A few days ago, someone on Reddit asked about lithium orotate for his mother who has Alzheimer’s disease (AD). He stated that he wanted to start her on a 5mg dose. He also said he asked his mother’s geriatrician about giving her lithium orotate. The geriatrician suggested it would be best if he could find a clinical trial for his mother. He posted in the Reddit Alzheimer’s community asking if anyone knew of a lithium orotate clinical trial. Someone quickly responded with a link to a Johns Hopkins trial. The original poster followed up and questioned if he should put his mother through a clinical trial or just give her the lithium orotate himself.

I responded with this rather lengthy reply:

You did not give your mother’s age and how many years she has had Alzheimer’s disease. I think those facts are important in considering her taking lithium orotate.

Regardless of her age and Alzheimer’s progression, I strongly encourage the Johns Hopkins clinical trial. This is a short trial managed by a top medical university. Your mother will have the best of care at Johns Hopkins. She will be contributing to a major research project that potentially will positively impact millions of Alzheimer’s patients for years to come.

I have studied lithium orotate somewhat extensively. My conclusion is that it has the potential to make Alzheimer’s patients feel better; but, I question its ability to actually treat the disease.

Lithium orotate is an unregulated natural supplement. That doesn’t necessarily make it good or bad.

A concern I have is the quality of the supplement. Are you buying a supplement from a pharmaceutical grade manufacturing facility? Or, is the supplement made in a basement in a third world country. This is why regulations are important from a safety and purity perspective.

I have no real opinion on lithium orotate. Many people have made amazing claims that the supplement actually treats Alzheimer’s. To the best of my knowledge, most of these claims are anecdotal.

It is time for clinical trials. In my opinion, Johns Hopkins is well suited to conduct this trial.

I am aware that lithium orotate is a hot topic within the Alzheimer’s world.

The interest in lithium orotate apparently began last year with the publication of a few studies. In addition to the legitimate studies, Amen Clinics published an article titled, New Hope for Alzheimer’s: Study Says Lithium May Reverse Aging Brain. The article is based on a 2025 study published in Nature.

The Amen Clinics article makes several bold statements:

• “This breakthrough points to a future where a safe, natural element could transform how we treat one of the most devastating brain disorders of our time.”

• “the researchers found evidence in mice that lithium orotate—a specific type of lithium supplement—undoes memory loss and reverses neurological changes, helping to restore the brain to a healthier and younger state in subjects with AD.”

• “the implications of this latest finding are profound. With clinical study, it could potentially lead to new and effective treatments for Alzheimer’s disease—and perhaps even Alzheimer’s prevention supplements of lithium orotate.”

The 2025 study published in Nature is a Harvard University study designed to gain “a fundamental understanding of the pathogenic processes leading to memory loss”. The Harvard researchers stated, “Of the metals we analyzed, Li was the only one that was significantly reduced in the brain in individuals with mild cognitive impairment (MCI).”

Lithium (Li), discovered in 1817, is a naturally occurring metal in the earth’s crust which in the solid phase is the least dense of all elements. In the form of carbonate (Li₂CO₃), it has become one of the most frequently used pharmaceuticals in psychiatric treatment owing to its normothymic (stabilized mood) effects.

I could write an entire article on Lithium (Li). It is a fascinating compound. Let’s stay focused on lithium orotate, though. There is a big difference between lithium orotate and therapeutic lithium. The brand name for therapeutic lithium is Lithium Carbonate.

Lithium affects the flow of sodium through nerve and muscle cells in the body. Sodium affects excitation or mania. Therapeutic, oral doses of Lithium Carbonate are usually within the limits of 600–1200 mg Li₂CO₃ per day. This is very dangerous drug. Lithium toxicity can cause death. Lithium Carbonate has a narrow range of safety. Toxicity can occur if you take only slightly more than a recommended dose.

Lithium orotate is a nutritional supplement. It is widely available in the United States (and presumably in most countries). Like most nutritional supplements, the sellers make claims to lure people to pull out their credit card. BrainMD (owned by Amen Clinics) states, “Feeling emotionally reactive or mentally scattered? Lithium Orotate delivers low-dose nutritional lithium—a trace mineral studied for its calming effects on mood, stress, and brain health.” BrainMD also has a disclaimer, “This low-dose lithium supplement is a nutritional formula, not a prescription drug. It is not intended to replace any medication or medical treatment.”

Another online seller, Life Extension, calls their product, “Lithium”. Under “Supplemental Facts” Life Extensions says “Lithium (from lithium orotate)”. I assume the name difference is simply a branding ploy.

Life Extension sells 100 1000mg capsules for $12. BrainMD sells 60 5mg capsules for $13.95. The reason Life Extension has a 1000mg capsule is that they combine lithium orotate with microcrystalline cellulose (a purified, partially depolymerized cellulose derived from refined wood pulp, commonly used as a versatile, safe excipient, binder, filler, and anti-caking agent in pharmaceuticals, foods, and cosmetics.)

Have I convinced you that lithium carbonate needs a clinical trial?

The Johns Hopkins University study is currently recruiting participants. According to ClinicalTrials.gov, the study is described as follows:

The goal of this clinical trial is to assess feasibility, safety, tolerability, and central nervous system target engagement of oral lithium orotate in adults with biomarker-confirmed early Alzheimer’s disease. The main questions it aims to answer are:

• Can participants be recruited, retained, and remain adherent (target ≥80%) over 9 weeks of treatment, and what is the frequency and severity of adverse events?

• Does lithium orotate increase cerebrospinal fluid (CSF) lithium concentration from baseline to 9 weeks compared with placebo? Researchers will compare daily lithium orotate to matched placebo to see if lithium orotate demonstrates acceptable feasibility, safety, and tolerability and engages the central nervous system target (CSF lithium).

If you are interested in participating in the clinical trail, the contact is:

Christopher Morrow, MD, MHS

410-955-5147 or cmorrow3@jh.edu

I don’t fault anyone for taking lithium orotate. As an AD patient, I may get desperate enough one day that I will try an unregulated nutritional supplement. Yet, I am a show me the proven data guy, so I plan to stick with Lecanemab.

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I am writing on my phone in the back seat of an Uber. This is a first!

I had my 14th Lecanemab infusion this morning. I slept through most of it.

When I got home, Big Bit and I took a long nap. I may start meowing and licking myself clean soon.

I am on the way home from Costco. I went to pick up a prescription. Generally, I have prescriptions delivered by Instacart. This drug requires a signature and can't be delivered.

Drug prices piss me off.

The cost for this drug is $58.05. I asked the cashier if the drug was not covered by insurance. She looked and said $58.05 is the BCBS price. She checked the Costco price (without insurance). It is $27.79.

Crazy!

I bet the wholesale cost is less than $20.

I bought a chicken taco kit with fresh grilled chicken.

Taco Tuesday!

Have a great evening (or day, depending on your time zone.)

Greg

What Is Trontinemab?

Trontinemab is a novel antibody made up of two components: gantenerumab and a delivery system called Brainshuttle. Trontinemab is engineered for enhanced access to the brain to enable rapid reduction of amyloid in people with Alzheimer’s disease (AD). It is developed by Roche.

How Does Trontinemab Compare to Lecanemab and Donanemab?

Trontinemab is an experimental drug designed to clear amyloid plaques faster and with fewer side effects (ARIA) than Lecanemab and Donanemab.

Gantenerumab (which works in a very similar way to Lecanemab and Donanemab) failed to significantly slow down AD progression in early trials. These early trials showed that gantenerumab on its own didn’t slow down AD progression because it was slower at removing amyloid. The results of the trial were based on measurements over 18 months. This may not have been long enough for it to have an effect.

