Speaker 0 00:00:59 Um, good evening. Thank you for joining disability and progress, where we bring you insights into ideas about and discussions on disability topics. My name is Sam. I'm the host of this show. Charlene doll is my research team. And tonight we are talking about Alzheimer's. How did we fare during the pandemic and what is all simers anyway, we'll find out all about that by talking with Dr. William you'll have to help me manta.
Speaker 2 00:01:25 Oh, that's really close. Um, yes, it's a mad tie. It's like
Speaker 0 00:01:29 A main tire.
Speaker 2 00:01:32 No, no, you're all good.
Speaker 0 00:01:33 Thank you so much for being on Dr. Mann. Ty is a behavioral neurologist and of the U of M medical school and M uh, Fairview specializing in the diagnosis and care of neurodegenerative diseases such as Alzheimer's disease. So thanks so much for joining me.
Speaker 2 00:01:56 Thank you for having me. It's an honor to be here. Yes.
Speaker 0 00:01:59 Well, we, we were thrilled to have you come on. So I want to talk a little bit about, um, first of all, I don't really know anything much about you except the little bit I got. So what made you decide to join to go into, um, neurodegenerative diseases?
Speaker 2 00:02:15 Well, I think it's a, um, area of brain health that we really don't know much about currently. And we've definitely made a lot of pioneering progress in other areas of brain health, like multiple sclerosis, or now we have medications to treat that disease. We've made progress in Parkinson's disease, where we can treat the tremor. We have medications to make patients move faster, but dementing illness like Alzheimer's disease, we still don't really have any good drugs. So I thought it was a field that had a huge unmet need and, um, um, I'm passionate about trying to find new ways to help patients. And that's why I chose that field. Excellent.
Speaker 0 00:02:57 Well, thank you so much. I'm so glad that somebody who has a passion is in there. I suppose. That's, you know, you don't go into something like that, unless you're really passionate about it. Can we start them up about, um, let's just start out by talking about what dementia is. So can you tell us what dementia is to begin with?
Speaker 2 00:03:18 Yeah, thanks for the question. Uh, dementia used to be synonymous with Alzheimer's disease. In fact, I would say up until the, uh, uh, 1990s, maybe even up to the two thousands, the two words meant the same thing. So if you said, oh, my uncle has Alzheimer's. That was almost the same as saying he had dementia. Um, however, that's not actually correct. So I'll talk more about what Alzheimer's disease is maybe later, but the Mentia is a disease that slowly robs someone of their ability to think. Um, so it can be their ability to remember something like, where did we go for dinner last week? Or where did we go for dinner yesterday? It can Rob people of their navigation abilities. So people will lose track of how do I get to my favorite store? How do I get to my favorite restaurant? And they can actually get lost instead of finding their way, it can also Rob people of their language abilities, so people can actually lose track of what words mean. Um, and some rare types of dementia can also Rob people of their personality. So when we see people who actually become a totally different person, um, so dementia is an umbrella term, meaning that it's a very general term that refers to any progressive loss of one's mental faculties. Um, Alzheimer's disease is the leading cause of dementia, but again, dementia is just a general term for when people lose their cognitive cognitive abilities.
Speaker 0 00:04:53 And how many different types of dementia are we talking about?
Speaker 2 00:04:59 Yeah, you know, that's a question. I don't have the answer off the top of my head, but there are dozens of different types of dementia. Um, most dementias are caused by abnormal proteins that accumulate in the brain and those proteins are toxic and they damage the brain and caused the loss of neurons and neurons are the cells that help us think. Um, and so those proteins are what defined the different types of dementia. Um, so I'll, I can talk about that more later, but, uh, one example is Alzheimer's disease that's caused by two different proteins, or at least that's how we define the disease. Um, so if there's, I'm sorry.
Speaker 0 00:05:42 Well, since you're there, why don't you talk a little bit about the difference between dementia and Alzheimer's?
Speaker 2 00:05:48 Yeah, so Alzheimer's makes up about 80% of all cases of dementia. So again, dementia is sort of the general Alzheimer's disease makes up the bulk of what causes dementia Alzheimer's disease is composed of, um, two toxic proteins. One is called amyloid, and then the other protein is called Taobao. And those proteins, you can only see under the micro spill, you can't see them with the naked eye, but they accumulate in the brain over many decades. And in fact, it's thought that maybe Alzheimer's disease even starts in someone's teenage years and that those proteins take so long to actually cause brain damage, but they do it so slowly over time that the symptoms only start when someone's, for instance, in their sixties, seventies, or eighties. So it's an extremely slow disease. Um, but one that's devastating than the last
Speaker 0 00:06:47 Oh, teenage years. Holy crumb. I can't even imagine. And
Speaker 2 00:06:53 Yeah, it's, it's definitely, um, you know, uh, uh, what should I say, um, uh, time in the field or understanding a lot more about how the disease progresses over time? Um, so what we know though, is that it takes many decades before those proteins actually cause symptoms.
