, and we are on our own. Hey, I am not a doctor, and I would never presume to give medical advice to others. I will, however, share my own personal experiences, and my own opinions. After all, I have bvFTD, and can share my opinion, sometimes at volume, and with great vigor, just about any time.

So, now, 6 months later I am looking back, and trying to figure out what went wrong, and what changes made things better. I am still not sure, but I will make some guesses loaded with intuition, and personal insight.

A couple things happened last March:
1. I changed my medications.
2. This Spring in Ohio was unusually hot, and the allergy season was much worse than usual for those, like me, allergic to tree pollen.

First the medications. When my allergies were bad I took antihistamines, usually a generic Chlortrimaton because it always worked well for me in the past with the only side-effect being increased libido. Yup! No down side there. When I had by routine blood work done, my blood glucose was elevated. This was no surprise given my weight gain of nearly 30 pounds since starting Aricept and Namenda. My doctor started me back on Metformin. I had taken it before, and tolerated it well. Of course, I was not taking Aricept or Namenda back when I was on it before. It has been 5 or 6 years since I had taken any drugs to control my blood sugar. My doctor said I was "diet and exercise controlled". The joke is I neither dieted nor exercised.

So maybe it was a reaction to starting the medication. I voiced my suspicion to my Neurologist, and he was unconvinced that Metformin was the cause. He was probably correct because I am currently still taking it without any adverse effects. If it was the Metformin causing the problems it was temporary. Maybe I just got used to it. I only mention it because it was a change in my medication at about the same time I started having problems. Maybe it was just a coincidence ...if you believe in that kind of thing.

First-and-a-half: Something else was going on at the time. My memory of it is very hazy, but I remember having a feeling of huge building stress in my romantic relationships getting more serious than I had planned, and having to choose between a couple of romantic options. I remember it as a heavy physical weight on my shoulders driving me downward. This situation resolved itself when one of the players removed themselves from the equation with a trip to Texas making my choices simple. I really don"t know how much, or if anything, this all had on the worsening of my symptoms, but it was going on and should at least be acknowledged as a possible contributing factor especially when the increased stress is factored into the overall equation.

The second is what we (Neurologist and I both) think really was going on. The weather was hot, and Spring was 4-6 weeks early. Last March in Ohio was bizarre with temperatures in the mid-eighties when it should have been freezing. Plants, trees, and everything else that could flower, fruit, or produce spores was doing so. The pollen and mold counts were astronomical in this area. My car was covered with yellow dust every day ...pollen.

My allergy symptoms were very bad. All the usual with ichy eyes, runny nose, sneezing, and even some mild asthma. I have always had allergies. I have always enjoyed the outdoors, and am a naturalist. I have never allowed my allergies to prevent me from doing what I loved to do. This Spring was no exception. I ignored my allergies as best I could, and went on with what I was doing. I was out in the park every week for several hours wallowing in all the pollen.

Well, I did a little research on a hunch. I looked into exactly what, if any, effects histamine had on memory. The connection seemed obvious to me: pollen - allergies-histamine-and anti-histamines.I didn't expect to find anything, so I was surprised when I found a lot. Histamine does effect memory. Who knew? One of my most severe and debilitating symptoms is a deficit in the functioning of my short-term memory. Duh! Could it really be something this simple?

I presented my theory to my Neurologist. He did not laugh it off. Instead he said another patient of his with bvFTD had had a severe setback similar to mine, but in that case it was clearly related to stress. His theory was that the allergies were acting as a physical stressor, and making my symptoms worse through the histamine pathway. The solution we came up with was to try taking anti-histamines more regularly, and switch to one of the more recent generations of drugs. I chose a generic version of Zyrtec because it was available at the Dollar Tree for a buck a box instead of $10 a box at the drug store. Yes, it is the exact same stuff!

Late Spring also brought on a cold snap returning temperatures to more normal, though still warmer than usual. Pollen counts remained high, but more typical of an Ohio Spring.

A few days after starting the anti-histamines, and using the air conditioner at night as a relief from the pollen, I was feeling better. A week later I was out and about, having company over, and by May 9th dating again. Lucky for me she is a very patient and understanding lady.

So, some days are better than others. Some whole months can be pretty bad. Most days, and most months are pretty good.

Comments are welcome.

Tuesday, August 28, 2012

Kroozer Loves the Pool

Well, he is a smart l'il skunk, and it has been one very hot Summer.

