← Becker’s Healthcare Podcast
Loading summary
Transcript24 lines
- [00:00]
A
This is Laura Dearda with the Becker's Healthcare Podcast. I'm thrilled today to be joined by Dr. Peter Gleibus, board certified neurologist and chief of neurology, as well as director of cognitive and behavioral neurology at the Marcus Neuroscience Institute at Baptist Health. Dr. Glebes, it's a pleasure to have you on the podcast today.
- [00:17]
B
Hi Laura. Thank you for having me.
- [00:19]
A
Absolutely. Now I'm excited for our conversation because it's such a timely topic looking at Alzheimer's disease and it's so important for many patients as well as clinicians today. So with that, we'll dive right in here. What are the early warning signs or symptoms of Alzheimer's disease?
- [00:36]
B
So typically, you know, the Alzheimer's disease presents with a slowly worsening memory, especially that short term memory and what do we call shorter memories, meaning you know something what's happening right now, having difficulty remember a couple hours from now. So you know, you had a dinner yesterday, you have difficulty remembering, you know, the details are maybe the whole dinner. So you know that type of difficulty. So that would be probably the most difficult, the most common presentation. Again, it's not all or nothing initially, just certain things can be forgotten. But then you start seeing that person is realist start asking you the same questions or repeating themselves classically. Again, it's memory problem. Now some people can present a little bit what we say atypically, meaning more with the language problems or visual spatial disorientation or even changes in their behaviors.
- [01:27]
A
Got it. That's really helpful to know and just fascinating to think about all the different ins and outs of the disease progression and where the, how it manifests in everyday life. So when you're looking at that, how does Alzheimer's typically progress over time?
- [01:46]
B
So Alzheimer's disease, and again in the typical cases, it's a slowly progressive condition, meaning that the symptoms are slowly evolving. And even the beginning, it's frequently to hear from us that people can't pinpoint when did it start? Because it's such a slow and subtle beginning, but it usually lasts years. You know, we give eight to 10 years with some of the survival with Alzheimer's disease, that's average. And you know, when we say average means that there are people who will progress slower and there are people who will progress faster.
- [02:15]
A
Got it. That makes a lot of sense. And I can imagine, like you said, the variety depends on a good number of factors. Now from your perspective, what are some of the big risk factors for developing Alzheimer's and you know, really have it progress More quickly.
- [02:30]
B
That's where realist science is moving forward because we started understanding a little bit better what are the possible risk factors for developing this condition. We can divide the risk factors into non modifiable, meaning that unfortunately we can't change those. And modifiable, non modifiable risk factors would be genetics, whatever genes we have. Unfortunately, at least where we are right now, we can change it. Age, one of the most significant risk factors to develop Alzheimer's disease is also unfortunately we can change that as well. There's also women are more likely to develop Alzheimer's disease. But again the factors that could be acting here is that the women live longer and maybe some biological factors as well. So again these are non modifiable, we can't change our genetics or age. Now the good thing that there are modifiable risk factors, meaning that we have influence trying to affect our risk of developing the disease. And based on the current studies, these modifiable risk factors might play up to 40% role in developing the disease. So by working on these risk factors, we can actually significantly reduce the risk of developing Alzheimer's. And what I'm talking about when I say modifiable risk factors, that would be your cardiovascular health would be high blood pressure, diabetes, obesity, hyperlipidemia, all of these can increase the risk of developing cognitive impairment in the future in Alzheimer's disease. So making sure that we address those can reduce the risk of Alzheimer's as well. Physical inactivity is another much if I will respect our diet. We know that studies again and again showed that Mediterranean diet, mind type of diet is beneficial to our cognitive health. And if we follow the diet, it can reduce the risk of developing cognitive decline in the future. And Mediterranean diet is really, it's vegetable and fruit forward diet, more unsaturated and saturated fats, less red meat and maybe more poultry or more fish, seafood. Now cognitive inactivity, low education level, lack of mental stimulation are also factors that can increase the risk of developing Alzheimer's in the future. Interestingly, hearing loss in the mid middle age was identified as one of the possible risk factors as well. Depression, chronic stress, alcohol misuse, hyster, traumatic brain injury, especially repeat traumatic brain injuries, sleep problems, ear pollution, all of those factors can increase our risk developing Alzheimer's disease.
- [05:12]
A
Got it. That's helpful to know, especially thinking about the aspects of risk factors that are modifiable and things that we should keep in mind as we're living our daily lives. How is Alzheimer's disease currently diagnosed?
- [05:25]
B
So first, it's still very Heavily on clinic. It has to make sense. When we were talking typically typical presentations, we actually have to have the pattern of the cognitive problems that would go with the Alzheimer's disease. When we have the suspicion, then at that point in the office, we make sure that there is nothing else going on because forgetfulness can be a sign of many other conditions. If we try to exclude all the other conditions, any other neurological insults like strokes or bleeds, then in that case we proceed with a detailed cognitive assessment. It's called neuropsychological testing, where we can quantify the deficit and really see the pattern of impairment. When we have that information, we usually get as a next step is brain scans to make sure that we're not missing anything else as an explanation for the disease. Now we definitely are at advantage because we have what we call biomarker studies and that we can get specific PET scans looking for those abnormal protein changes in the brain. We can also quantify those changes in our cerebral spinal fluid. And the new thing is the all the occurrence of the emergence. I'm sorry, of the blood based biomarkers. Again, with the blood based biomarkers, there's still more for screening. Some of the blood based biomarkers are reaching that the threshold where we can use it actually to confirm the diagnosis. But the science is moving forward, obviously.