Combining gantenerumab with the Brainshuttle delivery system, Trontinemab is thought to cross the blood-brain barrier much more efficiently than Lecanemab and Donanemab. If this proves to be true, Trontinemab will likely achieve similar or superior plaque reduction at significantly lower doses than Lecanemab and Donanemab.

What Is Brainshuttle Technology?

The Brainshuttle is a “fragment of an antibody” that interacts with cell-surface receptors on the blood-brain barrier. This interaction results in the Brianshuttle effectively penetrating the blood-brain barrier. If the Brainshuttle is carrying gantenerumab, it will be deposited deep within the brain.

Roche believes Brainshuttle might also carry “enzymes, oligonucleotides (short, synthetic single-stranded DNA or RNA molecules) or enable the delivery of specific gene therapies.”

When Will Trontinemab Be Available?

Roche began testing Trontinemab in their lab in 2012. Fourteen years later, Trontinemab is in its Phase 3 trial.

According to clinicaltrials.gov.:

Phase 3 began with two identical studies. TRONTIER 1 and 2 will treat 800 patients each with 3.6 mg/kg trontinemab or placebo monthly for six months, and then every three months for a total of 1.5 years. An open-label extension is offered. Participants will be amyloid-positive and have MCI or mild dementia, with less than four microhemorrhages, no siderosis, history of macrohemorrhage, or severe white-matter disease. ApoE4 homozygotes will be allowed. The primary endpoint is the CDR-SB; secondaries include MMSE, ADAS-Cog13, ADCS-ADLs, and global CDR score. Prescreening will use plasma p-tau217. The global trials will span 18 countries in North and South America, Asia, Europe, and Australia, with completion set for 2028.

If the Phase 3 results are positive, Roche will make the decision to apply for regulatory approval or not. Depending on a number of factors (which are not known at this point in time), it could take up to two years for regulatory approval and manufacturing to begin.

My best estimate is that the earliest Trontinemab could be available is late 2030.

Sources:

https://clinicaltrials.gov/study/NCT04639050

https://www.roche.com/solutions/pipeline

https://www.roche.com/media/releases/med-cor-2025-04-03

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The tradition is to take a break from Alzheimer’s discussions on Friday and have a bit of fun. Take a look back in history. Highlight a few fun or whacky events around the world. Maybe, even talk about favorite restaurants from my travels years ago.

Not today.

There is too much turmoil in the world that needs our focus and attention. Frankly, to a large degree the world is at an inflection point. There are important economic, political, military, and space exploration issues that have significant implications for all of us.

How these issues are resolved impacts the future of Alzheimer’s disease research. In the United States, the billions of dollars spent on the war will likely result in cuts to research grants.

Artemis II Comes Home Tonight

The technology is solid for a safe reentry. The crew certainly has the chops needed to endure the landing into the Pacific Ocean. Come home safely, astronauts,

Iran and the United States Representatives Meet in Pakistan Saturday

Under the cloud of a shaky ceasefire agreement, high level negotiators from Iran and the United States will meet to take the first steps toward a long-term peace accord.

Israel Continues to Bomb Lebanon

Lebanon said at least 182 people were killed and hundreds were wounded on Wednesday. The attacks continue with no end in sight.

The Iran War is pushing inflation higher around the globe.

Most economists do not see much relief in consumer prices until the war is over.

From a mental health perspective, the four events listed above are certain to create stress that results in anxiety, depression, and paranoia. Many innocent lives had been shattered in the Iran War leaving families and friends of the dead devastated. Thousands of people have sustained injuries. The physical injuries may heal; but, the mental health damage will likely linger forever.

Due to rapidly rising costs of fuel, groceries, and housing, many people will go to bed hungry tonight. They may be worried about paying their rent. Or, paying for gas for their car so they can drive to work.

If the world has the ability to develop Artificial Intelligence, and to build a rocket that can travel 695,081 miles over a ten-day period, why can we not prevent deadly wars?

I hope everyone has a nice weekend. Please pray, meditate, think deeply, or commit a random act of kindness in the name of world peace.

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Last night, I started thinking about the impact Alzheimer’s disease (AD) has on families. I spent several hours researching, reading, and learning about how families are effected and how they cope. Some of the information I found included dementia patients, not just people with Alzheimer’s.

A large 2024 study in the United Kingdom, stated, “Dementia can adversely affect the quality of life (QoL) of family members/partners of those affected. Measuring this often-neglected burden is critical to planning and providing appropriate support services.” During my meeting with Mia yesterday, I told her Duke Health did a phenomenal job preparing us for my infusion treatments with one exception - the personal and family burden. I believe the UK study is spot on when they talk about the “often-neglected” quality of life impact.

The UK study involved 711 family members/partners of patients with dementia and AD. The Family Reported Outcome Measure (FROM-16) was employed to measure the impact the disease had on the study participants. The FROM-16 comprises 16 items, each with three response options: “Not at All” (score=0), “A Little” (=1) and “A Lot” (=2). The 16 items are divided into 2 categories (domains): emotional (comprising 6 items, maximum score of 12) and personal and social life (comprising ten items, maximum score of 20). The two domains are calculated as a total summary. The lowest possible score of FROM-16 is 0, and the highest 32. The higher the total score, the greater is the negative effect on the family member’s quality of life.

The FROM-16 mean total score from the UK study was 17.48 (broken down as 7.86 for the emotional domain and 9.6 for the personal and social life domain.) Of the 16 items measured, “feeling sad”, “feeling worried, and “difficulty caring” had the highest mean scores. The study showed females experienced significantly more impact than males. Below is a chart showing the study results from the 16 items.

The UK study summarized their findings by stating, “family members/partners of people with dementia experience a very large negative impact on their QoL, limiting their personal, social, and emotional well-being, which is often ignored and excluded from healthcare policy, planning, and economic appraisal.”

Other studies and articles I read discussed the profound family changes that occur as AD progresses. In many cases family members take on new roles, with caregivers providing increasing support. These changes can lead to stress, as individuals may need to balance caregiving responsibilities with their daily lives.

MassMutual published a study in 2024 providing detailed information about the financial impact of AD. This statement resonated with me, “If a parent with Alzheimer’s makes poor financial decisions or gets scammed because of their illness, it can have ripple effects on the entire family. Even if they never make a bad decision, the cost of managing the disease can have a major impact on families.”

According to A Fact Sheet published in 2024 by the Alzheimer’s Impact Movement:

• The lifetime cost of dementia is estimated to be nearly $395,000, including the value of unpaid caregiving

• The lifetime cost of care for individuals with Alzheimer’s is more than twice the amount incurred by individuals without Alzheimer’s

• For a Black family, dementia in the last five years of life consumes, on average, more than 80% of the family’s assets.

Linda and I are feeling the impact of my AD in several significant ways. I will share three examples.

1. We have a close friend and neighbor in South Carolina who would often join us on our screen porch after work. We laughed, relaxed, and shared stories. Words can not describe how much we miss Benard.

2. Linda and I were making plans and dreaming about a trip to Cuba and an Alaskan cruise. Those trips are certainly off the table now.

3. Financially, we simply were not prepared for my AD related expenses. As a small business owner, I experienced good years, combined with years when I struggled. Saving was a challenge. Especially, when you like to travel and enjoy life as Linda and I do.

A common topic among everyone impacted by AD is prevention. I think preparation is as important as prevention. As a global society, we need to do a much better job educating children and young adults about AD. We are reaching a point where the risk someone has for AD can be measured. With every passing year, we have a better understanding of AD prevention.

Let’s focus on preparation by teaching the basics of caregiving, having banks offer savings accounts specifically for AD (and other costly diseases), and developing policies that allow family members time away from their job to care for a loved one suffering with AD.

