What's new in Alzheimer's disease research, treatment
Transcript
[00:00:00] Host Amber Smith: Upstate Medical University in Syracuse, New York invites you to be "The Informed Patient" with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. Alzheimer's disease seems to be in the news every other day, so I've invited Upstate's chief of geriatrics to discuss some developments that may have an impact on this disease, which affects so many lives. Dr. Sharon Brangman directs the center of excellence for Alzheimer's disease, the region's only comprehensive center for evaluation and treatment of memory problems. She's here to talk about some new research about what may increase risk for Alzheimer's, a couple of promising medications, a study of a possible new treatment that's underway at Upstate, and a rundown of things we can do for brain health. Welcome back to "The Informed Patient," Dr. Brangman.
[00:00:51] Sharon Brangman, MD: Oh, thanks for inviting me again.
[00:00:53] Host Amber Smith: Let's start with what is newly considered to have a potential impact on Alzheimer's development. Some of these items we've already heard are not healthy, but how firm of a connection are researchers finding between things like shingles and the development of Alzheimer's?
[00:01:11] Sharon Brangman, MD: Well, there's intense research to try to figure out what could trigger Alzheimer's disease. And there was one study, I think it was a Swedish study that showed that people who had shingles, which is related to the same virus that gives us chickenpox, seems to have a correlation. And it may also connect with the herpes virus, which are all in the same family. And so in this one study, people who had this virus had an increased risk of developing Alzheimer's disease. The mechanism isn't quite clear, but this is a virus that lives in our bodies and just reemerges, especially as we get older. So there's a theory that it might cause some sort of long-term nerve damage that then increases as we get older.
But there's still a lot of research. There are so many other pieces that are being looked at. There was recently a study that looked at the connection between increased risk for Alzheimer's and eating processed red meat. So it could be that the nitrates and other ingredients that are used to make things like bacon and bologna and ham are toxic to nerve cells. So they found a correlation that people who eat a lot of processed foods, especially red meat, had an increased risk for Alzheimer's. And that kind of connects to what we know about eating a healthy diet, which is good for our bodies and good for our brains.
But there are other things too. For example, there's a connection looking at the risk of air pollution exposure in Alzheimer's disease. And even though we don't understand all these mechanisms, we know that air pollution isn't good for our heart and our lungs, and whatever isn't good for your heart, isn't good for your brain. So we may not have all of the answers yet. We have these associations. And a lot more research needs to be done.
[00:03:14] Host Amber Smith: I've been reading a lot about climate change and extreme heat and all of the things that that can do. Are researchers seeing a connection with Alzheimer's, with extreme heat?
[00:03:25] Sharon Brangman, MD: Well, that one isn't quite as clear, but we know that people who have Alzheimer's don't do well in extreme heat, and most humans in general don't do well in extreme heat, but we don't have a clear connection there. There's a lot of research that's looking into all sorts of things that impact our change from normal aging and the trajectory that puts you on track to get Alzheimer's disease.
[00:03:53] Host Amber Smith: What about diabetes? Because I know that affects so many people. Is that a risk factor for Alzheimer's?
[00:04:00] Sharon Brangman, MD: Yes, that's a well known risk factor for Alzheimer's disease.
We know that the brain is very sensitive to sugar. It needs sugar, and when you have diabetes, your body doesn't process sugar well, and that can cause a cascade of events that starts to damage the nerve cells. We also know diabetes affects the lining of our blood vessels, and the lining of your blood vessels is what helps to ensure good circulation to your heart, your brain, your kidneys. So we know that people with diabetes have an increased risk for heart attacks and kidney failure. And it looks like that similar association is also involving the brain.
[00:04:48] Host Amber Smith: Now, recently there was news about a new blood test that can diagnose Alzheimer's. Can you tell us about that?
