Podcasts about apoe

Description: In the third and final episode of the healthspan series, Dr. Erin Faules and Dr. Jeff Graham explore the intersection between neurodegenerative disease and metabolic dysfunction—two often-connected drivers of decline. They discuss early detection strategies, the role of genetics, and insulin resistance, and emerging clinical tools to assess and reduce long-term risk. Key Topics Covered: Distinguishing normal aging from neurodegenerative disease Early signs of cognitive decline and how to detect them The role of APOE-4 and other genes in Alzheimer's risk Metabolic dysfunction as a driver of brain aging ("Type 3 diabetes") Blood-based biomarkers: phospho-tau, NFL, CRP, fasting insulin, and more Lifestyle interventions: sleep, strength training, CGMs, circadian-aligned eating Tools like CNS Vital Signs, PET scans, and neuroquant MRIs Supplements and prescriptions: Omega-3s, creatine, berberine, GLP-1s, inositol Connecting muscle mass to glucose control and long-term healthspan

Discover all of the podcasts in our network, search for specific episodes, get the Optimal Living Daily workbook, and learn more at: OLDPodcast.com. Episode 3043: Many traditional diets share key traits like rich sources of fat-soluble vitamins and the absence of processed foods, but Ben Greenfield highlights why your ideal diet depends heavily on your unique genetics. From amylase production to ApoE variants and vitamin A conversion, this piece reveals how ancestral eating patterns and individual gene expression shape the best nutritional approach for your body. Read along with the original article(s) here: https://bengreenfieldlife.com/article/nutrition-articles/how-to-figure-out-what-diet-is-right-for-you/ Quotes to ponder: "The more AMY1 copies you've inherited (and the more of this enzyme you produce as a result), the better your starch-metabolizing capabilities will be." "Depending on what you inherited from your parents, you'll carry a combination of any two ApoE variants: ApoE2, ApoE3, or ApoE4." "Two common mutations on the BCM01 gene, which helps govern the beta-carotene-to-vitamin-A conversion process, make it nearly impossible to get enough vitamin A from the plant kingdom alone." Learn more about your ad choices. Visit megaphone.fm/adchoices

Discover all of the podcasts in our network, search for specific episodes, get the Optimal Living Daily workbook, and learn more at: OLDPodcast.com. Episode 3043: Many traditional diets share key traits like rich sources of fat-soluble vitamins and the absence of processed foods, but Ben Greenfield highlights why your ideal diet depends heavily on your unique genetics. From amylase production to ApoE variants and vitamin A conversion, this piece reveals how ancestral eating patterns and individual gene expression shape the best nutritional approach for your body. Read along with the original article(s) here: https://bengreenfieldlife.com/article/nutrition-articles/how-to-figure-out-what-diet-is-right-for-you/ Quotes to ponder: "The more AMY1 copies you've inherited (and the more of this enzyme you produce as a result), the better your starch-metabolizing capabilities will be." "Depending on what you inherited from your parents, you'll carry a combination of any two ApoE variants: ApoE2, ApoE3, or ApoE4." "Two common mutations on the BCM01 gene, which helps govern the beta-carotene-to-vitamin-A conversion process, make it nearly impossible to get enough vitamin A from the plant kingdom alone." Learn more about your ad choices. Visit megaphone.fm/adchoices

For many women, memory changes during perimenopause and menopause can be unsettling. We find ourselves wondering: Is this just brain fog? Is this normal? Or could it be something more serious? In this critical episode, Shelley Craft is joined by Professor Ralph Martins, AO, one of the world's leading Alzheimer's researchers, to help us separate fact from fear and to understand what's really going on in our brains as we age. Dementia is now the leading cause of death for women in Australia, yet so few are talking about it. This conversation is about breaking the silence, reducing fear, and creating a proactive plan to protect our brain health — starting today. Here's a snapshot of our conversation:

BUFFALO, NY — June 12, 2025 — A new #research paper was #published in Aging (Aging-US) Volume 17, Issue 5, on May 3, 2025, titled “APOE genotype and biological age impact inter-omic associations related to bioenergetics.” In this study, led by first author Dylan Ellis and corresponding author Noa Rappaport from the Institute for Systems Biology, researchers discovered that different versions of the APOE gene—particularly ε2 and ε4—are linked to metabolic patterns associated with aging and Alzheimer's disease risk. Both variants were linked to increased levels of diacylglycerols, a type of fat molecule connected to insulin resistance and inflammation, suggesting shared disruptions in how the body regulates energy. The research team analyzed data from over 2,200 adults without an Alzheimer's diagnosis, exploring how APOE genotypes influence biological age, a measure of health that reflects how quickly or slowly someone is aging at a cellular level. They found that the same metabolic disturbances seen in ε2 carriers were also present in people considered biologically older, revealing unexpected overlap between genetic risk and aging-related metabolic changes. To examine these connections in more detail, the researchers used a multi-omics approach, combining blood-based metabolism and protein data, gut bacteria analysis from stool samples, and clinical chemistry data. This method allowed them to map how genetic differences and biological aging affect the body's energy systems. They observed altered connections between glucose metabolism, inflammatory markers, and key molecules that play roles in energy production, indicating early disruptions that could contribute to age-related diseases. One of the study's surprising findings was that the ε2 variant, usually associated with longer life and reduced Alzheimer's risk, showed metabolic traits similar to those found in insulin-resistant individuals. This suggests that ε2 may carry metabolic disadvantages earlier in life, with its protective effects becoming more pronounced later. Conversely, ε4—linked to greater Alzheimer's risk—may exert its influence based on interactions with lifestyle factors like diet, sex, and overall health status. “‘Omics association patterns of ε2-carriers and increased biological age were also counter-intuitively similar, displaying significantly increased associations between insulin resistance markers and energy-generating pathway metabolites.” By identifying these shared biological signatures, this study offers a new framework for understanding how genes and metabolism work together to influence aging. These findings could support more personalized health strategies aimed at delaying biological aging and reducing the risk of chronic diseases. As aging populations grow worldwide, understanding these pathways is essential to improving healthspan. DOI - https://doi.org/10.18632/aging.206243 Corresponding author - Noa Rappaport - noa.rappaport@isbscience.org Video short - https://www.youtube.com/watch?v=75hZQoO5U0U Sign up for free Altmetric alerts about this article - https://aging.altmetric.com/details/email_updates?id=10.18632%2Faging.206243 Subscribe for free publication alerts from Aging - https://www.aging-us.com/subscribe-to-toc-alerts Keywords - aging, apolipoprotein E (APOE), biological age, metabolism, Alzheimer's disease (AD), insulin resistance To learn more about the journal, please visit our website at https://www.Aging-US.com​​ and connect with us on social media at: Facebook - https://www.facebook.com/AgingUS/ X - https://twitter.com/AgingJrnl Instagram - https://www.instagram.com/agingjrnl/ YouTube - https://www.youtube.com/@AgingJournal LinkedIn - https://www.linkedin.com/company/aging/ Bluesky - https://bsky.app/profile/aging-us.bsky.social Pinterest - https://www.pinterest.com/AgingUS/ Spotify - https://open.spotify.com/show/1X4HQQgegjReaf6Mozn6Mc MEDIA@IMPACTJOURNALS.COM

Discover my premium podcast, The Aliquot Vitamin D is far more than just a vitamin—it's a potent steroid hormone regulating nearly 5% of our genome. Yet, remarkably, up to 70% of Americans aren't getting enough, placing them at increased risk for dementia and Alzheimer's disease. In this episode, I explore compelling new evidence from a study involving over 12,000 participants, demonstrating that vitamin D supplementation can reduce dementia risk by an impressive 40%, protecting even adults with genetic Alzheimer's risk (ApoE4 carriers). Timestamps: (00:00) Can vitamin D supplements reduce dementia risk? (00:46) How common is vitamin D deficiency? (03:31) What studies reveal about genes, vitamin D, and dementia (05:44) Does deficiency accelerate brain aging? (06:45) Can vitamin D supplementation enhance cognitive function? (08:15) Dementia risk reduction insights from 12,388 adults (09:58) Why women may benefit most (10:49) Normal vs. impaired cognition—who benefits more from vitamin D? (11:21) Do ApoE4 carriers get dementia protection from vitamin D? (13:00) How mild cognitive impairment affects dementia risk (13:41) Does the form of vitamin D matter? (14:11) What are the optimal vitamin D blood levels? (15:07) What dose corrects deficiency? (15:33) How vitamin D directly supports brain function Watch this episode on YouTube Show notes are available by clicking here The study discussed: Vitamin D supplementation and incident dementia: Effects of sex, APOE, and baseline cognitive status

How important is one's family history when determining Alzheimer's risk? Returning guests Drs. Jessica Langbaum and Sterling Johnson discuss the latest research on family history and genetic risk factors and share their perspectives on the topic, specifically focusing on the role of the APOE gene as a risk factor. Guests: Sterling Johnson, PhD, leader, Wisconsin Registry for Alzheimer's Prevention (WRAP), associate director, Wisconsin Alzheimer's Disease Research Center, associate director, Wisconsin Alzheimer's Institute, lead principal investigator, ADRC Consortium for Clarity in ADRD Research Through Imaging (CLARiTI), Jean R. Finley Professor of Geriatrics and Dementia, UW School of Medicine and Public Health, and Jessica Langbaum, PhD, senior director of research strategy, Banner Alzheimer's Institute, overseer, Observational Research Program, Clinical Trials Program, Alzheimer's Prevention Initiative, director, Alzheimer's Prevention Registry, director, Arizona Alzheimer's Disease Research Center Show Notes Read Dr. Langbaum's viewpoint, “The Risk of Alzheimer Disease in APOE4 Homozygotes,” on the Journal of American Medical Association (JAMA) website. Read Dr. Johnson's article, “APOE4 homozygosity represents a distinct genetic form of Alzheimer's disease,” on Nature Medicine's website. Read Dr. Chin's opinion piece, “What to do if your family has a history of Alzheimer's,” mentioned at 2:04 on the Wisconsin State Journal's website. Please note there is a paywall to access the article. Read Dr. Tobey Betthauser's paper, “Multi-method investigation of factors influencing amyloid onset and impairment in three cohorts,” mentioned by Dr. Johnson at 16:50, on the National Library of Medicine's website. Learn more about the Banner Alzheimer's Institute on their website.  Read about the GeneMatch program from the Alzheimer's Prevention Registry on their website.  Learn more about the Arizona Alzheimer's Disease Research Center on their website.  Connect with us Find transcripts and more at our website. Email Dementia Matters: dementiamatters@medicine.wisc.edu Follow us on Facebook and Twitter. Subscribe to the Wisconsin Alzheimer's Disease Research Center's e-newsletter. Enjoy Dementia Matters? Consider making a gift to the Dementia Matters fund through the UW Initiative to End Alzheimer's. All donations go toward outreach and production.

In this episode of Research Renaissance, host Deborah Westphal sits down with Dr. Alberto Serrano-Pozo, Assistant Professor of Neurology at Harvard Medical School, staff neurologist at Massachusetts General Hospital, and a 2022 Toffler Scholar. Together, they explore Dr. Serrano-Pozo's pioneering research into the role of glial cells—specifically astrocytes—and the APOE gene in the development and progression of Alzheimer's disease.Dr. Serrano-Pozo discusses how astrocytes, long overlooked in favor of neurons, are now recognized as key players in maintaining brain health—and how their dysfunction may contribute to Alzheimer's pathology. The conversation also covers the complexities of the APOE gene variants, how recent discoveries are reshaping our understanding of Alzheimer's across different populations, and promising advances in gene-editing research.Dr. Serrano-Pozo also reflects on the dual role he plays as both a researcher and a clinician, how patient interactions inspire his lab work, and why cautious optimism is warranted as new therapies and technologies emerge.What You'll Learn:Why astrocytes are crucial to brain function—and how they change in Alzheimer'sThe evolving understanding of the APOE gene's role in Alzheimer's riskHow glial cells interact with amyloid plaques and tau tanglesWhy certain APOE variants affect populations differentlyAdvances in gene-editing that may offer future protection against Alzheimer'sThe real-world challenges and rewards of balancing clinical practice with researchA hopeful look at the accelerating pace of Alzheimer's research and innovationKey Quotes: 

Could the signs of Alzheimer's and dementia appear before middle age?   Join host Chuck Carroll and renowned expert Dr. Neal Barnard on The Exam Room Podcast as they explore new research revealing that symptoms of cognitive decline may begin as early as your 30s or 40s. Discover the early warning signs, what causes them, and what you can do today to protect your brain health.   Subscribe for more expert interviews on health, nutrition, and disease prevention.   - In This Interview -   - What age dementia signs can first appear - The cause of cognitive deficits at a young age - The APOE ε4 factor - Hippocampus and memory loss - Best foods for fighting dementia - And more   — — SHOW LINKS — — Dementia Study https://bit.ly/AlzYouthStudy — — — Gregory J. Reiter Memorial Fund https://gregoryreiterfund.org — — — Chuck on The Fit Vegan Podcast YouTube: https://www.youtube.com/watch?v=xHoTC5gpQ8c Apple: https://podcasts.apple.com/us/podcast/the-untold-side-of-chuck-carrolls-265-lbs-weight/id1540427138?i=1000705562110 Spotify: https://open.spotify.com/episode/4FkGmNEEnDHT0dVUUueH1a?si=5461a466976d4e25 — — EVENTS — — Exam Room LIVE: Longevity and Muscle Building GreenFare Organic Restaurant Where: Herndon, VA When: May 28, 2025 Tix: https://bit.ly/ERTixGFMay2025 — — — NHA Conference Where: Cleveland, OH When: June 26-29, 2025 Tix & Speakers: https://www.healthscience.org/2025-nha-conference — — — International Conference on Nutrition in Medicine Where: Washington, DC When: August 14-16, 2025 Tix & Speakers: https://www.pcrm.org/icnm — — BECOME AN EXAM ROOM VIP — — Sign up: https://www.pcrm.org/examroomvip — — THIS IS US — — The Exam Room Podcast Instagram: https://www.instagram.com/theexamroompodcast — — — Chuck Carroll Instagram: https://www.instagram.com/ChuckCarrollWLC Facebook: https://www.facebook.com/ChuckCarrollWLC X: https://www.twitter.com/ChuckCarrollWLC — — — Physicians Committee Instagram: https://www.instagram.com/physicianscommittee Facebook: https://www.facebook.com/PCRM.org X: https://www.twitter.com/pcrm YouTube: https://www.youtube.com/user/PCRM Jobs: https://www.pcrm.org/careers — — SUBSCRIBE & SHARE — — 5-Star Success: Share Your Story Apple: https://apple.co/2JXBkpy​​ Spotify: https://spoti.fi/2pMLoY3 Please subscribe and give the show a 5-star rating on Apple Podcasts, Spotify, or many other podcast providers. Don't forget to share it with a friend for inspiration!

Do our cholesterol numbers tell the full story? Cardiometabolic health encompasses more than just heart function—it includes metabolic processes, blood sugar control, lipid levels, and inflammation markers that affect your entire body's health. Fewer than 12% of Americans are metabolically healthy, making it crucial to look beyond standard cholesterol numbers to understand your complete cardiovascular risk profile.In today's episode, functional nutritionist Chris Newport explores hidden factors that could be quietly impacting your heart and metabolic health.You'll discover: • Why traditional cholesterol tests might miss critical warning signs • What the size of your LDL particles can reveal about your risk • The simple blood test that offers a clearer picture of heart disease risk • A genetic marker that could influence your heart health—whether your labs are "normal" or not • How your body's ability to shift between fuel sources impacts your long-term health • The surprising link between blood sugar, carbs, and cholesterol problems • A fresh look at heart health through the American Heart Association's updated roadmap • How your environment and lifestyle could silently shape your risk • Why tiny daily habits can lead to massive improvements over time

In this episode, we sit down with Dr. Matthew Dawson, the founder and CEO of Wild Health, and leader in genomics-based precision medicine. Dr. Matt breaks down what precision medicine truly means--how it goes beyond traditional healthcare to create highly personalized plans based on your unique genetic blueprint and blood work. We explore some of the most important genes to assess for optimizing health, performance, and longevity, including the ApoE gene. He shares powerful insights into the future of medicine and why understanding your genetics is crucial for extending healthspan. Plus, we open up about our own personal Wild Health test results and how they've shaped our individual wellness journey. This conversation is packed with actionable insights you won't want to miss!Dr. Matthew Dawson is the founder and CEO of Wild Health, a genomics-based precision medicine company, and the CEO of TruDiagnostic, an epigenetics testing lab. He has authored two textbooks, published over two dozen studies, lectured in over 20 countries, and won national awards for education and innovation. His passion is unlocking the secrets of the genome and epigenome and using them to optimize health and maximize healthspan. He lives in the woods with his wife, four children, and two dogs.SHOW NOTES: 0:31 Welcome to the show!3:57 Dr. Matt Dawson's Bio4:40 Welcome Dr. Matt to the show!5:14 What is “Precision Medicine”?7:14 Your genes are not your destiny11:09 Renee's experience with Bulletproof coffee11:38 MTHFR & Homocysteine12:43 Combining lab work with genetics17:24 Alzheimer's genetics20:32 What to do for APOE-3/422:56 Biomarkers for optimal health 24:28 Can you change your sleep chronotype?28:26 Genes for telomere length31:37 *ALIGN MAT*33:16 *PIQUE TEA*35:27 Boosting BDNF37:30 Something new about HbA1C!39:47 FOXO3 Gene for Longevity43:40 Blue Zones & social connection45:12 Testing Biological Age49:08 Caloric Restriction for Longevity51:42 The perfect diet for your genes53:25 Comparing macro tolerances57:37 Wild Health reports 59:12 Coming soon for Precision Medicine!1:04:16 His final piece of advice1:04:56 Thanks for tuning in!RESOURCES:Website: wildhealth.com - discount code: BIOHACKERBABESInstagram: wildhealthmdLinkedIn: Wild HealthMy Align Mat - discount code: BIOHACKERBABES to save $250Pique Tea - Save $ with this link!Puori - Save 20% with discount code: BIOHACKERBABESEffecty - Save $50 with discount code: BIOHACKERBABESOur Sponsors:* Check out Effecty and use my code BIOHACKERBABES for a great deal: https://www.effecty.com* Check out Puori: https://Puori.com/BIOHACKERBABESSupport this podcast at — https://redcircle.com/biohacker-babes-podcast/donationsAdvertising Inquiries: https://redcircle.com/brands

In this episode, I sat down with Dr. Heather Sandison to talk about something that needs more attention Alzheimer's disease, and whether it can actually be reversed. She challenges the conventional belief that it's irreversible and dives into how environmental toxins, poor lifestyle habits, and hidden infections can drive cognitive decline. We broke it all down using the acronym "TNSSS-I" — Toxins, Nutrients, Stressors, Structure, Signaling, and Infections. Dr. Sandison shares powerful recommendations: an organic ketogenic diet, dual-task exercises, proper sleep, and detoxing from things like heavy metals, mold, and chemicals. We also touched on gut health, oral hygiene, blood sugar balance, and the role of APOE gene testing. If you've been impacted by Alzheimer's or want to protect your brain for the long run this episode gives you the practical tools and real hope. #alzheimer #wellness #antiaging Dr. Heather Sandison IG: @dr.heathersandison ==== Thank You To Our Sponsors! Calroy Head on over to at calroy.com/drg and Save over $50 when you purchase the Vascanox and Arterosil bundle at https://calroy.com/rachel. Cornbread Hemp Head to cornbreadhemp.com/DRG and use code DRG at checkout for a special discount—Cornbread Hemp: This is the good life. ==== Be sure to like and subscribe to #HealThySelf Hosted by Doctor Christian Gonzalez N.D. Follow Doctor G on Instagram @doctor.gonzalez https://www.instagram.com/doctor.gonzalez/ Sign up for our newsletter! https://drchristiangonzalez.com/newsletter/

Two-thirds of those diagnosed with Alzheimer's disease are women — but why? In this episode, we unpack the neurological, hormonal, and social drivers that uniquely affect women's brain health during the menopausal transition — from estrogen's protective role in the brain to the misunderstood history of hormone replacement therapy. We discuss: • Why women face a higher risk of Alzheimer's than men • How menopause accelerates brain aging (and how it starts earlier than is often expected) • The role of estrogen in brain metabolism and neuroprotection • The real story behind hormone replacement therapy (HRT) • The impact of genes like APOE4 on women's brain health • How lifestyle factors like stress, sleep, and cognitive activity can help reduce the impact of neurological changes onset by menopause ——— Get our free curation of women's brain health resources in our Brain Box: http://thebraindocs.com/brainbox ——— To help us tell this story, we welcome three world-renowned women's health experts to the podcast: DR. LISA MOSCONI: Director of the Women's Brain Initiative, author of ‘The Menopause Brain', and pioneering researcher in brain imaging and hormonal neuroscience. MARIA SHRIVER: Founder of the Women's Alzheimer's Movement, journalist, and relentless advocate for gender equity in brain health research. DR. LISA GENOVA: Neuroscientist and bestselling author of ‘Still Alice', which was adapted into a film starring Julianne Moore, who won the  2015 Best Actress Oscar for her role as Alice Howland. This is... Your Brain On Menopause. ‘Your Brain On' is hosted by neurologists, scientists and public health advocates Ayesha and Dean Sherzai. ‘Your Brain On... Menopause' • SEASON 5 • EPISODE 1 ——— Our free Women's Brain Health Brain Box includes: • Guides on how to speak with healthcare providers about menopause • Delicious brain-healthy Mother's Day brunch recipes • Meaningful gift ideas for the women you love • Inspiring interviews with world-leading women's health experts • And even a chance to check your cognitive health with an insightful, science-backed test Get the Brain Box for free! Here: http://thebraindocs.com/brainbox ——— References: Mosconi, L. (2017). Perimenopause and emergence of an Alzheimer's bioenergetic phenotype in brain and periphery. PloS One, 12(10), e0185926.  Belloy, M. E. & Alzheimer's Disease Neuroimaging Initiative. (2019). A quarter century of APOE and Alzheimer's disease: Progress to date and the path forward. Neuron, 101(5), 820-838.  Rahman, A. (2019). Sex and gender driven modifiers of Alzheimer's: The role for estrogenic control across age, race, medical, and lifestyle risks. Frontiers in Aging Neuroscience, 11, 315.  Rocca, W. A. (2012). Hysterectomy, oophorectomy, estrogen, and the risk of dementia. Neurodegenerative Diseases, 10(1-4), 175-178.  Scheyer, O. (2018). Female sex and Alzheimer's risk: The menopause connection. Journal of Prevention of Alzheimer's Disease, 5(4), 225-230.  Women's Health Initiative Memory Study Investigators. (2003). Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women: The Women's Health Initiative Memory Study—a randomized controlled trial. JAMA, 289(20), 2651–2662.  Women's Health Initiative Investigators. (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women's Health Initiative randomized controlled trial. JAMA, 288(3), 321-333.  Whitmer, R. A. (2005). Midlife cardiovascular risk factors and risk of dementia in late life. Neurology, 64(2), 277-281.  Livingston, G. (2024). Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet, 404(10452), 572-628. Maki, P. M. (2016). Hormone therapy, dementia, and cognition: The Women's Health Initiative 10 years on. Climacteric, 19(3), 313-315. 

