Podcasts about adrd

Journalist and patient advocate Carol Steinberg discusses her article, "Alzheimer's impact on the young should be an open book." She argues that while Alzheimer's disease and related dementias (ADRD) are known to affect the whole family, children under 18 are often excluded from conversations about a loved one's condition, leading to fear, confusion, and missed opportunities for connection. Carol details the emotional toll on children witnessing cognitive decline, the distinct difficulties for those with a parent with younger-onset ADRD, and the significant challenges faced by the 5.4 million caregiving youth in the U.S., who often experience adverse mental, physical, and academic outcomes. The discussion highlights a growing consensus among experts urging truthfulness and age-appropriate involvement for children, calling on the medical community and others to better recognize and support young carers. Carol introduces her children's book, Come Grandpa Meow, Let's Fly, as a tool to facilitate these difficult conversations and promote meaningful intergenerational activities, allowing families to connect and "meet in the moment" despite the disease's progression. Actionable takeaways emphasize the importance of candor, using resources to educate children, fostering continued relationships, and advocating for greater support systems for affected youth. Our presenting sponsor is Microsoft Dragon Copilot. Microsoft Dragon Copilot, your AI assistant for clinical workflow, is transforming how clinicians work. Now you can streamline and customize documentation, surface information right at the point of care, and automate tasks with just a click. Part of Microsoft Cloud for Healthcare, Dragon Copilot offers an extensible AI workspace and a single, integrated platform to help unlock new levels of efficiency. Plus, it's backed by a proven track record and decades of clinical expertise—and it's built on a foundation of trust. It's time to ease your administrative burdens and stay focused on what matters most with Dragon Copilot, your AI assistant for clinical workflow. VISIT SPONSOR → https://aka.ms/kevinmd SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended

Join this Policy Profile Podcast that examines the latest policy activities impacting research around Alzheimer's disease and related dementias (ADRD). Patricia D'Antonio, GSA's Vice-President for Policy and Professional Affairs, and Ian Kremer, Executive Director of the Leaders Engaged on Alzheimer's Disease (LEAD) Coalition, offer insights into the latest federal actions and what to expect in Congress this year around ADRD. Resources BOLD Act  NAPA   By Pass Budget  NAPA Annual Reports  KAER Toolkit and GSA Resources  U.S. Pointer Study  ADRD Summit 2025  Transcript Speaker Ian Kremer, JD, Executive Director of the LEAD Coalition Host Patricia D'Antonio, BSPharm, MS, MBA, BCGP, Vice President of Policy and Professional Affairs,  

In this large real-world study

Send us a textKristy Russell takes us on a deeply personal and professional journey through the world of Alzheimer's disease and related dementias (ADRD). As Utah's sole specialist covering the entire state, Kristy shares how her grandmother's Lewy body dementia diagnosis transformed her perspective on memory care after initially swearing off working with dementia patients due to challenging experiences.The conversation tackles misconceptions head-on. Memory loss is just one symptom — thinking, behavior, and problem-solving abilities are equally affected. Kristy reveals a startling reality: only half of people with Alzheimer's are diagnosed, and of those, merely 30% share their diagnosis with loved ones, often fearing loss of independence.Communication emerges as the cornerstone challenge for caregivers. Through vivid examples, Kristy explains why arguing with someone with dementia about recent events is futile. Her "filing cabinet" metaphor brilliantly illustrates how memory works — newest files disappear first — helping caregivers understand why their loved ones can't simply "try harder" to remember.For overwhelmed caregivers, Kristy offers practical wisdom about delegation and self-care. "The energy you put out is the energy you're going to get back from the person with dementia," she notes, emphasizing that seeking help isn't failure but excellence in caregiving. She explains respite options and encourages caregivers to maintain their own health appointments and activities.Looking forward, Kristy shares hope about new medications like aducanumab that can remove brain plaques in early stages, signaling a positive trajectory in treatment development. Her powerful closing message resonates deeply: "You're doing a good job and you're not alone."Whether you're caring for someone with dementia, working in healthcare, or simply seeking to understand these conditions better, this episode provides invaluable insights, practical strategies, and heartfelt encouragement for the journey ahead.• Kristy's journey from swearing off dementia care to becoming Utah's statewide ADRD specialist• Only about half of people with Alzheimer's disease are diagnosed, and of those, only 30% share their diagnosis with family and friends• Early diagnosis allows for better planning and less crisis management as the disease progresses• Communication challenges require meeting people with dementia in their reality rather than constantly correcting them• The "filing cabinet" memory metaphor explains why recent memories disappear first• Self-care for caregivers includes delegating tasks and utilizing respite services• New medications like aducanumab can help in early stages by removing brain plaques• The Utah government's WISE initiative focuses on helping seniors age in place independentlySupport the show

Dr. Bashir Easter joins Ron Aaron and Carol Zernial to talk about the Dementia Villages Project on this edition of Caregiver SOS. About Dr. Easter Bashir Easter, PhD, is the founder of Melanin Minded LLC & Melanin Minded Foundation. The organization was established with the mission to be the bridge for information, service, and support for people of color with a long-term vision to empower and equip people of color to have the optimal quality of life. Easter earned his Ph.D. from Capella University, an MBA from Concordia University, and a BS from Cardinal Stritch University. He also received an Associate of Science degree in business management from the Milwaukee Area Technical College. Started and successfully piloted in Milwaukee Wisconsin, a pioneering initiative led by Dr. Bashir Easter, the founder of Melanin Minded, is setting a adding new components for creating dementia-friendly communities starting in communities of color called "Dementia Villages" This project recognizes the unique needs and experiences of individuals of color living with dementia, who often face additional barriers and disparities in accessing appropriate care and support. The project brings a unique process that promotes economic stimulus and workforce development opportunities to communities affected by ADRD.  Hosts Ron Aaron and Carol Zernial, and their guests talk about Caregiving and how to best cope with the stresses associated with it. Learn about "Caregiver SOS" and the "Teleconnection Hotline" programs. Listen every week for deep, inspiring, and helpful caregiving content on Caregiver SOS!See omnystudio.com/listener for privacy information.

Send us a Text Message.The Davos Alzheimer's Collaborative ( DAC - https://www.davosalzheimerscollaborative.org/ ) is a pioneering worldwide initiative to cure Alzheimer's disease and dementia, seeking to mirror the success of global efforts against infectious diseases such as HIV/AIDS, Covid, and Malaria. Absent effective action at scale around the world, by 2050, more than 150 million families and half a billion people will be personally impacted by Alzheimer's, creating a social, financial, economic, and global security disaster of historic proportions. DAC was launched in Davos in 2021 by the World Economic Forum and the Global CEO Initiative on Alzheimer's Disease. Dr. Tim MacLeod is the Director of the Systems Preparedness workstream of the Davos Alzheimer's Collaborative (DAC) where he executes on a mission to facilitate the implementation of national, regional, and global commitments to provide access to future innovations in treatment, diagnosis, and care. Drawing on his background in implementation science and innovation consulting, Dr. MacLeod guides the development, execution, and dissemination of multi-site, real-world implementation studies that generate evidence about the facilitators and barriers to adopting and scaling novel technology in the ADRD space. Before joining DAC, Dr. MacLeod led the award-winning human-centered design studio Bridgeable as Managing Director, where he worked with Fortune 500 companies in the financial service and health spaces on significant innovation initiatives. Dr. MacLeod holds a Ph.D. in community psychology and has published widely on health innovation and implementation science. His research with the Mental Health Commission of Canada's At Home/Chez Soi team scaled the Housing First model from 5 pilot sites to over 20 cities nationally through multi-level policy change. Dr. Vaibhav Narayan is Executive Vice President at the Davos Alzheimer's Collaborative (DAC), which he joined after 13+ years at Johnson & Johnson (J&J) where he was Vice President of Digital Health Innovation and Head of Data Science for Neuroscience R&D. At J&J, Dr.  Narayan created and led programs that utilized multi-modal data from ‘genomics to digital' to understand disease subtypes and develop AI/ML driven digital health solutions for prevention, early detection, disease course monitoring and prediction in Alzheimer's and neuropsychiatric diseases. Dr. Narayan also previously served as Head, Discovery Informatics, Eli Lilly and Company, and as Director, Computational Sciences, Celera Genomics.  He also currently serves a role as Chief Industry Officer, UK Mental Health Mission, University of Oxford.Dr. Narayan obtained a PhD from Yale University in computational biology and an Executive MBA from Kellogg School of Management, Northwestern University.Important Episode Links The Davos Alzheimer's Collaborative Healthcare System Preparedness(DAC-SP) Early Detection Blueprint - https://www.dacblueprint.org/Alzheimer's Association International Conference 2024 - https://aaic.alz.org/#Alzheimers #Dementia #Davos #Neurology #Neuroscience #HealthyAging #BrainHealth  #TimMacLeod  #VaibhavNarayan #DavosAlzheimersCollaborative #ProgressPotentialAndPossibilities #IraPastor #Podcast #Podcaster #ViralPodcast  #STEM #Innovation #Technology #Science #ResearchSupport the Show.

Guest: Danelle Hubbard, Dir. Health Systems, Colorado Chapter, Alzheimers Association In 2020, 76,000 persons age 65+ had dementia which is expected to grow to 92,000 by 2026.Their care partners will be contributing 186 million hours of unpaid care to them. The state has created an ADRD, Alzheimer’s Disease and Related Dementias plan to support those afflicted and their caregivers. https://www.alz.org/co

Guest: Danelle Hubbard, Dir. Health Systems, Colorado Chapter, Alzheimers Association In 2020, 76,000 persons age 65+ had dementia which is expected to grow to 92,000 by 2026.Their care partners will be contributing 186 million hours of unpaid care to them. The state has created an ADRD, Alzheimer’s Disease and Related Dementias plan to support those afflicted and their caregivers. https://www.alz.org/co

Episode 24: Primary Care Summary: Early Detection and Diagnosis of Alzheimer's Disease Hosts Dr. Eukesh Ranjit and Dr. Raj Shah, talk about what they learned through the conduct of the Brain Trust podcasts to date and share some potential avenues that diagnosis may take in the near future. Learning Objectives: - Provide one key lesson learned about ADRD early diagnosis and detection in primary care from the Brain Trust series. - Provide one potential future development that may alter early diagnosis and detection in primary care. Earn 1-Hour State of Illinois Mandated Dementia Education CME iafp.mclms.net/en/ Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

Listeners, please welcome Dr. Eric Griffith to the show ...as a guest! In this episode, Eric takes a break from producing to talk about his research regarding human variation in dementia. Find the publication discussed in today's episode via this citation: Griffith EE. (2023). “Recruiting Participants for Dementia Research Without Saying ‘Dementia': A Site Study in Central Mexico.” In: Anthropological Perspectives on Aging, BM Howell & RP Harrod eds., University of Press of Florida. ------------------------------------------------------------ Dr. Eric Griffith received his Ph.D. in anthropology from the University of Massachusetts Amherst, as well as an MA in psychology from Boston University. He completed his dissertation fieldwork in central Mexico, focusing on the experiences of familial caregivers for people living with Alzheimer's disease. Eric's research interests include biocultural anthropology, dementia, cognitive aging, health disparities, and mixed methods research. Eric is currently a T32 postdoc at the Duke University Center for the Study of Aging and Human development. He also worked as a postdoctoral fellow with the Samuel DuBois Cook Center at Duke University on the project “The influence of religion/spirituality on Alzheimer's Disease and its related dementias (ADRD) for African Americans." ----------------------------------------------------------- Contact the Sausage of Science Podcast and Human Biology Association: Facebook: www.facebook.com/groups/humanbiologyassociation Website: humbio.org/, Twitter: @HumBioAssoc Chris Lynn, HBA Public Relations Committee Chair Website: cdlynn.people.ua.edu/, E-mail: cdlynn at ua.edu, Twitter:@Chris_Ly Eric Griffith, HBA Junior Fellow, SoS producer E-mail: eric.griffith at duke.edu

Podcast 44: Cultural Adaptation of ADRD Clinical Trials for Latino Participants by NIA IMPACT Collaboratory

In this episode, Matt and Donovan talk with Dr. Jason H. Moore, Director of the Center for Artificial Intelligence Research and Education (CAIRE) and Chair of the Department of Computational Biomedicine at Cedars-Sinai Medical Center. Jason discusses the coming impact of artificial intelligence on a spectrum of Alzheimer's disease and related dementia (ADRD) issues. We discuss how tools such as AI-powered chatbots may improve quality of life for people living with dementia (and their caregivers) and how AI may contribute in the future to diagnosis and treatment. Faculty Bio: https://researchers.cedars-sinai.edu/Jason.Moore Center for Artificial Intelligence Research and Education (CAIRE): https://www.cedars-sinai.edu/research/areas/caire.html The transcript for this episode can be found here.CAPRA Website: http://capra.med.umich.edu/ You can subscribe to Minding Memory on Apple Podcasts, Spotify, Google Podcasts or wherever you listen to podcasts. Hosted on Acast. See acast.com/privacy for more information.