The impact of AD on families will always be harsh. It doesn’t need to be devastating though.

My Alzheimer’s Journey does not offer paid subscriptions. Instead, we depend on subscriber donations to cover the cost of research and writing. Additionally, all donations support my direct and indirect Alzheimer’s treatment expenses. Thank you.

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I often see advertising for at home dementia testing and coaching provided by BetterBrain.com. After reviewing their website, a number of questions popped into my Alzheimer’s brain. Before digging deeper into BetterBrain.com, I searched for similar direct-to-consumer testing companies. I found four companies that seem to be the leaders in direct-to-consumer Alzheimer’s testing:

• Function Health

• Neurogen Biomarking

• Apollo Health BrainScan

• BetterBrain.com

Each company offers a variety of testing packages. In a few cases, coaching or consultations are also offered. The common thread running through all four companies is you do not need to involve your doctor to take their Alzheimer’s disease test. The companies avoid offering a definitive Alzheimer’s disease diagnosis, but rather tell the consumer their risk for getting the disease.

Until blood tests for Alzheimer’s disease became available in 2025, there was no way to test for Alzheimer’s disease except with a PET scan or a spinal tap to study cerebrospinal fluid. Typically, those tests are not ordered until a neurologist has given the patient a complete cognitive test, lab tests, and maybe an MRI.

I am a huge advocate for early testing and diagnosis of Alzheimer’s disease. At the same time, it feels like smart entrepreneurs see an opportunity with biomarker blood tests. I am concerned that direct-to-consumer Alzheimer’s testing via a website may lead people into either false security or incorrect diagnosis of Alzheimer’s disease.

When the FDA approved the P-tau217 blood-based biomarker test in 2025, it stated, “False positive results, in conjunction with other clinical information, could lead to an inappropriate diagnosis of, and unnecessary treatment for, Alzheimer’s disease. This could lead to psychological distress, delay in receiving a correct diagnosis as well as expense and the risk for side effects from unnecessary treatment. False negative results could result in additional unnecessary diagnostic tests and potential delay in effective treatment. Importantly, the Lumipulse G pTau217/ß-Amyloid 1-42 Plasma Ratio is not intended as a screening or stand-alone diagnostic test and other clinical evaluations or additional tests should be used for determining treatment options.”

The direct-to-consumer Alzheimer’s testing companies all have a website that makes bold claims. My favorite is,“blood tests to detect cognitive decline years before symptoms appear, offering a gentle alternative to spinal taps and costly PET scans."

Each company is combining expert marketing, consumer psychology principles, creative advertising, and the latest web technology to sell direct-to-consumer Alzheimer’s testing to anyone willing to pay. There is one company that pushes insurance coverage for their tests and counseling.

I have four primary concerns on the at-home tests:

• accuracy

• results may cause unnecessary stress and anxiety

• no direct physician involvement

• legitimacy of the company

Over the next two weeks, I plan to request an interview with each of four companies I have listed. I will write an article about each company detailing their services, their testing process, their counseling and coaching services, their testing costs, and their ownership.

What do you think? Please leave a comment.

The results just arrived - NO ARIA - E and NO ARIA- H.

I am so relieved.

Rock on, Lecanemab!

Does Alzheimer’s Start In The Body Instead Of The Brain? A New Study Says YES.

By Greg Rowland

A common definition of Alzheimer's disease is a biological process that begins with the buildup of proteins in the form of amyloid plaques and neurofibrillary tangles in the brain. This definition assumes the Amyloid Cascade Hypothesis is correct.

In 1991, Sir John Hardy and Gerald Higgins published an article in Science titled, “Alzheimer’s Disease: The Amyloid Cascade Hypothesis”. Based on years of research, the hypothesis states the deposition of the amyloid-β peptide in the brain is a central event in Alzheimer's disease pathology.

This hypothesis drove all Alzheimer’s research for more than twenty years.

In 2020, a new study made allegations that some evidence used to create the Amyloid Cascade Hypothesis were fraudulent. Thus, a controversy was born among leading researchers, neurologists, and pharmaceutical companies. Many people believe that amyloid plaques may be a result of Alzheimer’s disease, not the cause.

Meet Cesar Cunha

With a background in Biochemistry and Neuroscience, Cesar Cunha has always wanted to pursue research in Alzheimer's disease. His interest in human genetics led him to accepting a prestigious PhD fellowship from the Novo Nordisk Foundation.

The Novo Nordisk Foundation Center for Basic Metabolic Research (located at the University of Copenhagen in Denmark) focuses primarily on obesity and type 2 diabetes research, with a big emphasis in human genetics. This emphasis on human genetics opened the door for Cunha to perform Alzheimer's research in an environment that was not constrained by the Amyloid Cascade Hypothesis.

Cunha led a team of researchers to explore an idea that the initiation of Alzheimer's disease is not in the brain. Their comprehensive study resulted in a determination that the initiation of Alzheimer’s disease starts in immune cells outside the brain.

It seems counterintuitive that the risk of Alzheimer’s disease initiates somewhere different from where the pathology occurs. According to Cunha, this phenomenon is not very common. But it does happen. He said another example of the phenomenon is obesity. The genetic risk of obesity disease is concentrated in the brain, yet, the pathology is obviously the accumulation of fat tissue.

Cunha and his team mapped the entire genetic architecture of Alzheimer's disease across the whole body. This complex and challenging process required using genetic data from previous studies involving more than 85,000 people with Alzheimer’s and around 485,000 people without it.

The researchers analyzed gene activity across roughly five million single cells, covering forty body regions and the entire brain. The goal of the analysis was to learn where in the body are the genes associated with Alzheimer’s risk active. They focused on around one thousand genes that contain variants known to raise Alzheimer’s risk.

The study found that peripheral cell types are the primary targets of Alzheimer's genetic risk. Peripheral cells circulate in the bloodstream for immune defense. They also found Alzheimer’s genetic risk in certain organs, including the lungs and the digestive system. The only cell type in the brain that was actually significant in their analysis was microglia (immune effector cells.) The researchers found no other cell type in the brain enriched for Alzheimer's genetic risk.

Even the regions of the brain that specifically accumulate amyloid and tau were not enriched for Alzheimer's genetic risk.

Mounting evidence from previous studies suggests that viral infections may contribute to the onset and progression of neurodegenerative diseases, including Alzheimer’s disease. This further supports the findings of the University of Copenhagen team, since they found an association between the peripheral immune genetic signature of Alzheimer's disease and the immune cells of the lungs, digestive system, and other organs. In other words, a viral infection in your lungs may trigger a process that results in Alzheimer’s disease many years later.

This study strengthens the long held belief that genetics are the mechanisms that increase the risk of Alzheimer’s. It also signals (with strong evidence) that these Alzheimer’s risk genetics are acting primarily outside the brain, more specifically in immune cells.

Cunha said the next step is clinical valuation of their findings and eventual translation to patient stratification. That will not happen quickly. As in all large scientific discoveries, money is the driving force.

Hopefully, this study will open the minds of people who have held firm to the Amyloid Cascade Hypothesis. There is now data indicating that Alzheimer’s disease begins in the body’s immune system; likely, years before symptoms of Alzheimer’s disease appear.

Genetic testing and disease prevention have just become even more important.

A preprint of the study is published in MedRxiv.

