Another one I found fascinating re: Alzheimer's Disease, Dementia

I usually post articles on the pages (links above), and will add this one...but I found it so interesting I decided to give it special stand-alone billing on my blog :-). I am constantly amazed at what they are learning about our brains and how they work.

Can PET Match Up Areas of Protein Deposit With Alzheimer’s Symptoms?
Even though, overall, Alzheimer’s disease robs all people it afflicts of mind and memory, it progresses differently in different people. Its specific symptoms, their sequence, and how fast they worsen can vary quite a bit from one person to another. This used to be a tough nut to crack for researchers, but now, by combining data from multiple PET tracers in longitudinal study cohorts, they are beginning to decipher which regional pathologies provoke particular disease manifestations. The Human Amyloid Imaging conference, held January 15–17 in Miami, showcased the latest findings tying tangles, or plaques, to particular behavioral and cognitive impairments. Intriguingly, links between pathology and subtle symptoms emerged even in people who were still cognitively healthy. The data suggest that multitracer, and also multimodal, brain imaging may eventually allow researchers to predict how disease will progress in a given person...
https://www.alzforum.org/news/conference-coverage/can-pet-match-areas-protein-deposit-alzheimers-symptoms

Updated 3/1/20 - What is working when it comes to fighting Alzheimer's Disease and other dementias?

Pretty much the only things currently having any kind of an impact long-term on the fight against Alzheimer's Disease (AD) and other forms of dementia all come from the functional side of the medical world.

That's not to say that when caught early the traditional treatments don't always fail. Sometimes, when combined with increased physical exercise, dietary changes and maybe some supplements, early intervention works and continues to work.

Sadly, most people don't talk to their doctors about failing memory until they are past the point of current traditional, mainstream medical treatments working to keep AD at bay. I have personal experience with that silence. Those close to this individual kept everyone in the dark, although to be honest we kind of noticed some signs, just didn't pick up on them as we don't see them except in short doses for holidays. The Bredesen Protocol (see other posts, plus some of my pages linked below the header) could have worked for her but they are no longer following. Long story on that one. Sad, makes me so sad, wakes me up at night thinking about what they are facing.

Anywaze...onto brighter thoughts. Oh, wait, no...the next part deals with the current status of treatments for dementias. Not good news.

Quotes from a variety of articles on the current status of "traditional" treatments (click the quote to read the entire article):

• Previous Alzheimer’s medications have targeted specific toxins that are abundantly present in diseased brains, such as the aforementioned beta amyloid. However, these drugs all failed once going into clinical trials, perhaps because they were only targeting one part of the problem.
• As drug trials fail to find an effective treatment for the most common form of dementia, could it be time to go back to the drawing board?
• Current drugs only temporarily ease symptoms and do not alter the course of the disease.
• Because there are no effective disease-modifying treatments currently available for Alzheimer’s, drugs and other approaches — such as nutritional supplements, or nutraceuticals — designed to stop or slow disease progression have become a focus of ongoing research
• On the treatment front, we still do not know what causes Alzheimer’s disease, and we do not have a cure. The drugs that have been approved slow the progression of symptoms for a period of time, but then the disease takes over again. Someone with Alzheimer’s will die of it or with it.

Great article highlighting the general things we can do to help PREVENT dementia:

https://bewell.stanford.edu/boosting-brain-health/ 

I could have posted a thousand similar quotes. Almost every article has statements of hope about future treatments...but it's almost like they're tossing a tiny bone at the readers or maybe trying to give themselves hope. If you read my blogs, the comments I post on the pages (links above), you know I think they are barking up the wrong tree by focusing on amyloid plaques.

Now for some positive news!

However, we DO have current treatments that are working and have been working. They don't involve drugs and are multi-pronged so there's no money for grants, aside from some small ones for small groups. Also, most doctors have a tendency to look down their noses at what falls under the "functional medicine" heading. Even if their patients ignore their traditional advice and drugs and opt to change their diets, lose weight, exercise, take supplements --- and improve, get better.

I'm a prime example. I had high cholesterol. I balked at taking drugs. My doctor "allowed" me 2 months, which she "graciously" extended to three for me to try and decrease it with exercise and diet. I'll admit, I didn't do much research at the time, upped my exercise routine...and failed. She scared me sufficiently into starting to take the meds. She told me it was hereditary and I just had the gene, was stuck.

