Neurodegenerative disease: pathology, screening, and prevention | Kellyann Niotis, M.D.

Mon Jan 02 2023

The Drive podcast

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.

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 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.

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.

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 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.

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 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 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.

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.

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 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.

Peter Atia MD can be found on Twitter, Instagram, and Facebook with the same ID.
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.