Sept. 23, 2025
New Research On Alzheimer’s & Dementia with Dr. Christina Hugenschmidt
Send us a text In this episode, Dr. Mia and Dr. Christina Hugenschmidt discuss their insights from the Alzheimer's Association International Conference (AAIC 2025) this summer, and the importance of early diagnosis and lifestyle interventions. They explore the gut-brain connection, innovative drug research, and the impact of nutrition and environmental factors on cognitive health. The conversation emphasizes the need for social engagement and support for caregivers, highlighting the multiface...
In this episode, Dr. Mia and Dr. Christina Hugenschmidt discuss their insights from the Alzheimer's Association International Conference (AAIC 2025) this summer, and the importance of early diagnosis and lifestyle interventions. They explore the gut-brain connection, innovative drug research, and the impact of nutrition and environmental factors on cognitive health. The conversation emphasizes the need for social engagement and support for caregivers, highlighting the multifaceted approach required in managing dementia and promoting brain health.
Chapters
00:00 Introduction to Dementia Caregiving and Research
02:01 Personal Journey in Caregiving
03:51 Understanding Dementia: A Personal Journey
15:57 Lifestyle Interventions for Brain Health
27:57 The Impact of Hormones on Caregiving
39:53 Research Innovations in Dementia Treatment
45:47 Environmental Factors and Brain Health
Christina Hugenschmidt, PhD, MS, LCMHC, is a Associate Professor, Director of Wake Forest Memory Counseling Program. She is a neuroscientist and a counselor. Her experiences in clinical practice led her to question how support groups can be used to improve brain health. She began working with the Memory Counseling Program (MCP) after joining Gerontology and Geriatric Medicine and the Sticht Center for Healthy Aging and Alzheimer’s Prevention at Health/Wake Forest School of Medicine in Winston-Salem North Carolina in 2012 and was recently appointed MCP director following Dr. Shaw’s retirement. Her experiences leading and developing a support group for people with dementia have profoundly shaped how she views dementia and her research into how positive experiences like this group can support the well-being of people living with dementia and their care partners. Her research uses brain imaging to explore how common aging-related changes in the body, such as mobility, obesity and diabetes affect brain health, and how these effects on the brain can be modified by everyday lifestyle, like engaging in exercise and arts practices. https://improvment.wfu.edu/about/improvment-team/
AXS-05 dextromethorphan and bupropion for AD agitation
US version of world wide FINGER- US POINTER study
MIND diet slows cognitive decline with aging
Other AAIC 2025 press conferences or highlights: https://aaic.alz.org/releases-2025/highlights-aaic-2025.asp
Video on Ask Dr. Mia YouTube channel
Transcripts on www.miayangmd.com. Transcripts are automatically generated and may contain minor inaccuracies.
Email: ask@miayangmd.com
Opinions expressed are exclusive of Dr. Mia Yang and not reflective of her or guest speaker's employers or funders.
WEBVTT
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Alright, and how was your how about how old was your mom when you noticed the incident about the kitchen not being able to find the utensils?
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I think she was around 70.
00:00:15.041 --> 00:00:19.161
It might have been 68 or 69, but it was around 70.
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And then how is she doing now?
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So she currently has moderate stage dementia and kind of the trajectory of that was we knew she had amyloid in her brain starting in 2015 when she was part of the study, probably around 2019 or 2020.
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She got a diagnosis of mild cognitive impairment.
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And then I think it was either fall of 2022 or...
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very early in 2023 that shifted to early stage dementia.
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Okay, so you approach the conference with multiple hats, you know, as a sandwich generation caregiver, as a neuroscientist, and of course, as the director of the memory counseling program.
00:01:07.236 --> 00:01:16.885
uh So we're going to kind of hit three main uh buckets of research and presentations at AAIC.
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The first one, I think we both wanted to talk about what are some things that uh our listeners could do right now for their health, for the future of their brain health.
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And then we can talk about what are some exciting studies or research that was presented that may be relevant for the loved ones that you're caring for.
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And then finally, kind of just talking about the hope for the future for Alzheimer's disease and related dementias in terms of the science and things that we found to be really exciting in terms of the field moving forward.
00:01:56.204 --> 00:02:03.709
So Christina, what did you find useful or potentially really exciting about caring for yourself?
00:02:04.846 --> 00:02:14.069
you and I definitely have already talked about this, but the pointer study with some of the biggest news coming out of AAIC altogether.
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of course, Wake Forest, where we are and have been, is a big piece of that work.
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So that was great too.
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But the really cool part of that study that's important for caregivers to know is that dementia like I talked about with my mom, this is a long trajectory, right?
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Like we could see the buildup of the amyloid in her brain a decade ago.
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This is a long time and she's still actually pretty healthy.
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We still have a way to go ahead of us.
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But part of the importance of that is we could see that build up over like a decade ago.
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We probably could have seen it earlier if we'd looked earlier.
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So for caregivers, knowing that that disease starts early is important because lifestyle interventions may be able to affect it.
00:03:07.316 --> 00:03:13.038
So the cool thing about Poynter was everything they did is things that people can do on a daily basis.
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They help people form social groups.
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to adopt a healthier lifestyle and the healthier lifestyle involved taking medications that they needed to take to control things like hypertension and diabetes.
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exercising regularly and this involved getting your heart rate up for at least 150 minutes a week like you're recommended to do and it's important to note they did this with a team so you had friends supporting you you had people supporting you to help you make those changes they also help people to adopt healthier diet habits and also work on their sleep but they did all of this in a really in a way with support.
00:03:59.324 --> 00:04:01.544
So there's a group of people helping you.
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You started new things at new times.
00:04:03.745 --> 00:04:07.344
You weren't trying to start everything at once and like crunch it all in.
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You know, you're adding a little bit of healthy stuff here, adding some exercise there.
00:04:11.264 --> 00:04:17.324
And then over the course of two years, you build up to this set of a whole constellation of healthy habits.
00:04:17.324 --> 00:04:28.119
And they found when at the end of the two years that people actually had taken it was the equivalent of reversing brain aging by a couple of years.
00:04:28.139 --> 00:04:36.482
So that is huge and it's actually a larger effect than we see from anti-amyloid drugs in terms of the benefit.
00:04:36.482 --> 00:04:37.533
So that's huge.
00:04:37.533 --> 00:04:48.766
And it's important for caregivers because this study was in people who did not yet have memory loss and people who were at slightly younger ages as well as older ages.
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So whether you're a spousal caregiver or a child caregiver, this would apply.
00:04:53.978 --> 00:04:59.105
but it is important that it was before there was any diagnosis of cognitive impairment.
00:04:59.653 --> 00:05:09.754
Yeah, no, I think Poynter did a really great job of recruiting participants who are really reflective of the folks that we see in the community.
00:05:09.754 --> 00:05:22.274
So it was almost 70 % women, 30 % came from an ethno-racial group that's not white, and then 30 % are without a college degree.
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And like most Americans, you know, have higher risk for cardiovascular disease, whether that's high high cholesterol, high blood pressure, or both, or diabetes or pre-diabetes.
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uh And uh the majority of them have a family history of someone with dementia or memory loss.
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So this is definitely relevant for the folks who are listening.
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And just as you said, Christina, I think their average age is around 68, um which when you look at older adults, in my mind, that's actually not old at all.
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And it's actually right around the time that probably your mom, uh when she first, when you guys have first noticed her memory changes.
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And just as you said, this was not a placebo uh control trial in the sense that both of the arms had active intervention, like both groups did this comprehensive list of lifestyle changes, including a mind diet.
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physical exercise, health monitoring to monitor for blood pressure, cholesterol, blood sugar, as well as cognitive exercises.
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And they used a program called Brain HQ, which is available just by Google.
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in the study itself, they did about 30 minutes of these computer-based brain training three times a week.
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Plus they have regular engagement and other challenging and social activities.
00:07:02.095 --> 00:07:12.680
The two groups really differed in terms of how much support the study gave in the structured intervention, the more intensive intervention arm.
00:07:12.680 --> 00:07:19.225
had like facilitated team meetings, 38 of them over two years.
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And definitely, know.
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within the group of participants as well as with these coaches really kind of formed the community to improve their ah overall lifestyle.
00:07:30.673 --> 00:07:48.196
But the other group, notably the group that was getting the less intensive and self-guided, they only had six meetings over the two years and they were basically just given this general information for people to do without.
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the goal-directed coaching, and both groups actually improved in terms of their global memory.
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And when we look at their sub-types of memory, this is really noticeably improving in what's called executive functioning, which I think is really even more important than short-term memory, because if you don't have executive functioning, it's hard for you to figure out how to use the computer or a remote or how do you cook a meal when you know the recipe and have been cooking the same thing for forever.
00:08:21.230 --> 00:08:36.183
ah So I think that the scientific basis of the type of memory that improved also makes sense because we know those are the things that are important in both heart health and brain health.
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and that we see those changes being reflected in the study results.
00:08:41.020 --> 00:08:47.623
And I know, you know, this was one study that was very, very much got immediate blitz.
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And I had a patient actually call in asking about how can they sign up for the pointer?
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And I'm like, wow, here's some information I can give you and you can start right now.
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ah But I would have to say that, you know, I even checked out the brain HQ.
00:09:04.477 --> 00:09:30.721
uh website because I was curious as to what type of memory training this was and I think it's practicing uh like visual spatial short-term memory ah which to some people that might be fun but I would say if that's not enjoyable to you it definitely is not something you have to force yourself to do just because it was study in this particular study.
00:09:31.298 --> 00:09:45.928
Yeah, I guess I would add on to that by saying that I think it was the Achieve study where they first saw improvement in speed of processing in response to speed of processing training.
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That is, I think, one of the only studies, or at least the most robust study, to show that cognitive training by itself improves, can improve cognitive function.
00:09:56.294 --> 00:10:06.525
But I think that's important in the context of this too because in the Poynter study, they were talking about the fact that people didn't always love the cognitive training.
00:10:06.525 --> 00:10:09.407
They weren't as sure of the cognitive training dose.
00:10:09.407 --> 00:10:15.961
And there's a lot of evidence about exercise and that exercise can improve executive function.
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So I think that is, it's really important that.
00:10:20.265 --> 00:10:22.568
The exercise I would say is really important.
