Summary
In this podcast episode, the host interviews Amanda, a specialist in geriatric psychiatry, about Alzheimer's disease and its impact on patients and their families. Amanda discusses the diagnostic process for dementia, emphasizing the importance of obtaining a clinical history from the patient and their loved ones, conducting cognitive testing, brain imaging, and lab tests to rule out other causes of memory loss. She notes that Alzheimer's is the most common form of dementia, but there are other forms such as Lewy body dementia. Amanda also emphasizes the importance of recognizing the impact of dementia on families and caregivers.
The speaker discusses the potential for a blood-based test for Alzheimer's disease using plasma amyloid as a biomarker. They also explain that tau protein can be present without amyloid in certain types of dementia, such as frontotemporal dementia and chronic traumatic encephalopathy. The speaker provides a clinical distinction between classic Alzheimer's dementia and classic Lewy body disease, which presents with a triad of symptoms including cognitive impairment, parkinsonism, and visual hallucinations.
The speaker is a psychiatrist who specializes in geriatric psychiatry and Alzheimer's disease. They treat patients with dementia, including Lewy body, FTD, and Parkinson's plus syndromes. The speaker emphasizes the importance of early intervention, treating symptoms with the safest, lowest dose, and shortest treatment period possible. The speaker believes that the majority of patients with Alzheimer's disease in the US are receiving complementary care for the psychiatric component, specifically depression and anxiety.
The speaker also discusses the importance of support and education for caregivers of Alzheimer's patients. They share personal experiences of interacting with patients and caregivers and providing advice and tools to handle difficult situations. The speaker also talks about the stages of grief that both patients and caregivers go through and how it is important to focus on the present rather than the end game.
The context discusses the different categories of drugs being developed for Alzheimer's disease, including cognitive enhancement, neuropsychiatric and behavioral improvement, and disease modification. Disease-modifying drugs are the most promising as they target the underlying pathology of the disease, such as amyloid and tau proteins. Trials are ongoing to look at prevention by amyloid removal before cognitive symptoms start and treating people with mild cognitive impairment. The standard length for Alzheimer's trials is 18 months, and trials are expensive, costing on average 1.3 to 1.4 billion dollars and taking 10 to 15 years to get from development to FDA approval.
The context discusses the potential approval of a drug for Alzheimer's disease by the FDA. The biggest challenge in drug development for Alzheimer's disease is developing a good enough drug and studying it. The discussion ends with a contemplation of healthy aging and the importance of emotional health and quality relationships.
