Centered on Health 5-1-25 - New Treatments for Alzheimer's Disease with Dr. Patrick Matthiessen
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Speaker 1 (00:01):
It's now time for Centered on Health with Baptists Help
on news radio waight fortys.
Speaker 2 (00:07):
Now. Here's doctor Jeff Tubler.
Speaker 3 (00:11):
Good evening, everyone, and welcome to tonight's episode of Centered
on Health with Baptist Health here on news radio eight
forty wahas. I'm your host, doctor Jeff Tublin, and we
are joined from the studio with our producer mister Jim Benn.
He is awaiting to take your calls to have a
part of our discussion tonight, of which we are going
to be talking about new treatments for Alzheimer's disease and
(00:34):
headaches and all sorts of neurologic topics. Our phone number
is five oh two, five seven one, eight four eighty four.
If you want to call in and be a part
of the show, we hope that you do. Fifty five
million people around the world are diagnosed with dementia and
headaches are the third highest cause of disability. Adjusted life
here is meaning the amount of disability that takes people
(00:57):
away from living their life. So today we are very
fortunate to have doctor Patrick Matissen here who is a
neurologist in the Baptist Hospital Medical Group. His practice is
in Lagrange. He attended University of Louisville for medical school
and did his internal medicine and residency at the University
of Kentucky Medical Center. He has extensive experience greater than
(01:18):
twenty five years of treating everything from headaches to dementia
to a taxia, and tonight we're going to learn a
lot about Alzheimer's disease and hopefully get to pick his brain.
See what I did there about lots of neurologic conditions.
So welcome to Center on Help.
Speaker 2 (01:35):
Thank you, Jeff, I appreciate it.
Speaker 3 (01:37):
Yeah, we threw a little pun in there. A happy
Derby Week everybody, and we are so excited to have
you on the show. I know people are interested in
this topic. It is such an important topic. So by
way of background get and introducing you, tell us a
little bit about what a neurologist is and the types
of things that you take care of.
Speaker 1 (01:58):
Sure, first, thanks for having me on, Jeff, I really
appreciate it, and I'm delighted to be here and spend
an hour with you.
Speaker 2 (02:05):
So what does neurology do.
Speaker 1 (02:07):
Neurologists are sort of the internal medicine specialists of the brain.
We're not surgeons. We take care of everything involving the
peripheral nerves, the spinal cord in the brain, and that
could include.
Speaker 2 (02:21):
Diseases such as epilepsy.
Speaker 1 (02:23):
Dementia, migraine, Parkinson disease, multiple sclerosis, anything that affects the
nervous system.
Speaker 2 (02:33):
We're a part of it.
Speaker 3 (02:35):
Well, I mean, obviously we could have you on for
multiple shows because I think everybody would want to know
all about all of those things. But tell us what
drove you to the special What interested you in neurology.
Speaker 2 (02:47):
Well, that's interesting.
Speaker 1 (02:47):
I was one of those indecisive people that didn't know
what they wanted to do, and so it was probably
third year of med school when we were starting to
rotate through the specialties and I was trying to figure
out what was interesting to me. But when I got
to neurology, every single day that I was seeing patients
with our attendings, I saw something absolutely fascinating. And by
(03:10):
the end of their rotation, I thought, there's just nothing
as interesting to me as the brain and how it works.
And so that was what triggered it for me, and
I knew that was the specialty for me.
Speaker 3 (03:21):
Fantastic, So in the simplest of terms. What is Alzheimer's disease?
Speaker 2 (03:29):
Yeah, okay, well we'll try to make that simple.
Speaker 1 (03:31):
If I go all left too far into the weeds, Jeff,
just reel me back in, all right. So, Alzheimer's disease
is a neurodegenerative process of the brain. And it happens
when normal proteins that are made in the brain at
(03:51):
some point become misfolded. And when they do that, they
start to spread and involve multiple areas of the brain,
and they start to accumulate into flaques and tangles that
interrupt neuron or brain nerve function and synapse function in
the brain, And after a time they affect enough neurons
in the brain to really disrupt the function of the
(04:13):
patient from multiple perspectives, usually starting with memory.
Speaker 3 (04:19):
Yeah, we're going to we're going to get into, you know,
some of the symptoms and stuff. But so we hear
the term Alzheimer's disease and we hear the term dementia.
So how are those synonymous? Are they the same? Are
there is it different to use those terms differently?
Speaker 1 (04:36):
I think that's a fantastic question. I think that's confusing
for so many people. So if we back out just
a little bit and talk about dementia. Dementia is just
a big, overall umbrella term, and what it really means
is as simple as dementia means that your brain is
(04:56):
not functioning well enough for you to be into pendent
in order for you to be able to do all
the things you need to do by yourself.
Speaker 2 (05:05):
And that could involve any area of the brain.
Speaker 1 (05:07):
That could be speech, that could be memory, that could
be all kinds of things evolving the brain. But that's
just an umbrella term. Brain isn't working well enough for
you to be functioning independently.
Speaker 2 (05:18):
So you can.
Speaker 1 (05:19):
Imagine that there are a large variety of things that
could cause the brain to malfunction in that way. And
so the most common cause for that is Alzheimer's disease
by far, So it is an etiology or one of
the reasons that one might get dementia just happens to
be the most common one.
Speaker 3 (05:41):
And what are some of the other things we may
have heard of that fall under that category of dementia.
Speaker 1 (05:47):
Sure so some people may have heard of front to
temporal dementia. That's a different type of dementia, but it's
also a degenerative disease of the brain that just progresses
over time. People may have heard of Lewis body disease,
which in some way related to Parkinson's disease. There are
(06:11):
reversible causes for dementia. Let's imagine you get a vitamin
deficiency that it becomes so severe that your brain can't
function any longer. Well, that might be a reversible cause
for dementia, like a B twelve deficiency. So we could
spend all night talking about etheologies, but I think that's
a good intro to the fact that you know, there's
(06:32):
all kinds of ways to make the brain malfunction.
Speaker 3 (06:36):
You've said a couple terms neurodegenitive and progressive. What are
we talking about when we say something like Alzheimer's is
a progressive disease.
Speaker 1 (06:48):
So neurodegenerative diseases of the brain are diseases that cause
progressive dysfunction of the brain and progressive deterioration of the brain,
and each of them does it in a different or
specific or characteristic way. So Alzheimer's disease is one of
(07:10):
the neurodegenerative diseases of the brain, and interestingly, it tends
to come about in a very specific way. For most people.
It affects the temporal and parietal loves of the brain,
so memory and orientation seem to be the most common
ways that it presents. So people that are becoming more
and more forgetful over time, you might wonder, is this
(07:33):
the beginning of Alzheimer's disease?
Speaker 3 (07:37):
So that is something I was going to ask, because
you know, it's pretty normal for people to forget something
here and there, but as we get older, like I think,
it's very natural for us to go there and to
think right away, oh my gosh, I wonder if this
is the beginning of dementia. And so when somebody forgets
something or they feel that they're being a little forgetful,
(07:58):
what is the real time that they should potentially be concerned.
Speaker 1 (08:03):
What a terrific question is you can imagine it's not
an easy answer, but all no, I'll give you. I'll
give you a few for instances. So almost everybody after
fifty has a little bit of memory loss, all of
us do, and usually if the brain is normal, that
memory loss is simply irritating rather than debilitating. Where did
(08:27):
I put my darn keys?
Speaker 2 (08:29):
You know?
Speaker 1 (08:29):
Where did I lay my glasses down. Why did I
just walk into this room right? Maybe I should turn
around and go back and then see if I can
figure that out again. Or that guy looks familiar but
I can't come up with his name. All of those
things are very normal parts of aging. But they don't
keep you from being able to do your job or
(08:49):
mow your lawn, remember how to get to the grocery,
or how to take your medicines. They're just irritants, and
those are pretty normal parts of normal aging. If you're
more worried about dementia, then you're looking at things that
may cause dysfunction for you that really inhibits your life.
(09:13):
And that could be a lot of different things. But
I would put it this way, in this day and age,
I would be a little bit more proactive.
Speaker 2 (09:23):
If you're worried, then wait and see.
Speaker 1 (09:27):
And that is because we do have new treatments that
are coming out that might have an impact that earlier
you catch the disease. So if one thinks that their
memory is out of line compared to say, other people
their age, and or maybe they've got a really strong
family history of dementia, it probably is worth checking in
(09:50):
with their doctor and getting a memory screen or maybe
getting a few blood tests to see if that needs
to be looked at further, because the earlier we catch
it very often.