Episode 19: Caregiver Mini-Series #1 Katrina The Brain Trust Caregiver Mini-Series brings you into the quiet strength of Alzheimer's/Dementia care partners. Host Dr. Raj Shah and social worker Susan Frick from the Rush Alzheimer's Disease Center guide us through the delicate tapestry of caregiving. This mini-series addresses issues faced by caregivers dealing with the cognitive decline of their loved ones. The discussion centers on diagnosis, management, and the crucial role a primary care physician plays to enable an integrated approach of support for care partners of patients with ADRD. Learning Objective: - Identify one challenge caregivers experience in seeking a primary care evaluation. - Describe one desire from care partners regarding improving early diagnosis and detection. Earn 1-Hour State of Illinois Mandated Dementia Education CME iafp.mclms.net/en/

Lori La Bey talks with Tim MacLeod, the Director of the Healthcare Systems Preparedness workstream of the Davos Alzheimer's Collaborative (DAC). The mission of the systems preparedness program is to facilitate the implementation of national, regional, and global commitments to provide access to future innovations in treatment, diagnosis, and care. Drawing on his background in implementation science and innovation consulting, Tim guides the development, execution, and dissemination of multi-site, real-world implementation studies that generate evidence about the facilitators and barriers to adopting and scaling novel technology in the ADRD space. Before joining DAC, Tim led the award-winning human-centered design studio Bridgeable as Managing Director, where he worked with Fortune 500 companies in the financial service and health spaces on significant innovation initiatives. Tim holds a Ph.D. in community psychology and has published widely on health innovation and implementation science. Tim's research with the Mental Health Commission of Canada's At Home/Chez Soi team scaled the Housing First model from 5 pilot sites to over 20 cities nationally through multi-level policy change. Learn: The importance of brain health and mental health. If more education of primary care doctors is needed. The difference between brain health versus aging. About cure versus care or can they work together? The importance of family conservations regarding last wishes. Should Pharma integrate a social care model of support with their trials? About Davo's Alzheimer's Collaborative and why it was created. If some symptoms are reversible.   Other Podcasts https://pod.link/986940432   Contact Davos Alzheimer's Collaborative Website    https://www.davosalzheimerscollaborative.org YouTube   @davosalzheimers     https://www.youtube.com/@davosalzheimers LinkedIn  https://www.linkedin.com/company/davosalzheimers/   Contact Lori La Bey with questions or branding needs at https://www.alzheimersspeaks.com/ Alzheimer's Speaks Radio - Shifting dementia care from crisis to comfort around the world one episode at a time by raising all voices and delivering sound news, not just sound bites since 2011. Alzheimer's Speaks is part of the Senior Resource Podcast Network.   Support this Show: https://alzheimersspeaks.com/donate-now/See omnystudio.com/listener for privacy information.

Host Raj Shah, MD chats with Tonja Austin, MD, Assistant Professor, Family & Preventive Medicine, Rush University about early detection ADRD in African American communities. Learning Objectives: - Describe one common barrier to early detection and diagnosis of ADRD faced by primary care physicians serving African American communities. - Name one way to overcome a barrier to early detection and diagnosis of ADRD. Earn 1-Hour State of Illinois Mandated Dementia Education CME iafp.mclms.net/en/

Host Raj Shah, MD chats with Tracey Smith, DNP, PHCNS-BC, MS, Director of Community Health and the IPHA CHW Capacity Building Center, Illinois Public Health Association (IPHA) and Angelia Gower VP NAACP Madison, IL and Director of Health and Environmental Programs. They explore the experience of community-based organizations working with primary care physicians in underserved communities and discussing how community health workers can partner with local family medicine physicians to improve early detection of ADRD. Learning Objectives: - Describe two ways to incorporate CHWs into primary care practices in health systems - Discuss barriers that systems must address to integrate CHWs Earn 1-Hour State of Illinois Mandated Dementia Education CME iafp.mclms.net/en/

Special episode with Dare To Care radio show connecting social workers, community members and primary care physicians on the importance of efforts being made across the state in the early detection and treatment of Alzheimer's disease and related dementias. They offer profound insights into health literacy, dementia management, and how connections with community and social workers can enhance the efforts in primary care. Learning Objectives: - Describe how primary care physicians can work with the Dare To Care audience to promote early detection - Identify prevalence of Alzheimer's disease within communities within Illinois and the importance of education about the benefits of early detection Earn 1-Hour State of Illinois Mandated Dementia Education CME iafp.mclms.net/en/

Host Raj Shah, MD chats with Avinash Mantha, MD, Associate Program Director at Loyola Hines VA Geriatric Fellowship, to discuss the adaptations primary care will need to make with the introduction of new ADRD treatment modalities. Learning Objectives: - Describe one reason why current processes for early ADRD diagnosis will have to change. - Identify one action primary care physicians can take to support their patients concerned about cognitive changes go through the process of evaluation. Earn 1-Hour State of Illinois Mandated Dementia Education CME iafp.mclms.net/en/

Host Raj Shah, MD talks with Mark Drexler, MD, FAAFP. Lead Physician, for the Comprehensive Care Center at NorthShore University and Faculty at the University of Chicago Family Medicine Residency & Gene Kuhn, Sr. Health System Account Manager at the Alzheimer's Association. They discuss ways physicians can improve early detection of Alzheimer's disease by leveraging caregiver support. Learning Objectives: - Identify opportunities to guide caregivers and families of persons with dementia to appropriate care and support resources. - Describe the ways a Care Consultation can be beneficial to families dealing with Alzheimer's or other dementias. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

Host Raj Shah, MD talks with Chief Health Information Officer at IU Health Karl Kochendorfer, MD, FAAFP, FAMIA and Ravishankar K. Iyer, PhD about leveraging health IT and your EHR for managing and detecting patients at risk for Alzheimer's Disease and Related Dementias. Learning Objectives: - Describe tools that can be used to screen for dementia, discreetly stored within the EHR and tracked over time. - Discuss future directions and the use of AI for the early detection of ADRD. Earn 1-Hour State of Illinois Mandated Dementia Education CME iafp.mclms.net/en/

Episode 8: Early Detection in FQHC's Host Raj Shah, MD speaks with guest Emma Daisy, MD to discuss the roles Illinois physicians working in Federally Qualified Health Centers can play in the early detection and diagnosis of Alzheimer's disease and related dementias Learning Objectives: 1) Understand the roles Illinois physicians working in Federally Qualified Health Centers can play in the early detection and diagnosis of Alzheimer's disease and related dementias. 2) Name at least one potential solution to overcome barriers to early detection and diagnosis of ADRD by primary care physicians working in FQHCs. Earn 1-Hour State of Illinois Mandated Dementia Education CME iafp.mclms.net/en/

In this podcast, Karen M. Rose, the Vice Dean, the Director, and a Professor of the Center for Healthy Aging, Self-Management, and Complex Care at The Ohio State University College of Nursing, discusses insights on assessing caregiver burden and supporting the mindfulness of caregivers and families. These podcasts, excerpted from a 2022 webinar, build upon the information delivered in the Resources for Integrated Care (RIC) September 2022 webinar titled: “Innovations in Alzheimer's Disease and Related Dementias (ADRD) Caregiver Support Programs: Building and Leveraging Support Systems.” This webinar continues to explore innovative ways that health equity and caregiver support are addressed across ADRD programs supporting dually eligible people living with ADRD. The event speakers review community-level strategies to ensure adequate care for individuals living with ADRD and their caregivers. For more information about this webinar, click here: https://www.resourcesforintegratedcare.com/2022_ric_webinar_innovations_alzheimers_disease_related_dementias_adrd_caregiver_support_programs_innovative_community_strategies/.

In this podcast, Katie Scott, the President of CarePartners, discusses innovations from CarePartners in Texas regarding volunteer-based caregiver support programs. These podcasts, excerpted from a 2022 webinar, build upon the information delivered in the Resources for Integrated Care (RIC) September 2022 webinar titled: “Innovations in Alzheimer's Disease and Related Dementias (ADRD) Caregiver Support Programs: Building and Leveraging Support Systems.” This webinar continues to explore innovative ways that health equity and caregiver support are addressed across ADRD programs supporting dually eligible people living with ADRD. The event speakers review community-level strategies to ensure adequate care for individuals living with ADRD and their caregivers. For more information about this webinar, click here: https://www.resourcesforintegratedcare.com/2022_ric_webinar_innovations_alzheimers_disease_related_dementias_adrd_caregiver_support_programs_innovative_community_strategies/.

In this podcast, Nikki Racelis, a Consultant at The Lewin Group, facilitates a panel discussion with Karen M. Rose, the Vice Dean, the Director, and a Professor of the Center for Healthy Aging, Self-Management, and Complex Care at The Ohio State University College of Nursing, Katie Scott, the President of CarePartners, and Jo Smith, a caregiver. During this discussion, panelists offer strategies and promising practices regarding innovations in Alzheimer's Disease and Related Dementias, or ADRD, caregiver support programs regarding innovative community strategies. These podcasts, excerpted from a 2022 webinar, build upon the information delivered in the Resources for Integrated Care (RIC) September 2022 webinar titled: “Innovations in Alzheimer's Disease and Related Dementias (ADRD) Caregiver Support Programs: Building and Leveraging Support Systems.” This webinar continues to explore innovative ways that health equity and caregiver support are addressed across ADRD programs supporting dually eligible people living with ADRD. The event speakers review community-level strategies to ensure adequate care for individuals living with ADRD and their caregivers. For more information about this webinar, click here: https://www.resourcesforintegratedcare.com/2022_ric_webinar_innovations_alzheimers_disease_related_dementias_adrd_caregiver_support_programs_innovative_community_strategies/.

