Podcasts about apoe4

Welcome to the NeurologyLive® Mind Moments® podcast. Tune in to hear leaders in neurology sound off on topics that impact your clinical practice. In this episode, "Donanemab's New Dosing Regimen: Lowering ARIA Risk in Alzheimer's Care" John Sims, MD, head of medical development for donanemab at Eli Lilly and Company, joins NeurologyLive to discuss the recently updated label for donanemab (Kisulna), an anti-amyloid Alzheimer disease (AD) therapy. Sims breaks down the key safety data from the TRAILBLAZER-ALZ-6 study (NCT05738486) that led to a newly approved titration-based dosing regimen aimed at minimizing ARIA risk. He outlines considerations for clinicians treating patients with early-stage AD, including genotype-based stratification, ARIA severity patterns, and implications for prescribing and patient counseling. Furthermore, Sims also shares takeaways about donanemab's clinical impact and how the results may shape the future of anti-amyloid therapy development and AD care. Looking for more dementia and Alzheimer disease discussion? Check out the NeurologyLive® Dementia and Alzheimer disease clinical focus page. Episode Breakdown: 1:00 – Overview of the new donanemab dosing regimen and its goal to reduce ARIA risk 2:30 – Rationale behind the four different dosing strategies tested in Trailblazer-ALZ-6 6:00 – What clinicians should know about patient risk and genotype testing 8:00 – Neurology News Minute 10:10 – Clinical implications of the updated label, including risk-benefit conversations 13:45 – Surprising results from the trial, particularly for APOE4 homozygous patients The stories featured in this week's Neurology News Minute, which will give you quick updates on the following developments in neurology, are further detailed here: Orexin-Targeting Agent TAK-861 Meets All End Points in Phase 3 FirstLight and RadiantLight Studies FDA Shuts Down Sarepta's Distribution of Gene Therapy Elevidys Following Patient Deaths AD109 Meets End Points in Phase 3 LunAIRo Trial, Eyeing FDA Submission for Obstructive Sleep Apnea Thanks for listening to the NeurologyLive® Mind Moments® podcast. To support the show, be sure to rate, review, and subscribe wherever you listen to podcasts. For more neurology news and expert-driven content, visit neurologylive.com.

Rhonda Patrick, Ph.D. (@foundmyfitness) is a biomedical scientist and the founder of FoundMyFitness, a platform dedicated to delivering rigorous, evidence-based insights on improving healthspan and mitigating age-related diseases.Sponsors:Helix Sleep premium mattresses: https://HelixSleep.com/Tim (27% off all mattress orders)Momentous high-quality creatine and other supplements: https://livemomentous.com/tim (code TIM for up to 35% off)David Protein Bars 28g of protein, 150 calories, and 0g of sugar: https://davidprotein.com/tim (Buy 4 cartons, get the 5th free.)Monarch Money track, budget, plan, and do more with your money: MonarchMoney.com/Tim (50% off your first year at monarchmoney.com with code TIM)Timestamps:[00:00:00] Start.[00:04:54] Dealing with aging parents and other topics on the table.[00:10:43] How a common multivitamin helps reverse cognitive and memory aging.[00:12:04] The importance of supplementation — especially as we age.[00:13:10] Effectively supplementing with omega-3 fish oil to counter APOE4 and Alzheimer's risks.[00:16:50] The CoQ10 and omega-3 protocol that has helped Rhonda's father manage Parkinson's symptoms for nearly a decade.[00:19:28] Sulforaphane: a potent NRF2 activator with an unexpected benefit for Rhonda's mother's tremors.[00:25:34] How Rhonda convinced her mom to start CrossFit and the power of community-based, senior-focused fitness.[00:26:52] The earlier the intervention, the better the outcomes.[00:32:25] Intermittent fasting vs. extended fasting and my own results.[00:44:31] Does fasting destroy muscle mass? Debunking the catabolism fear and understanding the crucial role of the re-feeding phase.[00:57:24] "Dirty" fasting: what really happens to autophagy and metabolic benefits when you add a splash of cream or MCT oil to your coffee?[01:00:44] VO2 max: the one metric that may predict lifespan more accurately than anything else, and how we work to improve it.[01:12:07] How a two-year exercise program reversed heart aging by 20 years in previously sedentary, middle-aged adults.[01:16:18] Lactate isn't the enemy: how vigorous exercise creates a superfuel that protects and grows the brain.[01:20:30] The optimal sauna protocol (temperature and frequency) for slashing dementia risk by 66%.[01:29:17] If you're human, you'll find a use for curcumin.[01:30:43] Creatine for cognition: moving beyond the gym with a powerful, science-backed tool for focus and combating sleep deprivation.[01:42:41] Still vitamin D deficient despite taking supplements? Here's the critical cofactor you're probably missing.[01:53:52] Shocking sources of microplastics in our daily lives, including chewing gum and teabags.[02:04:10] The uncomfortable truth about "moderate" alcohol consumption, cancer risk, and why the "sick quitter" hypothesis makes most older studies unreliable.[02:17:03] The ups and downs of ketamine and psilocybin on cognition and longevity.[02:24:19] Parting thoughts and where to find more from Rhonda.*Show notes for this episode: https://tim.blog/2025/07/24/dr-rhonda-patrick/For show notes and past guests on The Tim Ferriss Show, please visit tim.blog/podcast.For deals from sponsors of The Tim Ferriss Show, please visit tim.blog/podcast-sponsorsSign up for Tim's email newsletter (5-Bullet Friday) at tim.blog/friday.For transcripts of episodes, go to tim.blog/transcripts.Discover Tim's books: tim.blog/books.Follow Tim:Twitter: twitter.com/tferriss Instagram: instagram.com/timferrissYouTube: youtube.com/timferrissFacebook: facebook.com/timferriss LinkedIn: linkedin.com/in/timferrissSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

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

“What we decide to put in our mouth each day, what time we decide to go to sleep, who we choose to engage with, how much movement we get, how we manage our stressors, those choices that we make each day that seem really simple, those have the biggest impact on our brain health as we age." - Dr. Heather Sandison When my son Grant suffered his traumatic brain injury, I learned firsthand how devastating cognitive decline can be for an entire family. That's why I was so excited to sit down with Dr. Heather Sandison, a pioneering naturopathic doctor who's literally rewriting the story around Alzheimer's and dementia. While most memory care centers are one-way doors, Heather runs what she calls a "memory recovery program" where the goal is for people to return home—and they're doing it! Through her groundbreaking work applying Dr. Dale Bredesen's protocols, she's seeing 74% of her patients with cognitive impairment actually improve. Her approach to preventing Alzheimer's in midlife women focuses on hope, action, and evidence-based strategies that work. Whether you're carrying APOE4 genes, worried about your family history, or simply want to protect your brain as you age, this conversation is packed with hope and actionable strategies for preventing Alzheimer's in midlife women. From the power of ketogenic nutrition and sleep optimization to addressing hidden infections and hormonal signaling, Heather breaks down the six pillars of brain health that every woman over 40 needs to understand. This isn't about accepting decline—it's about taking control of your cognitive destiny. The six key components of brain health and how to optimize each one for preventing alzheimer's in midlife women Why APOE genetic testing is crucial for women over 40 and how to act on your results How sleep apnea (even in thin women who don't snore) devastates brain health and simple at-home testing options The specific ketogenic approach that helps patients remember their grandchildren's names within 72 hours Hidden infections in your mouth and body that trigger brain inflammation and cognitive decline Why caregivers have 2-6 times higher risk of developing Alzheimer's and how to protect yourself The surprising connection between hormones, exercise, and building new brain connections after menopause Simple lifestyle interventions that work better than any pharmaceutical for preventing cognitive decline Love the Podcast? Here's what to do: Make My Day & Share Your Thoughts! Subscribe to the podcast & leave me a review Text a screenshot to 813-565-2627 Expect a personal reply because your voice is so important to me. Join 50,000+ followers who make this podcast thrive. Want to listen to the show completely ad-free?  Go to subscribetojj.com Enjoy the VIP experience for just $4.99/month or $49.99/year (save 17%!) Click “TRY FREE” and start your ad-free journey today! What You'll Learn:Full show notes (including all links mentioned): https://jjvirgin.com/reversingalzheimers Learn more about your ad choices. Visit megaphone.fm/adchoices

Humans have long been exposed to three main types of smoke: from early domestic fires, modern wildfires, and more recently, tobacco and fossil fuel pollution. All release tiny particles from partly burned plants, containing harmful chemicals like nitrogen oxides and carcinogens. These particles raise risks for lung cancer, dementia, and even childhood obesity. Studies show that air pollution can disrupt brain chemistry, increase Alzheimer's-related proteins, and activate stress-related genes (NFkB, Nrf2). A new drug (GSM-15606) shows promise in reducing brain damage from pollution in mice. People with the ApoE4 gene may be more vulnerable, while the ApoE3 gene, possibly evolved 200,000 years ago, may offer some protection. Series: "CARTA - Center for Academic Research and Training in Anthropogeny" [Humanities] [Science] [Show ID: 40700]

Humans have long been exposed to three main types of smoke: from early domestic fires, modern wildfires, and more recently, tobacco and fossil fuel pollution. All release tiny particles from partly burned plants, containing harmful chemicals like nitrogen oxides and carcinogens. These particles raise risks for lung cancer, dementia, and even childhood obesity. Studies show that air pollution can disrupt brain chemistry, increase Alzheimer's-related proteins, and activate stress-related genes (NFkB, Nrf2). A new drug (GSM-15606) shows promise in reducing brain damage from pollution in mice. People with the ApoE4 gene may be more vulnerable, while the ApoE3 gene, possibly evolved 200,000 years ago, may offer some protection. Series: "CARTA - Center for Academic Research and Training in Anthropogeny" [Humanities] [Science] [Show ID: 40700]

Humans have long been exposed to three main types of smoke: from early domestic fires, modern wildfires, and more recently, tobacco and fossil fuel pollution. All release tiny particles from partly burned plants, containing harmful chemicals like nitrogen oxides and carcinogens. These particles raise risks for lung cancer, dementia, and even childhood obesity. Studies show that air pollution can disrupt brain chemistry, increase Alzheimer's-related proteins, and activate stress-related genes (NFkB, Nrf2). A new drug (GSM-15606) shows promise in reducing brain damage from pollution in mice. People with the ApoE4 gene may be more vulnerable, while the ApoE3 gene, possibly evolved 200,000 years ago, may offer some protection. Series: "CARTA - Center for Academic Research and Training in Anthropogeny" [Humanities] [Science] [Show ID: 40700]

Humans have long been exposed to three main types of smoke: from early domestic fires, modern wildfires, and more recently, tobacco and fossil fuel pollution. All release tiny particles from partly burned plants, containing harmful chemicals like nitrogen oxides and carcinogens. These particles raise risks for lung cancer, dementia, and even childhood obesity. Studies show that air pollution can disrupt brain chemistry, increase Alzheimer's-related proteins, and activate stress-related genes (NFkB, Nrf2). A new drug (GSM-15606) shows promise in reducing brain damage from pollution in mice. People with the ApoE4 gene may be more vulnerable, while the ApoE3 gene, possibly evolved 200,000 years ago, may offer some protection. Series: "CARTA - Center for Academic Research and Training in Anthropogeny" [Humanities] [Science] [Show ID: 40700]