Speaker 2 (09:59):
The more we can do to slow it down. With
some of the new treatments that are.
Speaker 3 (10:02):
Available, well, we are excited to get to talk about
those tonight. So we are just getting started. We're going
to take a quick break. We want to remind everybody
that you are listening to Senate on Health with Baptist
Health here on news radio eight forty whas. Our phone
number is five oh two, five seven one, eight four
eighty four if you want to call in and ask
(10:24):
a question. We're talking tonight with neurologists doctor Patrick Matissen,
who's talking about Alzheimer's and we'll be right back. I
want to welcome you back to Senate on Health with
(10:46):
Baptist Health here on news radio eight forty Wahas. I'm
your host, doctor Jeff Pelberman. Tonight we're talking about Alzheimer's
disease with doctor Patrick Matissen, who is a neurologist with
the Baptist Hospital Medical Group. Our phone number five oh two,
five seven one, eight four eighty four. Our producer, mister
Jim fan is on standby to take your calls and
(11:07):
ask questions, So welcome, welcome back. I wanted to ask
something a little bit obviously on the serious side, is
is Alzheimer's life threatening? Is it a terminal condition?
Speaker 1 (11:22):
Yes, Alzheimer's disease is a terminal condition. It is an
exorably progressive and can't turn it around. Our treatments are
certainly getting better.
Speaker 2 (11:34):
We're going to talk about that a little bit later. Yes,
it would be considered a terminal condition.
Speaker 1 (11:40):
So deporting on the statistics that you look at, it
is between the fifth or the seventh leading cause of
death and.
Speaker 2 (11:48):
Folks above age sixty five.
Speaker 1 (11:50):
So it's it's a it's a big, big concern.
Speaker 3 (11:54):
Wow. So so when you're talking to a patient you've
made that diagnosed, and I know this is like a
four hour answer, but in general, like, what is your
approach Obviously, somebody receiving this news, you know, we have
all of our perceptions of what that's going to mean,
and how do you approach telling them that they have
this and what stress for treatment in general is. I
(12:18):
know we'll get into the specifics, but how do you
approach that conversation with a new diagnosis.
Speaker 1 (12:25):
That's a tough one and it's not just one conversation.
When we get to that point, we have gone through
multiple stages. So when somebody presents for the first time
or the family brings someone in for the first time
with the memory or cognitive complaint, the first thing we
do is, you know, do some memory screens and get
(12:45):
to good history and an examination and then check them
most importantly for reversible or treatable causes for their conditions.
So we're going to get a battery of routine blood
tests and MRI of the brain, and if we don't
find any reversible or treatable conditions, then we're starting to
address that possibility of underlying Alzheimer's disease. So we uh,
(13:11):
we talk about specific testing for Alzheimer's disease at that point,
and we can get into that if you'd like, h.
Speaker 3 (13:19):
Yeah, what is the evaluation?
Speaker 1 (13:21):
Like, yeah, okay, sure, sure, So just to finish finish
that other answer, it's probably the third visit or so
when we're working somebody up for dementia where we might
get to that point where we say, yes, this really
does represent underlying Alzheimer's disease, and that's never an easy
thing to present to someone. But on the other hand,
(13:44):
the patients that are coming in want answers one way
or the other, and there's really nothing more frightening than
the unknown for them for most people, and having an
answer is not only helpful, and then having a plan
for what we might do about it is also very
very helpful in relieving for patients. So I think your
(14:04):
subsequent question was how do we test for Alzheimer's disease?
Speaker 3 (14:08):
Is that the Yeah, what's a general if I came
to you or I brought a family member to about
what you mentioned some memory screening and some blood tests,
what's the evaluation.
Speaker 2 (14:19):
Like, okay, gotcha? Gotcha?
Speaker 1 (14:21):
So, yeah, we'll do some sort of memory screen The
common ones are the MOCHA or the minumental status exam,
and if the results of those are concerning and the
history that we get from a patient is concerning them,
we'll do a series of blood tests. And those are
going to include things like testing the thyroid, testing for
a vitamin B twelve deficiency, making sure the liver is
(14:43):
functioning correctly, because when the liver and kidneys aren't functioning correctly,
you get toxins that build up that affect brain function.
So we're doing all those blood tests to make sure
there's not something simple that we can just fix. It
would be the worst thing to do to miss one
of those fixable problems. And then we're getting an MRI
of the brain and if we can. There's some patients
(15:04):
that can't have an MRI because of a pace maker
or other problems, but optimally we're getting an MRI of
the brain, and we're making sure that there's some structural
problem in the brain that we need to address, like
a common one would be hydrocephalus. Hydrocephalus is a condition
where fluid builds up in the brain and can cause dementia.
(15:26):
And that's important because we can usually change that one.
We can have our surgeon colleagues put a drain in
and fix that problem before it becomes worse. So these
are always to look at potentially reversible causes or fixable
or treatable, modifiable causes for the patient's cognitive problems. Once
(15:49):
we get through all that, and if we don't find
something that we can look at, Oh and I didn't
mention things like sleep disorders. These are things that we
look at too. Obstructive sleep atnea, for instances of very
common reason for memory loss. If we aren't sleeping correctly,
we're not consolidating memories correctly. So anyway, suffice it to say,
(16:09):
there's a broad variety of things we're looking at at
that first and second visit to make sure we're not
missing something that just can be fixed.
Speaker 2 (16:17):
So that's job one.
Speaker 1 (16:19):
Once we get through that stage, then we're addressing whether
or not we're going to specifically test someone for Alzheimer's disease,
and those tests, you know, a few years ago we
didn't have tests specifically for alzheimer disease, So the testing
for Alzheimer's disease is a fairly new development as well.
And the two gold standard tests are a spinal tap
(16:43):
that looks at a chemical called beta amyloid in the
spinal fluid or a special PET scan of the brain
that looks at beta amyloid deposition in the brain. Those
are the two main ways we use to specific look
for Alzheimer's disease and a patient. And our blood tests
(17:05):
that are coming around those are starting to get better
and better. We're starting to see better and better blood tests,
and I expect probably within a year or so that
some of those blood tests will probably get FDA approval
and will start to gain more widespread acceptance, But for now,
the gold standards are a specialized PET scan of the
brain and a spinal tap for beta amyloid. Once those
(17:28):
results come back, we've got a really good answer. Yeah,
your nay on Alzheimer's disease pathology.
Speaker 3 (17:36):
So if anybody out there is listening, like I am,
we're sitting here and we're wondering, you know, am I
going to get Alzheimer's disease?
Speaker 2 (17:45):
So?
Speaker 3 (17:45):
Are there known genetic factors or predictable risk factors for
Alzheimer's or is it a pretty random assignment of who
gets this?
Speaker 2 (17:56):
Terrific question? Terrific questions.
Speaker 1 (17:59):
So there our genes involved, But most Alzheimer's disease is sporadic.
Speaker 2 (18:04):
That means it just happens.
Speaker 1 (18:06):
In the most So I'll address the genetic factors. If
you want to put a number on it, I would
say that roughly fifteen percent of Alzheimer's disease has a
genetic underpinning. So that means that most Alzheimer's disease is sporadic,
and the greatest risk factor for Alzheimer's disease is age alone,
(18:28):
so unfortunately, we can't do anything about that risk factor.
There are other risk factors, so a history of head
injuries is a risk factor. Metabolic syndrome like poorly controlled
diabetes and obesity, and a sedentary lifestyle.
Speaker 2 (18:46):
All of these things.
Speaker 1 (18:47):
Contribute to an increase in risk for Alzheimer's disease.
Speaker 2 (18:50):
But the big one is age.
Speaker 3 (18:53):
Well, I mean that's good. I mean all those things
are so good to know. Because so many of those
other things are common, we want to keep those under control.
So I know we are.
Speaker 2 (19:02):
Going to jump into study.
Speaker 3 (19:04):
I'm sorry, go ahead, yeah, go ahead, No, please, I.
Speaker 1 (19:06):
Was going to say that in that same vein that
study after study has shown that you know, regular physical
exercise and brain exercise, so keeping your brain active and
not vigioning out in front of the TV all the time,
and you know, a heart healthy diet like the Mediterranean diet.
These things sim tend to be relatively protected. That is,
(19:28):
they put the possibility of dementia further off into the future.
