Live Healthy Longer with Dr. Jim Polakof
Amazing Podcasts Created & Hosted by Dr. Jim Polakof to Stimulate Your Body, Mind and Soul! It's in our nature to explore opportunities that can improve our well-being. As a celebrated podcaster with thousands of listeners, Dr. Jim Polakof continually surpasses normal limits to explore new horizons in creating a better life for his listeners and readers. ‘Live Healthy Longer’ covers a wide range of topics including new advances in health and medicine; the possibility of having past lives and reincarnation; unique perspectives on entertainment, and ‘hot topics’ debates which present both sides of key issues.
Live Healthy Longer with Dr. Jim Polakof
What You Need to Know about Alzheimer’s and Symptoms You May Not be Aware of!
1 in 3 Older Adults DIE WITH ALZHEIMER’S or Another Dementia
What You Need to Know about Alzheimer’s
and Symptoms You May Not be Aware of!
Discover unknown symptoms of the disabling and deadly Alzheimer’s disease and how to combat them. Dr. Jim Polakof interviews – aging expert, Dr. Heather Whitson – leader of a collaborative Alzheimer's Disease initiative combining Duke University and the University of North Carolina (UNC) at Chapel Hill, with a bold vision to transform dementia research and care.
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I'm Dr Jim Polakoff and welcome to another episode of Live Healthy Longer. Alzheimer's is currently ranked as the seventh leading cause of death in the United States and it's the most common cause of dementia among older adults. It's the most common cause of dementia among older adults. But what makes Alzheimer's really challenging is the toll these diseases take on loved ones and family. Fortunately, my guest for this podcast is a leading expert who will provide insights and a close look at solutions.
Speaker 2:Live Healthy Longer is sponsored by LHL Institute, where aging presents a new stage of opportunity and the longer we live, the more beautiful life becomes. Our host, Dr Jim Polakoff, certified nutritionist, author and health specialist dedicated to enriching the lives of others. Now, here again is Dr Jim Polakoff.
Speaker 1:While dementia is a medical condition involving the decline of mental ability, alzheimer's disease actually damages brain cells. As a result, some signs of Alzheimer's include memory loss, poor judgment, leading to bad decisions, taking longer to complete normal tasks, repeating questions and forgetfulness, changes in mood and personality, losing or misplacing things, even wandering or getting lost, and, as the disease progresses, increased anxiety or depression. Well over 6.5 million Americans are living in the clutches of Alzheimer's, with more women than men suffering from this deadly disease. Fortunately, there's a leading expert who can shed light and hope. There's a leading expert who can shed light and hope. My guest is Dr Heather Whitson, director for the Study of Aging and Human Development at Duke University. Dr Whitson also leads a collaborative initiative that brings together investigators from Duke University and the University of North Carolina, chapel Hill, with a bold vision to transform the research and care of Alzheimer's disease and dementia. Welcome, dr Whitson.
Speaker 3:Thank you, thanks for having me and thanks for covering this topic.
Speaker 1:Well, it's our pleasure. It's an important one, that's for sure. Now, perhaps you can begin by describing how Alzheimer's disease affects the brain.
Speaker 3:Yeah, sure. So that's a good question. We know a lot more about that than we did even five or 10 years ago. So Alzheimer's disease and other types of pathology that cause dementia are caused by misfolded proteins in the brain and whatever it is that caused those proteins to misfold. So it's important to realize that when people are experiencing the symptoms of dementia, like memory loss and confusion, what's happening inside the brain, inside the nerves of the brain, are these misfolded types of proteins and then other changes to other types of cells that we think either cause those proteins to be there or are a reaction to those proteins being there.
Speaker 1:So what are they doing? Are they, these proteins? Are they actually slowing down the brain so that it's difficult to remember something, for example?
Speaker 3:So we don't entirely know, because it's possible to have a lot of those proteins in your brain and not have any cognitive problems at all. We call those people cognitively resilient. So we can look at people's brain images, or we can look at the protein levels in their spinal fluid and see that there are some people that carry a lot of those proteins and yet their brains seem to function really well. Their brains seem to function really well, and then sometimes there are people that don't seem to have super high levels of those proteins but have cognitive problems. So there's not a perfect correlation, but some of the proteins are actually inside the cells, some of the proteins are outside the cells. It certainly appears, though, increasingly, that the proteins themselves are at least part of the problem. So when the brain has Alzheimer's disease, the, the, the proteins are causing the brain to not be able to do its job as well.