In this episode we talk with Dr Mia Yang, a practicing physician involved in clinical care, teaching, and clinical research. She is Director of the Wake Forest House Call program and the co-Investigator for the D-CARE study, comparing health system-based dementia care versus community-based dementia care. Mia Yang, Welcome to the Move to Value Podcast.Thank you. It's an honor to be here.Dr. Yang, what is comprehensive Dementia Care and why is it more important now than ever?Absolutely. So, as many of us already know, the baby boomers are getting older and as people age there are more people who have cognitive impairment and dementia is where people whose cognitive impairment is making them have impairments in their daily function. So, as we get into the next couple of decades, we're going to see a tremendous increase in the millions of Americans who have some sort of cognitive impairment. And comprehensive dementia care means that it's not just talking about the medical aspect of treating dementia, we're not talking about just prescribing pills, which there are very few, but a very holistic treatment including caregiver support, education, discussing legal and other related topics that our patients go through, as well as kind of a wraparound service that helps these patients who are living with dementia and their families go through this journey. Dementia obviously has a pretty negative connotation when people hear about it. They think they're crazy or you know that you're going to go live in a rest home or something like that. But it really just means that someone's memory problems is affecting their daily function. It is an umbrella term, and the word dementia is used oftentimes interchangeably with Alzheimer's disease or Alzheimer's dementia, but there are many different types of dementia and Alzheimer's is the most common type but it's not the only type. And there are pre-dementia conditions called mild cognitive impairment where the person might notice some subjective signs of memory loss and objectively a memory testing, we don't think this is just what happens as you get older. Compared to other people of similar age and education, this person scores very poorly and those people are called mild cognitive impairment because they're still able to function independently, they're just noticing some subtle issues that are perhaps to beginning of dementia.Well tell me how a cognitive impairment or dementia diagnosis impacts the overall health of the patient and care team? So, dementia or cognitive impairment is not just one of the many chronic medical issues our patients deal with it. It really affects the self-management of all chronic illnesses. So, if you think of someone who has diabetes and they have memory problems, how are they going to remember to take their medicines accurately? Are they going to be able to draw up their insulin? Are they forgetting how to cook so they eat poorly or maybe they have forgotten that they have not eaten and are losing a lot of weight or gaining a lot of weight from forgetting that they have already eaten. So, that's just an example of how our cognition is really central to the overall health of the person.What is the current landscape like in cognitive impairment AKA dementia care?I think that research in Alzheimer's disease and related dementias, which we can call the general term dementia or ADRD is what the National Institute of health used to call all the related dementias to Alzheimer's. A lot of the research have been very focused on the biological pathways of the disease and of course in ways to prevent the development of cognitive impairment, but there hasn't been as much funding until recently in the care of patients who already have the disease. Most of the drug trials have moved earlier and earlier on in the disease course,...

What are the early diagnostic stages of Alzheimer's disease? What sort of brain changes can occur up to 20 years prior to symptoms of Alzheimer's disease? In this episode, Dr. Danielle Goldfarb addresses these questions and much more! She shares the most current research on dementia and geriatrics relevant to clinical practice. She also shares resources for early diagnosis of dementia and treating mental health in geriatrics. Dr. Danielle Goldfarb is an Assistant Professor of Neurology and Psychiatry at the University of Arizona and a dual board-certified neurologist and psychiatrist at the Banner Sun Health Research Institute and Cleo Roberts Memory Center in Sun City, AZ.  Dr. Goldfarb cares for patients and families with Alzheimer's disease and related dementias (ADRD). She leads several Alzheimer's clinical trials and is involved in research efforts to explore the neuropathologic substrates of early neuropsychiatric symptoms in ADRD, to improve the safety and efficiency of  the collection of cerebrospinal fluid biomarkers in older adults, and to expand access to ADRD care and research by underserved communities.

Los enfoques tradicionales de descubrimiento de fármacos que utilizan modelos animales de experimentación que recapitulan las características patológicas de la enfermedad de Alzheimer y la demencia relacionada (ADRD) han tenido un éxito limitado. Estos enfoques se han basado principalmente en la inhibición de la formación o eliminación de placas en el cerebro. Los enfoques de tratamiento alternativos incluyen la inhibición de la agregación de tau y la atenuación de la neuroinflamación.

Los enfoques tradicionales de descubrimiento de fármacos que utilizan modelos animales de experimentación que recapitulan las características patológicas de la enfermedad de Alzheimer y la demencia relacionada (ADRD) han tenido un éxito limitado. Estos enfoques se han basado principalmente en la inhibición de la formación o eliminación de placas en el cerebro. Los enfoques de tratamiento alternativos incluyen la inhibición de la agregación de tau y la atenuación de la neuroinflamación.

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2022.09.27.509283v1?rss=1 Authors: Fongang, B., Satizabal, C. L., Kautz, T. F., Ngouongo, Y. W., SherraeMuhammad, J. A., Vasquez, E., Mathews, J., Goss, M., Saklad, A. R., Himali, J., Beiser, A., Cavazos, J. E., Mahaney, M. C., Maestre, G., DeCarli, C., Shipp, E. L., Vasan, R. S., Seshadri, S. Abstract: A bidirectional communication exists between the brain and the gut, in which the gut microbiota influences cognitive function and vice-versa. Gut dysbiosis has been linked to several diseases, including Alzheimer's disease and related dementias (ADRD). However, the relationship between gut dysbiosis and markers of cerebral small vessel disease (cSVD), a major contributor to ADRD, is unknown. In this cross-sectional study, we examined the connection between the gut microbiome, cognitive, and neuroimaging markers of cSVD in the Framingham Heart Study (FHS). Markers of cSVD included white matter hyperintensities (WMH), peak width of skeletonized mean diffusivity (PSMD), and executive function (EF), estimated as the difference between the trail-making tests B and A. We included 972 FHS participants with MRI scans, neurocognitive measures, and stool samples and quantified the gut microbiota composition using 16S rRNA sequencing. We used multivariable association and differential abundance analyses adjusting for age, sex, BMI, and education level to estimate the association between gut microbiota and WMH, PSMD, and EF measures. Our results suggest an increased abundance of Pseudobutyrivibrio and Ruminococcus genera was associated with lower WMH and PSMD (p-values less than 0.001), as well as better executive function (p-values less than 0.01). In addition, in both differential and multivariable analyses, we found that the gram-negative bacterium Barnesiella intestinihominis was strongly associated with markers indicating a higher cSVD burden. Finally, functional analyses using PICRUSt implicated various KEGG pathways, including microbial quorum sensing, AMP/GMP-activated protein kinase, phenylpyruvate, and {beta}-hydroxybutyrate production previously associated with cognitive performance and dementia. Our study provides important insights into the association between the gut microbiome and cSVD, but further studies are needed to replicate the findings. Copy rights belong to original authors. Visit the link for more info Podcast created by PaperPlayer

In this podcast, Katie Palmisano, a Senior Consultant at The Lewin Group, facilitates a panel discussion with Dr. David B. Reuben, MD, the Chief of the Division of Geriatrics at the University of California, Los Angeles, and the Director of the UCLA Alzheimer's and Dementia Care, or ADC, Program, Dr. Debra Cherry, PhD, a Clinical Psychologist and the Executive Vice President of Alzheimer's Los Angeles, Linda Wade-Bickel, the Senior Director of Population Health & Clinical Operations at Health Net, Ed Mariscal, the Director of Public Programs and Long-Term Services & Supports at Health Net, and Anita Chacon Terry, a Manager of Care Management at Health Net. During this discussion, panelists offer strategies and promising practices regarding innovations in Alzheimer's Disease and Related Dementias, or ADRD, caregiver support programs regarding building and leveraging support systems. These podcasts, excerpted from a 2022 webinar, explore innovative ways that health equity and caregiver support are addressed across Alzheimer's disease and related dementias (ADRD) programs supporting dually eligible people living with ADRD. The event speakers review various strategies and lessons learned from existing programs for ensuring caregivers have the supports they need to care for a person living with ADRD, and speakers also describe strategies for health plans to consider supporting providers in their work with caregivers. For more information about this webinar, click here: https://www.resourcesforintegratedcare.com/2022_ric_webinar_innovations_alzheimers_disease_related_dementias_adrd_caregiver_support_programs_building_leveraging_support_systems/.

In this podcast, Linda Wade-Bickel, the Senior Director of Population Health & Clinical Operations at Health Net; Ed Mariscal, the Director of Public Programs and Long-Term Services & Supports at Health Net; and Anita Chacon Terry, a Manager of Care Management at Health Net, discuss the benefits of care manager education and the impact of home and community-based service referrals on member outcomes. These podcasts, excerpted from a 2022 webinar, explore innovative ways that health equity and caregiver support are addressed across Alzheimer's disease and related dementias (ADRD) programs supporting dually eligible people living with ADRD. The event speakers review various strategies and lessons learned from existing programs for ensuring caregivers have the supports they need to care for a person living with ADRD, and speakers also describe strategies for health plans to consider supporting providers in their work with caregivers. For more information about this webinar, click here: https://www.resourcesforintegratedcare.com/2022_ric_webinar_innovations_alzheimers_disease_related_dementias_adrd_caregiver_support_programs_building_leveraging_support_systems/.

In this podcast, Dr. Debra Cherry, PhD, a Clinical Psychologist and the Executive Vice President of Alzheimer's Los Angeles, discusses supporting caregivers of people living with Alzheimer's Disease and Related Dementias, or ADRD, who are also dually eligible for Medicare and Medicaid. These podcasts, excerpted from a 2022 webinar, explore innovative ways that health equity and caregiver support are addressed across Alzheimer's disease and related dementias (ADRD) programs supporting dually eligible people living with ADRD. The event speakers review various strategies and lessons learned from existing programs for ensuring caregivers have the supports they need to care for a person living with ADRD, and speakers also describe strategies for health plans to consider supporting providers in their work with caregivers. For more information about this webinar, click here: https://www.resourcesforintegratedcare.com/2022_ric_webinar_innovations_alzheimers_disease_related_dementias_adrd_caregiver_support_programs_building_leveraging_support_systems/.

In this podcast, Dr. David B. Reuben, MD, the Chief of the Division of Geriatrics at the University of California, Los Angeles, and the Director of the UCLA Alzheimer's and Dementia Care, or ADC, Program, discusses insights on UCLA's Alzheimer's and Dementia Care program as well as lessons learned and plans for program expansion. These podcasts, excerpted from a 2022 webinar, explore innovative ways that health equity and caregiver support are addressed across Alzheimer's disease and related dementias (ADRD) programs supporting dually eligible people living with ADRD. The event speakers review various strategies and lessons learned from existing programs for ensuring caregivers have the supports they need to care for a person living with ADRD, and speakers also describe strategies for health plans to consider supporting providers in their work with caregivers. For more information about this webinar, click here: https://www.resourcesforintegratedcare.com/2022_ric_webinar_innovations_alzheimers_disease_related_dementias_adrd_caregiver_support_programs_building_leveraging_support_systems/.