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I think there's also lot of emerging evidence about the importance of social engagement and social communication.
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So both groups improved, like you said.
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Both groups also had a group component where you were put with like a team that was all trying to change their behavior together.
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And then like you noted, the one that had the biggest improvements was actually had a coach and the coach.
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do think this is important because the coaches were trained in psychological techniques to help people be more likely to take up behavior change.
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So I think that some of those things also point to the fact that When you're a caregiver, it's really important to both ask for and accept help.
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And some of the help that you might want to be asking for and accepting can be around your own personal health.
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And that can be accepting coaching from somebody at the Y.
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It can be accepting help from friends.
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And that something simple, just like joining an exercise class or a walking group or a jogging group, some group that gets together can be really healthy and really help you even more to support those lifestyle changes because you can't always do it on your own.
00:11:34.186 --> 00:11:36.486
You shouldn't think you have to do it on your own.
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It's a team sport.
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Caregiving is a team sport and caring for yourself is also a team sport.
00:11:41.690 --> 00:11:42.811
Yeah, absolutely.
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And I know from personal experience, I definitely work out longer and with higher intensity when I'm in a workout class, I go to Orange Theory, no affiliation or promotion on behalf of them.
00:11:56.135 --> 00:12:01.937
But I have to say, I do it for a lot longer than if I were to work out at home by myself.
00:12:01.937 --> 00:12:07.801
And there is that coach being there telling me to keep running when I feel like dying.
00:12:07.801 --> 00:12:12.618
uh But yeah, I'm just curious.
00:12:12.618 --> 00:12:35.618
know you also are interested and have attended some talks about just our particular age group, this para-menopausal 40, 45, 40, 50, know, getting to menopause and all of the hormonal changes that are happening at this time of our lives when we're busy with our careers and our kids and our parents.
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you know, just a couple of days ago was my mom's one year.
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anniversary in terms of her passing.
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And I just remember, you know, that the two years when she was sick with cancer were some of the most exhaust, most emotionally exhausting years of my life.
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And uh so I mean, that's why we're, we're talking here and, hopefully for those who are listening, uh wanting you to feel like we're, here for you.
00:13:04.769 --> 00:13:10.501
And yeah, so coming back to hormones and paramenopause.
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Yeah, this is such a hot topic right now too.
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And I will say I've done a little bit of research in this area as well.
00:13:17.537 --> 00:13:21.739
So it's part of why it was really interesting to me in this meeting.
00:13:21.739 --> 00:13:27.201
But like you said, women in our age range, women are the most likely to be caregivers.
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Women are also the most likely to get Alzheimer's disease.
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And we do seem to be at actual elevated risk.
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That seems to not just be because of increased longevity.
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And that was something that was brought up multiple times in this meeting.
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I do feel like it's important whether I feel like probably a lot of people listening to this who are caregivers are women just statistically that's the case but also even if you are a male um you have women in your life that are probably also involved in this is valuable information but if you are caregiving say for your mom who has dementia which is such a common situation then you know you have family risk We also, like I said before, know that the pathology develops, begins developing up to 20 years before the onset of symptoms.
00:14:15.182 --> 00:14:24.182
So if you bring that back to my mom, those very first symptoms we saw when she was like 68, 69, she may have been getting...
00:14:24.639 --> 00:14:27.721
amyloid buildup in her brain at my age at 48, right?
00:14:27.721 --> 00:14:28.546
20 years earlier.
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That may have just been in its baby beginnings at my age.
00:14:32.702 --> 00:14:46.928
And that really brings home to me, listening to all these things really brings home to me that no matter how busy I am, It is very important to do these kinds of things that they were talking about in the Poynter study to whatever level I can.
00:14:46.928 --> 00:14:55.552
It may not be perfect, but whatever piece of that that I can incorporate into my life is going to be healthier for my brain.
00:14:55.552 --> 00:15:01.956
Because we know that in this time of menopause and perimenopause, there are metabolic changes in your brain.
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So the way your brain uses sugars during this time can have really dramatic shifts.
00:15:06.977 --> 00:15:10.541
um There are also differences in sleep patterns.
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and we know that sleep is really important and it was one of the things targeted in pointer that they tracked and that they looked at.
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um And we also know that those two things aren't separate, that when your sleep is disrupted, it disrupts things like your cortisol and your stress levels and your metabolism.
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So just realizing that as a caregiver, particularly if you're a female at this kind of vulnerable turning point with your hormones and all these changes, the stress of caregiving, you can feel like there's just not enough time to do these things.
00:15:44.749 --> 00:16:07.666
but any amount that you can do of exercise, keeping up with your health and wellness appointments to the best of your ability, trying to eat healthily when you can, that all of those things are really important for protecting your own brain and your own health so that you can continue to care for your loved one with dementia and for your family.
00:16:08.259 --> 00:16:17.528
Yeah, and we're gonna come back to talk more about food and diet and the gut-brain access because I was texting Christina during the conference.
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was like, this is so cool.
00:16:19.759 --> 00:16:21.741
This gut-brain access.
00:16:21.741 --> 00:16:22.863
we'll touch on that.
00:16:22.863 --> 00:16:44.494
ah But wanted to turn the conversation a little bit into kind of research that may be relevant to the loved ones you're caring for right now, people who might have either mild memory changes like mild cognitive impairment uh or they're on the dementia journey, whether that's mild, moderate or severe.
00:16:44.494 --> 00:17:09.130
So one thing that I uh heard during the talk that really didn't get as much publicity as I had expected uh was from this group, a company called Axome, uh A-X-O-M-E, uh where it looks like they tried different combinations of existing drugs for different indications.
00:17:09.191 --> 00:17:16.116
But the presentation was about AXS05.
00:17:16.337 --> 00:17:29.798
The actual name doesn't really matter except that it's a combination of dextromethorphan, which is like the DM part of your cough syrup, and then bupropion, which is the...
00:17:29.798 --> 00:17:36.698
the generic name for a well butrin, which is a pretty common anti-anxiety, anti-depressant medicine.
00:17:36.698 --> 00:17:40.498
more for anxiety than depression.
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And that AXS-05 basically is combining the two into one pill.
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And they did a phase three randomized control trial.
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So one arm was getting this medicine, this combination medicine, and people who have Alzheimer's disease and related dementias as well as behavioral changes uh and the other group was just getting placebo and both groups were getting it twice a day for the study duration which was 26 weeks.
00:18:14.738 --> 00:18:30.892
So they were looking at things like uh whether uh people caregivers reported that they are noticing changes in terms of the behavior as well as looking at potential side effects.
00:18:30.892 --> 00:18:51.107
we know with antipsychotic medications that are commonly used off label and people with living with dementia and potentially violent behavior or other challenging behavior that all of those antipsychotic medications not only make their memory worse but also have higher risk of death.
00:18:51.107 --> 00:18:58.566
um That's why they have a black box warning as well as make it more likely for people to fall, break a hip.
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have low blood pressure.
00:19:00.925 --> 00:19:15.306
This study on the dexamethorphin and buprenorphine combination surprisingly really didn't have a lot of those same side effects that we see in antipsychotics, which was a little exciting.
00:19:15.306 --> 00:19:30.913
And just knowing about how commonly probably a lot of people are on these meds also is a little reassuring for the geriatrician mind in terms of understanding the drugs and not that they're not totally brand new.
00:19:30.913 --> 00:19:39.374
Just curious from your perspective, Christina, from a neuroscientist perspective, why do those two drugs work well together?
00:19:39.404 --> 00:19:42.915
I can't tell you that because I'm not a pharmacologist.
00:19:43.436 --> 00:19:52.200
There's, neuropsychology is a really broad field um and I don't, that's not my area of study, but I was also super excited by this talk.
00:19:52.221 --> 00:19:57.262
I think you and I, because you were attending virtually and I was in person, we didn't know that we'd both gone to that one.
00:19:57.262 --> 00:20:00.923
But there were some things that I loved about the talk.
00:20:00.923 --> 00:20:07.307
One is that he was talking about combining the drugs and he called that rich pharmacology instead of a dirty drug.
00:20:07.307 --> 00:20:27.476
He was also talking about the fact that combination of drugs extended the um time over which the drugs were effective and that was really important because uh one of the limitations prior to this was that m the drug might be effective, but that on its own, but that it was very short term.
00:20:27.476 --> 00:20:34.118
When they put the two together, they could get this safe drug that also had a reasonable time course.
00:20:34.118 --> 00:20:42.432
And like you were saying, there's so little for caregivers and people with dementia for these kind of agitation symptoms.
00:20:42.432 --> 00:20:52.008
And sometimes it's violent and it can really be dangerous for caregivers or difficult to contain or can cause somebody to have the need to be in a placement.
00:20:52.008 --> 00:21:08.278
Other times it may not be quite that extreme but it's still preventing you or the person that you're caring for from sleeping or from getting things done during the day or it's preventing you from being able to bring caregivers in because they can't handle those behaviors.
00:21:08.278 --> 00:21:12.961
and those things also are presumably not pleasant for the person experiencing them.
00:21:12.961 --> 00:21:29.643
So it's really nice to think that there might be a drug with a better safety profile that can really help caregivers and people with dementia with those present right now symptoms until we get drugs that can actually cure these things longer term.
00:21:29.923 --> 00:21:41.207
Yeah, and I want to make sure that our listeners are not listening to this and then going out to buy a cough DM, mucinex DM in combination with their well-butrin.
00:21:41.207 --> 00:21:46.969
Please don't do that because they're still in the process of seeking FDA approval.
00:21:46.969 --> 00:21:58.597
And I want to make sure that we talk about how behavior is really just an expression of an unexpressed emotion or feeling.
00:21:58.597 --> 00:22:03.821
ah because in people living with dementia, they have trouble communicating.
00:22:03.821 --> 00:22:11.826
And so a behavior might be a way for them to really say that they're in pain, they're uncomfortable, they're bored, they're overtired.
00:22:11.826 --> 00:22:26.698
ah All of those things are important to try to address, not pharmacologically, but certainly having more options from a medication perspective that is hopefully safer.
00:22:26.698 --> 00:22:29.603
uh is really exciting to me.
00:22:31.252 --> 00:22:37.347
And kind of touching on what you were just saying, some of the other interesting things that I think we both heard had to do with that.
