The Brain Alarm Signs That Warn Of Dementia
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When it comes to predicting age-related cognitive impairment:
First there are genetic factors to take into account (such as the APOE4 gene for Alzheimer’s), as well as things such as age and sex.
When it comes to sex, by the way, what matters here is hormones, which is why [it seems; this as technically as yet unproven with full rigor, but the hypothesis is sound and there is a body of evidence gradually being accumulated to support it] postmenopausal women with untreated menopause get Alzheimer’s at a higher rate and deteriorate more quickly:
Alzheimer’s Sex Differences May Not Be What They Appear
Next, there are obviously modifiable lifestyle factors to take into account, things that will reduce your risk such as getting good sleep, good diet, good exercise, and abstaining from alcohol and smoking, as well as oft-forgotten things such as keeping cognitively active and, equally importantly, socially active:
How To Reduce Your Alzheimer’s Risk
(the article outlines what matters the most in each of the above areas, by the way, so that you can get the most bang-for-buck in terms of lifestyle adjustments)
Lastly (in the category of risk factors), there are things to watch out for in the blood such as hypertension and high cholesterol.
Nipping it in the blood
In new research (so new it is still ongoing, but being at year 2 of a 4-year prospective study, they have published a paper with their results so far), researchers have:
- started with the premise “dementia is preceded by mild cognitive impairment”
- then, asked the question “what are the biometric signs of mild cognitive impairment?”
Using such tools as functional near-infrared spectroscopy (fNIRS) while the participants performed cognitive tasks, they were able to record changes in plasma levels of extracellular vesicles, assessing them with small-particle flow cytometry.
Translating from sciencese: they gave the participants mental tasks, and while they completed them, the researchers scanned their brains and monitored blood flow and the brain’s ability to compensate for any lack of it.
What they found:
- in young adults, blood flow increased, facilitating neurovascular coupling (this is good)
- in older adults, blood flow did not increase as much, but they engaged other areas of the brain to compensate, by what’s called functional connectivity (this is next best)
- in those with mild cognitive impairment, blood flow was reduced, and they did not have the ability to compensate by functional connectivity (this is not good)
They also performed a liquid biopsy, which sounds alarming but it just means they took some blood, and tested this for density of cerebrovascular endothelial extracellular vesicles (CEEVs), which—in more prosaic words—are bits from the cells lining the blood vessels in the brain.
People with mild cognitive impairment had more of these brain bits in their blood than those without.
You can read the paper itself here:
What this means
The science here is obviously still young (being as it is still in progress), but this will likely contribute greatly to early warning signs of dementia, by catching mild cognitive impairment in its early stages, by means of a simple blood test, instead of years of wondering before getting a dementia diagnosis.
And of course, forewarned is forearmed, so if this is something that could be done as a matter of routine upon hitting the age of, say, 65 and then periodically thereafter, it would catch a lot of cases while there’s still more time to turn things around.
As for how to turn things around, well, we imagine you have now read our “How To Reduce Your Alzheimer’s Risk” article linked up top (if not, we recommend checking it out), and there is also…
Do Try This At Home: The 12-Week Brain Fitness Program To Measurably Boost Your Brain
Take care!
When it comes to predicting age-related cognitive impairment:
First there are genetic factors to take into account (such as the APOE4 gene for Alzheimer’s), as well as things such as age and sex.
When it comes to sex, by the way, what matters here is hormones, which is why [it seems; this as technically as yet unproven with full rigor, but the hypothesis is sound and there is a body of evidence gradually being accumulated to support it] postmenopausal women with untreated menopause get Alzheimer’s at a higher rate and deteriorate more quickly:
Alzheimer’s Sex Differences May Not Be What They Appear
Next, there are obviously modifiable lifestyle factors to take into account, things that will reduce your risk such as getting good sleep, good diet, good exercise, and abstaining from alcohol and smoking, as well as oft-forgotten things such as keeping cognitively active and, equally importantly, socially active:
How To Reduce Your Alzheimer’s Risk
(the article outlines what matters the most in each of the above areas, by the way, so that you can get the most bang-for-buck in terms of lifestyle adjustments)
Lastly (in the category of risk factors), there are things to watch out for in the blood such as hypertension and high cholesterol.
Nipping it in the blood
In new research (so new it is still ongoing, but being at year 2 of a 4-year prospective study, they have published a paper with their results so far), researchers have:
- started with the premise “dementia is preceded by mild cognitive impairment”
- then, asked the question “what are the biometric signs of mild cognitive impairment?”