[00:04:55] Sharon Brangman, MD: So we've been researching for years, and we know that many years before you even have signs of Alzheimer's disease, your body may be producing some of these abnormal proteins. These proteins are amyloid and tau, and these are associated with Alzheimer's disease. So they can be floating around in our bloodstream way before we have any signs of cognitive decline. So they have been looking at ways of correlating the presence of these abnormal proteins and connecting them with Alzheimer's disease and also with treatment for Alzheimer's disease, because with some of the new medications that are out there that actually remove these amyloid proteins from the brain, we know that the blood tests then show that they decrease in your bloodstream. So this is another source of research. We just got more information about it at a meeting I was at recently.
However, it hasn't been approved yet. It needs to be approved by the FDA and then also by the health department. And then that would decide whether insurance companies are going to pay for it. But we also need a lot of education on the best way to use these blood biomarkers because right now it doesn't look like it's good for anyone to just get the test just to see, because we know that some people who have these, um, abnormal proteins never develop Alzheimer's disease.
And so we don't want to cause unnecessary concern and anxiety for people who just want to test and see what the future might hold. So at this time, we don't believe that this is a good screening test for the general population. In other words, a healthy person who has no memory problems should probably not get this blood test because we don't know yet what that might mean for that person. There are some people who can have these proteins circulating who never develop Alzheimer's disease, and this would just increase someone's worry level and anxiety.
This test will most likely be used when there is a person who comes in with a memory complaint, and we as physicians are trying to sort out what could be going on. Another use for these blood biomarkers may be for people who are actually getting treatment with some of the amyloid-removing drugs, this might be a way to monitor the effectiveness of the therapy.
So there's still a lot of questions to be answered. The biomarkers have not been approved yet. And we are going to need a significant amount of education, not just to clinicians, but to the general public so that they can be used appropriately.
[00:08:01] Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking with Dr. Sharon Brangman, the director of the center of excellence for Alzheimer's disease at Upstate.
For so long there haven't been any medications for Alzheimer's, and now there are some. How promising are these new ones, Leqembi and Kisunla? I'm not sure how you say them.
[00:08:27] Sharon Brangman, MD: The words are definitely a mouthful. The generic words are lecanemab and donanemab, and these are the fancy words for monoclonal antibodies that remove amyloid buildup in the brain. And as I mentioned earlier, there's an association with amyloid accumulation in the brain, and amyloid is an abnormal protein that kind of gets onto the nerve cells and causes them to tangle up and die so that they can't send messages to each other. And these medications can remove that amyloid buildup. They're very effective in removing the amyloid buildup.
And in the research studies, it showed that it may help to slow down the disease for a period of time, maybe from anywhere from about four to six months. But it does not change the course of the disease long term. So in other words, this doesn't cure it. It may just stabilize it for a few months. And the side effects have to be very carefully monitored because as these drugs remove that amyloid buildup, they can loosen them from, say, blood vessels that might leak a little and cause bleeding or swelling in the brain.
So we have to do MRIs (magnetic resonance imaging) of the brain on a very regular schedule to monitor for any small swelling or bleeding. For the most part, it's temporary and there hasn't been serious long-term effects from these side effects. But there have been some people that have had serious side effects and have died. So we have to be very careful who gets selected to do this therapy. And the ideal person is somebody who has very mild changes. In other words, it has to be mild cognitive impairment, which is a kind of early, early memory loss, but you are functioning normally, and also people who have early Alzheimer's disease. And so these are people who have a little bit more memory loss, but are still pretty much functioning on a normal basis.
And you can't be on any blood thinners because these drugs, as I mentioned, can cause some bleeding as the amyloid is removed from the brain. And we found that people who are on blood thinners would then have more serious bleeding. And then there's some other things that we have to look at to discuss with the patient just to make sure that they understand all the risks before initiating therapy.
[00:11:14] Host Amber Smith: But if they work as designed, this might extend the lives of people with early stages of Alzheimer's?
[00:11:24] Sharon Brangman, MD: So it may provide some stabilization for four to six months. There's ongoing studies to look and see what happens long term. Do these people who take the medications continue to have benefit months or years later? Or there's also some studies looking to see if they should get a touchup periodically if we notice that the amyloid has reac accumulated.