00:22:37.347 --> 00:22:44.522
uh Other contribute, like the contributors to agitation, things like changes in sensory function and.
00:22:44.588 --> 00:22:58.766
beginnings of research to look into different ways to address sensory function better because as people get older, everybody as you get older, you lose sensory acuity in all five senses and your sensory perception changes.
00:22:58.766 --> 00:23:07.009
But with dementia, and it can vary across different kinds of dementia or the stage of dementia, but you can also get even more perceptual changes.
00:23:07.009 --> 00:23:22.959
um You can, it often goes with hearing loss, there are vision changes, and some of those are normal aging related, but some Some of them also are due to the dementia itself and might include things like hallucinations or visual distortions.
00:23:22.979 --> 00:23:39.230
addressing those can also sometimes help address the agitation because if someone feels more confident or is better able to perceive their environment, hear what is being said to them, see the things around them, then this can also help with reducing agitation.
00:23:39.748 --> 00:24:00.926
Yeah, there is actually a study that they're looking at over-the-counter hearing aids, as well as a, you know, a senior volunteer coach who can potentially use hearing aid, teach the caregivers to use hearing aids for people living with dementia and have agitation and challenging behaviors.
00:24:00.926 --> 00:24:06.088
That study is ongoing and we will hopefully know the results soon.
00:24:06.128 --> 00:24:29.102
But I think whether it's paying or or hearing impairment or vision impairment, it makes sense, you know, logically and that if your world is confusing, I will be feeling anxious and kind of maybe lash out of my environment because I just don't know what's going on in addition to the cognitive and the processing changes that's happening in the brain.
00:24:29.102 --> 00:24:36.230
So anything we could do to optimize that, I think will be, it's great and is within our control.
00:24:36.230 --> 00:24:45.636
ah Now, you know, there's always going to be people living with dementia who just absolutely refuse to wear a hearing aid or any sort of hearing amplifying device.
00:24:45.636 --> 00:25:01.499
But there may also be other people who, you know, once they know that this is something that could help with their brain, I think may be more willing to wear hearing aids that they have available but didn't think it was important enough ah to wear.
00:25:01.499 --> 00:25:03.907
Yeah.
00:25:03.907 --> 00:25:10.421
And then, so finally, um let's talk about some of the research that we both found really exciting.
00:25:10.421 --> 00:25:16.492
And I think uh I'll just ground our conversation a little bit in the MIND diet.
00:25:16.492 --> 00:25:24.166
So going back to the Poynter study, one of the key components was uh diet, was nutrition.
00:25:24.166 --> 00:25:32.509
And so the MIND diet really emphasized dark leafy greens, berries, nuts, whole grains, olive oil, and fish.
00:25:32.511 --> 00:25:41.086
and really limits the intake of sugar, uh cheese, red meat, and unhealthy fats.
00:25:41.086 --> 00:26:00.314
ah I think this is not necessarily news to those of us who are in this space, but I think what I found oh was really fascinating was when they look at the stool samples of people who are amyloid negative versus amyloid positive.
00:26:00.546 --> 00:26:04.989
know, protein in the brain that we think is one of the causes of Alzheimer's disease.
00:26:04.989 --> 00:26:20.387
uh The amount of these short chain fatty acids that are contained within fiber rich foods like in the mind diet are more present with a more diverse uh microbiome.
00:26:20.387 --> 00:26:28.031
So lots of different bacteria in the amyloid negative group compared to the amyloid positive group.
00:26:28.038 --> 00:26:37.781
um So they also saw less short chain fatty acids in older folks and women and those who have an APOE4 status.
00:26:37.781 --> 00:26:44.345
So that's the gene that um gives people a higher risk of developing Alzheimer's disease.
00:26:44.345 --> 00:26:47.945
So all of that I found to be super fascinating.
00:26:47.945 --> 00:26:58.560
It's not just to say, you know, eat this diet and you'll be better, but really looking at the underlying mechanism of how does that diet make our brain better.
00:27:00.898 --> 00:27:03.500
Yeah, that is totally fascinating.
00:27:03.821 --> 00:27:08.685
I don't think I heard that specific talk, so I'm actually really glad to get that from you.
00:27:10.765 --> 00:27:16.981
But what was your impression of kind of this whole brain gut um relationship?
00:27:18.037 --> 00:27:24.054
There will I it was an emphasis here and I was excited about that for some of the reasons that you're saying.
00:27:24.054 --> 00:27:28.586
um There is also some new things that I learned about it.
00:27:28.586 --> 00:27:37.369
um One was that one of the people who was speaking was talking about the fact that.
00:27:38.313 --> 00:27:52.577
she began looking at the gut brain axis and whether some of those things were changing prior to the onset of symptoms versus after, because those of us who are caregivers also know that diet changes with the disease, right?
00:27:52.577 --> 00:27:54.798
People's palate changes, what they want to eat change.
00:27:54.798 --> 00:28:00.971
You can't force people to eat things at some point, but she was interested in whether that was changing first.
00:28:00.971 --> 00:28:19.719
She was also interested in the question, was there any potential that some of these proteins that we think our causal and memory decline might be present in the gut or somehow getting out of the gut and up to the brain because we know there are all of these really important brain body connections.
00:28:19.719 --> 00:28:37.229
We know that both the gut and the brain have uh natural cellular barriers when we're young and healthy and that for both the gut and the brain, those barriers, the blood brain barrier and gut integrity can be affected by aging and an Alzheimer's disease.
00:28:37.229 --> 00:28:46.417
So she was really curious if leaky gut um might be allowing things that ought not to be coming from your gut to get to your brain to happen.
00:28:47.040 --> 00:28:56.675
So she found that that was happening and even that amyloid from the gut might be getting to the brain.
00:28:56.675 --> 00:28:58.816
So there were two cool things about that.
00:28:58.816 --> 00:29:08.881
I think one was like you were talking about the importance of gut health for brain health and potential mechanistic links between what's happening.
00:29:08.881 --> 00:29:16.974
But a second really cool part of that is that um she also asked the question, well, if that's happening, how?
00:29:16.974 --> 00:29:17.325
right?
00:29:17.325 --> 00:29:19.676
Like there's got to be something transporting it.
00:29:19.676 --> 00:29:22.990
Is it just flowing up through the blood or is it being transported?
00:29:22.990 --> 00:29:26.051
And she was able to find that it was being transported.
00:29:26.051 --> 00:29:40.961
And the really cool thing about that is one of the most difficult aspects of drug delivery to the brain is getting across the blood brain barrier, that natural barrier that the brain has between what's in the blood and what's actually inside the brain tissue.
00:29:41.547 --> 00:29:43.768
that's very tightly controlled.
00:29:43.949 --> 00:29:54.134
this discovery that she made might also open up a new pathway for new drugs that are developed to get into the brain in a better way.
00:29:55.718 --> 00:30:21.253
I think this was the plenary talk by the researcher from South Korea who looked super young, but she had beautiful skin and I just wanted to be like her when I got older, ah talking about the gut-brain relationship and how, ah I think she had one slide that talked about just how common constipation, inflammatory bowel disease, irritable bowel disease.
00:30:21.253 --> 00:30:32.759
um as well as a number of other GI related issues and how that was so much more common in people who have um Alzheimer's disease.
00:30:32.759 --> 00:30:34.580
And it's fascinating.
00:30:34.580 --> 00:30:41.305
I think it does relate to, you know, the leaky gut versus the leaky brain.
00:30:41.305 --> 00:30:50.713
And um I think in fact, their, uh study or her lab looks at, you know, the gut transmits stuff to the brain.
00:30:50.713 --> 00:30:59.137
via the blood, but the brain transmits stuff to the gut via a nerve called the vagus nerve.
00:30:59.137 --> 00:31:15.903
And so, I don't know, the nerd in me was just really excited because the vagus nerve controls so much stuff, is our parasympathetic nervous system, as well as the nerve that we can activate when we take a deep breath.
00:31:16.125 --> 00:31:18.786
All of the things that I think...
00:31:19.119 --> 00:31:26.173
we're probably not doing enough and knowing that it's related to this gut brain relationship.
00:31:26.554 --> 00:31:50.090
As you have mentioned, Christina, I think this also opens up new ways of getting drugs into the brain that doesn't cause too much toxicity because part of, whether it's chemo or even anti-amyloid drugs is that getting through that blood brain barrier could be potentially also causing side effects that because the the barrier itself becomes leaky.
00:31:50.090 --> 00:32:05.642
So those blood vessels, whether it's the amyloid-related imaging abnormalities or swelling of the brain or small areas of bleeding in the brain, those are the side effects that really relates to how the drug is working.
00:32:05.642 --> 00:32:23.269
uh And so if we have a natural way that our body is communicating between our gut and our brain, lots of other stuff that we can take by mouth and be digested and maybe we'll go up to our brain.
00:32:25.762 --> 00:32:27.364
Yes, yeah.
00:32:27.364 --> 00:32:40.410
this, there are two directions and I want to take this and I don't know which one to go first, but where you stopped, maybe the next logical one would be that there was another really cool talk that was actually about Licanumab, which is one of the approved drugs.
00:32:40.410 --> 00:32:49.074
And I didn't realize this, but they were saying that currently the way Licanumab gets into the brain is actually through the leaky blood brain barrier.
00:32:49.074 --> 00:32:52.174
So it doesn't have a great delivery system.
00:32:52.174 --> 00:32:55.737
And one of the results of that is it's not always evenly distributed.
00:32:55.737 --> 00:32:57.105
across the brain.
00:32:57.717 --> 00:33:09.613
So this group was looking at a new way to have it receptor mediated transport, which would mean the drug is actively pushed across the brain, blood brain barrier.
00:33:09.613 --> 00:33:16.336
And they showed some beautiful images of how that made the leucanum ab more evenly distributed across the whole brain.
00:33:16.336 --> 00:33:19.356
So the whole brain was more evenly targeted by the drug.
00:33:19.356 --> 00:33:40.353
And they were also saying that in their first stages of these trials, that there were fewer symptoms like you were talking about that we are concerned about with those drugs like the brain swelling and bleeds and things like that and they thought it was because it was bypassing, it was being taken directly in and not depending on the leaky blood-brain barrier and that that might be reducing some of those symptoms.