A bit later I made some serious changes to my diet. I went gluten-free (before it was a "thing"), took sugar out of my diet and then eventually moved to a plant-based diet. I was vegetarian initially. My cholesterol numbers dropped, I got off the meds...and got off my acid reflux medicine (which another doc said I'd be on for the rest of my life or risk esophageal cancer...they do like to scare one!).

If you're interested in HOPE as opposed to depressing news, a feeling of doom because you have a family history of dementia or Parkinson's, have been diagnosed with MCI (mild cognitive impairment), have found you have one or two APOE4 genes or have a family member dealing with Alzheimer's Disease take a look at the APOE4.info forum --- over 3,500 people who are focused on keeping dementia at bay. There are great success stories. There are many who are discovering the site and taking control of their health daily. You can also find some excellent Facebook groups.

NOTE: Many or most of the following docs see a role for traditional drugs and treatment, they just know that it's a much bigger picture. I agree. I think there is a place for drugs and applaud our great physicians who do a great job. I just think we have a personal responsibility to do our own research, do more than just pop a pill...

Pick up or check out one or all of the following books:
Dr. Dale Bredesen - An End to Alzheimer's
David Perlmutter - Grain Brain
Steven Gundry - The Plant Paradox
Amy Myers - The Thyroid Connection
Terry Wahls - The Wahls Protocol

Or check into Zack Bush, Mark Hyman, Stephen Phinney, Jeff Volek, Valter Longo, Jason Fung, Dave Asprey, Ivor Cummings, Sachi Panda, Rhonda Patrick, Peter Attia. (No particular order of preference and you'll like some, not like others!).

Melatonin...it's good for more than sleep...

...and there is debate as to whether melatonin supplements are truly good for sleep.

What?

The most commonly talked about sleep aid might not be good for sleep? Yikes.

I have been reading a lot about melatonin as it relates to sleep. I will read that taking it is good for sleep, that you need it when you're older and...that it's nothing but a placebo, that you shouldn't take it except possibly in small doses and then only when you're older or for jet lag...

The more research I do the stronger I feel that we just need to experiment and see if it works for us. But you do need to do your own reading, keep your dose low and make sure it's time release.

What else is melatonin good for? It impacts, in addition to sleep and circadian rhythms, heart disease, diabetes, Alzheimer's disease and other dementias, cancer, and blood pressure.

Given all the ongoing research that has shown and is showing that melatonin, a hormone, impacts many, many parts of our body and health I have decided to keep it in my nightly regime. At low doses.

I was taking 5 mg at one point --- just grabbed what was on the shelf not knowing anything about dosing, "assuming" if that was all that was offered it must be right. Ha. I discovered quickly that the dose was too high. I was melatonin overloading, it was not helping, and was hurting. I did some reading, which I SHOULD have done before buying and compromised on 1 mg, time-release. Then I stopped taking it as I heard Matthew Walker say it had more of a placebo effect and was only good for jet lag. Then I started again when I read the next article touting the benefits. Then I stopped. Then I started.

Finally, I have taken the time to read everything I possibly could on the subject and settled.

For the past few nights, I have taken a double dose (2mg time release). It certainly didn't help my deep or REM sleep. But I did sleep longer.

I won't go higher than 2mg as everything I've read says 3 is too high. I wouldn't do 2 if it wasn't time release. I'm tracking my deep and REM sleep so I'll see if it helps. I may just put the tabs by my bed and take if I wake up in the middle of the night, do a bit of experimenting.

Why time release? Here's a quote from the first article below: "Natural melatonin levels are low early in the evening, rise steadily through the night, and peak in the last third of sleep. Because melatonin has a short half-life (about 30-45 minutes), taking a standard-release tablet around bedtime results in a peak early in the night and a tail toward morning — precisely the opposite of the natural pattern...He suggests taking time-released tablets around bedtime or sublingual regular-release products in the middle of the night."

One would hope that there were ongoing studies to help us figure out this one but, per the article below (Melatonin: Magic Potion or Unregulated Danger?) --- "There is little financial incentive for studying melatonin more thoroughly, primarily because it can't be patented and competes with the lucrative hypnotics market"...