Speaker 0 00:07:11 Like we misuse the words, all simers and dementia, then it, like you said, it, it feels like that that's unless you really understand how dementia works or an Alzheimer's works, it feels like that's misunderstood. Um, so are there different types of Alzheimer's or is it just Alzheimer's is Alzheimer's
Speaker 2 00:07:33 Yeah, thanks for that question. Let's say, um, you know, a question that's still an area of active research, but the answer is yes. So the most common type of Alzheimer's disease is the type where someone can't remember what they did yesterday, or they can't remember what their spouse told them already 10 times, you know, for instance, we have an upcoming doctor's appointment and then their spouse might have to repeat that 10 times and they still won't get it. So that's the memory type of Alzheimer's disease. And that's again, probably 80% of all types of Alzheimer's disease, but then there are more rare types of Alzheimer's disease. One is called a posterior cortical atrophy, and that's a mouthful, but, um, it's the type of Alzheimer's disease that interferes with your visual spatial functioning. So people will lose their ability to park a car, you know, parking a car involves a lot of visual spatial skills.
Speaker 2 00:08:32 You have to know where the car is. You have to know where the parking spot is. You have to know all the car turns. You have to know where the car is in space as you're moving it. So there's a lot of visual spatial processing that happens when you drive. And so those individuals will lose their ability to, for instance, drive a car. Um, they might lose their ability to look at a, um, a movie and be able to tell how many characters on the screen, because they can't process all the visual imagery in front of them. So that's the visual spatial type of Alzheimer's disease. And that's, again, a rare type of Alzheimer's disease. Um, there's another type that robs somewhat of their language abilities and they can't find words anymore. So it makes them extremely, uh, an extremely difficult for the individual to find the correct word.
Speaker 2 00:09:24 Um, and then there's an even more rare type of Alzheimer's disease where someone loses their personality and they become a totally different person and engage in socially inappropriate behavior like belching and public are talking about very personal matters to someone at a shopping center line. Um, those types of behaviors. So Alzheimer's disease can affect really any area of the brain, but the most likely area that it affects, uh, is memory. And that's why, uh, when we see someone with memory problems, we generally think that the most likely causes is Alzheimer's disease in the right setting.
Speaker 0 00:10:03 So what are the stages of Alzheimer's?
Speaker 2 00:10:08 Yeah, so, right, right now there's different stages. Uh, there's what's called the presymptomatic stage and that's the stage when you know how I said that we think the protein start to accumulate when someone's a teenager. Well, let's say there's someone like be, you know, I'm, I'm a 36 year old guy. Um, you know, I technically could have Alzheimer's disease, but I just, the proteins haven't caused enough damage yet. And so, you know, if, if I'm thinking, okay, and not having any problems I would be in what's called the pre-symptomatic phase, meaning that I don't have any symptoms yet. Then there is what's called the mild cognitive impairment phase where people are just starting to notice problems that interfere with certain, very complex activities. So for instance, someone might have trouble doing taxes, you know, even normal people have a lot
Speaker 2 00:11:05 Back. Yeah, taxes are hard. And if you can't do taxes, that's not necessarily a red flag, but you know, that's one of the first things to go because it is something that's pretty hard to do. Um, you know, or the car breaks and they're not a mechanic and they have to figure out, you know, what part do they need? How do they fix a car doing something new that requires a lot of learning, um, might be a symptom, someone with mild cognitive impairment has, but they're still able to function and their other day-to-day activities. Um, so that's the mild cognitive impairment stage. And then we'd start crossing over into the, into the dementia stage. So again, dementia is a general term and what we mean by dementia is when someone can no longer do everything, um, independently. So they start meeting help with day-to-day activities.
Speaker 2 00:11:56 So they might need help with appointments. Um, they might need help with, um, grocery shopping because they just can't organize and remember what items to get. Um, and the first phase of dementia is called the early dementia phase. And that's, that's a phase when maybe loved ones will know that the person has a problem, but if they just go to a casual meeting or meet someone, let's say at a bus stop, that person might not notice that they really have a problem. Um, and then after the early dementia phase, there's, what's called the moderate phase. And the moderate phase is when someone starts needing help with routine things, um, that, uh, happen on a very frequent basis. So, um, making sure that their medications are ready and available, um, being able to cook and clean dishes, being able to use the laundry machine, um, you know, being able to, um, take a shower and, you know, use the faucet.
Speaker 2 00:12:57 You know, those things might start becoming impaired in the moderate phase. And then the last stage of Alzheimer's disease is the severe stage. And the severe stage is when someone needs help with things that people need just to survive. So they might need help with getting food to their mouth, or they might need help, you know, cleaning diapers because they can no longer, um, stay continent of urine and stool. Uh, they might need help moving, you know, at the end stage of Alzheimer's disease, people have difficulty moving their limbs. Um, you know, they might need help getting out of bed or into bed day or getting clothes on. So that's the last stage of Alzheimer's disease. Um, so, so just to briefly sum it up, there's the presymptomatic phase, there's the mild kind of impairment stage. There's the early moderate and severe stages of dementia. Um, so those are kind of the overall, uh, spectrum of different severities of, um, any type of dementia, but of Alzheimer's disease to,
Speaker 0 00:13:57 Is there a general timeline that all simers would take or can it be anywhere from, you know, brief to long?