Speaker 1:So how do you explain? I'm just curious. You have some brilliant minds. You know different people. I mean, one of the great movie directors, you might say, of all times won the academy award, clint eastwood. He's 93 years of age. Uh, carol burnett is 90 as a as a matter of fact. I mean there are, and their minds are very sharp and they're very quick. I mean clint eastwood can still memorize script, which is amazing at 93 years of age, and yet there are others in their 70s who just quite can't get there. Is there any explanation as to the difference?
Speaker 3:Yeah. So I think you're bringing up one of my favorite things about the field of geriatrics, which is just that if you tell me a person's age, all I really know is their, their age. Tell me a person's age, all I really know is their age. It tells me very little about how healthy they are or what they can do. Because, you're absolutely right, there are some of us maintain mobility, cognition, other, you know eyesight, hearing, other things that we really care about you know for all of our lives and others don't. And it's very. It was always interesting to me in medical school that in pediatrics, you know, a baby acquires different functions at one month and then two months and three months, and a pediatrician can test various things and tell you, you know, if the child is off the chart, not doing what it should be doing, by, say, exactly 16 months or 18 months, and when we start to lose those same functions. It doesn't happen in any stereotyped way at all. It's anybody's guess sort of how they're going no explanation.
Speaker 1:That's why the research goes on right.
Speaker 3:The research goes on. I think the best thing that we can probably say is that some of it is luck, some of it is you know what injuries, exposures and things like that you encounter over your lifetime that that cause various impairments or conditions to develop. Some of it is our genetics.
Speaker 1:I was going to ask you how you know basically what you inherit from your parents, grandparents, how that plays into effect.
Speaker 3:Yeah, and that's really interesting to me with Alzheimer's disease, because one of the things that we know is that Alzheimer's disease is a genetic disease.
Speaker 3:The gene that is most associated with Alzheimer's disease is called the APOE gene. The link between the APOE gene and Alzheimer's disease was discovered here at Duke and since then there have been hundreds of other genes that contribute to smaller amounts to a person's risk for Alzheimer's disease. But what's fascinating to me is that a person is born with those genes and then in normal Alzheimer's disease, most people don't get it until they're in their 70s or 80s. So we live decades with those genes. And then in normal Alzheimer's disease, most people don't get it until they're in their 70s or 80s. So we live decades with those genes and then something happens around 60s, 70s, 80s that kind of opened the door to suddenly this disease with the misfolded proteins in the brain. And one of the things that I'm most interested about is what is it that happens right before those proteins begin to appear and we can see them in the brain and we see them start to cause the problems that they do? What happens in the body when the genetic risk has been there for decades?
Speaker 1:Well, that leads me to my next question, and that is we know that Alzheimer's primarily affects seniors who are like 65 years and older, but what are the signs and symptoms that my listeners should be aware of?
Speaker 3:Yeah, so one of the most telltale signs is a loss of short-term memory and it's important for people to understand sort of the difference between short-term memory and how those problems might manifest in long-term memory. So people, even into very advanced stages of Alzheimer's disease, often have very intact long-term memories so they can remember things that happened 20 years ago very well. What they have difficulty with is storing and processing new memories. So the way that that can manifest if you love somebody who's developing Alzheimer's disease is they repeat questions, they repeat stories kind of on a loop.
Speaker 1:Now all of us do those things sometimes and that's I know, I repeat stories myself and I don't think I'm there yet. But I can't, sometimes I can't help it.
Speaker 3:But when that change happens and it's enough to be worried about, it's usually not subtle, it's you know, making it through one sitting at breakfast and the same question gets asked multiple times, with the person not really having a memory that it's already been asked and answered, and so that that can be a real key sign. The other kinds of things are disorientation, so having more difficulty either keeping track of dates and times and calendar appointments, or getting lost in what should be familiar places. So sometimes that will manifest if someone is driving, they feel very confident operating the car but they realize that they start to get lost and turned around in what should have been a familiar place to be. Or maybe in a big store like a Target or a Walmart Supercenter that they go into and suddenly find themselves getting more disoriented in a store like that. Or maybe in a house that they visited sometimes but not all the time, like going to stay with an adult kid or something like that, and suddenly they have a hard time finding the bathroom at night.