The clinical trials were only for 18 months. So we don't know if somebody takes it for, say, 24 months, are they going to get more benefit? So there's a lot of questions and a lot of ongoing research that has to happen and is happening before we know definitively what to tell people long term.
[00:12:19] Host Amber Smith: I know we all would like a cure, but these sound pretty encouraging, right?
[00:12:24] Sharon Brangman, MD: So yes, this is providing a lot of hope. It took 30 years to do this research, and this just tells you the long haul it is to kind of sort out all the issues with a complex disease such as Alzheimer's disease.
And amyloid is really just one piece of it. There are other factors that may be involved in Alzheimer's disease that are also being studied. And what a lot of researchers predict, and I agree with, is that everybody is going to enter this disease in a different way, and we're going to probably have to do what's called personalized medicine to figure out what that individual's triggers were so that they can get the special therapy. So for example, some people may enter the disease from amyloid with some inflammation and maybe a virus exposure and diabetes. So there are other drugs that are getting investigated right now that look at other pathways that could lead to Alzheimer's disease.
For example, there's a study that we are doing here at Upstate that's looking at thiamine and its role in developing Alzheimer's disease. And we know by doing research in rodents that mice that had low thiamine levels had a lot of changes in their brain that look very much like Alzheimer's disease. So as we get older, there are many people who have a thiamine deficiency, and the brain needs high levels of thiamine all through our life. So is there a role for taking a special preparation of thiamine to increase those levels? That's one of the studies that we're looking at.
Another study is looking at metformin, which is a well knowndrug that's been used for diabetes. Because there's such a close correlation between diabetes and Alzheimer's disease, any medication that can reduce your risk for diabetes or can be used to treat diabetes may also have an added benefit of treating Alzheimer's disease or reducing your risk for developing it in the first place.
And we've heard about all of these drugs that have been used for weight loss -- semaglutide, for example. They seem to have a correlation of also reducing your risk for Alzheimer's disease. And this can be because, as I mentioned earlier, our brains are so sensitive for the need of glucose. When you have diabetes, your body isn't handling that glucose or sugar in the right way, and it can start a cascade of events that leads to damage of these neurons in our brain.
So we're doing studies that are looking at that here at Upstate. And one of the things I really have been so excited about is that we can offer this here in Central New York, because before that, people had to go to a big city like Boston or New York City to participate in these trials. And we're able to offer them here in Central New York at Upstate so that people who want to be involved in helping to solve this horrible disease can participate without having to travel. And we have so many volunteers that say they know this may not help them per se, but they want to help other people, or maybe prevent their grandchildren from ever getting Alzheimer's disease. So it's really one of those things that you do to help increase our knowledge so that we can help people into the future.
[00:16:19] Host Amber Smith: I'm your host, Amber Smith, and this is "The Informed Patient" podcast. I'm speaking with Dr. Sharon Brangman, who leads the region's only comprehensive center for evaluation and treatment of memory problems, at Upstate Medical University in Syracuse. Well, let's talk about how these trials work. If there are listeners who are interested in participating, are you still recruiting people for the thiamine trial or the semaglutide or the metformin trial?
[00:16:45] Sharon Brangman, MD: So we have a number of trials that we are currently running, and if you're not eligible for one, you could be eligible for another.
And each trial has its own requirements for participation. So we're basically looking for adults, usually between the ages of 60 and 90, but it can vary. For the most part you should have very mild memory problems. Some people also can have early Alzheimer's disease. But it really just involves talking to our clinical research team and seeing which study you might be eligible for.
[00:17:25] Host Amber Smith: So people who are interested in volunteering, they can learn more at (3 1 5) 4 6 4 - 3 2 8 5. And I also understand there's an email address, Geri Research, that's G E R I [email protected]. Are those the best places for people to learn more?
[00:17:45] Sharon Brangman, MD: Aboslutely. If you call, we have a team that will answer all of your questions, tell you what each study might involve and then help you decide which one might be the best choice for you.