In this week's episode we'll learn more about how phosphoseryl-tRNA kinase inhibition promotes cell death in acute myeloid leukemia, or AML; APOE gene variants and their association with post-hematopoietic stem cell transplant outcomes in AML; and pathways by which chronic inflammation and oxidative stress may lead to cardiomyopathy in patients with sickle cell disease.Featured Articles:PSTK inhibition activates cGAS-STING, precipitating ferroptotic cell death in leukemic stem cells Common Hereditary Variants of the APOE Gene and Posttransplant Outcome in Acute Myeloid Leukemia 17R-Resolvin D1 Protects Against Sickle Cell Related Inflammatory Cardiomyopathy in Humanized Mice 

In this episode, I'm joined by Dr. Dale Bredesen, a true pioneer in Alzheimer's research and functional medicine. Together, we dive into groundbreaking advancements in the world of neurodegenerative diseases, with a special focus on the exciting breakthroughs in detecting and potentially reversing Alzheimer's and other related conditions. Dr. Bredesen sheds light on the new disease mechanisms and innovative blood tests that are changing the game, showing us that cognitive decline isn't something we simply have to accept. We also explore his integrative approach to combating Alzheimer's, which includes lifestyle modifications, early detection, and a holistic strategy for better brain health. This conversation is packed with hope and real strategies for a future where Alzheimer's doesn't have to be inevitable. Key Takeaways: New Era of Research: Alzheimer's and similar neurodegenerative diseases are not death sentences, thanks to innovative research and new treatment protocols that emphasize early detection and intervention. Significance of Gut Health: Investigations reveal that gut microbiota and inflammation are crucial risk factors in cognitive decline, underscoring the importance of gut health in preventing Alzheimer's. Role of Lifestyle Changes: Diet, exercise, sleep, and stress management are integral to maintaining brain health and can significantly influence the progression of neurodegenerative diseases. Advance in Diagnostics: Cutting-edge blood tests such as P Tau217 and brain scans can detect early signs of Alzheimer's up to 20 years prior to diagnosis, offering opportunities for preemptive action. The Power of Personalized Medicine: Individualized protocols based on genetic testing, like assessing APOE status, are pivotal in developing effective prevention and treatment strategies for cognitive disorders. More About Dr. Dale Bredesen: Dr. Dale Bredesen, M.D., is a globally recognized expert in neurodegenerative diseases, particularly Alzheimer's disease. With a background that includes graduating from Caltech and earning his M.D. from Duke University Medical Center, Dr. Bredesen's career is marked by groundbreaking research and clinical expertise. He completed his residency as chief resident in neurology at UCSF and further honed his skills at Nobel laureate Stanley Prusiner's lab at UCSF as an NIH postdoctoral fellow. Dr. Bredesen's academic career includes faculty positions at prestigious institutions like UCSF, UCLA, and UC San Diego. As the founding president and CEO of the Buck Institute for Research on Aging, he spearheaded pioneering work in the study of aging and neurodegenerative diseases. Currently, he serves as the chief medical officer of MPI Cognition, where he continues his innovative research and efforts to combat Alzheimer's and related conditions. Dr. Bredesen's expertise and leadership have made him a key figure in the field, with a focus on integrative approaches to prevent and reverse cognitive decline. His contributions are reshaping our understanding of neurodegenerative diseases, offering new hope for those affected by them. Website Instagram Take a Cognitive Assessment here: https://www.apollohealthco.com/know-your-cq/ Get a brain scan: https://getabrainscan.com/ KetoFLEX 12/3: https://www.trifectanutrition.com/apollohealthpartner Connect with me! Website Instagram Facebook YouTube   This episode is sponsored by Professional Co-op®, where clinicians gain exceptional access to industry-leading lab services without the hefty price tag—since 2001, they've been redefining what efficient, patient-focused support looks like. Imagine no hidden fees, no minimums, and only paying for completed tests. Experience lab services that not only meet but also exceed your expectations. Join the co-op trusted by countless licensed clinicians nationwide. Visit www.professionalco-op.com to learn more! This episode is also made possible by Functional Medicine University. FMU is a fully online, self-paced training program in functional medicine, founded in 2006 by Dr. Ron Grisanti. With students in all 50 U.S. states and 68 countries globally, FMU has become a cornerstone in advanced clinical education for healthcare practitioners. The curriculum is led by Dr. Grisanti, alongside contributions from over 70 distinguished medical experts on FMU's advisory board. Graduates earn the prestigious Certified Functional Medicine Practitioner (CFMP®) credential upon completion. FMU is also a nationally approved provider of continuing education for a wide range of licensed professionals, including MDs, DCs, DOs, NDs, acupuncturists, PAs, NPs, nurses, dietitians, pharmacists, and dentists. Whether you're looking to expand your clinical knowledge or bring a functional approach to your practice, FMU offers the tools, guidance, and certification to help you thrive. Visit www.functionalmedicineuniversity.com to learn more!

Aging is the leading risk factor for cognitive decline, and projected statistics show that the number of people diagnosed with Alzheimer's will reach 8.5 million by 2030 and 11.2 million by 2040.  Today, I am thrilled to connect with Dr. Heather Sandison, a naturopathic doctor and the founder and medical director of Solcere Health, a San Diego-based brain optimization clinic, and Marama, the first residential memory care facility that aims to return its residents to independent living. Dr. Sandison is also the New York Times bestselling author of Reversing Alzheimer's.  In our conversation today, Dr. Sandison and I explored the most common signs of early cognitive decline, looking at ways to differentiate dementia from formal Alzheimer's disease. We dive into the causes of dementia and Alzheimer's, examining six key imbalances that can affect ApoE status and tackle the limitations of current approaches to Alzheimer's research. We also share information on current drug modalities and touch on the importance of brain-nurturing environments and helpful activities for maintaining cognitive status as we age.  I look forward to having Dr. Sandison back for a second conversation, where we will dive deeper into practical ways to support and improve brain health. IN THIS EPISODE YOU WILL LEARN: Some early signs of neurocognitive decline Barriers to care for those with dementia or Alzheimer's What differentiates dementia from Alzheimer's? Various factors that could cause Alzheimer's The role ApoE genetics play in Alzheimer's risk How addressing lifestyle factors can help prevent cognitive decline. The limitations of current Alzheimer's treatments How the results of clinical trials on the Bredesen intervention have shown significant improvements in cognitive function Why individualized treatments are essential for managing Alzheimer's and dementia Making healthy choices accessible and creating environments that support cognitive function The benefits of making positive changes in your daily life and taking small steps to enhance brain health  Connect with Cynthia Thurlow   Follow on X Instagram LinkedIn Check out Cynthia's website Submit your questions to support@cynthiathurlow.com Connect with Dr. Heather Sandison On her website Facebook, Instagram, and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this special episode of The Drive, Peter joins a unique conversation inspired by his daughter's volunteer experience at a senior care center, where she formed meaningful relationships with residents curious about healthspan, lifespan, and strategies for living well as they age. Peter engages directly with the residents, covering critical topics like the profound impact of exercise—particularly strength training— for maintaining mobility, preventing falls, and preserving independence later in life. He also discusses the importance of nutrition, emphasizing adequate protein intake, along with strategies for sleep optimization and preservation of brain health. Peter also underscores the importance of emotional wellness, purpose, and social connections in healthy aging, provides advice on staving off chronic disease, and much more. We discuss: Peter's definition of longevity [2:30]; Why it's never too late to invest in your longevity [5:30]; The importance of adding “life to years” rather than just “years to life” [7:45]; The "four horsemen"—heart disease, cancer, neurodegenerative diseases, and metabolic conditions [9:15]; Advice for those managing chronic diseases later in life [11:30]; Why balance declines and falls become increasingly common with age, and how to prevent them [13:30]; Why strength training is essential (and effective) for older adults [18:30]; The five tools in Peter's longevity toolkit [21:00]; Practical ways older adults can safely begin exercising despite physical limitations or health issues [23:00]; Principles of good nutrition, and the importance of adequate protein intake [24:00]; The importance of sleep for cognitive health, and effective sleep-improvement strategies for seniors [27:30]; How emotional health, social connections, and a sense of purpose significantly impact quality of life and longevity [32:00]; Why Peter decided to focus his work on longevity [33:45]; Protein intake recommendations should be based on ideal body weight (not current weight) [34:45]; The potential of klotho as a therapy for improving cognitive function and combating aging-related cognitive decline [35:30]; The best types of protein supplements to consider [36:45]; The APOE gene's influence on Alzheimer's disease risk, and why everyone should proactively address brain health, regardless of genetics [38:15]; How falls can accelerate cognitive decline, and the importance of staying physically and mentally active [40:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

The FiltrateJoel TopfSwapnil HiremathAC GomezSopia AmbrusoNayan AroraSpecial Guests Michelle Rheault, Director, Division of Pediatric Nephrology, Professor of MedicineTiffany Caza, Nephropathologist, Scientist and self-described Freely Filtered fan girlEditing bySimon Topf and Sophia AmbrusoShow Notes10. Healthcare Cyberattacks9. ApoE in C3 glomerulonephropathy8. Workforce woes in Adult and Pediatric Nephrology7. Hyponatremia correction meta-analysis6. Microvascular inflammation increases risk of graft loss - in all of its forms5. Xenotransplantation4. KDIGO CKD Guidelines3. Hypertension control trials (ESPRIT, BPROAD)2. The Renaissance of IgAN: IgAN treatment trials1. FLOW: GLP-1 RAs in CKD

In this episode, Andrea Donsky, a nutritionist, menopause educator, published menopause researcher, and co-founder of WeAreMorphous.com, interviews Dr. Bredesen, the founding president of the Buck Institute for Research on Aging; he has published over 230 papers and achieved the first reversal of cognitive decline in Alzheimer's patients using a precision medicine protocol. Together, they explore cognitive health during perimenopause and menopause with Dr. Dale Bredesen, a pioneering expert in neurodegenerative diseases.Key Topics:Understanding cognitive changes during perimenopause and menopauseThe revolutionary Brain Scan Blood Test for cognitive profilingHow bioidentical hormone therapy (BHRT), nutrition, exercise, and sleep impact brain healthThe connection between dental health and brain microbiomeImpact of toxins on cognitive declineThe role of genetics (APOE states) in cognitionDeep sleep's importance for detoxing the glymphatic systemUnderstanding Heart Rate Variability (HRV) and stress managementResources Mentioned:Dr. Bredesen's RECODE Program: https://training.apollohealthco.com/courses/ReCODE-2-0 (Use code: MENOPAUSE200)Brain Scan Test: https://www.apollohealthco.com/brainscan/Free Cognitive Quotient Test: https://www.apollohealthco.com/know-your-cq-free/APOE Information: https://www.apoe4.info/Send us a text ✅ Fill out our surveys Support our SPONSORS: Qualia https://bit.ly/42mtvmx CODE MORPHUS15 BEAM Minerals https://bit.ly/41DCG1w Code MORPHUS EnergyBits https://bit.ly/49f05YV Code MORPHUS Livon: https://bit.ly/3EjrcGG CODE MORPHUS Order 1 carton of Lypo-Spheric® Vitamin C at LivOnLabs.com & get 1 carton of B Complex Plus FREE ($56 value) just by adding both products to the cart Timeline: timeline.com/morphus CODE MORPHUS

Subscribe to our channel: https://www.youtube.com/@optispanIn this video we discuss current studies relating to Rapamycin use and it's effects on brain function, specifically for APOE4 carriers. This data may (or may not) provide evidence to support the claim that Rapamycin can be beneficial for those with the APOE4 variant.0:00 - Introduction1:58 - Should APOE4 Carriers Take Rapamycin? 3:30 - What is APOE and APOE4? 13:06 - Why Knowing Your APOE Status Matters 15:03 - The Case for Rapamycin and APOE4 Carriers 22:52 - Study Findings32:53 - Comparing Rapamycin to Lifestyle Interventions 37:40 - Could Rapamycin Benefit E3/E3 Carriers? 38:44 - Speculation: Rapamycin and Traumatic Brain Injury Producers: Tara Mei, Nicholas ArapisVideo Editor: Jacob KeliikoaDISCLAIMER: The information provided on the Optispan podcast is intended solely for general educational purposes and is not meant to be, nor should it be construed as, personalized medical advice. No doctor-patient relationship is established by your use of this channel. The information and materials presented are for informational purposes only and are not a substitute for professional medical advice, diagnosis, or treatment. We strongly advise that you consult with a licensed healthcare professional for all matters concerning your health, especially before undertaking any changes based on content provided by this channel. The hosts and guests on this channel are not liable for any direct, indirect, or other damages or adverse effects that may arise from the application of the information discussed. Medical knowledge is constantly evolving; therefore, the information provided should be verified against current medical standards and practices.More places to find us:Twitter: https://twitter.com/optispanpodcastTwitter: https://twitter.com/optispanTwitter: https://twitter.com/mkaeberleinLinkedin: https://www.linkedin.com/company/optispanInstagram: https://www.instagram.com/optispanpodcast/TikTok: https://www.tiktok.com/@optispanhttps://www.optispan.life/Hi, I'm Matt Kaeberlein. I spent the first few decades of my career doing scientific research into the biology of aging, trying to understand the finer details of how humans age in order to facilitate translational interventions that promote healthspan and improve quality of life. Now I want to take some of that knowledge out of the lab and into the hands of people who can really use it.On this podcast I talk about all things aging and healthspan, from supplements and nutrition to the latest discoveries in longevity research. My goal is to lift the veil on the geroscience and longevity world and help you apply what we know to your own personal health trajectory. I care about quality science and will always be honest about what I don't know. I hope you'll find these episodes helpful!

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Tom Dayspring is a world-renowned expert in clinical lipidology and a previous guest on The Drive. In this episode, Tom explores the foundations of atherosclerosis and why atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death worldwide for both men and women. He examines how the disease develops from a pathological perspective and discusses key risk factors, including often-overlooked contributors such as insulin resistance and chronic kidney disease. He breaks down the complexities of cholesterol and lipoproteins—including LDL, VLDL, IDL, and HDL—with an in-depth discussion on the critical role of apolipoprotein B (apoB) in the development of atherosclerosis. Additionally, he covers the importance of testing various biomarkers, the impact of nutrition on lipid levels, and the vital role of cholesterol in brain health, including how cholesterol is synthesized and managed in the brain, how it differs from cholesterol regulation in the rest of the body, and how pharmacological interventions can influence brain cholesterol metabolism. We discuss: Defining atherosclerotic cardiovascular disease (ASCVD): development, risks, and physiological impact [2:45]; The pathogenesis of ASCVD: the silent development over decades, and the importance of early detection for prevention of adverse outcomes [10:45]; Risk factors versus risk markers for ASCVD, and how insulin resistance and chronic kidney disease contribute to atherosclerosis [17:30]; How hyperinsulinemia elevates cardiovascular risk [24:00]; How apoB-containing lipoproteins contribute to atherosclerosis, and why measuring apoB is a superior indicator of cardiovascular risk compared to LDL cholesterol [29:45]; The challenges of detecting early-stage atherosclerosis before calcification appears [46:15]; Lp(a): structure, genetic basis, and significant risks associated with elevated Lp(a) [55:30]; How aging and lifestyle factors contribute to rising apoB and LDL cholesterol levels, and the lifestyle changes that can lower it [59:45]; How elevated triglycerides, driven by insulin resistance, increase apoB particle concentration and promote atherosclerosis [1:08:00]; How LDL particle size, remnant lipoproteins, Lp(a), and non-HDL cholesterol contribute to cardiovascular risk beyond apoB levels [1:21:45]; The limitations of using HDL cholesterol as a marker for heart health [1:29:00]; The critical role of cholesterol in brain function and how the brain manages its cholesterol supply [1:36:30]; The impact of ApoE genotype on brain health and Alzheimer's disease risk [1:46:00]; How the brain manages cholesterol through specialized pathways, and biomarkers to track cholesterol health of the brain [1:50:30]; How statins might affect brain cholesterol synthesis and cognitive function, and alternative lipid-lowering strategies for high-risk individuals [1:57:30]; Exciting advancements in therapeutics, diagnostics, and biomarkers coming in the next few years [2:09:30]; Recent consensus statements on apoB and Lp(a) from the National Lipid Association (NLA) [2:12:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

Show notes: (0:48) Dr. Mark Rosenbloom and his mission (2:54) The ABCs for health optimization (8:39) APOE and COMT genes: Why they matter (14:30) Hormone therapy benefits across all ages (23:19) The Mediterranean diet and avoiding harmful foods (30:07) Follistatin gene therapy and rapamycin (43:03) How to find Dr. Rosenbloom and work with him (46:36) Outro Who is Dr. Mark Rosenbloom?   Dr. Rosenbloom is the CEO and Chief Medical Officer at LIFEFORCE Medical Institute. He began his training at Stanford University and attended Northwestern University Feinberg School of Medicine where he won the Dean's AOA Research Award and the prestigious Sigmund Winton Award in Biochemistry. Thereafter, he went on to become an Instructor and Assistant Professor of Clinical Medicine in the Department of Medicine at Northwestern University. More recently, Dr. Rosenbloom trained at the Cenegenics Education and Research Foundation and founded LIFEFORCE Medical Institute which focuses his practice on anti-aging and Bio-Identical Hormone Replacement Therapy(BHRP).   Dr. Rosenbloom is also the Founder of PEPID LLC, which is recognized as the number one developer of medical/drug information and decision support tools. PEPID is now used in schools and institutions worldwide for better risk management and higher productivity to benefit both the staff and patients. Dr. Rosenbloom has also been the Editor of "Your Health Magazine" and has been published in print and media on various topics such as age management, low testosterone for men, BHRT, medical errors, and vitamin toxicity.   An active organization member of the philanthropic community, Dr. Rosenbloom is the founder of Unicorn Children's Foundation, an organization dedicated to helping children and young adults with developmental, communication and learning disorders such as autism and ADD. In addition, he is also a Founding Member of the Interdisciplinary Council on Developmental and Learning Disorders. Dr. Rosenbloom is passionate about this cause and has publically spoken multiple times regarding Autistic-Spectrum Disorders in Children, including numerous network TV appearances in Miami, Boca Raton and Palm Beach, Florida. Connect with Dr. Rosenbloom: Website: https://www.lifeforcemed.com/ Links and Resources: Peak Performance Life Peak Performance on Facebook Peak Performance on Instagram  