00:33:40.353 --> 00:33:41.973
So that was really cool.
00:33:42.425 --> 00:33:45.088
Yeah, what was the other thing you wanted to talk about?
00:33:45.088 --> 00:33:50.622
The other thing with the gut, the gut brain as you were talking about it, this actually brought me back to my mom.
00:33:50.622 --> 00:33:56.984
So I've known for a long time because like you mentioned in the beginning, I'm interested in type two diabetes and obesity.
00:33:56.984 --> 00:34:07.990
And one of the interesting things about obesity is that as weight, weight gain and loss have a natural age related trajectory, but that has changed in dementia.
00:34:07.990 --> 00:34:17.855
And most people who are dementia caregivers have experienced that, that people with dementia often experience weight loss and they can often undergo periods of rapid weight loss.
00:34:17.855 --> 00:34:37.072
And there was actually a point at which I was reading about this and I found a paper back from like the 1950s where a neurologist was talking about unintentional weight loss being a diagnostic factor for Alzheimer's disease that it differentiated it from some other forms of pathology that could be happening.
00:34:37.152 --> 00:34:45.996
So with my mom in 2020 she experienced 30 pounds of unintentional weight loss and she really it was dramatic.
00:34:45.996 --> 00:34:55.528
It happened over six months and it what was interesting to me was we finally got it addressed and by Dr.
00:34:55.528 --> 00:35:00.001
Kate Callahan who we both know and who is also an amazing physician.
00:35:00.380 --> 00:35:10.998
She was like took care of that for my mom but what it turned out to be was an overgrowth of certain bacteria in her gut that was preventing her from digesting.
00:35:10.998 --> 00:35:19.942
But listening to that talk, it made me think about that weight loss piece that has been noted in Alzheimer's so many times.
00:35:19.942 --> 00:35:22.112
And it made me wonder about that with my mom.
00:35:22.112 --> 00:35:25.315
Was there some causal piece with this gut brain axis?
00:35:25.315 --> 00:35:26.715
Was that a turning point for her?
00:35:26.715 --> 00:35:35.099
Because that was right before she had a big inflection point and went on to early stage dementia, that she had that large weight loss.
00:35:35.101 --> 00:35:38.353
amount of weight loss and was having all of those gut problems.
00:35:38.353 --> 00:35:55.898
So that was definitely in my head thinking about that and thinking about maybe in the future will there be ways for us to more rapidly identify or maybe even prevent some of that by having the right set of probiotics to give people when we see that memory loss is happening.
00:35:55.898 --> 00:36:00.070
I know there is research happening on probiotics to help maintain gut integrity.
00:36:00.070 --> 00:36:04.554
it em just there's a lot of interesting future directions from this.
00:36:04.554 --> 00:36:17.862
in so many ways, both in terms of treatment of the gut or the gut-brain axis and then in terms of exploiting that relationship to deliver other drugs that may not be related to that but may need to get into the brain.
00:36:18.384 --> 00:36:19.614
Yeah, absolutely.
00:36:19.614 --> 00:36:34.291
And I think, I know we talked about this before in your mom's specific situation, it was a small bowel overgrowth of this bacteria, which is very difficult to diagnose.
00:36:34.291 --> 00:36:45.650
And I still remember when I was a, I think a medical student, one of the first patients that I saw who probably in hindsight had mild dementia, but I didn't realize, well.
00:36:45.650 --> 00:36:53.483
I knew something was wrong, but his presenting symptom was that he was losing a lot of weight and he was eating just as he's normally did.
00:36:53.483 --> 00:36:55.775
His wife was cooking the same thing.
00:36:55.775 --> 00:37:00.250
And I was so concerned about him having an undiagnosed cancer.
00:37:00.250 --> 00:37:04.210
I scanned, me and my preceptor, scanned him from head to toe.
00:37:04.210 --> 00:37:10.643
He didn't have cancer, ah but I also knew he was in conversation with me.
00:37:10.643 --> 00:37:13.175
There was something not right in terms of his memory.
00:37:13.175 --> 00:37:15.246
So I did some memory screening.
00:37:15.333 --> 00:37:18.577
and he definitely had memory impairment.
00:37:18.577 --> 00:37:38.070
So then I thought, well, is he just, I mean, he couldn't just be forgetting to eat because he had a reliable person who was providing that food and he was eating the food, but it just did not make sense to me why he would lose such a huge amount of weight and have apparently no explanation for it.
00:37:38.431 --> 00:37:44.146
That conversation just reminded me of that particular case where I was like, Mm-hmm.
00:37:44.146 --> 00:37:46.130
why you're losing so much weight.
00:37:46.130 --> 00:37:48.351
I hope it doesn't continue.
00:37:49.195 --> 00:37:54.442
But I can't seem to find out why it is that you're losing so much weight.
00:37:55.659 --> 00:38:11.523
The other piece with the leaky gut that she brought up that we haven't talked about yet, but is sort of maybe interesting for people to think about if they're reading the news and they're reading about things like inflammation and the relationship between inflammation and dementia is that.
00:38:11.907 --> 00:38:29.255
These certain kinds of gut bacteria can have byproducts like little fragments that break off from them and when the gut barrier is leaky, those fragments can get into the blood and can cause inflammation throughout the body.
00:38:29.255 --> 00:38:32.577
So that's yet another kind of link and pathway.
00:38:32.577 --> 00:38:41.740
So there's just so many things that it's really apparent that this gut brain axis is touching on that like we historically know about the weight loss, but we don't fully understand.
00:38:41.740 --> 00:38:42.041
it.
00:38:42.041 --> 00:38:54.525
um Maybe it's related to this that we know inflammation is a component and we know that when the gut barrier is um leaky that you can get increased inflammation from these fragments that can be there.
00:38:54.525 --> 00:38:58.945
We know that the composition of the bacteria is important for all of those things.
00:38:58.945 --> 00:39:01.947
So just so many so many cool directions.
00:39:02.726 --> 00:39:03.387
Absolutely.
00:39:03.387 --> 00:39:18.139
ah I think that the final thing I'm going to just mention, because as I was preparing for this conversation today, I also looked at the list of um media press releases that was released from AIC.
00:39:18.139 --> 00:39:39.034
And one thing that I didn't catch during the conference but was publicized on the news release is that they had a first time looking at longitudinal study of the US Supplemental Nutrition and Assistance Program, SNAP, or food stamps, and how that's linked to slower cognitive decline over time.
00:39:39.034 --> 00:39:49.690
It just made me think about the relationship between having access to food, healthy food, and how that's related to your overall health as well as brain health.
00:39:49.690 --> 00:40:10.891
And policy changes that cuts back on SNAP and healthy food really can have not just hunger and of course poverty and all of that, but also had long-term impacts potentially into young people and children's growth and their bring health over time.
00:40:10.891 --> 00:40:17.072
So I'm gonna conclude that uh conversation today on that.
00:40:17.072 --> 00:40:18.423
Please go, yes.
00:40:18.423 --> 00:40:21.237
I add one more thing that's important in that same vein?
00:40:21.237 --> 00:40:30.445
Another major press release that they had or thing that they talked about that's similarly kind of policy related was the importance of lead exposure.
00:40:30.445 --> 00:40:34.449
There was a really cool study where they were able to use kind of the variability in.
00:40:34.449 --> 00:40:42.211
um the use of leaded gas, gasoline, across the United States to look at exposure.
00:40:42.211 --> 00:40:47.034
these environmental toxicities that we know um can affect the brain.
00:40:48.396 --> 00:40:54.371
Making sure that the environment and that these toxins are not in there is incredibly important at all stages.
00:40:54.371 --> 00:40:59.815
Like we're aware of lead and risk for children, but we don't think about what is at risk later on in life.
00:40:59.815 --> 00:41:02.846
And that's creating vulnerabilities later on in life as well.
00:41:03.152 --> 00:41:24.949
Yeah, and I have so many patients who ask me, know, whether some exposure to whether it's mining or other industries that had a lot of pollution in the air, could that have related or military exposure to different agents that may or may not be classified as toxins by the, you know, Veterans Affairs Administration?
00:41:24.949 --> 00:41:27.971
And sometimes I just say, I don't know because...
00:41:27.971 --> 00:41:28.614
Mm-hmm.
00:41:28.614 --> 00:41:43.960
I mean, I'm sure it wasn't great for your health, but as to whether or not that truly relates to your memory problems, at least for this study on lead exposure, I think this is the first time that there is such a noticed um relationship.
00:41:43.960 --> 00:41:58.675
And I think the natural experiment of which areas had allowed lead gasoline versus those who didn't allow that kind of direct comparison, which is just not possible within a randomized controlled trial.
00:41:58.851 --> 00:42:02.728
Yeah, so interesting stuff, so many interesting things.
00:42:02.949 --> 00:42:06.650
Yeah, well, thank you so much for this conversation, Christina.
00:42:07.230 --> 00:42:13.530
I will link in the show notes some of the studies that we are talking about today.
00:42:13.530 --> 00:42:25.349
And then for those who are listening who really wanted to hear from the presentations themselves, the AIC virtual platform is actually still open and it's free.
00:42:25.349 --> 00:42:31.353
So people can, I think, can still sign up and log in, although I'm not entirely sure.
00:42:31.353 --> 00:42:46.282
But uh I think this was a great thing by the Alzheimer's Association to make this scientific conference widely available and for free when usually, you know, we have to pay money to attend.
00:42:46.282 --> 00:42:48.804
All uh right.
00:42:48.804 --> 00:42:50.764
Well, thank you, Christina.
00:42:50.784 --> 00:42:58.338
If you enjoyed this episode or this podcast, please click the follow or the plus sign in your podcast player.
00:42:58.338 --> 00:43:04.980
That way you will get uh the new episodes populated in your podcast feed whenever it comes out.
00:43:04.980 --> 00:43:07.445
Thank you all and talk to you next time.
00:00:02.315 --> 00:00:11.680
Alright, and how was your how about how old was your mom when you noticed the incident about the kitchen not being able to find the utensils?
00:00:13.422 --> 00:00:15.041
I think she was around 70.
00:00:15.041 --> 00:00:19.161
It might have been 68 or 69, but it was around 70.
00:00:20.986 --> 00:00:23.085
And then how is she doing now?