Speaker 1:And what about the idea of children worry if he can't or she can't remember the name of someone after you know, after shortly meeting them, or that's something I was. I would imagine that, god, I think from the time I was 20, I was poor at remembering names, so I'm not sure that's a sign.
Speaker 3:Well, so the answer is it certainly can be. Language difficulties are often one of the presenting symptoms of certain kinds of dementia and can be present in Alzheimer's disease dementia too. But what you're describing is a very common thing that we all experience, more of which, even in the aging literature. It's called TOT or tip of the tongue, where you know the thing but you're just having a hard time thinking of the word that you want to say for it. That happens a little bit more as we age, to all of us. Again, there's some point that it starts happening so frequently or to such degrees so you might hear a person with dementia substitute words very frequently. So you know that the word that they're trying to say is shirt, but they say jacket because they just couldn't find the word.
Speaker 1:They couldn't find the word shirt. What about the slow on the uptake? If someone you know seems to react very slowly to questions, you might ask them. For example, is that another sign?
Speaker 3:It could be a sign. And there are again certain neurological conditions that we maybe associate with that slowed reaction, which can happen in Alzheimer's but also Parkinson's disease and other conditions where that slowing is sort of a real feature. But again, you know, is sort of a real feature. But again, you know, everybody's processing speed and reaction time gets a little bit slower as we age. It just does. It starts about age 30 in the population.
Speaker 1:Right, I'm just wondering. I try to see if I can correlate our minds to a computer and over time, as we age and as we gather more and more and more information, does the computer begin to be a little bit congested and slow down. Have there been any studies that correlate to that?
Speaker 3:I think that's a great analogy. I think a lot of us realize that the neural circuits of our brain are not all that different than the electrical circuits of the computer. So I think thinking of it that way is a great analogy.
Speaker 1:So why does Alzheimer's disease affect women more than men?
Speaker 3:Oh, that's a great question and one that I'm also really interested in, and nobody knows for sure. So, you know, one of the questions that we've asked is is it possible, you know, when I talked before about we've lived with these genes our whole lives and then clearly something happens in these later decades of life that seem to sort of open the door and the disease manifests For women, is there something about menopause? You know, women go through a very dramatic body change at right about what would be the right time, that kind of late 40s or early 50s, and that seems to be the time at which the door opens. So there are certainly people asking that question, addressing that question, and there's some early data to suggest that that may have something to do with it, but the truth is we don't know.
Speaker 1:So much more to research. So once the signs or the symptoms of Alzheimer's present or manifest, what should a person or a loved one do?
Speaker 3:Yeah. So I think that it is important, and it's also important to realize that one of the things that is variable in Alzheimer's disease is the degree to which the patient has insight about it, and so that is for some people. One of their kind of clinical symptoms is that they don't have insight into the fact that they're having short-term memory problems or getting turned around. So, whereas some patients do, some patients are very aware that this is happening. So, if you're observing it in someone or you're feeling that it's happening yourself, either way, we really do encourage an evaluation, and the reason that I think that that's all the more important now to do the evaluation is that we're starting to get treatments, that we can actually do something about it, and all the data so far suggests that the treatments are going to be more effective the earlier we start them.
Speaker 1:So early detection is obviously the key. And then do you present yourself. I mean, obviously if you live in Raleigh or Durham, I mean you certainly can come and visit Duke, but if you're in an outlying area or in a different state or whatever, do you see your primary care doctor? Do you go straight to a neurologist? What's your advice?
Speaker 3:I would talk first to the primary care doctor. The other thing for people to know is that they can get you know. With Medicare you can get an annual. You should get as part of your annual wellness check a cognitive evaluation, just kind of a cognitive screener, that any primary care provider can administer. So they should administer that.
Speaker 1:But should you ask for that, because I'm familiar that some primary care doctors do not do that as part of the Medicare screening.
Speaker 3:That's right, and I think if you're having any concerns about it at all, or if you have a family history which might be enough reason to be concerned to ask for that as a screen. But also keeping in mind that, again, especially people who are lifelong good test takers can definitely be having true cognitive changes that they perceive and they still ace that test.