Humans have long been exposed to three main types of smoke: from early domestic fires, modern wildfires, and more recently, tobacco and fossil fuel pollution. All release tiny particles from partly burned plants, containing harmful chemicals like nitrogen oxides and carcinogens. These particles raise risks for lung cancer, dementia, and even childhood obesity. Studies show that air pollution can disrupt brain chemistry, increase Alzheimer's-related proteins, and activate stress-related genes (NFkB, Nrf2). A new drug (GSM-15606) shows promise in reducing brain damage from pollution in mice. People with the ApoE4 gene may be more vulnerable, while the ApoE3 gene, possibly evolved 200,000 years ago, may offer some protection. Series: "CARTA - Center for Academic Research and Training in Anthropogeny" [Humanities] [Science] [Show ID: 40700]

Humans have long been exposed to three main types of smoke: from early domestic fires, modern wildfires, and more recently, tobacco and fossil fuel pollution. All release tiny particles from partly burned plants, containing harmful chemicals like nitrogen oxides and carcinogens. These particles raise risks for lung cancer, dementia, and even childhood obesity. Studies show that air pollution can disrupt brain chemistry, increase Alzheimer's-related proteins, and activate stress-related genes (NFkB, Nrf2). A new drug (GSM-15606) shows promise in reducing brain damage from pollution in mice. People with the ApoE4 gene may be more vulnerable, while the ApoE3 gene, possibly evolved 200,000 years ago, may offer some protection. Series: "CARTA - Center for Academic Research and Training in Anthropogeny" [Humanities] [Science] [Show ID: 40700]

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:

Episode #115 is all about diving into the midlife woman's brain—your most vital, complex, and vulnerable organ—and why protecting it matters more than ever. Here's a fact that doesn't get enough attention: two out of three people with Alzheimer's are women. And this isn't just about old age. The seeds of cognitive decline can start as early as your 40s—or even sooner.We'll talk about:• Why women are at greater risk for Alzheimer's and dementia• The brain-hormone connection during menopause and midlife• What you can do now to preserve memory, focus, and cognitive resilience• How genes like APOE4 interact with lifestyle—and what that means• How belly fat, or visceral fat. Affect cognition and brain health• And the power of early, personalized preventionMy guest, Dr. Kellyann Niotis, MD, is the first fellowship-trained preventive neurologist in the world, specializing in risk reduction strategies for neurodegenerative disorders such as Alzheimer's Disease, Lewy Body Dementia, and Parkinson's Disease. Dr. Niotis led the preventive neurology program within Dr. Peter Attia's medical practice, Early Medical, and managed the country's first Alzheimer's Prevention Clinic at Weill Cornell Medical College/NewYork-Presbyterian Hospital, where she developed research programs for Parkinson's and Lewy Body Dementia prevention. Her work has been published in several medical journals, including Neurology, Nature Mental Health, Frontiers of Aging Neuroscience, Aging and Disease, Movement Disorders, Journal of Alzheimer's Disease, Alzheimer's & Dementia, and Journal of the Prevention of Alzheimer's Diseas,e and has been presented at national and international conferences.She is passionate about the budding medical space of preventive neurology, in particular pertaining to the advocacy of preventive neurology policy changes and making treatment & education more accessible to the masses. She has received numerous honors and awards, and her opinions have been featured in popular media outlets, including CNN.Whether you're looking for tools to sharpen your brain today or you're thinking long-term about protecting yourself and your loved ones, this conversation is full of insight and hope.Medical Disclaimer:By listening to this podcast, you agree not to use this podcast as medical advice or to make any lifestyle changes to treat any medical condition in yourself or others. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any of my guests on my podcast.Learn more about Dr. Niotis:Website: https://drkellyannniotis.com/IG: @drkellyannniotisFB: @drkellyannniotisResources:Lancet Commission Modifiable Risk Factor list:https://www.thelancet.com/infographics-do/dementia-riskStay connected with JFW:Watch on my YouTube channel: https://www.youtube.com/@jillfooswellness/videosFollow me on Instagram: https://www.instagram.com/jillfooswellness/Follow me on Facebook: https://www.facebook.com/jillfooswellnessGrab discounts on my favorite biohacking products: https://www.jillfooswellness.com/health-productsEnjoy 20% savings and free shipping at Fullscript for your favorite supplements by leading brands:https://us.fullscript.com/welcome/jillfooswellnessSubscribe to the JFW newsletter at www.jillfooswellness.com and receive your FREE Guide on How To Increase Your Protein in 5 Easy Steps and your free Protein Powder Recipe Ebook. Schedule your complimentary 30-minute Zoom consultation here:https://calendly.com/jillfooswellness/30-minute-zoom-consultations

Today we have the second installment of our interview with Dr. Michael A. Schmidt, the founder, CEO, and Chief Scientific Officer of Sovaris Aerospace, a company focused on assessments and solutions applied to humans in space and extreme environments on Earth. In today's interview, we talk to Michael about NASA's plans to send humans to Mars and build permanent colonies on the Moon and Mars. We also talk to Michael about his recent book, “Building a Space-Faring Civilization,” which addresses the challenges of civilian spaceflight and the construction of space settlements. In part one of our interview, Episode 182, we talked with Michael about his pioneering work in the field of precision medicine and how he has used it to improve the cognitive and physical performance of astronauts as well as NBA, NFL players and Special Operations forces. In addition to his work with Sovaris, Michael also is a professor of aerospace medicine at the University of Central Florida College of Medicine, one of the few programs in the U.S. that offers a medical residency in aerospace medicine. Show notes: [00:03:00] Dawn picks up our interview from where we left off in part one, discussing the Human Research Program for Civilian Spaceflight. She goes on to mention that Chris Mason at Cornell University has a biobank of 1,500 samples across 22 astronauts and seven missions, and that these samples will lead to deeper insights on the effects of spaceflight on humans. Dawn switches gears to ask Michael about the cognitive and physical challenges of spaceflight over long duration missions. [00:13:03] Following up on the cognitive challenges of long duration spaceflight, Ken mentions that the hippocampus, the primary memory center of the brain, has a relatively low radiation threshold compared to other tissues in the brain. Ken asks Michael to touch on the vulnerability of specialized brain tissues to radiation, particularly in the context of a long duration spaceflight to Mars. [00:21:53] Ken mentions that it is understood that the APOE4/4 genotype is associated with impaired cognitive performance under certain circumstances and an elevated risk of dementia. While it is currently unknown whether APOE4/4 has any correlation of increased risk associated with cognitive impact resultant from environmental exposure due to spaceflight, Ken highlights the concern with sending APOE4/4-positive astronauts on long duration spaceflights without knowing the risks. [00:29:26] Ken notes the worsened cognitive impacts resultant from medical radiation, and while therapeutic radiation is different than radiation experienced by astronauts, these results give some indication of the effects astronauts might experience. [00:33:27] Dawn mentions that we recently had planetary scientist and director of NASA's Haughton-Mars project, Pascal Lee, on the podcast, who explained his view that since there are so many engineering and biological challenges with going to Mars, we should take a more measured approach to a Mars mission, perhaps even beginning with a roundtrip to Mars rather than landing on our first visit. Dawn asks Michael what his thoughts are on this approach. [00:37:29] Ken shifts the discussion to the subject of one of Mars' moons, Phobos, and its potential role in a Mars mission. [00:40:30] Dawn pivots to talk about Michael's Book “Building a Space-Faring Civilization: Advancing the Renaissance of Science, Medicine and Human Performance in Civilian Spaceflight.” Dawn asks Michael to talk about the chapter concerning the question of space radiation from the standpoint of precision medicine. [00:55:12] Dawn asks Michael to talk about the lack of appreciation people have for the fact that a Mars mission would be the most dangerous thing we've ever done. [00:59:06] Ken mentions that Michael has worked with a lot of organizations, including Space X, which has a program, the Space X Mars Colonization Program,

In this episode, you'll learn the 10 most important things to know about APOE4, including its connection to Alzheimer's disease, heart disease, and stroke. Dr. Robert Todd Hurst, MD, FACC, FASE shares proven prevention strategies, lifestyle interventions, and cutting-edge technology to help you take control of your cognitive and cardiovascular future.  Key Time Stamps:  00:30 – What APOE4 is and what you will learn here today  01:15 – What does APOE4 mean, Alzheimer's and heart disease risks   02:05 – How dementia risk is growing and how genetics play a role  02:30 – How do you get APOE4 carrier and should you be screened  02:55 – Dementia may be preventable, what the science says  03:55 – The FINGER Trial and how lifestyle changes can improve brain function  04:30 – What's coming next in dementia prevention research  05:18 – A 15-minute cognitive assessment using eye-tracking technology  08:17 – APOE4 and your risk for heart disease and stroke  08:40 – Why waiting for symptoms is no longer an option  09:25 – What's included in the Cognitive Enhancement Program at HealthspanMD  10:35 – Why a team of experts is the path we take at HealthspanMD  12:25 – Why this is not just a checkup, but a strategy for long-term health  13:55 – How to take the first step toward protecting your future  This information is for educational purposes only and is not medical advice. Don't make any decisions about your medical treatment without first talking to your doctor.    Connect with HealthspanMD:  https://www.linkedin.com/company/healthspanmd/   https://www.facebook.com/healthspanmd   https://www.instagram.com/healthspanmd/  https://quiz.healthspanmd.com/    

Get ready for another insightful Q&A episode featuring your questions! Curious about hormone health and its impact on your well-being? Ever wondered why testosterone cream might cause pesky side effects like acne or hair growth? We discuss potential solutions and alternatives to consider. Struggling with weight gain or stubborn weight loss during menopause? Discover how hormone fluctuations might be playing a role and what steps you can take to regain control. We also delve into the nuances of estradiol therapy post-hysterectomy and the vital importance of monitoring your hormone levels for overall health. Concerned about hormone therapy's role in Alzheimer's risk management, especially if you have the APOE4 gene? We explore personalized strategies that combine diet, exercise, and hormone adjustments. Don't miss out on understanding how accurate hormone testing can enhance your health journey! In this episode, we uncover: How to manage common testosterone cream side effects like acne and hair growth. Why weight gain during menopause might be linked to hormone fluctuations. How estradiol and progesterone creams can alleviate menopause symptoms. Why individualized hormone strategies are crucial for Alzheimer's risk management. How different hormone testing methods provide insights into your health. Unlock valuable knowledge about hormone health by checking out this episode now. Whether you're navigating menopause or curious about HRT, there's something here for everyone!     Sponsors Use coupon code HORMONE for 20% off your order. Try the NEW Lemonade LMNT!! Order your LMNT electrolytes today and get a FREE 8 pack of samples! Plus try it risk free, they have a no-questions-asked refund policy – you don't even have to send it back! Timeline is offering 20% off your first order of Mitopure. Go to timeline.com/HORMONE20 and use coupon HORMONE20 and get 20% off your order.   Episode Mentions Urine Metabolite Testing for Hormones & What it Tells You, Who It is for & Why It is The Gold Standard of Testing with Karen Martel & Cohost Dr. Amie Hornaman Everything You Need to Know About Hormone Testing     Are you in peri or post menopause and looking to optimize your hormones and health? At Hormone Solutions, we offer telemedicine services and can prescribe in every U.S. state, as well as in British Columbia, Alberta, and Ontario in Canada.   Visit karenmartel.com to explore our comprehensive programs: Bioidentical Hormone Replacement Therapy Individualized Weight Loss Programs  Peptide Therapy for weight loss    Interested in our NEW Peptide Weight Loss Program? Join today and get all the details here.   Join our Women's Peri and Post Menopause Group Coaching Program, OnTrack, TODAY!   To our nursing audience members, our podcasts qualify for nursing CE @ RNegade.pro. Provide # CEP17654.   Your host: Karen Martel Certified Hormone Specialist, Transformational Nutrition Coach, & Weight Loss Expert   Karen's Facebook Karen's Instagram