Speaker 2 00:14:09 Yeah, that's another, um, very perceptive question. Um, so I always tell my patients that everyone is different. Um, one thing that I'll say is, uh, the average amount of time between diagnosis and someone passing away is about 10 years. And that's again an average, and there's a lot of variability around that. Um, that's again, not the time between one of the proteins accumulate and once someone passes away, which again, to her, we understand many, many decades, but the time that someone comes into my office and says, I have problems. And then the time that they pass away as again in general, 10 years, but there are, again, a lot of exceptions to that general rule. Um, there are patients who have Alzheimer's disease that, um, start having symptoms and the symptoms progressed extremely rapidly and they actually pass away within a year. Um, and that is a very aggressive form of Alzheimer's disease.
Speaker 2 00:15:09 And we still don't know why certain forms of Alzheimer's disease are more aggressive than others. Um, then there are people who are the opposite who gets symptoms of Alzheimer's disease and stay basically the same for DEC for, you know, one or two or three decades. Wow. Um, and we still don't exactly understand why that's the case too. One thing that I will say though, is that, um, the brain is an organ in your body that never heals itself. So unlike if you break your bone, your bone fixes itself, if you cut your skin open, your skin will heal over. You'll have a scar, but you'll still heal over, but your brain really, you know, those neurons, once you lose them, you know, they're gone. So the brain is kind of like a record of all the bad things that happen to it throughout its entire life.
Speaker 2 00:16:03 So if you had a concussion, let's say when you were in sixth grade or you played college or professional football, or you took certain medications or certain, um, uh, drugs that were dangerous to the brain, or, uh, let's say that you also had no opportunity to really get an education. Um, you know, all, a lot of things can contribute to brain health. Um, and so Alzheimer's disease is certainly bad for the brain, but when there are other bad things that are also happening to the brain Alzheimer's disease and do even more damage, it's kind of like adding insult to injury, you have already pre-existing brand issues. So one thing that we believe is that people who have a slow form of Alzheimer's disease probably have a healthy brain to begin with. You know, they might have had a lot of exercise growing up. They had a lot of stimulating activities when they were young and when they're in midlife, um, they weren't exposed to air pollution. You know, they ate healthy throughout their life. So again, there, there are certain things that you can do throughout your life to make your brain as healthy as possible, so that if you do develop Alzheimer's disease, um, it's not as, um, aggressive.
Speaker 0 00:17:24 We need to take the short station break and we will be writing
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Speaker 0 00:17:57 And we're back. This is disability and progress. And Kathy I, 90.3, FM Minneapolis, and Kathy I D O R G. My name is Sam. We're speaking with Dr. William Mann Thai dad to get that right. All right. So I want to step back just a minute and talk about something I read and I wasn't sure why I saw something on down syndrome and that, that it was linked in some way that if you are, if you have down syndrome, you are like 50% more likely to have all simers. Can you talk a little bit about that?
Speaker 2 00:18:36 Yeah. So what I'll first say is that, um, individuals with down syndrome, if they live long enough, will almost inevitably develop Alzheimer's disease. And, um, I know that's a hard thing to say, um, and maybe callous to say too, but, um, we understand that down syndrome, you know, what causes it is when you have three copies of the 21st from a cell phone. So, um, you know, everyone has two chromosomes, I should say. Most people have two chromosomes for, uh, one from the father and one from the mother, but in down syndrome, uh, the baby will inherit usually two chromosomes from the mother and then one from the father. So they have three copies of a gene instead of two copies. So again, normal individuals will have two copies of a gene and the down syndrome, they have three copies of the 21st chromosome. And, uh, on that chromosome is the gene.
Speaker 2 00:19:47 And again, genes are the instruction manual for proteins, um, is the gene for amyloid. So essentially there are three instruction manuals telling the cell and, you know, cells are the building blocks and tissues, uh, telling the cell to make the ALS to make the amyloid protein. And so there is much more, uh, sorry, much more amyloid protein being made in people with down syndrome than in normal individuals. And the amyloid protein is, um, one of the ways that you can develop Alzheimer's disease and the amyloid protein is toxic. And again, slowly accumulates over time, uh, and can cause brain damage. And so individuals down syndrome actually develop Alzheimer's disease at an extremely high rate. And, um, if they survive into their forties and fifties, uh, the chances of having a symptoms from Alzheimer's disease, uh, quite high,
Speaker 0 00:20:50 I want to talk a little bit about, um, diagnosis. I, I was listening to when you said, um, you know, how people can, some of the symptoms and where you may not remember where you go out to eat last week and I'm thinking, oh, but it is normal in some respects to forget certain things. Sometimes, um, all of us had misplaced something one time or another, and that boy of the heck did I put that? So when does it become a problem? What, and how do you even diagnose that? There's a, there is a problem.
Speaker 2 00:21:28 Yeah. Uh, thanks for that question. There, there are a couple of different ways that we diagnose someone with Alzheimer's disease, um, or at least the type of Alzheimer's disease, where they have symptoms due to the proteins. Because again, the proteins take many decades to accumulate and you can still be normal even with those proteins around. But once we, um, detect that there are symptoms, then we start asking about what type of symptoms they're having. So I, 100% agree with you that it's totally okay to lose your keys, to maybe forget where you parked your car to, you know, forget that someone told you about, you know, an upcoming event that just you spaced out on and you, you know, you missed, um, when it starts to become concerning though, is when it's happening extremely often. And when it's happening, despite numerous reminders and what is even more concerning is when someone says, oh, do you remember that?