Speaker 3:They, you know, it's a screener, so it's the screeners that are most often used in practice, are no more than 30 questions, often less than that, and so people might make a perfect on that and still, if you feel that you're having some kind of a change, that is more than just you know the occasional sometimes we all forget a name or sometimes we all ask the same question twice If you really think that this is happening in a sustained way, I think being upfront and not letting someone just reassure you and brush it off- is well.
Speaker 1:And you're exactly right Because you know, if you look at the typical average of a primary care doctor, the average national average is seven minutes for the patient. So in seven minutes there's a lot you can't do and that obviously is concerning. So is the next step? If your primary care doctor is concerned or you feel you're not getting the proper concern, would you then go to a neurologist? Is that what you recommend? I would.
Speaker 3:I would do one of two things. It can be a neurologist or other memory disorder specialist, which can be geriatricians, sometimes they're psychiatrists tests, but looking for a memory care specialty practice because also there are increasingly available tests that can be done. Now one of the tests that we use most commonly is a lumbar puncture. So some people say you know, I don't want to go in for a lumbar puncture unless I really want to know and I might do something differently or it would help me make different plans if I knew. But before long and when I say before long, we don't know exactly how long it'll take for these to get approval. But in research now we frequently use blood based tests. So I think it will. I think it will be not too long before we've tested those blood-based tests in enough people and enough populations to have more confidence in how to interpret them, just in the clinical population.
Speaker 1:And when we have that it suddenly becomes a lot easier, I think, for providers average person, particularly as they age past 55 or 60, it's an annual thing to have at least a CBC, or perhaps it would be an inalungated type of blood test. So that's a good suggestion, a good thought. Hopefully that will happen sooner than later in most practices. Now I know there are three stages of Alzheimer's and let's just talk about the first two. How do you treat or what form of treatment or what protocol is there for mild and moderate Alzheimer's treatments?
Speaker 3:Yeah, so. So for anyone with Alzheimer's disease I tell people or who are worried about Alzheimer's disease there's all kinds of things that we can do to protect our brain health that are not adding a new medication. So some of the things that absolutely do protect your brain and protect your brain health. You know, in some ways if it's good for the body, it's good for the brain too. So exercise, physical activity, social activity, reducing stress, getting good sleep If someone is having issues like depression or anxiety, getting those managed All of those things help us think better and help our brain work better, and people should be doing those.
Speaker 3:In addition, one of the things that we've definitely shown that protects your brain is controlling your blood pressure. So if you're a person who has high blood pressure, your blood pressure has been kind of borderline. Controlling the blood pressure is something that also seems to protect the brain going forward and even in people over age 50. And then, if we're at a point where we think that this person does have mild or moderate Alzheimer's disease and they want to start a pill or a medication for it, there are medications that have been on the market for a long time. It's important to realize that those that have been on the market for a long time. They're easy to take. They're pretty well tolerated by people. They don't cure the disease, so people shouldn't take them with the false hope that this is curing my Alzheimer's disease.
Speaker 1:It's not doing so what do they do?
Speaker 3:They seem to help the nerves in the brain function a little bit better. So the idea is to think of the brain with Alzheimer's disease is stressed and not functioning as efficiently as it should. And your analogy of the computer it's sort of a computer that's got some glitches, and what these do is it just kind of gives a boost to the proteins that the nerves use to communicate with each other. So it's sort of more like increasing the power to the computer or upping the juice, but not really fixing the problem that's inside it.
Speaker 1:Well, now there's an FDA-approved medication on the market. Now I'm curious about it. I'm not sure whether you go by the pronunciation or by the letters. It's either Lequimbi or it's L-E-Q-E-M-B-I, I understand. The preliminary results are promising.
Speaker 3:Yeah, so that's the one that I wanted to talk about next. So I'm glad that you brought that one up that I wanted to talk about next. So I'm glad that you brought that one up. So, licanumab, or licanbee, as you said, it just got its full FDA approval in July, so it's newly fully approved. It had a partial approval in January. So you know, we in the Duke Memory Clinic have been prescribing it since January, so we already have some experience and comfort level with prescribing it and it is available. The thing again that I like to sort of let people know is that what it does is it very effectively clears out one of those kinds of misfolded proteins that we talked about, so a protein called amyloid. It's an antibody against amyloid and it clears it out really effectively and in this kind of clearing out the cobwebs.