So I always have a talk with patients about those things.
So these healthy lifestyle factors can be important.
Speaker 3 (19:40):
Well, I had a whole list of myths to to
ask you yes or no, But you really have answered
all of them so beautifully already. So no, it's wonderful.
Since we're going to get into treatments on a very
kind of brief description. Are there anything that people can
do to prevent it? I know people do crosswords, and
(20:00):
they do saduko, and they take vitamins. Are any of
these Have they been studied to delay or prevent or
mitigate the severity of any type of dementia?
Speaker 1 (20:10):
Yeah, so the things that I just mentioned, A regular
physical exercise program, it doesn't prevent dementia, but it certainly
reduces the likelihood that you'll get it at any particular age.
That is, it puts it off further into the future.
A Mediterranean diet or the brain diet have been shown
(20:31):
to be helpful in.
Speaker 2 (20:31):
Putting that off into the future.
Speaker 1 (20:34):
And absolutely, if you don't use the brain, it's like
a muscle, you lose it. So brain exercise puzzles. Socialization
is people don't think of that, but socialization with friends
and family is a huge.
Speaker 2 (20:49):
Activator for the brain.
Speaker 1 (20:51):
So going out with friends and family, playing card games
and not you know, turning into a recluse at home
are big factors that keep the brain act and healthy
and functioning. There's multiple factors that play into keeping the
brain active. And if you don't use a particular part
of the brainded atrophies. And that reminds me of something
(21:12):
that's really come up recently in the literature, and that
is hearing loss. People with untreated hearing loss are much
more likely to get dementia. And you might wonder why
that is, but you know, when you're not feeding auditory
signals into the temporal lobes, well, the temporal lobes just
(21:32):
aren't being exercised much. And guess where our memories are
stored and the temporal lobes, So untreated memory loss, excuse me,
untreated hearing losses another risk factor that needs to be
looked at and considered for folks.
Speaker 2 (21:47):
And of course, if you do have dementia.
Speaker 1 (21:49):
Hearing loss just makes it seem that much worse because
it's one more tensory deprivation for a brain that's already struggling.
Speaker 3 (21:57):
Well, we are going to take a short break and
we are going to start to learn about these new treatments.
So we are so excited to get to that segment.
So we're going to take a break. I want to
remind everyone you're listening to Senate on Health with Baptist
Help here on news radio eight forty wahas our guests tonight,
doctor Patrick matisen talking to us about dementia and Alzheimer's
disease and new therapies. Will be right back. Welcome back
(22:32):
to Senate on Help with Baptist Health here on news
radio eight forty whas. I'm your host, doctor Jeff Tavlin.
We're talking tonight to neurologist doctor Patrick Matissen about Alzheimer's disease.
And right before the break, we did get a question submitted.
They asked me to ask it on their behalf, but
(22:53):
they have a family member that was just diagnosed with
Alzheimer's and they were wondering do all our Alzheimer's patients
able to maintain living independently or do they need to
be prepared for making arrangements for that down the road.
Speaker 2 (23:09):
Yeah, at some point arrangements will need to be made.
Speaker 1 (23:14):
A lot of folk meeting independence for years, but inevitably
the time when it's going to be very difficult for
family members to take care of all the needs that
a patient is going to require. So it is inevitable
that someone will need assistance later on.
Speaker 2 (23:33):
Yeah, thank you.
Speaker 3 (23:34):
So getting into the treatments, could you start by telling
us when you talk to patients, what do you tell
them the goals of therapy are and what are there?
Do you have to set sort of realistic goals or
do you go high in the sky. What's that? What
are the goals of treatment when you start to treat Alzheimer's.
Speaker 1 (23:56):
Wow, fantastic question. So absolutely being realistic is critically important
with folks. And before we dive too far into treatment,
I'd like to zoom back out and talk about the
treatments that have been available before and how that differs
from what we have today, if you don't mind, absolutely,
(24:16):
so if we zoom out. Prior to twenty twenty three,
there were a variety of medications available that treated Alzheimer disease,
but they only treated the symptoms of Alzheimer disease.
Speaker 2 (24:30):
You might think of.
Speaker 1 (24:30):
Them as memory support medications or crutches that if you
remove them, you know you're right back to where you were.
So that's what we call a symptomatic medication that isn't
actually treating or changing the underlying process.
Speaker 2 (24:47):
And that's all we had. That's all we ever had.
Speaker 1 (24:50):
So for the first twenty one years of my career,
that's all we had. And I watched trial after trial
come and go and fail with potential treatments for Alzheimer's
disease and nothing was available. So for years, all we
had were symptomatic medications, the most common ones being Donepezil
(25:13):
or air acept and Memantine or Namenda and some of
the similar competitors like Excellon and Excellon patch. These things
are sort of the common symptomatic treatments, and that's all
we had for a long time. Then in twenty twenty three,
the first fully FDA approved treatment that actually treats the
(25:34):
underlying disease became available, and since then there's been one more.
So there are two FDA approved medications that are disease modifying,
that is, they actually alter the underlying disease and modify.
Speaker 2 (25:49):
The progression of disease.
Speaker 1 (25:51):
So, getting back the original question, what's the reasonable expectation
for these If we're talking about the older symptomatic treatments,
talking about maybe a little boost in memory for folks
and hope for the best, and then with the newer
disease modifying medications, we can actually say that we absolutely
(26:16):
can slow down the disease. Now, they certainly aren't cures.
They don't reverse anything. What they do is start to
remove some of that data amyloid.
Speaker 2 (26:29):
Plaque that builds up in the brain.
Speaker 1 (26:33):
Unfortunately, that the abnormal proteins that are building up in
the brain, they eventually kill off brain cells and once
those are killed off, we're not getting them back. So
when we go in and we start to remove that
data amyloid plaque with these new treatments, we're helping to
preserve neurons that are left. And so that's the reason
(26:55):
they slow down the decline over time rather than reversing it.
So that's kind of where we are, and that's the
discussion I have with patients. We can actually do something
to slow this down and prolong the time that you're
going to be independent, prolong the time that you can
still do the stuff that you want to do and
not be in an institution. Those are reasonable goals. Reversal
(27:19):
of the condition is not a reasonable goal.
Speaker 3 (27:25):
So while you're giving these newer medicines, which I do
want to hear a little more about, but do you
use the older medicines that are symptom based to take
care of symptoms while you're trying to get these new
medicines to kick in, for lack of a better word,
or do these new medicines replace the need for those
older medicines.
Speaker 1 (27:46):
Now, using them together is probably the most common way
that we treat. Those medicines still work, They still give
a boost for patients whether they're on the newer medications
or not, and so absolutely having both on ord is
very common now. Having said that, if you look at
the stages of Alzheimer's disease, there are five stages of
(28:09):
alzheimer disease. The first two stages. First stages is no
memory loss. The only way you would know that there
was Alzheimer's disease president is do a spinal tap or
a PET scan.
Speaker 2 (28:22):
That's the first stage.
Speaker 1 (28:24):
Second stage is a little bit of memory loss, but
not enough to cause significant dysfunction.
Speaker 2 (28:29):
We call that MCI.
Speaker 1 (28:31):
Those first two stages, those symptomatic medications are not approved
for those, and so it's really later on when we
use those symptomatic memory support medications, and in those stations,
absolutely we use those in conjunction with the newer anti
amyloid treatments.
Speaker 3 (28:51):
What are those medicines like? Are they oral? Are they IV?
Are what can you tell us about these new drugs?
Speaker 1 (28:59):
Yeah, so the new drugs are both of them are intravenous,
so they're given through an IV. You would have to
go into an infusion center for one of them is
every two weeks, but the other one's every four weeks
and have an infusion that lasts usually between thirty minutes
and sixty minutes, and then go back, you know, two
(29:21):
weeks or four weeks later and repeat the process. They
have potential downsides. We talked about the upside. They actually
slow down the progression of disease, that's for certain. There
are downsides too, and that's you know, one of the
frank things that I have a discussion with patients about.
Speaker 2 (29:40):
They if you don't mind it, we'll dive into that now.
Speaker 3 (29:44):
If you'd like, well, why don't we hold that, Why
don't we take a break and we can start right
in with that when we come back. We'll take our
final break here and I'll and we'll go right into
that as soon as we come back. So you are
listening to Center on Health with Optics Health here on
news radio a WA whas our guest Patrick Matisan talking
to us about Alzheimer's disease. We will be right back
(30:07):
after these messages. Welcome back everyone to cent It On
Health with Baptists Health here on news Radio eight forty whas.