Speaker 2 00:22:28 We went to a movie last night and the person says, I have no idea what you're talking about, Oroville. Um, it's so it's when you provide a reminder and the person still doesn't know what you're talking about frequently, when we're providing reminders, we can kind of jog our memory. It was like, oh yeah, I know what you're talking about now. You know? Yeah. I remember last week, now that you say it, I remember that we went to get pizza. And then after that, we, you know, went to go for a bike ride. Again, it's normal not to be able to remember that off the top of your head, but when someone is reminding you of something and you still really don't remember it, and there's not an alternative explanation, like let's say the person got a concussion or let's say they were intoxicated, or, you know, maybe they were taking a medication as a painkiller.
Speaker 2 00:23:17 Um, and we've excluded these other possibilities that could explain it, you know, then it starts to become worrisome. Um, so once we get that level of being worried about someone, we then get a brain MRI and a brain MRI is basically a fancy term for a brain scan. And we actually look at the brain and we try to figure out, um, questions like is the brain shrinking? Is there a brain tumor that could be responsible for the symptoms? You know, the person maybe have a stroke, is that the cause of their, uh, memory issues? Um, so the MRI can really provide a lot of answers to, you know, what may be going on. Um, and if the brain MRI shows shrinkage, then that tells us, you know what, this is not, you know, a good sign. You know, this is not normal. The brain is shrinking.
Speaker 2 00:24:07 This could be Alzheimer's disease. And again, Alzheimer's disease and other dementias, the brain actually does shrink because those neurons are dying cells. Um, if the brain looks somewhat normal, then we, again, we explore other reasons why the person could be having problems. We ask a lot about medications. We ask about substance use. Um, we ask about, you know, um, psychiatric disease, you know, certainly severe depression, PTSD, severe anxiety, um, can sometimes cause severe memory problems too. So we, we ask about those diseases. So we basically do a comprehensive review of all medical issues that could alternatively explain the situation. Um, and then finally, we also look for certain vitamins and certain minerals. Um, you know, there's a lot of diets out there nowadays and sometimes people don't get the right amount of vitamins and minerals in their diet. Um, and we'll want to make sure that they're not missing a key vitamin that they need to maintain their, um, their memory.
Speaker 0 00:25:08 Do we have statistics on Alzheimer's?
Speaker 2 00:25:13 Yeah. So about one in 10 people over 65 in the United States has Alzheimer's disease. That ha that is symptomatic
Speaker 0 00:25:25 Gender, gender preference.
Speaker 2 00:25:27 Yeah. So women are more likely to get it than men and we, we're not entirely sure why that's the case yet. Um, but there is a gender preference and that's an area of, uh, extremely active research right now in terms of why are women more likely to have it than men, but there is a gender preference that is correct.
Speaker 0 00:25:46 Is it hereditary?
Speaker 2 00:25:49 It is highly hereditary. Um, there are certain genes that almost destined you to have the genes are what the appearance passed down in the form of kind of an instruction manual that tells the cells what type of proteins to be. But there are certain genes that will almost predestine you to get Alzheimer's disease, but those are very, very rare. And they typically cause symptoms of Alzheimer's disease in someone's thirties and forties. So that's a very, very rare form of Alzheimer's disease that causes symptoms that beyond. Um, there's another gene, uh, out there that's the most common genetic reason for Alzheimer's disease, at least in the United States that increases your chances of getting Alzheimer's disease by about triple. So, you know, again, if you live to 65, you just have a one in 10 shot getting Alzheimer's disease. Some now you have the 30%, you know, three intent shot having Alzheimer's disease with this particular gene.
Speaker 2 00:26:48 It doesn't predestine you to get it, but it at least increase your chance. Um, and then finally, it's, uh, also a disease that sometimes we, we think of as a deck of cards where you can just be dealt, you know, a bad set of, you know, five cards. So there's sometimes multiple different genes that have to come together to, um, kind of stack the deck against someone and, uh, cause the disease. Um, so there are, there are certain genes that predestinate people, there's one gene that increased the chances significantly. And then it's also thought to just be bad box sometimes when you just get multiple genes that come together to really create a bad situation.
Speaker 0 00:27:30 Um, how did we fare during the pandemic? What happened with people with Alzheimer's? How did, did the pandemic make it worse? Um, did you find, or have you been finding anything that says, um, I don't know how you do this, but that maybe the pandemic caused more Alzheimer's
Speaker 2 00:27:52 Yeah. And I'm glad you brought that up. I didn't have a, maybe I should have talked about this, your previous question. Um, but I'll answer it here. So one of the things that we know is important to not only preventing Alzheimer's disease, but to, um, to delay the worsening of Alzheimer's disease is to make sure that the person suffering from the disease has a social outlet. So, you know, I always tell people, the brain is a little bit like a plant that needs sunshine, and you need to have the person who has Alzheimer's disease feel stimulated, whether it's, um, having a conversation with them, um, you know, taking them to a different location, you know, whether it's a walk around the facility of the rant or a walk around the block, you know, watch a movie, you know, put music on, um, those things are actually really helpful for the brain to essentially stay happy and not decline as fast.