00:00:23.788 --> 00:00:40.024
So she currently has moderate stage dementia and kind of the trajectory of that was we knew she had amyloid in her brain starting in 2015 when she was part of the study, probably around 2019 or 2020.
00:00:40.024 --> 00:00:44.186
She got a diagnosis of mild cognitive impairment.
00:00:44.228 --> 00:00:49.159
And then I think it was either fall of 2022 or...
00:00:49.159 --> 00:00:53.649
very early in 2023 that shifted to early stage dementia.
00:00:54.765 --> 00:01:07.236
Okay, so you approach the conference with multiple hats, you know, as a sandwich generation caregiver, as a neuroscientist, and of course, as the director of the memory counseling program.
00:01:07.236 --> 00:01:16.885
uh So we're going to kind of hit three main uh buckets of research and presentations at AAIC.
00:01:17.105 --> 00:01:28.272
The first one, I think we both wanted to talk about what are some things that uh our listeners could do right now for their health, for the future of their brain health.
00:01:28.272 --> 00:01:39.299
And then we can talk about what are some exciting studies or research that was presented that may be relevant for the loved ones that you're caring for.
00:01:39.299 --> 00:01:56.204
And then finally, kind of just talking about the hope for the future for Alzheimer's disease and related dementias in terms of the science and things that we found to be really exciting in terms of the field moving forward.
00:01:56.204 --> 00:02:03.709
So Christina, what did you find useful or potentially really exciting about caring for yourself?
00:02:04.846 --> 00:02:14.069
you and I definitely have already talked about this, but the pointer study with some of the biggest news coming out of AAIC altogether.
00:02:14.069 --> 00:02:22.782
of course, Wake Forest, where we are and have been, is a big piece of that work.
00:02:22.782 --> 00:02:24.894
So that was great too.
00:02:24.894 --> 00:02:38.299
But the really cool part of that study that's important for caregivers to know is that dementia like I talked about with my mom, this is a long trajectory, right?
00:02:38.299 --> 00:02:43.877
Like we could see the buildup of the amyloid in her brain a decade ago.
00:02:45.515 --> 00:02:48.777
This is a long time and she's still actually pretty healthy.
00:02:48.777 --> 00:02:50.949
We still have a way to go ahead of us.
00:02:50.949 --> 00:02:54.949
But part of the importance of that is we could see that build up over like a decade ago.
00:02:54.949 --> 00:02:57.912
We probably could have seen it earlier if we'd looked earlier.
00:02:57.912 --> 00:03:07.316
So for caregivers, knowing that that disease starts early is important because lifestyle interventions may be able to affect it.
00:03:07.316 --> 00:03:13.038
So the cool thing about Poynter was everything they did is things that people can do on a daily basis.
00:03:13.038 --> 00:03:15.599
They help people form social groups.
00:03:15.599 --> 00:03:27.075
to adopt a healthier lifestyle and the healthier lifestyle involved taking medications that they needed to take to control things like hypertension and diabetes.
00:03:28.318 --> 00:03:59.324
exercising regularly and this involved getting your heart rate up for at least 150 minutes a week like you're recommended to do and it's important to note they did this with a team so you had friends supporting you you had people supporting you to help you make those changes they also help people to adopt healthier diet habits and also work on their sleep but they did all of this in a really in a way with support.
00:03:59.324 --> 00:04:01.544
So there's a group of people helping you.
00:04:01.544 --> 00:04:03.745
You started new things at new times.
00:04:03.745 --> 00:04:07.344
You weren't trying to start everything at once and like crunch it all in.
00:04:07.344 --> 00:04:11.264
You know, you're adding a little bit of healthy stuff here, adding some exercise there.
00:04:11.264 --> 00:04:17.324
And then over the course of two years, you build up to this set of a whole constellation of healthy habits.
00:04:17.324 --> 00:04:28.119
And they found when at the end of the two years that people actually had taken it was the equivalent of reversing brain aging by a couple of years.
00:04:28.139 --> 00:04:36.482
So that is huge and it's actually a larger effect than we see from anti-amyloid drugs in terms of the benefit.
00:04:36.482 --> 00:04:37.533
So that's huge.
00:04:37.533 --> 00:04:48.766
And it's important for caregivers because this study was in people who did not yet have memory loss and people who were at slightly younger ages as well as older ages.
00:04:48.766 --> 00:04:53.088
So whether you're a spousal caregiver or a child caregiver, this would apply.
00:04:53.978 --> 00:04:59.105
but it is important that it was before there was any diagnosis of cognitive impairment.
00:04:59.653 --> 00:05:09.754
Yeah, no, I think Poynter did a really great job of recruiting participants who are really reflective of the folks that we see in the community.
00:05:09.754 --> 00:05:22.274
So it was almost 70 % women, 30 % came from an ethno-racial group that's not white, and then 30 % are without a college degree.
00:05:22.274 --> 00:05:35.526
And like most Americans, you know, have higher risk for cardiovascular disease, whether that's high high cholesterol, high blood pressure, or both, or diabetes or pre-diabetes.
00:05:35.526 --> 00:05:42.211
uh And uh the majority of them have a family history of someone with dementia or memory loss.
00:05:42.291 --> 00:05:47.475
So this is definitely relevant for the folks who are listening.
00:05:47.495 --> 00:05:59.834
And just as you said, Christina, I think their average age is around 68, um which when you look at older adults, in my mind, that's actually not old at all.
00:06:00.216 --> 00:06:08.420
And it's actually right around the time that probably your mom, uh when she first, when you guys have first noticed her memory changes.
00:06:08.420 --> 00:06:26.329
And just as you said, this was not a placebo uh control trial in the sense that both of the arms had active intervention, like both groups did this comprehensive list of lifestyle changes, including a mind diet.
00:06:26.329 --> 00:06:36.637
physical exercise, health monitoring to monitor for blood pressure, cholesterol, blood sugar, as well as cognitive exercises.
00:06:36.637 --> 00:06:44.382
And they used a program called Brain HQ, which is available just by Google.
00:06:44.382 --> 00:06:54.310
in the study itself, they did about 30 minutes of these computer-based brain training three times a week.
00:06:54.310 --> 00:07:01.634
Plus they have regular engagement and other challenging and social activities.
00:07:02.095 --> 00:07:12.680
The two groups really differed in terms of how much support the study gave in the structured intervention, the more intensive intervention arm.
00:07:12.680 --> 00:07:19.225
had like facilitated team meetings, 38 of them over two years.
00:07:19.225 --> 00:07:21.156
And definitely, know.
00:07:21.156 --> 00:07:30.673
within the group of participants as well as with these coaches really kind of formed the community to improve their ah overall lifestyle.
00:07:30.673 --> 00:07:48.196
But the other group, notably the group that was getting the less intensive and self-guided, they only had six meetings over the two years and they were basically just given this general information for people to do without.
00:07:48.196 --> 00:07:54.869
the goal-directed coaching, and both groups actually improved in terms of their global memory.
00:07:55.406 --> 00:08:21.230
And when we look at their sub-types of memory, this is really noticeably improving in what's called executive functioning, which I think is really even more important than short-term memory, because if you don't have executive functioning, it's hard for you to figure out how to use the computer or a remote or how do you cook a meal when you know the recipe and have been cooking the same thing for forever.
00:08:21.230 --> 00:08:36.183
ah So I think that the scientific basis of the type of memory that improved also makes sense because we know those are the things that are important in both heart health and brain health.
00:08:36.250 --> 00:08:41.020
and that we see those changes being reflected in the study results.
00:08:41.020 --> 00:08:47.623
And I know, you know, this was one study that was very, very much got immediate blitz.
00:08:47.623 --> 00:08:53.585
And I had a patient actually call in asking about how can they sign up for the pointer?
00:08:53.585 --> 00:08:58.655
And I'm like, wow, here's some information I can give you and you can start right now.
00:08:58.655 --> 00:09:04.477
ah But I would have to say that, you know, I even checked out the brain HQ.
00:09:04.477 --> 00:09:30.721
uh website because I was curious as to what type of memory training this was and I think it's practicing uh like visual spatial short-term memory ah which to some people that might be fun but I would say if that's not enjoyable to you it definitely is not something you have to force yourself to do just because it was study in this particular study.
00:09:31.298 --> 00:09:45.928
Yeah, I guess I would add on to that by saying that I think it was the Achieve study where they first saw improvement in speed of processing in response to speed of processing training.
00:09:45.928 --> 00:09:56.294
That is, I think, one of the only studies, or at least the most robust study, to show that cognitive training by itself improves, can improve cognitive function.
00:09:56.294 --> 00:10:06.525
But I think that's important in the context of this too because in the Poynter study, they were talking about the fact that people didn't always love the cognitive training.
00:10:06.525 --> 00:10:09.407
They weren't as sure of the cognitive training dose.
00:10:09.407 --> 00:10:15.961
And there's a lot of evidence about exercise and that exercise can improve executive function.
00:10:15.961 --> 00:10:20.265
So I think that is, it's really important that.
00:10:20.265 --> 00:10:22.568
The exercise I would say is really important.
00:10:22.568 --> 00:10:28.758
I think there's also lot of emerging evidence about the importance of social engagement and social communication.
00:10:28.758 --> 00:10:31.681
So both groups improved, like you said.
00:10:32.258 --> 00:10:40.520
Both groups also had a group component where you were put with like a team that was all trying to change their behavior together.
00:10:40.520 --> 00:10:46.974
And then like you noted, the one that had the biggest improvements was actually had a coach and the coach.
00:10:46.974 --> 00:10:56.668
do think this is important because the coaches were trained in psychological techniques to help people be more likely to take up behavior change.
00:10:56.668 --> 00:11:05.991
So I think that some of those things also point to the fact that When you're a caregiver, it's really important to both ask for and accept help.
00:11:05.991 --> 00:11:11.553
And some of the help that you might want to be asking for and accepting can be around your own personal health.
00:11:11.575 --> 00:11:15.135
And that can be accepting coaching from somebody at the Y.
00:11:15.135 --> 00:11:17.537
It can be accepting help from friends.
00:11:17.537 --> 00:11:34.186
And that something simple, just like joining an exercise class or a walking group or a jogging group, some group that gets together can be really healthy and really help you even more to support those lifestyle changes because you can't always do it on your own.