Articles that sparked this blog:

Melatonin: Magic Potion or Unregulated Danger?
...there are certainly studies out there that suggest melatonin may be helpful for insomnia in older individuals, perhaps especially those who have significant declines in endogenous melatonin levels associated with aging," he said. "Those data, however, also show conflicting results."https://www.medscape.com/viewarticle/922202?nlid=132930_5402&src=wnl_dne_191209_mscpedit&uac=127754CG&impID=2196787&faf=1#vp_2

What New Research Says About Melatonin and Sleep
Here is what you need to know about taking melatonin to help you sleep...

It’s almost getting easier to ask: what chronic diseases don’t melatonin play a role in? Recent years have seen a flurry of studies showing the protective and therapeutic benefits of melatonin in the fight against the most significant chronic diseases of our time—heart disease, cancer, dementia, diabetes... 
https://www.psychologytoday.com/us/blog/sleep-newzzz/202002/what-new-research-says-about-melatonin-and-sleep

Heartburn

https://healthyy.net/heartburn/melatonin-and-heartburn-how-it-helps

Treating Alzheimer's Disease

Everything I've read in the mainstream is a mix of depressing currently and hopeful in the future. Generally, prevailing "wisdom" is that once you're diagnosed you're doomed. You are going to progress.

I happen to be of a mindset that there are ways to stop the progression and reverse it in many cases, but not all cases (see above for links to stories, books, doctors, etc.). However, I see case after case where even at the later stages people have calmed, have improved, using things other than current medications and/or in addition to current medications.

One story that stuck with me was about a military gentleman with diagnosed Alzheimer's Disease, was being treated via mainstream docs, who was always agitated, yelling, mad. His family started him on one of the prevailing "alternative" treatments (diet and supplements) and he calmed down, became a happy soul. It didn't change much of anything else, aside from better physical status, but he was in a better place mentally. That alone is worth the effort!

I believe that you don't stop trying, looking for the positive and working with doctors, but also using your own research and mind to build on doctor's prognosis and suggestions. In today's world of specialization, one specialized doctor may not be aware of what is going on in another aspect. Our bodies are miraculous machines that work synergistically.

Doctors are also notoriously prickly about "Google Doctors" as they call people like me. I walk a fine line and defer to their wisdom. But I still firmly believe that I have to double-check, do my own research.

(I guess that's another blog --- all my personal and friend's experiences with an incorrect diagnosis or being given a drug to treat something without ever being told how to fix it with diet or actions (ala Type 2 Diabetes and cholesterol). Personally, I use doctors to diagnose. Not that I have any problem with taking a prescribed medication if needed. We have amazing doctors, scientists, researchers and I'm blessed to live in a time where so much is available.)

When combatting cognitive issues you start early, you look at the entire body and lifestyle and then do the best you can to correct all the issues. Sadly, as I've said over and over, by the time we're willing to start addressing brain issues we're often well on the path. For some the issues start 20 years before 'symptoms" happen.

Someone close to me is a case in point. She is averse to getting help much of the time (and then sometimes she's fully on board), she has issues taking pills so supplements are difficult, if a drug has a side effect she doesn't like she flat out refuses to take it, she has so many real and imagined reasons for not moving or exercising it's extremely difficult to push, and so on.

Through it all she is still "there" most of the time. She can enjoy times with family. She knows what is going on and cries about the future. She has great days where she's going to fight this, where she will overcome and give God the glory, where she understands that using what God has provided via doctors and foods, etc., is a good thing. She knows when she is being treated like a child. She gets mad when treated like she doesn't know what's going on. Her main caretaker is great --- he involves her every step of the way.

Side note on current drug treatments for dementia: Most of the current drugs given for cognitive issues have some ugly side-effects. This individual won't take anything without reading the pamphlets. When I looked at all the drugs and saw the potential side-effects I thought "oh no, constipation..." that's all it will take...

OK, this is another blog post where I'll have to come back to it...am cooking some cauliflower, broccoli, carrots, and mushrooms so sliding over here in-between steps :-). So much on my mind after my last visit to see my parents...and every day the long list of alerts and news re: AD, cognition, dementia and health gets my little pea-brain zipping all over the place!!!