Speaker 2 00:28:52 Um, and I think COVID was absolutely devastating to individuals with Alzheimer's disease. I honestly think that, you know, there's not many other things in life that are that kind of depressing and know being alone in this disease, you know, not having your family, you know, be able to visit you, uh, you know, be able to provide you that conversation, you know, being able to bring in, you know, your grandkids so that you can feel like there's youth, then there's an energy in the room. You're not having someone say, I love you not having personal touch, you know, personal touches against something that's really helpful for brain health. You know, humans are we're primates and, you know, we, we really thrive off of that social aspect of, you know, personal touch. And, um, so yeah, it was a terrible, terrible time for people living with dementia and not having any of those social outlets.
Speaker 0 00:29:50 And I, I think our add to that people who have, um, experienced some significant depression in their, their lives, they may be at greater risk. Is that a, is that a, a real thing or are they just speculating?
Speaker 2 00:30:07 Yeah, no, that's definitely true that if you have depression, you're, you know, more than likely to, uh, develop Alzheimer's disease, but we don't know if that's a cause as in, if you're depressed, then that's going to cause Alzheimer's disease or whether it's the reverse, whether Alzheimer's disease causes depression interest. And we think it's probably maybe a little bit of both, but we definitely know that Alzheimer's disease can cause depression. So, um, Alzheimer's disease again, um, we, we think is caused by these two toxic proteins that accumulate in the brain and those proteins, they actually invade and they destroy the areas of the brain that produced serotonin. So serotonin is kind of that hormone that's like telling you that I'm content with my life. It's not, it's not the hormone that says, oh, I'm, you know, basking in pleasure. This is the most, you know, ecstasy I've felt, you know, ever.
Speaker 2 00:31:06 It's not that type of pleasure. It's just this general feeling that, yeah, I'm, I'm, I'm okay with my life, you know, um, things are going okay, it's this feeling of contentness and Alzheimer's disease essentially takes away serotonin. And so we, we, we see that people in the early phase of the disease can get quite depressed. Um, I've seen some patients who that's actually the first symptom, you know, they, they tell me, you know, what, I got really depressed three years ago. And then two years after that I started losing my memory. So we w we kind of are, are, are learning that, you know, there is a mind brain connection, you know, like if you affect the brain, you're going to also affect your, your mental and your psych psychological health or psychological health. Um, but yeah, so that's, uh, a long-winded answer to your question, but yeah, a good question to ask
Speaker 0 00:32:00 Carolyn, do you have any questions so far?
Speaker 4 00:32:03 Um, I'm pretty fascinated that just to let the doctor know, I worked at the VA in north Chicago for many years, in fact, over 20. And, uh, one of my jobs was the first Alzheimer's specific unit for the VA guys. And it was interesting because women are usually the, uh, victims of uh Alzheimer's but we had all the men and it was quite interesting. And what we've learned so much from, from the eighties until now, it's just, it's just blows me away.
Speaker 2 00:32:39 Yeah. That's a great point. You make, I agree.
Speaker 4 00:32:43 Uh, the medications have changed a little how, how, how much they're used and what, which ones they're using now. Can you talk a little bit about that?
Speaker 2 00:32:52 Definitely. Yeah. Thanks for the question. Uh, we still are a little bit in the dark ages, but I agree with you, there is more now than there was in the eighties. Um, and right now there's, there's two classes of medications that we use to treat Alzheimer's disease. The first one, um, boosts a level of a chemical in the brain that promotes alertness. And it's a medication that has a little bit of a drop in the bucket. It can help a little bit, but sometimes it doesn't really do a whole lot. Um, but we still offer it to patients because we don't have much else right now. Um, and then the other medication is, uh, what's thought to be a neuroprotective, uh, medication. So what that means is that it protects the brain against too much excitement. So one of the theories of Alzheimer's disease is that the proteins, uh, cause the neurons to, uh, essentially get a little bit overexcited and that overexcitement could actually lead to them dying.
Speaker 2 00:33:55 And so this is a drug that, um, kind of dampens down the excitement of the brain and it's thought to protect it, but it's, uh, it's again, a drug that's, uh, I'll use the term a drop in the bucket. It doesn't do a whole lot. Um, but it's, again, all that we have available. Um, I I'm planning on having the question asked about this new drug called <inaudible> that was approved by the FDA. And I can really talk about that now or later, but I'll just say briefly that, um, that's, you know, very controversial drug. We still don't really know if it works well enough to offer it to patients that has a lot of toxicities. Um, and we're still trying to figure out which patients might benefit the most, if any. So, yeah,
Speaker 0 00:34:43 And my, my understanding about that was that the FDA did approve it, but the medical field wasn't thrilled. Um, is that correct? And thinking,
Speaker 2 00:34:54 Yeah, I think you, you know, summarized it very well just there. Um, you know, I think the FDA also wasn't too thrilled in the way because they approved it, not based on it working to help with symptoms, they approved it based on it, taking it out, amyloid protein. So, um, it does a good job of taking out amyloid protein, but it doesn't do a whole Bosch, I should say it doesn't, uh, do, uh, a noticeably good job at actually helping out with the symptoms. And there are a lot of different theories out there for why that's the case. We know that amyloid is toxic to the brain. Um, but we're not sure why the drug by taking amyloid out is not actually, you know, doing a whole lot for symptoms. One theory out there is that you're kind of sending in the, what should I say? Uh, you're not strategically able to take out amyloid without hurting the rest of the brain. It's a bit like dropping a cluster bomb or like an atom bomb, you know, on a city where you're trying to, you know, take out a surgery target and instead of just
Speaker 0 00:36:07 Take out a whole lot more. Yeah,
Speaker 2 00:36:10 Yeah. You know, exactly. And we know it's a drug that causes brain bleeding, it causes brain swelling. Um, you could have seizures with the drug, could have strokes with the drug. So, you know, it's a little bit like, um,
Speaker 0 00:36:25 Another
Speaker 2 00:36:25 Analogy would be like hitting a nail with a sledgehammer, you know, you might kind of, you know, do too much. Um, so yeah, it's, that's one theory. There's a lot of other theories out there, but, but that's one of them, another theory is that you're touching patients too late. So, you know, I said that the amyloid protein we think starts to build up even in someone's teenage years. Well then why are we taking it out after the brain is already being damaged or, you know, are we intervening, you know, decades too late? You know, it's sort of like treating cancer after someone has the cancer, that's spread to their brain and spread to their pancreas, to their liver. You know, at that point in time, even with the best cancer drawers we have right now, there's not a whole lot. We can do, um, you know, we need to catch cancer as early as possible. And that's why people go to their doctors all the time, um, are, you know, the same thing applies to dementia. Are we catching dementia too late and treating it too late? Is that why it's not effective? Um, so that's another theory on there, but what is, I think clear to most people, what most people react is that the drug is, um, quite toxic and the actual benefits are still questionable.