------------------Support the channel------------ Patreon: https://www.patreon.com/thedissenter PayPal: paypal.me/thedissenter PayPal Subscription 1 Dollar: https://tinyurl.com/yb3acuuy PayPal Subscription 3 Dollars: https://tinyurl.com/ybn6bg9l PayPal Subscription 5 Dollars: https://tinyurl.com/ycmr9gpz PayPal Subscription 10 Dollars: https://tinyurl.com/y9r3fc9m PayPal Subscription 20 Dollars: https://tinyurl.com/y95uvkao This show is sponsored by Enlites, Learning & Development done differently. Check the website here: http://enlites.com/ Dr. Bianca Acevedo is an Instructor at New York University. She is a social neuroscientist whose research focuses on the neural basis of attachment, caregiving, sensory processing sensitivity (and related disorders), and mind-body interventions. She conducted the first neuroimaging studies of long-term pair-bonding in humans for which she was awarded the 2012 International Women in Science Award. She joined the NRI in 2016 where she has been examining empathy in caregivers of ADRD individuals. Dr. Acevedo is interested in understanding the biological basis of human attachment and sensory processing sensitivity. In addition, her research examines the neural and behavioral outcomes associated with engaging in mind-body practices in clinical and normative individuals and dyads. In this episode, we talk about attachment from a neuroscientific perspective. We get into romantic love, and relationship satisfaction. We discuss sensory processing sensitivity, and its relationship with mental disorders like depression. Finally, we talk about social neuroscience, and how social psychology intersects with neuroscience. -- A HUGE THANK YOU TO MY PATRONS/SUPPORTERS: KARIN LIETZCKE, ANN BLANCHETTE, PER HELGE LARSEN, LAU GUERREIRO, JERRY MULLER, HANS FREDRIK SUNDE, BERNARDO SEIXAS, HERBERT GINTIS, RUTGER VOS, RICARDO VLADIMIRO, CRAIG HEALY, OLAF ALEX, PHILIP KURIAN, JONATHAN VISSER, JAKOB KLINKBY, ADAM KESSEL, MATTHEW WHITINGBIRD, ARNAUD WOLFF, TIM HOLLOSY, HENRIK AHLENIUS, JOHN CONNORS, PAULINA BARREN, FILIP FORS CONNOLLY, DAN DEMETRIOU, ROBERT WINDHAGER, RUI INACIO, ARTHUR KOH, ZOOP, MARCO NEVES, COLIN HOLBROOK, SUSAN PINKER, PABLO SANTURBANO, SIMON COLUMBUS, PHIL KAVANAGH, JORGE ESPINHA, CORY CLARK, MARK BLYTH, ROBERTO INGUANZO, MIKKEL STORMYR, ERIC NEURMANN, SAMUEL ANDREEFF, FRANCIS FORDE, TIAGO NUNES, BERNARD HUGUENEY, ALEXANDER DANNBAUER, FERGAL CUSSEN, YEVHEN BODRENKO, HAL HERZOG, NUNO MACHADO, DON ROSS, JONATHAN LEIBRANT, JOÃO LINHARES, OZLEM BULUT, NATHAN NGUYEN, STANTON T, SAMUEL CORREA, ERIK HAINES, MARK SMITH, J.W., JOÃO EIRA, TOM HUMMEL, SARDUS FRANCE, DAVID SLOAN WILSON, YACILA DEZA-ARAUJO, IDAN SOLON, ROMAIN ROCH, DMITRY GRIGORYEV, TOM ROTH, DIEGO LONDOÑO CORREA, YANICK PUNTER, ADANER USMANI, CHARLOTTE BLEASE, NICOLE BARBARO, ADAM HUNT, PAWEL OSTASZEWSKI, AL ORTIZ, NELLEKE BAK, KATHRINE AND PATRICK TOBIN, GUY MADISON, GARY G HELLMANN, SAIMA AFZAL, ADRIAN JAEGGI, NICK GOLDEN, PAULO TOLENTINO, JOÃO BARBOSA, JULIAN PRICE, EDWARD HALL, HEDIN BRØNNER, DOUGLAS P. FRY, FRANCA BORTOLOTTI, GABRIEL PONS CORTÈS, URSULA LITZCKE, DENISE COOK, SCOTT, ZACHARY FISH, TIM DUFFY, TRADERINNYC, TODD SHACKELFORD, AND SUNNY SMITH! A SPECIAL THANKS TO MY PRODUCERS, YZAR WEHBE, JIM FRANK, ŁUKASZ STAFINIAK, IAN GILLIGAN, LUIS CAYETANO, TOM VANEGDOM, CURTIS DIXON, BENEDIKT MUELLER, VEGA GIDEY, THOMAS TRUMBLE, AND NUNO ELDER! AND TO MY EXECUTIVE PRODUCERS, MICHAL RUSIECKI, ROSEY, JAMES PRATT, MATTHEW LAVENDER, SERGIU CODREANU, AND BOGDAN KANIVETS!

Grapes could help protect against cognitive decline   University of California, Los Angeles - February 06 2022.   The January issue of Experimental Gerontology published the finding of researchers at the University of California, Los Angeles of a protective effect for powdered grape against a decline in brain metabolism in older adults. The results of the investigation suggest that eating grapes might contribute to the prevention of Alzheimer's disease. The study included ten men and women with mild cognitive decline. Participants were given freeze-dried grape powder or a placebo similar in flavor and appearance but lacking beneficial grape polyphenols. The grape powders, which provided the equivalent of three servings of grapes per day, were mixed with water and consumed in divided daily doses for six months. Cognitive performance and changes in brain metabolism as assessed by PET scans were evaluated before and after the treatment period.   (NEXT)   Loneliness associated with increased risk of dementia in older adults   New York University, February 7, 2022   As social isolation in the United States has been increasing among older adults, a new study shows a notable link between loneliness and dementia risk, and one that is most striking for Americans who represent a large part of the population. In the study publishing February 7 in Neurology, the medical journal of the American Academy of Neurology,researchers found a three-fold increase in risk of subsequent dementia among lonely Americans younger than 80 years old who would otherwise be expected to have a relatively low risk based on age and genetic risk factors. The study also found that loneliness was associated with poorer executive function (i.e., a group of cognitive processes including decision-making, planning, cognitive flexibility, and control of attention) and changes in the brain that indicate vulnerability to Alzheimer's disease and related dementias (ADRD).   (NEXT)   Dietary total antioxidant capacity and mortality outcomes: the Singapore Chinese Health Study   Huazhong University of Science and Technology (China), February 1, 2022   To evaluate the relations of dietary total antioxidant capacity (DTAC) with mortality outcomes in a Chinese population. The study included 62,063 participants from the Singapore Chinese Health Study. The participants were 45–74 years at baseline (1993–1998) when dietary data were collected with a validated 165-item food frequency questionnaire. During 1,212,318 person-years of follow-up, 23,397 deaths [cardiovascular diseases (CVD): 7523; respiratory diseases: 4696; and cancer: 7713] occurred. In multivariable models, the HR (95% CI) comparing participants in the highest vs. lowest quartile of CDAI was 0.85 for all-cause mortality, 0.82 for CVD mortality, 0.76 for respiratory disease mortality  and 0.94 for cancer mortality  Similar associations were found with the VCEAC index. Higher intakes of the DTAC components, i.e., vitamin C, vitamin E, carotenoids, and flavonoids, were all associated with lower mortality risk.   (NEXT)   Healthy lifestyle equals bigger brain   Yale University School of Medicine, February 4 2022.   Research findings scheduled to be reported at the American Stroke Association's International Stroke Conference 2022  demonstrated that adherence to Life's Simple 7 lifestyle behaviors is associated with greater brain volume and fewer indicators of damage among middle-aged men and women. The study included 35,914 participants enrolled in the UK Biobank. Magnetic resonance imaging (MRI) of the brain measured brain volume and white matter hyperintensity volume.   (NEXT)   No time to exercise? What about three seconds a day?   Edith Cowan University (Australia) and Niigata University (Japan), February 7, 2022   Lifting weights for as little as three seconds a day can have a positive impact on muscle strength, a new study from Edith Cowan University (ECU) has discovered. A collaboration with researchers from Niigata University of Health and Welfare (NUHW) in Japan had 39 healthy university students perform one muscle contraction at maximum effort for three seconds per day, for five days a week over four weeks. The participants performed either an isometric, concentric or eccentric bicep curl (see definitions below) at maximum effort, while researchers measured the muscles' maximum voluntary contraction strengthbefore and after the four-week period. Another 13 students performed no exercise over the same period and were also measured before and after the four weeks. Muscle strength increased more than 10 percent for the group who performed the eccentric bicep curl after the four weeks, but less increase in muscle strength was found for the other two exercise groups. The no exercise group saw no increase. The study shows all three lifting methods had some benefit to muscle strength, however eccentric contraction easily produced the best results.   (OTHER NEWS)   Dystopia Disguised as Democracy: All the Ways in Which Freedom Is an Illusion   John W. Whitehead & Nisha Whitehead, February 8, 2022   We are no longer free. We are living in a world carefully crafted to resemble a representative democracy, but it's an illusion. We think we have the freedom to elect our leaders, but we're only allowed to participate in the reassurance ritual of voting. There can be no true electoral choice or real representation when we're limited in our options to one of two candidates culled from two parties that both march in lockstep with the Deep State and answer to an oligarchic elite. We think we have freedom of speech, but we're only as free to speak as the government and its corporate partners allow. We think we have the right to freely exercise our religious beliefs, but those rights are quickly overruled if and when they conflict with the government's priorities, whether it's COVID-19 mandates or societal values about gender equality, sex and marriage. We think we have the freedom to go where we want and move about freely, but at every turn, we're hemmed in by laws, fines and penalties that regulate and restrict our autonomy, and surveillance cameras that monitor our movements. Punitive programs strip citizens of their passports and right to travel over unpaid taxes. We think we have property interests in our homes and our bodies, but there can be no such freedom when the government can seize your property, raid your home, and dictate what you do with your bodies. We think we have the freedom to defend ourselves against outside threats, but there is no right to self-defense against militarized police who are authorized to probe, poke, pinch, taser, search, seize, strip and generally manhandle anyone they see fit in almost any circumstance, and granted immunity from accountability with the general blessing of the courts. Certainly, there can be no right to gun ownership in the face of red flag gun laws which allow the police to remove guns from people merely suspected of being threats. We think we have the right to an assumption of innocence until we are proven guilty, but that burden of proof has been turned on its head by a surveillance state that renders us all suspects and overcriminalization which renders us all lawbreakers. Police-run facial recognition software that mistakenly labels law-abiding citizens as criminals. A social credit system (similar to China's) that rewards behavior deemed “acceptable” and punishes behavior the government and its corporate allies find offensive, illegal or inappropriate. We think we have the right to due process, but that assurance of justice has been stripped of its power by a judicial system hardwired to act as judge, jury and jailer, leaving us with little recourse for appeal. A perfect example of this rush to judgment can be found in the proliferation of profit-driven speed and red light cameras that do little for safety while padding the pockets of government agencies. By gradually whittling away at our freedoms—free speech, assembly, due process, privacy, etc.—the government has, in effect, liberated itself from its contractual agreement to respect the constitutional rights of the citizenry while resetting the calendar back to a time when we had no Bill of Rights to protect us from the long arm of the government. We've bartered away our right to self-governance, self-defense, privacy, autonomy and that most important right of all: the right to tell the government to “leave me the hell alone.” In exchange for the promise of safe streets, safe schools, blight-free neighborhoods, lower taxes, lower crime rates, and readily accessible technology, health care, water, food and power, we've opened the door to militarized police, government surveillance, asset forfeiture, school zero tolerance policies, license plate readers, red light cameras, SWAT team raids, health care mandates, overcriminalization and government corruption. In the end, such bargains always turn sour. We can no longer maintain the illusion of freedom.   (NEXT)   Preventive Use of Ivermectin Reduced COVID Mortality by 90%, Study Found   A peer-reviewed study published last month found the prophylactic use of ivermectin reduced COVID mortality by 90% among more than 223,000 study participants in a town in Southern Brazil.   David Charbonneau, Ph.D., February 7, 2022   A peer-reviewed study published last month found the prophylactic use of ivermectin reduced COVID mortality by 90% among more than 223,000 study participants in a town in Southern Brazil. The study, published in the Cureus Journal of Medical Science, also found a 44% reduction in COVID cases among those who took the re-purposed drug. Between July 7, 2020, and Dec. 2, 2020, all residents of Itajaí were offered ivermectin. Approximately 3.7% of ivermectin users contracted COVID during the trial period, compared with 6.6% of residents who didn't take the drug. Based on the results, Dr. Flavio Cadegiani, one of the study's lead authors, said, “Ivermectin must be considered as an option, particularly during outbreaks.” Dr Pierre Kory said: “You would think this would lead to major headlines everywhere. And yet, nothing. And this is not new, this censorship of this highly effective science and evidence around repurposed drugs. The censoring of it, it's not new, it's just getting more and more absurd. And it has to stop.” Kory said it's not even about ivermectin, “it's about the pharmaceutical industry's capture of our agencies and how our policies are all directed at suppressing and avoiding use of re-purposed drugs” in favor of high-profit medicines.