00:11:34.186 --> 00:11:36.486
You shouldn't think you have to do it on your own.
00:11:36.486 --> 00:11:37.398
It's a team sport.
00:11:37.398 --> 00:11:41.279
Caregiving is a team sport and caring for yourself is also a team sport.
00:11:41.690 --> 00:11:42.811
Yeah, absolutely.
00:11:42.811 --> 00:11:56.135
And I know from personal experience, I definitely work out longer and with higher intensity when I'm in a workout class, I go to Orange Theory, no affiliation or promotion on behalf of them.
00:11:56.135 --> 00:12:01.937
But I have to say, I do it for a lot longer than if I were to work out at home by myself.
00:12:01.937 --> 00:12:07.801
And there is that coach being there telling me to keep running when I feel like dying.
00:12:07.801 --> 00:12:12.618
uh But yeah, I'm just curious.
00:12:12.618 --> 00:12:35.618
know you also are interested and have attended some talks about just our particular age group, this para-menopausal 40, 45, 40, 50, know, getting to menopause and all of the hormonal changes that are happening at this time of our lives when we're busy with our careers and our kids and our parents.
00:12:35.758 --> 00:12:39.977
you know, just a couple of days ago was my mom's one year.
00:12:40.375 --> 00:12:42.626
anniversary in terms of her passing.
00:12:42.626 --> 00:12:54.734
And I just remember, you know, that the two years when she was sick with cancer were some of the most exhaust, most emotionally exhausting years of my life.
00:12:54.734 --> 00:13:04.769
And uh so I mean, that's why we're, we're talking here and, hopefully for those who are listening, uh wanting you to feel like we're, here for you.
00:13:04.769 --> 00:13:10.501
And yeah, so coming back to hormones and paramenopause.
00:13:11.244 --> 00:13:14.134
Yeah, this is such a hot topic right now too.
00:13:14.134 --> 00:13:17.537
And I will say I've done a little bit of research in this area as well.
00:13:17.537 --> 00:13:21.739
So it's part of why it was really interesting to me in this meeting.
00:13:21.739 --> 00:13:27.201
But like you said, women in our age range, women are the most likely to be caregivers.
00:13:27.201 --> 00:13:30.842
Women are also the most likely to get Alzheimer's disease.
00:13:30.842 --> 00:13:34.085
And we do seem to be at actual elevated risk.
00:13:34.085 --> 00:13:37.145
That seems to not just be because of increased longevity.
00:13:37.145 --> 00:13:40.988
And that was something that was brought up multiple times in this meeting.
00:13:41.181 --> 00:14:15.182
I do feel like it's important whether I feel like probably a lot of people listening to this who are caregivers are women just statistically that's the case but also even if you are a male um you have women in your life that are probably also involved in this is valuable information but if you are caregiving say for your mom who has dementia which is such a common situation then you know you have family risk We also, like I said before, know that the pathology develops, begins developing up to 20 years before the onset of symptoms.
00:14:15.182 --> 00:14:24.182
So if you bring that back to my mom, those very first symptoms we saw when she was like 68, 69, she may have been getting...
00:14:24.639 --> 00:14:27.721
amyloid buildup in her brain at my age at 48, right?
00:14:27.721 --> 00:14:28.546
20 years earlier.
00:14:28.546 --> 00:14:32.702
That may have just been in its baby beginnings at my age.
00:14:32.702 --> 00:14:46.928
And that really brings home to me, listening to all these things really brings home to me that no matter how busy I am, It is very important to do these kinds of things that they were talking about in the Poynter study to whatever level I can.
00:14:46.928 --> 00:14:55.552
It may not be perfect, but whatever piece of that that I can incorporate into my life is going to be healthier for my brain.
00:14:55.552 --> 00:15:01.956
Because we know that in this time of menopause and perimenopause, there are metabolic changes in your brain.
00:15:01.956 --> 00:15:06.977
So the way your brain uses sugars during this time can have really dramatic shifts.
00:15:06.977 --> 00:15:10.541
um There are also differences in sleep patterns.
00:15:10.541 --> 00:15:16.729
and we know that sleep is really important and it was one of the things targeted in pointer that they tracked and that they looked at.
00:15:16.729 --> 00:15:29.629
um And we also know that those two things aren't separate, that when your sleep is disrupted, it disrupts things like your cortisol and your stress levels and your metabolism.
00:15:29.629 --> 00:15:44.749
So just realizing that as a caregiver, particularly if you're a female at this kind of vulnerable turning point with your hormones and all these changes, the stress of caregiving, you can feel like there's just not enough time to do these things.
00:15:44.749 --> 00:16:07.666
but any amount that you can do of exercise, keeping up with your health and wellness appointments to the best of your ability, trying to eat healthily when you can, that all of those things are really important for protecting your own brain and your own health so that you can continue to care for your loved one with dementia and for your family.
00:16:08.259 --> 00:16:17.528
Yeah, and we're gonna come back to talk more about food and diet and the gut-brain access because I was texting Christina during the conference.
00:16:17.528 --> 00:16:19.759
was like, this is so cool.
00:16:19.759 --> 00:16:21.741
This gut-brain access.
00:16:21.741 --> 00:16:22.863
we'll touch on that.
00:16:22.863 --> 00:16:44.494
ah But wanted to turn the conversation a little bit into kind of research that may be relevant to the loved ones you're caring for right now, people who might have either mild memory changes like mild cognitive impairment uh or they're on the dementia journey, whether that's mild, moderate or severe.
00:16:44.494 --> 00:17:09.130
So one thing that I uh heard during the talk that really didn't get as much publicity as I had expected uh was from this group, a company called Axome, uh A-X-O-M-E, uh where it looks like they tried different combinations of existing drugs for different indications.
00:17:09.191 --> 00:17:16.116
But the presentation was about AXS05.
00:17:16.337 --> 00:17:29.798
The actual name doesn't really matter except that it's a combination of dextromethorphan, which is like the DM part of your cough syrup, and then bupropion, which is the...
00:17:29.798 --> 00:17:36.698
the generic name for a well butrin, which is a pretty common anti-anxiety, anti-depressant medicine.
00:17:36.698 --> 00:17:40.498
more for anxiety than depression.
00:17:40.837 --> 00:17:48.337
And that AXS-05 basically is combining the two into one pill.
00:17:48.337 --> 00:17:52.377
And they did a phase three randomized control trial.
00:17:52.377 --> 00:18:14.738
So one arm was getting this medicine, this combination medicine, and people who have Alzheimer's disease and related dementias as well as behavioral changes uh and the other group was just getting placebo and both groups were getting it twice a day for the study duration which was 26 weeks.
00:18:14.738 --> 00:18:30.892
So they were looking at things like uh whether uh people caregivers reported that they are noticing changes in terms of the behavior as well as looking at potential side effects.
00:18:30.892 --> 00:18:51.107
we know with antipsychotic medications that are commonly used off label and people with living with dementia and potentially violent behavior or other challenging behavior that all of those antipsychotic medications not only make their memory worse but also have higher risk of death.
00:18:51.107 --> 00:18:58.566
um That's why they have a black box warning as well as make it more likely for people to fall, break a hip.
00:18:58.566 --> 00:19:00.445
have low blood pressure.
00:19:00.925 --> 00:19:15.306
This study on the dexamethorphin and buprenorphine combination surprisingly really didn't have a lot of those same side effects that we see in antipsychotics, which was a little exciting.
00:19:15.306 --> 00:19:30.913
And just knowing about how commonly probably a lot of people are on these meds also is a little reassuring for the geriatrician mind in terms of understanding the drugs and not that they're not totally brand new.
00:19:30.913 --> 00:19:39.374
Just curious from your perspective, Christina, from a neuroscientist perspective, why do those two drugs work well together?
00:19:39.404 --> 00:19:42.915
I can't tell you that because I'm not a pharmacologist.
00:19:43.436 --> 00:19:52.200
There's, neuropsychology is a really broad field um and I don't, that's not my area of study, but I was also super excited by this talk.
00:19:52.221 --> 00:19:57.262
I think you and I, because you were attending virtually and I was in person, we didn't know that we'd both gone to that one.
00:19:57.262 --> 00:20:00.923
But there were some things that I loved about the talk.
00:20:00.923 --> 00:20:07.307
One is that he was talking about combining the drugs and he called that rich pharmacology instead of a dirty drug.
00:20:07.307 --> 00:20:27.476
He was also talking about the fact that combination of drugs extended the um time over which the drugs were effective and that was really important because uh one of the limitations prior to this was that m the drug might be effective, but that on its own, but that it was very short term.
00:20:27.476 --> 00:20:34.118
When they put the two together, they could get this safe drug that also had a reasonable time course.
00:20:34.118 --> 00:20:42.432
And like you were saying, there's so little for caregivers and people with dementia for these kind of agitation symptoms.
00:20:42.432 --> 00:20:52.008
And sometimes it's violent and it can really be dangerous for caregivers or difficult to contain or can cause somebody to have the need to be in a placement.
00:20:52.008 --> 00:21:08.278
Other times it may not be quite that extreme but it's still preventing you or the person that you're caring for from sleeping or from getting things done during the day or it's preventing you from being able to bring caregivers in because they can't handle those behaviors.
00:21:08.278 --> 00:21:12.961
and those things also are presumably not pleasant for the person experiencing them.
00:21:12.961 --> 00:21:29.643
So it's really nice to think that there might be a drug with a better safety profile that can really help caregivers and people with dementia with those present right now symptoms until we get drugs that can actually cure these things longer term.
00:21:29.923 --> 00:21:41.207
Yeah, and I want to make sure that our listeners are not listening to this and then going out to buy a cough DM, mucinex DM in combination with their well-butrin.
00:21:41.207 --> 00:21:46.969
Please don't do that because they're still in the process of seeking FDA approval.
00:21:46.969 --> 00:21:58.597
And I want to make sure that we talk about how behavior is really just an expression of an unexpressed emotion or feeling.
00:21:58.597 --> 00:22:03.821
ah because in people living with dementia, they have trouble communicating.
00:22:03.821 --> 00:22:11.826
And so a behavior might be a way for them to really say that they're in pain, they're uncomfortable, they're bored, they're overtired.