Speaker 0 00:37:38 There was another thing I saw was a pred, um, Bredesen protocol. Are you familiar with that? Non-medicated right.
Speaker 2 00:37:49 Yep. So there's no medications at least no, no pharmaceutical medications involved in the Bredesen
Speaker 0 00:37:56 Protocol at work.
Speaker 2 00:37:58 So the Bredesen protocol, um, has a lot of things that, and I'm going to kind of, um, share my opinion here, just stick in time. Um, but has, in my opinion, two different arms to it. You know, one arm is what I will call well-accepted and what I would recommend to anyone with, uh, with any type of brain disease, whether it's dementia or any other type of, um, neurological condition. And that is one to get exercise. So we know that exercise is probably the number one thing we can do to promote brain health. Um, and I told my patients all the time that recommend half an hour of physical activity, five times a week. Um, the other thing is just eating a balanced diet. So, you know, a lot of us, you know, we live chaotic, we live stressful, we live busy lives. And so, you know, a lot of us eat processed foods and, you know, might not eat vegetables or fruits or might not have time to go to the grocery store, might not have the income to buy, you know, these, um, uh, you know, types of fresh legumes. And so, you know, diet is a huge issue in the United States and other countries as well. Um, so the Bredesen protocol recommends that hearing to, you know, a diet that, um, eh, at least isn't heavy on, you know, fats and processed foods and sugars that a lot of us have as our main state diet.
Speaker 0 00:39:30 So that's one part of
Speaker 2 00:39:34 Chocolate chocolate. That's an interesting question. I, you know, a lot of people think that chocolate is actually good in moderation. So we definitely say, you know, chocolate is okay, but you know, in moderation. So
Speaker 0 00:39:45 Yeah, that, there's a small line for me there. I tend to step over. Um, so I get it, the diet, um, stress, those things is a thing that I wanted to touch on is sleep that you're hearing a lot in the, in, um, everywhere now amount of sleep can really depend on how well you focus, how well you think, and even maybe lead to, um, earlier dementia or Alzheimer's. So is there anything to that or are we still a as a jury out with the sleep deal and they're using anything they can to try to keep you on a more,
Speaker 2 00:40:27 Yeah, that's, that's another fascinating question. Um, it's a little bit like your question on depression, where does insufficient or bad sleep cause Alzheimer's disease or is the reason why patients have bad sleep because it's actually the Alzheimer's disease that's disrupting our sleep wake cycle. Um, again, we think it's a little bit of both that you get into this vicious circle. Um, what we do know about sleep though, is that sleep is the time of our day or night when you get rid of toxic proteins. So your brain actually is producing toxic proteins all day. You know, when you're thinking, when you're going around, when you're doing things, you know, just being awake, you produce these toxic proteins. And when you sleep, it's actually a time when the brain is able to more or less recycle and push out those tasks, proteins. So there is a strong, theoretical underpinning to the idea that sleep is a key factor in order to get rid of those toxic proteins and avoid developing Alzheimer's disease or other dimensions.
Speaker 2 00:41:43 Um, on the flip side, Alzheimer's disease definitely can cause sleep disruption. So there's an area of your brain that tracks what time of day it is that tells you subconsciously that you're tired or that you should wake up or that, um, you know, now's the time that you're able to fall asleep and, you know, that's kind of your internal clock. You know, people will refer to that as your circadian rhythm and, um, Alzheimer's disease disrupts that circadian rhythm and frequently you see patients with Alzheimer's disease who have a real tough time adhering to a normal, uh, bedroom routine. So, you know, they'll be up all night and, um, sleeping all day. Uh, and then when you try to move that around, um, you know, that can be very problematic. Uh, patients with Alzheimer's disease tend to sleep more too. They tend to sleep just longer.
