the mountains are calling & i must go.

Eyes reveal early Alzheimer’s disease

Reduced blood capillaries in the back of the eye may be a new, noninvasive way to diagnose early cognitive impairment, the precursor to Alzheimer’s disease in which individuals become forgetful, reports a newly published Northwestern Medicine study.

Scientists detected these vascular changes in the human eye non-invasively, with an infrared camera and without the need for dyes or expensive MRI scanners. The back of the eye is optically accessible to a new type of technology (OCT angiography) that can quantify capillary changes in great detail and with unparalleled resolution, making the eye an ideal mirror for what is going on in the brain.

“Once our results are validated, this approach could potentially provide an additional type of biomarker to identify individuals at high risk of progressing to Alzheimer’s,” said Dr. Amani Fawzi, a professor of ophthalmology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician. “These individuals can then be followed more closely and could be prime candidates for new therapies aimed at slowing down the progression of the disease or preventing the onset of the dementia associated with Alzheimer’s.”

Therapies for Alzheimer’s are more effective if they are started before extensive brain damage and cognitive decline have occurred, added Fawzi, the Cyrus Tang and Lee Jampol Professor of Ophthalmology.

The study was published in PLOS ONE.

It’s known that patients with Alzheimer’s have decreased retinal blood flow and vessel density but it had not been known if these changes are also present in individuals with early Alzheimer’s or forgetful mild cognitive impairment who have a higher risk for progressing to dementia.

Multicenter trials could be implemented using this simple technology in Alzheimer’s clinics. Larger datasets will be important to validate the marker as well as find the best algorithm and combination of tests that will detect high-risk subjects, said Sandra Weintraub, a co-author and professor of neurology and of psychiatry and behavioral sciences at Feinberg.  

Weintraub and her team at the Northwestern Mesulam Center for Cognitive Neurology and Alzheimer’s Disease recruited 32 participants who had cognitive testing consistent with the forgetful type of cognitive impairment, and age-, gender- and race- matched them to subjects who tested as cognitively normal for their age. All individuals underwent the eye imaging with OCT angiography. The data were analyzed to identify whether the vascular capillaries in the back of the eye were different between the two groups of individuals.

Now the team hopes to correlate these findings with other more standard (but also more invasive) types of Alzheimer’s biomarkers as well as explore the longitudinal changes in the eye parameters in these subjects.

She figured it out last week.

I was the person who told her that her mother was dying.

I had family meetings with a giant, loving clan during the course of a few nights, and finally, they looked to her to decide if her mother should go on comfort care.

She made that decision and put her mother on comfort care.

She doesn’t know it, but her mother was the first patient who died under my care.

Ever.

That was the first end-of-life discussion I had on my own with a family. That was the first time I managed a patient on comfort care.

That was the first time I looked at someone and told them that their mother had a very serious illness, and I did not expect her to recover.

And pause to let that sink in, and wait for them to respond.

And confirm I thought her mother would die soon, and while I would never want her to give up hope, sometimes we change what we hope for - instead of a full recovery, we can hope for time spent with those we love most, free of pain or suffering.

As soon as my patient told me this today, I saw her in that hospital room nearly two years ago and was struck speechless.

My patient very quickly said that she didn’t hold it against me and she still wanted me to be her doctor and deliver her baby, and appreciated how I’d taken care of her mom and her family, and I regained the ability to speak and said how honored I was that she’d include me in such a joyful event for her family, and we carried on with the appointment.

But holy cow, y'all.

The grandbaby of the first patient who died under my care will be one of my last continuity babies in residency.

I’m covered in goosebumps.

Not only has this patient come back to subsequent appointments, but her sister is pregnant and established with me.

I will be delivering two grandbabies of the first patient who died under my care.

My doggo, Ezri, who rarely barks and mostly borks.

She’s a German spitz - in the same family as keeshonds and pomeranians. She might be crossed with something else as her freckled coat, non-pointy nose, and personality are not standard for her breed (they’re usually a lot more high energy and excitable - she’s super laid back and chill). She’s a bit less fluffy than breed-standard too, mostly because she’s grown out from her spring/summer trim (not usually necessary/good for her type of coat but she gets terribly itchy otherwise). It also makes her look like a puppy of a large breed:

Ezri’s best friend is Murder Cat, who is a gentle friend to humans and Ezri, but does things to mice that would make Hannibal Lecter go “Isn’t that a bit much?”

I got Murder Cat as a kitten, and she used to try to nurse on everything when she was small. Eventually, she settled on her favourite thing to nurse on, Ezri, who has never had puppies and a little confused at first but eventually went with it. She grew out of it, but they have stayed snuggly buddies ever since.

New Years here is full of fireworks outside and Ezri gets Vry Scared. I usually set her up somewhere with a snuggly spot right by me, and Murder Cat comes and does this all night: 

She goes everywhere with me in my bakfiets (cargo bike) and lets me warm my hands in her fur on cold days.

And her ears disappear if I say her name to get her attention.

ok so great thanks for coming to my TED talk about my dog, good night, drive safe