In this episode of the Root Cause Medicine Podcast, Dr. Kate Kresge sits down with neurologist and bestselling author Dr. Dale Bredesen to challenge everything we think we know about brain aging. Dr. Bredesen shares why age-related cognitive decline is not just treatable but in many cases preventable—and even reversible. Drawing on decades of lab research and clinical success, he outlines the root causes of cognitive decline and introduces the listener to the "cognoscopy," a powerful tool for early detection. With practical, science-backed insights on inflammation, insulin resistance, environmental toxins, and the emerging brain microbiome, this is a masterclass in 21st-century brain health. You'll here them discuss: - Why cognitive decline is often preventable—and sometimes reversible - The three key drivers of cognitive decline: inflammation, energy deficit, and toxicity - How to use the "cognoscopy" to catch signs of dementia early - The role of the brain's microbiome and oral health in neurodegeneration - Why mold, metals, and mycotoxins are underestimated threats - New blood biomarkers like pTau217, GFAP, and NFL - Supplements that support brain health, including magnesium threonate and omega-3s - How to tailor treatment using functional lab testing and wearables - Stories of patient recovery—and what makes the difference Order tests through Rupa Health, the BEST place to order functional medicine lab tests from 30+ labs - https://www.rupahealth.com/reference-guide

Is your health routine actually making you healthier, or just making you more anxious?In this episode of The Augmented Life, Michael J.J. Tiffany sits down with biohacker and longevity expert Nathalie Niddam to unpack the line between meaningful health optimization and counterproductive obsession.They dive deep into practical longevity, the role of hormones, light, genetics, wearables, and even peptides, starting with what really matters: How you feel, how you live, and whether you've nailed the basics.Nathalie offers a grounded, systems-thinking approach to health: Test intelligently, live in sync with light and circadian rhythms, move naturally, and don't skip the fundamentals in your rush to "biohack" your way to 100.This conversation is for anyone who's trying to balance data with intuition, modern tech with ancestral wisdom, and optimization with actually enjoying life.—⏱️ Timestamps00:00 – Intro: Optimization vs over-optimization01:00 – Why chasing data can backfire on your wellness04:00 – Foundational health vs fancy interventions06:30 – How to know if you're actually thriving09:00 – Light as a missing piece of the wellness puzzle12:00 – Circadian biology, vitamin D, and UVB tech15:00 – Behavioral change vs jumping to TRT18:00 – The role of strength training in longevity21:00 – Labs that actually matter (and what they tell you)23:00 – Why most people are taking the wrong supplements24:30 – Biological age tests and what to do with the data28:00 – HRV: Overrated, misunderstood, or useful?32:00 – The value of tuning in before you tune your metrics35:00 – Genetics as lifestyle feedback, not destiny39:00 – Living well with APOE4 and other gene variants42:00 – Why the foundations still matter more than any one hack44:00 – Peptides, testing, and when to actually start46:00 – Final advice: Direction > perfection

Big shift in Alzheimer's care! We can now predict it years in advance using

Send us a textAnswer a few questions to help me improve this podcast here.We all want to live long and well—but how do we determine how many good years we have ahead?In this episode of Live Long and Well with Dr. Bobby, we explore how to estimate both our total lifespan and the number of years we can expect to remain active and pain-free. Dr. Bobby reflects on personal experiences, emerging science, and time-tested frameworks to help you reframe your health trajectory with clarity and motivation. While we may not find exact answers, the tools and thought experiments shared in this conversation can shape the way we live now—and influence how we plan for the future.We begin with why this topic matters, touching on personal stories of loss, aging milestones, and medical advancements. Then we move into three frameworks: how many years you might live (using tools from actuarial tables to cardiovascular risk calculators), how many of those years might be "good," and the wildcard of unpredictable events.The simplest predictor comes from actuarial life tables, which estimate life expectancy by age and sex. A 55-year-old man today might expect to live to 79; a woman to 82. More advanced tools include the Framingham Risk Score, which factors in cholesterol, blood pressure, smoking status, and diabetes to estimate 10-year cardiovascular risk. Research suggests that sharing these risk scores can lead to behavior changes, as shown in this meta-analysis of 28 studies and preliminary evidence of outcome improvements.On the genetics side, polygenic risk scores offer a glimpse into inherited risks, though they remain research tools for now (Nature study). More accessible are tests for specific genes like APOE4, which increases the risk of dementia (PubMed).Beyond numbers, simple physical tests can offer insight. The Brazilian sit-stand test links mobility with mortality risk: fewer than 8 points doubles your six-year mortality risk. Grip strength, too, is a strong predictor of all-cause mortality across 17 countries (PubMed).While biologic clocks based on DNA methylation are generating buzz, their utility remains limited due to variability between samples and testing methods (Nature Communications).When it comes to estimating “good” years—those lived free from major pain or disability—the data are sparse. Some disease-specific tools (e.g., for MS or dementia progression) exist, but there's no universal actuarial equivalent. However, we know muscle mass and aerobic capacity decline predictably with age—1–2% muscle loss per year and a 10% drop in aerobic fitness per decade (OUP Journal). Predicting your future function can begin with assessing how far you can walk, whether stairs leave you breathless, or how your weight and strength compare to a decade ago.Finally, we can't forget unpredictable events: the odds of a serious fall increase significantly after 65, and vision or hearing loss multiplies that risk (NCOA). Building physical resilience now can reduce these odds—see

You might not realize just how much your oral health is tied to your heart and overall wellness—but it's a connection worth knowing about. I caught up again with my amazing colleague, Dr. Ellie Campbell, and we got into why regular lab tests sometimes miss the early signs of things like heart disease, stroke, and even dementia. We talked about why your dentist could actually be one of the most important people on your health team, plus some sneaky risks that only advanced testing can catch. Dr. Ellie has been in family medicine for over 25 years, mixing integrative and functional approaches to help people truly understand their health. She shared some eye-opening stuff about how sleep apnea can mess with your blood sugar, why fasting blood sugar numbers matter more than you think, and how your genes could be playing a bigger role than you realize. She also gave some solid advice on how to speak up for yourself in a medical system that doesn't always connect these dots. If you're someone who wants to take better care of yourself and catch problems before they sneak up, this episode is packed with tips that really hit home. And by the way, just to sweeten things up—my new Mighty Maca Mango is out now, perfect for spring and summer. It's a delicious twist on Mighty Maca that you can toss in sparkling water or make into popsicles. Check it out anytime at dranna.com—it's a little treat with big benefits.   Key Timestamps: [00:00:00] Introduction. [00:04:54] How to know if you have cardiovascular disease. [00:10:09] Corrupted LDL cholesterol explained. [00:11:32] Oxidative stress and antioxidants. [00:15:54] Gender differences in blood sugar. [00:20:20] Increased mortality with very low blood sugar. [00:24:21] Continuous glucose monitors' impact. [00:28:56] LDL cholesterol management post-heart attack. [00:32:03] Markers of oxidative stress. [00:36:43] ApoE4 gene and health risks. [00:39:57] 2 recommended radiology tests for patients over 40. [00:46:13] Atherosclerosis awareness and prevention.   Memorable Quotes: "People with the highest cholesterol live the longest. You heard that right." [00:10:30] – Dr. Ellie Campbell "I believe that we saved that patient from a heart attack or a stroke by identifying leading indicators in blood that told me she had a dental problem that took three dentists to find." [00:34:21] – Dr. Ellie Campbell   Links Mentioned: Mighty Maca Mango: https://drannacabeca.com/products/mighty-maca The Blood Pressure Blueprint: https://bpblueprint.com/   Connect with Dr. Ellie Campbell: Website: https://www.campbellfamilymedicine.com/ Instagram: https://www.instagram.com/ellie.cfm/   Connect with Dr. Anna Cabeca: Website: https://drannacabeca.com/pages/show Instagram: https://www.instagram.com/thegirlfrienddoctor/ YouTube: https://www.youtube.com/@thegirlfrienddoctor TikTok: https://www.tiktok.com/@drannacabeca   Produced by Evolved Podcasting: www.evolvedpodcasting.com

You might not realize just how much your oral health is tied to your heart and overall wellness—but it's a connection worth knowing about. I caught up again with my amazing colleague, Dr. Ellie Campbell, and we got into why regular lab tests sometimes miss the early signs of things like heart disease, stroke, and even dementia. We talked about why your dentist could actually be one of the most important people on your health team, plus some sneaky risks that only advanced testing can catch. Dr. Ellie has been in family medicine for over 25 years, mixing integrative and functional approaches to help people truly understand their health. She shared some eye-opening stuff about how sleep apnea can mess with your blood sugar, why fasting blood sugar numbers matter more than you think, and how your genes could be playing a bigger role than you realize. She also gave some solid advice on how to speak up for yourself in a medical system that doesn't always connect these dots. If you're someone who wants to take better care of yourself and catch problems before they sneak up, this episode is packed with tips that really hit home. And by the way, just to sweeten things up—my new Mighty Maca Mango is out now, perfect for spring and summer. It's a delicious twist on Mighty Maca that you can toss in sparkling water or make into popsicles. Check it out anytime at dranna.com—it's a little treat with big benefits.   Key Timestamps: [00:00:00] Introduction. [00:04:54] How to know if you have cardiovascular disease. [00:10:09] Corrupted LDL cholesterol explained. [00:11:32] Oxidative stress and antioxidants. [00:15:54] Gender differences in blood sugar. [00:20:20] Increased mortality with very low blood sugar. [00:24:21] Continuous glucose monitors' impact. [00:28:56] LDL cholesterol management post-heart attack. [00:32:03] Markers of oxidative stress. [00:36:43] ApoE4 gene and health risks. [00:39:57] 2 recommended radiology tests for patients over 40. [00:46:13] Atherosclerosis awareness and prevention.   Memorable Quotes: "People with the highest cholesterol live the longest. You heard that right." [00:10:30] – Dr. Ellie Campbell "I believe that we saved that patient from a heart attack or a stroke by identifying leading indicators in blood that told me she had a dental problem that took three dentists to find." [00:34:21] – Dr. Ellie Campbell   Links Mentioned: Mighty Maca Mango: https://drannacabeca.com/products/mighty-maca The Blood Pressure Blueprint: https://bpblueprint.com/   Connect with Dr. Ellie Campbell: Website: https://www.campbellfamilymedicine.com/ Instagram: https://www.instagram.com/ellie.cfm/   Connect with Dr. Anna Cabeca: Website: https://drannacabeca.com/pages/show Instagram: https://www.instagram.com/thegirlfrienddoctor/ YouTube: https://www.youtube.com/@thegirlfrienddoctor TikTok: https://www.tiktok.com/@drannacabeca   Produced by Evolved Podcasting: www.evolvedpodcasting.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.