Speaker 3:Yeah. So it sort of scrubbed, scrubs out the cobwebs of this amyloid. What we've seen is that when, when you compare people who got that drug versus people who look the same but didn't get that drug, both of them continue to decline. So it doesn't stop the cognitive decline and in both groups of people they decline. It's just how quickly do you decline? And it's clear now in a couple of trials that the people who get the drug, they decline more slowly and that's good news.
Speaker 3:If you, you know, know that you've gotten, you have a diagnosis of Alzheimer's disease and it is a progressive disease and there is going to be decline. If you slow that decline, that can be worth a lot to people. And then the question just becomes is the is is slowing the decline? And our best estimates from the trials are that over about an 18 month period, taking the drug puts you about five or six months behind the group that didn't get the drug. So it's over an 18 month period. It'll sort of slow you down by about five or six months worth of time. And for some people say, you know, well, wow, that sounds disappointing, I was hoping for more. And other people say, hey, I'll take it five to six months, you know that could be.
Speaker 1:Those five or six months can be very precious. Gives you time to prepare, gives your loved one, loved ones, an opportunity to adjust. So do you see any other advances in the horizon, anything new that might be coming up?
Speaker 3:Yes, so. So maybe before before we get on that, I just want to also kind of share with your listeners the other things about this drug that caused some people to say it's not for me. Number one it is expensive. Medicare is now covering it, but most Medicare plans cover about 80% and it costs in the tens of thousands per year to take. Oh, my goodness, Even paying 20% of that can be you know the 20% hope.
Speaker 1:Well, it could be $2,000 a year, roughly out of pocket.
Speaker 3:Absolutely. So that alone puts it. You know some people are not going to go down that road. Now there may be payment programs and things like that through the drug company that we could still get over that hurdle. The other thing is that you have to take it by an infusion. So every two weeks you go into an infusion center and you get the drug infused. Some people tolerate the infusions better than others. Most people do fine with the infusions.
Speaker 3:But the real thing that we think about with this drug is it comes with a side effect and it's a side effect that it depends on your genetics how at risk you are for the side effect. There's three different kinds of of three different varieties. You can either be somebody who doesn't have the APOE4 gene at all. You can be a person who has one copy of it, or you can be a person who has two copies of it. The two copies people are at much higher risk and what they're at risk of is brain bleeding or swelling and so that seems.
Speaker 3:You know that's that that can be a pretty serious complication if it occurs. Fortunately, in the, in the studies and in our experience so far, when we stop the drug and follow people, their brains recover and there's there hasn't been lasting damage, but in the studies, particularly if people were on any kind of blood thinner, there were deaths associated with the brain bleed. So people need to go in understanding that. You know, I really don't recommend it for people that are on blood thinners like Coumadin or Warfarin or Eliquis.
Speaker 1:Right, that makes a lot of sense. You mentioned APO at late terms. What does that mean?
Speaker 3:Yeah, so that's just the name of the gene. That's the gene that we already knew is a major risk factor for getting Alzheimer's disease. It turns out it's also a major risk factor for getting this complication associated with the treatment. So it's important to know your genetic status If you're making a decision whether or not I want to go down this treatment road. Most people say now I want to know my genes because I know I'm at higher risk or lower risk depending on what my genes are.
Speaker 3:So to monitor for that side effect, we have to do MRIs, and several of them during the time that people are getting treated. So if you're a person who hates being in the MRI machine, or you can't be in the MRI machine for some reason, like you have a defibrillator or a pacemaker or something else, again this isn't going to be the drug for you. So the thing that I tell people about these drugs are it's so exciting, it's an incredibly exciting time to be practicing an Alzheimer's disease when there are new drugs coming to the market and it's the first time in two decades that that that's been the case, where we have something to offer people that seems directly to be hitting the pathology of the disease that you know gets me up in the morning and very excited it also. The thing that really gets me up in the morning is that I think that this is far from the best drug that's going to eventually be available to treat this disease.
Speaker 1:So there are new. There are new medications, new drugs under development. I'm assuming that's what you're saying.
Speaker 3:That's yeah. So there's a lot of other drugs under development and it could be that some of them, either in combination with this one or instead of this one, begin to really make a difference in the fight against this disease. And it's been a long fight, a long and frustrating one for the patients and families dealing with the disease and also for researchers like me that have been trying to crack the code and get something out there to people.