Yes, they are both sound asleep floating in the pool after a nice cool swim. Kroozer loves to swim around in the pool, but beware! He is a known pool-pooper! Arrrrrbhhhhhhh! Quick! Grab the net!

Though Kroozer decided he did not care much for Pomegranate Margaritas, he sure did want to know exactly what was in that glass.

He is doing fine. Right now he is happily shedding all over the place. He does that about twice a year. He is a great pet, and a wonderful addition to the household. He is ideal for me because he is very low maintenance, and gets along well with my particular set of symptoms.

Some days are better than others, but every day is just a little better with Kroozer around.

Comments are welcome.

More about the camping trip. And a few pictures...

...pictures of what I wrote about in the previous post.

So, the campsite was nice, and we had great weather the whole trip. It wouldn't have mattered if it rained because that would just have made the off-road trails all the more fun. The camp kitchen, tent, and Ruby are all in this picture. So is Cindy.

You could always tell when you were driving on one of the main roads in the area because there were road signs..Hahahahahahahahahaha!

...OK, it isn't as bad as it looks. This is actually one of the best roads we were on that wasn't paved. The actual road does curve sharply left, and the road that continues straight ahead is a National Forest road which quickly deteriorates. The main difference is that the named roads are mostly passable, and the forest roads may be passable in four wheel drive with high wheel clearance. The question is: If a tree falls in the National Forest, and it lands on a road, will they remove it this year, or next year, or just let you drive around it through the woods and make a new curve in the road. Really! Anyway, this was a good road, so good in fact that it was named "Good Road". It was even in the Jeep's GPS system. Go figure! At one point we actually got Ruby up into 3rd gear. Three out of six ain't bad!

Yes!, Ruby has a six-speed manual transmission ... so with a 2-speed transfer case and low range that makes for 12 speeds forward, and 2 in reverse, with a couple of neutrals thrown in here and there. My doctor guesses I will have trouble driving the manual before I actually have trouble driving. I hope he is right! So far ...so good. With all that she is really easy to drive, and can go just about anywhere you dare to try, on the road, or off.

I was afraid my passenger might get bored hanging on for dear life bouncing around the seat next to me dodging occasional branches, so I coerced her into driving for a while. Ruby really is easy to drive, and very comfortable all things considered. Imagine my pleasant surprise a few minutes later when we were bouncing up a rutted hillside road, tires churning the dirt, as this woman giggled hysterically fists clenched on the wheel.

Did you notice that the rut in the road she is standing in is waist deep? It is hard to tell in the picture, but there was about a 30 inch drop off. Ruby didn't even spin a tire.

What great fun!

She is driving. I was taking the picture to prove it! This is a typical good part of one of the park's seasonal roads. They call them that because they just give up, and close them all when the weather gets bad.

We had many places where we had to turn around because the road ended, or there was a huge tree fallen across the road with no way around it. Sometimes the road just kept getting worse, and worse, and disappeared. Once the road just went right into a swamp. I think the road stopped a couple hundred yards before we did. It finally just got too rough, and there was no track to follow, and I could not see what was hidden in the tall weeds. But ...the trail continued to somewhere. I think there was an old saw mill back there somewhere, but I turned around before I got stuck. OK, there was really little danger of that, but I did finally have to use low range. That might just be a first!

We did not spend all of the time off-roading, but that was the most fun ...at least for me. I mentioned we explored the town. It was very picturesque in the "Historical Downtown District", but a little touristy.
The river walk along the Manistee River, in Manistee, Mi.

I spent a little time taking some pictures. There were plenty of flowers, and some other interesting scenery. The night in camp were cool. The temperature was around 80 degrees during the day, but dropped into the 50's at night. The campfire was welcomed, and were the Margaritas after a hard days play.

Our campsite at night. The light is from a Coleman Lantern.

One night, around two o'clock in the morning, and owl decided to give us a serenade from the tree above the tent. It screeched, whistled, hooted, and clucked for a while before moving on. From the sound of it , it was probably a Barred Owl, common in the park. We heard many different owls calling each night in the distance. Other than that, and the crickets, there was silence broken only by the faint sound of a car on the road a few miles away.  It was dark with no lights from any nearby city polluting the night sky, and the stars were amazing.
I adjusted this a little so it would show better on a computer, but the sky was black, and the stars ...the stars!

I wish I was there right now!

Comments are welcome