If you’re worried about memory loss or have a family history of Alzheimer’s, this episode is a must-listen. Angela sits down with world-renowned neurologist and author Dr. Dale Bredesen to unpack the groundbreaking science behind Alzheimer’s prevention and reversal—even if you carry the APOE4 gene. With over 30 years of research, Dr. Bredesen shares how to optimise your brain health through metabolic flexibility, inflammation control, and personalised interventions. In this powerful and deeply personal episode, Angela also opens up about her own genetic risk and experience caring for her mum with Alzheimer’s. They explore why cognitive decline is not inevitable and how Dr. Bredesen’s new book, The Ageless Brain, is putting the power back into your hands. Whether you're 35 or 75, the steps to preserve your cognition start now—and the tools have never been more accessible. KEY TAKEAWAYS: Alzheimer’s Is Preventable and Reversible: Dr. Bredesen explains how addressing root causes like inflammation, metabolic dysfunction, and toxicity can stop and even reverse cognitive decline. Perimenopause and Brain Fog: Oestrogen loss affects brain energy metabolism, making perimenopausal women more vulnerable to cognitive decline. Your Brain Runs on Supply & Demand: Cognitive health depends on supporting your brain’s high energy needs while reducing inflammatory load and toxic exposure. Check Your Cognitive Biomarkers Early: Blood markers like P-Tau217, GFAP, and A-beta42 can reveal risk decades before symptoms appear. Lifestyle = Medicine: Sleep quality, insulin sensitivity, resistance training, brain stimulation, and even stress reduction all play a critical role. GLP-1s and Alzheimer’s Risk: While popular for weight loss, these drugs may negatively impact cognition in some people—especially APOE4 homozygotes. TIMESTAMPS AND KEY TOPICS:0:00 – Introduction 6:48 – Pathogens, toxins, and the real cause of Alzheimer’s 13:32 – Menopause, oestrogen, and female brain vulnerability 24:05 – Judy’s story: reversing cognitive decline for 13+ years 32:18 – Most common risky behaviours for brain degeneration 42:21 – Best exercises for insulin sensitivity and cognition 51:10 – Supplements that protect brain structure & function 54:22 – How to use The Ageless Brain as a practical guide 58:45 – Final thoughts + where to learn more from Dr. Bredesen VALUABLE RESOURCES Click here for discounts on all the products I personally use and recommend A BIG thank you to our sponsors who make the show possible: Get 20% off the Creatine I love at trycreate.co/ANGELA20, and use code ANGELA20 to save 20% on your firsts order. Brain Boost: Try Neuro Regenerate at lvluphealth.com/angela and use code ANGELA15 to save 15% ABOUT THE GUEST Dale Bredesen, M.D. is an expert in the mechanisms of neurodegenerative diseases such as Alzheimer's disease. He is a graduate of Caltech, and received his MD from Duke University Medical Center. His career has included serving as Chief Resident in Neurology at the University of California, San Francisco, and served as a NIH Postdoctoral Fellow. His faculty position included working at UCSF, UCLA, and the University of California, San Diego. He was the director of the Program on Aging at the Burnham Institute. He was the founding President and CEO of the Buck Institute. He has developed a new therapeutic approach to treating Alzheimer's disease. He is the author of The End of Alzheimer's: The First Program to Prevent and Reverse Cognitive Decline. Dr Dale Bredesen’s latest book: The Ageless Brain: How to Sharpen and Protect Your Mind for a Lifetime - https://amzn.eu/d/gdrjKQm https://www.apollohealthco.com/ https://www.instagram.com/drdalebredesen/ https://www.facebook.com/drdalebredesen/ ABOUT THE HOST Angela Foster is an award winning Nutritionist, Health & Performance Coach, Speaker and Host of the High Performance Health podcast. A former Corporate lawyer turned industry leader in biohacking and health optimisation for women, Angela has been featured in various media including Huff Post, Runners world, The Health Optimisation Summit, BrainTap, The Women’s Biohacking Conference, Livestrong & Natural Health Magazine. Angela is the creator of BioSyncing®️ a blueprint for ambitious entrepreneurial women to biohack their health so they can 10X how they show up in their business and their family without burning out. The High Performance Health Podcast is a top rated global podcast. Each week, Angela brings you a new insight, biohack or high performance habit to help you unlock optimal health, longevity and higher performance. Hit the follow button to make sure you get notified each time Angela releases a new episode. CONTACT DETAILS Instagram Facebook LinkedIn Affiliate Disclaimer: Note this description contains affiliate links that allow you to find the items mentioned in this video and support the channel at no cost to you. While this channel may earn minimal sums when the viewer uses the links, the viewer is under no obligation to use these links. Thank you for supporting the show! Disclaimer: The High Performance Health Podcast is for general information purposes only and do not constitute the practice of professional or coaching advice and no client relationship is formed. The use of information on this podcast, or materials linked from this podcast is at the user's own risk. The content of this podcast is not intended to be a substitute for medical or other professional advice, diagnosis, or treatment. Users should seek the assistance of their medical doctor or other health care professional for before taking any steps to implement any of the items discussed in this podcast. This Podcast has been brought to you by Disruptive Media. https://disruptivemedia.co.uk/

Language is the invisible prison that keeps us trapped in a medical paradigm designed to manage symptoms rather than restore health. When we adopt words like "diagnosis," "treatment," and "cure," we unwittingly submit to a worldview where health is impossible and disease inevitable.I've spent nearly four decades guiding people back to health by first liberating them from the constraints of medical terminology. The words you use about your body create biochemical realities – changing your language is the first step toward changing your biology. This isn't just philosophical; it's practical physiology.Consider what happens when tissue is damaged by radiation, creating pleural effusions that make breathing difficult. The conventional approach treats this as a "side effect" to be managed, but it's actually a direct consequence of cellular damage from ionizing radiation producing free radicals. The solution isn't more medication but abundant antioxidants to neutralize these reactive species, along with movement, proper sleep timing, and nutritional support to restore normal function.Even conditions like Alzheimer's, which medicine portrays as genetic destiny, are primarily responses to environmental toxicity and nutritional deficiencies. The APOE4 gene doesn't determine your fate; it simply affects how cholesterol is distributed – a process profoundly influenced by diet, dental health, and hormone balance. When patients restore these foundational elements, cognitive function often returns.The gateway to healing begins with recognizing that your body isn't harboring invaders called diseases – it's adapting as best it can to toxic burdens. Cleansing through juicing, biological dentistry, and targeted supplements creates the conditions for recovery, while practices like meditation provide an inner sanctuary from whichSend us a text Join Dr. Lodi's Inner Circle membership and unlock exclusive access to webinars, healthy recipes, e-books, educational videos, live Zoom Q&A sessions with Dr. Lodi, plus fresh content every month. Elevate your healing journey today by visiting drlodi.com and use the coupon code podcast (all lowercase: P-O-D-C-A-S-T) for 30% off your first month on any membership option. Support the showThis episode features answers to health and cancer-related questions from Dr. Lodi's social media livestream on Jan. 19th, 2025Join Dr. Lodi's FREE Q&A livestreams every Sunday on Facebook, Instagram, and Tiktok (@drthomaslodi) and listen to the replays here.Submit your question for next Sunday's Q&A Livestream here:https://drlodi.com/live/Facebookhttps://www.facebook.com/DrThomasLodi/Instagramhttps://www.instagram.com/drthomaslodi/ Join Dr. Lodi's Inner Circle membership and unlock exclusive access to webinars, healthy recipes, e-books, educational videos, live Zoom Q&A sessions with Dr. Lodi, plus fresh content every month. Elevate your healing journey today by visiting drlodi.com and use the coupon code podcast (all lowercase: P-O-D-C-A-S-T) for 30% off your first month on any membership option. Learn to Thrive with ADHD Podcast Welcome to the Learn to Thrive with ADHD Podcast. This is the show for you if you're... Listen on: Apple Podcasts Spotify Join Dr. Lodi's informative FREE Livestreams...

Key Takeaways: Nikki Schultek, Executive Director of the Alzheimer Pathobiome Initiative, shares groundbreaking research at the International Lyme and Associated Diseases Society (ILADS) Conference. The initiative is investigating the connection between infections—such as Lyme disease, Epstein-Barr virus, and long COVID—and neurodegenerative diseases like Alzheimer's. ILADS provides a crucial platform for researchers to collaborate, break down silos, and drive innovation in chronic illness research. A recent symposium brought together experts across multiple disciplines to explore microbial drivers of brain diseases. The team has submitted a major grant proposal to advance research on infectious and microbiome influences on Alzheimer's. A newly published review article in the Journal of Infectious Diseases highlights key findings and perspectives from the initiative. Insights into host vulnerabilities, including the role of the ApoE4 gene, are shaping a deeper understanding of individual susceptibility to neurodegenerative conditions. The discussion underscores systemic healthcare challenges in addressing chronic, complex diseases and the urgent need for research-driven changes in medical practice. Resources & Links: Follow the latest ILADS updates at ILADS.org Learn more about Nikki Schultek and her work: Intracellular Research Group Stay connected with Tick Boot Camp: Website | Instagram | Facebook | YouTube | TikTok | Twitter (X)

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. 

Send us a textThis week on The Less Stressed Life, we're talking about reversing cognitive decline and optimizing brain health with Dr. Heather Sandison, author of Reversing Alzheimer's. As a naturopathic doctor and founder of the first memory recovery residential program, Dr. Sandison shares the six root causes of neurodegeneration—and how you can bring the brain back into balance at any age.We're talking about reversing Alzheimer's and neurodegenerative conditions (although it is so much more). From toxins to stress to nutrition, this empowering episode offers real hope and practical tools for preventing and even reversing memory loss. Whether you're supporting a loved one or thinking ahead for your own brain, this is one conversation you don't want to miss.Dr. Sandison's free Keto Diet Guide can be downloaded at: https://www.drheathersandison.com/In that website people can also watch all her content and read her blogKEY TAKEAWAYS:The six root causes of cognitive decline (and how to assess them)How toxins and stress quietly sabotage brain healthWhat your ApoE4 gene does—and doesn't—mean for your futureSigns of early cognitive decline most people missWhat Dr. Sandison's clinical trial revealed about reversing Alzheimer'sABOUT GUEST:Dr. Heather Sandison is the NYT bestselling author of “Reversing Alzheimer's The New Toolkit to Improve Cognition and Protect Brain Health”. She is a renowned naturopathic doctor specializing in neurocognitive medicine and the founder of Solcere Health Clinic, San Diego's premier brain optimization clinic, and Marama, a residential program turning memory care into memory recovery. She has dedicated her career to supporting those suffering with dementia and is the primary author of peer reviewed research published in the Journal of Alzheimer's Disease. She is excited to shatter common misconceptions about Alzheimer's and share what she has learned about keeping your brain sharp at any age.WHERE TO FIND:Website: https://www.drheathersandison.com/Instagram: https://www.instagram.com/dr.heathersandison/WHERE TO FIND CHRISTA:Website: https://www.christabiegler.com/Instagram: @anti.inflammatory.nutritionistPodcast Instagram: @lessstressedlifeYouTube: https://www.youtube.com/@lessstressedlifeSPONSOR:Thanks to Jigsaw Health for sponsoring this episode! Struggling with dry, cracked hands? Try their Alaska Cod Liver Oil for omega-3s + vitamins A & D to support skin and immune health. Use code LESSSTRESSED10 at JigsawHealth.com for 10% off—unlimited use!WORK WITH CHRISTA: I've streamlined my proven method to help you get to the REAL root of eczema and food sensitivities—without the overwhelm. Join the program at christabiegler.com before doors close!