Season five of our podcast continues with another presentation from our 2020 annual conference: ‘Engaged Phenomenology' Online. This episode features a presentation written by Mary Fridley & Susan Massad, with Gwen Lowenheim presenting for Susan Massad, all from The East Side Institute, New York City.   ABSTRACT: As viewed through a biomedical lens – which remains the dominant way in which dementia is seen – Alzheimer's and related dementias (ADRD) is seen primarily as a condition of loss of capabilities within an individual: of speech, of cognitive abilities, of physical capacities and, eventually, of life while research and treatment is directed toward cure of the  individual. Dementia activists across the globe are now raising the question: Is the shame, stigma, and isolation that people with ADRD and their families experience in large part a result of this very narrow lenses through which dementia is understood? In this paper we will present on the Joy of Dementia (You've Got to Be Kiddin!) project, a  playful, philosophical and conversational collective exploration of the dementia experience as an effort to introduce a different lens – a development lens – as a counter narrative that challenges the current “tragedy narrative” surrounding ADRD. Seen through a development lens, humans are no longer are viewed, not as discrete and isolated individuals but as relational beings, connected to one another in ways that allows us to grow with, rather than fear, uncertainty.  In this view, a dementia diagnosis presents transformational opportunities not just for the individual diagnosed, but to everyone in the “dementia ensemble” – including people of all ages who fear growing older and losing cognitive abilities. The workshops, always experiential, often involve mixed groupings of family members, care givers, professionals and those diagnosed, introduces improvisational play and philosophical conversation as activities that support the discovery of new ways of relating, being together, listening and responding. Participants are supported to challenge deeply held assumptions about what we and others “know” about the dementia experience, and it is within this collaborative ensemble building activity that the joy that comes with creating a new performances of dementia is discovered.   BIOS:    Mary Fridley is pro-bono Director of Special Projects at the East Side Institute in NYC and an accomplished teacher and workshop leader. She practiced social therapy for 12 years and continues to use the social therapeutic approach as an Institute faculty member. Mary co-leads two popular workshop series, “The Joy of Dementia (You Gotta Be Kidding)” and “Laughing Matters” and was featured in a February 2019 Washington Post article, “Changing ‘the tragedy narrative': Why a growing camp is promoting a more joyful approach to Alzheimer.” Mary is also a playwright and theater director and works as a non-profit fundraising consultant.   Susan Massad is a retired clinician and medical educator. A primary care physician she has researched and taught in the arena of doctor-patient communication and the social-cultural-biological dimensions of health and wellness. She is a faculty member at the The East Side Institute where she is the co-creator of the Joy of Dementia© workshops that she coleads all over the US with colleague, Mary Fridley.   Gwen Lowenheim is a learning design specialist and TESOL instructor. She is co-founder/co-director of The Snaps Project, an educational consulting firm. Gwen trains and supervises educators and social entrepreneurs around the world in a social therapeutic, performance-based learning approach that brings creativity and innovation into classrooms and community-based programs. Her programs introduce theatrical improvisation, philosophical exploration, remix and group play as part of developing collaborative teams, language learning and stress management.   This recording is taken from the BSP Annual Conference 2020 Online: 'Engaged Phenomenology'. Organised with the University of Exeter and sponsored by Egenis and the Wellcome Centre for Cultures and Environments of Health. BSP2020AC was held online this year due to global concerns about the Coronavirus pandemic. For the conference our speakers recorded videos, our keynotes presented live over Zoom, and we also recorded some interviews online as well. Podcast episodes from BSP2020AC are soundtracks of those videos where we and the presenters feel the audio works as a standalone: https://www.britishphenomenology.org.uk/bsp-annual-conference-2020/   You can check out our forthcoming events here: https://www.britishphenomenology.org.uk/events/   The British Society for Phenomenology is a not-for-profit organisation set up with the intention of promoting research and awareness in the field of Phenomenology and other cognate arms of philosophical thought. Currently, the society accomplishes these aims through its journal, events, and podcast. Why not find out more, join the society, and subscribe to our journal the JBSP? https://www.britishphenomenology.org.uk/

ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world's leading professional organization for doctors who care for people with cancer. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so the data described here may change as research progresses. In the Research Round Up series, members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field and explain what it means for people with cancer. In today's episode, 3 Cancer.Net Associate Editors discuss new research in cervical cancer, melanoma, and cancer in adults 65 and over, presented at the 2021 ASCO Annual Meeting, held virtually June 4th through 8th. This episode has been adapted from the recording of a live Cancer.Net webinar, held August 9th, and led by Dr. Merry Jennifer Markham, Dr. Ryan Sullivan, and Dr. William Dale. Dr. Markham is Chief of the Division of Hematology and Oncology and a clinical professor in the Department of Medicine at the University of Florida. She is also the Cancer.Net Associate Editor for Gynecologic Cancers.  Dr. Sullivan is board certified in medical oncology and an attending physician in the Division of Hematology/Oncology at Massachusetts General Hospital. He is also the Cancer.Net Associate Editor for Melanoma and Skin Cancer.  Dr. Dale is a clinical professor, the Arthur M. Coppola Family Chair in Supportive Care Medicine, and director of the Center for Cancer and Aging at City of Hope Comprehensive Cancer Center. He is also the Cancer.Net Associate Editor for Geriatric Oncology.  Full disclosures for Dr. Markham, Dr. Sullivan, and Dr. Dale are available at Cancer.Net. Greg Guthrie: Good afternoon, everyone. I'm Greg Guthrie, and I'm a member of the Cancer.Net content team. And I'll be your host for today's Research Round Up webinar. This webinar will focus on gynecologic cancers, melanoma, and cancer in adults age 65 and older. Cancer.Net is the patient information website of the American Society of Clinical Oncology, also known as ASCO. Our participants will be answering questions at the end of this webinar during the Q&A session. Please note that the participants cannot answer questions about anyone's personal medical situation. If you have specific questions about your cancer care, please contact a member of your health care team. Today we'll be addressing research from the 2021 ASCO Annual Meeting, which was held virtually in June, and our participants are members of the Cancer.Net Editorial Board. Now, they are Dr. Merry Jennifer Markham of the University of Florida Health. Dr. Markham is the Cancer.Net Associate Editor for gynecologic cancers. Dr. Ryan J. Sullivan of Massachusetts General Hospital Cancer Center, Harvard Medical School. Dr. Sullivan is the Cancer.Net Associate Editor for melanoma and skin cancer. Dr. William Dale of City of Hope Comprehensive Cancer Center. Dr. Dale is the Cancer.Net Associate Editor for geriatric oncology. And thank you, everyone, for joining us today. So starting us off today is Dr. Markham with highlights in gynecologic cancers. Dr. Markham: Thank you so much, Greg. It's great to be here talking about a couple of studies that were presented at ASCO. Just to point out that I don't have any conflicts of interest for either of the 2 studies that I'll be presenting today. This first slide is a study that looked at a database to answer a question. And really, the primary question the study was trying to answer was whether HPV screening or cancer screening or HPV vaccination has made any difference in the United States over the last 15 years for HPV-associated cancers. And so the primary population that the results of this study really impact are any people, all people at risk for HPV-associated cancers, and these include oropharyngeal squamous cell carcinoma cancers. So head and neck cancers, anal and rectal squamous cell carcinomas, vulvar, vaginal, and cervical squamous cell carcinomas, and penile as well. So this study evaluated data from 2001 to 2017 in a database, the U.S. Cancer Statistics Database, and specifically tried to answer these questions. And the findings were rather complex, broken down by men and women, and so I'll walk you through. In women, the overall incidence of HPV-related cancers was 13.68 per 100,000. And so of those cases, 52% were cervical cancer. What the authors found is that over the last 16 years, the incidence of cervical cancer decreased at an annual percent change of 1.03%. So a decrease annually by a little over a percent. And the incidence of cervical cancer in 2017 was 7.12 per 100,000. Over that same timeframe, the incidence rates of other HPV-associated cancers in women increased significantly. So rather than decrease, they went in the opposite direction. And specifically oropharyngeal, head and neck cancer, increased by 0.77% annually, anal and rectal cancer increased by 2.75% annually, and vulvar squamous cell carcinoma increased by 1.27% annually. Specifically in women over age 80, the incidence of anal and rectal cancer approached that of cervical cancer. The incidence of cervical cancer in that age population was 6.95 per 100,000, which was a decrease of 2.9% annually. Anal and rectal cancer incidence in women over 80 was 6.36 per 100,000 or 1.23% increase annually. So the authors did a projection model and found that the incidence in women of anal and rectal cancer was expected to surpass that of cervical cancer by the year 2025 for every age group over age 55. Now if we switch to men, the incidence of all HPV-related cancers was 11 per 100,000 in the year 2017 and 81% were head and neck cancers. Over the last 16 years, there was an increase in HPV-related cancers in men 2.36% per year, with the highest increase in head and neck cancers, 2.71%, and in anal and rectal squamous cell carcinomas, 1.71% annual increase. Those who were at highest risk of head and neck cancer, the squamous cell carcinoma that I'm referring to, were older men. They were ages 65 to 69 with an incidence rate of 36.5 per 100,000 and an annual increase of 4.24%. White men actually had the highest incidence. So white men ages 65 to 69 had the highest incidence of head and neck squamous cell carcinoma at 41.6 per 100,000. So it's a lot of numbers, a lot of data. Boiled down, what this really means is that cervical cancer has been decreasing. All other HPV-related cancers have been increasing. Now, the decrease in cervical cancer incidence is likely a combination of factors. Primarily, we have regular screening for cervical cancer, and we have HPV vaccination. Now, the risk for other HPV-related cancers, such as head and neck and anal and rectal squamous cell carcinoma, does remain high and is increasing, unfortunately. These are not cancers with routine screening. And so the authors concluded, and I think this makes sense, that screening and vaccination efforts, specifically HPV vaccination efforts, might help to impact those rising cancer numbers and help to decrease those rising incidence rates. So that is study 1. Greg, are we ready to go to the next one? Greg Guthrie: Yeah, we are. Dr. Markham: So this is the OUTBACK study. This is adjuvant chemotherapy following chemoradiation. That's primary treatment for locally advanced cervical cancer compared to chemoradiation alone. This was a phase III randomized study. We refer to it as the OUTBACK study, which was its official name. And this study sort of hits at the opposite end of that HPV cancer-related spectrum. So we're out of the prevention and in sort of incidence arena now in a realm of treatment. So this study impacts women who had locally advanced cervical cancer and specifically those who were able to be treated for cancer with chemoradiation. And just to clarify, chemoradiation, when that term is used together usually means chemotherapy and radiation given at the same time. And the chemotherapy is usually designed to make the radiation work better. So standard practice, the standard treatment that oncologists give for locally advanced cervical cancer is chemotherapy with a medicine called cisplatin and radiation, and this together is again chemoradiation. So the question the authors wanted to ask in this study was whether adding chemotherapy at the end of chemoradiation helped to improve survival outcomes. So the study compared 2 groups, 1 group of women - and this was randomized - received chemoradiation alone. And that's absolutely standard of care practice. The other group, the experimental group, received chemoradiation, which was standard, but an additional 4 cycles of chemotherapy with a platinum and a taxane chemotherapy agent. The primary endpoint was overall survival. The study took a little bit of time to accrue. It recruited from 2011 to 2017, and ultimately 919 women with locally advanced cervical cancer were eligible and were analyzed in this dataset. Of those, 456 were assigned to chemoradiation, and 463 were assigned to chemoradiation followed by the additional 4 cycles of chemotherapy. What the study found is that overall survival at 5 years was similar in both groups. So 71% for the standard treatment arm and 72% for the arm that received the 4 additional cycles of chemotherapy. In addition, the progression-free survival was similar at the 5-year mark. So 61% compared to 63%. I think important to note is that this is a negative study. So the 4 additional cycles did not make a difference for these women. However, 81% of the women who were assigned to the chemoradiation and the chemotherapy had grade 3 to 5 adverse events within a year of being randomized, compared to only 62% of women who received the chemoradiation alone. So more women who received that experimental arm had more toxicity, more adverse events. As we like to do in any randomized study, the authors did evaluate both groups of women to make sure there were no differences, and there were no statistical differences inherent between those 2 groups, and patterns of their cancer recurrence were similar in both groups. So what does this mean for our patients? For women with locally advanced cervical cancer, what we know now based on this study is that the standard treatment really does remain chemotherapy with radiation concurrent, so given simultaneously, and that we actually don't get any improvement in survival by adding additional chemotherapy. We do get extra side effects and extra toxicity. But women do not have better outcomes with this regimen. And that's it for these 2 studies, Greg. Greg Guthrie: Thanks, Dr. Markham. I was wondering if you could really quickly give a sense of scope for how much do grade 3 through grade 5 adverse events affect somebody's well-being, quality of life. Dr. Markham: Yes, absolutely. So typically, a side effect on a clinical trial are graded from 1 to 5. 5 is the absolute worst. That typically is death from a treatment. Grade 1 is very mild side effects such that you as a patient, if you're being treated with that, that treatment course may not really have much in the way of side effects or symptoms. But once we get to grade 3 and 4, there is some consequence. So, for example, for someone with anemia, they might actually require hospitalization or a blood transfusion. So it's definitely not a mild side effect. These are what we would consider significant or severe. Greg Guthrie: Thanks, Dr. Markham. Now we'll move on to Dr. Sullivan with highlights in melanoma. Dr. Sullivan: Greg, thanks so much for the introduction. It's a pleasure to be here today, and I'd like to thank Cancer.Net for the opportunity to provide highlights in melanoma from the Annual Meeting at ASCO. So I thought what I would do is show a few pictures and then describe what these pictures mean. So, the first study that I'm going to talk about is actually not a new trial. This is probably the fifth or sixth time this trial has been presented at ASCO. It's the CheckMate 067 study, which is a trial. And if you look at the upper right, this is a randomized trial. So patients were randomized to receive in gray ipilimumab, which at the time of this study launch was the standard of care for patients with newly diagnosed, advanced or metastatic melanoma. Patients could have been randomized to nivolumab, which had been shown to be effective in the second line after ipilimumab and was being compared in the front line with ipilimumab. And then the third arm and that-- was sorry, that's in green. And then the third arm in orange is the combination of nivolumab and ipilimumab. As I said, this trial has been presented many times, but this follow-up presentation was with 6 and a half years of following how patients did on the study. And I don't generally like to show survival curves, certainly not overall survival curves, but I want to show them in this scenario, because what we're seeing, if you look at the lower left, this is progression-free survival. These are patients who started therapy and then their disease hasn't-- when the curve sort of flattens out, that means that whatever that number is, that's probably the number of patients at least with 6 and a half years follow-up, who are likely to remain progression-free over time. We know with ipilimumab, which is the gray line, and it shows 7% of patients who started therapy remain without growth of their disease. We know that those patients, if you're alive and without evidence of disease progression at 5 years, you're probably alive and without disease progression at 10 years. And that may be true for the combination of nivolumab and ipilimumab and nivolumab, which are the green and orange lines. And what's important about that is this is probably the potential cure rate of these therapies. As you can see, the numbers at 60 months and the numbers at 78 months don't look a lot different. And I would anticipate that about 30% of patients treated with nivolumab, which is a PD-1 blocking drug, and more than that, maybe 33 or 34% of patients treated with the combination of nivolumab and ipilimumab, are cured of their melanoma, which was metastatic at the time of starting treatment. And that is really amazing, particularly because this is a disease before these drugs came around that generally led to the death of greater than 90% and closer to 95% of patients who developed it. And that leads me to the second curve, which is the lower right, which shows that at 6 and a half years of follow-up, almost half of the patients treated with ipilimumab and nivolumab are alive and again, compared to probably less than 5% in historical dataset. So this is without a doubt, the most remarkable data when thinking about how patients do with melanoma that's ever been shown, and that's why I wanted to show these pictures. This sort of picture shows actually the number of patients who are alive and treatment-free. So one of the important concepts of oncology, and I think if patients are polled, generally speaking, they would like a therapy that works, they would like a therapy that's tolerable. And ideally, if that therapy makes your disease go away, they'd like a therapy they can stop. And so on the left where it says nivo-plus-ipi and “n equals 145,” what it's saying is that 77% of patients who are alive in and were randomized to that regimen are treatment-free, meaning they never needed another therapy. For the nivolumab, that's 69% of the patients. And for ipilimumab, that's 43% of the patients. And so I think the other point that I wanted to make is that not only does this therapy lead to really remarkable outcomes, but it also leads to one of the key metrics that we want, which are control of disease and not needing to be on therapy. So to summarize, this study was patients previously untreated with unresectable stage 3 or stage 4 melanoma. It's a 6 and a half year update. And it's a randomized trial of nearly 1,000 patients. This, again, is the longest follow-up data of any anti-PD-1 therapy, with or without an anti CTLA4 antibody like ipilimumab. A durable progression-free survival was seen in about a third of patients with a combination, about 30% of patients with single agent nivolumab, and less than 10% with single agent ipilimumab. And the durable overall survival is close to 50% with the combination, over 40% with single agent nivolumab, and just over 20% for ipilimumab. And then again, importantly, patients alive at this data cutoff, almost 80% with the combination remained off of therapy and never required subsequent therapy. And then one other important point that was presented by the authors was that in patients who had complete or partial responses, about 80% of those who were treated with a combination, those complete or partial responses were maintained over this time. That was compared to almost 90% of the complete response to the nivolumab, but only a little more than 60% of the partial response with nivolumab were durable. And this is a question that as an oncologist caring for melanoma patients, I'm asked all the time by my patients who have a nice response to therapy, "How long's it going to last, Doc?" And the answer is, in the majority of patients, it seems to last at least 6 and a half years. And again, having additional follow-up data is really important to be able to answer these key questions. So what does this mean for patients? Say the data suggests that a significant minority of patients treated with either the combination of ipilimumab plus nivolumab or single agent nivolumab have durable benefit. I'm not sure if I said it, but it's important that I do say it, that I have been a paid and an unpaid consultant with Bristol Myers Squibb, who is the sponsor of this trial, since 2017. That goes for this presentation as well. So another really critical presentation that was made at ASCO this year was the so-called RELATIVITY-047 study. So this, again, was a randomized trial. This randomized over 700 patients to either the combination of relatlimab plus nivolumab or to nivolumab by itself. Relatlimab is an anti-LAG-3 antibody. Nivolumab is in the anti-PD-1 monoclonal antibody. Anti-PD-1 antibodies have become the standard of care for a number of different cancers, either in combination or by itself. And they block a key way that the cancer's preventing the immune system from attacking it. Relatlimab is another drug in targeting another one of these important molecules that cancers can use to help prevent immune destruction. And so the idea here is that blocking 2 of these key proteins that the cancer cells may be using to help prevent their destruction by the immune system might be better than just blocking 1. So this is the progression-free survival. So, again, the number, the percentage of patients over time whose disease hasn't grown since starting the therapy. And what was shown is that the combination was better than just nivolumab by itself at preventing growth of disease. And to say it another way, of preventing disease progression. And this is busy, and it's not meant to be kind of seen, but essentially that where you see all of those little teal bubbles next to a dotted line, they're all to the left of that dotted line. And that generally means that the combination was better in a lot of different subgroups of patients based on sex, based on age, based on how functional the patients were when they went in, based on BRAF mutation status. And importantly, they look to see whether or not this was true also for patients who had PD-L1 expression, which is an important, potentially predictive factor of nivolumab treatment, as well as LAG-3 expression, which again was the target of one of the drugs. And the hint here is that there seems to be benefit no matter whether the tumor expresses PD-L1 or not, and whether the tumor expresses LAG-3 or not. So to summarize, this is another study looking at patients previously untreated, unresectable stage 3 or 4 melanoma, randomized 700 patients, over 700 patients to either a combination of a LAG-3 inhibitor, relatlimab, and a PD-1 inhibitor and nivolumab versus nivolumab by itself. The trial met its primary endpoint. The combination was well-tolerated, although there was some increased toxicity with the combination compared to the single agent. But it doesn't appear that the toxicity is significantly dose limiting, and the majority of patients were able to continue therapy and similarly to those who were treated with nivolumab. And then this subset analysis, it consistently favored the combination. So what does this mean for patients? Well, the data suggests that the combination of relatlimab and nivolumab may be a new standard of care in patients with advanced melanoma. However, there are caveats, including it's contingent on this combination being approved by regulatory authorities. And also important to note that there's no data yet to determine whether this combination would replace or be better than the combination of the ipilimumab and nivolumab, the combination that I talked about in that first presentation that I'm summarizing as part of the CheckMate 067 study. So we really don't know whether this will be replacing frontline therapy for all patients who have unresectable stage 3 or 4 melanoma or just a subset. But it does seem that this data is potentially revolutionary in terms of how we manage this disease. And finally, I'm going to talk about a clinical trial of a product called lifileucel. This is a trial sponsored by a company called IOVANCE, and I served on a scientific advisory board for the company over a year ago. This is a trial that was looking at the benefit of something called TIL therapy. So TIL stands for tumor infiltrating lymphocytes. So in tumors, we often can identify immune cells that may just be hanging around and watching what's going on or actually may be there with bad intentions, meaning they got there because they can recognize the tumor and are trying to destroy it. And long ago, in the 1990s, a group at the National Cancer Institute began to develop ways of removing these tumor infiltrating lymphocytes, testing whether or not the lymphocytes could recognize a tumor and then would give them back to patients. The cells themselves are unmodified other than they come out, they're grown, expanded, and then given back to patients. The way this works is that a patient will have a tumor removed. So call it the harvest. The lymphocytes or TILs will be removed. They'll be expanded. They'll be tested to see if the TILs actually recognize the cancer. And then a patient will be hospitalized, given chemotherapy to basically prepare their body to receive the TILs. The TILs will be given. And then patients will receive something called interleukin-2, which is a growth factor for the T cells. And then patients remain in the hospital until their blood counts recover from the chemotherapy. And then that's it. That's the only therapy that's given as part of TIL therapy. So this study was looking at cohort 2, which was patients who had previously been treated for melanoma with a PD-1 blocking drug and then received TILs because the PD-1 blocking drug wasn't working and they needed another therapy. In the bottom left is a curve called a waterfall plot. Down is good. The down can go to 100%, which means that all the tumors that were measurable went away. And in the majority of patients' tumors got smaller. And about 35 to 37% of patients actually had what we call partial response or a complete response. And those responses to the right is shown that they tended to be ongoing and that with a median follow-up of over 30 months, the majority of responders remained in response. So 1 concern is do these responses last, and the answer is they seem to. So to summarize, this was a trial for patients who had unresectable stage 3 or stage 4 melanoma who were previously treated with an anti-PD-1 antibody. This was an update of a clinical trial for lifileucel. Sixty-six (66) patients were enrolled. The majority had received both ipilimumab and an anti-PD-1 antibody. This it says upfront toxicity. That's why patients are in the hospital. But once patients leave the hospital, there tends to be very few long-term toxicities. Over 35% of patients had a response, and the majority of those responses were maintained with nearly 3 years of follow-up. One additional thing that was presented is