So I'm not a political pundit I don't think people
really care what I have to say about politics and I'm not talking about
politics today but I am talking about the MoCA
and why would you care about what I have to say about a MoCA
first of all what is a MoCA the Montreal Cognitive Assessment
we've actually been using that for years because we've been doing work
in terms of cognitive decline Alzheimer's
and as many of you maybe most maybe all of you know
the MoCA hit the news again when our president Donald Trump
was bragging about his perfect score on it
now again few other docs not many but a few other docs use some cognitive
assessment but that's the MMSE it's a different thing
we'll talk about that in a minute but I'll talk with you as we go through this
I'll give you my perspective as someone who works routinely with the MoCA
and what does it really mean for Trump and for us
well the MoCA again stands for the Montreal Cognitive Assessment it's a
brief screening tool for cognitive impairment
it was developed by Ziad Nesreddine the first author on this
article you can actually watch a MoCA test being administered on the
Internet right here click on this link and you'll see the
actual components you'll see an actual patient taking the test in terms of the
components I've covered that before in other videos you have tracking like
1 to a to 2 to b to 3 to c that's some executive function type of
things you have very simple identify this animal lion
rhino camel draw this 3D box so you continue to have
some basics in terms of looking at how your brain works now I mentioned some
other docs here's where other docs often will do
cognition exams it's the MMSE and you'll see it
mostly in Medicare Advantage it's one of the requirements for quality
evaluations with Medicare Advantage you see MMSE
much more because it's about a 3-minute exam
like 9 questions 9 or 10 questions compared to 3
minutes compared to 10 to 15 to 30 to do the MoCA
now there have been comparisons of the two the MoCA does have significant
advantages it goes deeper into executive function
if you look at things like evidence on stroke it's much more clearer if someone
has had a stroke by looking at the MoCA rather than the
MMSE MoCA and the Mini-Cog or MMSE
are not the only ways there's also just the very simple
draw the clock version I've got a video on
patients with congestive heart failure and it talks about
cognitive decline and problems with drawing the clock
drawing the clock is really easy unless you've got cognitive problems and as you
begin to see these are some different versions of
problems that you'll get you'll see big gaps in areas where the
numbers needed to be you'll see one hand on the clock instead of two
you'll see the shorthand and the long hand
confused and again numbers can go anywhere so there's 3 different ways
that we've mentioned so far the MoCA the Mini-Cog
or MMSE and just a simple clock drawing test
and there's comparison science between all of these why did this make the news
again this time political reasons you look at
this Fox News poll the two political contenders for
president for next year and one of the issues is cognition but
again I'm not going to voice an opinion in
that space the question is does that perfect score
on the mocha mean that he's really smart no this is not an IQ exam the Montreal
Cognitive Assessment MoCA test discussed by President Trump and Chris Wallace is
"not an IQ test" that's a quote by Dr.
Ziad Nesreddine the guy who developed who created the Montreal Cognitive
Assessment there's another guy who was psychologist
made a comment not so complimentary he said I'm a
psychologist I've administered the MoCA test
hundreds if not thousands of times let me tell you
bragging about acing this test is the equivalent of bragging that you tied
your own shoes this morning well again I've given the MoCA and no
it's not a thing to brag about if you pass it there's studies that show about
where this is if you look at 70-year-olds for example
and above about 30 will start showing
some challenges score 27 or 26 or less so yeah there are some numbers here in
this one 31 of participants scored below the
cutoff 26 over 30. so
again it doesn't mean that he's a genius but it's a little bit more than tying
your shoes in the morning especially if you're 70
or 74 like he is but what does this mean to me
I have to tell you my brain goes somewhere else and
it has to do with this whole question of why a physician
focused on prediabetes would get into cognitive decline have you ever read a
book The End of Alzheimer's it was written by
a physician named Dale Bredesen I remember doing a 2-day training
program with him and he came up afterwards and asked me what
I thought about the training program i said to him
I was surprised after 2 days you only had about an hour
hour and a half on prediabetes he said yeah
and I said so I thought way over half and I was being very
conservative at that point I thought way over half of Alzheimer's
was due to prediabetes he looked at me
funny and said no probably all of it's due to prediabetes
even if there isn't documented prediabetes in the body
it's CNS meaning central nervous system insulin resistance or brain insulin
resistance you ever heard of that brain insulin resistance what is that
well here's a Nature magazine article about brain insulin resistance in