Speaker 1:Love your enthusiasm and excitement about what's happening in this field. I'd like to discuss some natural methods of preventing or at least reducing the risk of Alzheimer's Like, for example I'm going to throw some out. I'd love to have your comments. Diets including high protein foods and fruits. Certain supplements Out there is lion's mane, melatonin supposedly there's a Japanese study that says that may have a positive effect and, of course you mentioned it earlier getting adequate sleep. Any comments about those?
Speaker 3:Yeah. So the diet one is a big question and it's probably one of the most common questions I get in clinic is what should I be eating to protect my brain? There are so many studies hundreds that have looked at a specific vitamin or macronutrient or micronutrient. My feeling on those is that it's probably there. I haven't seen any of them that look like a game changer. To me, the best data for just a general type of diet that most people feel like can be kind of sustainable is a Mediterranean type diet.
Speaker 1:And that's the one I recommend.
Speaker 3:Yeah, so I think, a Mediterranean diet, and people can go online and see what they can and can't eat on a Mediterranean diet. The other thing is that the evidence is pretty, pretty strong that that there's a lot of things that we can eat and drink that are bad for our brain. So, whereas I never tell people that they have to go total teetotal and avoid all alcohol, I think people should know that alcohol is a neurotoxin and if you're worried about protecting your brain, not overdoing it with alcohol is is a good thing to do. The other thing is avoiding really processed foods. There's, there's, you know quite a bit of data that that sort of processed foods and general foods that are not healthy, and by that I just mean kind of your snack foods and desserts and all the things that we know we shouldn't eat. They're bad for other parts of your body there, but they seem to be bad for your brain too.
Speaker 1:And that's a good correlation. Are you familiar with? It's called the MIND diet. It's a combination of the Mediterranean diet and the DASH diet. I don't like the word diet, I'd rather use the word style, Mediterranean style, whatever. But are you familiar with that and is there much difference between that and just a straight Mediterranean diet?
Speaker 3:So there is some difference. And, yes, I do think that the MIND diet again a thing that people can look up. You know the DASH diet. A lot of what it did was reduce sodium and and it was initially designed to control blood pressure, and we sort of talked before about how there is this correlation between somebody's blood pressure being out of control and maybe not even terribly out of control, but just higher than it needs to be and that not being good for long-term brain health. So I do think that combining those two with the MIND diet is a real promising diet or lifestyle. I like that too.
Speaker 1:Well so, dr Whitson, why don't we turn to your, which I find very interesting? You lead a collaborative Alzheimer's disease initiative that brings together investigators from Duke and as well as UNC, chapel Hill. Tell us about the program.
Speaker 3:Yeah. So we started this program a few years ago and got NIH funding as a center of excellence in fall of 2021. So this is a collaboration between Duke and UNC Chapel Hill. So normally, obviously, we're bitter rivals on the basketball court, but our tagline for the center is that when it comes to fighting Alzheimer's disease, we're all on the same team. So I think that this collaboration made a lot of sense because in many ways the schools are. They're so close in location, both, you know, national super houses of superpowers of medical research and very complimentary in the kinds of Alzheimer's disease and dementia relevant research that was going on at the two different schools and so coming together to form this center.
Speaker 3:And we have, you know, our long-term mission is to really transform dementia care and early diagnosis and care across our whole catchment area, which is Eastern North Carolina. We also have what we refer to as our sister center, which is Wake Forest, has an Alzheimer's disease center too. So between these two centers we really have the state of North Carolina well covered. And then at our center at Duke and UNC, our focus is on these changes across the lifespan that alter people's presentation of Alzheimer's disease or their experience of it. So we're very focused on what's happening in your 30s, 40s, 50s. That puts you at higher risk for Alzheimer's disease and that's a way that our center is a little different from what a lot of the other centers are doing. We're one of the only Alzheimer's disease centers in the country that mostly enrolls people who do not have Alzheimer's disease, because we're trying to get people younger and when their brains are still free of Alzheimer's disease, because we want to catch what's happening during that critical transition period right before they get the disease.
Speaker 1:That's so important and obviously, with all these institutions collaborating together, you have a larger study group than probably most universities in the country do, so that's laudatory, so I'm very impressed. I understand you have a clinical trial. Can you tell us a little bit about that, exactly what the trial is at the early detection of Alzheimer's? I think you alluded to part of it there in your statement.