that patients who actually had the poorest prognosis factors going in, meaning their disease grew right away when they got immunotherapy before or they had what's called an elevated LDH, those patients actually seem to have the best responses, the best outcomes. So what does this mean? Well, lifileucel's been shown to be effective in a subset of patients with PD-1 resistant disease, the anti-PD-1 resistant disease. And this data suggests that patients with primary refractory disease, anti-PD-1 may benefit the most. And it remains to be seen whether or not this becomes a standard therapy. But if it does, this data supports its use in this setting. I'll stop there. Thanks, Greg. Greg Guthrie: All right. Thank you, Dr. Sullivan. And now we'll turn to Dr. Dale, who's going to discuss highlights in geriatric oncology research. Dr. Dale: Well, thank you so much, Greg. And thanks to my fellow panelists, to ASCO, and Cancer.Net for the chance to present this exciting new work in cancer and aging or cancer with older adults. I'm going to present 3 studies, 2 of which are related to each other in that they're both about cognitive loss with the treatment of cancers, and a second one about the pre-existing deficits, which also partners with the others. So I think a really nice, natural follow-up to my colleagues who talked about the risks of balancing toxicities and treatment effects, which is often highlighted for older adults. So the first study by Schiaffino, et al. is identifying pre-existing dementia in older adults diagnosed with cancer through a national claims database. I'll mention up front that I am a mentor for Dr. Schiaffino, but not of this particular work, which was done independently with another group of providers and mentors. So this study was done in older adults with cancer who were found to have pre-existing dementia of the Alzheimer's type or a related kind of dementia. So the advance of this case is to take a large database, not a clinical trial database, and through the development of a unique algorithm, actually, 2 of them, identify people who have perhaps unknown pre-existing dementia or cognitive impairment. These are all patients over 65 years old in Medicare, combined with a national cancer database called SEER, which is Surveillance, Epidemiology, and End Results study, for about a 10-year period. And it was conducted in people with 6 different kinds of common cancers. And what did we find that was new in this study? It's surprisingly common using this algorithm adapted from clinical diagnostics for people to have pre-existing cognitive impairment concerning for Alzheimer's or another dementia. This is often thought to be quite low, probably because most people with cognitive impairment do not end up enrolled in clinical trials. But if you look at a real-world database like this, 15 to 30% were found to have evidence of pre-existing cognitive losses. So they assessed the prevalence of this pre-existing disease through this algorithm across the cancer types, and it was even more common among certain racial and ethnic subgroups, basically non-white subgroups compared to white subgroups. Again, white individuals are more commonly enrolled to significant degrees in clinical trials. So what does this mean for patients and caregivers if up to 1 in 3 older adults facing cancer treatment have pre-existing dementia, evidence of Alzheimer's, or related dementia? They need to be identified and screened for in advance of being treated for their cancer. Why is this important? Patients with cognitive impairment are at an increased risk for both overtreatment and undertreatment for their cancers. Those with pre-existing cognitive loss are at very high risk for a number of different toxicities and at high risk for mortality when being treated with chemotherapy and other kinds of cancer treatments. And if it's not identified in advance, they could be placed at higher risk and may want to reconsider the therapy choices. If someone is identified with dementia or cognitive impairment, one thing they're at especially high risk for, as we'll see in the next study, is chemotherapy-related, additional cognitive impairment during treatment, which can lead to a number of complications such as delirium and other problems. On the flip side, patients with dementia are often, as we saw with trials, not offered the most aggressive therapies, even when they're not at risk and offered the appropriate support. And so they're at risk of being undertreated based on perhaps an early kind of dementia that would be perfectly appropriate to be treated. So caregivers and family members may need to advocate on behalf of their older relatives or parents or grandparents to get appropriate treatment. So it's important to ask your oncologists and your primary care doctors about the risks when deciding what treatments and in some cases to undergo appropriate screening and testing for cognitive impairment prior to starting treatment. So the next study is another study of cognitive impairment moving in the direction that the field of cancer and aging is moving, which is identifying effective interventions rather than simply identifying risk factors. So this is a phase II study of 2 combined interventions, exercise and low-dose ibuprofen for cancer-related cognitive impairment, essentially chemobrain, during chemotherapy for patients with cancer led by Dr. Janelsins and their team at the University of Rochester. Who does this study affect? Patients with cancer receiving chemotherapy who are facing cognitive difficulties with the initiation of chemotherapy and testing for 7 different domains of cognition, including memory, attention, concentration, and executive function, among a few others. This was 86 participants reporting cognitive difficulties during chemotherapy. The majority were breast cancer patients, and the vast majority were women. I do note that patients' average age was 54, younger than our usual cutoff of 65, but highlighting the fact that cognitive difficulties can be identified at any age with chemotherapy. I mentioned the 7 cognitive tests. Patients were then randomized into 3 different groups versus placebo for 6 weeks: an exercise alone arm, which included a walking program and a resistance band training program which has been validated in other contexts for cancer patients; daily ibuprofen, 200 milligrams given twice a day by itself; or a combination of exercise and low-dose ibuprofen together. And what did they find, particularly for the issue of attention? So this is the ability to maintain attention on a cognitive task. Exercise alone was the most valuable intervention. People were able to maintain their attention for a significant amount of time, over 20 seconds. Ibuprofen alone also improved significantly compared to placebo at about 10 or 11 seconds. Interestingly, the 2 together had a non-significant improvement in attention of about 8 seconds and raises some questions about why the 2 together would work less well than either alone, perhaps suggesting they use similar mechanisms. Self-reported cognitive function was also found in both of the exercise groups to be improved. So this was the subjective experience of chemobrain was seen to improve in those randomized to the exercise arms. So what does this mean for patients with cancer receiving chemotherapy? These simple, validated, home-based exercises improved attention and the self-reported or subjective sense of cognitive performance. These are things that could easily be done in the home during chemotherapy and may well improve the situation for those who are experiencing chemobrain. Low-dose ibuprofen, just 200 milligrams, that's 1 over-the-counter pill twice a day, improves the same attention, although not quite as much as exercise. Again, the caveats are noted that these were younger patients. The benefits may be even greater for older patients who are more likely to have cognitive impairment, as we saw, and that it was primarily breast cancer patients and primarily women. There are still questions remaining about why the combination was less effective than either intervention alone. And the last study I want to talk about is about other kinds of pre-existing conditions for older adults, focusing on those not with earlier stage disease, but with poor prognosis patients. So this was patients over 65 with poor prognosis cancers defined as a median survival expectation of less than 1 year and combined 2 large databases. To understand this, the Health and Retirement Survey, a large nationally representative study, combined with claims information or people's experience utilizing the health care system or on Medicare, and identified over 2,000 older adults with cancer, and just assessed the frequency of these pre-existing conditions, all of which are detected with a geriatric assessment, which is our standard way of assessing older patients with cancer and as part of the ASCO guidelines that were published a couple of years ago. 26% of the patients had lung cancer, 14% had GI cancer, and 60% had other kinds of cancers. What was found? Patients with poor prognosis have high rates of these pre-existing geriatric conditions. Of greatest concern, perhaps, is daily activities difficulties with well over 60% having difficulty climbing stairs, which are in the homes of many people, nearly 50% had trouble standing up from a chair, and a quarter had trouble walking 1 block. This is important as we anticipate giving people chemotherapy to know that the functional losses should be accounted for in advance, if at all possible, and to be prepared for people who may have lived in a house with stairs for many years or who have a low-slung chair that's difficult to get out of, that will become even more of a problem in the future. About a third of people over the year had a significant fall, 12% of which resulted in injuries, again, suggesting that changes in the home or a falls assessment be done or physical therapy to strengthen prior to treatments. And as we noted, just the last couple studies with cognitive impairment, nearly 1 in 10 had trouble managing their finances and another 6% had difficulties with their medications, highlighting additional challenges that come with older adults when they start on chemotherapies and helping anticipate problems that could be addressed or adjusted for. Of note, as people get older, these problems become even more pronounced. In those who are 85 and older who had cancer, over half had falls and even more presented cognitive problems with a fully one-fourth difficulty managing money, 12% difficulty taking their medications. Often, they're on a number of additional medications, just highlighting the challenges for simply getting through their days and anticipating that in the decision-making for starting on therapy or providing the appropriate support prior to starting on therapy. So I don't have conflicts of interest with this study or the prior study of any kind. And that's my last slide. Oh, I'm sorry, I have 1 more. Let me do the “what this means for patients and families.”  Advanced cancer is often accompanied by these geriatric conditions that affect health, functional status, cognitive status, falls, and social support is another common one along with the establishing appropriate goals of care. These conditions are detectable with the geriatric assessment. Here I've linked to the ASCO guidelines that came out in 2018. It's now becoming more of a standard of care for older patients. I will point out with the geriatric assessment, it does not require time in clinic to be conducted. It can be done in advance of clinic, and it can be done with nursing support or other staff doing it. Oftentimes online questionnaires can be answered so that these issues can be identified even prior to coming to the clinic or being seen in a video call. Interventions can improve many of these outcomes. We heard earlier from Dr. Markham about chemotherapy toxicities. Geriatric assessment interventions have been shown to decrease toxicities. Polypharmacies, so the reduction in the number of medications that are required that may not be appropriate any longer. Completion of advanced directives goes up with the use of geriatric assessment interventions, and the decision-making choices that need to be made for cancer therapies, whether it's chemotherapy or immunotherapy or others, are enhanced and happen more often with the geriatric assessment being done and help to mitigate the long-term outcomes, especially toxicities and geriatric issues that come up for older adults. I think with my last slide, my timing is just about perfect, Greg, so thanks. Greg Guthrie: It is perfect, Dr. Dale. So thanks very much for that. And now we can move on to our Q&A session. And we can see what questions we have. Ah, so our first question is for Dr. Sullivan, and it is, is relatlimab a checkpoint inhibitor or is LAG-3 not a checkpoint? Dr. Sullivan: Excellent question. LAG-3 is an immune checkpoint. Immune checkpoints are molecules that-- I guess the way to step back is to say that to have an active immune response, there needs to be a few things to happen. Typically what the immune response we're talking about against cancer is T-cell immune response. And so the T-cells need to be able to recognize something like a piece of tumor protein that's expressed on the outside of the tumor, like a flag. And then once they've sort of, there's this teaching process or priming process and then that process is involved. So there's a lot of these so-called checkpoints. Some of these checkpoints actually activate the immune system better, and some of these actually block the immune system from working well. And it's this delicate balance. It's almost like our immune systems have to be in the Goldilocks zone so it's not too hot, not too cold, but just right. And so a lot of these drugs, these checkpoint inhibitors, are blocking drugs to either activate cells or once the cells are activated and get into the immune microenvironment of the tumor, then they have to navigate these other potential checkpoints. And so PD-1 and PD-L1 are checkpoints on the immune system that are targeted by drugs like nivolumab, pembrolizumab, atezolizumab. And another checkpoint is LAG-3. So LAG-3 is expressed on what we call exhausted immune cells or T-cells. And so blocking LAG-3 can actually overcome that exhaustion and make those immune cells work better. So LAG-3 is a checkpoint and relatlimab is a checkpoint inhibitor. And that was a long way of saying it. Greg Guthrie: One of the things that's really interesting about that study is that relatlimab is used in combination, and is that to reach that kind of Goldilocks situation that you were saying? Dr. Sullivan: It's like the Goldilocks zone. Yeah, not too hot, not too cold. Greg Guthrie: Just right. Dr. Sullivan: Well, relatlimab and nivolumab are trying to make the immune system hotter. And so that's a good thing when we're talking about anticancer immunity. The downside, and to Dr. Markham's and Dr. Dale's points about toxicity, the downside of having the immune system too hot is that it can lead to side effects, and those side effects are generally inflammatory. So we worry the more checkpoints we inhibit, that the more side effects we'll see. So the combination in that first study of ipilimumab and nivolumab, when we use that combination, we get a lot of side effects that can be very challenging to get patients through that treatment, which is why we're looking for other combinations that will be more effective than just nivolumab or pembrolizumab by itself, but also will lead to substantial and better antitumor outcomes. Greg Guthrie: Great. All right. We have another question, this one for Dr. Dale. How often do doctors evaluate patients for ADRD, or if they do not, will they still go ahead and provide chemotherapy? Dr. Dale: Always risky for me to say what doctors do. I feel like I'm talking about my oncology colleagues like the anthropologist in Mars, I sometimes say where I'm just the geriatrician observing. So I don't know what people do for sure. We do know is that it's still not common for geriatric assessments that include cognitive screening tests to be done in oncology practices for a number of reasons. Resources is a particular challenge. So we already have very busy oncologists, particularly community oncologists, but all of them. And to fit in a cognitive screening test can be a real challenge. And so we have to come up with a different systematic way. Having said that, do they go ahead and treat? I think in most cases when people with dementia are identified, they are less likely to be treated for the concerns people have for cognition. But the way it's identified through family report in patients is known to be inconsistent and not as good as formal testing. So what I would say is we're getting better at creating screening tests that take very little time to do some cognitive assessment. And those who are screened as positive can then be sent for appropriate follow-up with a geriatrician or to a neurologist, whatever is appropriate. But those who are not can then move ahead with chemotherapy and not be excluded. So we're getting there, but there's more work to be done. Greg Guthrie: Okay, great. And not a follow-up question, but another question for you, Dr. Dale. It seems like we've gotten a couple of questions about ibuprofen. So what is the mechanism by which ibuprofen is thought to improve or affect cognitive function in older adults with cancer? Dr. Dale: Great. And I'm not an expert in the cognitive impairment directly, more in the health services sense, but my understanding is older adults are especially affected by inflammatory responses. So being frail, for example, is associated with inflammatory markers in our system such as CRPE and other inflammatory markers. And it's thought that ibuprofen as an anti-inflammatory reduces that. And those same markers are associated with this chemobrain cognitive impairment in several different studies. These are still association, so we can't say they're causal relationships. But the hypothesis is if we give ibuprofen and lower the inflammatory profile, that will allow cognition to improve and attention by extension. There is another theory I'll put out there. This is my personal one that I'm a little more sympathetic to, which is the inflammatory response from cancer and cancer treatments is fatigue. And fatigue is by far the most common side effect as Dr. Markham can tell us on the toxicity profile. It's very prevalent. For older adults, being fatigued affects cognition just like it does physical functioning. And it's very difficult to concentrate when you're so tired. And to the extent that we can reduce that inflammatory response and reduce the sense of fatigue, the more people could concentrate. Again, none of this is proven. This is still all at the hypothesis testing stage. Greg Guthrie: Great. Our next question is for Dr. Markham. Is there any indication from the research that either vaccine, this HPV vaccine, or screening alone made the difference in the lowered incidence rate for cervical cancer? Or was it a combination of vaccination and screening? Dr. Markham: So I don't think we know the answer to that really, and I have not seen it in studies. We have data that screening is helpful and we have data that the HPV vaccine is helpful.  So I suspect that it's the combination, but I don't know how much of each is contributing. I do think that like many things with cancer, it does take a multiple-pronged approach whether to treat it or to diagnose it. So to me, it makes sense that it's some combination of the 2. Greg Guthrie: So a quick follow-up. For a lot of the squamous cell carcinomas that are included in that HPV study, they conclude by saying that there aren't a lot of screening protocols in place for these types of cancer. Do you think that we have the knowledge to do screening for those cancers and we just don't? Or will further research be needed to find ways to detect and prevent? Dr. Markham: So I think like many of these things, we do need more research. The challenge with screening research is that we have to prove, our scientists have to prove that you can screen a lot of people safely and not in a costly   manner and actually reduce the incidence of cancer or some other outcome. And those studies are actually really hard to do, and they take a long time. I think the data that has come out on prostate cancer screening and on breast cancer screening with mammograms and at what age do we start and so on and so forth, I think is just a testament to how complicated the screening studies can be. So do we have the ability to screen? I think yes. I know that some dentists, for example, and head and neck doctors, head and neck specialists like ENT physicians, are able to just visually take a look in the mouth, for example, to screen for any abnormalities that look like cancer. Do we as a country or a health system have the ability to do that on a large scale [not] in a costly manner? I don't know the answer to that. And that's where we really do need more research. And same with anal and vulvar cancers, etc. Greg Guthrie: That's great. Thanks, Dr. Markham. So I think we're going to move on to our final question, and that's for you, Dr. Sullivan, is how similar is TIL therapy to CAR T-cell therapy? Dr. Sullivan: That's a great question. Both are T cells that are taken from a patient and given back to the same patient. But a CAR T-cell is made by removing a bunch of white blood cells from the blood and then those white blood cells, those T cells, are modified so that they are able to recognize the cancer. And when they do, the immune cell turns it on and they can actually expand. It's really like a living and modifying kind of in real time drug. And so there are a few of those CAR T cells that are approved by the FDA to treat a number of different diseases that express what we call an antigen that the CAR T recognizes. T-I-L therapy, or TIL therapy, are T cells that are removed from the tumor itself. They are not modified in the way, at least, that the standard NIH protocol, which is the protocol that we presented today and was presented at ASCO, which essentially is take the cells from the tumor, expand them, grow them, make sure they recognize the tumor, and then give them back. And so the difference is-- their similarities is they're both T cells and the T cells theoretically can recognize the cancer. The differences are that CAR T cells are taken from the blood and modified, and TILs are taken from tumors and are not modified. Greg Guthrie: Great. That's very clear, Dr. Sullivan. Thank you, and thank you to all of our panelists for joining us today and sharing this great research and, of course, your expertise. It's been a real pleasure. And to all of you who attended this Research Round Up webinar, thank you to all of you for joining us today. You can find more coverage of the research from the ASCO Annual Meeting and other scientific meetings at the Cancer.Net blog. That's Cancer.Net/blog. If you're interested in more Cancer.Net content, please sign up for our monthly Inside Cancer.Net newsletter or follow us on social media. We're on Facebook, Twitter, and YouTube. And our handle is always @CancerDotNet with dot spelled out. Thank you for everybody for attending, and have a good day. Thanks. ASCO: Thank you, Dr. Markham, Dr. Sullivan, and Dr. Dale. You can find more research from recent scientific meetings at www.cancer.net. And if this podcast was useful, please take a minute to subscribe, rate, and review the show wherever you listen to podcasts. This Cancer.Net podcast is part of the ASCO Podcast Network. This collection of 9 programs offers insight into the world of cancer care, covering a range of educational, inspirational, and scientific content. You can find all 9 shows, including this one, at podcast.asco.org. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds breakthrough research for every type of cancer, helping patients everywhere. To help fund Cancer.Net and programs like it, donate at conquer.org/donate.