Using such tools as functional near-infrared spectroscopy (fNIRS) while the participants performed cognitive tasks, they were able to record changes in plasma levels of extracellular vesicles, assessing them with small-particle flow cytometry.
Translating from sciencese: they gave the participants mental tasks, and while they completed them, the researchers scanned their brains and monitored blood flow and the brain’s ability to compensate for any lack of it.
What they found:
- in young adults, blood flow increased, facilitating neurovascular coupling (this is good)
- in older adults, blood flow did not increase as much, but they engaged other areas of the brain to compensate, by what’s called functional connectivity (this is next best)
- in those with mild cognitive impairment, blood flow was reduced, and they did not have the ability to compensate by functional connectivity (this is not good)
They also performed a liquid biopsy, which sounds alarming but it just means they took some blood, and tested this for density of cerebrovascular endothelial extracellular vesicles (CEEVs), which—in more prosaic words—are bits from the cells lining the blood vessels in the brain.
People with mild cognitive impairment had more of these brain bits in their blood than those without.
You can read the paper itself here:
What this means
The science here is obviously still young (being as it is still in progress), but this will likely contribute greatly to early warning signs of dementia, by catching mild cognitive impairment in its early stages, by means of a simple blood test, instead of years of wondering before getting a dementia diagnosis.
And of course, forewarned is forearmed, so if this is something that could be done as a matter of routine upon hitting the age of, say, 65 and then periodically thereafter, it would catch a lot of cases while there’s still more time to turn things around.
As for how to turn things around, well, we imagine you have now read our “How To Reduce Your Alzheimer’s Risk” article linked up top (if not, we recommend checking it out), and there is also…
Do Try This At Home: The 12-Week Brain Fitness Program To Measurably Boost Your Brain
Take care!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
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A Fresh Take On Hypothyroidism
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
The Three Rs To Boost Thyroid-Related Energy Levels
This is Dr. Izabella Wentz. She’s a doctor of pharmacology, and after her own diagnosis with Hashimoto’s thyroiditis, she has taken it up as her personal goal to educate others on managing hypothyroidism.
Dr. Wentz is also trained in functional medicine through The Institute for Functional Medicine, Kalish Functional Medicine, and the American Academy of Anti-Aging Medicine. She is a Fellow of the American Society of Consultant Pharmacists, and holds certifications in Medication Therapy Management as well as Advanced Diabetes Care through the American Pharmacists Association. In 2013, she received the Excellence in Innovation Award from the Illinois Pharmacists Association.
Dr. Wentz’s mission
Dr. Wentz was disenchanted by the general medical response to hypothyroidism in three main ways. She tells us:
- Thyroid patients are not diagnosed appropriately.
- For this, she criticises over-reliance on TSH tests that aren’t a reliable marker of thyroid function, especially if you have Hashimoto’s.
- Patients should be better optimized on their medications.
- For this, she criticizes many prescribed drugs that are actually pro-drugs*, that don’t get converted adequately if you have an underactive thyroid.
- Lifestyle interventions are often ignored by mainstream medicine.
- Medicines are great; they truly are. But medicating without adjusting lifestyle can be like painting over the cracks in a crumbling building.
*a “pro-drug” is what it’s called when the drug we take is not the actual drug the body needs, but is a precursor that will get converted to that actual drug we need, inside our body—usually by the liver, but not always. An example in this case is T4, which by definition is a pro-drug and won’t always get correctly converted to the T3 that a thyroid patient needs.
Well that does indeed sound worthy of criticism. But what does she advise instead?
First, she recommends a different diagnostic tool
Instead of (or at least, in addition to) TSH tests, she advises to ask for TPO tests (thyroid peroxidase), and a test for Tg antibodies (thyroglobulin). She says these are elevated for many years before a change in TSH is seen.
Next, identify the root cause and triggers
These can differ from person to person, but in countries that add iodine to salt, that’s often a big factor. And while gluten may or may not be a factor, there’s a strong correlation between celiac disease and Hashimoto’s disease, so it is worth checking too. Same goes for lactose.
By “checking”, here we mean testing eliminating it and seeing whether it makes a difference to energy levels—this can be slow, though, so give it time! It is best to do this under the guidance of a specialist if you can, of course.
Next, get to work on repairing your insides.
Remember we said “this can be slow”? It’s because your insides won’t necessarily bounce back immediately from whatever they’ve been suffering from for what’s likely many years. But, better late than never, and the time will pass anyway, so might as well get going on it.