------------------
This one is interesting.
Scientists to test drug meant to stop or slow Alzheimer’s before symptoms appear
https://www.columbian.com/news/2020/feb/08/scientists-to-test-drug-meant-to-stop-or-slow-alzheimers-before-symptoms-appear/

My thoughts? Much of the current prevailing wisdom seems to be that the amyloid plaques are protective responses. I've heard them likened to ambulances and police that swarm to a wreck. Yes, they get tangled but they are there in response not as the cause. They seem, at least from what I'm reading, to be initially protective. Then if you don't correct the underlying issue they increase, get tangled, and start causing problems.

Clearing them up after they're tangled can be beneficial. It seems that it's short-lived though if the underlying reason for them isn't addressed. Which is why most of our mainstream drugs rarely work for long. They clear them out, there is a temporary improvement or a temporary "stay" in progression, then wham things are back and often worse than before the drug. Not always given that some find or correct the problem.

Also, they've found that many people have the plaques but never develop Alzheimer's Disease or any type of dementia. Just like many people are diagnosed with Alzheimer's Disease who have other issues ranging from Lyme disease to mold toxin issues to...oh, shoot, the list is soooo long.

That's an interesting thing, too. When they first started diagnosing Alzheimer's Disease they (the wise ones of the day :-)) came up with a list of SUGGESTED criteria to consider. Somehow that became the definitive criteria. It was initially supposed to be a tool, a possibility, not a "they have it" list. Will have to see if I can find the various articles and podcasts where I heard that one...


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A few of the articles, research, and studies that caught my attention:

Is This Under-the-Radar Stock Set to Succeed in Alzheimer's Disease?
A promising new approach could potentially yield a new drug providing hope for millions of Alzheimer's patients worldwide.https://www.fool.com/investing/2020/02/07/is-this-under-the-radar-stock-set-to-succeed-in-al.aspx
In recent years, scientific evidence forged a link between P. gingivalis infection, more commonly known as gingivitis, and Alzheimer's disease. The scientific thesis for Cortexyme's approach focuses on the discovery that the P. gingivalis bacteria can enter the bloodstream and make its way to the brain, particularly in older individuals and those with a genetic predisposition. Once inside brain cells, also called neurons, the bacteria release a toxic substance called gingipains. The gingipains digest neuronal proteins leading to the death of the brain cell..

Loss of BIN1 protein in Alzheimer’s disease promotes synaptic accumulation of phosphorylated tau and disrupts tau release: Tau-directed effects of BIN1 loss in AD
https://kclpure.kcl.ac.uk/portal/en/publications/loss-of-bin1-protein-in-alzheimers-disease-promotes-synaptic-accumulation-of-phosphorylated-tau-and-disrupts-tau-release(c8017124-cc51-4c71-a39d-9f2a985aeec3).html
Polymorphisms associated with BIN1 confer the second greatest risk for developing late onset Alzheimer’s disease. The biological consequences of this genetic variation are not fully understood, however BIN1 is a binding partner for tau. Tau is normally a highly soluble cytoplasmic protein, but in Alzheimer’s disease tau is abnormally phosphorylated and accumulates at synapses to exert synaptotoxicity. The purpose of this study was to determine if alterations to BIN1 and tau in Alzheimer’s disease promote the damaging redistribution of tau to synapses, as a mechanism by which BIN1 polymorphisms may increase risk of developing Alzheimer’s disease. We show that BIN1 is lost from the cytoplasmic fraction of Alzheimer’s disease cortex, and this is accompanied by the progressive mislocalization of phosphorylated tau to synapses. We confirmed proline 216 in tau as critical for tau interaction with the BIN1-SH3 domain and show that phosphorylation of tau disrupts this binding, suggesting that tau phosphorylation in Alzheimer’s disease disrupts tau-BIN1 associations...

Alzheimer's treatments: What's on the horizon?
https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers-treatments/art-20047780

PET Tracer Detects Synapse Loss Across Alzheimer’s Brain
https://www.alzforum.org/news/conference-coverage/pet-tracer-detects-synapse-loss-across-alzheimers-brain

Ramblin' about Alzheimer's Disease

Note: This is an older blog that I hadn't finished, hadn't posted. Posting now, late, some redundancy in ones I've posted since...but not gonna waste all these words :-). In addition to the articles that were current at the time I wrote this (at the bottom) I've added some that are more up-to-date.

For a variety of reasons, I've been reading a lot about Alzheimer's Disease. I have Google Alerts set up on a wide variety of related topics, am on the APOE4.info site with great info, read every study & article that pops up, have checked out or bought every book on the subject. I've become a believer that it is possible to prevent it in many cases and reverse it in some.