00:22:11.826 --> 00:22:26.698
ah All of those things are important to try to address, not pharmacologically, but certainly having more options from a medication perspective that is hopefully safer.
00:22:26.698 --> 00:22:29.603
uh is really exciting to me.
00:22:31.252 --> 00:22:37.347
And kind of touching on what you were just saying, some of the other interesting things that I think we both heard had to do with that.
00:22:37.347 --> 00:22:44.522
uh Other contribute, like the contributors to agitation, things like changes in sensory function and.
00:22:44.588 --> 00:22:58.766
beginnings of research to look into different ways to address sensory function better because as people get older, everybody as you get older, you lose sensory acuity in all five senses and your sensory perception changes.
00:22:58.766 --> 00:23:07.009
But with dementia, and it can vary across different kinds of dementia or the stage of dementia, but you can also get even more perceptual changes.
00:23:07.009 --> 00:23:22.959
um You can, it often goes with hearing loss, there are vision changes, and some of those are normal aging related, but some Some of them also are due to the dementia itself and might include things like hallucinations or visual distortions.
00:23:22.979 --> 00:23:39.230
addressing those can also sometimes help address the agitation because if someone feels more confident or is better able to perceive their environment, hear what is being said to them, see the things around them, then this can also help with reducing agitation.
00:23:39.748 --> 00:24:00.926
Yeah, there is actually a study that they're looking at over-the-counter hearing aids, as well as a, you know, a senior volunteer coach who can potentially use hearing aid, teach the caregivers to use hearing aids for people living with dementia and have agitation and challenging behaviors.
00:24:00.926 --> 00:24:06.088
That study is ongoing and we will hopefully know the results soon.
00:24:06.128 --> 00:24:29.102
But I think whether it's paying or or hearing impairment or vision impairment, it makes sense, you know, logically and that if your world is confusing, I will be feeling anxious and kind of maybe lash out of my environment because I just don't know what's going on in addition to the cognitive and the processing changes that's happening in the brain.
00:24:29.102 --> 00:24:36.230
So anything we could do to optimize that, I think will be, it's great and is within our control.
00:24:36.230 --> 00:24:45.636
ah Now, you know, there's always going to be people living with dementia who just absolutely refuse to wear a hearing aid or any sort of hearing amplifying device.
00:24:45.636 --> 00:25:01.499
But there may also be other people who, you know, once they know that this is something that could help with their brain, I think may be more willing to wear hearing aids that they have available but didn't think it was important enough ah to wear.
00:25:01.499 --> 00:25:03.907
Yeah.
00:25:03.907 --> 00:25:10.421
And then, so finally, um let's talk about some of the research that we both found really exciting.
00:25:10.421 --> 00:25:16.492
And I think uh I'll just ground our conversation a little bit in the MIND diet.
00:25:16.492 --> 00:25:24.166
So going back to the Poynter study, one of the key components was uh diet, was nutrition.
00:25:24.166 --> 00:25:32.509
And so the MIND diet really emphasized dark leafy greens, berries, nuts, whole grains, olive oil, and fish.
00:25:32.511 --> 00:25:41.086
and really limits the intake of sugar, uh cheese, red meat, and unhealthy fats.
00:25:41.086 --> 00:26:00.314
ah I think this is not necessarily news to those of us who are in this space, but I think what I found oh was really fascinating was when they look at the stool samples of people who are amyloid negative versus amyloid positive.
00:26:00.546 --> 00:26:04.989
know, protein in the brain that we think is one of the causes of Alzheimer's disease.
00:26:04.989 --> 00:26:20.387
uh The amount of these short chain fatty acids that are contained within fiber rich foods like in the mind diet are more present with a more diverse uh microbiome.
00:26:20.387 --> 00:26:28.031
So lots of different bacteria in the amyloid negative group compared to the amyloid positive group.
00:26:28.038 --> 00:26:37.781
um So they also saw less short chain fatty acids in older folks and women and those who have an APOE4 status.
00:26:37.781 --> 00:26:44.345
So that's the gene that um gives people a higher risk of developing Alzheimer's disease.
00:26:44.345 --> 00:26:47.945
So all of that I found to be super fascinating.
00:26:47.945 --> 00:26:58.560
It's not just to say, you know, eat this diet and you'll be better, but really looking at the underlying mechanism of how does that diet make our brain better.
00:27:00.898 --> 00:27:03.500
Yeah, that is totally fascinating.
00:27:03.821 --> 00:27:08.685
I don't think I heard that specific talk, so I'm actually really glad to get that from you.
00:27:10.765 --> 00:27:16.981
But what was your impression of kind of this whole brain gut um relationship?
00:27:18.037 --> 00:27:24.054
There will I it was an emphasis here and I was excited about that for some of the reasons that you're saying.
00:27:24.054 --> 00:27:28.586
um There is also some new things that I learned about it.
00:27:28.586 --> 00:27:37.369
um One was that one of the people who was speaking was talking about the fact that.
00:27:38.313 --> 00:27:52.577
she began looking at the gut brain axis and whether some of those things were changing prior to the onset of symptoms versus after, because those of us who are caregivers also know that diet changes with the disease, right?
00:27:52.577 --> 00:27:54.798
People's palate changes, what they want to eat change.
00:27:54.798 --> 00:28:00.971
You can't force people to eat things at some point, but she was interested in whether that was changing first.
00:28:00.971 --> 00:28:19.719
She was also interested in the question, was there any potential that some of these proteins that we think our causal and memory decline might be present in the gut or somehow getting out of the gut and up to the brain because we know there are all of these really important brain body connections.
00:28:19.719 --> 00:28:37.229
We know that both the gut and the brain have uh natural cellular barriers when we're young and healthy and that for both the gut and the brain, those barriers, the blood brain barrier and gut integrity can be affected by aging and an Alzheimer's disease.
00:28:37.229 --> 00:28:46.417
So she was really curious if leaky gut um might be allowing things that ought not to be coming from your gut to get to your brain to happen.
00:28:47.040 --> 00:28:56.675
So she found that that was happening and even that amyloid from the gut might be getting to the brain.
00:28:56.675 --> 00:28:58.816
So there were two cool things about that.
00:28:58.816 --> 00:29:08.881
I think one was like you were talking about the importance of gut health for brain health and potential mechanistic links between what's happening.
00:29:08.881 --> 00:29:16.974
But a second really cool part of that is that um she also asked the question, well, if that's happening, how?
00:29:16.974 --> 00:29:17.325
right?
00:29:17.325 --> 00:29:19.676
Like there's got to be something transporting it.
00:29:19.676 --> 00:29:22.990
Is it just flowing up through the blood or is it being transported?
00:29:22.990 --> 00:29:26.051
And she was able to find that it was being transported.
00:29:26.051 --> 00:29:40.961
And the really cool thing about that is one of the most difficult aspects of drug delivery to the brain is getting across the blood brain barrier, that natural barrier that the brain has between what's in the blood and what's actually inside the brain tissue.
00:29:41.547 --> 00:29:43.768
that's very tightly controlled.
00:29:43.949 --> 00:29:54.134
this discovery that she made might also open up a new pathway for new drugs that are developed to get into the brain in a better way.
00:29:55.718 --> 00:30:21.253
I think this was the plenary talk by the researcher from South Korea who looked super young, but she had beautiful skin and I just wanted to be like her when I got older, ah talking about the gut-brain relationship and how, ah I think she had one slide that talked about just how common constipation, inflammatory bowel disease, irritable bowel disease.
00:30:21.253 --> 00:30:32.759
um as well as a number of other GI related issues and how that was so much more common in people who have um Alzheimer's disease.
00:30:32.759 --> 00:30:34.580
And it's fascinating.
00:30:34.580 --> 00:30:41.305
I think it does relate to, you know, the leaky gut versus the leaky brain.
00:30:41.305 --> 00:30:50.713
And um I think in fact, their, uh study or her lab looks at, you know, the gut transmits stuff to the brain.
00:30:50.713 --> 00:30:59.137
via the blood, but the brain transmits stuff to the gut via a nerve called the vagus nerve.
00:30:59.137 --> 00:31:15.903
And so, I don't know, the nerd in me was just really excited because the vagus nerve controls so much stuff, is our parasympathetic nervous system, as well as the nerve that we can activate when we take a deep breath.
00:31:16.125 --> 00:31:18.786
All of the things that I think...
00:31:19.119 --> 00:31:26.173
we're probably not doing enough and knowing that it's related to this gut brain relationship.
00:31:26.554 --> 00:31:50.090
As you have mentioned, Christina, I think this also opens up new ways of getting drugs into the brain that doesn't cause too much toxicity because part of, whether it's chemo or even anti-amyloid drugs is that getting through that blood brain barrier could be potentially also causing side effects that because the the barrier itself becomes leaky.
00:31:50.090 --> 00:32:05.642
So those blood vessels, whether it's the amyloid-related imaging abnormalities or swelling of the brain or small areas of bleeding in the brain, those are the side effects that really relates to how the drug is working.
00:32:05.642 --> 00:32:23.269
uh And so if we have a natural way that our body is communicating between our gut and our brain, lots of other stuff that we can take by mouth and be digested and maybe we'll go up to our brain.
00:32:25.762 --> 00:32:27.364
Yes, yeah.
00:32:27.364 --> 00:32:40.410
this, there are two directions and I want to take this and I don't know which one to go first, but where you stopped, maybe the next logical one would be that there was another really cool talk that was actually about Licanumab, which is one of the approved drugs.
00:32:40.410 --> 00:32:49.074
And I didn't realize this, but they were saying that currently the way Licanumab gets into the brain is actually through the leaky blood brain barrier.
00:32:49.074 --> 00:32:52.174
So it doesn't have a great delivery system.
00:32:52.174 --> 00:32:55.737
And one of the results of that is it's not always evenly distributed.
00:32:55.737 --> 00:32:57.105
across the brain.
00:32:57.717 --> 00:33:09.613
So this group was looking at a new way to have it receptor mediated transport, which would mean the drug is actively pushed across the brain, blood brain barrier.
00:33:09.613 --> 00:33:16.336
And they showed some beautiful images of how that made the leucanum ab more evenly distributed across the whole brain.
00:33:16.336 --> 00:33:19.356
So the whole brain was more evenly targeted by the drug.
