CredentialsPositions
Board Certifications
Education and Training
- Gerald J. and Dorothy R. Friedman Professor of New York University Alzheimer's Disease Center, Department of Neurology at NYU Grossman School of Medicine
- Professor, Department of Pathology at NYU Grossman School of Medicine
- Professor, Department of Psychiatry at NYU Grossman School of Medicine
- Director, Alzheimer's Disease Center
- Director, Division of Cognitive Neurology
- Director, Neuropathology Fellowship
- Director, Center for Cognitive Neurology
- Director, Pearl I. Barlow Center for Memory Evaluation and Treatment
- Associate Chair for Research, Department of Neurology
Board Certifications
- American Board of Pathology (Neuropathology), 1990
- American Board of Psychiatry & Neurology - Neurology, 1989
Education and Training
- Fellowship, Columbia Presbyterian Medical Center, Neuropathology, 1990
- Residency, NYU Medical Center, 1988
- MD from University of London, 1983
- Specialties: Neuropathology, Dementia & Alzheimer's
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
The following is a paid podcast.iHeartRadio's hosting of this podcast constitutes neither an
endorsement of the products offered or theideas expressed. The following program is brought
to you by NYU Land Going Health. It's Katz's Corner with doctor Aaron Katz.
You're trusted expert in men's health,providing straight talk on a wide range
(00:21):
of men's health topics and advice onhow to live your healthiest life. Now
on seven ten WOOR. It's theChairman of Urology at NYU Land Going Hospital,
Long Island. Here is doctor AaronKatz. Well, good morning everyone,
and welcome again to Katz's Corner hereon wr iHeartRadio. So glad you
(00:42):
could join us this morning. Wehave a wonderful show for you today.
And many times in my practice anddealing with men, the issue of memory
comes up. And along with memory, there is also concern from the patient
with loved one about the possibility ofdeveloping dementia and Alzheimer's. And you know
(01:07):
this does affect obviously many many peoplehere in the United States, both the
men, women and younger people wereseeing this and I thought that we would
have an interesting discussion about this thismorning, and I've asked doctor Thomas Vishnevsky,
who is the professor of Neurology,Pathology and Psychiatry three departments. He's
a professor at NYU School of Medicine, and he is the director of the
(01:33):
NYU Alzheimer's Disease Research Center and theCenter of Cognitive Neurology and the Barlow Memory
Disorders Centers. He's been the fieldchief editor of Frontiers in Aging Neurosciences,
and he does have a laboratory thathas developed specific targets in the area of
(01:56):
Alzheimer's and of neurodegenitive orders. DoctorVishnewski, thank you so much for joining
us here on Katsus Corner. Ireally appreciate you coming on. Thank you.
I'm delighted to be on your program. Thanks for inviting me. So
let's get right into it. Andperhaps you know the myth of you know,
dementia affecting older people. I certainlyhave seen younger and younger people in
(02:22):
my practice. Is that is thatyour experience as well? Is it something
that is it changing or is itsomething that we're just recognizing earlier because we
have different diagnostic techniques so Alzheimer's diseaseand related dementia's our disorder is mainly affecting
(02:43):
elderly individuals and their emergence is agedependent. But you're absolutely correct that Alzheimer's
disease can affect young individuals, andthis specifically early onset Alzheimer's disease forms that
(03:05):
are much less common. They affectperhaps five percent of the total of Alzheimer's
disease, and those earlier onset formsof Alzheimer's are more likely to be genetic.
I've had very unusual subjects who havehad the onset of dementia and Alzheimer's
(03:30):
disease as early as age twenty eight, so it can affect very young individuals.
And a situation where Alzheimer's disease typicallyaffects a much younger population is in
the setting of Down syndrome. Soindividuals with Down syndrome one hundred percent of
(03:54):
them will develop Alzheimer's disease pathology,and that can stop at a very early
age when they're just teenagers. Andthat because of their trisomy twenty one having
three copies of chromosome twenty one,and that particular chromosome has a gene the
(04:18):
amyloid precursor protein that can drive Alzheimer'sdisease pathology and Down syndrome individuals because they
have that extra copy of that gene, they all get Alzheimer's disease. I
did not know that. I betmost of the listeners didn't know. I
never knew that. I mean,certainly have seen in my life many people
(04:43):
with Down syndrome, but never realizethat is there anything that can be done,
knowing that they're going one hundred percentto do it to either slow it
down or prevent it, Is thereanything that the treatments that are available for
Alzheimer's disease that can be applied toDown syndrome individuals, And in fact,
(05:03):
Down syndrome is the most common geneticform of Alzheimer's disease, also being the
most common chromosomal abnormality in the UnitedStates. So there's a move now to
initiate and develop clinical trials for Alzheimer'sdisease in the Down syndrome population, because
(05:29):
that's quite a substantial population where youknow Alzheimer's disease for sure will occur and
it's very age dependent. The degreeof Alzheimer's disease decade by decades in Down's
syndrome individuals, And that's an areathat I study, looking at biomarkers and
(05:53):
the neuropathological legions in Down syndrome folks. Just thinking about the on the patient
and on the patient's family, itbecomes a very difficult situation because imagine syndrome
individuals are often taken care of bytheir parents, sure, and as they
(06:15):
become developed a dementia, which isoften in their early fifties, then their
parents are perhaps no longer in aposition to be able to take care of
them, and other family members andcaregivers have to step in, and that
can be quite a tricky situation andvery burdensome to imaginaly members and difficult for
(06:46):
the affected individual. Well, Ididn't expect our early conversation in the show
to go this direction, but certainlysomething that is fascinating I didn't know about.