type 2 diabetes and Alzheimer's disease concepts and conundrums
here's a little bit more detail out of that article brain insulin resistance
can be defined as the failure of brain cells to respond to
insulin as they normally would resulting in
impairments of synaptic metabolic and immune
response functions in other words yes your brain can become insulin
resistant now am I saying Donald Trump's brains and sources no my
concern is not so much that one individual
my concern is all of us and insulin resistance is
inextricably linked to loss of our cognitive
function we used to think that these things were like
"normal aging" they're not now am I saying that the president
doesn't have prediabetes no I'm not in fact he raised this issue
himself a couple of weeks ago he was announcing a much needed improvement
break on prices for insulin and he said I don't use insulin should I
be yeah the English is kind of messed up
but that's a direct quote I don't think he
has diabetes I think it would probably be out if he does
and but I do think he probably does have some carb metabolism impairment
look he's age 74 he's got excess body fat we all know
that and we can all see his dietary habits they're a challenge
but again my concern is not the president it's the rest of us
type 3 diabetes the linkage between brain dysfunction and
insulin resistance processed food high fructose corn syrup
juice sodas high carb diets these things are linked
with obesity cardiovascular impairment diabetes and aging and those
are all very much linked to Alzheimer's and that goes through increased
oxidative stress mitochondrial dysfunction increased
inflammation and elevated amyloid beta levels we'll get a little bit deeper
in terms of that yes it has to do with cardiovascular inflammation
oxidative stress increased AGE you ever heard that term AGE
we've used it several times it stands for advanced glycation end products
it is basically where glucose has become covalently or permanently bonded
to proteins that's because your glucose levels are too high an AGE
advanced glycation end product that I bet you've heard of
even if you didn't know it the most commonly known one
is hemoglobin A1c or glycated hemoglobin as you start getting deeper in terms of
these bioindicators again you begin to see the relationship
of those with impaired insulin signaling and
cognitive decline again going back to that same
theme of Alzheimer's disease and the link
to diabetes and insulin resistance for those of you who get more to the
cellular level you're talking about the astrocytes the microglia
the neurons the parts of the brain that the functioning cellular parts and you
say look no there's inflammation where astrocytes and microglia
may actually even burn up and damage the neurons
yeah there is and that does happen and yes that's very much associated with
the inflammatory process that you see with prediabetes that you see with
cognitive decline type 3 diabetes and mitochondrial
dysfunction for those of you who are focused on mitochondrial dysfunction
yes mitochondrial dysfunction is very much a part of this
aging hyperglycemia overloaded free fatty acids
increased body fats and diabetes insulin resistance and Alzheimer's
the pattern goes on and on and on for those of you who are more focused on
you say no wait a minute it's amyloid amyloid beta
it's neurofibrillary tangles it's tau phosphorylation oxidative stress AGEs
you see that pattern going again with those
biomarkers and the links between insulin resistance and neurodegeneration
or Alzheimer's and let me just say it one
more time if you think no no it's amyloid beta it's not diabetes
go back and look at the actual metabolic pathways they are linked
so the facts the models the hypotheses go
on and on and on as we try to get our arms around
this devastating disease that's having a huge impact on America and the
rest of the world no matter what the theories
the end result is still the same significant brain damage
so what can we learn from this well I would strongly consider
get a Kraft insulin survey try a Freestyle Libre or a Dexcom 6
know your glucose your carbohydrate metabolism
get an inflammation panel see these things are key missing data
for your health indicator dashboard make sure you're healthy
you can call us at 859-721-1414 or email us at
myhealth@prevmedheartrisk.com thank you so much
so i'd like to talk with you a minute about the webinar people don't
understand what the webinar is it's actually a great way to get some
access to health care that you're just not going to get any other way
you actually get the lab tests yourself for at a local lab a Quest lab near you
for the inflammation panel and the OGTT and the insulin survey these are things
inflammation and prediabetes that your doctor just
does not know about and here's the thing Harvard Health and
many others have said look sudden death is not always so sudden the
Hollywood picture that it's a bolt out of the blue is
not realistic it's more like real lightning preceded by clouds wind and
rain stop that metabolic storm before the
lightning strikes and here's where that metabolic storm
comes from it's inflammation and it has to do
usually with prediabetes so again we actually get labs
we go over them in the webinar and then you can start finding out
how you can prevent that heart attack others said
that you couldn't even predict we can show you how
thanks