This multi-institutional project will develop artificial intelligence (AI) tools to:

• uncover the biological causes of Alzheimer’s and related dementias

• improve the understanding of disease progression

• develop more precise treatment options

Led by Paul M. Thompson, PhD, associate director of the USC Mark and Mary Stevens Neuroimaging and Informatics Institute (Stevens INI) at the Keck School of Medicine, AI4AD brings together 10 investigators and 23 co-investigators from 10 institutions. This project builds on the original AI4AD initiative launched in 2020, which developed AI tools to detect Alzheimer’s-related patterns in brain scans and showed how machine learning can link imaging findings to underlying genetic risk.

I am excited that the primary goal of this project is to create subtypes of AD and related dementias. Using AI, specific categories based on brain scans, neuropathology, and genetic data will be created. These subtypes will benefit scientists as they attempt to match treatments to patients best suited for that specific treatment. There are many variables with AD and the ability to target new therapies to a specific variability should result in improved treatment efficacy.

Another goal of AI4AD involves teaching AI to search large genetic datasets to identify combinations of DNA changes associated with AD, disease progression, and key biomarkers. With over 58,000 participants, AI can effectively identify combinations much faster than traditional research methods. The goal is to uncover new genetic and protein-related changes that may help drive neurodegeneration, and to link them to measurable changes in the brain and behavior.

The third goal of AI4AD is making sure AI tools work well across global populations. Current biomedical datasets lean heavily toward people of European ancestry. AI4AD will adapt the AI tools for African, Indian, Korean, and US populations.

The final goal of AI4AD is discovering treatments using an approach known as genome-guided drug discovery. Primarily, the project will look at existing drugs to see if they can be repurposed for patients with specific Alzheimer’s-related biological profiles.

A project schedule has not been released.

In my opinion, AI4AD will benefit every current scientific research project and all future discoveries by providing vast amounts of organized data that is not readily available today.

Since today is Friday, I feel compelled to provide a bit of interesting information about today in history and this weekend. It is a My Alzheimer’s Journey tradition!

Easter traditions vary across cultures.

• In New Zealand and Australia, Easter falls during autumn, and many people enjoy eating hot cross buns — spiced sweet bread marked with a cross. Rather than celebrate the Easter rabbit, they celebrate an endangered Australian animal called a bilby.

  

• In Ethiopia, Christian churches celebrate Fasika, the 55 days leading up to Easter. Fasika is actually a bigger deal to people than Christmas! During this holiday celebration, people spend 55 days fasting from meat and animal products.

• In South Africa, the day after Easter is known as Family Day, designed to provide a chance for loved ones to gather and reflect on the holiday’s meaning.

• In the Philippines, Easter morning begins with two separate processions — the men are in one procession and follow an image of Jesus risen from the dead while the women make up another procession and follow an image of Jesus’ mother, Mary, who’s wearing a black veil.

• In Germany, families decorate Easter trees with painted eggs, much like Christmas trees in December.

• In Poland, families gather for Easter Sunday breakfast, which often includes sweet bread called babka.

On this day in 1960, Elvis Presley recorded ‘It's Now Or Never’, ‘Fever’ and ‘Are You Lonesome Tonight’ at RCA studios in Nashville, Tennessee.

In closing, Linda and I send strength and resilience to the thousands of the United States military families who have a loved one serving in the Iran War. Sadly, the casualties from all involved countries continue to mount. As Benjamin Franklin said in 1783, “There never was a good war or a bad peace.”

My Alzheimer’s Journey is a reader and subscriber funded blog. We do not solicit paid subscriptions. Instead, donations are greatly appreciated. Thank you.

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To be fair, most of the research includes dogs as well as cats. Linda and I are cat parents, so that is my experience.

A study published December 26, 2023 in JAMA found pet companionship offset the previously reported association of living alone and declining memory and spoken fluency. The study conducted by the School of Public Health, Sun Yat-sen University, Guangzhou, China had 7,945 participants age 50 years and older. In summary, this study found pet companionship resulted in slower rates of decline in verbal memory and verbal fluency among older adults living alone, but not among those living with other people. In other words, for the people living alone, their pet compensated for the perceived negative feelings of being alone.

Another study also published December 2023 in Preventive Medicine Reports determined that dog owners had a lower risk of dementia compared to non-dog owners. The study looked at data from more than 11,000 older adults over a 4-year period and adjusted for certain preexisting health factors. This study also examined if physical activity and social connection of dog owners contributed to the lower risk of dementia. The study found that dog owners who walked their dogs daily had a significantly lower risk of dementia than dog owners who did not walk their dog. The study determined that exercise was not the only reason for the lower risk of dementia. Social interactions also contributed to the lower risk.

In the May-June 2025 edition of Geriatric Nursing, an article reviewed a study conducted by two nurses in Turkey. The study was a “systematic review and meta-analysis” of previous studies to determine the impact of “animal-assisted rehabilitation interventions on symptom management in Alzheimer’s disease patients.” The results showed “significantly impacted physical outcomes, such as improving physical competence and independence in basic daily living activities, as well as psychological outcomes, including reducing depression and enhancing mini-mental state examination scores in Alzheimer’s patients.”

According to the Alzheimer’s Society in the United Kingdom, people with Alzheimer’s can benefit from pet companionship in these ways:

• improve self-esteem and confidence

• promote quality of life and encourage independence

• source of love and laughter

• provide a sense of purpose

In my research, I came across Husson Univeristy in Bangor, Maine USA. They offer a Bachelor of Science in Animal-Assisted Therapy. According to Husson’s website, “Animal-assisted therapy for dementia patients and Alzheimer’s patients provides a non-medical way to engage and support those who are struggling with memory loss. Whether it's through touch, movement or simply enjoying the presence of an animal, these sessions help patients feel calmer, more engaged and less isolated. Over time, consistent interaction with therapy animals can lead to measurable improvements in mood, as well as overall quality of life.”

Assisted Living Centers, skilled nursing homes, and hospitals are embracing the evidence that pets offer many benefits to their patients. An interesting organization I discovered is Pet Partners. Based in Washington State USA, they organize, train, and provide volunteer teams (and animals) to a variety of healthcare, workplace, and law enforcement organizations around the world. According to their website, “Humans and animals share a deep, innate connection, and we believe that through the human-animal bond we can improve the physical, social, and emotional lives of more people and communities.”

If you or your loved are unable to manage the responsibilities of pet ownership, there are robotic dogs and cats. This is a fascinating story from 7NEWS Australia. Tell me that is not the cutest puppy you have ever seen! The smiles on the people make it crystal clear that pets (even robotic ones) are beneficial in many ways. You can buy a robotic pet here.

Our three cats (Bella, Lola, and Big Bit) are happy they have a meaningful purpose in life.

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I had my 13th Lecanemab infusion this morning. I am too tired to do any deep research this afternoon. Instead, I am going to share the infusion experience with you. If you have never had an infusion or have never been with someone while they received an infusion, I believe you will find the experience interesting.

I arrived at the Duke Clinics at 8:40 this morning. The clinics are located on the primary Duke University campus and adjoined to the main Duke Health hospital. After entering the Cancer Center building and passing through a magnetometer, I walked toward the Cancer Center lobby. At the edge of the lobby is a staircase with an open design allowing people to look down to the lower floor or up to the upper floors. On the lower floor, a grand piano is visible. No one was playing the piano. I was a tad disappointed.

Continuing through the Cancer Center lobby, I arrived at a small single elevator. This elevator took me to the second floor. My destination was Clinic 2A, the Duke Specialty Infusion Center.

My appointment was at 9:15. I arrived at the reception lobby about 9:00. The room was packed with patients and caregivers or family members. As always, the initial check-in process was efficient. After my wristband was printed and placed on my right arm, I was handed a clipboard and a dry-erase marker. The clipboard had a laminated sheet with maybe a dozen questions. The questions ranged from, ‘how do you feel today,’ to ‘do you have Covid.’

