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Neurology (Expert Forum)
MRI's, Prophylactic use of Statins and Gingko Biloba
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury
MRI's, Prophylactic use of Statins and Gingko Biloba
by ontherecord, Apr 28, 2004 12:00AM
Dear Doctor
What do you make of the research indicating the protective effect of second-generation statins against Alzheimer's Disease? Do you think that elevated cholesterol levels increase levels of APOE4 or trigger pre-exisiting levels?
What do you make of the research indicating the protective effect (or helpful effect) of 120-240mgs of Ginkgo Biloba against Alzheimer's, based on the work already done? Effective? Promising? Worth taking at any age (I'm 26)? Does it work much like antioxidants?
I'm scheduled to have an MRI with and without contrast very soon, and I would like to know what serious conditions this would exlude for certain? My neurological exam was NORMAL, and my doctor didn't even think I needed one (for a mild head injury that I sustained almost a year ago, where there was no LOC, no PTA, no dizziness/nausea or headaches, but which seems to have knocked some unquantifiable level of intelligence out of me, which he attributes to pre-existing depression. The depression is being addressed with antidepressants).
Can you detect APOE4 or neurofibrilliary tangles/plaques, or microscopic brain injury on MRI? Would it be possible to talk to the radiologist right after for a summary?
I know you've said that the MRI is test of structure, not function, but at 26, IF the MRI comes back normal, combined with a normal neurological exam and no symptoms besides this self-described (but honest belief) loss of intellgence, would you feel comfortable that enough was done and that there is nothing serious to worry about?
Thanks again for your time.
What do you make of the research indicating the protective effect of second-generation statins against Alzheimer's Disease? Do you think that elevated cholesterol levels increase levels of APOE4 or trigger pre-exisiting levels?
What do you make of the research indicating the protective effect (or helpful effect) of 120-240mgs of Ginkgo Biloba against Alzheimer's, based on the work already done? Effective? Promising? Worth taking at any age (I'm 26)? Does it work much like antioxidants?
I'm scheduled to have an MRI with and without contrast very soon, and I would like to know what serious conditions this would exlude for certain? My neurological exam was NORMAL, and my doctor didn't even think I needed one (for a mild head injury that I sustained almost a year ago, where there was no LOC, no PTA, no dizziness/nausea or headaches, but which seems to have knocked some unquantifiable level of intelligence out of me, which he attributes to pre-existing depression. The depression is being addressed with antidepressants).
Can you detect APOE4 or neurofibrilliary tangles/plaques, or microscopic brain injury on MRI? Would it be possible to talk to the radiologist right after for a summary?
I know you've said that the MRI is test of structure, not function, but at 26, IF the MRI comes back normal, combined with a normal neurological exam and no symptoms besides this self-described (but honest belief) loss of intellgence, would you feel comfortable that enough was done and that there is nothing serious to worry about?
Thanks again for your time.
Doctor's Answer
by CCF-Neuro-M.D.-CS, May 03, 2004 12:00AM
The evidence for use of statins in patients with AD is not complete. There are reports for and against using statins. The formal studies to answers these questions are being completed now (randomized double blind placebo controlled). I can not speculate as to whether these medications will ultimately be used to help AD patients.
The same can be said for Ginko. Again there are studies in the literature on both sides of the debate. There was one double blind placebo trial which suggested a benefit with Ginko, but the study used non-standard measures for the endpoints. I know it is used heavily in Europe for various conditions. One of the problems in the U.S. is that these agents are not controlled in regards to manufacturing and cotent. Therefore, the various products on the market can have varying levels of the active agent. Also, ginko can interact with other medications, and therefore, I tell all patients to inform their doctors so that known drug interactions can be avoided. Regarding it's use in young patients, I believe there is no evidence to support its use at this time.
The unltrastructural changes you are mentioning can not be seen on MRI scans. The MRI helps to exclude mass lesions, vascular disease, diseases of the white matter (such as MS), and looks for atrophy. Certain patterns of cortical atrophy may suggest one diagnosis over another. In patients with documented dementia occasionally a PET scan (studies how the brain uses radioactive glucose) is helpful. This tests more of the function of the brain. Regarding the interpretation by the radiologist, it is typically performed minutes to hours after the scan is completed. I am not sure if you can speak to the radiologist, but you should be able to review the results with your neurologist.