Neurons have long enjoyed a kind of rock star status. We think of them as the most fundamental units of the brain—the active cells at the heart of brain function and, ultimately, at the heart of behavior, learning, and more. But neurons are only part of the story—about half the story, it turns out. The other half of the brain is made up of cells called glia. Glia were long thought to be important structurally but not particularly exciting—basically stage-hands there to support the work of the neurons. But in recent decades, at least among neuroscientists, that view has faded. In our understanding of the brain, glia have gone from stage-hands to co-stars.   My guest today is Dr. Nicola Allen. Nicola is a molecular neuroscientist and Associate Professor at the Salk Institute in La Jolla, California. She and her lab study the role of glial cells—especially astrocytes—in brain function and dysfunction.   Here, Nicola and I talk about how our understanding and appreciation of glial cells has changed. We do a bit of Brain Cells 101, reviewing the main division between neurons and glia and then sketching the subtypes within each category. We discuss the different shapes and sizes of glial cells, as well as the different functions. Glia are an industrious bunch. They're involved in synapse formation and pruning, the production of myelin, the repair of injuries, and more. We also talk about how glial cells have been implicated in various forms of brain dysfunction, from neurodegeneration to neurodevelopmental syndromes. And how, as a result, these cells are attracting serious attention as a site for therapeutic intervention.   Well, it's that time of year again folks. Applications are now open for the 2025 Diverse Intelligences Summer Institute, or DISI. This is an intense program—highly interdisciplinary, highly international—for scholars and storytellers interested in all forms and facets of intelligence. If you like thinking about minds, if you like thinking about humans and animals and plants and AIs and collectives and ways they're alike and different—you would probably like DISI. For more info, check out disi.org—that's D-I-S-I dot org. Review of applications begins March 1st, so don't dally too too long.   Alright friends—on to my conversation with Dr. Nicola Allen. Enjoy!   Notes and links 3:00 – Correction: “glia” actually comes from the Greek—not the Latin—for “glue.” 3:30 – See this short primer on glia by Dr. Allen and Dr. Ben Barres. For a bit of the history of how glial cells were originally conceived, see this article on Ramón y Cajal's contributions to glia research. 10:00 – On the nascent field of “neuroimmunology,” see here. 14:00 – On the idea that “90% of brain cells are glia” see this article by (former guest) Suzana Herculano-Houzel. 18:00 – The root “oligo” in “oligodendrocyte” means “few” (and is thus the same as the “olig” in, e.g., “oligarchy"). It is not related to the “liga-” in “ligament.” 28:00 – On the idea that the glia-neuron ratio changes as brains grow more complex, see again the article by Dr. Herculano-Houzel. 30:00 – See Dr. Allen's paper on the idea of glia as “architects.” See also Dr. Allen's paper on the idea of glia as “sculptors.” 33:00 – See Dr. Allen's paper on the idea of the “tripartite synapse.” 42:00 – A recent paper reviewing the phenomenon of adult neurogenesis.  48:00 –  See Dr. Allen's recent review of the role of astrocytes in neurodegeneration. 51:30 – A recent article on the roles of APOE in Alzheimer's.   Recommendations Glia (2nd edition), edited by Beth Stevens, Kelly R. Monk, and Marc R. Freeman   Many Minds is a project of the Diverse Intelligences Summer Institute, which is made possible by a generous grant from the John Templeton Foundation to Indiana University. The show is hosted and produced by Kensy Cooperrider, with help from Assistant Producer Urte Laukaityte and with creative support from DISI Directors Erica Cartmill and Jacob Foster. Our artwork is by Ben Oldroyd. Our transcripts are created by Sarah Dopierala.   Subscribe to Many Minds on Apple, Stitcher, Spotify, Pocket Casts, Google Play, or wherever you listen to podcasts. You can also now subscribe to the Many Minds newsletter here! We welcome your comments, questions, and suggestions. Feel free to email us at: manymindspodcast@gmail.com.    For updates about the show, visit our website or follow us on Twitter (@ManyMindsPod) or Bluesky (@manymindspod.bsky.social).

Çdo javë emisioni trajton një patologji të ndryshme, ku flasin njerëzit rreth një sëmundje, sqarohet si nisen simptomat e para dhe ndjesitë e tij. Më pas ky rrëfim i tregohet ekipit të mjekëve i cili shikon nëse mund të nxjerrin një diagnozë paraprake pa vizituar pacientin ose mund t'i japin një këshillë në mënyrë direkte, medikamente, ushtrime, këshilla, etj.

Recent progress in neurogenetics and molecular pathology has improved our understanding of the complex pathogenetic changes associated with neurodegenerative dementias. In this episode, Katie Grouse, MD, FAAN, speaks with Sonja W. Scholz, MD, PhD, FAAN, an author of the article “Genetics and Neuropathology of Neurodegenerative Dementias,” in the Continuum® December 2024 Dementia issue. Dr. Grouse is a Continuum® Audio interviewer and a clinical assistant professor at the University of California San Francisco in San Francisco, California. Dr. Scholz is a senior investigator at the National Institutes of Health in Bethesda, Maryland and an adjunct professor of neurology at Johns Hopkins University in Baltimore, Maryland. Additional Resources Read the article: Genetics and Neuropathology of Neurodegenerative Dementias Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Full episode transcript available here:  Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, which features conversations with Continuum's guest editors and authors who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME. Dr Grouse: This is Dr Katie Grouse. Today I'm interviewing Dr Sonia Scholz about her article on genetics and neuropathy of neurodegenerative dementias, which appears in the December 2024 Continuum issue on dementia. Welcome to the podcast, and please introduce yourself to our audience.  Dr Scholz: Thank you so much for inviting me. My name is Sonia Scholz. I'm a neurologist working at the National Institutes of Health. My main focus of research and clinical work are neurodegenerative diseases, and I have a particular interest in using modern genomic tools to understand these diseases and potentially leverage it for new translational applications. Dr Grouse: Sonia, we're really excited to have you today and thanks for joining us.  Dr Scholz: I'm pleased to be here.  Dr Grouse: I'd like to start by asking what you think is the most important message or takeaway point from your article? Dr Scholz: So, this is an article that really captures a very broad and exciting field. So, one thing I wanted to really highlight is that there's a lot of heterogeneity, clinical, pathological, molecular heterogeneity in age-related neurodegenerative dementia syndromes. Our article was really aimed at providing a bird's eye view of the pertinent pathological characteristics, but also important genetic advances and insights and how we can leverage that, particularly in the new physician medicine era, hopefully come up with better treatments and better ways to counsel our patients.  Dr Grouse: What do you think is the most challenging aspect of understanding the genetics and neuropathologic basis of neurodegenerative dementias?  Dr. Scholz: That's a good question. There're many big and challenging questions, but I think one of the things we struggle the most with is really the heterogeneity. I see patients with one and the same Mendelian form of dementia. One patient is in their forties another patient is in their eighties, and the clinical manifestations can be very different from one patient to another. There's a lot of heterogeneity, also, on the pathological level. Not every patient has exactly the same distribution. And so, we're starting to slowly define what the underlying causes are, but it's still quite baffling and quite challenging to put them together and understand them. Dr Grouse: Do you feel that the genome-wide association studies has helped our understanding of these diseases, specifically the heterogeneity? And if so how?  Dr Scholz: That's a great question, but you're talking to a geneticist here. And I definitely would say genome-wide association studies have helped us a lot in identifying what the underlying disease pathways are and what the relationships between neurodegenerative disease entities are. It really also gave us a better understanding of apparently sporadic diseases where genetic factors are still playing a role. And we can leverage that type of knowledge increasingly to highlight high-risk groups, but also, we can increasingly use it to stratify patients for clinical trials, for example. And that's really exciting and there's still a lot of knowledge that we have to garner very quickly, especially in the non-Alzheimer dementia space.  Dr Grouse: You've mentioned, of course, the heterogeneity and these syndromes. And in your article, you go into a lot of the issue of the significant crossover between the genetic links and the neuropathological findings for the various types of neurodegenerative dementias. Do you think that this crossover has been more of a help or a hindrance in better understanding these diseases? Dr Scholz: Yeah, it can be a little bit, you know, challenging to wrap one 's mind around it. But by and large, I think it's actually good news because it highlights that there is a shared biology between many of the neurodegenerative disease entities. And by figuring out which the pathways are that are very often involved, we can prioritize certain targets for therapy development. But we can also be smarter about how we developed treatments. We could repurpose a drug that has been developed for Alzheimer's disease very easily for Lewy body dementia because we increasingly understand the overlap. And we can also leverage new clinical trials design, like basket trials. This is something that has been really transformative in the oncology sphere and now, increasingly, neurodegeneration. We're trying to apply that kind of thinking as well to our patient populations. Dr Grouse: What do you think our listeners will find to be most surprising when they read the article? Dr Scholz: We often present these diseases in our textbooks as these black-and-white entities, but the reality is that there's a lot of overlap. And we also see that co-pathologies are actually the norm and not the exception, and a lot of the molecular risk factors are shared. It's not really surprising. And I think that overlap and crosstalk between the various diseases is something that's a little bit strange to think about, but it actually makes increasingly sense now that we see the genetic risk profiles coming up. Dr Grouse: In reading your article, I was really struck by how many, or how much the prior studies have been lacking in inclusion of different ethno-racial backgrounds in the patients who've been studied. How can this be improved going forward?  Dr Scholz: Yeah, thank you. That's a really important and crucial question, and I think it really takes the collective effort of everybody in the healthcare research community to improve upon that. We need to talk to our patients about genetic testing, about brain donation programs, about referrals to clinical trials, and don't feel shy about reaching out to our colleagues and academic centers, even if you don't have the resources in a smaller institution. We also not only need to engage with the communities, we also need to build up a healthcare research community that has representatives from these various communities. So, it's really a collective effort that we build up and are proactive about building a more equitable healthcare system and research system that works for all of us and that really is going to provide us with the precision medicines that work for everybody. Dr Grouse: What do you think is the biggest debate or controversy related to the genetics and neuropathology of neurodegenerative dementias?  Dr Scholz: Yeah, there are loads of interesting debates, but I think in my field, in particular in the genetics is what to do with risk variance. What is it that I actually communicate to the patient? Obviously, I can learn a lot on the bench and I think I can use a lot of the genetic risk factors for molecular modeling, etc. But to which extent should I share that information? Because genetic information is something that we cannot alter and many of the risk factors are actually mild, that they may never result in disease. And so, communicating risk with patients is something that's very challenging and we used to just steer away from it. But now the discussion is starting to shift a little bit. You know, nowadays we are starting to offer, for example, testing for the APOE4 allele in individuals who are considering antiamyloid therapies. And this really, this is precision medicine in his earliest days because it allows us to stratify patients into those that are high-risk versus low-risk and those that need more frequent follow-up or may be advised not to pursue this treatment. And we're probably going to see more of those discussions and the ethics around it. And it's even harder in an aged population where you know, you may never manifest any of the symptoms despite carrying a lot of these risk deals. Dr Grouse: You mentioned, you know, that testing, APOE4 testing for certain populations when deciding to do the antiamyloid immunotherapies. Apart from that, which I think is a really good example of where genetic testing makes sense, what other scenarios do you think it makes sense at this point in time to recommend genetic testing for symptomatic patients who are concerned about neurodegenerative dementias? Dr Scholz: Yeah. So, I usually have a very frank discussion with patients in whom I suspect the genetic etiology. So those are individuals who have a strong family history, individuals from very early onset of the disease where genetic testing may allow us to establish a molecular diagnosis, individualize and refine our counseling, and potentially get them into targeted clinical trials that may be suitable for that. Those are always very nuanced discussions, but I usually start with those high-risk individuals. Increasingly patients are, even with the apparently sporadic forms, are asking me about it. And then I have a frank discussions about the pros and cons and offer it to the patients who really would like to pursue it.  Dr Grouse: That makes a lot of sense. What about in the case of patients who are asymptomatic but might have high risks because of, well, family members with certain types of neurodegenerative dementias? When would it make sense, if ever, to do genetic testing for them? Dr Scholz: Yeah, that's a that's a tough situation, to be honest. By and large, I would say I would like to understand what the motivation is to learn about the genetic status. If the motivation is something like family planning, future care planning, etc, then it may be a reasonable thing. But I also want to make it very clear upfront that knowing a genetic status, at least aside from APOE status, at least for now, doesn't actually change the clinical management. And I want to make sure patients understand if they are trying to lower their risk, knowing that genetic status is not going to lower their risk. There are other things, brain health habits, that are really important, that patients should double down on: avoiding vascular disease, avoiding traumatic brain injury, excessive alcohol use, etcetera. It's a discussion that really tries to understand the motivations behind the testing. But some patients are very frank and they want to have it. They may want to contribute to the research community, and so in those instances we may offer it, but I also really want to make them understand that knowing a genetic diagnosis may be acceptable to them, but family members who are related to them may not wish to know. And they can really cause a lot of psychological stress that extends beyond the individual. And then that's something to really consider before actually pursuing testing. Dr Grouse: I think that's a really good reminder, especially about how this can even affect people outside of the patient themselves. I think a lot of us don't even think about that. And certainly, our patients may not either. Taking it a step further, thinking about newly available biomarkers, imaging modalities, how should we incorporate the use of these for our patients when we're suspicious of things like Alzheimer's disease or dementia with the Lewy bodies? Dr Scholz: So by and large these biomarkers are used in in the research area, but we can, in a given patient where maybe the clinical presentation is somewhat atypical, we can use it to help with our diagnostic impression. It doesn't get rid of the clinical evaluation, but at least it gives us a little bit more certainty. Here are the you know, the molecular features, the abnormal amyloid tau deposits, for example, that we're there we're detecting supports diagnosis. May also sometimes help in patients where we suspect there could be even the co-pathology going on where we get a mixture of features, where we can counsel the patients and you know, detecting copathologies is something that is certainly challenging. We know that patients who have more pathologies on average are not doing as well as the ones who have relatively pure disease forms. But this is also an area of intense research and as long as it's used judiciously to help with the diagnostic compression, to reduce a diagnostic odyssey, I think there's a lot of potential there to improve the clinical evaluations nowadays. Dr Grouse: It is really exciting to see the options that are opening up as the years go by, which brings me to my next question. There is certainly, as we know, this new category of disease modifying therapies that are available in the form of the anti-amyloid immunotherapies. What else do you think's on the horizon for treatment and prevention, neurodegenerative dementias, going down the road five, ten, fifteen years down the line?  Dr Scholz: Yeah, I think we're entering the era of precision medicine already and we're, we're seeing it already with the anti-amyloid therapies. By and large, I think the standard of care is going to be a multidisciplinary individualized treatment plan that incorporates a more holistic view. It incorporates diet, lifestyle factors, symptomatic management, but also disease modification strategies and potentially even multitarget disease modifying strategies. I think there's a lot more work that we have to do, especially in in the non-Alzheimer's dementia field. But overall, we're becoming much better in refining our diagnostic impression and in treating some of the complications that arise in these very complex diseases.  Dr Grouse: I'm curious, with the future of dementia care and diagnosis being more of a precision medicine model, how do you think this will be possible in an aging population with already, I think, probably a limited access to neurologists even in current state? Dr Scholz: Yeah, this is- these are these are very challenging societal questions. Increasingly, you know, we can use modern technologies such as televisits for follow up, but also, you know, remote monitoring devices. We have to educate the next generation, we need more neurologists, we can't do it alone; but we also need to empower primary care doctors who are usually the first go-to person. And perhaps biomarker testing will become much more common even in the primary care setting. I think overall, you know, we can tackle it by educating the community, empowering participants in various clinical trials, and being flexible of embracing certain new technologies. Dr Grouse: Absolutely. I think that makes a lot of sense and hopefully this will be another call to arms to try to get the word out, get more access to neurology and more people interested and like you said, getting our other colleagues involved and being able to manage it as well.  Dr Scholz: Yeah.  Dr Grouse: I wanted to transition a little bit into learning more about you. How did you become interested in genetics of neurodegenerative dementias? Dr Scholz: Yeah, it's something, it's an interest that has grown gradually. I started out as a neuroscientist in in Austria, where I was fortunate to work with a group that was very strongly involved in Parkinson's disease care. And I was so thrilled to see patients, you know, treated with deep brain stimulation. But yet in the same clinic, I also saw the patients who were not eligible because they had atypical neurodegenerative diseases. And it's the realization that there is such a broad spectrum of diseases that we frankly don't understand very well, that we really need to work with, understand and hopefully develop the treatments with. That's really has resonated with me. And I've since then really built my entire career around it through different countries at the United Kingdom and the United States. And I'm very fortunate to work at the National Institutes of Health, where I can pursue a lot of these research passions and work with interesting patients and colleagues.  Dr Grouse: Well, I've learned a lot today, and I'm sure our listeners would agree. Thank you so much for joining us. It's really been a pleasure speaking with you.  Dr Scholz: Well, thank you so much for allowing me to contribute. And, you know, I hope the review article conveys a lot of the exciting developments in this really challenging field. But there's loads of hope that we will eventually get to the point to tackle these conditions.  Dr Grouse: I encourage all of our listeners to check out Dr Scholz 's article. It is a great overview of these conditions and the genetics and neuropathology underlining them. Again, thank you so much.  Dr Scholz: Thank you for having me. Dr Grouse: Again, today I've been interviewing Dr Sonia Scholz, whose article on genetics and neuropathology of neurodegenerative dementias appears in the most recent issue of Continuum on dementia. Be sure to check out Continuum audio episodes from this and other issues. And thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, associate editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use this link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/AudioCME. Thank you for listening to Continuum Audio.