(30:29):
I'm your host, doctor Jeff Tavlin, and we're talking tonight
to doctor Patrick Matissan, neurologist with the Baptist Hospital Medical Group,
about Alzheimer's disease and new treatments. I want to remind
everybody to download the iHeartRadio app to re listen to
this or any of our previous segments, and to have
access to all the other features that the app has
to offer. So right before we went to break, we
(30:51):
were learning about these new IV medications that are available
for Alzheimer's, and you were just about to tell us that,
you know, nothing is without the other side we have
to consider. So I'll hand it back to you to
tell us about that.
Speaker 1 (31:07):
Absolutely so as exciting as it was, especially for me
in my career and what I've seen over the last
twenty five years, to see something come out that actually
treats the disease.
Speaker 2 (31:18):
Of course, there's no free lunch, So just a.
Speaker 1 (31:21):
Little quick, little background on what Alzheimer's disease is doing
in the brain. It's laying down that abnormal beta anaaloid
plaque throughout the brain, and some of that plaque gets
deposited in arteries as well, so that makes the arteries
sometimes a little bit leaky. So in Alzheimer's disease, sometimes
(31:41):
you just get random swelling or even little microbleads in
the brain just from having Alzheimer's disease, and that happens
about nine percent of the time. Now you can imagine
when we go in and we start to remove all
that plaque, we might exacerbate that problem.
Speaker 2 (31:58):
So with these medications.
Speaker 1 (32:00):
Pulling that abnormal plaque out of the brain, we increase
the risk that folks can have a little bit of
swelling or edema or even little micro bleeds in the brain.
And so because of that, regular MRI monitoring of the
brain for the first six months is required, so that
(32:21):
that's really the biggest downside of the medications is the
potential that we exacerbate that that little microbleed and sometimes
swelling in the brain.
Speaker 2 (32:30):
That front that comes from this.
Speaker 3 (32:34):
So as you think about these new medicines, what makes
somebody a good patient for these are there are there
patients that will respond better to them, or patients where
you're like, I'm not sure it just will work. How
do you decide who's a good candidate.
Speaker 1 (32:51):
Terrific, Yeah, fantastic question. So first of all, the drugs
are only approved for early stages of disease, so that's
the mc I state that we talked about and mild dementia.
Speaker 2 (33:03):
And it makes sense that they're only approved for mild.
Speaker 1 (33:06):
Stages of disease because, as we talked about a moment ago,
they are slowing down progression and once you lose enough
brain cells, there's not really much that.
Speaker 2 (33:16):
These drugs can do.
Speaker 1 (33:17):
So the earlier you start them, the more brain cells
there are to save and to make a difference in,
and once you get beyond a certain point, they don't
really make a difference for folks.
Speaker 2 (33:29):
So that's first.
Speaker 1 (33:30):
They're only to be used in early stages of the disease,
so you have to meet that criteria, and then you
need to be really cautious in somebody who might, let's say,
be on a blood dinner like Kumidin or Eloquist because
of that potential for bleeding.
Speaker 2 (33:47):
In the brain. Those are our problems.
Speaker 1 (33:50):
Another issue that might be a problem is if you
have something like a pacemaker that would prevent you from
having regular MRIs to follow up and make sure that
drug is pay for you. So those are the biggies.
If you fall outside of any of those categories, it's
probably not going to be the safest or best medication
for you.
Speaker 3 (34:11):
And you mentioned that these were ivs. How often are
they given? I know in GI we're using a lot
of biologics and disease modifying drugs and the intervals that
we have to give them very greatly. So for these
two medicines, what's the frequency of getting the treatment?
Speaker 1 (34:27):
Yeah, so one, the first one that came out in
twenty and twenty three, it's given every two weeks for
the first first eighteen months, and then you go on.
Speaker 2 (34:37):
To maintenance therapy every four weeks.
Speaker 1 (34:40):
The second drug that came out is given every four weeks,
so every month.
Speaker 2 (34:44):
Basically that's similar to what we use.
Speaker 3 (34:48):
So are we are we kind of where we can
see the future? Like is this the current state where
we think will be or are we even are there
future directions that you see treatment going?
Speaker 2 (35:02):
Yeah, what a terrific question.
Speaker 1 (35:04):
I'm really excited because I kind of see this as
a watershed moment in Alzheimer's disease, much like it was
in multiple sclerosis back in the eighties and early nineties,
when we didn't have any treatments and then finally new
treatments came along that actually altered the course of the disease.
And you see what's happened in multiple sclerosis. There's now
what twenty drugs.
Speaker 2 (35:23):
Available and they're.
Speaker 1 (35:25):
Very powerful, and I see this as kind of Alzheimer's
disease moment referable to that. I think it's the watershed
moment where we're starting to be able to actually understand
this disease a little bit better and therefore get in
and treat it a little bit better. So yeah, I
think there are new ways to approach this that are
coming down the line. One that pops to mind is
(35:48):
an anti PAU medication, So there's a couple of those
in the pipeline, and I'm hopeful for the results of
those studies. The current ones, if you remember, are beta
amyloid BASEDUG.
Speaker 2 (36:00):
So yes, I'm hopeful.
Speaker 1 (36:02):
I wasn't hopeful until twenty twenty three, and now I'm
hopeful that this really is a watershed moment as we're
starting to get a handle on this disease, and I'm
very hopeful that this just gets better from here.
Speaker 3 (36:16):
You know. I know we're not talking about GI specific tonight,
but we do use some of these similar concept medications
and it's a real privilege to be a part of
a change where you see something like Alzheimer's or for me,
you know, inflammatory bowel disease with these new medications making
such a difference in the way that we're treating these patients.
(36:37):
So it's just an exciting time to get to be
a part of that. But it's great. Are Yeah, It's.
Speaker 2 (36:46):
Yeah, go ahead.
Speaker 1 (36:47):
I just I just completely agree. I didn't think i'd
see this in my career. I'd kind of given up,
and now it's given me new excitement and interest. And
I always had an interest in to mention Alzheimer's disease,
and this it's just really let that spark a little
bit more.
Speaker 3 (37:04):
Yeah, I feel the same. So as much as these
medicines are great and you've been very balanced about telling us,
we know that there are going to be patients that
are seeking things that might help a little bit on
the more natural side. Have you seen or have any
experience and adotically with non medications that help in terms
(37:26):
of vitamins or omegas or ginko or some of the
things that time to get popular on you know, forums
and stuff.
Speaker 4 (37:35):
Is there any any data to support those things. Sure,
I think that fish oil is probably good for the brain.
I wouldn't say that it's going to slow down alzheimer.
Speaker 2 (37:47):
Disease, right.
Speaker 1 (37:50):
I think be complex vitamins, especially vitamin B twelve, are important,
And I think the way to think about these things
is as supportive devices and not treating devices. Because if
your levels are adequate with vitamins or say vitamin B twelve.
Speaker 2 (38:09):
No problem.
Speaker 1 (38:10):
But what they what supplementing does is make sure we're
not adding on stress to the brain with a deficiency
that could be covered with a simple vitamin. So I
think those things are useful, but I think you just
have to have a little bit of caution and if
you wanted to say something like these are going to
treat the Alzheimer's disease, they're not going to. But I
(38:32):
think they can be helpful and supporting and making sure
patients aren't having additive burdens on top of an already
devastating disease.
Speaker 3 (38:42):
Well, I mean I could talk to you forever about this,
so unfortunately that we are out of time, but you
have provided us with so much information, so I is
going to do it. For tonight's episode, I've centered on
health with Boptic Health. I'm your host, doctor Jeff Teblin.
I want to thank our guest Patrick W. Matithin, who
has taught us so much about the new treatments for
(39:03):
Alzheimer's disease. We are going to be here every Thursday night,
and I want to thank our producer, mister Jim Benn.
Of course, you the listener, have a great derby week
and a safe weekend, and.
Speaker 5 (39:14):
We will see you next week.
Speaker 3 (39:34):
This program is for informational purposes only and should not
be relied upon as medical advice. The content of this
program is not intended to be a substitute for professional
medical advice, diagnosis, or treatment. The show is not designed
to replace a physician's medical assessment and medical judgment. Always
seek the advice of your physician with any questions or
concerns you may have related to your personal health or
(39:56):
regarding specific medical conditions. To find a Baptist health provider,
please visit baptistealth dot com,
It's now time for Centered on Health with Baptists Help
on news radio waight fortys.
