The Peter Attia Drive
Neurodegenerative disease: pathology, screening, and prevention | Kellyann Niotis, M.D.
Mon Jan 02 2023
The Drive podcast
00:11 - 07:13
- Focuses on translating the science of longevity into something accessible for everyone.
- Hosted by Dr. Kelly Ann, a fellowship trained preventative neurologist specializing in risk reduction strategies for neurodegenerative disorders.
- Discusses neurodegeneration and diseases associated with it, including Alzheimer's disease, Lewy body dementia, and Parkinson's disease.
- Covers Parkinson's disease pathology, role in movement capacity, anxiety, sleep, prevention tools, and possible future biomarkers.
- Explores Alzheimer's disease pathology, cognitive testing, visual and auditory issues, oral health, exercise, hypertension, and higher risk for women.
06:43 - 14:06
- Umbrella term encompassing dementia and other processes like Parkinson's disease.
- Dementia includes Alzheimer's disease, vascular dementia, Lewy body dementia, and frontal temporal dementia.
- Other neurodegenerative diseases include Huntington's disease, ALS, progressive supular nuclear policy, multiple system atrophy, and cortical bazzler degeneration.
- Different diseases affect different parts of the brain.
- Visual impairment is a risk factor for neurodegenerative diseases.
- Vascular dementia overlaps more with Alzheimer's than with frontal dementia.
- High ABOB levels can lead to reduced speed of processing.
MCI and Neurodegenerative Diseases
13:42 - 21:07
- MCI can happen quickly or slowly depending on the person.
- Lab values and risk factors should be considered when assessing executive function and speed of processing.
- Sleep is important for speed of processing and cognition.
- Different types of dementia cause different symptoms.
- Parkinson's disease is a central problem related to Lewy body, while ALS is more of a peripheral nerve problem.
- Diagnosing Parkinson's disease based on clinical symptoms alone is rudimentary.
- By the time Parkinson's disease is diagnosed, 50% of dopamine-producing brain cells are already lost.
20:42 - 28:08
- Caused by the death of dopamine-producing brain cells in the substantia nigra, PARS-compacta.
- Dopamine is needed for movement and mood regulation.
- Risk factors include pesticide exposure, particularly to paraquat.
- Prevalence of Parkinson's disease is growing rapidly in the US.
- Smoking has been found to be 'protective' against Parkinson's disease, but this theory is not well-supported.
- Loss of movement capacity due to daily activities and screen time may contribute to the development of Parkinson's disease.
Genetics and Risk Factors
27:44 - 34:54
- 10% of Parkinson's disease cases are related to clear genetic etiology.
- GBA and LRRK2 are the most common genes tested in 23andMe.
- Penetrance for these genes depends on factors such as ancestry.
- Sleep disturbances can be an early sign of neurodegenerative problems.
- Movement assessment is key to identifying abnormal movement patterns indicating Parkinson's disease.
- Patients with Parkinson's disease tend to have abnormal movement patterns years before tremors or slow movements start.
- Training out pathology through deconstructing breathing and movement patterns can help patients.
Sleep and Biomarkers
34:43 - 42:00
- Sleep tracking is important for Parkinson's disease patients.
- Optimizing sleep with simple sleep hygiene is crucial.
- Bright light therapy helps regulate the melatonin signaling cycle and improves REM sleep.
- Anxiety may have something to do with dopamine signaling.
- Knowing risk for a disease can help delay onset or slow loss of dopaminergic cells.
- Environmental triggers need to be identified to halt the loss of dopaminergic cells.
Prevention and Biomarkers
41:39 - 48:44
- Early intervention is key to preventing neurodegenerative diseases.
- Lifestyle interventions and supplements, such as B vitamins, may help reduce disease risk.
- Without a biomarker, it's difficult to scale up prevention methods.
- Amyloid and tau are necessary but not sufficient for Alzheimer's disease.
- Alpha-synuclein accumulation is directly proportional to the death of dopaminergic cells in Parkinson's disease.
- Neurodegenerative diseases should be viewed as related processes with shared underlying mechanisms.
- Targeting commonalities between these diseases may lead to better outcomes.
Amyloid and Tau
48:24 - 55:44
- Amyloid protein can cause neurodegenerative problems.
- Tau and alpha-synuclein are physical structures found inside neurons.
- Inflammatory cascade drives neurodegeneration.
- FDG PET scan is helpful in differentiating between different diseases.
- Amyloid PET scans show amyloid deposition but don't necessarily indicate Alzheimer's disease.
- Looking at an image of amyloid buildup doesn't provide much information.
Cognitive Testing and Biomarkers
55:17 - 1:01:58
- Cognitive testing requires a trained professional.
- Olfactory testing is key in cognitive testing.
- Memory function and auditory processing are tested.
- Visual spatial processing and episodic memory are difficult for many patients.
- Different versions of the test are available for non-English speakers.
- APOE4s can be retested without concern for improvement due to skill acquisition.
- Basic tests like mini-mental status tests do not provide a good sense of memory problems.
- Few FDA-approved drugs available for Alzheimer's treatment.
Neurodegenerative Diseases and Oral Health
1:08:39 - 1:15:31
- Oral health is a strong predictor of overall health.
- Red complex pathogens are associated with higher risk of neurodegenerative diseases.
- High colonization of gram-negative bacteria in the mouth drives up peripheral inflammation.
- Focusing on oral health is important for high-risk patients, especially those with APOE4.
- Dental implants and root canals provide breeding grounds for bacteria.
- Cleaning between teeth effectively removes bacteria.
- Genes like APOE4 and Apo C1 are linked to Alzheimer's risk.
- Genes are not destiny; there are ways to mitigate their effects.
Mitochondrial Haplogroups and Exercise
1:34:49 - 1:41:57
- Knowing mitochondrial haplogroup can help understand risk for neurodegenerative diseases.
- Exercise has the most potential to improve brain health.
- Different types of exercise have different effects on cognitive reserve and neuroplasticity.
- Lower blood pressure is better for cognitive outcomes long-term.
- Continuous blood pressure monitors are needed for non-diabetics.
- Alzheimer's disease disproportionately affects women, while Lewy body Parkinson's is more common in men.
- Diversifying exercise routines can improve brain health.
Movement Patterns and Disease
1:48:15 - 1:55:39
- Movement patterns can help identify problems early on.
- Incorporating exercise in movement can advance the field.
- Alzheimer's and movement disorders are related.
- Understanding genetics and family history is crucial to identifying risk factors.
- Preventative strategies can be targeted once risk factors are identified.
- Neurodegenerative conditions rob people of cognition and personality.
- There is a need for reevaluating how and when we look at disease.
1:55:10 - 1:56:14
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- This podcast is for general informational purposes only and does not constitute the practice of medicine or other professional healthcare services.
- No doctor-patient relationship is formed through this podcast.
- Users should seek medical advice from their healthcare professionals for any medical conditions they have.
- Conflicts of interest are taken seriously by Peter Atia MD. For disclosures and a list of companies he invests in or advises, visit peteratiamd.com/about.