For this, she recommends a gut-healthy diet with specific dietary interventions for hypothyroidism. Rather than repeat ourselves unduly here, we’ll link to a couple of previous articles of ours, as her recommendations match these:
She also recommends regular blood testing to see if you need supplementary TSH, TPO antibodies, and T3 and T4 hormones—as well as vitamin B12.
Short version
After diagnosis, she recommends the three Rs:
- Remove the causes and triggers of your hypothyroidism, so far as possible
- Repair the damage caused to your body, especially your gut
- Replace the thyroid hormones and related things in which your body has become deficient
Learn more
If you’d like to learn more about this, she offers a resource page, with resources ranging from on-screen information, to books you can get, to links to hook you up with blood tests if you need them, as well as recommended supplements to consider.
She also has a blog, which has an interesting relevant article added weekly.
Enjoy, and take care of yourself!
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- Thyroid patients are not diagnosed appropriately.
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Brain Benefits in 3 Months…through walking?
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Keeping it Simple
Today’s video (below) is another Big Think production (can you tell that we love their work?). Wendy Suzuki does a wonderful job of breaking down the brain benefits of exercise into three categories, within three minutes.
The first question to ask yourself is: what is your current level of fitness?
Low Fitness
Exercising, even if it’s just going on a walk, 2-3 times a week improves baseline mood state, as well as enhances prefrontal and hippocampal function. These areas of the brain are crucial for complex behaviors like planning and personality development, as well as memory and learning.
Mid Fitness
The suggested regimen is, without surprise, to slightly increase your regular workouts over three months. Whilst you’re already getting the benefits from the low-fitness routine, there is a likelihood that you’ll increase your baseline dopamine and serotonin levels–which, of course, we love! Read more on dopamine here, here, or here.
High Fitness
If you consider yourself in the high fitness bracket then well done, you’re doing an amazing job! Wendy Suzuki doesn’t make many suggestions for you; all she mentions is that there is the possibility of “too much” exercise actually having negative effects on the brain. However, if you’re not competing at an Olympic level, you should be fine.
Fitness and Exercise in General
Of course, fitness and exercise are both very broad terms. We would suggest that you find an exercise routine that you genuinely enjoy–something that is easy to continue over the long term. Try browsing different areas of exercise to see what resonates with you. For instance, Total Fitness After 40 is a great book on all things fitness in the second half of your life. Alternatively, search through our archive for fitness-related material.
Anyway, without further ado, here is today’s video:
How was the video? If you’ve discovered any great videos yourself that you’d like to share with fellow 10almonds readers, then please do email them to us!
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Without Medicare Part B’s Shield, Patient’s Family Owes $81,000 for a Single Air-Ambulance Flight
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Without Medicare Part B’s Shield, Patient’s Family Owes $81,000 for a Single Air-Ambulance Flight
Debra Prichard was a retired factory worker who was careful with her money, including what she spent on medical care, said her daughter, Alicia Wieberg. “She was the kind of person who didn’t go to the doctor for anything.”
That ended last year, when the rural Tennessee resident suffered a devastating stroke and several aneurysms. She twice was rushed from her local hospital to Vanderbilt University Medical Center in Nashville, 79 miles away, where she was treated by brain specialists. She died Oct. 31 at age 70.
One of Prichard’s trips to the Nashville hospital was via helicopter ambulance. Wieberg said she had heard such flights could be pricey, but she didn’t realize how extraordinary the charge would be — or how her mother’s skimping on Medicare coverage could leave the family on the hook.
Then the bill came.
The Patient: Debra Prichard, who had Medicare Part A insurance before she died.
Medical Service: An air-ambulance flight to Vanderbilt University Medical Center.
Service Provider: Med-Trans Corp., a medical transportation service that is part of Global Medical Response, an industry giant backed by private equity investors. The larger company operates in all 50 states and says it has a total of 498 helicopters and airplanes.
Total Bill: $81,739.40, none of which was covered by insurance.
What Gives: Sky-high bills from air-ambulance providers have sparked complaints and federal action in recent years.
For patients with private insurance coverage, the No Surprises Act, which went into effect in 2022, bars air-ambulance companies from billing people more than they would pay if the service were considered “in-network” with their health insurers. For patients with public coverage, such as Medicare or Medicaid, the government sets payment rates at much lower levels than the companies charge.
But Prichard had opted out of the portion of Medicare that covers ambulance services.
That meant when the bill arrived less than two weeks after her death, her estate was expected to pay the full air-ambulance fee of nearly $82,000. The main assets are 12 acres of land and her home in Decherd, Tennessee, where she lived for 48 years and raised two children. The bill for a single helicopter ride could eat up roughly a third of the estate’s value, said Wieberg, who is executor.