Speaker 2 (00:07):
Now. Here's doctor Jeff Tubler.
Speaker 3 (00:11):
Good evening, everyone, and welcome to tonight's episode of Centered
on Health with Baptist Health here on news radio eight
forty wahas. I'm your host, doctor Jeff Tublin, and we
are joined from the studio with our producer mister Jim Benn.
He is awaiting to take your calls to have a
part of our discussion tonight, of which we are going
to be talking about new treatments for Alzheimer's disease and
(00:34):
headaches and all sorts of neurologic topics. Our phone number
is five oh two, five seven one, eight four eighty four.
If you want to call in and be a part
of the show, we hope that you do. Fifty five
million people around the world are diagnosed with dementia and
headaches are the third highest cause of disability. Adjusted life
here is meaning the amount of disability that takes people
(00:57):
away from living their life. So today we are very
fortunate to have doctor Patrick Matissen here who is a
neurologist in the Baptist Hospital Medical Group. His practice is
in Lagrange. He attended University of Louisville for medical school
and did his internal medicine and residency at the University
of Kentucky Medical Center. He has extensive experience greater than
(01:18):
twenty five years of treating everything from headaches to dementia
to a taxia, and tonight we're going to learn a
lot about Alzheimer's disease and hopefully get to pick his brain.
See what I did there about lots of neurologic conditions.
So welcome to Center on Help.
Speaker 2 (01:35):
Thank you, Jeff, I appreciate it.
Speaker 3 (01:37):
Yeah, we threw a little pun in there. A happy
Derby Week everybody, and we are so excited to have
you on the show. I know people are interested in
this topic. It is such an important topic. So by
way of background get and introducing you, tell us a
little bit about what a neurologist is and the types
of things that you take care of.
Speaker 1 (01:58):
Sure, first, thanks for having me on, Jeff, I really
appreciate it, and I'm delighted to be here and spend
an hour with you.
Speaker 2 (02:05):
So what does neurology do.
Speaker 1 (02:07):
Neurologists are sort of the internal medicine specialists of the brain.
We're not surgeons. We take care of everything involving the
peripheral nerves, the spinal cord in the brain, and that
could include.
Speaker 2 (02:21):
Diseases such as epilepsy.
Speaker 1 (02:23):
Dementia, migraine, Parkinson disease, multiple sclerosis, anything that affects the
nervous system.
Speaker 2 (02:33):
We're a part of it.
Speaker 3 (02:35):
Well, I mean, obviously we could have you on for
multiple shows because I think everybody would want to know
all about all of those things. But tell us what
drove you to the special What interested you in neurology.
Speaker 2 (02:47):
Well, that's interesting.
Speaker 1 (02:47):
I was one of those indecisive people that didn't know
what they wanted to do, and so it was probably
third year of med school when we were starting to
rotate through the specialties and I was trying to figure
out what was interesting to me. But when I got
to neurology, every single day that I was seeing patients
with our attendings, I saw something absolutely fascinating. And by
(03:10):
the end of their rotation, I thought, there's just nothing
as interesting to me as the brain and how it works.
And so that was what triggered it for me, and
I knew that was the specialty for me.
Speaker 3 (03:21):
Fantastic, So in the simplest of terms. What is Alzheimer's disease?
Speaker 2 (03:29):
Yeah, okay, well we'll try to make that simple.
Speaker 1 (03:31):
If I go all left too far into the weeds, Jeff,
just reel me back in, all right. So, Alzheimer's disease
is a neurodegenerative process of the brain. And it happens
when normal proteins that are made in the brain at
(03:51):
some point become misfolded. And when they do that, they
start to spread and involve multiple areas of the brain,
and they start to accumulate into flaques and tangles that
interrupt neuron or brain nerve function and synapse function in
the brain, And after a time they affect enough neurons
in the brain to really disrupt the function of the
(04:13):
patient from multiple perspectives, usually starting with memory.
Speaker 3 (04:19):
Yeah, we're going to we're going to get into, you know,
some of the symptoms and stuff. But so we hear
the term Alzheimer's disease and we hear the term dementia.
So how are those synonymous? Are they the same? Are
there is it different to use those terms differently?
Speaker 1 (04:36):
I think that's a fantastic question. I think that's confusing
for so many people. So if we back out just
a little bit and talk about dementia. Dementia is just
a big, overall umbrella term, and what it really means
is as simple as dementia means that your brain is
(04:56):
not functioning well enough for you to be into pendent
in order for you to be able to do all
the things you need to do by yourself.
Speaker 2 (05:05):
And that could involve any area of the brain.
Speaker 1 (05:07):
That could be speech, that could be memory, that could
be all kinds of things evolving the brain. But that's
just an umbrella term. Brain isn't working well enough for
you to be functioning independently.
Speaker 2 (05:18):
So you can.
Speaker 1 (05:19):
Imagine that there are a large variety of things that
could cause the brain to malfunction in that way. And
so the most common cause for that is Alzheimer's disease
by far, So it is an etiology or one of
the reasons that one might get dementia just happens to
be the most common one.
Speaker 3 (05:41):
And what are some of the other things we may
have heard of that fall under that category of dementia.
Speaker 1 (05:47):
Sure so some people may have heard of front to
temporal dementia. That's a different type of dementia, but it's
also a degenerative disease of the brain that just progresses
over time. People may have heard of Lewis body disease,
which in some way related to Parkinson's disease. There are
(06:11):
reversible causes for dementia. Let's imagine you get a vitamin
deficiency that it becomes so severe that your brain can't
function any longer. Well, that might be a reversible cause
for dementia, like a B twelve deficiency. So we could
spend all night talking about etheologies, but I think that's
a good intro to the fact that you know, there's
(06:32):
all kinds of ways to make the brain malfunction.
Speaker 3 (06:36):
You've said a couple terms neurodegenitive and progressive. What are
we talking about when we say something like Alzheimer's is
a progressive disease.
Speaker 1 (06:48):
So neurodegenerative diseases of the brain are diseases that cause
progressive dysfunction of the brain and progressive deterioration of the brain,
and each of them does it in a different or
specific or characteristic way. So Alzheimer's disease is one of
(07:10):
the neurodegenerative diseases of the brain, and interestingly, it tends
to come about in a very specific way. For most people.
It affects the temporal and parietal loves of the brain,
so memory and orientation seem to be the most common
ways that it presents. So people that are becoming more
and more forgetful over time, you might wonder, is this
(07:33):
the beginning of Alzheimer's disease?
Speaker 3 (07:37):
So that is something I was going to ask, because
you know, it's pretty normal for people to forget something
here and there, but as we get older, like I think,
it's very natural for us to go there and to
think right away, oh my gosh, I wonder if this
is the beginning of dementia. And so when somebody forgets
something or they feel that they're being a little forgetful,
(07:58):
what is the real time that they should potentially be concerned.
Speaker 1 (08:03):
What a terrific question is you can imagine it's not
an easy answer, but all no, I'll give you. I'll
give you a few for instances. So almost everybody after
fifty has a little bit of memory loss, all of
us do, and usually if the brain is normal, that
memory loss is simply irritating rather than debilitating. Where did
(08:27):
I put my darn keys?
Speaker 2 (08:29):
You know?
Speaker 1 (08:29):
Where did I lay my glasses down. Why did I
just walk into this room right? Maybe I should turn
around and go back and then see if I can
figure that out again. Or that guy looks familiar but
I can't come up with his name. All of those
things are very normal parts of aging. But they don't
keep you from being able to do your job or
(08:49):
mow your lawn, remember how to get to the grocery,
or how to take your medicines. They're just irritants, and
those are pretty normal parts of normal aging. If you're
more worried about dementia, then you're looking at things that
may cause dysfunction for you that really inhibits your life.
(09:13):
And that could be a lot of different things. But
I would put it this way, in this day and age,
I would be a little bit more proactive.
Speaker 2 (09:23):
If you're worried, then wait and see.
Speaker 1 (09:27):
And that is because we do have new treatments that
are coming out that might have an impact that earlier
you catch the disease. So if one thinks that their
memory is out of line compared to say, other people
their age, and or maybe they've got a really strong
family history of dementia, it probably is worth checking in
(09:50):
with their doctor and getting a memory screen or maybe
getting a few blood tests to see if that needs
to be looked at further, because the earlier we catch
it very often.