[00:17:59] Host Amber Smith: So let's talk about the things that are supported by science that people can do to maybe help reduce their risk of dementia.
[00:18:09] Sharon Brangman, MD: You know, there's a lot that's within our control that we can do to help reduce that risk. And one of those is exercise. There's a lot of studies that show that exercise is very, very important for our overall health, but especially important for brain health. We know that the brain requires a good circulation, a good blood flow, and when you exercise, that increases blood flow to the brain. The other thing that happens is that there's these chemicals that help stabilize and grow nerve cells that move from our peripheral or external circulation into the brain and help stabilize the brain. And I tell people, you don't have to go run a marathon. It's as simple as taking a walk every day. And if you can build up to taking a walk about 30 minutes a day, that is excellent. The bare minimum is 150 minutes a week.
And the other piece I say is take a walk with a friend, because socializing and talking to people is very, very good for our brains. And we learned during the pandemic when people were isolated they actually had a decline in their brain power and had an increased risk of developing Alzheimer's disease.
So socialization, meeting people in groups, in person as much as possible is the best for our brains. The screens are not as good. They're probably better than nothing, but it's really that in-person interaction that our brains do the best in.
[00:19:48] Host Amber Smith: You're listening to Upstate's "The Informed Patient" podcast with your host, Amber Smith. My guest is Dr. Sharon Brangman, the chief of geriatrics, who also leads the center of excellence for Alzheimer's disease at Upstate Medical University in Syracuse.
Now we talk about healthy diet. What is that, though? What kinds of foods should be on your shopping list?
[00:20:10] Sharon Brangman, MD: So a healthy diet means eating foods that look as natural and normal as possible. The more they are processed, the worse they are for our bodies. So we want foods that look like what they're supposed to, and in general, those foods that are convenient that you heat up quickly, that you get by taking out are generally processed to the point where a lot of extra ingredients are added, such as salt and sugar and excess fats, and maybe certain chemicals to make them maintain color or last longer. Those are all bad for our body.
So you want to eat a healthy diet, which means not that much red meat, mostly fish and lean meats, lots of vegetables -- the more color in your vegetables, the better -- fruits. Stay away from things that are highly concentrated in sugar, such as sodas and fruit juices, and of course all the things we love like chocolate and dessert. I'm not saying you should eliminate all of them. And people get all nervous because they don't want to do radical changes in their diet. So I say just start small with one thing. So maybe stop drinking soda, and don't even drink diet soda because artificial sugars aren't very good for you either. Try doing water or maybe a seltzer or something like that.
Skip the orange juice in the morning because that's usually too much sugar first thing in the morning. And maybe reduce your takeout food, or your fast food, and do more food preparation in your own home. And I know everyone's busy, and it gets hard to make those meals, but those are the things that may help to make the difference.
And then the other thing that most people don't want to hear is that alcohol isn't really good for our brains. And there's more and more research that shows there's no safe amount of alcohol in general for our bodies, but we know that alcohol is toxic to nerve cells, and we've seen this in people who have had problems with alcohol use who get a form of dementia from too much alcohol. So I try to encourage people to maybe save alcohol for very special occasions. Try to pass it up. Certainly don't drink it every day. And that's another way of making sure that you have good brain health.
[00:22:50] Host Amber Smith: Let me ask you about supplements. I know a lot of people are prescribed things like fish oil, or their doctors tell them to take fish oil for their heart. Is that also good for their brain?
[00:23:02] Sharon Brangman, MD: So that has not really panned out, even for your heart. And so the recommendation right now is it's better to eat fish than to take fish oil tablets. So having salmon is probably healthier than taking fish oil tablets.
And there's lots of commercials on TV for different supplements to help your brain and your memory as you age. Those are all a waste of money. They don't do anything for your brain. So I would say save your money. So many times I have patients who come in after they've spent the money and they show me the bottle and I tell them it doesn't do anything.
