largely reflects Dr . Gibbs ’ background as an excellent neurologist . He seems to have a way of explaining complex topics in simple terms , which is indeed a major attraction of the book . I like his narrative of how we accomplish performance of complex activities . He states that it “ relies on your brain ’ s capacity to remember : to listen , learn , recall , process new information and evaluate and translate all of that into meaning and action . Alzheimer ’ s gums up the works . In effect , it destroys the compass and coordinates of memory , eventually leaving the mind adrift at sea .”
In subsequent chapters , Dr . Gibbs takes us through his early symptoms and the eventual diagnosis of AD . His first symptom was problem with smell : hyposmia and phantosmia ( olfactory hallucination ). MRI of the brain showed a pituitary adenoma , which was later removed . As expected , it did not correct the olfactory problem . He started worrying about Parkinson ’ s disease ( PD ), in which hyposmia is an early feature , even though he did not experience any other symptoms of PD . The next milestone came serendipitously when he underwent DNA analysis as a part of genealogical study . His DNA was negative for LRRK2 mutations , which are seen in PD . However , he had two copies of apolipoprotein E4 ( APOE-4 ) gene , a significant risk factor for AD . Over the years , he noticed “ mild lapses in memory ” and progressive worsening in his “ ability to consolidate immediate memory into even short-term memory .” Amyloid PET scan showed “ unmistakable telltale signs of AD .”
Like many patients , he alludes to his “ bucket list ” of things to do after being diagnosed with early AD . He wanted to climb Mt . Kilimanjaro ( just short of 20,000 feet ); however , at the first stop on the way , at 9,000 feet , he developed “ headache and queasiness ” and could not pursue the arduous climb . Next year he wanted to go back but compromised to a less strenuous adventure : climb the Beacon Rock , one of the tallest monoliths in the U . S . ( 848 feet ). True to form as a neurologist , he took part in a study to see if his cognitive function ( measured by an app on the iPhone ) improved after reaching the top ( he describes feeling “ exhilarated ” after the climb ); his cognitive assessment score apparently increased by 15 %. In a later chapter he discusses the role of physical exercise to slow down the progression of cognitive decline . week after his third infusion he developed headaches , and later had trouble reading even simple words . He describes this as , “ Everything written turned to alphabetic soup .” He did not experience any difficulty understanding spoken language and started using more and more audiobooks . The headaches became severe along with very high blood pressure culminating in admission to the ICU . An MRI showed brain edema with areas of microhemorrhages , findings typical of amyloid-related imaging abnormalities ( ARIA ). A course of IV corticosteroids led to improvement and the MRI normalized except for hemosiderin pigment from the microhemorrhages . Dr . Gibbs states “ Hemosiderin in my brain is very similar to pigments in the ink used in tattoos . I really do have a tattoo in my brain .”
A Tattoo on my Brain is a great book dealing with both the humane and the scientific aspects of AD and is a must-read for physicians , patients with early AD and caregivers . Aducanumab has since been approved by the FDA for early stage of AD and the prospects for early diagnosis and prevention / treatment of AD appear to be getting brighter and brighter .
Let me conclude with a trivia for you to solve ( just for fun !) and assure yourself that you are not having early AD : mention 5 words which start with letter A , which very closely relates to AD in 5 minutes ( of course , Aloysius Alzheimer deserves to be the first !).
Dr . Iyer practices at the Neurodiagnostic Center of Louisville and is a retired professor of neurology at the University of Louisville School of Medicine .
Dr . Gibbs talks about taking part in clinical trials in the chapter titled “ My Experimental Life .” In his unique style he states , “ Clinical trials are the bricks and mortar of medical science , and if having Alzheimer ’ s means I ’ ve had to step away from any professional involvement with them it also opened a new opportunity to stay involved . Now I can be a subject , participate in clinical trials as a patient . That appeals to me .” In March 2016 , he participated in a Phase 3 clinical trial of the monoclonal antibody called aducanumab . Dr . Gibbs believes that he received placebo , but in the subsequent extended trial he was able to receive aducanumab infusions . A
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