Speaker 2 (09:59):
The more we can do to slow it down. With
some of the new treatments that are.
Speaker 3 (10:02):
Available, well, we are excited to get to talk about
those tonight. So we are just getting started. We're going
to take a quick break. We want to remind everybody
that you are listening to Senate on Health with Baptist
Health here on news radio eight forty whas. Our phone
number is five oh two, five seven one, eight four
eighty four if you want to call in and ask
(10:24):
a question. We're talking tonight with neurologists doctor Patrick Matissen,
who's talking about Alzheimer's and we'll be right back. I
want to welcome you back to Senate on Health with
(10:46):
Baptist Health here on news radio eight forty Wahas. I'm
your host, doctor Jeff Pelberman. Tonight we're talking about Alzheimer's
disease with doctor Patrick Matissen, who is a neurologist with
the Baptist Hospital Medical Group. Our phone number five oh two,
five seven one, eight four eighty four. Our producer, mister
Jim fan is on standby to take your calls and
(11:07):
ask questions, So welcome, welcome back. I wanted to ask
something a little bit obviously on the serious side, is
is Alzheimer's life threatening? Is it a terminal condition?
Speaker 1 (11:22):
Yes, Alzheimer's disease is a terminal condition. It is an
exorably progressive and can't turn it around. Our treatments are
certainly getting better.
Speaker 2 (11:34):
We're going to talk about that a little bit later. Yes,
it would be considered a terminal condition.
Speaker 1 (11:40):
So deporting on the statistics that you look at, it
is between the fifth or the seventh leading cause of
death and.
Speaker 2 (11:48):
Folks above age sixty five.
Speaker 1 (11:50):
So it's it's a it's a big, big concern.
Speaker 3 (11:54):
Wow. So so when you're talking to a patient you've
made that diagnosed, and I know this is like a
four hour answer, but in general, like, what is your
approach Obviously, somebody receiving this news, you know, we have
all of our perceptions of what that's going to mean,
and how do you approach telling them that they have
this and what stress for treatment in general is. I
(12:18):
know we'll get into the specifics, but how do you
approach that conversation with a new diagnosis.
Speaker 1 (12:25):
That's a tough one and it's not just one conversation.
When we get to that point, we have gone through
multiple stages. So when somebody presents for the first time
or the family brings someone in for the first time
with the memory or cognitive complaint, the first thing we
do is, you know, do some memory screens and get
(12:45):
to good history and an examination and then check them
most importantly for reversible or treatable causes for their conditions.
So we're going to get a battery of routine blood
tests and MRI of the brain, and if we don't
find any reversible or treatable conditions, then we're starting to
address that possibility of underlying Alzheimer's disease. So we uh,
(13:11):
we talk about specific testing for Alzheimer's disease at that point,
and we can get into that if you'd like, h.
Speaker 3 (13:19):
Yeah, what is the evaluation?
Speaker 1 (13:21):
Like, yeah, okay, sure, sure, So just to finish finish
that other answer, it's probably the third visit or so
when we're working somebody up for dementia where we might
get to that point where we say, yes, this really
does represent underlying Alzheimer's disease, and that's never an easy
thing to present to someone. But on the other hand,
(13:44):
the patients that are coming in want answers one way
or the other, and there's really nothing more frightening than
the unknown for them for most people, and having an
answer is not only helpful, and then having a plan
for what we might do about it is also very
very helpful in relieving for patients. So I think your
(14:04):
subsequent question was how do we test for Alzheimer's disease?
Speaker 3 (14:08):
Is that the Yeah, what's a general if I came
to you or I brought a family member to about
what you mentioned some memory screening and some blood tests,
what's the evaluation.
Speaker 2 (14:19):
Like, okay, gotcha? Gotcha?
Speaker 1 (14:21):
So, yeah, we'll do some sort of memory screen The
common ones are the MOCHA or the minumental status exam,
and if the results of those are concerning and the
history that we get from a patient is concerning them,
we'll do a series of blood tests. And those are
going to include things like testing the thyroid, testing for
a vitamin B twelve deficiency, making sure the liver is
(14:43):
functioning correctly, because when the liver and kidneys aren't functioning correctly,
you get toxins that build up that affect brain function.
So we're doing all those blood tests to make sure
there's not something simple that we can just fix. It
would be the worst thing to do to miss one
of those fixable problems. And then we're getting an MRI
of the brain and if we can. There's some patients
(15:04):
that can't have an MRI because of a pace maker
or other problems, but optimally we're getting an MRI of
the brain, and we're making sure that there's some structural
problem in the brain that we need to address, like
a common one would be hydrocephalus. Hydrocephalus is a condition
where fluid builds up in the brain and can cause dementia.
(15:26):
And that's important because we can usually change that one.
We can have our surgeon colleagues put a drain in
and fix that problem before it becomes worse. So these
are always to look at potentially reversible causes or fixable
or treatable, modifiable causes for the patient's cognitive problems. Once
(15:49):
we get through all that, and if we don't find
something that we can look at, Oh and I didn't
mention things like sleep disorders. These are things that we
look at too. Obstructive sleep atnea, for instances of very
common reason for memory loss. If we aren't sleeping correctly,
we're not consolidating memories correctly. So anyway, suffice it to say,
(16:09):
there's a broad variety of things we're looking at at
that first and second visit to make sure we're not
missing something that just can be fixed.
Speaker 2 (16:17):
So that's job one.
Speaker 1 (16:19):
Once we get through that stage, then we're addressing whether
or not we're going to specifically test someone for Alzheimer's disease,
and those tests, you know, a few years ago we
didn't have tests specifically for alzheimer disease, So the testing
for Alzheimer's disease is a fairly new development as well.
And the two gold standard tests are a spinal tap
(16:43):
that looks at a chemical called beta amyloid in the
spinal fluid or a special PET scan of the brain
that looks at beta amyloid deposition in the brain. Those
are the two main ways we use to specific look
for Alzheimer's disease and a patient. And our blood tests
(17:05):
that are coming around those are starting to get better
and better. We're starting to see better and better blood tests,
and I expect probably within a year or so that
some of those blood tests will probably get FDA approval
and will start to gain more widespread acceptance, But for now,
the gold standards are a specialized PET scan of the
brain and a spinal tap for beta amyloid. Once those
(17:28):
results come back, we've got a really good answer. Yeah,
your nay on Alzheimer's disease pathology.
Speaker 3 (17:36):
So if anybody out there is listening, like I am,
we're sitting here and we're wondering, you know, am I
going to get Alzheimer's disease?
Speaker 2 (17:45):
So?
Speaker 3 (17:45):
Are there known genetic factors or predictable risk factors for
Alzheimer's or is it a pretty random assignment of who
gets this?
Speaker 2 (17:56):
Terrific question? Terrific questions.
Speaker 1 (17:59):
So there our genes involved, But most Alzheimer's disease is sporadic.
Speaker 2 (18:04):
That means it just happens.
Speaker 1 (18:06):
In the most So I'll address the genetic factors. If
you want to put a number on it, I would
say that roughly fifteen percent of Alzheimer's disease has a
genetic underpinning. So that means that most Alzheimer's disease is sporadic,
and the greatest risk factor for Alzheimer's disease is age alone,
(18:28):
so unfortunately, we can't do anything about that risk factor.
There are other risk factors, so a history of head
injuries is a risk factor. Metabolic syndrome like poorly controlled
diabetes and obesity, and a sedentary lifestyle.
Speaker 2 (18:46):
All of these things.
Speaker 1 (18:47):
Contribute to an increase in risk for Alzheimer's disease.
Speaker 2 (18:50):
But the big one is age.
Speaker 3 (18:53):
Well, I mean that's good. I mean all those things
are so good to know. Because so many of those
other things are common, we want to keep those under control.
So I know we are.
Speaker 2 (19:02):
Going to jump into study.
Speaker 3 (19:04):
I'm sorry, go ahead, yeah, go ahead, No, please, I.
Speaker 1 (19:06):
Was going to say that in that same vein that
study after study has shown that you know, regular physical
exercise and brain exercise, so keeping your brain active and
not vigioning out in front of the TV all the time,
and you know, a heart healthy diet like the Mediterranean diet.
These things sim tend to be relatively protected. That is,
(19:28):
they put the possibility of dementia further off into the future.
So I always have a talk with patients about those things.
So these healthy lifestyle factors can be important.