The caveat on reversing? It is tough. First, you have to identify the many potential contributing causes, which involves testing (blood tests mainly) that most insurance companies will not cover totally. Then, if you find that you have one or more "causes" (and it's always more than one from what I've found in my reading) you have to do a lot to correct the contributors. If someone is partially down the path --- for instance already at the point where they have issues swallowing pills or their mental abilities have deteriorated to the point where they can't adjust their diet --- it is extremely, extremely difficult.

Winding my way through all the data can be confusing! Learning the language requires a medical degree, which I do NOT have! However, I AM learning. I'm also comparing all the data that is popping up and looking for commonality.

I probably have a higher chance than many of developing some sort of dementia (aside from genetics, I am a crazy artist :-)). So, as I discover things that seem to make sense I'm incorporating them into my life.

Currently, I'm working on my sleep habits. Increasing my dives into deep sleep and extending the number of hours my little pea brain stays asleep are two areas I am focusing on.

From what I've discovered melatonin levels drop as one ages. Taking melatonin when we're younger has more of a placebo effect (per Matthew Walker). However, adding it to the nighttime routine if quality sleep is an issue when we're older can help. I just ordered some.

I've added a blue light blocker to my phone, tablet and laptop. Blue light triggers something in our brains that says "stay awake" (I can hear some of you groaning at that simple-ed down description). I can get all technical if you'd like? No? Yes? No. Try Bing or Google --- you'll find a ton of info out there.

I put in a sleep-promoting light in my bedside lamp. It allows me to read but doesn't cause my bod to think it needs to be running around cleaning the cave.

I am trying a white noise machine. It also has pink noise, which is supposedly just as good or better. It does help to even out the background noises. Last night I didn't use it and when the air conditioner kicked in I woke up a few times. Could be that if I hadn't gotten used to the noisemaker I wouldn't have noticed.

I got rid of or covered all lights in the room. I covered the windows with dark sheets (strange shaped windows so typical shades won't work)

The other things I'm doing? I've added some supplements, changed my exercise time to mornings and am more diligent, I've added and subtracted some foods from my diet, and I am doing 12-14 hour fast every day. I'll write more about each of those at another time.

Current new articles on APOE4, Alzheimer's Disease, etc.:

Plant flavonols significantly reduce Alzheimer’s risk
https://www.news-medical.net/news/20200202/Plant-flavonols-significantly-reduce-Alzheimere28099s-risk.aspx
(I posted this one on APOE4.info and one person pointed out some flaws in the study.)

Biogen And Neurotrope: Why Numbers Cannot Overcome Alzheimer's Disease
https://seekingalpha.com/article/4320953-biogen-and-neurotrope-why-numbers-cannot-overcome-alzheimers-disease

Finding the cure for dementia | 60 Minutes Australia (YouTube Video)
https://www.youtube.com/watch?v=iEpTH70xRIs&feature=youtu.be

Predicting Alzheimer’s by Combining Blood Test With Genetic Screening
https://www.managedcaremag.com/news/20190806/predicting-alzheimer-s-combining-blood-test-genetic-screening

Dietary choline associated with reduced risk of dementia
https://www.sciencedaily.com/releases/2019/08/190806101530.htm

Dementia, Parkinson's Disease and our genes...

Two articles. The first I'm posting is much better. Given that I am APOE 3/4 plus have quite a few Parkinson's genes and all kinds of other contributing nasties like short-sleep, etc. I'm primed for a potentially ugly future genetically. However, I am not gonna let those nasties be my future.

One thing I've learned over the past 8 or 9 months of bombarding my brain with all the latest and greatest research, news, podcasts, theories while trying to help my mom is that prevention is possible. The scary thing is that the nasty genes can kick in 20 years or more before you start seeing "symptoms". Often by the time you start experiencing cognitive issues you're in a battle that main-stream science currently says you will lose. There is no cure. Currently. There is great promise for changing that though, just probably not in time to help my mother. Catching it early and/or prevention is critical.

Side note: My uncle has Parkinson's and my mother, grandmother and great-grandmother all have/had some form of dementia. My other aunt has a plethora of health issues, not sure what all of them are as there's not much communication. Not aware of any Parkinson's or dementia on the paternal side of the family, tons of cancer though. And yes, I have all kinds of cancer-related bad genes...