The family’s predicament stems from the complicated nature of Medicare coverage.
Prichard was enrolled only in Medicare Part A, which is free to most Americans 65 or older. That section of the federal insurance program covers inpatient care, and it paid most of her hospital bills, her daughter said.
But Prichard declined other Medicare coverage, including Part B, which handles such things as doctor visits, outpatient treatment, and ambulance rides. Her daughter suspects she skipped that coverage to avoid the premiums most recipients pay, which currently are about $175 a month.
Loren Adler, a health economist for the Brookings Institution who studies ambulance bills, estimated the maximum charge that Medicare would have allowed for Prichard’s flight would have been less than $10,000 if she’d signed up for Part B. The patient’s share of that would have been less than $2,000. Her estate might have owed nothing if she’d also purchased supplemental “Medigap” coverage, as many Medicare members do to cover things like coinsurance, he said.
Nicole Michel, a spokesperson for Global Medical Response, the ambulance provider, agreed with Adler’s estimate that Medicare would have limited the charge for the flight to less than $10,000. But she said the federal program’s payment rates don’t cover the cost of providing air-ambulance services.
“Our patient advocacy team is actively engaged with Ms. Wieberg’s attorney to determine if there was any other applicable medical coverage on the date of service that we could bill to,” Michel wrote in an email to KFF Health News. “If not, we are fully committed to working with Ms. Wieberg, as we do with all our patients, to find an equitable solution.”
The Resolution: In mid-February, Wieberg said the company had not offered to reduce the bill.
Wieberg said she and the attorney handling her mother’s estate both contacted the company, seeking a reduction in the bill. She said she also contacted Medicare officials, filled out a form on the No Surprises Act website, and filed a complaint with Tennessee regulators who oversee ambulance services. She said she was notified Feb. 12 that the company filed a legal claim against the estate for the entire amount.
Wieberg said other health care providers, including ground ambulance services and the Vanderbilt hospital, wound up waiving several thousand dollars in unpaid fees for services they provided to Prichard that are normally covered by Medicare Part B.
But as it stands, Prichard’s estate owes about $81,740 to the air-ambulance company.
More from Bill of the Month
- The Colonoscopies Were Free. But the ‘Surgical Trays’ Came With $600 Price Tags. Jan 25, 2024
- When a Quick Telehealth Visit Yields Multiple Surprises Beyond a Big Bill Dec 19, 2023
- Out for Blood? For Routine Lab Work, the Hospital Billed Her $2,400 Nov 21, 2023
The Takeaway: People who are eligible for Medicare are encouraged to sign up for Part B, unless they have private health insurance through an employer or spouse.
“If someone with Medicare finds that they are having difficulty paying the Medicare Part B premiums, there are resources available to help compare Medicare coverage choices and learn about options to help pay for Medicare costs,” Meena Seshamani, director of the federal Center for Medicare, said in an email to KFF Health News.
She noted that every state offers free counseling to help people navigate Medicare.
In Tennessee, that counseling is offered by the State Health Insurance Assistance Program. Its director, Lori Galbreath, told KFF Health News she wishes more seniors would discuss their health coverage options with trained counselors like hers.
“Every Medicare recipient’s experience is different,” she said. “We can look at their different situations and give them an unbiased view of what their next best steps could be.”
Counselors advise that many people with modest incomes enroll in a Medicare Savings Program, which can cover their Part B premiums. In 2023, Tennessee residents could qualify for such assistance if they made less than $1,660 monthly as a single person or $2,239 as a married couple. Many people also could obtain help with other out-of-pocket expenses, such as copays for medical services.
Wieberg, who lives in Missouri, has been preparing the family home for sale.
She said the struggle over her mother’s air-ambulance bill makes her wonder why Medicare is split into pieces, with free coverage for inpatient care under Part A, but premiums for coverage of other crucial services under Part B.
“Anybody past the age of 70 is likely going to need both,” she said. “And so why make it a decision of what you can afford or not afford, or what you think you’re going to use or not use?”
Bill of the Month is a crowdsourced investigation by KFF Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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Skin Care Down There (Incl. Butt Acne, Hyperpigmentation, & More)
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Dr. Sam Ellis, dermatologist, gives us the low-down:
Where the sun don’t shine
Common complaints and remedies that Dr. Ellis covers in this video include:
- Butt acne/folliculitis: most butt breakouts are actually folliculitis, not traditional acne. Folliculitis is caused by friction, sitting for long periods, or wearing tight clothes. Solutions include antimicrobial washes like benzoyl peroxide and changing sitting habits (i.e. to sit less)
- Keratosis pilaris: rough bumps around hair follicles can appear on the butt, often confused with acne.