00:33:19.356 --> 00:33:40.353
And they were also saying that in their first stages of these trials, that there were fewer symptoms like you were talking about that we are concerned about with those drugs like the brain swelling and bleeds and things like that and they thought it was because it was bypassing, it was being taken directly in and not depending on the leaky blood-brain barrier and that that might be reducing some of those symptoms.
00:33:40.353 --> 00:33:41.973
So that was really cool.
00:33:42.425 --> 00:33:45.088
Yeah, what was the other thing you wanted to talk about?
00:33:45.088 --> 00:33:50.622
The other thing with the gut, the gut brain as you were talking about it, this actually brought me back to my mom.
00:33:50.622 --> 00:33:56.984
So I've known for a long time because like you mentioned in the beginning, I'm interested in type two diabetes and obesity.
00:33:56.984 --> 00:34:07.990
And one of the interesting things about obesity is that as weight, weight gain and loss have a natural age related trajectory, but that has changed in dementia.
00:34:07.990 --> 00:34:17.855
And most people who are dementia caregivers have experienced that, that people with dementia often experience weight loss and they can often undergo periods of rapid weight loss.
00:34:17.855 --> 00:34:37.072
And there was actually a point at which I was reading about this and I found a paper back from like the 1950s where a neurologist was talking about unintentional weight loss being a diagnostic factor for Alzheimer's disease that it differentiated it from some other forms of pathology that could be happening.
00:34:37.152 --> 00:34:45.996
So with my mom in 2020 she experienced 30 pounds of unintentional weight loss and she really it was dramatic.
00:34:45.996 --> 00:34:55.528
It happened over six months and it what was interesting to me was we finally got it addressed and by Dr.
00:34:55.528 --> 00:35:00.001
Kate Callahan who we both know and who is also an amazing physician.
00:35:00.380 --> 00:35:10.998
She was like took care of that for my mom but what it turned out to be was an overgrowth of certain bacteria in her gut that was preventing her from digesting.
00:35:10.998 --> 00:35:19.942
But listening to that talk, it made me think about that weight loss piece that has been noted in Alzheimer's so many times.
00:35:19.942 --> 00:35:22.112
And it made me wonder about that with my mom.
00:35:22.112 --> 00:35:25.315
Was there some causal piece with this gut brain axis?
00:35:25.315 --> 00:35:26.715
Was that a turning point for her?
00:35:26.715 --> 00:35:35.099
Because that was right before she had a big inflection point and went on to early stage dementia, that she had that large weight loss.
00:35:35.101 --> 00:35:38.353
amount of weight loss and was having all of those gut problems.
00:35:38.353 --> 00:35:55.898
So that was definitely in my head thinking about that and thinking about maybe in the future will there be ways for us to more rapidly identify or maybe even prevent some of that by having the right set of probiotics to give people when we see that memory loss is happening.
00:35:55.898 --> 00:36:00.070
I know there is research happening on probiotics to help maintain gut integrity.
00:36:00.070 --> 00:36:04.554
it em just there's a lot of interesting future directions from this.
00:36:04.554 --> 00:36:17.862
in so many ways, both in terms of treatment of the gut or the gut-brain axis and then in terms of exploiting that relationship to deliver other drugs that may not be related to that but may need to get into the brain.
00:36:18.384 --> 00:36:19.614
Yeah, absolutely.
00:36:19.614 --> 00:36:34.291
And I think, I know we talked about this before in your mom's specific situation, it was a small bowel overgrowth of this bacteria, which is very difficult to diagnose.
00:36:34.291 --> 00:36:45.650
And I still remember when I was a, I think a medical student, one of the first patients that I saw who probably in hindsight had mild dementia, but I didn't realize, well.
00:36:45.650 --> 00:36:53.483
I knew something was wrong, but his presenting symptom was that he was losing a lot of weight and he was eating just as he's normally did.
00:36:53.483 --> 00:36:55.775
His wife was cooking the same thing.
00:36:55.775 --> 00:37:00.250
And I was so concerned about him having an undiagnosed cancer.
00:37:00.250 --> 00:37:04.210
I scanned, me and my preceptor, scanned him from head to toe.
00:37:04.210 --> 00:37:10.643
He didn't have cancer, ah but I also knew he was in conversation with me.
00:37:10.643 --> 00:37:13.175
There was something not right in terms of his memory.
00:37:13.175 --> 00:37:15.246
So I did some memory screening.
00:37:15.333 --> 00:37:18.577
and he definitely had memory impairment.
00:37:18.577 --> 00:37:38.070
So then I thought, well, is he just, I mean, he couldn't just be forgetting to eat because he had a reliable person who was providing that food and he was eating the food, but it just did not make sense to me why he would lose such a huge amount of weight and have apparently no explanation for it.
00:37:38.431 --> 00:37:44.146
That conversation just reminded me of that particular case where I was like, Mm-hmm.
00:37:44.146 --> 00:37:46.130
why you're losing so much weight.
00:37:46.130 --> 00:37:48.351
I hope it doesn't continue.
00:37:49.195 --> 00:37:54.442
But I can't seem to find out why it is that you're losing so much weight.
00:37:55.659 --> 00:38:11.523
The other piece with the leaky gut that she brought up that we haven't talked about yet, but is sort of maybe interesting for people to think about if they're reading the news and they're reading about things like inflammation and the relationship between inflammation and dementia is that.
00:38:11.907 --> 00:38:29.255
These certain kinds of gut bacteria can have byproducts like little fragments that break off from them and when the gut barrier is leaky, those fragments can get into the blood and can cause inflammation throughout the body.
00:38:29.255 --> 00:38:32.577
So that's yet another kind of link and pathway.
00:38:32.577 --> 00:38:41.740
So there's just so many things that it's really apparent that this gut brain axis is touching on that like we historically know about the weight loss, but we don't fully understand.
00:38:41.740 --> 00:38:42.041
it.
00:38:42.041 --> 00:38:54.525
um Maybe it's related to this that we know inflammation is a component and we know that when the gut barrier is um leaky that you can get increased inflammation from these fragments that can be there.
00:38:54.525 --> 00:38:58.945
We know that the composition of the bacteria is important for all of those things.
00:38:58.945 --> 00:39:01.947
So just so many so many cool directions.
00:39:02.726 --> 00:39:03.387
Absolutely.
00:39:03.387 --> 00:39:18.139
ah I think that the final thing I'm going to just mention, because as I was preparing for this conversation today, I also looked at the list of um media press releases that was released from AIC.
00:39:18.139 --> 00:39:39.034
And one thing that I didn't catch during the conference but was publicized on the news release is that they had a first time looking at longitudinal study of the US Supplemental Nutrition and Assistance Program, SNAP, or food stamps, and how that's linked to slower cognitive decline over time.
00:39:39.034 --> 00:39:49.690
It just made me think about the relationship between having access to food, healthy food, and how that's related to your overall health as well as brain health.
00:39:49.690 --> 00:40:10.891
And policy changes that cuts back on SNAP and healthy food really can have not just hunger and of course poverty and all of that, but also had long-term impacts potentially into young people and children's growth and their bring health over time.
00:40:10.891 --> 00:40:17.072
So I'm gonna conclude that uh conversation today on that.
00:40:17.072 --> 00:40:18.423
Please go, yes.
00:40:18.423 --> 00:40:21.237
I add one more thing that's important in that same vein?
00:40:21.237 --> 00:40:30.445
Another major press release that they had or thing that they talked about that's similarly kind of policy related was the importance of lead exposure.
00:40:30.445 --> 00:40:34.449
There was a really cool study where they were able to use kind of the variability in.
00:40:34.449 --> 00:40:42.211
um the use of leaded gas, gasoline, across the United States to look at exposure.
00:40:42.211 --> 00:40:47.034
these environmental toxicities that we know um can affect the brain.
00:40:48.396 --> 00:40:54.371
Making sure that the environment and that these toxins are not in there is incredibly important at all stages.
00:40:54.371 --> 00:40:59.815
Like we're aware of lead and risk for children, but we don't think about what is at risk later on in life.
00:40:59.815 --> 00:41:02.846
And that's creating vulnerabilities later on in life as well.
00:41:03.152 --> 00:41:24.949
Yeah, and I have so many patients who ask me, know, whether some exposure to whether it's mining or other industries that had a lot of pollution in the air, could that have related or military exposure to different agents that may or may not be classified as toxins by the, you know, Veterans Affairs Administration?
00:41:24.949 --> 00:41:27.971
And sometimes I just say, I don't know because...
00:41:27.971 --> 00:41:28.614
Mm-hmm.
00:41:28.614 --> 00:41:43.960
I mean, I'm sure it wasn't great for your health, but as to whether or not that truly relates to your memory problems, at least for this study on lead exposure, I think this is the first time that there is such a noticed um relationship.
00:41:43.960 --> 00:41:58.675
And I think the natural experiment of which areas had allowed lead gasoline versus those who didn't allow that kind of direct comparison, which is just not possible within a randomized controlled trial.
00:41:58.851 --> 00:42:02.728
Yeah, so interesting stuff, so many interesting things.
00:42:02.949 --> 00:42:06.650
Yeah, well, thank you so much for this conversation, Christina.
00:42:07.230 --> 00:42:13.530
I will link in the show notes some of the studies that we are talking about today.
00:42:13.530 --> 00:42:25.349
And then for those who are listening who really wanted to hear from the presentations themselves, the AIC virtual platform is actually still open and it's free.
00:42:25.349 --> 00:42:31.353
So people can, I think, can still sign up and log in, although I'm not entirely sure.
00:42:31.353 --> 00:42:46.282
But uh I think this was a great thing by the Alzheimer's Association to make this scientific conference widely available and for free when usually, you know, we have to pay money to attend.
00:42:46.282 --> 00:42:48.804
All uh right.
00:42:48.804 --> 00:42:50.764
Well, thank you, Christina.
00:42:50.784 --> 00:42:58.338
If you enjoyed this episode or this podcast, please click the follow or the plus sign in your podcast player.
00:42:58.338 --> 00:43:04.980
That way you will get uh the new episodes populated in your podcast feed whenever it comes out.
00:43:04.980 --> 00:43:07.445
Thank you all and talk to you next time.