Alzheimer's doesn't just “happen” later in life—it's a slow, silent process that can begin decades before symptoms appear. In this solo episode, we challenge the myth that Alzheimer's is purely genetic, and break down what the science really says about your risk. I explore the role of the APOE4 gene, how it interacts with lifestyle and metabolic health, and why women—especially during and after menopause—may face a unique vulnerability. Most importantly, I introduce three cutting-edge blood tests that can detect the earliest signs of Alzheimer's, long before memory loss sets in. We'll also talk prevention: from blood sugar and insulin resistance to inflammation, hormone balance, and brain energy metabolism—everything you can start doing right now to safeguard your cognitive future. This is more than a conversation about Alzheimer's—it's a roadmap for taking control of your brain health. SponsorsA huge thank you to my sponsors for supporting this episode. Check them out and enjoy exclusive discounts:ZocDoc – Finding a great doctor has never been easier. With ZocDoc, you can browse top-rated physicians, read real patient reviews, and book appointments online - all in one place. Get started here: https://www.zocdoc.com/neuroHone Health – Take control of your hormones with at-home testing designed specifically for men. Get personalized insights and expert guidance to optimize your health and performance. Learn more at: https://honehealth.com/Momentous – Science-backed supplements trusted by elite athletes and experts. Whether you're looking to improve recovery, performance, or overall wellness, Momentous has you covered. Use code NEURO for 20% off your order: https://www.livemomentous.com/neuroTroscriptions – Unlock your cognitive potential with precision-dosed nootropics developed by medical experts. Whether you need more focus, clarity, or energy, Troscriptions offers innovative solutions.- Get 10% off: https://troscriptions.com/NEURO- https://troscriptions.com/discount/NEUROMAIL?utm_source=affiliate&utm_medium=email&utm_campaign=NeuroMailTimestamps: 00:00 Top Alzheimer's Myth: Genetics Don't Seal Your Fate01:43 APOE4 Gene Explained: Risk Factors vs. Reality 04:00 Alzheimer's Risk Isn't Just in Your DNA10:50 Top 3 Alzheimer's Biomarkers You Can Test for Today14:47 APOE4 Prevention Plan: Lifestyle Changes That Protect Your Brain The 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 Ray Dorsy, Dr Dale Bredeson, Dr. Ben Bikman

 Did you know that Alzheimer's is mostly preventable and sometimes reversible?  Today we'll talk about what we used to think Alzheimer's is, what it really is, what you can do to lower your chances of getting it, and when you need to start. You have more control over your future health outcomes than you're led to believe.  Even having 2 copies of the APoE4 gene isn't a match for how you choose to live your life now.Book: The End of Alzheimer'ssend me a message: healthcouragecollective@gmail.comcome get some free stuff from my website: www.healthcouragecollective.com /free resources

El Alzheimer no es un simple efecto del envejecimiento, sino un proceso que comienza décadas antes de los primeros síntomas. En este episodio desvelamos los mecanismos del "ladrón silencioso" de la memoria: el papel del amyloide y el tau, los factores genéticos como el APOE4, y lo más importante, las 14 claves científicamente probadas para reducir hasta un 45% el riesgo de desarrollar demencia. Desde la importancia de cuidar nuestras encías hasta cómo la música y la lectura crean "reserva cognitiva", ofrecemos un mapa completo para enfrentarnos al fantasma que nos acecha a todos. Escucha el episodio completo en la app de iVoox, o descubre todo el catálogo de iVoox Originals

For decades, we've been told that our DNA is a fixed blueprint—an unchangeable code that dictates our health and lifespan. But what if that's only half the story? Sharon Hausman-Cohen, a physician, researcher, and genomics expert at IntellxxDNA, joins Dave to reveal the cutting-edge science of genetic optimization—how understanding your DNA can unlock longer life, better brain function, and even protection from chronic disease. Forget the old-school genetic reports that left you with useless percentages. The new frontier of precision genomics goes beyond risk factors to actionable insights, showing you exactly how to turn on your body's most powerful longevity genes and turn off the pathways driving inflammation, cognitive decline, and disease. What You'll Learn in This Episode: • Why genetics alone don't determine your future—and how to use epigenetics to control your health • The truth about MTHFR, APOE4, and other “bad” genes—are they actually harming you? • How genetic reports can predict and eliminate brain fog, fatigue, and pain • The hidden genetic reasons behind ADHD, depression, and anxiety—and how to fix them • Why some people age faster—and the one longevity gene that determines your biological age • Cutting-edge breakthroughs in DNA-based biohacking—is it possible to edit your genes for peak performance? This is the future of personalized medicine. By understanding your own genetic blueprint, you can stop guessing and start making the precise changes that will optimize your energy, brainpower, and lifespan! ** Visit IntellxxDNA at https://intellxxdna.com/asprey/ When you go to the website to find a clinician please select “human upgrade/longevity” as the type of consult to get specialized biohacking clinicians! ** SPONSORS -Timeline | Head to https://www.timeline.com/dave to get 10% off your first order. -Leela Quantum Tech | Head to https://leelaq.com/DAVE for 10% off. Resources: • Dave Asprey's New Book - Heavily Meditated: https://daveasprey.com/heavily-meditated/ • IntellxxDNA Website: https://intellxxdna.com/asprey/ • 2025 Biohacking Conference: https://biohackingconference.com/2025 • Danger Coffee: https://dangercoffee.com • Dave Asprey's Website: https://daveasprey.com • Dave Asprey's Linktree: https://linktr.ee/daveasprey • Upgrade Collective – Join The Human Upgrade Podcast Live: https://www.ourupgradecollective.com • Own an Upgrade Labs: https://ownanupgradelabs.com • Upgrade Labs: https://upgradelabs.com • 40 Years of Zen – Neurofeedback Training for Advanced Cognitive Enhancement: https://40yearsofzen.com Timestamps: • 00:00 – Intro • 02:00 – The Role of Genetics in Longevity • 03:37 – Gene Variants & Cognitive Health • 05:58 – Epigenetics vs. Genetics • 08:21 – Genomics & Pain Management • 09:26 – Breakthroughs in Genetic Research • 12:33 – The Future of Genomic Medicine • 14:27 – How to Use Genomic Reports • 38:25 – Mitochondria & Longevity • 42:40 – BH4 & Mental Health • 43:42 – Folinic Acid & Brain Function • 44:37 – Genomics & Autism • 46:06 – Personalized Medicine • 56:00 – APOE4 & Alzheimer's Risk • 59:44 – Genetics & Heart Health • 01:04:54 – The Future of Precision Medicine • 01:20:23 – Conclusion & Next Steps See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Story at-a-glance Research found that higher levels of harmful bacteria (Prevotella intermedia) in the mouth are linked to cognitive impairment, while beneficial bacteria (Neisseria and Haemophilus) support better brain function Nitric oxide production by beneficial oral bacteria plays a crucial role in maintaining blood flow to the brain. Nitrate-rich vegetables help boost the population of these healthy bacteria People with the APOE4 gene show a distinct oral microbiome composition. Research shows they have lower levels of Neisseria bacteria and higher amounts of Prevotella, which is associated with increased dementia risk Harmful oral bacteria have the ability to enter the bloodstream and cross the blood-brain barrier, leading to brain inflammation that results in cognitive decline Maintaining oral health through proper diet, regular brushing and flossing, nose breathing, avoiding antibacterial mouthwash and practicing oil pulling are effective strategies against cognitive decline

Alzheimer's disease begins 10 to 30 years before symptoms appear—which means there's a massive window for prevention if you know your risk factors.In this first episode of our four-part series on Alzheimer's prevention, Amy shares why "early is everything" when it comes to protecting your brain health, especially for women navigating midlife. Discover how genetic testing can help predict your risk and why our current healthcare system's approach to Alzheimer's is fundamentally backward.What to Listen For: (10 different points)[00:00:00] Why Amy's personal experience with her mother's Alzheimer's diagnosis in 2016 drove her to research prevention.[00:03:00] The three tiers of prevention in healthcare: primary, secondary, and tertiary—and why Alzheimer's care is fundamentally backwards.[00:07:00] The shocking reality: by the time Alzheimer's symptoms appear, 20% of the hippocampus is already damaged.[00:10:00] How insurance companies limit early testing and what you can do about it.[00:13:00] Understanding preclinical vs. clinical Alzheimer's and why the preclinical phase offers a huge window for intervention.[00:15:00] The three-phase model of Alzheimer's: amyloid plaques, tau tangles, and neuroinflammation—explained.[00:19:00] Why 50 million Americans could already have preclinical Alzheimer's without knowing it.[00:21:00] Genetic factors like APOE4 and their impact on your risk of developing Alzheimer's.[00:24:00] Blood biomarkers for detection: what they reveal and why they're underused.[00:25:00] Why lifestyle changes are just as actionable as new drugs for Alzheimer's prevention.By understanding your genetic risks, you can take meaningful action long before symptoms appear. Tune in to learn more about how to protect your brain health.Don't forget to subscribe for the rest of this series!RESOURCES: Book a FREE Discovery Call with Amy Lang Order Amy's book Thoughts Are Habits Too: Master Your Triggers, Free Yourself From Diet Culture, and Rediscover Joyful Eating. Follow Amy on Instagram @habitwhisperer

In today's episode I am kicking off a 10-part series, "Women's Guide to Alzheimer's Disease," focusing on understanding the complexities of the brain. Delve into the basics of neurons, synaptic connections, and the essential role of vascular health in cognitive function. Discover how lifestyle factors contribute to Alzheimer's and the critical window for intervention. Explore key elements like mitochondrial function and the APOE4 gene's impact. With insights into brain health and disease prevention, this episode lays the groundwork for optimizing cognitive performance and demystifying Alzheimer's.SponsorsZocDoc: https://www.zocdoc.com/neuroMomentous - Use code NEURO to get 20% off your order - https://www.livemomentous.com/neuroTimestamps 0:00 Understanding the Brain's Role in Alzheimer's Disease3:55 Momentous Supplements: Purity, Potency, and Safety Guaranteed5:15 Streamlining Doctor Appointments with Zocdoc6:38 The Brain's Vascular Health and Its Link to Alzheimer's9:27 Understanding Alzheimer's Disease and Brain Health InterventionsThe 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 Ray Dorsy, Dr Dale Bredeson, Dr. Ben Bikman

This week, we're diving into a topic that affects all of us—our brain health. Whether it's memory lapses, difficulty focusing, or a family history of dementia, cognitive decline is something we all want to prevent. But with so much misinformation out there, it's hard to know what actually works.That's why we're thrilled to have Dr. Pamela  Hutchison, a naturopathic doctor focusing in neurological health, on the podcast. Dr. Pamela  has focused her 24-year career on supporting people with neurological and mental health concerns live healthy lives. In this episode, we break down real, science-backed ways to protect your brain, including:When you should start thinking about brain health (hint: it's earlier than you think!)The biggest risk factors for cognitive decline and how to reduce themHow mental health conditions like depression and anxiety impact brain agingThe role of diet, including the MIND diet and the surprising power of leafy greensWhether Alzheimer's should really be called "Type 3 Diabetes"Genetic risk factors like APOE4—should you get tested?The best lifestyle changes that actually slow cognitive declineConnect with Dr. Hutchison below:Instagram: @dr_pamela_hutchison_ndHer clinic: https://acaciahealth.ca/Her podcast: The well nurtured brainDon't forget to follow us on Instagram @girlsgonewellnesspodcast for updates and more wellness tips. Please subscribe to our podcast and leave a review—we truly appreciate your support. Let's embark on this journey to wellness together!DISCLAIMER: Nothing mentioned in this episode is medical advice and should not be taken as so. If you have any health concerns, please discuss these with your doctor or a licensed healthcare professional.

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!