It seems that you are receiving a good evaluation. Without personally seeing you I can not tell you if the evaluation is complete. The only other test that may be of help is a neuropsychological test. It may reveal areas of cognition which are not working properly. If specific areas are identified, then strategies and skills to adress this area may be of some benefit. I hope this answers your question, and good luck. Sorry for the delay, I wanted to check on a few sources.
The same can be said for Ginko. Again there are studies in the literature on both sides of the debate. There was one double blind placebo trial which suggested a benefit with Ginko, but the study used non-standard measures for the endpoints. I know it is used heavily in Europe for various conditions. One of the problems in the U.S. is that these agents are not controlled in regards to manufacturing and cotent. Therefore, the various products on the market can have varying levels of the active agent. Also, ginko can interact with other medications, and therefore, I tell all patients to inform their doctors so that known drug interactions can be avoided. Regarding it's use in young patients, I believe there is no evidence to support its use at this time.
The unltrastructural changes you are mentioning can not be seen on MRI scans. The MRI helps to exclude mass lesions, vascular disease, diseases of the white matter (such as MS), and looks for atrophy. Certain patterns of cortical atrophy may suggest one diagnosis over another. In patients with documented dementia occasionally a PET scan (studies how the brain uses radioactive glucose) is helpful. This tests more of the function of the brain. Regarding the interpretation by the radiologist, it is typically performed minutes to hours after the scan is completed. I am not sure if you can speak to the radiologist, but you should be able to review the results with your neurologist.
It seems that you are receiving a good evaluation. Without personally seeing you I can not tell you if the evaluation is complete. The only other test that may be of help is a neuropsychological test. It may reveal areas of cognition which are not working properly. If specific areas are identified, then strategies and skills to adress this area may be of some benefit. I hope this answers your question, and good luck. Sorry for the delay, I wanted to check on a few sources.
Do you actually expect to get a helpful answer to this question on this board? Have you read the other responses? Maybe 1 out of 10 is information you couldn't just get off of Google.
If you think a busy neurologist is going to take the time to answer this question in-depth, you're not paying attention.
Myself I have a Visual Evoked Response Report, as yet uninterpreted by the doctor, and it would be real helpful to be able to post it and get an interpretation. The stuff you are posting will be helpful to no one.
Even to you, because apparently no one thinks there is anything wrong with you!
And be aware that antidepressants can have wide and diverse effects on different individuals, and there have been reports of cognitive dysfunction, frontal-lobe syndrome, etc,. from antidepressants. You should really be off that stuff if you want an honest assessment of your brain.
Finally, nowhere in psychiatry (that I am aware of) is "lack of intelligence" a sign of depression, nor are antidepressants approved, marketed, or even clinically tested for such a condition. The kook that gave them to you is probably trying to get you to shut up and go away. Antidepressants ARE good for doctors in that way!
Consider reading "Prozac Backlash" by Joseph Glenmullen.
Only a reliable competent doctor should be giving any advice to patients. They come here for answers, ideas, and advice for a direction on their suffering and they don't need an arrogant want to be trying to give them help off of something you may have read on another sight and then try to pass it on to them.
On behalf of the people who would really like to use this sight and donate to use this sight, I ask you to find another sight that you can chat with other arrogant want to be hobbiests and let us post our sincere questions.
I wasn't kidding about the hobby thing. The only thing about your hobby, is, it has negative ramifications for people who actually want to reach the neurologist or exchange info with others who actually have neurological conditions.
Of course you have the RIGHT to post here, but be aware that many of us don't find it helpful and may actually find it annoying and counter-productive.
Second, of course I have the RIGHT to post here, just like you have the right as well. Algernon71: if you want answers to your tests, talk to your treating neurologist instead of venting your misdirected ire at me.
LT: CAGE: if you've noticed, I haven't posted many commnents recently because I realized that I couldn't care less about you or anyone else, and I have my own problems to worry about.
Since you've accused me of being arrogant, I feel I must respond. I DO believe that I AM better than you. I believe I have a right to be CONFIDENT (I don't call it arrogance). I am 26 and have a law degree and an MBA from one of the finest institutions in the country and am admitted to practice law in two Northeastern states (NY and Massachusetts). When you accomplish what I have, then come back and talk to me.
I take an interest in neurology for a variety of reasons, personal interest being one of them. I will never get jerked around by doctors the way you two may, and you know why? Because doctors have a tremendous amount of respect for me and the knowledge I come in with. Believe me, they'll go the extra mile with me, spend the extra time, and be more cordial with ME than they will be with YOU. More often than not, their tone goes from paternalistic to supplicating in a New York minute within 5 minutes of the conversation, and I get the time and treatment I need, in large part because of my awareness.
