Ep 6: What Does the Future Hold for Alzheimer's Diagnosis and Treatment?

[00:00:02] Kelly O'Brien: The scientific discoveries that are emerging right now are really, really exciting. 

[00:00:09] Dan Kendall: Hope may not be the first feeling that comes to mind when you hear the words Alzheimer's disease – but perhaps it should be. 

[00:00:15] Dr. Sharon Cohen: I think the future is bright. We can now detect the earliest changes of the disease in a living person. We don't need to wait till late-stage disease or autopsy. Early in the disease we can be sure about it biologically.

[00:00:30] Dan Kendall: Among the people working in the field of Alzheimer's research, there's a feeling of optimism in the fight against this as-yet incurable disease. Advances in early detection, promising new treatments, and increased understanding of how to improve brain health have researchers, as well as those affected by the disease, feeling hopeful. Across many measures, we're entering a new era in the diagnosis and treatment of Alzheimer's disease. 

I'm Dan Kendall, and this is the Rethinking Alzheimer's Disease Podcast. The Rethinking Alzheimer's Disease Podcast was created by Mission Based Media with support from Eisai. This series is for educational purposes only, and is not a substitute for formal medical advice, diagnosis, or treatment. The opinions expressed are the individual views of the speakers themselves and do not necessarily represent those of any organizations. If you have  questions about a medical condition, talk to your qualified healthcare provider. For our list of resources about Alzheimer's disease, please visit healthunmuted.com/resources.  All guests participated voluntarily and did not receive any form of compensation for their involvement.

[00:01:41] Dan Kendall: Throughout this series, we've heard from the people living with Alzheimer's, caregivers, and leading medical experts who research and treat it. We've learned how to recognize symptoms and about the diagnosis process, as well as the importance of a healthy lifestyle and the impact of a proper support network. So you may be wondering, what does the future hold? 

[00:02:01] Dr. Sharon Cohen: Things are picking up. We have an aging population that is concerned about staying well and independent, and I think the timing's right for us to see more progress and to expect more for ourselves.

[00:02:13] Dan Kendall: That's Dr. Sharon Cohen, she's a behavioral neurologist and medical director of Toronto Memory Program. What has researchers so excited? 

[00:02:23] Dr. Sharon Cohen: It is a very hopeful time now in Alzheimer's disease. We are finally seeing the results of decades of work, actually, trying to develop early diagnostics so that we can be clear about confirming or ruling out a diagnosis of Alzheimer's.

[00:02:41] Dan Kendall: Dr. Thomas Obisesan, a professor of medicine at Howard University, is excited about a new diagnostic, one that will help detect Alzheimer's disease at the very early stages and in a more affordable and reliable way.

[00:02:54] Thomas Obisesan: We are close to having a blood test that can detect the proteins that cause Alzheimer's disease in the blood.

[00:03:03] Dr. Sharon Cohen: We're just at the beginning of that era and we call these tests "blood-based biomarkers" as opposed to scans or a spinal tap that looks at spinal fluid. So those are other gold standard ways of diagnosing Alzheimer's with an amyloid scan, PET scan, or a spinal tap.

[00:03:21] Dan Kendall: Detecting these biomarkers in the blood will make it easier and more affordable to diagnose Alzheimer's disease. 

[00:03:28] Dr. Sharon Cohen: Taking blood is something that is common experience for physicians and for patients, and it's more accessible, you don't have to travel to a fancy nuclear medicine center to have a special scan. So we're excited that we will finally be able, hopefully in the very near future, roll out in a larger scale, these new blood-based biomarkers. Some of them are very accurate in predicting amyloid in the brain. That will help people get answers, at a lower cost and in greater numbers.

[00:04:04] Dan Kendall: Making blood-based biomarker tests available on a large scale will require some coordination, and possibly require some secondary tests.

[00:04:13] Dr. Sharon Cohen: I think there's still some education that needs to happen for physicians as to how to interpret. People may be clearly in a zone where the test is abnormal, the blood-based biomarker is abnormal, and we don't need to go on to a confirmatory test, or we may have an intermediate zone where it's not clear whether the blood test is positive or negative, and those individuals may then need to go on to a confirmatory test like a PET scan. So it's still being a little bit worked out how best to use these blood-based biomarkers and whether it should be in primary care or in specialists’ hands. But it's such a huge advance and it's moving quickly, and I think that it will really revolutionize the field in terms of diagnostics very soon, and maybe following how people are doing in treatment as well. Just the way we do in oncology, we monitor a lot of things by blood test to see whether patients are responding to a treatment.

[00:05:10] Dan Kendall: And there's something else Dr. Cohen is excited about: artificial intelligence.