Send us a textCan lifestyle choices truly prevent more than 50% of dementia cases? Join Dr. Douglas Beck and Dr. Dung Trinh as we explore this thought-provoking question and uncover groundbreaking insights. Our discussion dives into the 2024 Lancet study, highlighting 14 modifiable risk factors for dementia and the potential to prevent or delay nearly half of all cases. You'll learn about the crucial role primary care plays in managing Alzheimer's amidst a shortage of neurologists and the importance of addressing lifestyle factors like sleep and obesity. We also weigh the benefits and challenges of FDA-approved monoclonal antibodies, exploring their promise and limitations.In our in-depth conversation, we explore the evolving landscape of Alzheimer's detection and treatment. Hear about the promising potential of biomarkers like P-tau-217 and the role of genetic factors like APOE4. We discuss shifting treatment strategies, moving beyond amyloid-targeted therapies to consider tau proteins and the immune system's involvement. The conversation also shines a light on the flaws in our healthcare system's focus on treatment over prevention, examining the impact of lifestyle industries and Medicare Advantage plans on preventive health measures. Join us for this enlightening discussion that promises to challenge your understanding of Alzheimer's care and prevention. Connect with the Hearing Matters Podcast TeamEmail: hearingmatterspodcast@gmail.com Instagram: @hearing_matters_podcast Twitter: @hearing_mattasFacebook: Hearing Matters Podcast

Anti-amyloid therapies provide the first FDA-approved option to alter AD pathology, but an understanding of overall utility and value to patients remains in its infancy. In this episode, Teshamae Monteith, MD, FAAN, speaks with David S. Geldmacher, MD, FACP, FANA, author of the article “Treatment of Alzheimer Disease” in the Continuum® December 2024 Dementia issue. Dr. Monteith is the associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Geldmacher is a professor and Warren Family Endowed Chair in Neurology and the director of the Division of Cognitive and Behavioral Neurology, Department of Neurology, Marnix E. Heersink School of Medicine at the University of Alabama at Birmingham in Birmingham, Alabama. Additional Resources Read the article: Treatment of 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: @headacheMD Transcript Full interview 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 Monteith: This is Dr Teshamae Monteith. Today, I'm interviewing Dr David Geldmacher about his article on treatment of Alzheimer's disease, which appears in the December 2024 Continuum issue on dementia. Welcome to our podcast, Dr Geldmacher. How are you?  Dr Geldmacher: I'm very well, thank you. It's a pleasure to be here.  Dr Monteith: Yeah. So, why don't you introduce yourself to our audience? Dr Geldmacher: Sure. I'm David Geldmacher. I'm a professor of neurology at the University of Alabama in Birmingham and I lead the division of Cognitive and Behavioral Neurology.  Dr Monteith: So, I'm really excited about this, to personally learn, and I know that or neurology community is also really excited about this interview. So, why don't we start off with your main objective.  Dr Geldmacher: So, my main goal in the article was to review the FDA-approved pharmacologic treatments for dementia. There's lots of ways of thinking about treatment of dementia; psychosocial, caregiver support, and so forth. But I really wanted to focus on the issues of drug treatment because that's what has been our backbone for a long time and now has recently expanded.  Dr Monteith: Why don't we talk a little bit about, first of all, the boom in the field? What's that been like?  Dr Geldmacher: So, the big change in the field is over the last several years, we've had treatments become available that actually attack the underlying Alzheimer pathology, and that's new and different. For decades, we've been able to treat the symptoms of the disease, but this is the first time we've really been able to get to the root of the pathology and look toward removing amyloid plaques from the brain.  Dr Monteith: Let's step back a little bit and talk about the framework of diagnosis and how that leads into the therapeutic potential. I know you're going to dive into some of the biologics, but we should probably talk about the kind of holistic approach to considering the diagnosis. Dr Geldmacher: Sure. So, you know, when someone comes to the clinic with memory complaints, our question we have to ask is, is this neurologic origin, a structural origin like Alzheimer's disease or vascular dementia? Are there complicating factors, the software issues of mood disorders and sleep disorders and pain that can all magnify those symptoms? The clinical reasoning is a critical part of that, but in Alzheimer's disease, typically the problems revolve around difficulty forming new memories of events and activities, the episodic memory. And then it's often accompanied by changes in word finding and semantic knowledge. And those are the things that we look for in the clinic to really point toward an AD diagnosis. And then we support it with exclusion of other causes through blood work and identification of patterns of brain atrophy on MRI. And then most recently in the last couple of years, we've been able to add to that molecular imaging for amyloid with PET scans as well as, most recently, blood-based biomarkers for Alzheimer's pathology. So, it's really been a revolution in the diagnosis over these last several years.  Dr Monteith: And when approaching patients or populations of individuals, there seems to be a real full spectrum with looking at the societal burden, the biological impact, of course, risk factors of primary prevention, and now this whole area of brain health and secondary prevention. How do you kind of tie all of this together when talking to patients and family members?  Dr Geldmacher: Sure. So, the approaches for brain health apply to everyone. In basically every clinic visited, our brain aging and memory clinic, we reviewed lifestyle approaches to brain health like regular physical exercise, healthy diet, cognitive and social stimulation. And those are fundamental to the approach to everyone, whether they have cognitive impairments that are measurable or not. These are all things that are good for our brain health. And then, you know, focusing on the vascular risk factors in particular and working with the patient and their primary care team to ensure that lipids and blood sugar and blood pressure are all in good healthy ranges and being appropriately treated.  Dr Monteith: You know, there's this kind of whole considerations of clinically meaningful endpoints and clinical trials, and even when we're talking to our patients. What would you say the field has kind of identified has the best endpoints in helping patients? Would you call it impaired daily function? Is that like the best hard endpoint? Obviously, there are other things such as caregiver burden, but you know, how do you approach assessing patients? Dr Geldmacher: Defining the endpoints is very difficult. Typically, if we talk to patients and their families, they would like to have better memory or improve memory. How that applies in everyday life actually is daily function. And so, we focus very much on daily function. And when I talk about our therapies, whether they're symptomatic therapies or the new disease-modifying therapies, I really talk about maintenance of function and delays and decline or slowing of decline, helping to foster the person's independence in the activities that they have and be able to sustain that over the longer term.  Dr Monteith: And when thinking about diagnosis- and we're going to get into treatments, but when thinking about the diagnosis, and of course, it's full-spectrum from mild cognitive impairment to moderate and severe forms of dementia, but who should have CSF testing and PET imaging? Obviously, these are invasive, somewhat invasive and expensive tests. Should all people that walk in the door that have memory complaints? How do you stratify who should have tests? Dr Geldmacher: I think about this in a big funnel, basically, and the starting point of the funnel, of course, is the person with memory complaints. Then there's that neurologic reasoning. Are these memory complaints consistent with what we expect from the anatomy of Alzheimer's disease, with atrophy in in the hippocampus and temporal lobe? Do they have episodic memory loss or not? That first step is really trying to characterize, do the clinical patterns act like those of Alzheimer's disease or not? And then we follow the Academy of Neurology guidelines, looking for reversible sources of cognitive decline, things like B12 deficiency and depression, sleep disorders and the like, and try to exclude those. We start with structural imaging with everyone, and MRI, typically, that will help us understand vascular burden and patterns of atrophy, looking for things like mesial temporal atrophy or precuneus atrophy that are characteristic of Alzheimer's disease. If those things are all pointing in the direction of AD as opposed to something else, then typically before moving on to CSF or PET scan, we will use blood-based biomarkers, which are one of the big changes in the field in the last year or so, and there are now multiple panels of these available. The downside is they are typically not covered by insurance. On the other hand, they can really help us identify who is likely to have a positive PET scan or positive findings on CSF. We start to provide that counseling and information to the patient before they get to those more definitive tests. We can push people in the other direction. We can say, your blood-based biomarkers are negative or do not indicate AD as the most likely source of your condition now, so let's treat other things. Let's see what else we can focus on. The blood-based biomarkers are now, in our clinic at least, the critical choke point between the routine workout that we've always done on everyone and then the more advanced workup of proving amyloid pathology with CSF or a PET scan. Dr Monteith: How sensitive are those blood biomarkers and how early are they positive?  Dr Geldmacher: The sensitivity is generally pretty good, in the ninety plus percent range on average and it depends on which panel. And as you point out, when in the course of symptoms that they're done, we know that they become positive and presymptomatic or asymptomatic people. We're using these kinds of markers to screen people for prevention trials. So, I think when someone is symptomatic, they're a good indicator of the presence or absence of AD pathology. Now that doesn't mean the AD pathology is the sole cause of their symptoms. And so, we still need to think about those other things like sleep and mood and so forth. But they do point us in the in the direction of Alzheimer's change.  Dr Monteith: So why don't we talk about some of the more standard older treatments, and it's also important to leave with kind of some rational approach to when we start and what should we be counseling our patients on. So why don't we start with the older, you know, choline esterase inhibitors and then some of the MDA- I guess there's only one modulator, SEPTA modulator. Dr Geldmacher: So, I've been really fortunate in my career span, the time from the first of those symptomatic agents reaching the market in 1993 to seeing the disease modifying drugs enter the market now. I think most neurologists actually have entered practice after those clinical trials of the colon esterase inhibitors were published. So, one of my goals in this article was to review that primary data and what can we expect from those symptomatic drugs. We know that they are inconsistently effective in mild cognitive impairment, and the Academy of Neurology guidelines says there is not strong evidence to use them in mild cognitive impairment. But in mild AD and beyond, the cholinesterase inhibitors provide meaningful benefits. They delay decline, they can delay nursing home placement. They reduce overall costs of care. So, I think they provide real value. So, in the article I have reviewed what the data looked like on those. My approach is to start with oral Donepezil at five milligrams and increase it to ten in everyone who tolerates the five. If for whatever reason the oral Donepezil is not well tolerated, I'll switch to transdermal rivastigmine to help improve tolerability. There are very few head to head comparisons, but nothing suggests that one of the cholinesterase inhibitors is superior to the other for clinical outcomes, and there's no evidence to support conjoint use of more than one at a time. Should someone be showing decline then on typical cholinesterase inhibitor therapy - and people will, it's often delayed, but the decline will reemerge - then I will add the NMDA receptor, a modulator memantine and titrate that up to full dosing, either 10 mg twice a day for the conventional release or 22 mg extended release. And at that point we're sort of on maximal pharmacologic therapy for Alzheimer's disease. These agents can provide some benefit in other conditions, they're off-label except for Lewy body disease where rivastigmine is labeled. But they can provide benefit across different conditions. And there's some preliminary data, for instance, of acetylcholinesterase inhibitors being helpful in vascular cognitive impairment. So, I will use them, but I expect the greatest response when someone really does follow the patterns of Alzheimer's disease.  Dr Monteith: And you have a great chart, by the way, and nice figures looking at some of the meta-analyses on cognitive outcomes as well as functional outcomes. So, thank you for that.  Dr Geldmacher: In general, all of those tables favor treatment over placebo in the domains of cognition, daily function, neuropsychiatric symptoms. And it's that consistency of result that lets me know that we really are seeing a drug effect, that it's not a class effect with those, that we really are helping our patients. It's not like some studies are positive and some are negative. They are very consistently positive. Small magnitude, but consistently positive.  Dr Monteith: And I know we have a lot of patients coming in where, at least, their caregivers are complaining about agitation, and sleep is also a problem for others. And so how do you help that patient? I know you have a good algorithm that also you included in your article, but why don't you summarize how we should approach these symptoms? Dr Geldmacher: Sure. So, for nonpsychotic agitation, you know, just restlessness, wandering, pacing and so forth, my first choice is an off-label use of citalopram. And there is good clinical trials evidence to support that. if someone has psychotic agitation that is with delusions or hallucinations and so forth, I think we do need to move to the antipsychotic drugs. And the one drug that is now approved for treatment of agitation and Alzheimer's disease does fall into that antipsychotic category, along with its various black box warnings - and that's brexpiprazole. For many of our patients, getting coverage for that agent is difficult. It's not on many formularies. So, it is something I progress toward rather than start with. Similarly, for sleep, there is one approved agent for sleep, that's a dual orexin agonist. And it shows effectiveness, but can have some negative cognitive effects, and so I tend not to start with that either. My first choice when sleep is the primary issue for our patients with dementia is trazodone, and there are some small, limited studies for it's off-label used to enhance sleep. It's safe, inexpensive, often effective, and therefore it's my first choice. Dr Monteith: So, now let's get into the big conversations that everyone is having. Let's talk about the newer disease modifying anti amyloid therapies. Give us a summary dating back 2021 probably, although we can hold the preclinical work, but let's talk about what is available to our patients. Dr Geldmacher: Sure. And the development of anti-amyloid therapies goes all the way back to 1999. So, it's a pretty long course to get us to where we are today.  Dr Monteith: Yeah, that's why we limited that.  Dr Geldmacher: With that first approved agent with aducanumab in 2021, it received a limited or accelerated approval in FDA parlance. These agents, the aducanumab, lecanemab and donanemab, all approved, are known to remove amyloid pathology from the brain as measured by CSF and/or BIPET. They are amyloid lowering therapies, often called disease-modifying therapies. And across the agents there's some variable results. But if we look at the two with full approval, lecanemab and donanemab, they slow clinical progression by 25% to 35% on average. And that's measured by either cognitive measures or global measures or composite measures, but it's pretty consistent in that range of about one-third slowing. That makes it really difficult to discern in an individual patient, though, because there's so much variability in the progression of the disease already that it can be difficult to tell in one person that these drugs are working. They're also complex to use, so there's a qualification process that involves MRI to exclude things like a high tendency toward hemorrhage. It includes genetic testing for papal E4 status to help us understand the risk for complication, and then once-monthly or twice-monthly infusions with standardized schedule for MRI scanning. So, there's a lot that goes into managing these agents. And they are expensive, and we don't yet know their cost effectiveness. The cost effectiveness of the cholinesterase inhibitors was questioned when they first came out back in the 1990s, and it took five or ten years to really understand that they provided benefit to society and to individuals in those domains of quality of life and return on investment. And we're still learning about that with the disease modifying therapies.  Dr Monteith: So, two questions. One, the case that you presented was an individual having symptoms and kind of voiced their desire to be on these therapies. So, people are going to be asking, coming to clinic asking and then of course, they're going to be people that you select out. So, how do you make that decision to recommend this treatment for patients given the potential risk? Dr Geldmacher: We've got some really good guidance from appropriate use recommendation papers for aducanumab and lecanemab, and I'm expecting one from donanemab fairly soon. But the key is to identify individualized risks, and that involves knowing their APOE4 status, knowing their- whether they've had microhemorrhages in the brain previously, and then documenting that they really do have amyloid pathology with something like PET scan to establish those baselines. I talk to people about the burden of twice-monthly infusions or, now with donanemab, once-monthly infusions. And for instance, for someone who's got a working caregiver, getting to an infusion center twice a month can be a significant burden. And then if there are complications, frequent MRI scans and so forth. So, we talk about the burden of entering into this therapeutic pathway. The reality is that people who are qualified generally want it. I have relatively few folks who have said, no, these risks are more than I'm willing to accept. For decades my patients have said, anything you can do to slow this down, I'm willing to try. And now we're seeing that translated to reality with people willing to accept high-risk, high-cost treatments with the chance of slowing their individual progression.  Dr Monteith: And how do you select between the two treatments? Dr Geldmacher: So far that's been easy because donanemab's not readily available.  Dr Monteith: Outside of clinical trials, right?  Dr Geldmacher: Exactly. For prescription use, it's coming in - the first cases have now been infused - but it's not generally available. Nonetheless, what I will do for patients in this is look at the risk tables. So donanemab appears to have in general some higher rates of the Aria complications, amyloid-related imaging anomalies, and some people are going to be more risk tolerant of that for the payoff of potentially faster response. The donanemab trials restructured that. They did their first assessment of effectiveness. I had amyloid removal at six months and a significant proportion of people were eligible to discontinue treatment at six months because their amyloid was below treatable thresholds. So higher risk, perhaps faster action and fewer infusions for donanemab. Lecanemab we have more direct experience with, and between the two of them, the eighteen month outcomes are pretty much the same and indistinguishable. So are we in it for a quick hit, or are we in it for the long race? And different patients and different families will have differing opinions on where they want to accept that risk and burden and so forth. But so far, the data don't indicate a lot of difference in their longer-term outcomes. We still have plenty to learn.  Dr Monteith: And so, it sounds like, as you mentioned, we're looking at eighteen months out for kind of a hard outcome, and that there is a lot of variability in response rate. How are you tracking patients- you know about the imaging, so just in terms of clinical outcomes and efficacy?  Dr Geldmacher: Sure. So, for Medicare to reimburse on these treatments, people need to be enrolled in a registry program - and there are several of these, CMS runs one of their own. But the requirement for that is, every six months, to do cognitive and functional outcomes through the first two years. Cognitive outcomes are up to the clinician, but things like the mini mental state exam, the MoCA, are appropriate. In our own program, we use something we developed locally called the Alabama Brief Cognitive Screener. As for the cognitive outcomes and then for functional, we use an instrument called the General Activities of Daily Living Scale, but there are many other ADL scales that could be used as well. CMS does not mandate specific tests. Since the progression of the disease is variable to begin with, we don't really know how to interpret these results in reference to whether the drug is working, but I can tell a patient or a family member, your scores are stable, or, you have a decline of three points in this test. That's typical for this duration of illness. But there isn't a good way to know whether the drug is working in this person at this time, at least with our current levels of data.  Dr Monteith: So, I think we have to talk about health equity, and it sounds like Medicare is reimbursing for some of us. We look at different socioeconomic backgrounds, educational backgrounds, race, ethnicity. Not everyone is aware of these treatments. So, how do we get more patients to become aware of these treatments? And how do we get them to more people to help people? Dr Geldmacher: Yeah, I mean, that's- it's a major, major issue of inequity in our population. We've done some work at UAB looking at the flow of members of minority communities into memory clinics. So, we know that the overall population of, and I'll choose, for an example, blacks and African Americans, that they are represented a much higher rate in our overall UAB treatment population than they are in our memory clinic population. So, they're not even getting to us in the specialty clinic at the same rates as other segments of our population. We also know that blacks and African Americans in our population are not receiving PET scans as often as the overall treatment population. So yes, there are real, real problems with access. There are cultural issues behind this as well. And in many communities, a change in cognition, a loss of memory is an expected part of the aging process rather than recognized as a disease. So, people who come to us from minority communities are often further along in the course of cognitive and functional decline and beyond the point where they might qualify for the disease-modifying therapies, where early AD is the sort of defining boundary. So, I think more awareness and more screening in primary care settings, perhaps more community outreach to let people know that changes in memory that affect daily function are not normal as part of the aging process and should be evaluated for intervention. So, there's lots of places in our healthcare community where we could foster better outreach, better knowledge to get more folks access to the medicines. And this is before we even get to cost. Dr Monteith: Yeah, yeah. And obviously, there's some stigma as well.  Dr Geldmacher: That's right.  Dr Monteith: Really recognizing what the issues are and diving and asking those questions and funding research that asks those questions, as you mentioned, is really important. And then you have also a nice area where, you know, looking on the impact of treatments on caregiver-related outcomes, and of course ultimately want to keep patients out of nursing homes and prevent death. And so, can you talk a little bit about that? And, you know, mainly the caregiver burden.  Dr Geldmacher: So, my research in that area goes back a long way now. But I learned early in the course of therapy that many times the outcome that the family is noticing for symptomatic therapies is not a change in the patient's memory per se, but that there is less work involved in the caregiving. Less time is spent in direct caregiving roles. The patient may shadow less and because they have better independent cognition. I remember one family member once told me, the medicine you started is a godsend because now I can go to the bathroom by myself and he's not pounding on the door saying where are you, where are you. He's able to recall long enough that I'm in the bathroom that I have that moment of privacy. That was very meaningful to me to hear that. So. Dr Monteith: Cool. So why don't you just help us wrap this up and just give us, like, three main takeaway points that we should be getting out of your article? Dr Geldmacher: The three points that I would emphasize from my article is that the symptomatic therapies provide meaningful benefits and measurable, consistent, meaningful benefits. The second is that those benefits extend beyond things like cognitive test scores and into things like caregiver well-being and maintenance of independence in the home environment. And the third is that the disease-modifying therapies are an exciting opportunity to modify the pathology, but we still are learning about their cost effectiveness and their long-term benefit both to individuals and to society. But the only way we're going to learn that is by using them. And that was the experience that we gained from the symptomatic therapies that took use in the community for years before we really began to understand their true value. Dr Monteith: Thank you. That was excellent. And I put you on the spot, too.  Dr Geldmacher: No problem.  Dr Monteith: Again, today I've been interviewing Dr David Geldmacher, whose article on treatment of 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 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 contentpub.com/AudioCME. Thank you for listening to Continuum Audio.