A pragmatic and organized approach is needed to recognize patients with symptomatic Alzheimer Disease in clinical practice, stage the level of impairment, confirm the clinical diagnosis, and apply this information to advance therapeutic decision making. In this episode, Aaron Berkowitz, MD, PhD, FAAN, speaks with Gregory S. Day, MD, MSc, MSCI, FAAN, author of the article “Diagnosing Alzheimer Disease,” in the Continuum December 2024 Dementia issue. Dr. Berkowitz is a Continuum® Audio interviewer associate chief medical information officer at the Cleveland Clinic in Cleveland, Ohio. Dr. Day is an associate professor in the Department of Neurology at Mayo Clinic Florida in Jacksonville, Florida. Additional Resources Read the article: Diagnosing Alzheimer Disease Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @AaronLBerkowitz Guest: @GDay_Neuro Full episode transcript available here Dr Jones: This is Doctor Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, which features conversations with Continuum's guest editors and authors, who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME. Dr Berkowitz: This is Dr Aaron Berkowitz, and today I have the pleasure of interviewing Dr Gregory Day about his article on Alzheimer disease, which appears in the December 2024 Continuum issue on dementia. Welcome to the podcast, Dr Day. Would you mind introducing yourself to our audience?  Dr Day: Thanks very much, Aaron. I'm Gregg Day. I'm a behavioral neurologist at Mayo Clinic in Jacksonville, Florida, which means that my primary clinical focus is in the assessment of patients presenting typically with memory concerns and dementia in particular. Dr Berkowitz: Fantastic. Well, as we were talking about before the interview, I've heard your voice many times over the Neurology podcast and Continuum podcast. I've always learned a lot from you in this rapidly changing field over the past couple of years, and very excited to have the opportunity to talk to you today and pick your brain a little bit on this very common issue of evaluating patients presenting with memory loss who may have concerns that they have dementia and specifically Alzheimer disease. So, in your article, you provide a comprehensive and practical approach to a patient presenting for evaluation for possible dementia and the question of whether they have Alzheimer disease. The article is really packed with clinical pearls, practical advice. I encourage all of our listeners to read it. In our interview today, I'd like to talk through a theoretical clinical encounter and evaluation so that I and our listeners can learn from your approach to a patient like this. Let's say we have a theoretical patient in their seventies who comes in for evaluation of memory loss and they and/or their family are concerned that this could be Alzheimer disease. How do you approach the history in a patient like that? Dr Day: It's a great way to approach this problem. And if you're reading the article, know that I wrote it really with this question in mind. What would I be doing, what do we typically do, when we're seeing patients coming with new complaints that concern the patient and typically also concern those that know the best? So be that a family member, close friend, adult child. And in your scenario here, this seventy year old individual, we're going to use all the information that we have on hand. First off, really key, if we can, we want to start that visit with someone else in the room. I often say when talking to individuals who come alone that there's a little bit of irony in somebody coming to a memory assessment alone to tell me all the things they forgot. Some patients get the joke, others not so much, but bringing someone with them really enhances the quality of the interview. Very important for us to get reliable information and a collateral source is going to provide that in most scenarios. The other thing that I'm going to start with, I'm going to make sure that I have appropriate time to address this question. We've all had that experience. We're wrapping up a clinical interview, maybe one that's already ran a little bit late and there's that one more thing that's mentioned on the way out the door: I'm really concerned about my memory or I'm concerned about mom 's memory. That's not the opportunity to begin a memory assessment. That's the opportunity to schedule a dedicated visit. So, assuming that we've got someone else in the room with us, we've got our patient of interest, I'm going to approach the history really at the beginning. Seems like an easy thing to say, but so often patients in the room and their caregivers, they've been waiting for this appointment for weeks or months. They want to get it out all out on the table. They're worried we're going to rush them through and not take time to piece it together. And so, they're going to tell you what's going on right now. But the secret to a memory assessment, and particularly getting and arriving at an accurate diagnosis that reflects on and thinks about cause of memory problems, is actually knowing how symptoms began. And so, the usual opening statement for me is going to be: Tell me why you're here, and tell me about the first time or the first symptoms that indicated there was an ongoing problem. And so, going back to the beginning can be very helpful. This article is focused on Alzheimer disease and our clinical approach to the diagnosis of Alzheimer disease. And so, what I'm going to expect in a patient who has a typical presentation of Alzheimer disease is that there may be some disagreement between the patient and the spouse or other partners sitting in the room with me about when symptoms began. If you've got two partners sitting in the room, maybe an adult child and a spouse, there may be disagreement between them. What that tells me is at the onset, those first symptoms, they're hard to pin down. Symptoms typically emerge gradually in patients with symptomatic Alzheimer disease. They may be missed early on, or attributed or contributed to other things going on in the patient's time of life, phase of life. It's okay to let them sort of duke it out a little bit to determine, but really what I'm figuring out here is, are we talking about something that's happened across weeks, months or more likely years? And then I'm going to want to listen to, how did symptoms evolve? What's been the change over time? With Alzheimer disease and most neurodegenerative diseases, we expect gradual onset and gradual progression, things becoming more apparent. And at some point, everyone in the room is going to agree that, well, as of this state, there clearly was a problem. And then we can get into talking about specific symptoms and really begin to pick that apart the way that we traditionally do in any standard neurological assessment. Dr Berkowitz: Fantastic. And so, what are some of the things you're listening for in that history that would clue you in to thinking this patient may indeed be someone who could have Alzheimer's disease and going to require a workup for that diagnosis? Dr Day: It's pretty common when I have new trainees that come to clinic, they just head into the exam room and they sort of try to approach it the way that we would any patient in the emergency department or any other clinical scenario. The challenge with that is that, you know, we're taught to let the patient speak and we're going to let the patient speak - open-ended questions are great - but there's only so many questions you need to sort out if someone has a memory problem. And memory is really only one part, one component, of a thorough cognitive evaluation. And so, I'm going to help by asking specific questions about memory. I'm going to make sure that there is memory challenges there. And whenever possible, I'm going to solicit some examples to back that up, add credibility and sort of structure to the deficits. I'm also going to choose examples that help me to understand how does this concern, or this complaint, how does that actually affect the patient in their day-to-day life? Is it simply something that they're aware of but yet hasn't manifested in a way that their partner knows about? Is it to a level where their partner's actually had to take over their responsibility? It's causing some difficulties, disability even, associated with that. That's going to be important for me as I try to understand that. So, I'll ask questions when it comes to memory, not just, you know, do you forget things, but do you manage your own medications? You remember to take those in the morning? Do you need reminders from your partner? What about appointments; health appointments, social appointments? Are you managing that on your own? Sometimes we need a little bit of imagination here. Partnerships, and particularly those who have been together for a long time, it's natural that different people are going to assume different responsibilities. And so, might have to say, Imagine that you went away for the weekend. Would you worry about your partner remembering to take their medications over that time frame? That can help to really solidify how much of an impact are these challenges having on a day-to-day basis. I may ask questions about events, something that they maybe did a couple of weeks ago. Is the patient likely to remember that event? Are they going to forget details? Maybe the most important of all, with each of these, when there's a yes or an affirmation of a problem, we want to be clear that this represents a change from before. We all have forgetfulness. Happens on a day-to-day basis, and we all pay attention to different details, but what we're concerned about and typically the reasons patients want to come and see us as neurologists is because they've noticed a change. And so, I'm going to focus in on the things that represent a change from before. After I've discussed memory, I think it's really important to talk about the other domains. So, how is judgment affected? Decision-making?  In a practical way, we often see that borne out in financial management, paying the bills. Not just paying them on time and consistently, but making wise choices when it comes to decisions that need to be made. You're out at a restaurant. Can you pay the bill? Can you calculate a tip? Can you do that as quickly and as efficiently as before? Are we starting to see a breakdown in decision-making abilities there? We can sometimes lump in changes in behavior along with judgment as well. The patient that you know, maybe isn't making wise choices, they've picked up the phone and given their social security number out to someone that was calling, seeming to be well-meaning. Or maybe they've made donations to a few more institutions than they would have otherwise? Again, out of- out of order. Again, something that could be atypical for any individual. Looking for behavioral changes along with that as well. And then I'm going to talk about orientation. What's their ability to recognize days of the week, date of the month? Do they get lost? Is there concerns about wayfinding? Thinking about that, which is really a complex integration of some memory, visuospatial processing, judgment, problem solving, as we look to navigate our complex world and find our way from point A to B. And then I like to know, you know, what are they doing outside of the home? What are they doing in the community? How are they maintaining their engagement? Do they go to the store? Do they drive? An important topic that we may need to think about later on in this patient 's assessment. And inside the home? What responsibilities do they maintain there? Are the changes in decision making, memory problems, are they manifesting in any lost abilities inside the home? Cooking being a potentially high-risk activity, but also using typical appliances and interacting with technology, in a way that we are all increasingly, increasingly doing and increasingly reliant on. And last but not least, you know, maybe the one that everyone wants to think about, well, I can still manage all of my own personal care. Well, good news that many of our patients who have early symptoms can manage their own personal care. Their activities of daily living are not the big problem. But we do want to ask about that specifically. And it's not just about getting in the shower, getting clean, getting out, getting your teeth brushed. Do you need reminders to do that? Do you hop in the shower twice because you forgot that you'd already been in there once during the day? And so, asking some more of those probing questions there can give us a little bit more depth to the interview and really does sort of round out the overall comprehensive history taking in a patient with a memory or cognitive concern. Dr Berkowitz: Fantastic. That was a comprehensive master class on how to both sort of ask the general questions, have you noticed problems in fill in the blank memory, judgment, behavior, orientation, navigation and to sort of drill down on what might be specific examples if they're not offered by the patient or partner to try to say, well, in this domain, tell me how this is going or have you noticed any changes because the everyone's starting from a different level cognitively based on many factors. Right? So, to get a sense of really what the change is in any of these functions and how those have impacted the patient's daily life. So, let's say based on the history, the comprehensive history you've just discussed with us, you do find a number of concerning features in the history that do raise concern for dementia, specifically Alzheimer's disease. How do you approach the examination? We have the MoCA, the mini-mental. We have all of these tools that we use. How do you decide the best way to evaluate based on your history to try to get some objective measure to go along with the more subjective aspects of the history that you've ascertained? Dr Day: And you're honing in on a really good point here, that the history is one part of the interview or the assessment. We really want to build a story and potentially and hopefully a consistent story. If there are memory complaints, cognitive complaints from history, from reliable- that are supported by reliable collateral sources, we're going to expect to see deficits on tests that measure those same things. And so, I think that question about what neuropsychological measures or particular bedside tests can we integrate in our assessment is a good one. But I'll say that it's not the end-all-be-all. And so, if you've got a spouse, someone that lives with an individual for twenty or thirty years, and they're telling you that they notice a change in daily activity and it's impairing their day to day function, or where there's been some change or some concern at work, that's going to worry me more than a low score on a cognitive test with a spouse saying they haven't noticed any day-to-day impact. And so, we're going to take everything sort of in concert and take it all together. And it's part of our job as clinicians to try to process that information. But often we're going to see corroborating history that comes from a bedside test. He named a few that our listeners are probably pretty familiar with. I think they're the most common ones that are used. The Mini-Mental State Exam, been in practice for a long time. All the points add up to thirty and seems to give a pretty good sample of various different cognitive functions. The Montreal Cognitive Assessment, another favorite; a little bit more challenging of a test, I think, if we're if we're looking at how people tend to perform on it. And like the MMSE, points add up to thirty and gives a pretty good sample. There are others that are out there as well, some that are available without copyright and easy for use in clinical practice. The Saint Louis Mental Status Exam comes to mind. All these tests that we're willing to consider kind of share that same attribute. They can be done relatively quickly. They should sample various different aspects of function. There should be some component for language reading, spoken, spoken word, naming items, something that's going to involve some kind of executive function or decision making, problem solving. Usually a memory task where you're going to remember a set of words and be asked to recall that again later. So, learn it, encode it, and recall it later on. And then a few other features, I mean, some of them, these tests, most of these tests use some sort of drawing tasks so that we can see visuospatial perception and orientation questions about date, time, location, sort of the standard format. Any of these tests can be used aptly in your practice. You're going to use the one that you're most comfortable with, that you can administer in a reasonable amount of time and that seems to fit with your patient population. And that's the nuance behind these tests. There are many factors that we have to take into account when we're picking one and when we're interpreting the test results. These tests all generally assume that patients have some level of traditional sociocultural education that is westernized for the most part. And so, not great tests for people that aren't well into integrated into the community, maybe newcomers to the United States, those that have English as a second, third, or fourth language, as many of our patients do. Statements like no ifs, ands, or buts may not be familiar to them and may not be as easy to repeat, recall and remember. And so, we want to weigh these considerations. We may need to make some adjustments to the score, but ideally, we're going to use these tests and they're going to show us what we expect and we're going to try to interpret that together with the history that we've already ascertained. When I obtain that history and I'm thinking about memory loss, I'm going to look at the specific domain scores. And so, if I'm using the mini mental state examination thirty point test, but three questions that relate to relate to recall. Apple, penny, table. And so, depending on how our patients do on that test, they could have an overall pretty good score. Twenty seven. Oh, that looks good. You're in the normal range according to many different status. But if I look at that and there's zero out of three on recall, they could not remember those three items, that may support the emergence of a memory problem. That may corroborate that same thing on the MoCA, which uses five-item recall, and other tests in those same parameters. I mentioned some other caveat cities testing. Are patients who are presenting with prominent language deficits important part of cognition. They can't get the words out. They can't frame their sentences. They may really struggle with these tests because a lot of them do require you to both understand verbal instructions and convey verbal instructions. People with prominent visual problems, either visual problems that come because of their neurodegenerative disease and so part of cognition, visual perceptual problems, or people who simply have low vision. Are there difficulties for that? These tests require many people to read and execute motor commands, to draw things, to follow lines and connect dots, all very difficult in that setting. And so, we have to be cautious about how we're interpreting test results in patients who may have some atypical features or may arrive with sort of preexisting conditions that limit our ability to interpret and apply the test to clinical practice.  Dr Berkowitz: Really fantastic overview of these tests, how to use them, how to interpret them. It's not all about the number. As you said, it depends if all the points are lost in one particular domain, that can be salient and then considering, as you said, the patient 's background, their level of education, where English falls in their first language, second, third or fourth, as you said, and then some of the aspects of the MoCA, right, are not always as culturally sensitive since it's a test designed in a particular context. So, let's say your history and exam are now concerning to you, that the patient does indeed have dementia. Tell us a little bit about the next steps in the laboratory neuroimaging evaluation of such a patient?  Dr Day: I've got a history of memory and thinking problems. I've got some corroborating evidence from bedside cognitive testing, a normal neurological exam. This is where we think about, well, what other tests do we need to send our patients for? Blood testing really can be pretty cursory for most patients with a typical presentation who have typical risk factors, and that can include a thyroid study and vitamin B12. So, measuring those in the blood to make sure that there's no other contributions from potential metabolic factors that can worsen, exacerbate cognitive function. And pretty easy to do for the most part, if patients have other things in their history, maybe they come from a high-risk community, maybe they engage in high risk behaviors, I may think about adding on other tests that associate with cognitive decline. We'll think about the role of syphilis, HIV, other infections. But generally, that's when it's driven by history, not a rule of thumb for me in my typical practice. But beyond the blood tests, neuroimaging, some form of structural brain imaging is important. A CT scan will get you by. So, if you have a patient that can't get in the scanner for one reason or another or won't get in the scanner, or you don't have easy access to an MRI, a CT scan can help us in ruling out the biggest things that we're looking for. That's strokes, hemorrhages, and brain masses. So other things that obviously would take us down a very different path, very different diagnosis and very different treatment approach. An MRI, though, is going to be preferred, not only because it gives us a much higher-resolution view, but also because it helps us to see sort of regional areas of atrophy. It's a sensitive scan to look for small vessel disease, tiny strokes, tiny bleeds, microhemorrhages that again might point towards meteorology for us. Of course, it's better at finding those small masses, whether they be metastasis or primary masses, that could give us something else to consider in our diagnostic evaluation. I get an odd question often from patients, well, can you see Alzheimer's disease on an MRI? And the true answer to that is no, you can't. Can we see the signs of Alzheimer's disease? Sure, in some patients, but really what we see on an MRI is a reflection of neurodegeneration. And so, we see evidence of tissue loss and typically in areas that are most often involved early on in Alzheimer's disease. The hippocampus, the entorhinal areas around the hippocampus, we may see atrophy there. We may see biparietal atrophy, and of course, as the disease progresses, we're going to see atrophy distributed throughout other areas of the brain. But if you're looking for atrophy, you've got to have a pretty good idea what's normal for age and what you expect in that patient population. So, I do encourage clinicians who are assessing patients routinely, look at your own images, look at the images for patients with and without cognitive impairment. So we develop a pretty good sense for what can be normal for age, and of course work with our colleagues in radiology who do this for a living and generally do an excellent job at it as well.  Dr Berkowitz: Perfect. So, you're going to look for the so-called reversible causes of dementia with serum labs, structural imaging to either rule out or evaluate for potential structural causes that are not related to a neurodegenerative condition or patterns of regional atrophy suggestive of a neurodegenerative condition, and maybe that will point us in an initial direction. But the field is rapidly expanding with access to FDG-PET, amyloid PET, CSF biomarkers, genetic testing for APOE 4, probably soon to be serum biomarkers. So, patients may ask about this or a general neurologist referring to your clinic may ask, who should get these tests? When should we think about these tests? How do you think about when to send patients for advanced imaging, CSF biomarkers, genetic testing for APOE 4? Dr Day: It's not that patients may ask about this. Patients will ask about this. And you've probably experienced that in your own world as well. They're going to ask about any of these different biomarkers. Certainly, whatever they've recently read or has been covered on television is going to be common fodder for consideration in the clinic environment. It's important to know what tests you can get, what reliable tests that you can get, and to know the differences between some of these tests when making a recommendation or weighing the pros and cons of doing additional testing. I think common practice principles apply here. Let's order tests that are going to change our next steps in some way. And so, if we have a patient, particularly a patient like the one that we've been talking about: seventy something year old, presenting with memory complaints, they're concerned, the family is concerned. We've got that history, physical exam, and now we may need to really hone in on the etiology. Well, I say may need because for that patient it may be enough to know, yeah, I agree, there's a problem here. And I can say it's an amnestic, predominant, gradual-onset progressive cognitive decline. This is probably Alzheimer disease based on your age. And maybe that's all they want to hear. Maybe they're not ready to pursue additional testing or don't see the value or need for additional testing because it's not going to change their perspective on treatment. In that case, it's okay to apply an often underrated test, which is the test of time. Recognizing this is a patient I can follow. I can see them in six months or twelve months, depending on what your clinic schedule allows. If this is Alzheimer disease, I'm going to expect further gradual progression that may affirm the diagnosis. We can think about symptomatic therapies for a patient like that, perhaps Donepezil as an early, early medication that may help with symptoms somewhat and we can leave it at that for the time being. But there's many scenarios where that patient or the family member says, look, I really need to know. We really want this answer. And as you pointed out, there are good tests and increasingly good tests that we have access to.  Dr Berkowitz: Well, that's a very helpful overview of the landscape of more precise diagnostic testing for Alzheimer disease specifically and how you think about which tests to order and when based on your pretest probability and the patient 's candidacy for some of these new potential therapies. To close here, as you said, treatment is discussed in another podcast. There's another article in this issue. So, we won't get into that today. But let's say you have gotten to the end of the diagnostic journey here. You are now convinced the patient does have Alzheimer's disease. How do you present that diagnosis to the patient and their family? Dr Day: I think here we're going to recognize that different styles align with different patients and families, and certainly different clinicians are going to have different approaches. I do tend to take a pretty direct approach. By the time that patients are coming to see me, they've probably already seen another neurologist or at least another physician who's maybe started some of the testing, maybe even built the foundation towards this diagnosis and shared some indications. Certainly, when they look up my profile before they come to see me, they know what I specialize in and so, they may even have done their own research, which has ups and downs in terms of the questions that I'll be faced with at that point in time. The way I like to start is first acknowledging the symptoms. And the symptoms that the patients have shared with me, recognizing if those symptoms are impacting daily life, how they impacted daily life, and usually using that information to synthesize or qualify the diagnosis. Is there cognitive impairment, yes or no? And at what level is that cognitive impairment? Is this mild cognitive impairment? Is this mild dementia? Is it maybe more moderate or severe dementia? So, using those terms directly with patients and explaining the meaning of them. But I then transition in relatively quickly to the important point of not leaving it at the syndrome, but actually thinking about the cause. Because it is cause that patients come to talk about. And if they don't say that directly, they say it in their next question, which is what are we going to do about it and how are we going to treat this? And so, I will use the information I have available at that time to suggest that based on your age, based on the history, the normal physical examination, the performance and the bedside testing that we've done. And hey, that's pretty normal structural imaging or imaging that only shows a little bit of atrophy in a few areas. I think that this condition is most consistent with symptomatic Alzheimer's disease, mild cognitive impairment due to Alzheimer's disease, or mild dementia due to Alzheimer's disease. And then I'll discuss the next options in terms of testing and try to get a feel of what our patients are thinking about when it comes to treatment. Do they want to be on the cutting edge with brand-new therapies that offer potential benefits but counterbalance by pretty substantial risks that warrant individualized discussions? Are they interested in symptomatic therapies? Would that be appropriate for them? And I can usually round out the discussion with advice that works for everyone. And that's where we talk about the importance of brain health. What are the other things that I should be doing, you should be doing, and our patients and their partners should be doing as well to maintain our brain in its best possible state as we hope that we all continue to age and look towards the future where we maintain our cognition as best as possible? And that is still the goal. Even when we're talking to patients who have neurodegenerative diseases that are working against our efforts, we still want to do what we can to treat other problems, to evaluate for other problems that may be contributing to decline and may be amenable to our management as well.  Dr Berkowitz: Well, thank you so much for taking the time to speak with us today. I've learned a lot from your very nuanced and thoughtful approach to taking the history, performing the examination, making sense of cognitive tests and how they fit into the larger picture of the history and examination, and thinking about which patients might be candidates for more advanced imaging as we try to make a precise diagnosis in patients who may be candidates and interested in some of the potential novel therapies, which we both alluded to a few times, but are deferring to another podcast that we'll delve more deeply into that topic in this series. So, thank you so much again, Dr Day. Again, I've been interviewing Dr Gregory Day from the Mayo Clinic, whose article on Alzheimer's disease appears in the most recent issue of Continuum on Dementia. Be sure to check out Continuum Audio episodes from this and other issues. And thank you so much to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, associate editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use this link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/AudioCME. Thank you for listening to Continuum Audio.

In this episode, Lyell K. Jones Jr, MD, FAAN, speaks with Lisa C. Silbert, MD, MCR, FAAN, who served as a guest editor of the Continuum® December 2024 Dementia issue. They provide a preview of the issue, which publishes on December 2, 2024. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Silbert is co-director at Oregon Alzheimer's Disease Research Center, a Gibbs Family Endowed professor of neurology, a professor of neurology at Oregon Health & Science University, a staff neurologist, director of Cognitive Care Clinic, and director of the Geriatric Neurology Fellowship Program at Portland Veterans Affairs Health Care System in Portland, Oregon. Additional Resources Continuum website: ContinuumJournal.com Subscribe to Continuum: shop.lww.com/Continuum More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology, clinical review and CME journal from the American Academy of Neurology.  Thank you for joining us on Continuum Audio, a companion podcast to the journal.  Continuum Audio features conversations with the guest editors and authors of Continuum who are the leading experts in their fields. Subscribers to the Continuum Journal have access to exclusive audio content not featured on the podcast. If you're not already a subscriber, we encourage you to become one. For more information, please visit the link in the show notes.  Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum: Lifelong Learning in Neurology. Today I'm interviewing Dr Lisa Silbert, who recently served as Continuum's co-guest editor for our latest issue on dementia alongside Dr Lianna Apostolova. Dr Silbert is a professor in the Department of Neurology at Oregon Health and Science University of the School of Medicine in Portland, Oregon, where she's also the director of the Neuroimaging Core and now the co-director of the Alzheimer's Disease Research Center. She also serves as director of the dementia clinic at the VA Portland Healthcare System. Which, Dr Silbert, sounds like a lot of work? Anyway, welcome. I really appreciate you taking the time to join us today and co-guest editing this issue. Why don't you introduce yourself a little bit to our listeners?  Dr Silbert: Well, thank you so much for interviewing with me today and for inviting me to be the guest, co-guest editor of this issue. It's a really exciting time for dementia care and dementia research. As you already said, my name is Lisa Silbert. I'm in Oregon Health and Science University in Portland, Oregon. I've been involved in caring for dementia patients and their families for over twenty years now and been involved in a lot of really exciting research during that time. But I would say now is probably the most dynamic time in dementia research and care that I've seen. So, it's really, really exciting to be here.   Dr Jones: It really is an interesting time. So, I look back  in our last issue of Continuum focusing on dementia came out in 2022, which doesn't sound like that long ago, but a lot has changed, right? With the anti-amyloid monoclonals for Alzheimer's disease, new biomarkers and so on. And as the guest editor, you have this unique view, Dr Silbert, of the issue and the whole topic of dementia. As you were reading these really outstanding articles, what was the biggest “aha” moment for you or the biggest change in practice that you saw that's come up over the last couple of years?     Dr Silbert: I think, you know, in reading through the different manuscripts or chapters in this issue, it really struck home the advances that have been made throughout all the different areas of dementia. Not just- so, we hear a lot about Alzheimer's biomarkers and Alzheimer's treatments on the horizon, which is really exciting, but this is happening across other dementias as well. There's biomarkers on the horizon for a Lewy body disease and potentially for some of the frontaotemporal dementias. And so that to me really struck home as this is really, across the board, a change in the entire field that we're looking at.  Dr Jones: That is exciting. And I'd like to come back to some of those biomarker developments because I think that's an area where we've really been lacking in neurology as a specific way to diagnose those disorders. I think a topic which you just alluded to that a lot of our listeners and readers are thinking about are those antiamyloid monoclonal therapies for Alzheimer's disease. So, addicanumab, lecanumab and most recently the approval of donanemab. For these drugs specifically, how are you using them in your practice and how should our listeners be thinking about these drugs?  Dr Silbert: These are, you know, relatively new, really exciting new and emerging therapies for Alzheimer's disease. They are shown to remove amyloid from the brain. Patients who have clinical manifestations of Alzheimer's disease, and that is those in the stages of mild cognitive impairment or mild dementia. We are using lecanemab at Oregon Health and Science University through our therapeutics and clinical units. It's a really exciting time and it's a time where we have to be, also, cautious about who undergoes these therapies. So being really informed about the use, who's appropriate to undergo these therapies, what kind of safety tests need to be undergone, how do you assess risk in individual patients so that you can counsel them.  So, all of these factors need to be weighed in when you're making a decision about whether or not to treat a patient with a monoclonal antibody therapy. And specifically, we do neuroimaging to assess whether there are already the presence of microhemorrhages in the brain. We do genetic testing to look for APOE 4 genotypes that can increase the risk of Aria, which is amyloid-related imaging abnormalities. And all of these factors go into how we counsel patients and discuss whether or not to pursue treatment with monoclonal antibodies.    Dr Jones: So certainly a complex patient selection process and drug administration and monitoring of therapy for those patients.  And that- it brings to mind for me how we already have too few neurologists in the US. And now for a really prevalent disorder, Alzheimer's disease, we're making it a lot more complicated to deliver these new disease-modifying therapies. What do you think or what do you see as the role of the neurologists in caring for patients with dementia? And do these developments change that role?  Dr Silbert: For now, I think these developments make it even more important in a way that neurologists are involved in making a very specific clinical diagnosis of which dementia is playing a factor in the patient 's clinical presentation. I think one thing to note is with these emerging biomarkers, a lot of them can be positive before there are clinical symptoms and multiple etiologies are also very prevalent. And so just having one positive biomarker, it doesn't necessarily tell you what's going on with an individual patient. You need to take the whole picture into consideration. So, I think a really detailed evaluation by the neurologist, especially with these emerging therapies that have potential risks, is extremely important right now. Just getting a test is really not sufficient. You really have to take the entire clinical picture into account and know the ins and outs of the risks involved in these disease-modifying therapies.  Dr Jones: Which brings us back to something you mentioned earlier, right? Which is good news. We have on the horizon new potential biomarkers for other neurodegenerative causes of dementia. I can foresee and maybe I'm, you know, being an alarmist here, Dr Silbert, but if we have sensitive biomarkers for other neurodegenerative conditions, we know patients often have copathologies. Is that going to help clarify things? Is it going to confuse us? How is that going to work?  Dr Silbert: Well, I think ultimately, it's going to help clarify things. Because there are multiple pathologies that are common in age related cognitive impairment, any kind of additional specific input that we can get with different biomarkers is going to be helpful in putting the pieces together to come up with what's happening clinically with each individual patient. Ultimately, I think these biomarkers, they're not- any one biomarker isn't going to be a solution to diagnosis, but putting them together to help improve early and accurate diagnosis is really the goal here. Having a very early diagnosis, having a very accurate diagnosis will improve our ability to give prognosis and also improve effective treatment strategies moving forward. I think that these biomarkers have the promise in facilitating that for us.  Dr Jones: And progress is always a good thing. We just have to learn how to adapt and use the evidence appropriately. There have been and I think most of our listeners will be familiar with some of the controversies related to these, these new disease-modifying drugs for Alzheimer's disease. Do you want to walk us through a couple of those, and what are your thoughts about those controversies?  Dr Silbert: Yeah, these new therapies, they're very exciting for everyone in the field, but they, like you mentioned, they're not without their controversies. I think one controversy or one potential downside to these therapies is access to them. Like you already mentioned there, there's really not enough neurologists out there. There's not enough behavioral neurologists out there. There's limitations to infusion centers, sites and prescribers. Access to these therapies is is significantly limited. They are requiring infusions quite frequently. So, if you're not living near specialty care, you're not really able to feasibly undergo these kinds of treatments. Another controversy is the fact that the treatment effects are considered by some to be fairly modest when looking at the clinical data and in association with that, there are risks involved. Like I already mentioned, there's the amyloid-related imaging abnormalities, which sounds kind of like a benign thing, but they really consist of microhemorrhages that can lead to bigger hemorrhages and edema in the brain. These risks are relatively small - they are seeing more commonly in those who have a specific genotype, an APOE E 4 genotype - but they're risks nonetheless.  And so, there's controversy about the risk-benefit ratio and access to care with these new therapies.  Dr Jones: It's very exciting, but we should be cautious, right? I recall a few years ago as a program director, a neurology residency program director, interest in different areas of neurology would often follow developments in those areas, right? Lots of interest in autoimmune neurology when those developments would proceed in neuro oncology, etc. And I wonder if the therapeutic advances in in behavioral neurology and neurodegenerative cognitive disorders, I wonder if that's going to stimulate interest among our trainees to pursue behavioral neurology? Do you have a view on that or have you seen much change in interest in in this field?  Dr Silbert: You know, we are seeing a lot more interest in our trainees. The residents are very interested in these new therapies and how to apply them. And I'm really excited about that.  I'm hopeful that this will stimulate interest in the field. And we need those specialists, we need those sub specialists to undergo fellowship training in behavioral neurology and geriatric neurology so that we have more access to the subspecialty care and delivering these new therapies. So, I agree with you, I'm hopeful about it and I am seeing new interest in our trainees about these new therapies.  Dr Jones: We can hope so. And all the other fellowship directors will be anxious if neurology residents start leaving to go into behavioral neurology. But there's certainly demand. And I know that under the best of circumstances, dementia is so common. It's something that we have to care for in partnership with primary care and community resources. And these disease-modifying therapies capture a lot of attention, but it's really a small part of the continuum of care of these patients. And Dr Silbert as an expert, you know, if we put that disease-modifying therapy to the side for a second and just said, well, what are the biggest gaps in the care for patients with dementia? What do you see as those biggest gaps and, and what can we do to fix them at not just a neurology level, but at a societal level?  Dr Silbert: That's a big question. And you know, what I see almost every day are gaps in the support mechanisms for families who are caring for patients with dementia. These caregivers are under a lot of stress and oftentimes they just don't have the resources to take care of somebody who at some point will often need twenty-four hour care and supervision. Caregivers are older, usually of older age themselves and have their medical issues as well. And then we're just not doing a good job as a nation in in supporting patients and their families with like supportive care and respite care that's really needed. So, you know, I'm not just seeing and treating patients with dementia, but I'm seeing and I'm really trying to support and care for those who are taking care of patients with dementia. To me, that's the biggest gap in our system. Dr Jones: Yeah. And as I look through this issue of Continuum, we touched on not only the conventional topics in dementia and behavioral neurology. I'm really happy in hindsight that we have invited some discussion of the psychiatric symptoms in dementia, which I think are really important and often underrecognized and maybe undermanaged or mismanaged, and really also focusing on the caregiver burden and support services. We do have an article dedicated to that as well, and I think that'll be useful to our readers and listeners when we when we publish those podcasts. We we've heard this year especially a lot of public conversation about cognitive impairment and dementia. I sometimes wonder if that public attention is helpful and constructive for the population of patients with dementia. Sometimes I wonder if that conversation is counterproductive. What's your take on that?  Dr Silbert: You know, I think it's- it can be a mixed bag, but ultimately, it's in the conversation. We're talking about it. And I think that's only a good thing. There's more public awareness of it.  There is more interest in therapies. So, I think at the end of the day, talking about it, making it more prevalent in the ether, it stimulates the conversation and discussion. And even if there's controversies about it, we're talking about it. And I think that's kind of the first step in acknowledging that we need more support, we need more therapies.  Dr Jones: Yeah, I agree. And I think often patients with neurologic disorders and their caregivers and families often appreciate being seen.   Dr Silbert: Yeah, no, absolutely true. So, I'd say in regards to the monoclonal antibody treatments, you know, despite the controversies with these new treatments, I think there's a real promise and a real hope and a real excitement across a lot of behavioral neurologists, including myself, that this is just the beginning. That even if these first line, first generation therapies maybe have downsides, that there'll be second generation and third generation variations on these kinds of treatments that are going to be more accessible, have less side effects and hopefully be more clinically effective. And, and down the line, the other real hope for the field is that these maybe second generation therapies will actually delay the onset or prevent clinical manifestation of the disease. And that's the real goal here.  Dr Jones: And that's a great segue to the to the next thing I wanted to ask you about and you, you may have already answered the question. We talked about how we have and will have new biomarkers which will help us with diagnosis. We have hopefully the first phase in increasingly effective disease modifying therapies for Alzheimer, maybe prevent Alzheimer's disease. Wouldn't that be great? Are there any other things on the horizon that you see maybe for other neurodegenerative disorders from a therapeutic perspective? What do you, what do you think the next big thing will be in that area?  Dr Silbert: Well, that's a great question. I think, you know, there's a lot of exciting research in Lewy body dementia and targeting alpha synuclein pathologies. We really need biomarkers.  So, we're ways off from therapeutics, but I think there's a lot of exciting progress in that area.  Dr Jones: So, like many areas of neurology, there are rewarding and challenging aspects to the care of these patients. What  do you- what's the most rewarding aspect of your practice, Dr Silbert?   Dr Silbert: You know, a lot of… I hear from trainees over the years that, you know, they can't imagine or it's difficult for them to think about caring for patients who have a neurodegenerative disease that has no cure. But I feel like that's a lot of what neurologists do. We don't necessarily cure all diseases, but we treat the patient throughout their disease process. And to me that is extremely satisfying. You know, I enjoy listening to patients' stories and hearing about what they have been through over the years. And I really feel, like, appreciated for the care that I provide in giving not just an accurate diagnosis, which a lot of people come in lacking, but talking about future planning and, really, treatment throughout the course of the disease. And I was in clinic yesterday and talking to one of my patients' caregivers, and we were talking about a particularly difficult behavioral manifestation that her husband was going through. And we were talking through how to manage it. And she said to me, you know, Dr Silbert, I really feel like I have a partner in going through this disease. And you know, that's kind of what it's all about for me. So, to me, it's extremely rewarding field. It's also a very exciting field, especially right now with all these new biomarkers and treatments. So, I just think there isn't a better area of neurology to be involved in right now.   Dr Jones: What a great place to land and end the interview. And I hope our listeners and our readers really do enjoy this issue. It's really a fantastic, not just an update, but a survey of a very dynamic aspect of the field of neurology. And Dr Silbert, I want to thank you for joining us and thank you for such a thorough and fascinating discussion on caring for patients with dementia.    Dr Silbert: It was my pleasure. Thank you.    Dr Jones: Again, we've been speaking with Dr Lisa Silbert, co-guest editor, alongside Dr Leanna Apostolova for Continuum 's most recent issue on dementia. Please check it out, and thank you to our listeners for joining us today.  Dr Monteith: This is Dr Teshamae Monteith, associate editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use this link in the episode notes to learn more and subscribe. Thank you for listening to Continuum Audio. 

In the concluding chapter of our two-part series on “Everyday Epigenetics. Raw. Real. Relatable.”, we continue our deep dive with Christina Cadden, a dedicated healthcare professional whose journey through personal and professional health challenges has illuminated a path for many seeking wellness. Join us as we pick up the conversation exactly where it left off into our discussion into mold and functional medicine. **If you have not listened to part 1 head over to the podcast and check out “Pt 1: Mold and Functional Medicine with Christina Cadden”In this episode:- Understand how genetic testing has changed Christina's approach to nutrition, including tailored adjustments to her keto diet based on her APOE genotype and saturated fat processing.- Explore the benefits of PH360 profiles and how personalizing diets can lead to better health outcomes, reinforced by real-world examples from Susan's clients.- Hear about the transformative impact of small dietary changes- Dive into the often-overlooked importance of lab tests and the psychological barriers preventing people from seeking proper diagnosis and care.RESOURCES:Visit the website: healthyawakening.co/podcastFind listening links here: https://healthyawakening.co/linksSHOW NOTES: healthyawakening.co/episode33Connect with Susan:Contact me for your DNA testing or epigenetic coaching!To schedule a FREE consultation, send an email to susan@healthyawakening.coFaceboook: https://www.facebook.com/susanrobbinshealthyawakeningInstagram: @susanrobbins_epigeneticcoachLearn About Christina Cadden:A board-certified Family Nurse Practitioner and registered nurse with a background in critical care. Christina's holistic approach to patient care stems from her comprehensive nursing education and career.Originally from Texas, Christina recently relocated to the mountains. Her personal health journey began two years ago when she experienced hair loss and chronic fatigue. Frustrated by conventional medical advice, she delved into functional medicine, discovering unique approaches to health. Christina has battled conditions like Hashimoto's, EBV, IBS, SIBO, Leaky Gut, and Mold, fueling her passion to help others facing similar issues.She founded Watchful Wellness, PLLC, launching this November. Outside of work, Christina enjoys traveling, hiking, and spending time with her husband, two daughters, and their chocolate lab.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/WZX865. CME/MOC/NCPD/AAPA/IPCE credit will be available until November 16, 2025.Using APOE as a Key in Alzheimer's Disease Treatment: Unlocking the Amyloid-Targeting Therapy Risk–Benefit Conundrum In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/WZX865. CME/MOC/NCPD/AAPA/IPCE credit will be available until November 16, 2025.Using APOE as a Key in Alzheimer's Disease Treatment: Unlocking the Amyloid-Targeting Therapy Risk–Benefit Conundrum In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/WZX865. CME/MOC/NCPD/AAPA/IPCE credit will be available until November 16, 2025.Using APOE as a Key in Alzheimer's Disease Treatment: Unlocking the Amyloid-Targeting Therapy Risk–Benefit Conundrum In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/WZX865. CME/MOC/NCPD/AAPA/IPCE credit will be available until November 16, 2025.Using APOE as a Key in Alzheimer's Disease Treatment: Unlocking the Amyloid-Targeting Therapy Risk–Benefit Conundrum In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/WZX865. CME/MOC/NCPD/AAPA/IPCE credit will be available until November 16, 2025.Using APOE as a Key in Alzheimer's Disease Treatment: Unlocking the Amyloid-Targeting Therapy Risk–Benefit Conundrum In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.

In this fascinating episode of the Gut Health Gurus Podcast, host Kriben Govender, a renowned Food Scientist and nutritionist, interviews medical doctor and vascular biologist, Dr William Li on how to have a healthy heart, circulatory system and much more. Topics Discussed: 00:00 - Who is Dr William Li 03:06 - Why do we die from heart disease? 08:22 - How do we prevent heart disease? 15:00 - Current medical paradigm for heart disease? 21:36 - What is APOE? 25:32 - Dietary recommendations to prevent heart disease  31:32 - Dietary Supplements for heart health 36:15 - Statins and the microbiome 38:25 - Food as Medicine or Poison 42:54 - What are Plant Sterols  46:20- Tips to Handle Erectile Dysfunction 53:10 - Oral Microbiome 56:34 - How Viagra was discovered 59:10 - Dr Li's top Gut Health tip This episode is a must-watch for anyone interested in understanding the complex world of the gut - heart axis, the science behind it, and practical approaches to improving heart health issues. About Dr William Li: Dr. William Li is a renowned physician, scientist, and author, recognized for his pioneering work in angiogenesis—the process through which the body forms new blood vessels—and its implications for treating various diseases. He serves as the President and Medical Director of the Angiogenesis Foundation, a nonprofit organization he co-founded in 1994 to advance angiogenesis-based medicine, diet, and lifestyle interventions. About Kriben Govender: Kriben Govender is a Food Scientist, Nutritionist, and the founder of Nourishme Organics, a company specialising in gut health and fermentation products. With over 20 years of experience in the food industry, Kriben is passionate about the intersection of diet, gut health, science and well-being.   Sponsor: Nourishme Organics https://www.nourishmeorganics.com.au/ 10% off using code : happygut Microbiome Stool Testing, Deuterium Testing and Nutritional Consulting https://www.nourishmeorganics.com.au/collections/nutritionist-consultation   Connect with Kriben Govender here:  https://linktr.ee/kribengovender   Connect with Dr William Li: https://drwilliamli.com/   Download links               If you enjoyed this episode and would like to show your support:   1) Please subscribe on Apple Podcasts, give us 5 stars and leave a positive review     Instructions:   - Click this link  https://itunes.apple.com/au/podcast/gut-health-gurus-podcast/id1433882512?mt=2   - Click "View in Itunes" button on the left-hand side - This will open the Itunes app - Click the "Subscribe" button - Click on "Ratings and Reviews" tab - Click on "Write a Review" button   Non-Itunes users can leave a Google Review here: https://goo.gl/9aNP0V     2) Subscribe, like and leave a positive comment on Youtube   https://www.youtube.com/channel/UCq5KxLvGIY4r6SqNaAphEUw?sub_confirmation=1   3) Share your favourite episode on Facebook, Instagram, and Stories 4) Let your friends and family know about this Podcast by email, text, messenger etc   Thank you so much for your support. It means the world to us.  

Understand which cohort is defined as a cognitive super-ager Characteristics that are consistent across super-agers in systematic review studies Role of APOE e4 allele as well other alleles in potentials causes of Alzheimer's Disease Future immunotherapy options   Host: Dr Marita Long | Total Time: 28 mins Experts: Dr Alice Powell, Neurologist & Geriatrician Register for our fortnightly FREE WEBCASTSEvery second Tuesday | 7:00pm-9:00pm AEDT Click here to register for the next oneSee omnystudio.com/listener for privacy information.