I found an empty chair and completed my questionnaire. In about five minutes, a nurse came to get me for part two of the check-in process.

On one side of the reception room is a curtained area where two nurses weigh each patient and check their vital signs. Weight is important because for most infusions, the amount of the drug you receive is determined by your weight. If time allows, these nurses place the infusion port in your arm or hand.

I was weighed and my blood pressure and pulse were checked and recorded. The information on my clipboard was transferred to my medical chart.

This process of recording the critical information needed for a safe and effective infusion, not only updates my medical chart, it notifies the staff in the infusion center that I am ready to have my infusion port installed, and it provides the pharmacy my current weight.

The process has obviously been carefully designed to achieve maximum efficiency without compromising on patient comfort and safety. It reminds a bit of a restaurant system where the waiter enters the customers order in a handheld wireless device. The kitchen receives the order and the chef/manager plans for the meal preparation and eventual delivery to the customer.

It was decided that my IV portal would be placed into my arm or hand after I go to the infusion center. Most importantly, the pharmacy has queued my Lecanemab order among the dozens of drug orders they continually process.

I returned to my seat and within five minutes Nurse Thea greets me. She checked my wristband, and we walked across the hall to the infusion center. Nurse Thea remembered me from a previous infusion several weeks ago. Her demeanor was friendly and calming.

You are never assigned the same infusion nurse two appointments in a row. I assume someone with a lot of education and experience determined the benefits of moving nurses around from patient to patient. My guess is the infusion center has about 100 patients each day. Each patient is unique in the drug they receive, the disease being treated, and their level of anxiety.

I looked around the room, and I am disappointed that the new chairs and curtains have not arrived.

The current chairs are a tad worn and some do not recline without a shove or two. The curtains are ugly, old, and faded. I have been told replacements are on the way.

Nurse Thea took me to my chair and another staff member appeared like magic.

I call the other person the Queen of Comfort. She has one of the most important tasks - taking warm blankets to patients and tucking them in as needed. She does a lot of other very important things, but the blankets are what I remember.

Working efficiently and following patient safety protocols, Nurse Thea brought my pre-infusion medication and a cup of water. She scanned my wristband and asked me my name and date of birth. I took the medication under Nurse Thea’s watchful eye.

Next in the process is the dreaded IV port installation. I am sure there is a more appropriate word than installation, but it sure feels like they are installing the damn thing in me.

Nurse Thea searched for a vein very methodically. She located her target, cleaned the area, and suddenly with no pain the needle was in my left arm.

Now the wait began.

I pulled out my book and my phone and I passed the time reading. Before too long, Nurse Thea returned with my bag of Lecanemab. She again scanned my wristband and asked me for my name and date of birth.

I admit that my memory is failing; however, I still remember my name and when I was born. Is Nurse Thea testing my memory or does she think an imposter took my chair? Safety first I suppose.

It took about ten minutes (maybe less) to connect the Lecanemab to the pump and me to the pump.

I almost forgot the awesome snack guy. I can’t remember his name (Alzheimer’s is killing my memory). This cool volunteer wanders around the infusion center pushing a snack cart. I envision him as a secret snack dealer handing out goodies to all the patients. It is not just the snacks he freely gives you, it is his friendly and calming personality. Mr. Snack Guy is loved by all the patients.

I dozed off for a bit while the Lecanemab flowed into my blood stream. The combination of a warm blanket and Benadryl put me to sleep quickly. I hope my snoring wasn’t too loud.

It is hard to describe the relationship among the patients on the same schedule. It isn’t that we are becoming friends - of course, that could happen. The relationship is more like comrades. We are all stuck (literally) in this big room being fed a drug that we hope will make us healthier.

Eventually, my IV pump beeped and Nurse Thea returned. She shakes the IV bag and told me she doesn’t want to waste any Lecanemab. You go Nurse Thea, that stuff is liquid gold.

Before long, I am disconnected, the IV port is removed, my vitals are checked, and Nurse Thea officially releases me.

It is nice that I no longer have to wait and see if I have any nasty reactions to the infusion. Yet, what better place to nap than under a warm blanket among my comrades?

Just like a busy restaurant, they have to turn the chairs, so I packed up and wandered back to the beautiful lobby. Still no piano player. Maybe in two weeks.

The Duke Specialized Infusion Center is a very special place (see what I did there?). It is a well-organized team of professionals focused on one thing - giving personalized care to patients undergoing a procedure that is far from fun. It may be like a group of ducks moving rapidly across a pond - smooth, peaceful, and graceful above the water and paddling as hard as possible underneath the water. As a patient, I only see the results of the underwater work. Thank you Team Duke.

Before I sign off today, I have a short video I want you to watch. A friend in Texas (Erin), is genetically destined to develop Alzheimer's disease. Erin is also a young mother of two, a wife, an entrepreneur, and an artist. Her dad has Alzheimers disease and in 2023, Erin learned that she carries the same genetic mutation he does–a rare mutation that causes a person to develop Alzheimer's Disease. She can tell you more as you watch her videos. There is one video in particular that caught my attention yesterday. She addresses the same issue I did last week - the stigma surrounding mental illness and in particular, Alzheimer’s.

Thank you for being a part of my journey.

My Alzheimer’s Journey is a reader and subscriber funded blog. We do not solicit subscriptions. Instead, donations are greatly appreciated. Thank you.

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Frank Longo, MD, PhD, is a professor of neurology and neurological sciences at Stanford University. Actually, Dr. Longo is much more than just a professor.

He and his team of researchers have spent years studying various mechanisms that seem to slow the damage to and loss of brain synapses (small pocket of space between two cells, where they can pass messages to communicate). Dr. Longo believes this approach will counter Alzheimer’s and other neurodegenerative diseases.

The human brain is said to contain about 86 billion neurons and at least hundreds of trillions of synapses. During fetal and early childhood development, many more synapses are created resulting in extreme redundancy. While this redundancy can impede cognition, there is a neurotrophin receptor (p75NTR) that in very simple terms trims or prunes the excess synapses.

According to a study published in Nature Neuroscience in November 2022, p75NTR slows down (becomes dormant) after childhood development. Yet, as we age the receptor gradually becomes more active. This leads to a loss of cognitive function.

Dr. Longo and his team studied a family in Columbia who had an unusually high number of Alzheimer’s stricken members. The family members had inherited a mutation causing their brains to massively overproduce amyloid-beta. One member of this family who had large amounts of amyloid-beta remained Alzheimer’s free for decades. It was determined that this person had a gene that controls many of the same nerve cell signaling mechanisms regulated by p75NTR. Dr. Longo set out to find a synthetic mechanism that would target p75NTR and create a resilience to amyloid-beta.

A compound (LM11A-31) was eventually developed that is designed to block the activity of p75NTR. Stanford does no commercial-development work, so Dr. Longo co-founded PharmatrophiX Inc. with his wife, CEO Anne Chun Longo. PharmatrophiX has an exclusive license agreement with Stanford to develop LM11A-31.

Between 2017 and 2020, a Phase 2a clinical trial primarily focused on the safety of LM11A-31. The trial had 242 participants with mild to moderate Alzheimer’s. Participants were randomly assigned to one of three groups: a placebo group, a group receiving 200 mg of LM11A-31, or a group receiving 400 mg. Each participant took two pills daily for 26 weeks. The trial concluded that the drug is safe and tolerable enough for larger trials.

This study was focused on safety and tolerability; however, the participants completed cognitive tests to begin to explore potential effects of LM11A-31. Results showed no significant difference between the drug and placebo groups in cognitive performance. However, further analyses revealed that participants taking LM11A-31 had lower levels of beta-amyloid and tau, compared to those who received the placebo. Brain scans also showed smaller reductions in gray matter and glucose metabolism in key brain regions among those taking the drug.