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.

In this week's episode of The Metabolic Classroom, Dr. Bikman delivers a comprehensive lecture on hormone replacement therapy (HRT), focusing on its role in addressing metabolic health challenges faced by women during menopause.The loss of estradiol causes fat to redistribute from healthier storage areas, like the hips and thighs, to the abdominal region, where larger fat cells become more insulin-resistant and pro-inflammatory. This shift contributes to systemic inflammation and elevates the risk of cardiometabolic diseases. Ben explains how HRT, particularly with estradiol, can mitigate these effects by improving insulin sensitivity, reducing inflammation, and promoting healthier fat storage patterns.He also addresses historical concerns about HRT, including risks of blood clots and cancer. Dr. Bikman explains that oral estrogens may slightly increase clotting risks due to their first-pass metabolism in the liver, but transdermal delivery methods like patches and gels do not carry this same risk. Regarding cancer, he highlights how older studies, such as the Women's Health Initiative, overstated the connection between HRT and breast cancer, particularly when using estrogen-only therapies. Ben emphasizes the importance of evaluating the absolute risks, which are relatively small.Beyond its metabolic benefits, HRT also shows promise in protecting against conditions like Alzheimer's disease. Ben discusses studies suggesting that HRT, when started early in menopause, may improve cognitive outcomes, preserve brain volume, and reduce the risk of Alzheimer's, particularly in women with the APOE4 gene. These findings suggest that timely HRT may support brain health alongside its other benefits.In conclusion, Ben underscores the substantial metabolic and overall health changes women face during menopause and the potential for HRT to improve quality of life, metabolic health, and long-term outcomes. He stresses the importance of individualized HRT plans tailored to each woman's unique circumstances, allowing for a nuanced approach to mitigating menopause-related challenges.visit https://www.benbikman.comBen's favorite yerba maté and fiber supplement: https://ufeelgreat.com/usa/en/c/InsulinIQBen's favorite meal-replacement shake: https://gethlth.com (discount: BEN10)Ben's favorite electrolytes (and more): https://redmond.life (discount: BEN15)Ben's favorite allulose source: https://rxsugar.com (discount: BEN20)Ben's favorite health check-up for women: https://choosejoi.co/drben15 (discount: DRBEN15)Ben's favorite health check-up for men: https://blokes.co/drben15 (discount: DRBEN15)Ben's favorite exogenous ketone: https://www.americanketone.com (discount: Ben10)Show Notes/References:Due to character length constraints, references are not posted here. However, for a complete list, we respond quickly. Please email: support@benbikman.com with your request, and be sure to mention which Metabolic Classroom episode you are referring to, which in this case is “Episode 80 - Hormone Replacement Therapy in Women”. Hosted on Acast. See acast.com/privacy for more information.