Did you know that some people can have signs of Alzheimer's but show no cognitive decline? The secret lies in something called "cognitive reserve."In this episode, Amy breaks down the four essential components of cognitive reserve, why it's a critical part of Alzheimer's prevention, and how women, especially those over 45, can take steps to build a resilient and adaptable brain.What to Listen For:The definition of cognitive reserve and why it's crucial for brain health.How brain size and neuron count contribute to brain reserve.The difference between brain reserve, resilience, maintenance, and compensation.Why some people with signs of Alzheimer's don't show symptoms thanks to cognitive reserve.The impact of lifestyle choices on your cognitive health, even if you carry Alzheimer's risk genes.Four components of cognitive reserve: Brain reserve, maintenance, resilience, and compensation.The role of brain maintenance activities like glucose metabolism and waste removal.How white matter and gray matter function differently in brain processing.The 14 modifiable risk factors for dementia according to the latest research.Practical tips for enhancing your cognitive reserve and supporting long-term brain health.Cognitive reserve could be your brain's best line of defense against Alzheimer's. By understanding and nurturing the four key components—brain reserve, maintenance, resilience, and compensation—you can help your brain adapt to challenges and stay sharp, no matter what comes your way. Make proactive choices today that will pay off in the long run. Tune in, take action, and don't forget to subscribe so you don't miss future episodes packed with more insights on maintaining your health and happiness.Sources Referenced In This Episode::The Lancet Commission on Dementia Prevention, Intervention, and CareThe Alzheimer's Solution on Amazon by Drs. Dean and Ayesha SherzaiStudy by Dr. Lindsay Farrer on APOE-4 Gene and Alzheimer's Risk (1997): Impact of APOE-4 on Alzheimer's RiskResearch by Dr. Yaakov Stern on Cognitive Reserve: Cognitive Reserve - Dr. Yaakov SternNun Study by Dr. David Snowden: The Nun StudyRESOURCES: Access the FREE Masterclass: How To Optimize Your Sleep Order Amy's book Thoughts Are Habits Too: Master Your Triggers, Free Yourself From Diet Culture, and Rediscover Joyful Eating. Join our private Facebook group: Moxie Club Meetup Follow Amy on Instagram @habitwhisperer

Hannah Went, a pioneer in epigenetics, is the co-founder of TruDiagnostic and founder of Everything Epigentics. She shares her journey from the early days of TruDiagnostic to its burgeoning role in healthcare. She reflects on the rapid evolution of epigenetics, the challenges of making groundbreaking science accessible, and the gratifying shift towards mainstream acceptance. Hannah also delves into her personal growth, emphasizing the transformative impact of "The 15 Commitments of Conscious Leadership" and her desire to be remembered as loving and impactful.  Guest links: trudiagnostic.com | everythingepigenetics.com Charity supported: Equal Justice Initiative Interested in being a guest on the show or have feedback to share? Email us at podcast@velentium.com.  PRODUCTION CREDITS Host: Lindsey Dinneen Editing: Marketing Wise Producer: Velentium   EPISODE TRANSCRIPT Episode 041 - Hannah Went [00:00:00] Lindsey Dinneen: Hi, I'm Lindsey and I'm talking with MedTech industry leaders on how they change lives for a better world. [00:00:09] Diane Bouis: The inventions and technologies are fascinating and so are the people who work with them. [00:00:15] Frank Jaskulke: There was a period of time where I realized, fundamentally, my job was to go hang out with really smart people that are saving lives and then do work that would help them save more lives. [00:00:28] Diane Bouis: I got into the business to save lives and it is incredibly motivating to work with people who are in that same business, saving or improving lives. [00:00:38] Duane Mancini: What better industry than where I get to wake up every day and just save people's lives. [00:00:42] Lindsey Dinneen: These are extraordinary people doing extraordinary work, and this is The Leading Difference. Hello, and welcome back to another episode of The Leading Difference podcast. I'm your host, Lindsey, and I am so excited to introduce you to my guest today, Hannah Went. Hannah has a lifelong passion for longevity and breakthrough disruptive technologies that drive radical improvement to the human condition. She attended the University of Kentucky and graduated with a degree in biology. During that time, she had multiple research internships studying cell signaling and cell biology. After graduation, she worked for the International Peptide Society as their Director of Research and Content. Through work in the integrative medicine industry, Hannah saw an opportunity for a methylation based age diagnostics and started TruDiagnostics in 2020. TruDiagnostic is a company focused on array based methylation diagnostics for life extension and preventative healthcare serving functional medicine providers. TruDiagnostic has a commitment to research with over 30 approved clinical trials investigating the epigenetic methylation changes of longevity and health interventions. Since TruDiagnostics' inception, they have created one of the world's largest private epigenetic health databases with over 75, 000 patients tested to date. Hannah has since created Everything Epigenetics, where she shares insights on how DNA regulation has an impact on your health. All right, well, welcome to the show, Hannah. I'm so excited to talk with you today. Thanks for taking some time. [00:02:14] Hannah Went: Thanks, Lindsey. I'm excited to speak with you. [00:02:17] Lindsey Dinneen: Awesome. Well, would you mind starting off by sharing a little bit about yourself and your background and what led you to MedTech? [00:02:25] Hannah Went: Yes, absolutely. I've known since I was a little girl that I've always been interested in science, how the world works, how the body works. I remember being a little girl and going in our backyard, lifting up rocks, finding roly-polies and worms and getting all down and dirty. I was definitely a tom girl, if you will, growing up. I love sports. I loved connecting with people. So I also loved the social aspect of understanding how the body works as well. And I was very athletic growing up. So I played track soccer, basketball, sports all year round, essentially. I knew I wasn't good enough though, to go to like a D1 or probably even D2 college for sports. So I was like, "All right, well, I'll just go to a larger university, maybe play some club soccer and really focus on my academic route." And I ended up going to University of Kentucky. It wasn't too far from me. I'm just from Ohio, north of Dayton, a small town called Piqua. And I did end up playing soccer, club soccer there, got involved in a lot of other activities. Ended up actually going into veterinary work, animal science. UK has a really good program for that. They have a really good agriculture department. I ended up shadowing a vet one summer and I hated it. It was one veterinarian clinic. So a lot of work, a lot of late hours. And I knew I wanted to have a family growing up. So I was like, "Eh, let me just switch to general biology. Let me just open my doors." And fast forward to senior year. I was really interested in genetics and you know, how do we have these predispositions that are passed on throughout our family? How does that affect our health outcomes essentially? So I applied to genetic counseling school, which is a very new program. It's a master's program. It is where you get your master's essentially in genetics and counseling. So it's like the best of both worlds, exactly what I loved growing up. You have the science aspect, but you're sitting down and helping people actually understand their risk. Applied to school, Lindsey, and didn't end up getting in. So I was like, "Oh, I'm heartbroken. I'm still super young. My life's over!" type of deal, a big eye roll ,and thought it was the end of the world. But really where my career took a huge turning point was at that failure point. I took a job, my best friend got me a position at a compounding pharmacy in Nicholasville, Kentucky, which is just a little bit South of Lexington. And that was when I was opened up into this entire medtech space of healthcare providers and the integrative functional medicine journey who were focusing on healthcare, like true healthcare, not sick care, not taking care of sick people when they're already sick, they're already doomed and just trying to bill them for all of these medications through insurance. So that's really how I've gotten to where I am today. [00:05:23] Lindsey Dinneen: Oh, that is so cool. Well, first of all, thank you for sharing a little bit about your background. It was fun to even hear about your childhood and how that theme of interest in all those different aspects has woven its way through your story. And I would love to hear a little bit more then about, okay, so what does present day look like and how did you end up where you are? [00:05:43] Hannah Went: Yes, so I'll try and keep it short and concise. So this pharmacy was very innovative. It was the fourth fastest growing healthcare company in the nation in 2019. And it's really focused on the unique peptide products. It was again a compounding pharmacy by trade, meaning you can compound anything in all different dosing as long as you have a prescription from a healthcare provider by it. They grew really fast. So, you know, we always had regulatory agencies come check in, make sure we were doing everything correctly, which we absolutely were. But there was always this worry that these products made people feel better, but there wasn't a lot of quantitative data behind it. So we were like, "All right. Well, what can we measure in clinical trials and institution review boards to really prove to people out there, 'Hey, these are having a massive underlying biological effect on people.' They don't just feel better." We used to joke and say, "People can become tan, they can become skinny, they can increase their libido from these products, but they also actually save people's life." They stabilize insulin sensitivity. They can help people lose weight who have metabolic disease. They can mediate a lot of the effects of specific autoimmune diseases. So there are massive impacts that these products had. And we're like, "All right, well, if you had one test, like if you could measure one thing that really relates to all of those items I just mentioned, it's aging," right? These age related diseases. So, "how do you even measure age" is the follow up question and you can do that in all sorts of different ways. But there are actually these DNA regulation markers, like these on and off switches, called your epigenetics that seems to be the best way to measure aging. So we really started measuring and doing clinical trials with these epigenetic aging biomarkers to prove the efficacy of these products. And what we ended up doing is just selling the pharmacy in 2019. It became-- oh-- pretty boring, I guess, for lack of a better word, because there were new rules and regulations in place by regulators on what you can and cannot compound. And then you have built my company now, TruDiagnostic, from the ground up. We have our laboratory in Lexington, Kentucky, and we started out with one goal, which was essentially to offer the best age testing. And now we're doing a lot of different things. So that's what I'm really involved in now on a day to day basis. [00:08:10] Lindsey Dinneen: Wow. Well, thank you for sharing about that. And okay, so, so you embrace this entrepreneurial endeavor, which is a whole second set of-- I mean, obviously you have all the skills from your experience and your education and whatnot, but then to compound that with owning your own business and then setting up a brick and mortar, it's an actual lab and whatnot. How was that transition? Did you feel prepared for it? Did it catch you off guard? What was that like? [00:08:38] Hannah Went: We were kind of creating TruDiagnostic behind the scene when we had the pharmacy. So like end of 2019, we were really creating it. But I do think it caught me off guard looking back where it was like, "Okay, pharmacy sold, full time TruDiagnostic. How the heck do we set up this lab at the beginning of 2020?" It was go mode. So we bought a building in Lexington. It was an old insurance building. We completely knocked out the top floor, which was offices, carpeted, not usable lab space and built the lab again, like I mentioned, from the ground up. So I joke and say, "I'm a construction worker. I was an interior designer." I was doing all of these other things. And of course I had a lot of amazing people helping me all throughout the way, but testing SOPs for standard operating procedures, creating those. I remember the first day we were running samples in like trialing the protocol. I was here till 5am because we were thawing things and freezing things as part of the protocol and didn't even realize that was part of the step once we started to get into it. So yeah, it definitely took me off guard. And I think furthermore, we launched right before COVID 19. So it was the worst timing in history to launch. And you know, we did it anyways. And then the first year and a half, two years, it was a lot of follow up. It was a lot of cold calling. It was chasing or following up with these healthcare providers to use these kits that we sent out because we did a really nice promotion to get the product out there, but it was hard to balance because when COVID 19, this nasty pandemic, came into the U. S., you almost felt guilty asking the healthcare providers to focus on anything else, right? You're like, "That is not what you should be worrying about right now." So it was definitely hard to balance. [00:10:23] Lindsey Dinneen: And yeah, my goodness. And honestly what resonated with me too is, you know, you're talking about, you've worn so many hats, obviously, as a business owner and setting this up. And I used to joke that, when I had a brick and mortar business and I was like, "On any given day, I'm everything from the CEO to the janitor." [00:10:40] Hannah Went: I can relate. I can definitely relate to that. I remember we needed some kind of-- I don't even know what we need this for-- it was like some type of part that had to regulate water temperature or something like that. So a traditional thermometer wouldn't work. I remember I drove across the street to a pet store and I got something that belonged in a fish tank. And I'm like, " I don't even know if this will, will work." But I mean, we are just piecing everything together. It was like you were doing yet literally everything and anything that you could just because you wanted it to work so bad. You had that passion, that, that push. And you realized that the end goal in mind, which for us, it's really just to help our people, you know, people who are working with us, and our clients, whether that's anyone from now a healthcare provider offering our services or a researcher or academic collaboration, it's someone doing third party processing at our lab or even down to the end consumer client patient, whatever you'd like to call them that come directly to our website and do our testing. [00:11:40] Lindsey Dinneen: Yeah. Great. And that actually addresses my next question, which was going to be, so do you only work with healthcare providers? Is it a B2B enterprise? But it sounds like you also do the B2C and you can sell directly to them, to people who are interested. [00:11:55] Hannah Went: Definitely. Yeah. When we opened, we had that one goal in mind, which is what we knew, which were our healthcare providers that we really transitioned from the pharmacy over to TruDiagnostic. So that was like our main customer at the time. And I think we completed that goal of offering the best aging diagnostic tools at the end of last year with a large study we did with Harvard. But now what we've noticed and, of course-- we kind of got lucky in this sense, we would have never imagined where we are now-- is that epigenetics, these DNA markers, these on and off switches are really great for creating new and novel biomarkers. So you can predict almost anything with them. You can predict even how much you've smoked across your entire lifetime, how much alcohol you've consumed, your zip code based on where you live, just because of the environment you're exposed to and your behaviors in that environment. So it's pretty crazy, obviously we, we didn't expect that and I mean it's just being really blown up and everywhere you, you look, I mean it's related to every aspect of life and of course changeable as well. So even, providers who are using this test on a patient once, they'll retest them every 6 to 12 months. And then of course people coming from our website, we just released actually a subscription model a couple days ago so people can start to retest this in more of a hands off fashion. even every three to four months if they wanted to. [00:13:19] Lindsey Dinneen: Wow. So when somebody does your test and they get the results, is this something that you walk them through and say, okay "Here's where things stand now. If you make these tweaks, here's how things could stand?" Or how does it work from that perspective? [00:13:34] Hannah Went: Definitely. So just to walk you through the process, you would get your kit, we'd ship it to you, you would prick your finger. So just a little blood spot card about the size of a quarter, you ship that sample back to our lab in Lexington and we get results back to you in about two to three weeks from the time we receive it. Then you would get all these different age related reports, some of those characteristic and trait based reports I mentioned, like this smoking and alcohol. And we, we do, so we can project you out saying, "Hey, if you still stay on this trend, whether it's aging faster or aging younger, here's where you're, where you'll be in six months, 12 months." So it may be exciting to some, it may be scary to some, depending on where they are. Regardless, it's changeable. So if anyone's listening and they're like, "Oh my gosh, I don't want to know that. I'm so scared." If you've tested your genetics, that's in my opinion, even scarier. That doesn't change, right? You know your risk, you know your predisposition. So, this can all be mitigated through lifestyle factors, through supplements, medications, procedural based therapies as well. So we do give you recommendations on the report on what to do. You can absolutely again take it by yourself, but we can always help you and connect you with a healthcare provider if you're really wanting to go on this journey. But I always say, Lindsey, the first test is really fun. It's sexy. It's really trendy right now. But it doesn't mean much. It's just a baseline. It's telling you where you are, just like your hormones and your CBC panel, your second test is more important than your first third, more than the second fourth, more than the third. And so on and so forth. [00:15:09] Lindsey Dinneen: Okay. Yeah. And you addressed something else that I was going to ask. So when people are interested, they'd like to do it, but they have this like, "Ooh, I don't know if I really want to know," how do you help overcome that? Is it because things are changeable? Like everything can be changed? [00:15:26] Hannah Went: Yeah. Yeah. I'll even give you to an extent, I would say most of it, right. For the purpose of this conversation, yes. There are of course some exceptions, but my grandmother, for example, passed away from Alzheimer's when I was senior in high school. Right after that happened and what started some of my interest in genetics is I went and got my genes tested. I'm like, "Oh my gosh, that was awful to watch her go through. Am I doomed, right? Am I going to have that same risk?" And my results came back. Well, I have this specific snip. It's a single nucleotide polymorphism. So this specific variant on my genes that's APOE 3-4. So this means I'm at a more increased risk to have Alzheimer's, and even at a younger age as well. I would say you have an even further increased risk if you're at APOE 4/4. So I'm not the worst, but I'm the second worst, essentially, and I'm like, "Well, this obviously isn't good. But this can't be it, right? This can't be the end of this story." And you hear a lot of people say that too, people with metabolic disease or diabetes in their family. And, they may shrug and just say, "Oh, well, you know, I can eat whatever I want, right? I don't have to work out, like I'm doomed anyways, type of thing." And we know now that's not true, right? You're no longer really the victim of your genetic predisposition that we may have thought due to these epigenetic changes or the fact that it's changeable. So there are even peer reviewed published papers that come out showing estrogen, so optimizing your hormone levels can actually reduce your risk of Alzheimer's from an epigenetic standpoint along with everything else, exercising, eating very healthy, no artificial foods, flavoring. So you're, of course, always going to have that genetic risk, but you also have all of these other types of risks and you have this epigenetic risk, which should really be the main focus, because you're in the driver's seat again. You're no longer in the passenger seat. And that's really empowering to have all of that knowledge. [00:17:22] Lindsey Dinneen: Yeah. Yeah, absolutely. I know that the test is really important in terms of telling an individual exactly what's going on and how things can change, but in doing all this research and data collection, are there certain lifestyle things that pretty much everybody regardless should pay attention to. Is that a thing? [00:17:45] Hannah Went: Of course, that's the multimillion dollar question and a very frequent one that we get. And the answer is, "Sure, yes and no, kind of, maybe so." And what I mean by that is you can look at all of these general population studies that come out, right? These clinical trials and look at what really moved the needle. But again, those are populational trials, so you really need to find out what works for you. I can tell you what works for me. There is a study on this, which is why I wanted to try it first. So again, you can start to maybe trial some things based on results that are already out there, but I've tested my aging before and what I've noticed that really slows it down is caloric restriction. So it's not necessarily intermittent fasting or time restricted feeding or skipping an entire meal, it's just continual, 10 percent caloric restriction. So if you're on a 2000 caloric based diet, take out about 200 calories, which if you're eating healthier anyways, you may not even be hitting your intake of calories based on your metabolic rate and what your specific goals are. And I've noticed that helps slow down my aging. I've also noticed that I need to do more aerobic based exercises. So things like VO2 max, increasing FEV1, we can actually quantify those on our test. So really VO2 max is your oxygen uptake, so how much oxygen you can get into the body. Your FEV1 is your forced expiratory volume, so how much oxygen you can get out in and out of your lungs. Swimmers have a really good VO2 max and FEV1. So I noticed I was doing maybe too much like weightlifting, too much HIIT type of workouts. So you can get a lot of feedback from those reports. So for me, personally, that's what works. [00:19:30] Lindsey Dinneen: Wow. That's great. That is amazing what you can test and gain knowledge about and then make those changes based off of. So on your LinkedIn profile, something that I was really intrigued by is you are a founding member of an organization, I believe, called Opscotch. Did I get that right? Okay. And one thing that really stood out to me, and I'd love to just hear your take on the organization as a whole, but you said part of your mission is to make biohacking accessible to everyone. And I really appreciated that. And I'm curious if you would share a little bit maybe more about that. [00:20:05] Hannah Went: Yeah. Obscotch is a really cool community. So it is really democratizing the way healthcare I think has been viewed, even healthcare, like the model where we should go towards rather than that sick care. So it's making it a lot less scary. And I know that the founders of Obscotch, Spencer Coppin and Matt Christensen, and they're amazing people. They really set up this community as a way for people to have a support system. I think it can be really scary when you're entering really optimizing your overall health, what do you do? You see all of these ads, what protein should you take? What supplements should you take? They're just everywhere. Whose supplements really match the label? There are a lot of studies that show, that they don't even have promised ingredients on the label included in the supplement itself. So it's really confusing. And then you go down these rabbit holes and after a while, you don't know what you're looking at. So if you're part of this community, you can choose to get a Whoop and to start tracking a lot of these markers. You probably know the quote by Peter Drucker, "You can't manage what you're not measuring," so they measure a lot of things. They do the biological age testing through TruDiagnostic, and then they do some other laboratory based testing as well. So there's different levels of the membership that you can actually get depending on how involved you want to be, but they also do these monthly quarterly type of challenges. So it could be to get your Whoop fitness score above 12 for 15 days of the month. So again, it really encourages people to come together and I love that community aspect of it. They've done a really nice job. And again, are just amazing people there. They're located in Canada too. [00:21:46] Lindsey Dinneen: Oh, nice. Yeah. So taking ownership of your health, but within a community, which makes it a lot, well, more fun, at least. [00:21:54] Hannah Went: Yeah. And the community is awesome. That's probably a really good group for you to even look into, Lindsey. It's a lot of founders and entrepreneurs and people who have like wild backgrounds. And they're from all over the world too. So it's not just like, oh, you have to be in Canada. They do have a lot of like local meetups in Canada, which is really cool for things like cold plunging or running or, you know, scheduling dinners or seeing like Andrew Huberman, he was in town like a couple of months ago or something. So they put together the events and they also send you even like recommended podcast or YouTube videos to watch. So it's really curated health information if you're looking to optimize your own health. [00:22:35] Lindsey Dinneen: Wow. Amazing. Yeah. And then, so another thing that I really enjoyed reading about you and your experience is, you mentioned that you appreciate taking complex scientific ideas and translating them into narratives that resonate with the intended audience. And I love that, and I think that's really important, but I'm wondering if you could tell us a little bit about your process in doing that, translating very technical engineering science speak into maybe what other people who aren't in that world could relate to. [00:23:14] Hannah Went: Yeah, definitely. So I have my personal company too, called Everything Epigenetics. So this is a, something TruDiagnostic wanted to do for a while is just educate others on epigenetics and what that means because there's a lot of education lacking out there. There's not much you can find. With all things that kind of got pushed under the rug in our early days, but I was just, " Screw it. I'll just make it mine." And I set up all of the social, the website domain and didn't do much with it for the first couple of months. And I was like, "Okay, I really want to get into this." And I think I started it at the end of 2022, so almost two years, which is crazy to say. And, I used it as a way to really keep myself honest and involved in the research. So I'm not as involved in our research on a day to day. So I work with a lot of postdocs or PhDs who have created epigenetic algorithms or interpretations. And basically, hopefully break those conversations down for people to easily understand. It's still very high science and not as applicable, so it can be tough sometimes. But my real goal is just educating those on this massive paradigm shift we're seeing with epigenetics in terms of not only taking over traditional lab testing, but just medicine in general. I mean, it's causing a massive wave and really, I think, flipping our understanding of how this field works, how even really the body works. So I don't monetize that at all. It's just something I do on the side. I have a podcast that runs every other week. And then I also am pretty active on Instagram doing these Journal Club Friday kind of spiels. That's where it's usually a video that's anywhere, I think, they're at least 90 seconds, but 90 seconds to four minutes long, just highlighting some type of research paper in the space and trying to do it in really simple terms that way people can understand it. So it's not maybe always going to be applicable to everyday life. I think it's absolutely going to get there where we are able to measure epigenetics, see our exact plan, have everything served us on a silver platter. But we're a little bit far away from that now. And I think that's can be really frustrating to some people, but I think it's also as equally as exciting. And you have to keep in mind that this came out after the iPhone, after the first iPhone. So it only came out about, or I would say only became popularized about 10 years ago, which is very new. So we just have to be a little bit patient. [00:25:51] Lindsey Dinneen: Yeah, that's fair. Well, thank you for helping translate some of these crazy things into more digestible pieces of information for those of us who maybe don't have that same background. So I do appreciate that. [00:26:05] Hannah Went: Yeah, of course. It's really fun to just continue the conversation and start to break these complex ideas down. [00:26:12] Lindsey Dinneen: Yeah, absolutely. Yeah. So, within your journey you know, as a scientist and researcher and entrepreneur and everything else, are there any moments that stand out to you that, that really affirm to you that you were in the right place at the right time in the right industry? [00:26:34] Hannah Went: Ooh, that's a good question. I, I think yeah, I think probably a couple months ago, three months ago. So, we've actually joined with some other clinics on really pushing forward epigenetics. And I think we're starting to see everything coming together. So I think it is hopefully becoming mainstream. And that is just huge, because the vision for epigenetic testing is to be able to use one blood spot card, so really simple, easy collection method at a really cheap cost and getting every single biomarker back that you could possibly imagine: clinical lab values, hormones, inflammatory markers, vitamin levels, minerals, proteins, metabolites. And I think, I remember just a couple months ago, when we really started to get an increased volume and testing, more healthcare providers just saying yes and super open to this idea. So I usually spend my day to day on calls with healthcare providers or our partnerships that we have with, whether it be wholesale or like resellers of these kits. And people are just starting to get it more. Like I remember at the beginning of TruDiagnostic, we always had to set up a call with every single account. It was, Hey, start from the top. What is epigenetics? Even before epigenetics, what is aging? How do you measure this? This is a really weird idea. And now we're starting to see where people set up accounts with us and they don't even set up a call and they just start ordering, right? Or they set up a call and they're like, "Hey, I know what aging is. I know what epigenetics is. Help me market this to my patients. How do I sell this?" So, so we're starting to see that change and that's definitely not been overnight. To answer your question, right time, right room with the right people. But I think probably at the beginning of this year is when we started to really see that change, which has been super exciting. [00:28:35] Lindsey Dinneen: Yeah, that is. It is because it's hard to-- it's great to educate-- but it is hard when that is your entire job day in and day out. And eventually maybe the science will catch up or the understanding of the science will catch up so that you finally get to this, you know, "we're getting there" stage. [00:28:54] Hannah Went: I think it's hard, yeah, because you know, with us we speak with the healthcare providers. We speak with the academics, but we may not actually be seeing the end user, the end patient. So sometimes it can be hard. It's like, "Hey, what difference are we actually making?" And that can be a little bit of a pain point or a struggle. I think not so much anymore because our providers will come back and give us case studies or, you know, talk to us about some of their findings, which is really exciting. And that, continues to expand as we do these clinical trials and dive deeper into the research. But I think we're TruDiagnostics sits right now is just an awesome opportunity because we are in between collaborators in terms of universities and academics and healthcare providers and patients. So we really bridge that gap as new algorithms, as new research is happening. We really do feel like we're at the centerfold and it's our responsibility to push that out to healthcare providers because there's no one really there to merge the two. So we'll start to see our type of healthcare providers we work with are willing to try anything, and willing to want the newest, latest, and greatest information as well to test on their patients. So they make for a really great group. [00:30:04] Lindsey Dinneen: Yeah, that's incredible. And it's so great to hear about the ability to bridge the gap between an individual being able to take ownership of their own health versus-- doctors are amazing. I'm so thankful for every medical person-- but also it's nice to be able to feel a little bit empowered to take ownership as well. So I appreciate that you're able to start bridging the gap and, and help them make be more accessible. So that's great. [00:30:30] Hannah Went: Yeah. Yeah. Definitely. [00:30:32] Lindsey Dinneen: Yeah, so, pivoting the conversation just for fun, imagine that you were to be offered a million dollars to teach your masterclass on anything you want. It can be in your industry, but it doesn't have to be. What would you choose to teach and why? [00:30:47] Hannah Went: Ooh. What would I choose to teach and why? I think the ,there's a book that's really good that I think everyone should read and it's called "The 15 Commitments of Conscious Leadership." And have you ever heard of it before, Lindsey? [00:31:00] Lindsey Dinneen: Nope, but I'm writing it down. [00:31:02] Hannah Went: Yeah. It's awesome. So there, there are a couple of authors on the book, but yeah, Jim Dethmer, he would previously go to all of these companies and understand how their leadership worked. And it's a super readable book, super short, breaks it down in all of these chunks, depending on what you want to really focus on. He actually came and spoke to our company and it was really cool to learn from him about this. He doesn't do it much anymore. So, we felt very special to, to be able to have him. And It can act in all areas of your life. So it's not necessarily just leadership . It really extrapolates out to relationships, whether it be a romantic one, or not, or kind of a family one. It is really I think changed my outlook on a lot of things in life. So I think I would want to teach something that has to do with that, that book. Jim's wife actually does a lot of the Enneagram work too. So the Enneagram test and understanding really your, kind of, why you're wired the way you are almost. Everyone has this conception of life. And you get to learn more about the way people think and how they work and why they do the things they do. So everyone did that test, the Enneagram test, in our company, and you can start to see these patterns and things. And it's just very useful information and it just makes everyone, I think, work together and flow together a little bit better too, which is awesome. [00:32:25] Lindsey Dinneen: Yeah. It sounds like a great masterclass and I have it written down. I'm going to, I'm going to look it up right after so I can secure my copy. Yeah. So, and then how do you wish to be remembered after you leave this world? . [00:32:39] Hannah Went: Oh, how do I wish to be remembered? Hopefully as someone who is loving and fun and taught the world something. Doesn't necessarily have to be epigenetics related, but I think people probably see me right now as someone who is like very busy running around all of the time, going from place to place, and I don't think I like that. That's just what I think my interpretation of me maybe would be from the outside. But it doesn't feel like I'm busy, right? It feels like I'm doing the things that I want to do right now and I don't think I necessarily even like the word busy, right? What does that mean? Everyone's busy. Everyone's doing something to a degree. So, yeah, I just want to be remembered as fun, loving you know, I think would also be remembered, though, just as hardworking, determined and yeah, willing to work hard to reach specific goals. [00:33:32] Lindsey Dinneen: I love that. Yeah. And then final question. What is one thing that makes you smile every time you see or think about it? [00:33:41] Hannah Went: Just my family, my husband, my sisters, my mom, my stepdad, everyone. So I get to hang out with them next weekend. I'm super, super excited. We'll be with them at their lake house. So I'm excited to be with the family. [00:33:55] Lindsey Dinneen: Nice. Oh yeah. That's going to be wonderful. Well, Hannah, this has been such a great conversation and I so appreciate your spending some time with me today and sharing about your incredible journey and everything that's coming up too. And I'm so excited for you and for this mission and to see the company continue to grow and expand, so I do really appreciate you. being here. And we are so honored to be making a donation on your behalf as a thank you for your time today to the Equal Justice Initiative, which provides legal representation to prisoners who may have been wrongly convicted of crimes, poor prisoners without effective representation, and others who may have been denied a fair trial. So thank you for choosing that organization to support and we just wish you the most continued success as you work to change lives for a better world. [00:34:49] Hannah Went: Awesome. Thank you, Lindsey. I appreciate your time. [00:34:51] Lindsey Dinneen: Absolutely, you too. And thank you also to our listeners for tuning in and if you're feeling as inspired as I am right now, I would love it if you would share this episode with a colleague or two and we will catch you next time. [00:35:06] Ben Trombold: The Leading Difference is brought to you by Velentium. Velentium is a full-service CDMO with 100% in-house capability to design, develop, and manufacture medical devices from class two wearables to class three active implantable medical devices. Velentium specializes in active implantables, leads, programmers, and accessories across a wide range of indications, such as neuromodulation, deep brain stimulation, cardiac management, and diabetes management. Velentium's core competencies include electrical, firmware, and mechanical design, mobile apps, embedded cybersecurity, human factors and usability, automated test systems, systems engineering, and contract manufacturing. Velentium works with clients worldwide, from startups seeking funding to established Fortune 100 companies. Visit velentium.com to explore your next step in medical device development.