Speaker 2 00:42:39 Um, and, uh, you know, frequently I have patients to sleep 16, sometimes up to 18. I had one patient who slept 20 hours a day, you know, as much as, uh, a koala sleeps. Um, and it's funny, we're not really sure why that's the case, but some people think that it's the body's attempt to actually get rid of those toxic proteins say, well, sleep is one of the ways we can get rid of that toxic protein. We know that we have, this is again, me kind of pretending I'm the brain talking. Um, why don't we get rid of these toxic proteins? Let's just sleep more. That's one theory that the body is trying to sleep more and more to get rid of those toxic proteins. But again, we're not really sure what's happening, but it's still an area of active research.
Speaker 0 00:43:24 So Dr. Monte, I totally see your passion in this and figured we could probably talk for another 40 minutes and we don't have it, but I wanted to touch real quickly on because you're doing research, I think, with the development of, um, image and, and biomarkers, um, for neurodegenerative disease. Yes.
Speaker 2 00:43:47 That's true.
Speaker 0 00:43:48 Can you talk a little bit about that briefly?
Speaker 2 00:43:51 Yeah. Well, I think one of the, uh, success stories of the last couple of years is that there will almost certainly be a blood test for Alzheimer's disease within the next couple of years, maybe even one year. Um, so there are new technologies that can detect those proteins that are in the brain by just looking at the blood. So those brain proteins actually seep out in very, very small amounts into the bloodstream. And there are new machines that are sensitive enough that they can detect those proteins in the bloodstream. So people will be able to go to their doctor with problems and say, you know what, I might be having Alzheimer's disease. I don't know. And instead of having to go through a lot of really expensive tests, they can just get one of these blood tests. Um, it still wouldn't obviate the need, or I should say, get rid of the need to have someone take a very detailed look at anything else that could be contributing to, um, memory loss.
Speaker 2 00:44:57 Because again, like I mentioned, there's a whole slew of things that can also cause memory loss. Um, but it at least would simplify the whole process significantly. Um, and it would speed up the referrals to people like me, um, who would be able to, uh, really, uh, quickly and accurately, um, get people a diagnosis. And I think that's going to be really huge to future drugs that treat Alzheimer's disease because going back to that, that idea that we need to treat people before the brain starts to die. Cause we still don't have any drugs on the Verizon that can bring back dead brain cells. It's like, um, maybe eight dating myself here, but Christopher Reeves, when he fell off his first paralyzed, once you're paralyzed, there's still no coming back from that. And that's because the brain still cannot regenerate. Um, and there's still no drugs on the horizon that will do that. So I'm sorry. Go ahead.
Speaker 0 00:45:59 Um, so then that might you start testing really early? Like how early are you talking that you could test?
Speaker 2 00:46:07 Yeah. And that's, yeah, that's an excellent, um, you know, segue and you're kind of seeing where this is going. So, um, we're, we're thinking that we might even start testing people as early as their thirties, for instance. Um, you know, it's kind of like getting a cholesterol check when you're in your thirties and if you have a high cholesterol, then, you know, maybe you think about taking a cholesterol lowering medication or, or, you know, engaging in a healthier lifestyle.
Speaker 0 00:46:33 I can see though where people might say, you know, I think it's great and all that you can test, but if you don't have something for me to slow things or do whatever I don't want to know.
Speaker 2 00:46:45 Yep. And it's certainly an ethical issue too. Um, like you, because there's certainly discrimination whether it comes to mind.
Speaker 0 00:46:54 Oh my gosh.
Speaker 2 00:46:56 So do you want that to be, you know, an albatross around your neck that, you know, or, you know, like I said, health insurance companies are technically not allowed to discriminate, but you know,
Speaker 0 00:47:08 You know, you know, they do, we've all been there when they have so, uh, and then there, you could try to count it as a pre-existing maybe, but you know, then there's that whole catch 22 of that one.
Speaker 2 00:47:24 Yeah. So it's a really, you know, fraught ethical and, and I should say, I mean, like I said, this, this has real implications for people. Um, and I, I agree with you that those blood tests really wouldn't start to be tested and younger individuals until there's a therapy that can do something about it. It's a little bit like, um, you know, maybe a colonoscopy that people get now, you know, when you turn 50, you're supposed to get a colonoscopy so that you can make sure you don't have full on cancer. So if you do have it, you can at least take it out before it started spreading everywhere in the body. Um, and that's, you know, something you get whether or not you have colon cancer, it's just a screening test. Um, so people think that maybe that's the same direction. This will go once we have effective therapies, but again, that's one avenue the future might take. But I think a lot of it depends again on, um, like you were bringing up these really important issues when it comes to, uh, insurance or employment for, um, you know, one's own anxiety levels, you know, knowing, oh, I'm like, I'm like, I'm gonna be that recognized my family members. I mean, that's not something that is easy to obviously live with a lot of issues that we have to battle it.
Speaker 0 00:48:40 Flip side though, does the medical field believe enough in diet exercise and et cetera, et cetera, to think that, well, Jesus, we tested you in your 20. Maybe you can make enough changes to get it much later or to slow things. Do, do you believe enough in the, and those other things too, and that's a question to you, do you?
