Summary of "[Part 1] Alzheimer’s and Brain Health" Featuring Dr. Kellyann Niotis

In the premiere episode of "The Interview with Leslie Heaney," released on June 11, 2025, Leslie Heaney delves into the critical topics of Alzheimer’s disease and brain health alongside esteemed expert Dr. Kellyann Niotis. As June marks Alzheimer’s and Brain Awareness Month, this conversation offers invaluable insights into the prevalence, early indicators, and genetic aspects of neurodegenerative disorders.

1. Introduction to Neurodegenerative Disorders

Leslie Heaney opens the discussion by introducing Dr. Kellyann Niotis, the Director of Parkinson's and Lewy Body Dementia at the Institute for Neurodegenerative Diseases. Dr. Niotis is renowned for her pioneering work in preventive neurology, focusing on risk reduction strategies for disorders like Alzheimer’s, Parkinson’s, and Lewy Body Dementia.

Notable Quote:

Leslie Heaney [00:05]: "...June is Alzheimer's and Brain Awareness Month, and we are so fortunate to have Dr. Kellyanne Niotis with us..."

2. Prevalence and Statistics

Dr. Niotis provides a comprehensive overview of the current landscape of neurodegenerative diseases:

• Alzheimer’s Disease: Accounts for 60-80% of all dementia cases. Recent studies estimate that in the United States alone, up to 7.2 million individuals are affected, a number higher than previously thought.

• Parkinson’s Disease: The second most common neurodegenerative disorder, impacting approximately 1.1 million people in the U.S. Notably, it is the fastest-growing neurological disease, with incidence rates expected to reach 25 million globally by 2050.

• Lewy Body Dementia: Often overlaps with Alzheimer’s pathology, making accurate diagnosis challenging.

Notable Quote:

Dr. Kellyann Niotis [06:07]: "Alzheimer's, as I mentioned, is the most common form of dementia. That's about 60 to 80% of all dementia cases is Alzheimer's. So it's by far the most common."

3. Diagnostic Challenges and Methods

Diagnosing the specific type of dementia during a person's lifetime remains complex. While the gold standard is an autopsy, non-invasive methods include:

• Lumbar Puncture: Analyzes spinal fluid for amyloid and tau proteins indicative of Alzheimer’s.

• Imaging Studies: Utilize radio tracers to detect plaque and tangle buildup in the brain.

• Blood Tests: Emerging techniques now allow for the detection of these proteins in blood samples.

Dr. Niotis highlights the significant overlap in pathologies, noting that 50% of Alzheimer’s cases exhibit sufficient Lewy Body pathology, complicating diagnoses.

Notable Quote:

Dr. Kellyann Niotis [07:02]: "...you have to really look at these things in the right context of the right person."

4. Early Indicators and Symptoms

Identifying early warning signs is crucial for prevention and risk reduction:

General Risk Factors:

• Loss of Sense of Smell: Often precedes other symptoms.
• Mood Changes: Depression and anxiety are common but non-specific indicators.
• Sleep Disturbances: Insomnia and REM sleep behavior disorder (acting out dreams) can be precursors.

Notable Quote:

Dr. Kellyann Niotis [12:51]: "REM sleep behavior disorder... can predate Parkinson's in Lewy body by years."

Parkinson’s-Specific Indicators:

• Motor Symptoms: Tremors, stiff muscles, shuffling gait.
• Non-Motor Symptoms: Cognitive impairment in about 80% of cases, excessive fatigue, constipation, bladder issues, and handwriting changes.

Alzheimer’s-Specific Indicators:

• Cognitive Decline: Word-finding difficulties, repeating stories, trouble following conversations.
• Functional Decline: Challenges in performing daily activities like cooking or following a recipe.

Notable Quote:

Dr. Kellyann Niotis [16:57]: "...there are other early indicators that we might want to be aware of."