[00:05:16] Dr. Sharon Cohen: AI is really coming into the Alzheimer's field the way it has in so many other areas of medicine. In terms of early diagnosis, there are digital biomarkers that are being explored. 

[00:05:28] Dan Kendall: Digital biomarkers are created when things from the physical world, like biological or physiological characteristics, are collected or tracked in a digital format. For example, your voice can be converted to digital, and so can the way you walk, or the way you drive, and AI is being used to find patterns in the data that are distinct to people with Alzheimer's disease. 

[00:05:49] Dr. Sharon Cohen: Looking at speech patterns, looking at movement patterns, collecting a lot of data and analyzing this through AI to see whether we can see changes in people's behavior.

[00:06:00] Dan Kendall: In terms of treatments for Alzheimer's disease, research has taken big strides and it's paying off. Some recent clinical studies have shown promising results and many clinical studies are underway. 

[00:06:12] Dr. Sharon Cohen: In terms of treatments, there are disease slowing treatments, there are prevention treatments under investigation. There are treatments tackling both amyloid, and treatments tackling tau, combination therapies being tested. So a whole host of different approaches to Alzheimer's disease, including at the very early stages and aiming some of these programs at prevention. We'll have even more rationale to detect the disease early and keep people at that pre-symptomatic stage.

[00:06:51] Dan Kendall: With new diagnostic testing and promising advances on the way, there is renewed attention on the importance of being able to access healthcare facilities and providers. Here's Jason Resendez, president and CEO of the National Alliance for Caregiving. 

[00:07:06] Jason Resendez: I think we're making a lot of changes across different systems to better serve the diverse needs of communities that have been historically marginalized by the health care system at large and also by the Alzheimer's research and treatment enterprise. We are prioritizing equity and understanding and addressing disparities like we've never done before.

[00:07:31] Dan Kendall: Advances in the medical community continue to improve screening and cognitive care. Also, research often moves faster than medicine, so it's important to talk to your doctor about how you can access some of these newer care options by joining a clinical trial.

[00:07:46] Dr. Sharon Cohen: Clinical trials are research studies and these comprise the hope for the future. They are the obligatory pathway by which any drug comes to the market. It requires that a drug go through certain stages to prove that the drug is safe, and that it is effective. And for Alzheimer's disease, we've shown, over the years, a real growth in what we call the drug development pipeline, meaning there are more and more drugs being tested for Alzheimer's disease, as we've understood the complexity of the disease and the multiple different ways we may be able to intervene.

So individuals can participate in trials. We need you, you need us, to move the field forward. And anybody who participates in a trial is what we consider a medical hero. Somebody who's giving of themselves in the hope of helping themselves, yes, but others that they don't know, future generations. This is so valuable. 

When we go to a pharmacy and pick up our medicines for high blood pressure, diabetes, COVID, whatever it is, we often don't think about all of the people who worked within clinical trials to bring that drug to the market. No different in Alzheimer's. We need people to come forward and say, "I'd like to participate, is there a trial that's a good fit for me? What's it about? Maybe I can join and help myself and help other people." So, I think that clinical trial opportunities are not offered enough to individuals and many individuals say, "Yes, I'd like to do that," once they hear about the opportunity.

[00:09:23] Dan Kendall: I hope this series has inspired you to take steps toward better brain health, and has increased your knowledge and understanding about the scientific advances that are making new diagnostic and treatment options available.

As we conclude the Rethinking Alzheimer's Disease Podcast, we have some final words of encouragement from some of the contributors to this series. 

[00:09:45] Brandon Burke: Dig into your strength. You're stronger than you think that you are. And with the support system that you have around you, you will be okay.

[00:10:00] Finch: Focus on getting the good things into your life. Joy, love, happiness, exercise, art, music. What brings more meaning to your lives and to your loved ones?

[00:10:16] Kelly O'Brien: It's not all about the amyloid, tau in your brain. It's the quality of your life every day. So, I would say, take action to do the things that improve the quality of that life for you.

[00:10:28] Doreen Monks: Don't give up hope. You have every right to expect that you will have a good life.

[00:10:33] Dan Kendall: You can find links to all the organizations and resources we've mentioned during this series at healthunmuted.com/resources. 

I want to extend my sincere gratitude to all of the wonderful experts, care partners and those living with Alzheimer's disease who generously shared their time and experiences in the making of this podcast.  The Rethinking Alzheimer's Disease Podcast was hosted by me, Dan Kendall, and was produced by the team at Mission Based Media. 

[00:11:01] This show is part of the Health UNMUTED audio library and was created with support from Eisai. To listen and learn more, visit healthunmuted.com. Please like and follow Health UNMUTED on your favorite podcast player, where you can stay up to date about health conditions and be notified about future series.