Speaker 3 (19:40):
Well, I had a whole list of myths to to
ask you yes or no, But you really have answered
all of them so beautifully already. So no, it's wonderful.
Since we're going to get into treatments on a very
kind of brief description. Are there anything that people can
do to prevent it? I know people do crosswords, and
(20:00):
they do saduko, and they take vitamins. Are any of
these Have they been studied to delay or prevent or
mitigate the severity of any type of dementia?
Speaker 1 (20:10):
Yeah, so the things that I just mentioned, A regular
physical exercise program, it doesn't prevent dementia, but it certainly
reduces the likelihood that you'll get it at any particular age.
That is, it puts it off further into the future.
A Mediterranean diet or the brain diet have been shown
(20:31):
to be helpful in.
Speaker 2 (20:31):
Putting that off into the future.
Speaker 1 (20:34):
And absolutely, if you don't use the brain, it's like
a muscle, you lose it. So brain exercise puzzles. Socialization
is people don't think of that, but socialization with friends
and family is a huge.
Speaker 2 (20:49):
Activator for the brain.
Speaker 1 (20:51):
So going out with friends and family, playing card games
and not you know, turning into a recluse at home
are big factors that keep the brain act and healthy
and functioning. There's multiple factors that play into keeping the
brain active. And if you don't use a particular part
of the brainded atrophies. And that reminds me of something
(21:12):
that's really come up recently in the literature, and that
is hearing loss. People with untreated hearing loss are much
more likely to get dementia. And you might wonder why
that is, but you know, when you're not feeding auditory
signals into the temporal lobes, well, the temporal lobes just
(21:32):
aren't being exercised much. And guess where our memories are
stored and the temporal lobes, So untreated memory loss, excuse me,
untreated hearing losses another risk factor that needs to be
looked at and considered for folks.
Speaker 2 (21:47):
And of course, if you do have dementia.
Speaker 1 (21:49):
Hearing loss just makes it seem that much worse because
it's one more tensory deprivation for a brain that's already struggling.
Speaker 3 (21:57):
Well, we are going to take a short break and
we are going to start to learn about these new treatments.
So we are so excited to get to that segment.
So we're going to take a break. I want to
remind everyone you're listening to Senate on Health with Baptist
Help here on news radio eight forty wahas our guests tonight,
doctor Patrick matisen talking to us about dementia and Alzheimer's
disease and new therapies. Will be right back. Welcome back
(22:32):
to Senate on Help with Baptist Health here on news
radio eight forty whas. I'm your host, doctor Jeff Tavlin.
We're talking tonight to neurologist doctor Patrick Matissen about Alzheimer's disease.
And right before the break, we did get a question submitted.
They asked me to ask it on their behalf, but
(22:53):
they have a family member that was just diagnosed with
Alzheimer's and they were wondering do all our Alzheimer's patients
able to maintain living independently or do they need to
be prepared for making arrangements for that down the road.
Speaker 2 (23:09):
Yeah, at some point arrangements will need to be made.
Speaker 1 (23:14):
A lot of folk meeting independence for years, but inevitably
the time when it's going to be very difficult for
family members to take care of all the needs that
a patient is going to require. So it is inevitable
that someone will need assistance later on.
Speaker 2 (23:33):
Yeah, thank you.
Speaker 3 (23:34):
So getting into the treatments, could you start by telling
us when you talk to patients, what do you tell
them the goals of therapy are and what are there?
Do you have to set sort of realistic goals or
do you go high in the sky. What's that? What
are the goals of treatment when you start to treat Alzheimer's.
Speaker 1 (23:56):
Wow, fantastic question. So absolutely being realistic is critically important
with folks. And before we dive too far into treatment,
I'd like to zoom back out and talk about the
treatments that have been available before and how that differs
from what we have today, if you don't mind, absolutely,
(24:16):
so if we zoom out. Prior to twenty twenty three,
there were a variety of medications available that treated Alzheimer disease,
but they only treated the symptoms of Alzheimer disease.
Speaker 2 (24:30):
You might think of.
Speaker 1 (24:30):
Them as memory support medications or crutches that if you
remove them, you know you're right back to where you were.
So that's what we call a symptomatic medication that isn't
actually treating or changing the underlying process.
Speaker 2 (24:47):
And that's all we had. That's all we ever had.
Speaker 1 (24:50):
So for the first twenty one years of my career,
that's all we had. And I watched trial after trial
come and go and fail with potential treatments for Alzheimer's
disease and nothing was available. So for years, all we
had were symptomatic medications, the most common ones being Donepezil
(25:13):
or air acept and Memantine or Namenda and some of
the similar competitors like Excellon and Excellon patch. These things
are sort of the common symptomatic treatments, and that's all
we had for a long time. Then in twenty twenty three,
the first fully FDA approved treatment that actually treats the
(25:34):
underlying disease became available, and since then there's been one more.
So there are two FDA approved medications that are disease modifying,
that is, they actually alter the underlying disease and modify.
Speaker 2 (25:49):
The progression of disease.
Speaker 1 (25:51):
So, getting back the original question, what's the reasonable expectation
for these If we're talking about the older symptomatic treatments,
talking about maybe a little boost in memory for folks
and hope for the best, and then with the newer
disease modifying medications, we can actually say that we absolutely
(26:16):
can slow down the disease. Now, they certainly aren't cures.
They don't reverse anything. What they do is start to
remove some of that data amyloid.
Speaker 2 (26:29):
Plaque that builds up in the brain.
Speaker 1 (26:33):
Unfortunately, that the abnormal proteins that are building up in
the brain, they eventually kill off brain cells and once
those are killed off, we're not getting them back. So
when we go in and we start to remove that
data amyloid plaque with these new treatments, we're helping to
preserve neurons that are left. And so that's the reason
(26:55):
they slow down the decline over time rather than reversing it.
So that's kind of where we are, and that's the
discussion I have with patients. We can actually do something
to slow this down and prolong the time that you're
going to be independent, prolong the time that you can
still do the stuff that you want to do and
not be in an institution. Those are reasonable goals. Reversal
(27:19):
of the condition is not a reasonable goal.
Speaker 3 (27:25):
So while you're giving these newer medicines, which I do
want to hear a little more about, but do you
use the older medicines that are symptom based to take
care of symptoms while you're trying to get these new
medicines to kick in, for lack of a better word,
or do these new medicines replace the need for those
older medicines.
Speaker 1 (27:46):
Now, using them together is probably the most common way
that we treat. Those medicines still work, They still give
a boost for patients whether they're on the newer medications
or not, and so absolutely having both on ord is
very common now. Having said that, if you look at
the stages of Alzheimer's disease, there are five stages of
(28:09):
alzheimer disease. The first two stages. First stages is no
memory loss. The only way you would know that there
was Alzheimer's disease president is do a spinal tap or
a PET scan.
Speaker 2 (28:22):
That's the first stage.
Speaker 1 (28:24):
Second stage is a little bit of memory loss, but
not enough to cause significant dysfunction.
Speaker 2 (28:29):
We call that MCI.
Speaker 1 (28:31):
Those first two stages, those symptomatic medications are not approved
for those, and so it's really later on when we
use those symptomatic memory support medications, and in those stations,
absolutely we use those in conjunction with the newer anti
amyloid treatments.
Speaker 3 (28:51):
What are those medicines like? Are they oral? Are they IV?
Are what can you tell us about these new drugs?
Speaker 1 (28:59):
Yeah, so the new drugs are both of them are intravenous,
so they're given through an IV. You would have to
go into an infusion center for one of them is
every two weeks, but the other one's every four weeks
and have an infusion that lasts usually between thirty minutes
and sixty minutes, and then go back, you know, two
(29:21):
weeks or four weeks later and repeat the process. They
have potential downsides. We talked about the upside. They actually
slow down the progression of disease, that's for certain. There
are downsides too, and that's you know, one of the
frank things that I have a discussion with patients about.
Speaker 2 (29:40):
They if you don't mind it, we'll dive into that now.
Speaker 3 (29:44):
If you'd like, well, why don't we hold that, Why
don't we take a break and we can start right
in with that when we come back. We'll take our
final break here and I'll and we'll go right into
that as soon as we come back. So you are
listening to Center on Health with Optics Health here on
news radio a WA whas our guest Patrick Matisan talking
to us about Alzheimer's disease. We will be right back
(30:07):
after these messages. Welcome back everyone to cent It On
Health with Baptists Health here on news Radio eight forty whas.