Algernon71 once again: Neuropsychological testing is USELESS here because I do not want any subtle deficits (if any exist) revealed, because there is nothing we can do about them anyway. As well, I DO have pre-existing depression that was exacerbated by my head injury, so the antidepressant prescription was good doctoring, as it has helped me regain my mental clarity, slowly but surely. And my neurologist is board certified in neurology and psychiatry and has OVER a decade of experience, so he is not some "kook" as one of you clowns suggested. In any event, the neuropsychiatric sequelae from mild head injury is sometimes persistent and often variable, and more complicated than you may think, or appreciate.
Finally, yes, much of the information is available on the internet, but I am asking about the PROPHYLACTIC USE of statins and Gingko Biloba, which HAS NOT been addressed by the literature.
In summation, you guys are entitled to your opinion, but I don't accord it much weight. I will post whatever I want, whenever I want, because I owe you nothing and couldn't care less what two faceless clowns on the internet think about me. You know why? Because I AM better than both you guys will EVER be.
Furthermore, whether you are a real leiutenant or not is questionable, but whatever the case may be, your strongarming tactics carry no weight in the civilian world, where people are allowed to have ideas of their own. So don't try to pull that nonsense on me.
You have signs of a personality disorder. Ask your neuropsychiatrist about Narcisistic PD.
I have an advanced degree also and could list my resume, but I don't come here to impress others. You apparently do.
Qualifications mean nothing to me. My neurologist is **** and he has similar qualifications. If yours is so great and listens so closely to you, why are you posting questions on here?
As far as the antidepressant, since you're so smart and thorough and all, I'm just suggesting that you might want to investigate antidepressant treatment a little bit closer. Do so- or don't- I couldn't care less.
Now, I have to go to work. That's why I've only posted on here rarely- I do other things with my time! It might be something for you to consider- if you're a lawyer, think of the billable time you are spending annoying us, when you could be earning!
All my best,
Algernon71
I just don't agree with the way you post to other people. You are not a doctor. I don't care how much education or experience you may have. Let the other people post questions so they may move on in their life.
Your attempt to impress has failed. Like Algernon said, if you are so important why are you here and not doing your ambulance chasing lawyer thgs?
I am here because of a car accident and several surgeries that have left me disabled. There is very little information on the internet or through other sources about my condition and this neuro on this sight is the most honest and gives a direction for hope. That is why I would like to post a question but you are too busy trying to impress the world while you hide behind a computer somewhere else in the world. Sorry you have such a worthless petty life. I am done here for good.
As to the neuro, I appreciate what you have done on this sight. I guess I will just keep checking the archives for answers. If I wasn't so far away, I would love to come to your clinic.
Algernon71: you've already gotten through once, and received what seemed to be a sufficient response, so I don't know what you're complaining about.
Lt Cage: your problems are your problems and mine are mine. To me, my situation is more important, even though your situation is objectively (at least on paper) seemingly more serious. Again, I owe you nothing. You have absolutely the same opportunity to post as I do. And if you like my comments, ignore them. No one is forcing you to read them.
To both you guys: if you look at the "purpose" of the forum, it's exactly to ask the questions like the ones I'm asking -- for GENERAL INFORMATION. So my original question (before the thread was hijacked with diatribes and vilifications) is consistent with the purposes of the forum.
Since you're both self-appointed experts in psychology (and I majored in psychology in college, so I know all about it), you are both responsible for PROJECTION. I'm sure you pysch gurus know all about it.
Finally, although my neurologist does take the time to answer my questions, he is a busy guy and has a lot of patients to manage, so he's not going to talk about prophylactic measures for Alzheimer's disease with a 26 year old when he's got 10 patients in the waiting room. Here, the neurologist responds at his or her OWN time, and in any case, a Cleveland Clinic neurologist would probably be more up-to-date on these developments than a private practice neurologist.
Just remember, when it comes right down to it, you're essentially telling me that your problems are more important than mine and that I should yield to people like you. I say screw you both, and best of luck, whatever you do.
I don't envy you- I suspect that people react that way to you in general, not just on the Internet.
In any event, it's a recurring pattern with you: with another poster in the past, you told her to get off the internet for a couple of weeks and see if that helps. Alright buddy, the world revolves around you and no one else. Who is narcisstic NOW buddy? YOU.