Speaker 2 00:49:07 Yeah, I think that it's a double-edged sword and, um, you know, it can, it can be used for bad things, but it can be used that information can be used for good things too. Um, I'll compare it to, uh, the, you know, there's this company you probably have heard of called 23 and me, it's like, you know, it's a way to get your, some of your genetic information, you know, for a pretty low cost. I have a lot of patients come to me and they say, I got my 23 and me, and guess what? I have the two genes that increase my likelihood of developing Alzheimer's, uh, significantly. And my mom had Alzheimer's and so what do I do?
Speaker 0 00:49:48 And that stress that you now have should even make it go faster.
Speaker 2 00:49:52 Uh, and, and, you know, those people also deal with, um, insurance discrimination because they, you know, life insurance is more expensive disability. That's good. Um, so, you know, already there have that sort of discrimination. Um, but like you were saying, I can tell them if you exercise and you prioritize exercise in your life. Cause we all have so many things pulling us in different directions. You know, we have our work, we have our family, we have our mental health, we have, um, our hobbies. We have our friends, we have, you know, you name it. Like we have so many different things perhaps in our life. And sometimes you have to prioritize and make tough decisions. And what, when you know that you're at high likelihood of developing Alzheimer's disease and you have one thing that you can do to avoid it, like getting exercise, you know, that might help that person. They might say, you know what, I have that information and I'm going to act on it. I'm going to, you know, make sure that I carve out half an hour, a day, five days a week to get exercise. Um, so yeah, the information can be useful. Um, but I think, uh, uh, it has to be used, you know, for good and, you know, there has to be obviously protections in place so that people, um, uh, use it for the right reasons.
Speaker 0 00:51:11 Where are you going with your research then? Do you see it coming like really quickly?
Speaker 2 00:51:18 Yeah, I think in, I think, uh, these blood tests again, uh, right around the corner, um, but there's a lot of questions about how well they work in a nonclinical trial population. So, you know, all of the blood tests have been, uh, you know, developed in the clinical trial population, which means that to be in a clinical trial, you can't really have anything else wrong with you other than Alzheimer's, but they know they, the people running the trial don't want to get confusing results. You know, they want the straightforward, uh, up in analysis as possible. So those people are basically healthy other than having Alzheimer's disease. Um, so how well are those tests going to work and your more realistics, uh, kind of an everyday person, you know, who has type two diabetes who has high blood pressure who might have liver disease who might have had cancer in the past, or have some other issue.
Speaker 2 00:52:17 You don't do those blood tests work as well on those people. Um, there also is part of the blood test that, um, takes into consideration that gene I was talking about that can triple your risk for Alzheimer's disease. Uh, but it turns out that then gene, um, the effect of that gene is the strongest and people with European or Japanese ancestry and, and people of African ancestry and, um, Latin American ancestry. It actually does not increase the risk as much like it, we don't know why, but there might be a protective factor. Um, and so there's some, again, ancestry dependent effects to have that particular blood test that we still are kind of trying to figure out. So we're trying to increase the diversity of our, um, uh, of our blood test, uh, development. Cause right now it's mainly focused on those of European ancestry.
Speaker 2 00:53:12 Um, so diversity is a huge issue, but also just representing a more real world situation, you know, that you, you know, it's pretty rare to have someone who just has Alzheimer's again, that's most people have other health issues. So, you know, how do, how do we bring this, you know, to, to make it a, uh, to bring this to prime time? You know, we need to, um, um, expanded out a little bit in terms of who was being included in the study. So that's one of the things that I'm doing at university of Minnesota is trying to bring more diversity to the, um, the study of these blood tests.
Speaker 0 00:53:45 Um, people find out more about Alzheimer's and, and where they can go to get help for it, et cetera, et cetera.
Speaker 2 00:53:53 I really liked the Alzheimer's association website. Um, the Alzheimer's association is in my opinion, the number one resource for patients and caregivers to learn about, um, Alzheimer's disease. Um, it also can teach someone about other types of dementing illnesses. Um, it's a pretty easy website to remember. Um, the website is a L z.org.
Speaker 0 00:54:21 Yeah,
Speaker 2 00:54:22 Yeah. The first three letters of Alzheimer's disease. So just a L z.org. Um, and it's a very good website for learning about it. Um, it has a lot of resources. There's actually a number that you can call and talk to someone. Um, you know, there's a lot of philanthropy for Alzheimer's disease, um, out there. And there's a lot of really generous, uh, people who are donating money to find a cure and to help support caregivers. And the Alzheimer's association is the, as gotten a lot of these funds to, um, to help with patients and caregivers. So I highly recommend going there. They have a great system. That's my number one recommendation
Speaker 0 00:55:04 Dr. Monteith. Thank you so much for joining us tonight. I really appreciate your time.
Speaker 2 00:55:09 Lots of great. Thanks for having
Speaker 0 00:55:11 Me. Thank you very much. Good night.
Speaker 0 00:55:21 This has been disability and progress. The views expressed on the show are not necessarily those of cafe or its board of directors. My name is Sam. I've been the host of the show, Charlene dollars. My research team, we've been speaking with Dr. Mill William <inaudible>, who is the, um, from the university of Minnesota medical school and M health Fairview. And he specializes in diagnosis, um, and care of neuro degenerative diseases. If you want to be on our email list, you can email
[email protected]. We'll greatly stick you on and let me know what's coming up. Thanks so much for listening. Good night.