Can Alzheimer's really be optional? Join Dr. Dale Bredesen and Louisa Nicola as they dive into cutting-edge research and practical strategies to prevent cognitive decline. In this eye-opening episode, you'll discover why Alzheimer's doesn't have to be inevitable.Dr. Bredesen reveals the power of proactive steps—like advanced blood tests, genetic risk assessments, and lifestyle changes—that can reshape your brain health. From the role of the APOE gene to inflammation and detoxification, you'll learn how to take control of your cognitive future.If you're ready to challenge the narrative that Alzheimer's is unavoidable, this episode is for you. Timestamps0:00 Alzheimer's Prevention Through Lifestyle and Supplements3:02 Alzheimer's Disease as an Optional Condition Through Early Intervention9:47 Maui Nui Venison Sticks: The Ultimate On-The-Go Protein Snack12:05 Understanding Alzheimer's Disease and Its Underlying Causes15:40 Understanding Alzheimer's as a Network Insufficiency and Its Causes20:53 Metabolic Flexibility and Its Role in Cognitive Health25:47 Lifestyle Factors and Genetic Risks in Alzheimer's Prevention35:27 Inflammation's Role in Alzheimer's and Environmental Impact on Health44:21 Tau and Amyloid as Antimicrobial Peptides in Alzheimer's Disease49:56 Exploring Links Between MS, Alzheimer's, and Immune Responses57:15 Reversing Alzheimer's Through Nutrients, Detox, and Lifestyle Changes1:04:51 Innovations in Brain Health and Alzheimer's PreventionMomentous - Use code NEURO to get 20% off your order - https://www.livemomentous.com/neuroMaui Nui Venison - Use code NEURO to get 20% off https://mauinuivenison.com/pages/NEUROThe Neuro Athletics Newsletter Instagram: @louisanicola_Twitter : @louisanicola_YouTube: @Louisa NicolaThe Neuro Experience Podcast is proud to have hosted: Dr Andrew Huberman, Dr Gabrielle Lyon, Dr Layne Norton, Thomas DeLauer, Shawn Stevenson, Dr. Rocio Salas-Whalen, Saad Alam, Uma Naidoo, Dr. Lanna Cheuck, Angela Lee Pucci, Jillian Turecki, Dr. Jordan Feigenbaum, Dr. Darren Candow, Dr. Sue Varma, Evy Poumpouras, Dr Casey Means, Renee Deehan, Dr Chris Palmer, Dr Charles Brenner, Dr Joe Zundell

Dr. Steven DeKosky is professor of Alzheimer's research at the University of Florida College of Medicine and Deputy Director of the McKnight Brain Institute at that institution. He also is a professor of neurology and neuroscience there. Previously, he served as vice president and dean of the University of Virginia School of Medicine and was chairperson of the department of neurology at the University of Pittsburgh. Part 2 For the short-term, with mild to moderate traumatic injury you can have altered synaptic structure and function. For the longer term, chronic inflammation and chronic oxidative stress can lead to subsequent degeneration and also some chronic microglial activation, which may turn on mechanisms that you do not necessarily want, including cleaning up partially injured neurons that may recover. Especially in patients who get the disease in an older age, there is other pathology in the CTE. There are nerve fibrillary tangle and Lewy body.  Amyloid beta can be elevated in both white matter and grey matter and might add to the cascade that is thought amyloid leads to, which leads to degeneration especially Alzheimer's disease, but cannot prove it. Participants in contact sports all are at significant risk. APOE 4 increases the risk of Alzheimer's disease and the risk of tau deposition. Currently, when patients arrive for rehabilitation, they are going to have things a lot better described than was the case previously.  We can look at disruption of structures, see hemorrhage and inflammation. We know that CTE is not a new disease, but we do see the pathology in other contact sports and we do not view it in autopsy series unless the individual had a history or repetitive head injury. A Question & Answer period followed.

This week's guest on Health Theory is Dr. Steven Gundry. Steven Gundry is a cardiothoracic surgeon, researcher and author who has performed over 10,000 surgeries throughout his 40-year career. In this episode, he talks about the impact our diets have on our health, why the gut is the source of our health, and how to stay young at any age. [Original air date: May 9, 2019]. SHOW NOTES The myths of aging [01:52] Why aging starts in the gut [03:28] How to gut actually works [07:55] Why glyphosate is everywhere [10:18] Why we're thinking about heart disease all wrong [12:18] What are lectins and why are they so dangerous? [16:49] The role of fat in areas of inflammation [19:32] How your immune system reacts to misplaced bacteria [22:59] Why amyloid plaques aren't the cause of dementia [26:09] What is the APOE-4 gene mutation?[29:04] How fecal microbial transplants may fix your gut [30:39] Is the key to health in the holobiome? [35:12] Why women are more able to listen to their gut [37:03] The potential causes of autism [38:15] Foods that can improve your gut health [41:57] Why exercise can prevent Alzheimer's [44:05] The importance of "washing" your brain [46:10] Why olive oil is miraculous [49:35] FOLLOW STEVEN GUNDRY WEBSITE: https://bit.ly/2JseyqD PODCAST: https://apple.co/2VuiGOc YOUTUBE: https://bit.ly/2xZVkzo INSTAGRAM:: https://bit.ly/2KQ57hy FACEBOOK: https://bit.ly/2kttvho TWITTER: https://bit.ly/2VTeM0u FOLLOW TOM: Instagram: https://www.instagram.com/tombilyeu/ Tik Tok: https://www.tiktok.com/@tombilyeu?lang=en Twitter: https://twitter.com/tombilyeu YouTube: https://www.youtube.com/@TomBilyeu SUPPORT OUR SPONSORS: Get 5 free AG1 Travel Packs and a FREE 1 year supply of Vitamin D with your first purchase at https://impacttheory.co/AG1pod. Secure your digital life with proactive protection for your assets, identity, family, and tech – Go to https://impacttheory.co/aurapod to start your free two-week trial.  LISTEN AD FREE + BONUS EPISODES on APPLE PODCASTS: apple.co/impacttheory Feeling stuck? Check out Billion Dollar Habits and unlock the mindset strategies that helped me achieve all my goals. This community will show you how to gain clarity and build discipline so you can become the person you've always wanted to be. Click here to learn more. Learn more about your ad choices. Visit megaphone.fm/adchoices

In the past few years, Big Pharma has released not one, but three new treatments for Alzheimer's disease. Aducanemab (2021), Lecanemab (2023), and Donanemab (2024), are the first treatments to effectively clear the brain of amyloid plaques — the sticky protein clumps whose build-up in the brain has defined the disease for decades. The problem? They may not help patients at all.Today's guest, Stanford neurologist Mike Greicius, considers the new amyloid-clearing drugs a major disappointment — and worse, says they likely do more harm than good for patients.Despite this critique, Greicius, thinks that the next few years will be an exciting time for novel Alzheimer's therapies, as growing biological understanding of Alzheimer's risk and resilience bear fruit with promising new approaches to treatment.Learn More:Greicius is the Iqbal Farrukh and Asad Jamal Professor of Neurology and Neurological Sciences at Stanford Medicine, and a member of the Knight Initiative for Brain Resilience and Alzheimer's Disease Research Center at Stanford University.Amyloid Drug Skepticism:Substantial Doubt Remains about the Efficacy of Anti-Amyloid Antibodies(Commentary, Journal of Alzheimer's Disease, 2024)New Drug Approved for Early Alzheimer's (New York Times, 2024)Alzheimer's drug adoption in US slowed by doctors' skepticism (Reuters, 2024)One step back: Why the new Alzheimer's plaque-attack drugs don't work (Stanford Medicine Scope Blog, 2024)Alzheimer's Genetics Research:Knight-funded research uncovers gene mutations that may prevent Alzheimer's Disease (Knight Initiative for Brain Resilience, 2024)Why is a common gene variant bad for your brain? (Stanford Medicine Magazine, 2024)Scientists find genetic Alzheimer's risk factor tied to African ancestry (Stanford Medicine, 2023)Episode CreditsThis episode was produced by Michael Osborne, with production assistance by Morgan Honaker, and hosted by Nicholas Weiler. Art by Aimee Garza.Send us a text!Thanks for listening! If you're enjoying our show, please take a moment to give us a review on your podcast app of choice and share this episode with your friends. That's how we grow as a show and bring the stories of the frontiers of neuroscience to a wider audience. Learn more about the Wu Tsai Neurosciences Institute at Stanford and follow us on Twitter, Facebook, and LinkedIn.

Questions, comments? Shoot me a text.Imagine transforming your fear of Alzheimer's into actionable steps for better brain health. Amy White takes you on a personal journey through the maze of genetic testing, specifically the ApoE gene, and how lifestyle choices can be game-changers in mitigating cognitive decline. By challenging the traditional view of Alzheimer's as merely a structural issue, she introduces groundbreaking research suggesting it's also a metabolic condition. Amy candidly shares her family's history with memory issues and how her professional expertise in holistic nutrition has reshaped her outlook on brain health.Discover the power of nutrition, fasting, and stress management in optimizing your well-being. Amy offers practical tips like extending your overnight fasting window, eliminating processed foods, and adopting a low-carb diet to maintain metabolic health. She also highlights the significance of managing stress and monitoring blood sugar and ketone levels. Listen to Amy's strategies for achieving a healthier lifestyle without drastic changes and find out how you can get support through a free consultation. This episode promises to provide you with tools to become leaner, stronger, and healthier, all while keeping your brain in peak condition.Protein Snack Challenge: Get It HereWeight Loss Coaching Program: Hangry to Healthy™Get Your Food Audit HereWhat to Eat Guide: Healthy Food ListSchedule Your Free Consult: Lose Weight For The Last TimeWebsite: The Simplicity of WellnessFollow Me on Instagram

White matter, composed largely of myelinated nerve fibers, facilitates communication between different brain regions. Damage to white matter, observed (i.e., lesions) via MRI, is associated with cognitive decline and increased dementia risk. Plasma concentrations of omega-3 fatty acids in epidemiological research is associated with a reduced burden of white matter lesions (WML)An RCT published in Neurology (PMID: 39088212) this August looked at the effects of omega-3 supplementation on white matter lesions (size of which can be indicative of neurodegenerative diseases like Alzheimer's) in adults aged 75 and over.This study examined whether supplementing with omega-3 fatty acids daily (from 2014-2019) could slow the progression of WML in older adults with low baseline omega-3 levels.Findings:Fish Oil Benefits: reduction in WML progression not statistically significant across the entire cohort. However, participants with the APOE ε4 allele (genetic marker linked to a higher risk of Alzheimer's) experienced a significant decrease in neuronal integrity breakdown when supplemented with omega-3s.EPA for the win? - Plasma levels of the omega 3 fatty acid EPA in this case and past research had the largest association with less white matter lesions (EPA is more abundant in microglia vs. DHA)Fish Oil Dosage: The study used 1.65 grams of omega-3 per day, containing 975 mg of EPA and 675 mg of DHA (EPA dominant).Fish Oil Side Effects: supplementation at this dosage was well-tolerated, with no significant difference in adverse events between the omega-3 and placebo groups, making it a viable option for long-term use in older adults.For those concerned about cognitive health, especially if there's a genetic predisposition to Alzheimer's, maintaining an adequate intake of omega-3s through diet or supplementation is generally recommended. The fish oil benefits for men and women likely extend beyond cardiovascular health, offering potential protection against the neurodegenerative changes associated with aging especially those at high risk for something like Alzheimer's disease.https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821809?resultClick=3Support the Show.