(30:29):
I'm your host, doctor Jeff Tavlin, and we're talking tonight
to doctor Patrick Matissan, neurologist with the Baptist Hospital Medical Group,
about Alzheimer's disease and new treatments. I want to remind
everybody to download the iHeartRadio app to re listen to
this or any of our previous segments, and to have
access to all the other features that the app has
to offer. So right before we went to break, we
(30:51):
were learning about these new IV medications that are available
for Alzheimer's, and you were just about to tell us that,
you know, nothing is without the other side we have
to consider. So I'll hand it back to you to
tell us about that.
Speaker 1 (31:07):
Absolutely so as exciting as it was, especially for me
in my career and what I've seen over the last
twenty five years, to see something come out that actually
treats the disease.
Speaker 2 (31:18):
Of course, there's no free lunch, So just a.
Speaker 1 (31:21):
Little quick, little background on what Alzheimer's disease is doing
in the brain. It's laying down that abnormal beta anaaloid
plaque throughout the brain, and some of that plaque gets
deposited in arteries as well, so that makes the arteries
sometimes a little bit leaky. So in Alzheimer's disease, sometimes
(31:41):
you just get random swelling or even little microbleads in
the brain just from having Alzheimer's disease, and that happens
about nine percent of the time. Now you can imagine
when we go in and we start to remove all
that plaque, we might exacerbate that problem.
Speaker 2 (31:58):
So with these medications.
Speaker 1 (32:00):
Pulling that abnormal plaque out of the brain, we increase
the risk that folks can have a little bit of
swelling or edema or even little micro bleeds in the brain.
And so because of that, regular MRI monitoring of the
brain for the first six months is required, so that
(32:21):
that's really the biggest downside of the medications is the
potential that we exacerbate that that little microbleed and sometimes
swelling in the brain.
Speaker 2 (32:30):
That front that comes from this.
Speaker 3 (32:34):
So as you think about these new medicines, what makes
somebody a good patient for these are there are there
patients that will respond better to them, or patients where
you're like, I'm not sure it just will work. How
do you decide who's a good candidate.
Speaker 1 (32:51):
Terrific, Yeah, fantastic question. So first of all, the drugs
are only approved for early stages of disease, so that's
the mc I state that we talked about and mild dementia.
Speaker 2 (33:03):
And it makes sense that they're only approved for mild.
Speaker 1 (33:06):
Stages of disease because, as we talked about a moment ago,
they are slowing down progression and once you lose enough
brain cells, there's not really much that.
Speaker 2 (33:16):
These drugs can do.
Speaker 1 (33:17):
So the earlier you start them, the more brain cells
there are to save and to make a difference in,
and once you get beyond a certain point, they don't
really make a difference for folks.
Speaker 2 (33:29):
So that's first.
Speaker 1 (33:30):
They're only to be used in early stages of the disease,
so you have to meet that criteria, and then you
need to be really cautious in somebody who might, let's say,
be on a blood dinner like Kumidin or Eloquist because
of that potential for bleeding.
Speaker 2 (33:47):
In the brain. Those are our problems.
Speaker 1 (33:50):
Another issue that might be a problem is if you
have something like a pacemaker that would prevent you from
having regular MRIs to follow up and make sure that
drug is pay for you. So those are the biggies.
If you fall outside of any of those categories, it's
probably not going to be the safest or best medication
for you.
Speaker 3 (34:11):
And you mentioned that these were ivs. How often are
they given? I know in GI we're using a lot
of biologics and disease modifying drugs and the intervals that
we have to give them very greatly. So for these
two medicines, what's the frequency of getting the treatment?
Speaker 1 (34:27):
Yeah, so one, the first one that came out in
twenty and twenty three, it's given every two weeks for
the first first eighteen months, and then you go on.
Speaker 2 (34:37):
To maintenance therapy every four weeks.
Speaker 1 (34:40):
The second drug that came out is given every four weeks,
so every month.
Speaker 2 (34:44):
Basically that's similar to what we use.
Speaker 3 (34:48):
So are we are we kind of where we can
see the future? Like is this the current state where
we think will be or are we even are there
future directions that you see treatment going?
Speaker 2 (35:02):
Yeah, what a terrific question.
Speaker 1 (35:04):
I'm really excited because I kind of see this as
a watershed moment in Alzheimer's disease, much like it was
in multiple sclerosis back in the eighties and early nineties,
when we didn't have any treatments and then finally new
treatments came along that actually altered the course of the disease.
And you see what's happened in multiple sclerosis. There's now
what twenty drugs.
Speaker 2 (35:23):
Available and they're.
Speaker 1 (35:25):
Very powerful, and I see this as kind of Alzheimer's
disease moment referable to that. I think it's the watershed
moment where we're starting to be able to actually understand
this disease a little bit better and therefore get in
and treat it a little bit better. So yeah, I
think there are new ways to approach this that are
coming down the line. One that pops to mind is
(35:48):
an anti PAU medication, So there's a couple of those
in the pipeline, and I'm hopeful for the results of
those studies. The current ones, if you remember, are beta
amyloid BASEDUG.
Speaker 2 (36:00):
So yes, I'm hopeful.
Speaker 1 (36:02):
I wasn't hopeful until twenty twenty three, and now I'm
hopeful that this really is a watershed moment as we're
starting to get a handle on this disease, and I'm
very hopeful that this just gets better from here.
Speaker 3 (36:16):
You know. I know we're not talking about GI specific tonight,
but we do use some of these similar concept medications
and it's a real privilege to be a part of
a change where you see something like Alzheimer's or for me,
you know, inflammatory bowel disease with these new medications making
such a difference in the way that we're treating these patients.
(36:37):
So it's just an exciting time to get to be
a part of that. But it's great. Are Yeah, It's.
Speaker 2 (36:46):
Yeah, go ahead.
Speaker 1 (36:47):
I just I just completely agree. I didn't think i'd
see this in my career. I'd kind of given up,
and now it's given me new excitement and interest. And
I always had an interest in to mention Alzheimer's disease,
and this it's just really let that spark a little
bit more.
Speaker 3 (37:04):
Yeah, I feel the same. So as much as these
medicines are great and you've been very balanced about telling us,
we know that there are going to be patients that
are seeking things that might help a little bit on
the more natural side. Have you seen or have any
experience and adotically with non medications that help in terms
(37:26):
of vitamins or omegas or ginko or some of the
things that time to get popular on you know, forums
and stuff.
Speaker 4 (37:35):
Is there any any data to support those things. Sure,
I think that fish oil is probably good for the brain.
I wouldn't say that it's going to slow down alzheimer.
Speaker 2 (37:47):
Disease, right.
Speaker 1 (37:50):
I think be complex vitamins, especially vitamin B twelve, are important,
And I think the way to think about these things
is as supportive devices and not treating devices. Because if
your levels are adequate with vitamins or say vitamin B twelve.
Speaker 2 (38:09):
No problem.
Speaker 1 (38:10):
But what they what supplementing does is make sure we're
not adding on stress to the brain with a deficiency
that could be covered with a simple vitamin. So I
think those things are useful, but I think you just
have to have a little bit of caution and if
you wanted to say something like these are going to
treat the Alzheimer's disease, they're not going to. But I
(38:32):
think they can be helpful and supporting and making sure
patients aren't having additive burdens on top of an already
devastating disease.
Speaker 3 (38:42):
Well, I mean I could talk to you forever about this,
so unfortunately that we are out of time, but you
have provided us with so much information, so I is
going to do it. For tonight's episode, I've centered on
health with Boptic Health. I'm your host, doctor Jeff Teblin.
I want to thank our guest Patrick W. Matithin, who
has taught us so much about the new treatments for
(39:03):
Alzheimer's disease. We are going to be here every Thursday night,
and I want to thank our producer, mister Jim Benn.
Of course, you the listener, have a great derby week
and a safe weekend, and.
Speaker 5 (39:14):
We will see you next week.
Speaker 3 (39:34):
This program is for informational purposes only and should not
be relied upon as medical advice. The content of this
program is not intended to be a substitute for professional
medical advice, diagnosis, or treatment. The show is not designed
to replace a physician's medical assessment and medical judgment. Always
seek the advice of your physician with any questions or
concerns you may have related to your personal health or
(39:56):
regarding specific medical conditions. To find a Baptist health provider,
please visit baptistealth dot com,
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