Speaker 3:Yeah, yeah, so we do have some trials going on.
Speaker 3:So when I hear trial, what I think of is that we're offering somebody an intervention and comparing it to placebo. So the study that I think you're talking about is not really a trial, and that we're not giving people a treatment Although if we hear about an opportunity for a treatment trial that would benefit them, we send them over there and they can get the treatment. But in this study that you're talking about, what we're doing is enrolling people. We're enrolling people who have a family history or a known genetic risk factor, and we're starting there's studies for people as young as age 25. So a 25-year-old who has a grandparent first you know, a relative with Alzheimer's disease can come and be in the study.
Speaker 3:We collect samples from them. So some of the samples that we collect are bloods and spinal fluid, images of their brain, images of their eyes, and then, when people turn 45, we can include them in the study where we can follow them every year. So we follow them every year, and both so that we can give them information about themselves and connect them to new data and findings about how they can protect their brain and reduce their risk, but also so that the data we get from them can get into the hands of our researchers and investigators, who are trying to develop new treatments and learn new things.
Speaker 1:I think that's a great program. Now, do you study like for somebody who's in their 30s or 40s? Do you study them over a period of time as opposed to just, you know, gaining some initial information and evidence from them?
Speaker 3:Yeah.
Speaker 3:So starting at age 45 is when we bring them back every year, the people in our very young cohort.
Speaker 3:What they're doing is kind of doing us the favor, so that if we start to see something in 50 and 60-year-olds that looks like it might be preceding this onset of Alzheimer's disease, the question then becomes is what we're seeing just an age-related change, just something that happens with people as they get older, or is this really disease-related? And having that younger cohort, their data, is a good touch point for us to be able to go back and compare and say no, is this just a change that we're seeing that's mostly an age thing, or does it look like this is more disease related? So the young folks we only see them one time when they're young, just because we don't expect a lot to change until they start to get about 45. Then if those young folks who contributed some data to us in the past, if they're still living in North Carolina and want to come back and join the cohort at age 45 and get followed every year, we're happy to have them. It's even more valuable, in fact, because we have information from when they were very young.
Speaker 1:Sounds like an excellent study. Now I know you have a background in ophthalmology. How does the eye fit into all of this, into Alzheimer's? Any correlation? Well, obviously there's a correlation there.
Speaker 3:Yeah, so that's really interesting. So I guess I'll clarify. I'm not a trained ophthalmologist. My training is in internal medicine and geriatrics, but my research has been in ophthalmology and I've collaborated with a lot of ophthalmologists.
Speaker 3:Because one of the things that I've always been very interested in is, you know, when we have, when a person has a brain that has started to experience either these misfolded proteins of diseases like Alzheimer's disease or other issues, strokes, other vascular problems that happened with age, what are all the other things that we can do to try to help and protect that brain? And one of the obvious things is to provide it with the best sensory information that it can get. So you know, we all don't, we don't, we kind of take it for granted, but the but for most of us, the information that our brain uses relies on what we see and hear or taste and smell, and those are other functions that often decline with age. So if we can do everything that we can to sort of protect vision and hearing or help people accommodate vision or hearing problems that they may be having, my question has always been is that important sort of a treatment approach that we haven't fully leveraged in being able to protect aging brains?
Speaker 1:And you're exploring that further obviously, which is good.
Speaker 3:Sorry.
Speaker 1:I said, you're exploring that in greater depth, obviously, which is good.
Speaker 3:Yes, we are, and you know it certainly looks like there's real opportunities there, and that is another thing that we tell people when they're just getting an early diagnosis is that you know, if they need hearing aids, to go ahead and see about getting hearing aids. If they have issues with their vision, it's a good time to see an eye doctor. Again, you just want to give the brain the clearest signals that it can possibly get, especially if it's starting to struggle with information.
Speaker 1:Right Now, as we conclude, I think we want to get to what I call the bad news, because we haven't talked about it yet. We get to stage three and you know, basically, I know I guess the typical life expectancy is somewhere once you've been diagnosed with Alzheimer's. It's a wide variance, but three to 11 years, if I'm correct. But when you get to that final stage, what is someone to expect and what can someone do, and particularly in regards to the loved ones who at that point are reached almost a stage of panic? That's what I've seen happen in someone's lives.