People ask me, "should I take a vitamin every day?" So it probably doesn't hurt. If you're going to take a vitamin, you should make sure it's for the 50-plus age group, because that usually doesn't have iron in it. You shouldn't take iron as you get older because your body doesn't have a way of eliminating it from the system, and iron is potentially damaging to nerve cells over time. So it's not good to take a lot of iron unless you're a woman and you're still having your monthly menses. But most older adults do not need iron replacement, unless specifically prescribed by their doctor for a certain medical conditions.
[00:24:27] Host Amber Smith: Is there a connection between sleep quality and Alzheimer's risk?
[00:24:32] Sharon Brangman, MD: Yes. So here's another thing that happens in our society where everybody is working real hard and not sleeping very well. But we know that sleep is a period of time when your brain actually repairs itself from the day's activities. And there's a lot of chemical reactions that our brains are doing all the time during the day. And when we're sleeping, they clean up the waste products from these chemical activities. So we really need to figure out a way to turn off the screens, turn off the TV and go to bed.
And the other piece is there are really no safe sleeping pills, so don't think that you can take a sleeping pill and it's going to help. We have to figure out natural ways of getting some sleep and rest. And it can start with the caffeine that we see a lot of people taking all day. And other things that can keep you up at night so that you're not getting that important sleep that's needed for brain health.
[00:25:35] Host Amber Smith: So does it get easier if, in retirement, you could sleep anytime you retired, right? Does that get easier for people when they don't have a job to get up for?
[00:25:46] Sharon Brangman, MD: You don't want to wait until you retire to have a plan for brain health. You know, we want our brains to last our lifespan, so that means you should be doing good activities for brain health and general health throughout your lifespan. Don't wait till you retire. Although it's always beneficial to do healthy things, these are habits that we should have throughout our life.
So all of these things we've been talking about are kind of meant to be reducing the risk for dementia. Once a person has some symptoms, or maybe they are in early stages of Alzheimer's, do you still prescribe these same things about eating healthy and sleeping adequately? So yes. Some studies have indicated that even if you have early Alzheimer's disease, if you exercise every day, you do better than people who don't. So we still recommend people walk or exercise. Eating a healthy diet is always good because you want to give your body the nutrients it needs. And processed foods and foods that are high in sugar and fat are not helping. So yes, you want to maintain good health, even if you have symptoms of Alzheimer's disease,
[00:27:07] Host Amber Smith: Will these same habits, if people can make them habits, will these help people who are simply aging, not necessarily with signs of dementia? Is this a good way to go into the senior years?
[00:27:19] Sharon Brangman, MD: You know, I'm a geriatrician, so I'm always helping people to understand what we need to do to age well or age successfully. And that doesn't necessarily mean that you age without getting certain diseases, but you try to control the things that you can control. And the things that we can control are eating well, sleeping well, maintaining social contacts, exercising, keeping close eye on the amount of alcohol you're taking. Of course, if you smoke -- don't smoke. I can't think of any disease where smoking is helpful. If you have diabetes or high blood pressure, see your doctor and get those under control. If you have high cholesterol, get that under control.
These are all things that cause wear and tear on our bodies -- whether it's your brain, your heart, or your kidneys -- and can get in the way of you aging well.
[00:28:19] Host Amber Smith: Well, Dr. Brangman, I really appreciate you taking time for this interview. Thank you.
[00:28:24] Sharon Brangman, MD: Well, thank you.
[00:28:26] Host Amber Smith: My guest has been Dr. Sharon Brangman, chief of geriatrics at Upstate and director of the center of excellence for Alzheimer's disease, the region's only comprehensive center for evaluation and treatment of memory problems. Reach the center at (3 1 5) 4 6 4 - 5 1 6 6. "The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe. Find our archive of previous episodes at upstate.edu/informed. If you enjoyed this episode, please tell a friend to listen, too. You can rate and review "The informed Patient" podcast on Spotify, Apple podcasts, YouTube, or wherever you tune in. This is your host, Amber Smith, thanking you for listening.