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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.

Parkinson's Disease

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.

Podcast Information

1:55:10 - 1:56:14

  • 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