“The plaque-attack drugs are narrowly focused on removing amyloid,” Longo said. “That’s only one of several parallel mechanisms causing the neurodegeneration. LM11A-31 slows down a broad range of the degenerative cascade.”

PharmatrophiX is working on funding a Phase 3 clinical trial of LM11A-31 in Alzheimer’s patients.

“LM11A-31 could really be a breakthrough if it gets through Phase 3. If it’s successful, it will be the first neuroprotective drug to prove itself for Alzheimer’s disease.”said Howard Fillit, MD, a co-founder and the chief scientific officer of the Alzheimer’s Drug Discovery Foundation.

I will continue to follow PharmatrophiX as they raise the funds for the Phase 3 trial.

My Alzheimer’s Journey is a reader and subscriber funded blog. We do not solicit subscriptions. Instead, donations are greatly appreciated. Thank you.

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Since I skipped writing Wednesday (March 25), I am punishing myself by writing a serious post today. No Fun Friday for me this week!

I have been reading about how artificial intelligence (AI) is being used to enhance Alzheimer’s research and diagnosis. There are several successful AI utilizations across the globe. I think the two most promising AI deployments will be for dataset analysis and early diagnosis.

Today, I want to introduce you to StateViewer (photo below). Developed by the Mayo Clinic, StateViewer is an AI tool that helps clinicians quickly identify brain activity patterns of nine types of dementia including Alzheimer’s disease. StateViewer analyzes fluorodeoxyglucose positron emission tomography (FDG-PET) scans.

I always refer to a FDG-PET scan as a PET scan. Today, I learned that fluorodeoxyglucose (FDG) is the radioactive glucose analog tracer that you are given intravenously prior to the actual PET scan. Our brains run on glucose, so FDG is essentially marked glucose. The positron emission tomography (PET) scanner is a highly sensitive machine that detects the marked (glowing) glucose. The result is a 3D map of your brain using fuel.

StateViewer compares a patient’s FDG-PET scan to a large database of scans from people with confirmed dementia diagnoses and identifies patterns that match specific types, or combinations, of dementia.

Dr. David Jones (photo above), a Mayo Clinic neurologist and director of the Mayo Clinic Neurology Artificial Intelligence Program, says StateViewer is “a step toward earlier understanding, more precise treatment and, one day, changing the course of these diseases." Dr. Jones directed the development of StateViewer alongside Leland Barnard, Ph.D., a data scientist who is the brains behind the AI engineering driving StateViewer.

An article published June 27, 2025 in Neurology explains the methodology the Mayo Clinic used to gather the database of scans. There were 3,671 individuals with a mean age of 68 years. 49% reported as female. This article also reports that StateViewer helped researchers identify the dementia type in 88% of cases.

StateViewer enabled clinicians to interpret brain scans nearly twice as fast and with up to three times greater accuracy than standard workflows.

"As we were designing StateViewer, we never lost sight of the fact that behind every data point and brain scan was a person facing a difficult diagnosis and urgent questions," Dr. Barnard says. "Seeing how this tool could assist physicians with real-time, precise insights and guidance highlights the potential of machine learning for clinical medicine."

The Mayo Clinic continues to expand the tools’ use and evaluate its performance. I can envision a time when StateViewer is integrated into the FDG-PET scanner. As quick as a patients scan is complete, StateViewer is hard at work diagnosing the brain disease.

It appears that StateViewer is a big step forward in accurate and early diagnosis of dementia including Alzheimer’s.

I hope everyone has a great Spring weekend. Thank you for your continue support.

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Last week, at the 2026 International Conference on Alzheimer's and Parkinson's Diseases, Eisai presented new real-world findings on the long-term usage of Lecanemab. Analyzing data from the PurpleLab claims database (a comprehensive dataset based on medical insurance claims across the United States), Eisai determined the percentage of patients that continued using Lecanemab after the initial 18 months of treatment. The analysis showed:

• 78.4% of individuals continued Lecanemab treatment at 18 months

• 71.7% at 20 months

• 67.3% at 24 months

These high percentages compare to the Phase 3 Clarity AD study where 94% of patients who completed the initial 18 months of Lecanemab infusions chose to continue with the maintenance treatment.

Previous studies have shown that patients with chronic diseases who stay on their treatments longer tend to experience better clinical outcomes. The announcement at the conference did not mention the success of Lecanemab in removing amyloid-beta. I assume many of the patients from the database had a PET scan at the 18-month treatment point. Continuing with my assumption, if there is evidence that Lecanemab is effective and doing its job, then moving into maintenance treatment would be an easy decision to make.

As someone who is receiving Lecanemab infusions, this report is extremely encouraging.

Held in Copenhagen this year, the Conference on Alzheimer’s and Parkinson’s Diseases describes itself as the world’s largest gathering of experts in neurology and neuroscience. They present and discuss the latest advances in the science and treatment of Alzheimer’s, Parkinson’s, Huntington’s, Amyotrophic lateral sclerosis, Frontotemporal Dementia, Lewy body dementia and other neurodegenerative diseases.

I reviewed the conference program and discovered several interesting presentations and discussions. One panel discussion that grabbed my attention was called, “Personalizing Alzheimer’s Care: Biomarker-Driven Strategies for Precision Medicine.” This panel discussed the shift toward a “precision medicine approach in Alzheimer's research”. One of the presenters was Pallavi Sachdev with Eisai. According to her Linkedin profile, Dr. Sachdev is a big deal at Eisai. (Big deal means that she is one of the smartest people in any room.) In her summary of the panel discussion, she stated, “The consensus is clear—to beat Alzheimer's, we must treat the diverse biological pathways of aging. The road to a cure isn’t a single path; it’s a personalized map!”

I believe all of us can agree that the road to a cure isn’t a single path.

Eisai is a Tokyo based pharmaceutical company. Lecanemab was developed by Eisai in partnership with the Swedish company BioArctic. Biogen collaborates on the drug's development and commercialization.

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About twenty-five years ago, I was diagnosed with Major Depressive Disorder (MDD). My doctor told me that many men do not seek medical treatment for depression because they fear repercussions and a change in relationship with friends, family, and employers. As I began sharing my diagnosis, I certainly experienced a stigma. Many people equated my depression with laziness. Some people even said I was faking my depression. Others told me to just talk to a therapist. The idea that I was taking medication to treat depression was almost laughed at.

Fortunately, as a society we have come a long way in the past twenty-five years. Mental illness in general, and specifically depression, is much more understood and accepted today.

Sadly, an understanding and acceptance of dementia and Alzheimer’s disease (AD) is not prevalent in society. It seems that unless someone has direct experience with AD, most people lack a basic understanding of the disease.

In my experience, there are five common misconceptions of AD:

• all memory loss is caused by AD

• only older people get AD

• people with AD are easily agitated and demonstrate aggression

• people with AD can’t enjoy new activities and experiences

• nothing can be done for AD

The reality is:

• memory loss can be part of the natural aging process

• early onset AD can start in people aged 40 to 50 (and even younger)

• many people with AD are not aggressive (or it is controlled by medication)

• people with AD often learn new hobbies, travel on new adventures, or become an Alzheimer’s awareness activist like me

• there are treatments to slow the progression of AD and other new medication to manage cognitive decline

The problem with a stigma is that it spreads misinformation, it is hurtful to those suffering, and it holds us back as a progressive society.

If AD did not have a stigma, more people with AD would get the treatment they need, more investments would be made in AD therapies, and people with AD would have more opportunities to enjoy the years they have left.

How to fight the stigma?

• education - children should be taught about mental illness starting at an early age

• share our stories - if you have a parent with AD, share with your friends that experience, help people understand that while there is no cure for AD, people with AD can still enjoy life

• media exposure - recognize people with AD who are active and productive, talk about emerging treatments, and explain why we need major investment in AD research

• investment - more people with extreme wealth need to invest in AD research and governments around the world need to prioritize AD research

• be a friend - connect with someone with AD through the Alzheimer’s Association, your place of worship, or through your friends; become a friend and show them even though they have AD their life matters

I started this blog to help people like me. When I was diagnosed with AD it impacted many people in my life. I did not fully understand AD. My wife and I certainly were not prepared for the financial repercussions. Some people looked puzzled when I told them I had early stage AD. I have even lost a few friends because they simply don’t know how to conduct themselves around me.

I plan to spend my ‘long goodbye’ helping others and removing the AD stigma by sharing my story. Please join me.

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On March 17, I wrote about how caregivers deal with personality and behavior changes of their loved one. Today, let’s dig deeper into the common causes and management of agitation and aggression.

Agitation is defined as an emotional state of excitement or restlessness. While not all agitation leads to aggression, it is a significant risk factor that frequently escalates into aggressive behavior. Aggressive behavior can quickly become violent and dangerous.

According to the Alliance for Aging Research, the symptoms of agitation in Alzheimer’s often include restlessness, pacing, wandering, shouting, and repetitive questions. The Alliance goes on to say that about 44% of people with Alzheimer’s show signs of agitation.

An article written in 2022 by Malissa A Mulkey, PhD, APRN, CCNS, CCRN, CNRN and Cindy L Munro, PhD, RN, ANP-BC, FAAN, FAANP, FAAAS provided strategies for calming an agitated patient. While this article is geared toward clinicians, I believe many of the strategies are applicable for caregivers.

This article lists three main goals when managing patient agitation:

• early recognition and treatment of the underlying cause of the agitation

• rapid control of the behavior

• prevention of harm to the patient and those around him or her

I have studied agitation extensively in recent weeks. Based on information from a variety of resources, I believe there are six primary causes of agitation:

• Change in residence. This is often one of three situations: downsizing, moving into an adult child’s home, or moving into some type of managed care facility.

• Changes in caregiver arrangement. For example, if a family member has been the caregiver and then a professional caregiver is hired.

• Environmental changes. This may be as simple as an overnight guest to more challenging travel or hospitalization.

• Environmental triggers. These triggers often include noise, crowds of people, light glare, and a perceived hectic situation.

• Fear and confusion of the changes taking place in their life.

• A unitary tract infection (UTI) and other medical conditions.

The first goal from the Mulkey and Munro study is to recognize and treat the cause of the agitation. Using my broad list of causes, recognition should be somewhat easy. The challenge is treatment or elimination of the cause.

In my opinion, environmental changes, environmental triggers, and an UTI are the easiest cases of aggression to treat or eliminate. A change of residence and a change of caregiver generally can’t be avoided. Fear and confusion seems to the most difficult aggression cause to manage.

Recognizing and treating aggression is complicated by cognitive deficiencies and communication difficulties of the person with Alzheimer’s. As all caregivers know, you often can’t reason with someone with Alzheimer’s.

I believe that time, patience, and love can go a long way in helping someone with Alzheimer’s adjust and accept a new living arrangement and a new caregiver. This is why good caregivers are gentle, tolerant, caring, and loving individuals.

Rapid control is the second goal from the Mulkey and Munro study. In their study, they cite how clinicians (caregivers) should remain calm and emotionally neutral around the patient. Smiling is stated as a simple, yet effective method for rapidly controlling an aggressive situation. Distraction is also a good technique. If I ever When I become aggressive, ice cream or a Krispy Kreme donut would be a very effective distraction. In 1939, the British had a propaganda poster that said, Keep Calm and Carry On. I believe that sentiment is applicable to managing aggressive behavior.

The story behind “Keep Clam and Carry On” is fascinating.

If you have successfully, recognized and treated the cause of the aggression, and you have rapidly controlled the behavior, the next goal is preventing harm to the patient and the caregiver (and others around the person with Alzheimer’s).

I have three basic safety principles:

• maintain a safe environment - no knives or guns, nothing that could be picked up and used as a weapon, no hazardous cleaning supplies, etc

• put space between yourself and the loved one or patient - always have a clear path out of the room

• always have a telephone or an emergency notification device (Silent Beacon is one option) on your person

You must remember that the aggressive person is ill. If they are a loved family member, they are not the person you loved prior to their becoming ill. Their behavior is a result of their Alzheimer’s disease.

Your first priority must be protecting yourself and other family members.

A Milestone of 100 Posts—and a Tribute to the Journey

When I recently wrote my 100th post on Substack, it gave me a chance to look back at the stories we’ve shared and the community we’ve built. My writing has always been about the intersection of Alzheimer’s, life, business, and the heart—and today, I’m bringing that same spirit to Greg’s AZ Store.

To celebrate this milestone, I’ve launched a collection that is deeply personal to me: the Caregiver’s Appreciation Collection.

Caregiving is one of the most profound roles a person can take on. It’s a journey of immense compassion and quiet resilience. To honor those who walk this path, I’ve designed a signature series featuring the message: “Tough Enough To Be A Caregiver, Crazy Enough to Love It.”

This collection—featuring a premium t-shirt, insulated water bottle, and durable apron—is more than just merchandise. It’s a wearable tribute to the strength required for the journey, and every piece proudly features the Cat Man logo to raise Alzheimer’s awareness.

As a thank you for being part of my first 100 posts, I invite you to head over to the store and see what I’ve created. Whether you’re a caregiver yourself or supporting a hero in your life, this 3-piece set is designed with the quality and passion you’ve come to expect from my work.

Visit the Caregiver Collection at Greg’s AZ Store

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Not to worry though, I have a couple of things for you on this Friday.

On this day in 2016, Barack and Michelle Obama visited Cuba. President Obama was the first United States President to visit Cuba.

March 20, 2003 ground troops (A.K.A boots on the ground) invaded Iraq. Approximately 130,000 troops from the US, 45,000 from the UK, 2,000 from Australia, and 194 from Poland participated in the initial invasion.

On a happier note, on this day in 1930, Harland Sanders started selling his world-famous chicken, from a Route 25 gas station near North Corbin, Kentucky. KFC was born. Damn good chicken, but certainly not heart and brain healthy.

My final words today are about healthy food. Many years ago, I created a salmon with mango salsa recipe. It has stood the test of time. I hope you will try it and let me know if you enjoyed it. Are you surprised to learn that I cook?

HERB-GRILLED SALMON WITH MANGO SALSA (A Greg Rowland Original)

MANGO SALSA:

1 cup peeled ripe mango (chopped)

1 cup sliced banana

¼ cup fresh mint

2 tablespoons orange juice

1 teaspoon grated lime rind

1 tablespoon fresh lime juice

1 cup fresh pineapple (chopped)

1 Serrano chili, seeded and finely chopped

SALMON FILLETS:

4 salmon fillets (about 1 inch thick)

¼ cup chopped cilantro

¼ cup chopped fresh mint

1 teaspoon olive oil

1/8 teaspoon ground red pepper

½ teaspoon salt

¼ teaspoon black pepper

To prepare salsa, combine all ingredients, cover, and refrigerate overnight.

To prepare salmon fillets, combine salmon, cilantro, mint, olive oil, and red pepper in a large plastic bag. Seal and shake gently. Marinate in refrigerator for 20 minutes.

Remove salmon from bag and sprinkle with salt and pepper. Cook on grill for about five minutes on each side.