Erin shares the level of commitment and rules of Roller Derby

Ab Brody, PhD, RN, FAAN, Ellen McCreedy, PhD, MPH and Jessica Colburn, MD continue their conversation from their January 13 Grand Rounds webinar presentation. This discussion with IMPACT Principal Investigator Susan Mitchell, MD, MPH answers questions from their presentation on providing real world examples of implementation in ongoing AD/ADRD ePCTs in different health care settings.

In this episode we address the issue of Alzheimer's Disease and Related Dementias, “ADRD,” and how to approach it. Dr. Guillermo Castillo will explain the various types of various Dementias and options for our seniors and their loved ones.

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.09.23.310276v1?rss=1 Authors: Greenfest-Allen, E., Klamann, C., Valladares, O., Kuzma, A., Gangadharan, P., Leung, Y. Y., Stoeckert, C. J., Wang, L.-S. Abstract: INTRODUCTION: The NIAGADS Alzheimer's Genomics Database is an interactive knowledgebase for AD genetics that provides access to GWAS summary statistics datasets deposited at NIAGADS, a national genetics data repository for AD and related dementia (ADRD). METHODS: The website makes available >70 genome-wide summary statistics datasets from GWAS and genome sequencing analysis for AD/ADRD. Variants identified from these datasets are mapped to up-to-date variant and gene annotations from a variety of resources and linked to functional genomics data. The database is powered by a big-data optimized relational database and uses ontologies to consistently annotate study designs and phenotypes, facilitating data harmonization and efficient real-time data analysis and variant or gene report generation. RESULTS: Detailed variant reports provide tabular and interactive graphical summaries of known ADRD associations, as well as highlight variants flagged by the Alzheimer's Disease Sequencing Project (ADSP). Gene reports provide summaries of co-located ADRD risk-associated variants and have been expanded to include meta-analysis results from aggregate association tests performed by the ADSP allowing us to flag genes with genetic-evidence for AD. DISCUSSION: The GenomicsDB makes available >100 million variant annotations, including ~30 million (5 million novel) variants identified as AD-relevant by ADSP, for browsing and real-time mining via the website or programmatically through a REST API. With a newly redesigned, efficient, search interface and comprehensive record pages linking summary statistics to variant and gene annotations, this resource makes these data both accessible and interpretable, establishing itself as valuable tool for AD research. Copy rights belong to original authors. Visit the link for more info

Executive Director for the IMPACT Collaboratory Jill Harrison speaks with Laura C. Hanson, MD, MPH and Sheryl Zimmerman, PhD about their recent IMPACT Collaboratory Grand Rounds. The Grand Rounds focused on finding pragmatic and relevant outcomes for AD/ADRD ePCTs.