In the realm of nutrition science, individual differences are more profound and impactful than many realize. For decades, we've developed dietary recommendations with a “one-size-fits-all” approach, assuming that most people respond similarly to specific nutrients. But Dr. Martin Kohlmeier, a pioneer in precision nutrition, challenges this very notion. How might an individual's genetic makeup alter their need for certain nutrients? With advances in nutrigenetics, we're beginning to see how personalized nutrition could bridge long-standing gaps in dietary efficacy. Dr. Kohlmeier's work highlights fascinating examples, from the APOE4 gene's influence on cholesterol metabolism to variations in folate metabolism that could affect everything from heart health to birth outcomes. As Dr. Kohlmeier explains, precision nutrition is not simply about adding genetic testing to a wellness regimen. Instead, it requires rethinking nutrition research from the ground up—ensuring studies capture these individual variations and that public health policy moves beyond broad averages. With genetic testing now more accessible than ever, could commercial pressures and oversimplified testing derail the science before it even gets going? In this episode, we dive deep into the potential and pitfalls of precision nutrition, exploring the future of personalized dietary advice and the road to truly individualized health. Timestamps [02:33] Introduction of Dr. Martin Kohlmeier and his background [05:10] Rethinking assumptions in nutrition science [07:42] The role of genetic variations in nutrient responses [13:15] Practical examples of genetic impact on nutrition [22:55] Misinformation and commercial misuse in nutrigenetics [29:48] Case studies: cholesterol sensitivity (APOE4) and folate metabolism (MTHFR) [41:03] Public health implications and the need for tailored research [49:27] Future directions and the path forward for precision nutrition Links Go to episode page Join the Sigma email newsletter for free Subscribe to Sigma Nutrition Premium Enroll in the next cohort of our Applied Nutrition Literacy course Kohlmeier, 2023 – One size does not fit all: on the need for categorical stratification in nutrition science, practice and policy

Trump 2.0 presents opportunities and challenges for leaders of the biopharma industry, which needs effective public policy to thrive. On the latest BioCentury This Week, BioCentury Washington Editor Steve Usdin explains what those opportunities are and lays out the potential impact on the public policy environment, which could have repercussions on FDA and beyond.BioCentury's editors then analyze how companies, academics and advocates are pushing back on claims that they should have disclosed the results of APOE4 genotype testing to Alzheimer's trial participants and investigations by Chinese authorities into AstraZeneca China President Leon Wang and fellow AZ employees past and current, assessing what's known about the allegations and whether the situation could affect other MNCs operating in the country.View full story: https://www.biocentury.com/article/65415700:00 - Introduction01:01 - Prepping for Trump09:41 - Alzheimer's Ethics17:44 - AstraZeneca's Challenges in China21:51 - Myths and MisperceptionsTo submit a question to BioCentury's editors, email the BioCentury This Week team at podcasts@biocentury.com.Reach us by sending a text

The gene variant APOE4 is finally giving up some of its secrets, how putting dead trees underground could make carbon sequestration cheap and scalable, and the latest in our series of books on an optimistic future   First up this week, Staff Writer and Editor Jocelyn Kaiser joins host Sarah Crespi to discuss APOE4, a gene linked with a higher risk of Alzheimer's disease. They talk about new research into why APOE4 might be a good target for preventing or treating this dreaded neurodegenerative disease.   Next, Ning Zeng, a professor in the Department of Atmospheric & Oceanic Science and at the Earth System Science Interdisciplinary Center at the University of Maryland, joins the show to discuss an unusual approach to carbon sequestration and a very old piece of wood. He talks about how an unearthed 3000-year-old log that has held on to most of its carbon is pretty good proof that we can efficiently put carbon underground at low cost by burying trees.   Finally, we have the latest in our series of books on a future to look forward to. Books host Angela Saini talks with Peter Coveney and Roger Highfield, the two authors of the book Virtual You: How Building Your Digital Twin Will Revolutionize Medicine and Change Your Life.   This week's episode was produced with help from Podigy.   About the Science Podcast Episode page: https://www.science.org/doi/10.1126/science.z8oerdq   Authors: Sarah Crespi; Jocelyn Kaiser; Angela Saini Learn more about your ad choices. Visit megaphone.fm/adchoices

Are environmental toxins silently eroding our brain health? In this episode, I sit down with Max Lugavere, author and filmmaker of "Little Empty Boxes," to explore the hidden dangers lurking in our modern environment and how they are silently affecting our brain health.   We discuss Max's journey of losing his mother to dementia and the startling discoveries he made along the way. We also discuss neurodegenerative diseases like Alzheimer's and Parkinson's and their links to long-term exposure to environmental toxins found in everyday items.    Max Lugavere is a health and science journalist, filmmaker, and bestselling author. He is the author of the Genius trilogy of books, including the New York Times bestseller Genius Foods and the Wall Street Journal bestseller Genius Kitchen. He hosts The Genius Life podcast, one of the top health and wellness podcasts in the U.S. His appearances on The Joe Rogan Experience, The Rachael Ray Show, The Today Show, and PBS's Brief but Spectacular, along with features in VICE, Fast Company, The New York Times, and People Magazine have made him a respected and well-known voice in the field. An engaging speaker on relevant health and wellness topics, Lugavere regularly leads keynote talks for events around the world.   What we discuss:  04:02 - Definition of a "super life" 07:43 - Max's mother and her health issues 15:20 - APOE4 gene and Alzheimer's risk 17:01 - The documentary "Little Empty Boxes" 24:41 - Ultra-processed foods and their health impacts 28:55 - Factors potentially contributing to neurodegenerative diseases 33:50 - Environmental toxins and Parkinson's disease 42:47 - Top things to avoid for brain health 54:10 - Obesity, insulin resistance, and brain health 59:45 - Exercise and its benefits for Parkinson's disease 1:01:52 - Future hopes for Alzheimer's and dementia research 1:10:47 - The importance of individual action and knowledge   Thank you to our sponsors: Therasage: Go to www.therasage.com and use code DARIN at checkout for 15% off TruNiagen: Go to www.truniagen.com and use code Darin20 for 20% off Vivo Barefoot: Get 20% off your first Vivobarefoot order with DARIN20 at www.vivobarefoot.com Fatty15 : Get an additional 15% off their 90-day subscription Starter Kit by going to fatty15.com/DARIN and using code DARIN at checkout.   Find more from Darin: Website: https://darinolien.com/ Instagram: https://www.instagram.com/Darinolien/ Book: https://darinolien.com/fatal-conveniences-book/ Down to Earth: https://darinolien.com/down-to-earth/   Find more from Max Lugavere: Website: https://www.maxlugavere.com/  Documentary: Little Empty Boxes Instagram: @maxlugavere

Dr. William “Bill” Jagust, renowned expert in brain science and Alzheimer's research - and one of the reasons Matt chose to move to UC Berkeley - joins our host today for an in-depth discussion on aging, cognitive decline, and the critical role of neuroimaging, with some sleep talk woven in as well. Dr. Jagust shares groundbreaking insights into how PET scans can detect amyloid and tau proteins in the brain—two key contributors to Alzheimer's disease—years before symptoms emerge. Together with Matt he goes on to explore the connection between these proteins and brain aging, highlighting the power of biomarkers and advanced imaging in tracking the disease's progression. Our esteemed guest also emphasizes that early detection and intervention are crucial in slowing Alzheimer's progression, but warns that once neurons are damaged, the brain has minimal capacity to repair itself. He further discusses lifestyle choices such as exercise, diet, and sleep, which can lower the risk of cognitive decline, and dives into emerging research on genetic factors like the APOE4 gene. The episode concludes with a hopeful outlook on the future of Alzheimer's research, offering insights into potential preventive treatments.Please note that Matt is not a medical doctor, and none of the content in this podcast should be considered medical advice in any way, shape, or form, nor prescriptive in any way.Support for today's podcast comes from Magic Spoon. I've always loved cereal, but focusing on wellness meant giving it up due to unhealthy ingredients. Enter Magic Spoon, introduced to me by Dr. Peter Attia. Their high-protein, low-sugar cereals transformed my mornings, and now, they've added Magic Spoon Treats, packed with 11g of protein, 1g of sugar, and only 4 net carbs in flavors including chocolate, peanut butter, and strawberry milkshake, And, thanks to their generosity, you can now take advantage of a special offer: Get $5 off at magicspoon.com/mattwalker. Enjoy!The good people at InsideTracker are also one of the sponsors of this week's episode, and they are generously offering a special 25% off any one of their programs for anyone who uses the above link during the time window of this episode. InsideTracker is a personalized biometric platform that analyzes your blood and your DNA to better understand what's happening inside of you and offers suggestions regarding things that you can do to better try and adjust some of those numbers, optimize them, and, as a result, optimize you.Another sponsor this week is the biochemical electrolyte drink company LMNT, and they are very kindly offering eight free sample packs when you purchase any one of their orders at drinklmnt.com/mattwalker. LMNT is an electrolyte sports drink that I can get behind - it's created from the basis of science, and it has no sugar, no coloring, and no artificial ingredients – all qualities that are so important to maintaining your blood biochemical balance. If you want to give LMNT a try, just head on over to drinklmnt.com/mattwalker and get your eight free samples with your first purchase. As always, if you have thoughts or feedback you'd like to share, please reach out to Matt on Instagram.

Welcome back to today's Friday Review where I'll be breaking down the best of the week!     I'll be sharing specifics on these topics:     Reimagining Health Summit Omron Blood Pressure Monitor (product review) APOE4 Diet (study) High Blood Pressure (research) Hydrogen Water (research)   For all the details tune in to today's Cabral Concept 3122 – Enjoy the show and let me know what you thought!   - - - For Everything Mentioned In Today's Show: StephenCabral.com/3122 - - - Get a FREE Copy of Dr. Cabral's Book: The Rain Barrel Effect - - - Join the Community & Get Your Questions Answered: CabralSupportGroup.com - - - Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - Get Your Question Answered On An Upcoming HouseCall: StephenCabral.com/askcabral - - - Would You Take 30 Seconds To Rate & Review The Cabral Concept? The best way to help me spread our mission of true natural health is to pass on the good word, and I read and appreciate every review!  

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Dena Dubal is a physician-scientist and professor of neurology at UCSF whose work focuses on mechanisms of longevity and brain resilience. In this episode, Dena delves into the intricacies of the longevity factor klotho: its formation and distribution in the body, the factors such as stress and exercise that impact its levels, and its profound impact on cognitive function and overall brain health. Dena shares insights from exciting research in animal models showing the potential of klotho in treating neurodegenerative diseases as well as its broader implications for organ health and disease prevention. She concludes with an optimistic outlook for future research in humans and the potential of klotho for the prevention and treatment of Alzheimer's disease. Disclosure: Peter is an investor in Jocasta Neuroscience, a company working to develop klotho as a therapy for people with Alzheimer's disease. We discuss: Dena's fascination with aging and how she came to study klotho [3:30]; Biological properties of klotho: production, regulation, decline with age, and factors influencing its levels [11:45]; Potential benefits of klotho on brain health [22:00]; The relationship between soluble klotho protein, platelet factors, and cognitive enhancement [33:45]; The role of platelet factor 4 (PF4) and it's interaction with GluN2B in mediating cognitive enhancement [46:45]; Benefits of klotho observed in a mouse model of Parkinson's disease [55:45]; Benefits of klotho observed in a mouse model of Alzheimer's disease [1:03:00]; Promising results of klotho in primate models, and the importance of finding an appropriate therapeutic dose before moving to human trials [1:08:00]; Speculating why a single klotho injection has such long-lasting effects [1:25:30]; Potential cognitive benefits of klotho in humans, the impact of the KL-VS genetic variant on klotho levels, and the need for human trials to confirm these effects [1:27:45]; The interaction between the KL-VS genetic variant and APOE4 and how it impacts risk of Alzheimer's disease [1:34:45]; The significance of klotho levels: studies linking lower levels to increased mortality and the broader implications for organ health and disease prevention [1:47:15]; Measuring klotho levels and determining an individual's KL-VS status [1:52:15]; The promising potential of klotho for Alzheimer's disease treatment, and the importance of philanthropy for funding research [1:58:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube