Dr. Sanjay Gupta: I have a family history of Alzheimer’s disease. I wanted to understand my own risk

Editor’s note: Dr. Sanjay Gupta, CNN’s chief medical correspondent, is a practicing neurosurgeon and bestselling author on brain health. “The Last Alzheimer’s Patient” will premiere on CNN’s “The Whole Story with Anderson Cooper” on Sunday, May 19 at 8 p.m. ET/PT and air on MAX on June 18.

CNN
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I’ve been reporting on Alzheimer’s disease for more than two decades, and any progress in the field seems incremental at best, leaving most patients and their loved ones with few options. But while filming a new documentary, “The Last Alzheimer’s Patient,” I met people across the country who had been diagnosed with the disease or were at high risk of developing it . Through lifestyle changes alone, I saw amyloid plaque levels decrease in their brains, their cognition improve, and even signs of disease reversal.

It was amazing and also made me think about my own brain, as I have a family history of Alzheimer’s disease.

So it was with some trepidation that I decided to learn more about my dementia risk. It was one of the most personal and eye-opening experiences I have ever had.

To begin with, I underwent an intensive exploration of my brain, much deeper than I thought possible. This was not a simple examination of the anatomy or even the genetics that might predispose me to a particular type of dementia. The goal was to get a complete history of my brain, from my earliest days through my years of education and training to today: a man in his fifties. More importantly, the extensive testing could give me a clearer idea of ​​where I was heading and how to steer my path in the most favorable direction.

Even as a brain surgeon myself, I was surprised how well your brain health can be measured. When it comes to the heart, it is widely accepted that a battery of tests can give us a clear idea of ​​how to predict, prevent and treat heart disease. However, until recently, we really couldn’t say the same about the brain. Many brain scientists still struggle to define the criteria for a healthy brain. The general consensus was that the “black box” in your skull was rather fixed and there was little you could do to evaluate it, let alone optimize it.

Dr. Richard Isaacson, a neurologist, convinced me otherwise, and it led to one of the most fascinating – and somewhat frightening – days I’ve experienced in my life. I have known Richard for a long time and we are friends. We’ve had great conversations about our shared love of the brain, and I often turn to him for his thoughts on neurological developments in the news. What has always struck me about Richard is that he is systematically reluctant to accept the status quo in medicine, almost more as a matter of justice than of scientific research, although he is the rare individual who knows differentiate in both cases.

So I immediately thought of him when thinking about the idea of ​​a preventive visit to neurology.

To be clear, I wasn’t going to see Richard because I thought I had a problem. But that’s the point: when people talk about the American medical field as a “sick care” system rather than a health care system, I think that’s what they mean. say. Richard would certainly see me if I was sick, but he preferred to see me now, when I was healthy, fully believing that it could help maintain my brain, reduce my risk of dementia, and even optimize my functions, as he described in a 2018 study.

I flew to Boca Raton, Florida, to see Richard at the Florida Institute for Neurodegenerative Diseases clinic on a beautiful March day. He had advised me in advance not to exercise or eat that morning and to prepare myself for a day of intense mental gymnastics. Even though it wasn’t an IQ test, he said that in some ways it would be much more personal.

I have to say, it was very meta to do an assessment of my own brain and find out if it was working as it should or if there were any issues that I hadn’t noticed yet. Was I starting to rust? Maybe I was making mistakes that my family, friends, and colleagues were too polite to point out to me. If there were any gaps in processing speed or executive judgment, they could now be uncovered and unmasked.

When I arrived at the clinic, I first underwent a battery of blood tests, checking my phosphorylated tau ratio, better known as the Alzheimer’s blood test, and measurements of my lipid levels, inflammation and glucose, to name a few. I was also tested for my genetic risk of Alzheimer’s. If I carried the APOE4 gene, it could lead to a much higher risk of disease. I spit into a tube to check my oral health. After that, I stepped on a body composition scale to determine where and how much bone, fat, and muscle I had in my body.

I was a little surprised to catch Richard in the corner, looking at the display and saying, “Interesting…” while stroking his chin. No one likes to see their doctors do that. Even doctors don’t like seeing other doctors do this. “What?” I asked from across the room. “Oh,” he replied. “I don’t know, it’s probably good.” He later told me that he saw evidence of an old injury in my left arm and accurately predicted that I had done an intense leg workout the day before. It was a real reminder of how clearly the body keeps score. Even though I hadn’t thought about this injury in years, it had clearly left a mark on my body and still triggered a result on this test.

Next come the cognitive tests. This was perhaps the most surprising. At first I was told to relax and listen to the detailed news about a captain of the Atlanta football team, a quarterback who had injured his finger on a fishing trip before the great match. I thought I was paying attention, but I suddenly realized that I probably wasn’t as engaged as I thought I was. “What day did he get injured and how many stitches did he need? What was the player’s name? I was asked 15 minutes later. Can I even be sure if it was his thumb or his left ring finger?

Quick: Say as many words as possible starting with the letter “G”, then immediately say as many animal names as possible, both in one-minute increments. The longer the words and the more unusual the animals, the better. There were lists of words to remember, three-dimensional cubes and clocks to draw, and dozens of faces corresponding to their names. I had to scratch and sniff 50 different smells and determine, in one case, whether something smelled more like gasoline, acetone, or a forest fire. In another case it was lavender or lilac. I found myself suddenly unsure and tried to remember that smell to try and answer correctly.

I felt like my brain was being cross-examined by a very competent prosecutor.

It wasn’t just about how many mistakes I made, but also what type of mistakes, how long it took me to respond, and whether I simply lost my attention. There are obvious red flags that appear if someone turns back a clock or has lost the ability to distinguish certain smells. The more subtle concerns involved visuospatial construction, or the ability to ignore incongruent stimuli in the Stroop Color and Word Test, such as identifying the color red, even if that word appears purple on the screen .

Although I have never been diagnosed with dyslexia, Richard thinks it may be something I suffer from. “Do you count on your fingers?” he asked me. I’ve always done this and never considered it remarkable or suggestive of anything important. It turns out that I was less likely to remember words with lots of B’s ​​and D’s because perhaps I had always avoided letters that I confused more easily. These types of insights into my own brain, large and small, were all very fascinating (and a little unsettling) to me. For Richard, however, they represented opportunities for early intervention, some of which are remarkably simple.

“Most doctors would look at your results and say you’re fine,” Richard explained before showing me my lab test results. “But what they’re really saying is that you’re probably fine – for the next few years. I’m playing the long game here, and I think you’re going to see a lot of areas that we can start to address now, today. I’m a pretty competitive guy, so I’m used to seeing all the “greens” pop up when I look at my lab test results. After all, I take great pride in my health and I approach it with the same rigor that I approached my grades in medical school. I really wanted to do well, certainly as well as I could do.

So when Richard flipped through my lab results and showed me a page that contained not only a considerable amount of yellow but also some red, my heart broke.

My homocysteine ​​level was high, but my B12 level was low. This didn’t surprise Richard, as he had also discovered a mutation in my MTHFR gene, which meant I probably hadn’t been processing homocysteine ​​well. My omega-3 levels were good, but not when compared to my omega-6 levels. My DHEA levels were a little low, which might partly explain why I had more problems…