- [07:03]
A
Got it. That's really helpful to know. Thank you for explaining that to us. And in going past the diagnosis, what treatment options are available today and how effective are they?
- [07:13]
B
So the treatments, again, we can divide into the non pharmacological and pharmacological. And they're very important. Both of these are very important, non pharmacological. Every patient who goes through our clinic, you know, we counseled about the importance of the staying physically active, staying socially active, staying cognitively active, getting good sleep, controlling their cardiovascular risk factors, all the things, you know, I mentioned earlier. Now the medications, there are these new medications that were recently approved by the fda, the infusion medications, monoclonal antibodies that specifically target amyloid components in the brain. And those medications were shown to slow the disease progression. Again, they don't stop, they don't reverse the disease, but they slow down the disease progression. It's definitely, you know, are these perfect treatments? No, but it's definitely a right step forward. There are also other older medications we use that don't have that disease modifying effect, meaning they don't slow down the disease progression, but they can affect the person's ability to be functionally independent. So we continue using those medications as well.
- [08:26]
A
Got it makes sense. What are some of the most promising breakthroughs in Alzheimer's research right now?
- [08:31]
B
So there are more and more medications are being studied that would be affecting the amyloid component of the disease development. We're also looking for a result from the studies that are working on other components, because amyloid is just one piece of the puzzle in the disease development. There are tau proteins and there are clinical trials that are looking into whether affecting the tau proteins and development of them. We can change the disease projector even more. If you look at the number of Alzheimer's disease trials, we're talking over 100, 200 trials. And they're looking at any possible molecule right now that can affect. So the landscape of the treatment will be completely different in 10 years than what it is right now. And we're very excited about this because there are so many ways to look at the disease and so many ways to try to affect the disease progression, and not even chemically. Also the electrical stimulations, the human stem cell transplantation, et cetera. So as I said, it's not around the corner immediately, but in 10 years, the landscape of the treatment will be completely different. Absolutely.
- [09:45]
A
That's amazing to hear. And you definitely will be fascinating to see this progression of the treatments and different types of medications therapies. Now, how are some of these new medication therapies changing the outlook for patients? What do you see in the next 10 years?
- [09:59]
B
So, you know, one thing, you know, the medications that were already approved, you know, those infusion medications that we're using right now that slow down the disease progression, it's already giving, you know, hope to the patients because, you know, that by slowing down the disease progression, we're giving them more, you know, months and years to spend with their families, attend more graduations and all of the other events that are important for people. Also, by slowing down the disease progression, we are giving them a chance to be eligible for any new treatments that should be available in the future.
- [10:38]
A
That makes a lot of sense, and I appreciate your candidness. What resources or support systems are most important for families and caregivers as they're being diagnosed and going through Alzheimer's?
- [10:49]
B
So that's a very good question, because as you can imagine, Alzheimer's disease is, you know, it's not as a disease, it's not only a person's disease, but it changes the whole dynamic in the, you know, for the loved ones as well, because the loved ones will have to take, you know, more responsibilities over time. So they're having the. The being connected to the correct resources, including, you know, the, the future planning, the estate planning, the, the safety, home safety evaluation, as well as being connected to any resource for mental health because as you can imagine, it takes a big toll on the, not only the patient but also on the family, including the worsening of the mental health of the caregivers. So all of those resources are very, very important for the caregivers, what we noticed. It's also very important to feel that they're not alone because when you're facing these diagnoses, you sort of, you know, the whole world turns upside down. So the connecting in the groups and what we call caregiver support groups could be very helpful for these, for the caregivers as well.
- [11:56]
A
I can imagine. So, looking ahead, what gives you the most hope that the future of Alzheimer's treatment and what are you excited about?
- [12:04]
B
I'm excited about the overall the energy that is being put into the development of new treatment modalities and you know, that translates into, you know, the good financial support for their research and that many people are trying to look out of box, look for other solutions for the disease and that frequently brings novel and good meaningful therapeutics. So I'm optimistic for the future of the treatment. It can come soon enough, obviously, because when we have a patient today, while we optimistic about the future, it's today that matters. But, but I'm very, you know, I'm hopeful and optimistic, you know, about the future of the treatment of this condition or control, you know, even, you know, if we can even completely stop the progression at the earliest stages. That's already a huge achievement.
- [13:02]
A
Absolutely, I certainly agree. Dr. Klebus, can you tell us a little bit about the Marcus Neuroscience Institute? What are you doing there and how is it structured? What's really kind of new and innovative about the things that you're doing? Point.
- [13:15]
B
So the, what we're, you know, we're very excited, you know, the, or the way we're growing to be able to deliver the care, you know, to the community here because we, you know, as, as we discussed, it's a, you know, it's, it's a disease that, you know, it's not only biological disease, but it's such a social, you know, disease as well as it affects any aspects of persons and their loved ones help. So the team is, is extremely important and we already established, you know, we have our social worker nurse nav and we became one of the guide, the Medicare sponsored guide program where they're looking at different ways of delivering care for the patient. We're one of the centers, nationwide centers here, obviously. We're also growing in our research portfolio, educating future generations to make sure that they know all the newest treatments and also they can identify the diseases correctly. So the holistic approach is not only the biological treatment of the disease, but also the social interventions to make sure that people are connected to the right resources. We provide the research opportunities, the educational opportunities for the future generations, as well as caregiver support.
- [14:38]
A
Dr. Glebes, thank you so much for joining us on the podcast today. This has been such a fascinating conversation, and I look forward to connecting with you again soon.
- [14:45]
B
Of course, my pleasure.