Speaker 3:Yeah. So I think that you know, importantly at that stage, it is when people reach a stage that they can't take care of themselves. It really is a disease that the family is experiencing with them because they're having to make choices for how do I keep my loved ones safe? How do I give them the best quality of life that I can? How do I deal with some of the things that arise with the disease? That can be anxiety, fearfulness, and there are really great strategies for kind of dealing with all those things.
Speaker 3:I definitely think that people should reach out to clinics, and oftentimes it's not the physician in the clinic that will be the best source of this information, but the social worker, either in the clinic or associated in people's counties with the agency on aging.
Speaker 3:And then in North Carolina, for your listeners who are in North Carolina, there's something called the Duke Dementia Family Support Program, which is a free service to anybody in North Carolina. That is a group of social workers that, through funding from the state and philanthropy, have made this service available to people and can give people just really practical tips, everything from how to navigate all of the payment systems for, if we're needing to think about assisted living or memory units. How do we make that change? How do we deal with things like taking away somebody's car, if a person is not safe to be on the road and yet that independence is really important to people? How do we have those conversations? What are our legal responsibilities? How do we get things set up like wills and power of attorney documents? Practical questions of what do I do if it's two o'clock in the morning and mom is wandering and won't settle down and go to bed. What are my options? What can I do? And so I think those become very real, very important questions.
Speaker 1:Very important considerations. I'm glad we covered this and again I want to advise my listeners who are outside of the state of North Carolina. I mean, it's great that North Carolina has these programs available, but check with your state and see what's available. If you have a loved one who's getting near that stage stage three you definitely want to explore every opportunity available to you to get as much assistance and support as you possibly can.
Speaker 3:Yep and I would say look at their counties and also look at the Alzheimer's Association, which is national and a great advocacy group that has lots of information, also through the National Institute on Aging. But I think the thing for listeners to know is that if they're going through this, they're not alone. Often we feel very alone when we're caring for somebody with Alzheimer's disease, but almost any conundrum that they're facing is something that other people caring for a person with with Alzheimer's disease have faced too. So just reaching out to those networks to get suggestions, tips, solutions You're not alone.
Speaker 1:Well, dr Woodson, you've been a wealth of excellent information. I'm so glad you've been able to join us. How does someone who suspects they might have Alzheimer's, you know, or really their primary care doctor, might be concerned as well. How do they get to you, or how did they get to your department at Duke?
Speaker 3:Yeah, so I think the Internet is always one great way to do it. So if you you know Google Duke, unc Alzheimer's Disease Research Center, then you'll find a website and you can go from there.
Speaker 1:Well, also your links, whatever links you wish to send to us, will be published on our website. So if any of our listeners are curious or want to go to the website, they'll be able to find those links. So I want to thank you so much. You've been extremely gracious and your knowledge, I think, is important to all of our listeners, either for themselves or for their loved ones, because if it's not happening now, it may soon. We want to be prepared.
Speaker 3:Yeah, well, thank you, and again thanks for covering the important topic.
Speaker 1:You're welcome.
Speaker 2:Live Healthy Longer is sponsored by LHL Institute, where aging presents a new stage of opportunity, and the longer we live, the more beautiful life becomes. Our website, jamespolakoffcom, contains links to excellent Alzheimer's programs offered by Duke University. But, as important, the site also has a great selection of outstanding, informative podcasts, as well as health-oriented blogs written by Dr Polakoff. Again, please visit jamespolakoffcom. That's jamespolakoffcom. Now back to Dr Jim Polakoff for our conclusion.
Speaker 1:Again, I wish to thank Dr Whitson for joining us, and please check out our website for links to Duke's Alzheimer's resources. I also want to alert my audience to a relatively new Alzheimer's blood test that is available to consumers. One of the advantages of taking this test is that it lets you know, potentially, that you are at risk for Alzheimer's. More information about this AAD detect test for Alzheimer's disease is available on our website, jamespolikoffcom. I once again want to thank my listeners for making Live Healthy Longer a fast-growing, popular podcast. It's nice to know that more and more listeners are following my podcast and finding them interesting, informative, even helpful, so please continue to tune in each week. I appreciate it. This is Dr Jim Polakoff. Thank you for listening and please remember the words of Gandhi it is health that is real wealth, not pieces of gold or silver. Thank you.