5. Genetic Risk Factors

Genetics play a significant role in the risk for neurodegenerative diseases. Dr. Niotis elucidates the impact of specific genes:

APOE Gene:

• Variants: APOE2, APOE3, APOE4.

• Prevalence:

  • APOE3: Present in about 65% of the population (ApoE33).
  • APOE4: Found in approximately 25%, increasing the risk for Alzheimer’s and cardiovascular diseases.
  • APOE2: Rare (<5%), offers protective benefits against neurodegenerative diseases.

• Impact: APOE4 impairs cholesterol transport in the brain, leading to toxic buildup and cell death.

Notable Quote:

Dr. Kellyann Niotis [29:00]: "...Everything is not always good. Like people with this gene can have age-related macular degeneration."

Parkinson’s-Related Genes:

• LARK2 and GBA Genes: Particularly prevalent in Ashkenazi Jews, Northern African Arabs, Berbers, and Southern Europeans.

6. Genetic Testing: Pros and Cons

Dr. Niotis advocates for genetic testing as a means to understand individual risk profiles but emphasizes its personal and psychological implications:

• Pros: Enables proactive lifestyle changes, such as diet modification and cholesterol management, to mitigate risk.

• Cons: Psychological stress, potential impact on insurance eligibility, and privacy concerns.

Notable Quote:

Dr. Kellyanne Niotis [42:06]: "These genes are not your destiny. They increase your risk. But there's lots of things that we can do to change the cards that we were dealt."

7. The Role of Gender and Perimenopause

Women are at a higher risk for Alzheimer’s, influenced by hormonal changes during perimenopause:

• Hormonal Decline: A rapid decrease in estrogen and progesterone affects brain function.
• Associated Changes: Increased cholesterol levels, insulin sensitivity alterations, and changes in body composition.

This hormonal shift coincides with the period when Alzheimer’s pathology is most likely to develop, compounding risk factors.

Notable Quote:

Dr. Kellyann Niotis [37:37]: "We need to talk about this genetic question, but it's just so important to hear. Women are at a higher risk for Alzheimer's disease, full stop."

8. Implications of Genetic Information and Insurance

Genetic data can influence insurance policies, particularly life, long-term care, and disability insurance, despite protections like the Genetic Information Nondiscrimination Act (GINA). Dr. Niotis advises caution and informed decision-making before undergoing genetic testing.

Notable Quote:

Dr. Kellyann Niotis [44:19]: "...it does not protect against life insurance, long-term care insurance, and disability insurance."

9. Recommendations for Genetic Testing

For those considering genetic testing, Dr. Niotis recommends:

• Consultation with Healthcare Providers: Preferably conducted through a doctor to ensure clinical-grade accuracy and genetic counseling.

• Understanding the Tests: Options include blood or saliva tests from companies like Invitae or through clinical panels.

• Privacy Considerations: Awareness of how genetic information may be stored or used by testing companies.

Notable Quote:

Dr. Kellyann Niotis [46:03]: "I personally recommend doing this testing with your doctor because it's a clinical grade test and you really should get genetic counseling around the results."

Conclusion

Part one of this in-depth conversation underscores the rising prevalence of neurodegenerative diseases and the importance of early detection and preventive strategies. By understanding genetic predispositions and recognizing early symptoms, individuals can take proactive steps to reduce their risk. Dr. Kellyann Niotis emphasizes that while genetics play a role, lifestyle and environmental factors are equally crucial in combating these debilitating disorders.

Upcoming in Part Two: Leslie Heaney and Dr. Niotis will continue their discussion, delving into lifestyle risk factors, comprehensive prevention strategies, and actionable steps individuals can take to safeguard their brain health.

Credits:

• Podcast: The Interview with Leslie Heaney
• Episode: [Part 1] Alzheimer’s and Brain Health - feat. Dr. Kellyann Niotis
• Host: Leslie Heaney
• Guest: Dr. Kellyann Niotis
• Release Date: June 11, 2025