- Boils and abscesses: painful, large lumps; these need medical attention for drainage.
- Hidradenitis suppurativa: recurrent painful cysts and boils in skin creases, often in the groin and buttocks. These require medical intervention and treatment.
- Ingrown hairs: are common in people who shave or wax. Treat with warm compresses and gentle exfoliants.
- Hyperpigmentation: is often caused by hormonal changes, friction, or other irritation. Laser hair removal and gentle chemical exfoliants can help.
In the event that the sun does, in fact, shine on your genitals (for example you sunbathe nude and have little or no pubic hair), then sun protection is essential to prevent further darkening (and also, incidentally, reduce the risk of cancer).
For more on all of this, plus a general introduction to skincare in the bikini zone (i.e. if everything’s fine there right now and you’d like to keep it that way), enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
The Evidence-Based Skincare That Beats Product-Specific Hype
Take care!
Don’t Forget…
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Live Life in Crescendo – by Stephen Covey and Cynthia Covey-Haller
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Stephen Covey is of course best known for his “7 Habits of Highly Effective People“, while the dozen books he wrote afterwards, not including this one, did not get the same acclaim.
Not including this one, because this one was published posthumously and, notwithstanding the order of the names on the cover, in all likelihood his daughter wrote most of.
And yet! The very spirit of this book is in defiance of 7 Habits being his “early career” magnum opus. We say “early career”, because he was 57 already when that was published, but it was one of his earlier books.
In this work the authors lay out the case for how “your most important work is always ahead of you“, and that it is perfectly possible to “live life in crescendo“, and keep on giving whatever it is that we want to give to the world.
We also learn, mostly through storytelling, of how people are infinitely more important than things, and that it is there that we should put our investments. And that while adversity may not make us stronger, it just means we may need to change our approach, to continue to be productive in whatever way is meaningful to us.
Bottom line: if ever you wonder how your future could live up to your past (in a good way), this is the book to get you thinking.
Click here to check out Live Life in Crescendo, and figure out what your next great work will be!
Don’t Forget…
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The Alzheimer’s Gene That Varies By Race & Sex
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The Alzheimer’s Gene That Varies By Race & Sex
You probably know that there are important genetic factors that increase or decrease Alzheimer’s Risk. If you’d like a quick refresher before we carry on, here are two previous articles on this topic:
- Genetic Testing: Health Benefits & Methods (about personal genomics and health, including Alzheimer’s)
- The Surprising Link Between Type 2 Diabetes & Alzheimer’s (about the APOE-ε4 allele that is implicated in both)
A Tale of Two Alleles
It has generally been understood that APOE-ε2 lowers Alzheimer’s disease risk, and APOE-ε4 increases it.
However, for reasons beyond the scope of this article, research populations for genetic testing are overwhelmingly white. If you, dear reader, are white, you may be thinking “well, I’m white, so this isn’t a problem for me”, you might still want to read on…
An extensive new study, published days ago, by Dr. Belloy et al., looked at how these correlations held out per race and sex. They found:
- The “APOE-ε2 lowers; APOE-ε4 increases” dictum held out strongest for white people.
- In the case of Hispanic people, there was only a small correlation on the APOE-ε4 side of things, and none on the APOE-ε2 side of things per se.
- East Asians also saw no correlation with regard to APOE-ε2 per se.
- But! Hispanic and East Asian people had a reduced risk of Alzheimer’s if and only if they had both APOE-ε2 and APOE-ε4.
- Black people, meanwhile, saw a slight correlation with regard to the protective effect of APOE-ε2, and as for APOE-ε4, if they had any European ancestry, increased European ancestry meant a higher increased risk factor if they had APOE-ε4. African ancestry, on the other hand, had a protective effect, proportional to the overall amount of that ancestry.
And as for sex…
- Specifically for white people with the APOE-ε3/ε4 genotype, especially in the age range of 60–70, the genetic risk for Alzheimer’s was highest in women.
If you’d like to read more and examine the data for yourself:
APOE Genotype and Alzheimer Disease Risk Across Age, Sex, and Population Ancestry
Want to reduce your Alzheimer’s risk?
We have just the thing for you:
How To Reduce Your Alzheimer’s Risk: It’s Never Too Early To Do These 11 Things
Take care!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
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