Also, have a ton of SNPs that say I'm primed for Type 2 Diabetes. My mom was diagnosed as pre-diabetic, and told her cholesterol was too high a few years back (not sure exactly when) and they wanted to put her on meds. She changed her diet...lowered her cholesterol...blood tests currently show good on the diabetes front but she is a true sugar-holic & carb-holic (as am I)...however, she went way too far and lost way too much weight, didn't understand eating healthy vs starvation/extremely small portions! Been trying to increase her weight since last June, some success but it's a battle :-).

Anywaze, here are the two articles on Parkinson's, APOE, etc.:

--------
Gene ID’d as potential therapeutic target for dementia in Parkinson’s
Targeting gene linked to Alzheimer’s may reduce dementia risk in Parkinson’s
Dementia is one of the most debilitating consequences of Parkinson’s disease, a progressive neurological condition characterized by tremors, stiffness, slow movement and impaired balance. Eighty percent of people with Parkinson’s develop dementia within 20 years of the diagnosis, and patients who carry a particular variant of the gene APOE are at especially high risk.

In new research, scientists at Washington University School of Medicine in St. Louis have found a clue to the link between Parkinson’s, APOE and dementia.
https://medicine.wustl.edu/news/gene-idd-as-potential-therapeutic-target-for-dementia-in-parkinsons/

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Lab: Discovery could help stave off anguish of dementia in people battling Parkinson’s

PARKINSON’S disease can be especially cruel. Its slow but sure onset inflicts tremors, slows down movement and impairs balance. And perhaps the most bitter blow of all is that 80 percent of people newly diagnosed will go on to develop dementia within 20 years.

But there is hope for the future, after experts made a breakthrough that could lead to treatments capable of slowing down or stopping this mental decline.

https://www.metro.news/bbc-science-focus-discovery-could-help-stave-off-anguish-of-dementia-in-people-battling-parkinsons/1899963/
----

Info at end of first article with study info I think:
Davis AA, Inman CE, Wargel ZM, Dube U, Freeberg BM, Galluppi A, Haines JN, Dhavale DD, Miller R, Choudhury FA, Sullivan PM, Cruchaga C, Perlmutter JS, Ulrich JD, Benitez BA, Kotzbauer PT, Holtzman DM. APOE Genotype Regulates Pathology and Disease Progression in Synucleinopathy. Science Translational Medicine. Feb. 5, 2020. DOI: 10.1126/scitranslmed.aay3069

National Alzheimer's Disease Awareness Month, 2008

RJ Note: The effects of Alzheimer's Disease on a family can be debilitating. The loss of a loved one who is still physically among us is a hard road to travel. During this month, take time to remember those who take care of these loved ones. Take time to give the caretakers encouragement. Be there for them all.

During National Alzheimer's Disease Awareness Month, we recognize the dignity and courage of the men and women living with Alzheimer's disease. We also honor the devoted family members and caretakers who bring them love and comfort, and we underscore our dedication to finding a cure for this tragic disease.

Alzheimer's disease is a brain disorder that seriously impairs a person's ability to function normally. Age is the most important known risk factor, and scientists are studying the role that genetics, education, diet, and environment might play in the development of this debilitating disease. Through research supported by the National Institutes of Health and the Department of Veterans Affairs, we are learning more about the disease and enhancing the quality of life for those affected. In addition, the Department of Health and Human Services is improving the delivery of home and community-based services to people with Alzheimer's.

National Alzheimer's Disease Awareness Month is an opportunity to pay tribute to the courageous individuals facing this disease and remember the precious lives lost due to Alzheimer's. All Americans appreciate the strong support and dedication of the families, medical professionals, scientific researchers, and caregivers who are helping build a society that values the life and dignity of every person.

NOW, THEREFORE, I, GEORGE W. BUSH, President of the United States of America, by virtue of the authority vested in me by the Constitution and laws of the United States, do hereby proclaim November 2008 as National Alzheimer's Disease Awareness Month. I call upon the people of the United States to observe this month with appropriate programs and activities.

IN WITNESS WHEREOF, I have hereunto set my hand this twenty-ninth day of October, in the year of our Lord two thousand eight, and of the Independence of the United States of America the two hundred and thirty-third.

GEORGE W. BUSH

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