Serve with salsa and white rice.

As the mystery of my left thigh pain continues, an MRI was ordered. This MRI required part of the scan to be with contrast. That adds a layer of excitement to the already fun process.

An Uber delivered me to Duke Medicine Pavilion MRI about 12:50 this afternoon. By 1:00, I was checked in, and an MRI technician took to an exam room. He asked me approximately sixty questions all related to metal in my body. Well, maybe not sixty but at that moment it felt like it. My favorite question was, “Have you ever been shot?” Sign of the sad time we live in, I suppose.

After passing the test and knowing I have zero metal in my body, he presents me with a very fashionable paper shorts and shirt. The shorts were blue, and the shirt was green. Really, if I have to wear this paper junk, at least let the colors match.

The MRI technician departs to fetch an IV port, leaving me with detailed instructions on how to change into the paper clothes. At 68, I think I can handle changing my clothes without instructions.

The next bit of excitement came when the MRI technician failed to successfully insert the needle into my right arm. He moved to my left arm and claimed victory. Not that I am counting (actually, I am); but, I had an infusion Tuesday with the port in my left hand, I had blood drawn yesterday from my left arm, and today I had a failed attempt to place am IV port in my right arm and a successful insertion in my left arm. That is more than enough jabs for three days.

Wearing my beautiful paper outfit and carrying my clothes in a plastic bag, we head down the hall toward my favorite machine in the entire world (not!). After depositing my clothes and my phone in a locker, we enter the dreaded room. I can feel my blood pressure rising. Not to mention my anxiety meter going ding, ding, ding. I read that roughly 37% of patients experience MRI anxiety.

I think Duke should serve cocktails to MRI victims. A cold Grey Goose and tonic would have calmed me down immensely. Maybe I will suggest that to whoever is the Queen of MRI’s.

The process of placing pillows under my legs, taping the spot where my leg pain originates from, placing some strange boards on top of my leg, and strapping me down to keep me still took about fifteen minutes. Next came a warm blanket, ear plugs, and headphones. I am finally ready for my MRI. So, damn excited.

The bed slides me into the tunnel. Then, nothing happens for several minutes (seemed like ten minutes). I start worrying about suddenly having a leg pain episode. The pain is so sharp that I would be pushing the panic button and trying to crawl out of the machine.

Waiting for the MRI scan to start must be similar to being strapped in a rocket waiting for launch. I will never know because I have no desire to travel in a rocket. I suspect there is some rule that people with amyloid plaque can’t be space explorers anyway.

Eventually, the techno banging starts.

I am thinking about really stupid things. I should have gone to the bathroom. What if I start itching. What if I sneeze. And, the colossal concern is my leg pain.

The banging continues in odd patterns, rhythms, and pitches. If I didn’t know better, I would think the engineers that design MRI scanners do this on purpose. Hey, Joe, I took acid last weekend while listening to Metallica, I have an idea for a new noise we can add to our next MRI.

At some point in this lengthy process, my buddy, the MRI tech, speaks to me through the headsets. Between the banging and the dreadful music playing in my headset, I had no idea what he said. I just wanted out of the tunnel. Now!

Suddenly, I hear a young female voice in my ear. She clearly informs me that it is time for my shot of contrast. The bed slides out, and she gives me the contrast through my IV port. I am told that there had been a shift change during the hour that I had been in the machine. Maybe not an hour.

The MRI tech tells me I am doing a good job. How exactly does one do a good job in the metal torture chamber? Maybe, because I had not activated the panic button.

As I am pulled back into the tube, I began questioning if it is really important to know why my leg hurts. My ears have white noise most of the time, I am often confused about where I am when I wake up, I get anxious about lots of things, so what is a little leg pain? Excuse me, may I just go home.

Eventually, the techno banging stops and I feel the bed moving. Yippy! This dreadful adventure is over.

I am unstrapped, the IV port is removed, and I am led back to the locker and eventually to the exam room. With instructions to put my blue shorts and green shirt in the trash (where else would they go), I change and then order an Uber.

The Uber driver seemed worried about me. He kept asking if I was alright. Hell no, I just had an adventure in a loud, claustrophobic tube while wearing paper clothes that did not match.

The best news is that I have an MRI of my brain scheduled for April 7. Can’t wait.

To be serious for a moment, everyone took great care of me today. Duke Health rocks!

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An Update on Greg’s Journey: Challenges, Progress, and New Horizons

Hello everyone,

We wanted to share an update on Greg’s journey. Currently, Greg is navigating a mix of good and bad days. While his physical symptoms are manageable, the emotional toll of this battle—depression and anxiety about the future—has been heavy. We have noticed some recent declines in his memory, yet he remains remarkably independent, still handling daily tasks like grocery shopping and household chores.

Medical updates have been a bit of a mystery lately. Greg has been experiencing sharp, debilitating pain in his upper left leg. The team at Duke Health is running extensive tests, but a cause hasn’t been found yet. Greg received his 12th transfusion yesterday. We are anxious for his PET scan in September to see if the Lecanemab is successfully removing plaque. In the meantime, he continues to manage side effects like severe body aches and chills with the help of new medication.

Our Financial Shift
We are making big changes to stay afloat. Our home in South Carolina is officially on the market, and we are preparing to auction Greg’s business equipment soon. To cut costs, we’ve sold our cars and are relying on Chapel Hill’s great bus system, Uber, and Greg’s daily walks.

How You Can Help (Beyond Donations)
You have already been so incredibly generous, and we are not asking for further financial donations at this time. Instead, we are asking for your help in making us self-sufficient.

Greg is working hard on his online store and is exploring public speaking opportunities to share his story. You can support us by visiting his sites, sharing his blog, or passing his contact info to anyone looking for a powerful speaker.

• Read his Journey

• Visit the Store

• Speaking Inquiries (this site is a work in progress)

Thank you for everything. Without your support, Greg’s treatment at Duke would not be possible. We are so grateful to have you in our corner.

With love,
Linda

Without actually proof (just my gut feeling), the majority of the questions posted in the Alzheimer’s community of Reddit are from caregiver’s struggling to deal with personality and behavior changes of their loved one. Some of the situations are really sad. Many of the stories show a scenario that is dangerous for the caregiver. The one common thread is heartbreak.

I had my twelfth Lecanemab infusion today. As is typical for me, I napped most of the afternoon. The behavior must be like an alcoholic sleeping off a bender. I sleep off my infusions.

I woke up from my long nap thinking about a particularly difficult caregiver situation I read about last night on Reddit. For privacy reasons, I am not going into detail about the Reddit post. In summary, the situation was an adult child trying to deal with continual anger from a parent with Alzheimer’s.

People with Alzheimer’s disease often become agitated or aggressive as the disease gets worse. Agitation means that a person is restless and worried, and they aren’t able to settle down.

Studies suggest that something triggers the agitation. It happens for a reason. Determining the cause of the agitation will help the caregiver to manage the situation before full-blown aggressive anger develops.

Some common causes of agitation and aggression are:

• Pain, depression, or stress

• UTIs (Urinary Tract Infections)

• Constipation

• Sudden environmental changes

• Losing the ability to drive, go to a favorite place, or visit friends

• Too much noise or confusion in their room

• Being forced (pressured) to take a bath or other activity that is uncomfortable or painful

• Feeling lonely

• Reactions to medication or combination of medications

Because this is such an important issue that all caregivers must face, I want to carefully and thoroughly discuss these common causes and the best practices for managing the resulting behavior. Starting tomorrow, I will begin this discussion.

A few days ago, I designed a shirt that I hope many of you will appreciate. Tomorrow I will create other garments and accessories with the same graphic.

Thank you for your continued support.

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