In today's Ask Me Anything episode, Ken and Dawn answer a wide range of questions that cover: A recent FDA approval of a neural implant device for people with degenerative neuromuscular disease or spinal-cord injuries. Global security in the age of AI. A study that looked at ways to optimize glymphatic clearance for people with acute or chronic sleep deprivation. Why more gyms don't offer blood-flow restriction classes for their clients. Developments in the realm of Generative AI. The tradeoffs between a low-carb diet versus a ketogenic diet. A study on Alzheimer's titled, “APOE 4 Homozygosity Represents a Distinct Genetic Form of Alzheimer's Disease.” Plus, Ken reveals his favorite science-fiction author. [00:02:38] Dawn opens the episode with a question for Ken about the FDA's recent approval of a neural implant device which is touted as a means of allowing people with degenerative neuromuscular disease, or spinal-cord injuries, to interface with external technology via neural signals. The listener asks Ken for his insights into what is being called “brain-computer interface technologies.” [00:05:44] A listener asks Ken if he has a favorite science-fiction writer, or if there is a particular sci-fi series/story that really moves him. [00:08:48] Multiple listeners ask Ken about a paper recently published titled: “APOE 4 Homozygosity Represents a Distinct Genetic Form of Alzheimer's Disease.” Listeners ask if it is true that people with two copies of APOE4 allele are certain to develop the disease. [00:19:30] A listener asks Ken about his time on the National Security Commission on Artificial Intelligence. The commission issued its report five years ago with specific recommendations on how the government should prepare for and defend against the national security implications of AI. Ken shares his thoughts on the implementation of the commission's recommendations. [00:21:16] A listener asks Dawn about her collaboration with Dr. Jeff Iliff that looked at a potential approach to optimizing glymphatic clearance for people with acute or chronic sleep deprivation. [00:27:10] A listener asks Ken why more gyms and physical therapy centers don't have blood flow restriction devices (BFR) available for their clientele, given that studies have shown that BFR improves strength and muscle mass in both young and older adults. (Two STEM-Talk episodes that cover blood-flow restriction include episode 34 and episode 161. [00:28:38] A listener asks Ken for his thoughts on AI given the recent developments in the field, particularly in the realm of Generative AI, with programs like Chat GPT becoming a household name. The listener mentions that one of their friends thinks that AI is about to peak, and another says that AI is just getting warmed up. [00:37:00] A listener writes that they are astounded at how many disorders can be treated with a ketogenic diet and mentions that they themselves have difficulty with a ketogenic diet. Instead, the listener eats low-carb diet and asks if the benefits of a low-carb, non-ketogenic diet are similar to a ketogenic one. [00:38:19] A listener asks if Ken could talk about carotid scans and if this is a test that those with high LDL should consider getting. [00:40:17] A 72-year-old listener explains how they structure their daily exercise routine between resistance and endurance training. The listener asks Ken whether they should focus more on resistance training as they are beginning to lose strength, and if so, how they should implement that given their age and the increasing risk for injury. [00:45:51] To wrap up this episode, a listener asks Ken if he has any new annoyance that he would like to share, as he did in 2022, when he noted his disdain for the phrase “new normal” and the prevalence of cellphone addiction. Links: Learn more about IHMC STEM-Talk homepage Ken Ford bio Ken Ford Wikipedia page Dawn Kernagis bio

"People have to take this into their own hands. I still think that if you're doing this testing in the long run, you're gonna save money."Welcome to another episode of the Pain and Performance Podcast. In this episode, I provide a comprehensive guide to testing and quantifying your health. I emphasize the importance of tracking your health to ensure you're doing the right things for your body. I discussed various tests that should be done every year, including micronutrient and vitamin levels, cholesterol panel, hormone levels, glucose tolerance test, and liver function test. I also recommend tests for body composition, muscle strength, full-body mobility, and cardiovascular health. Additionally, I suggest one-time tests for APOE genotype and MTHFR mutation. Overall, these tests provide actionable information to improve your health and prevent future issues.Takeaways--Regular testing and quantifying of your health is important to ensure you're doing the right things for your body.-- Tests that should be done every year include micronutrient and vitamin levels, cholesterol panel, hormone levels, glucose tolerance test, and liver function test.-- Tests for body composition, muscle strength, full body mobility, and cardiovascular health should also be done regularly.-- One-time tests for APOE genotype and MTHFR mutation can provide valuable information about your risk for certain health conditions.-- These tests provide actionable information to improve your health and prevent future issues.Chapters00:00 Introduction: The Importance of Testing and Quantifying Your Health04:04 The Essential Yearly Tests: Micronutrient, Cholesterol, Hormone, Glucose, and Liver Function11:25 Understanding Cholesterol and Lipoproteins14:13 The Significance of Hormone Levels24:50 Body Composition and Muscle Strength30:34 Full Body Mobility and Cardiovascular Health35:21 Cancer Screening and Risk Assessment43:16 One-Time Tests: APOE Genotype and MTHFR Mutation47:08 Conclusion: Taking Action and Tracking Your HealthLinks:DERRICKTikTok:https://www.tiktok.com/@drderrickInstagram:https://www.instagram.com/derrickbhines/Youtube:https://www.youtube.com/@DrDerrick

On this episode of Dementia Matters, Dr. Scott Roberts talks about disclosing genetic test results for APOE, a gene that can increase one's likelihood of developing Alzheimer's disease. While this information can be concerning, Dr. Roberts shares that it can empower individuals to take the necessary precautions to lower their risk of developing the disease. He discusses the Risk Evaluation and Education for Alzheimer's Disease (REVEAL) study, walks us through the APOE disclosure process and shares how it is evolving with the development of new Alzheimer's treatments. Guest: Scott Roberts, PhD, interim chair, professor of health behavior & health education, University of Michigan School of Public Health   Show Notes Read Dr. Roberts' article, “Genetic risk assessment for adult children of people with Alzheimer's disease: the Risk Evaluation and Education for Alzheimer's Disease (REVEAL) study,” on the SageJournals website. Decide if you're a fit forAPOE testing using Virginia Tech's ‘Gene Test or Not?' decision aid tool, mentioned at 17:00 in the episode. Learn more about Dr. Roberts on his University of Michigan profile. Learn more about APOE by listening to our episode, “DNA Is Not Your Destiny: Genetics and Alzheimer's Disease Risk,” with Dr. Corinne Engelman on our website. Read “WRAP data used in study finding a distinct, genetic form of Alzheimer's disease” on the Wisconsin Alzheimer's Institute (WAI) website.   Connect with us Find transcripts and more at our website. Email Dementia Matters: dementiamatters@medicine.wisc.edu Follow us on Facebook and Twitter. Subscribe to the Wisconsin Alzheimer's Disease Research Center's e-newsletter. Enjoy Dementia Matters? Consider making a gift to the Dementia Matters fund through the UW Initiative to End Alzheimer's. All donations go toward outreach and production.

Há muitos mitos e tabus acerca da famosa Cannabis, essa plantinha cujo uso acontece há milhares de anos. Mas, afinal, o que a ciência já sabe sobre a maconha? Tinha que ser em duas partes! Aqui, a parte 2 de 2.Confira a segunda (e última) parte do papo entre o leigo curioso, Ken Fujioka, e o cientista PhD, Altay de Souza.> OUÇA (46min 36s)*Naruhodo! é o podcast pra quem tem fome de aprender. Ciência, senso comum, curiosidades, desafios e muito mais. Com o leigo curioso, Ken Fujioka, e o cientista PhD, Altay de Souza.Edição: Reginaldo Cursino.http://naruhodo.b9.com.br*REFERÊNCIASThe relationship between cannabis use, schizophrenia, and bipolar disorder: a genetically informed studyhttps://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(23)00143-8/abstractDoes a history of cannabis use influence onset and course of schizophrenia?https://onlinelibrary.wiley.com/doi/full/10.1111/acps.13562Cannabis and schizophrenia: A complex relationshiphttps://cdn.mdedge.com/files/s3fs-public/CP02212043.pdfCannabis use in Attention – Deficit/Hyperactivity Disorder (ADHD): A scoping reviewhttps://www.sciencedirect.com/science/article/pii/S0022395622006549?casa_token=sBTLU5vfSxkAAAAA:ilKFmuKH2GQG9ylQZoK0WVi9qdlaWwSZl3L4n4o4VUpSZFtzdpPHt3loJJBzwVl3XKEaSyYVOgPrenatal cannabis use and the risk of attention deficit hyperactivity disorder and autism spectrum disorder in offspring: A systematic review and meta-analysishttps://www.sciencedirect.com/science/article/pii/S0022395624000591Exploring the Link between ADHD and Cannabis Use in Swedish Ninth Graders: The Role of Conduct Problems and Sensation-Seekinghttps://www.tandfonline.com/doi/full/10.1080/10826084.2022.2155478UK Medical Cannabis Registry: An analysis of clinical outcomes of medicinal cannabis therapy for attention-deficit/hyperactivity disorderhttps://onlinelibrary.wiley.com/doi/full/10.1002/npr2.12400Associations of cannabis use, use frequency, and cannabis use disorder with violent behavior among young adults in the United Stateshttps://www.sciencedirect.com/science/article/pii/S0955395924001166?casa_token=ODtslt9jke0AAAAA:-uxBbGJnqrra1ax1jysPu6ki-EiFxh-ZvU9tVT0YFSwwnhmmpUNrh5snI5al-CUBUA8xDBEBoAAssociation Between Cannabis and Violence in Community-Dwelling Patients With Severe Mental DisordersA Cross-sectional Study Using Machine Learninghttps://journals.lww.com/jonmd/abstract/2023/02000/association_between_cannabis_and_violence_in.2.aspx?context=latestarticlesEdible Cannabis Legalization and Cannabis Poisonings in Older Adultshttps://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2818635Plantations Beyond Monocrops: Cannabis Ecologies From Colonial Angola to São Toméhttps://journals.sagepub.com/doi/full/10.1177/02780771231222335Cannabidiol (CBD) and its analogs: a review of their effects on inflammationhttps://nida.nih.gov/publications/drugfacts/cannabis-marijuana“Do You Need Someone to Share With?”: Exchange and Demand Sharing in Social Cannabis Supplyhttps://journals.sagepub.com/doi/full/10.1177/00914509221146794Consuming unregulated “diet weed”: The social context of motivations and risk among users of Delta-8 THChttps://anthrosource.onlinelibrary.wiley.com/doi/abs/10.1111/napa.12211Examining the effect of cannabis cues on cannabis demand in sleep, driving, and typical drug-use contextshttps://www.sciencedirect.com/science/article/pii/S0376871623012954?casa_token=XiUEz9zkGV8AAAAA:aDWrpxsa5V7hO3RKEmbIO_V-7nSihgxXgOgJIRGfepldc2kRY3aYNtHs0RbqIdYdVmZmBe8cqwCritical chemsex studies: Interrogating cultures of sexualized drug use beyond the risk paradigmhttps://journals.sagepub.com/doi/full/10.1177/13634607211026223Culturally tailored substance use interventions for Indigenous people of North America: a systematic reviewhttps://www.emerald.com/insight/content/doi/10.1108/JMHTEP-07-2021-0088/full/htmlDevelopment of a rational scale to assess the harm of drugs of potential misusehttps://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)60464-4/abstractAdverse effects of medical cannabinoids: a systematic reviewhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2413308/Gut microbiome and metabolomic profiles reveal the antiatherosclerotic effect of indole-3-carbinol in high-choline-fed ApoE-/- micehttps://www.sciencedirect.com/science/article/pii/S0944711324002800?via%3Dihub#bib0028Table 3 Anti-tumor activities of I3C and DIM compoundshttps://cancerci.biomedcentral.com/articles/10.1186/s12935-023-03031-4/tables/3Cannabinoids in medicine: A review of their therapeutic potentialhttps://web.archive.org/web/20100524141419/http://www.doctordeluca.com/Library/WOD/WPS3-MedMj/CannabinoidsMedMetaAnalysis06.pdfDread : the Rastafarians of Jamaicahttps://archive.org/details/dreadrastafarian00owenNaruhodo #371 - Qual o impacto do alcoolismo nos dias de hoje? - Parte 1 de 2https://www.youtube.com/watch?v=JAIjJ6E8ZHkNaruhodo #372 - Qual o impacto do alcoolismo nos dias de hoje? - Parte 2 de 2https://www.youtube.com/watch?v=ZRwC2GQevIoNaruhodo #49 - O que causa o vício?https://www.youtube.com/watch?v=--Z_ylPXIWcNaruhodo #207 - Vape e cigarro eletrônico são seguros?https://www.youtube.com/watch?v=Raa9CUrIFbsNaruhodo #85 - Por que é tão difícil parar de fumar?https://www.youtube.com/watch?v=SPkIT0ehoisNaruhodo #267 - O que é dissonância cognitiva? - Parte 1 de 2https://www.youtube.com/watch?v=1xJwqmir5UwNaruhodo #268 - O que é dissonância cognitiva? - Parte 2 de 2https://www.youtube.com/watch?v=--OHlHmOQTM*APOIE O NARUHODO PELA PLATAFORMA ORELO!O podcast Naruhodo está no Orelo: bit.ly/naruhodo-no-oreloE é por meio dessa plataforma de apoio aos criadores de conteúdo que você ajuda o Naruhodo a se manter no ar.Você escolhe um valor de contribuição mensal e tem acesso a conteúdos exclusivos, conteúdos antecipados e vantagens especiais.Além disso, você pode ter acesso ao nosso grupo fechado no Telegram, e conversar comigo, com o Altay e com outros apoiadores.E não é só isso: toda vez que você ouvir ou fizer download de um episódio pelo Orelo, vai também estar pingando uns trocadinhos para o nosso projeto.Então, baixe agora mesmo o app Orelo no endereço Orelo.CC ou na sua loja de aplicativos e ajude a fortalecer o conhecimento científico.bit.ly/naruhodo-no-orelo

Há muitos mitos e tabus acerca da famosa Cannabis, essa plantinha cujo uso acontece há milhares de anos. Mas, afinal, o que a ciência já sabe sobre a maconha? Tinha que ser em duas partes! Aqui, a parte 1 de 2.Confira a primeira parte (de duas) do papo entre o leigo curioso, Ken Fujioka, e o cientista PhD, Altay de Souza.> OUÇA (53min 20s)*Naruhodo! é o podcast pra quem tem fome de aprender. Ciência, senso comum, curiosidades, desafios e muito mais. Com o leigo curioso, Ken Fujioka, e o cientista PhD, Altay de Souza.Edição: Reginaldo Cursino.http://naruhodo.b9.com.br*REFERÊNCIASThe relationship between cannabis use, schizophrenia, and bipolar disorder: a genetically informed studyhttps://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(23)00143-8/abstractDoes a history of cannabis use influence onset and course of schizophrenia?https://onlinelibrary.wiley.com/doi/full/10.1111/acps.13562Cannabis and schizophrenia: A complex relationshiphttps://cdn.mdedge.com/files/s3fs-public/CP02212043.pdfCannabis use in Attention – Deficit/Hyperactivity Disorder (ADHD): A scoping reviewhttps://www.sciencedirect.com/science/article/pii/S0022395622006549?casa_token=sBTLU5vfSxkAAAAA:ilKFmuKH2GQG9ylQZoK0WVi9qdlaWwSZl3L4n4o4VUpSZFtzdpPHt3loJJBzwVl3XKEaSyYVOgPrenatal cannabis use and the risk of attention deficit hyperactivity disorder and autism spectrum disorder in offspring: A systematic review and meta-analysishttps://www.sciencedirect.com/science/article/pii/S0022395624000591Exploring the Link between ADHD and Cannabis Use in Swedish Ninth Graders: The Role of Conduct Problems and Sensation-Seekinghttps://www.tandfonline.com/doi/full/10.1080/10826084.2022.2155478UK Medical Cannabis Registry: An analysis of clinical outcomes of medicinal cannabis therapy for attention-deficit/hyperactivity disorderhttps://onlinelibrary.wiley.com/doi/full/10.1002/npr2.12400Associations of cannabis use, use frequency, and cannabis use disorder with violent behavior among young adults in the United Stateshttps://www.sciencedirect.com/science/article/pii/S0955395924001166?casa_token=ODtslt9jke0AAAAA:-uxBbGJnqrra1ax1jysPu6ki-EiFxh-ZvU9tVT0YFSwwnhmmpUNrh5snI5al-CUBUA8xDBEBoAAssociation Between Cannabis and Violence in Community-Dwelling Patients With Severe Mental DisordersA Cross-sectional Study Using Machine Learninghttps://journals.lww.com/jonmd/abstract/2023/02000/association_between_cannabis_and_violence_in.2.aspx?context=latestarticlesEdible Cannabis Legalization and Cannabis Poisonings in Older Adultshttps://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2818635Plantations Beyond Monocrops: Cannabis Ecologies From Colonial Angola to São Toméhttps://journals.sagepub.com/doi/full/10.1177/02780771231222335Cannabidiol (CBD) and its analogs: a review of their effects on inflammationhttps://nida.nih.gov/publications/drugfacts/cannabis-marijuana“Do You Need Someone to Share With?”: Exchange and Demand Sharing in Social Cannabis Supplyhttps://journals.sagepub.com/doi/full/10.1177/00914509221146794Consuming unregulated “diet weed”: The social context of motivations and risk among users of Delta-8 THChttps://anthrosource.onlinelibrary.wiley.com/doi/abs/10.1111/napa.12211Examining the effect of cannabis cues on cannabis demand in sleep, driving, and typical drug-use contextshttps://www.sciencedirect.com/science/article/pii/S0376871623012954?casa_token=XiUEz9zkGV8AAAAA:aDWrpxsa5V7hO3RKEmbIO_V-7nSihgxXgOgJIRGfepldc2kRY3aYNtHs0RbqIdYdVmZmBe8cqwCritical chemsex studies: Interrogating cultures of sexualized drug use beyond the risk paradigmhttps://journals.sagepub.com/doi/full/10.1177/13634607211026223Culturally tailored substance use interventions for Indigenous people of North America: a systematic reviewhttps://www.emerald.com/insight/content/doi/10.1108/JMHTEP-07-2021-0088/full/htmlDevelopment of a rational scale to assess the harm of drugs of potential misusehttps://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)60464-4/abstractAdverse effects of medical cannabinoids: a systematic reviewhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2413308/Gut microbiome and metabolomic profiles reveal the antiatherosclerotic effect of indole-3-carbinol in high-choline-fed ApoE-/- micehttps://www.sciencedirect.com/science/article/pii/S0944711324002800?via%3Dihub#bib0028Table 3 Anti-tumor activities of I3C and DIM compoundshttps://cancerci.biomedcentral.com/articles/10.1186/s12935-023-03031-4/tables/3Cannabinoids in medicine: A review of their therapeutic potentialhttps://web.archive.org/web/20100524141419/http://www.doctordeluca.com/Library/WOD/WPS3-MedMj/CannabinoidsMedMetaAnalysis06.pdfDread : the Rastafarians of Jamaicahttps://archive.org/details/dreadrastafarian00owenNaruhodo #371 - Qual o impacto do alcoolismo nos dias de hoje? - Parte 1 de 2https://www.youtube.com/watch?v=JAIjJ6E8ZHkNaruhodo #372 - Qual o impacto do alcoolismo nos dias de hoje? - Parte 2 de 2https://www.youtube.com/watch?v=ZRwC2GQevIoNaruhodo #49 - O que causa o vício?https://www.youtube.com/watch?v=--Z_ylPXIWcNaruhodo #207 - Vape e cigarro eletrônico são seguros?https://www.youtube.com/watch?v=Raa9CUrIFbsNaruhodo #85 - Por que é tão difícil parar de fumar?https://www.youtube.com/watch?v=SPkIT0ehoisNaruhodo #267 - O que é dissonância cognitiva? - Parte 1 de 2https://www.youtube.com/watch?v=1xJwqmir5UwNaruhodo #268 - O que é dissonância cognitiva? - Parte 2 de 2https://www.youtube.com/watch?v=--OHlHmOQTM*APOIE O NARUHODO PELA PLATAFORMA ORELO!O podcast Naruhodo está no Orelo: bit.ly/naruhodo-no-oreloE é por meio dessa plataforma de apoio aos criadores de conteúdo que você ajuda o Naruhodo a se manter no ar.Você escolhe um valor de contribuição mensal e tem acesso a conteúdos exclusivos, conteúdos antecipados e vantagens especiais.Além disso, você pode ter acesso ao nosso grupo fechado no Telegram, e conversar comigo, com o Altay e com outros apoiadores.E não é só isso: toda vez que você ouvir ou fizer download de um episódio pelo Orelo, vai também estar pingando uns trocadinhos para o nosso projeto.Então, baixe agora mesmo o app Orelo no endereço Orelo.CC ou na sua loja de aplicativos e ajude a fortalecer o conhecimento científico.bit.ly/naruhodo-no-orelo

APOE is the primary cholesterol carrier in the brain and plays a major role in packaging and transporting LDL cholesterol throughout the body.