Maybe we can twitch gears a littlebit towards the gen population that people
that are somewhat I guess concerned abouttheir memory. When would it be time
(07:08):
to escalate it? You know,I mean if you start, you know,
at what point in your memory lossphase would you say is should there
be a concern. I mean,all of us say, oh, you
know, I was, well,I can't remember what I had for breakfast
this morning? What did I havefor breakfast? Or what did I do
last night? Or what was thelast book I read? Or what was
(07:30):
the last movie I saw? OrI can't remember that actor that was in
that movie I saw. I knowthat actor, it's just a tip of
my tongue, but I can't.And then you say, well, you
know, I didn't remember that.I didn't remember a couple of other things.
So when when is it concerning orthose things just like normal aging memory
and it's okay, or or therecertain signs that you should Yeah, the
things that you have just described.Really our part and parcel of normal aging
(07:58):
memory dysfunction, so called the ninthescent forgetfulness, and our raw memory power
does decline a bit as we getolder in our fifties and sixties. It
peaks in our twenties or so,and then very steadily declines, and that
(08:18):
decline is a little bit more markedin later decades. But really it's when
there's the beginnings of the memory lossinterfering with some day to day activity and
when your family members or close friendsstart noticing a change in your memory and
(08:43):
your memory becomes worse than that ofyour age match tiers, then at that
point it's perhaps worth getting a medicalevaluation. Yeah, it's often difficult to
know that you know age match piersand you don't know. Sometimes you get
a little nervous, you know,I mean, certainly the things that I
(09:05):
was mentioning are seen benign. ButI guess if you are with a friend
then you can't remember their name,or a family member you can't recognize,
or but for certain things, likeyou know, you go into a room.
Let's say, I mean I've hadthis myself. I'll go out there
right and say it. I've walkedinto a room and I'm like, okay,
know why did I come in here? I know I came in.
I know I'm here for a reason, but I just forgot it. And
(09:26):
then it might take you a fewseconds to remember, and you use those
you know, you go deep intoyour mind and you figure it out.
Right, as long as that normalback after a few seconds or a few
minutes, even that's perfectly fine.It becomes more problematic when that memory do
(09:48):
just does not come back, andfor example, you completely forget where you
park your call, or you keepon losing your car keys and or misplace
your wallet and can't find it.So it's it's normal just to have those
(10:13):
slips of memories, and it's thedifficulty in retrieving the information and there's a
little bit of a delay. Butif it does eventually come back with that
delay, it's really not of concern. It's more problematic when they're a growing
(10:33):
number of episodes where that memory justfails to come back. Yeah, you
say about the parking the car,you know, when I was just thinking,
when I go to the gym,I always park in the same section
so I won't have that problem.And I take a picture of the locker
so that after an hour and ahalf, if I'm working out, i'll
(10:54):
know which locker because I have iton my phone, you know, and
I probably could remember it. Timestry not to look at the phone to
try to just use my memories.Okay, I know which which number it
is, but I see oftentimes inthe locker room, even young guys that
are there, they're asking the attendantfor the keys because they can't figure out
which locker they're in. So Iguess that that gives me a sense of
(11:18):
Okay, maybe I'm still okay,right, but you're doing five you know.
Yeah, but those little things can'thelp with with memory. Uh So,
if you needed to see someone,what would what would the testing be
like? Would it would it belike an image like a cat scan,
MRI or some other testing that we'redoing today. What's what's what, what's
(11:41):
the standard and what's kind of newout there? Well, so what one
would have done is just a regularmedical examination, a neurological examination, and
then some sort of cognitive test.The Mini Mental eight exam is something that
(12:03):
is very commonly done a thirty pointscale to get an assessment of one's memory
and cognitive function. And then typicallythis blood work that gets done to make
sure hormone levels, vitamin levels,electrolytes, all of those things are okay.
(12:28):
And then getting brain imaging is oftenpart of the workup, and that
can be a regular MRI at thebrain, but of what also gets done
is a volumetric MRI where the differentparts of the brain are compared to age
(12:54):
controls and one can get an ideaof the specific volume of different parts of
the brain. And in Alzheimer's diseaseand related dementias, this shrinkage of particular
parts of the brain that starts tooccur at the beginning of the disease process
(13:16):
and progresses further. And then alsoa clinician might order a PET study,
a positron emission tomography brain scan thatlooks at the function of the brain with
a fluoridoxy glucose PET, and morerecently, one can also order PETS that
(13:43):
look directly at the pathology that occursin Alzheimer's disease, the amyloid plaques,
So one can image amyloid plaques inthe living patient, something that in the
past required having a piece of braintissue, but now with modern imaging techniques,
(14:09):
we can obtain the quantitation of amyloidplaques using a PET study. Well
that's good. You don't have togo through a brain biop so you're saying,
if you just wake it up inthe morning. We're talking with doctor
Thomas Vishnevsky, who is Professor ofNeurology, Pathology and Psychiatry at NYU School
of Medicine and the director of theNYU Alzheimer's Disease Research Center, and also
(14:35):
intimately involved with the Barlow Memory DisorderCenter and the New York Center for Excellence
of Alzheimer's Disease. You were mentioningsome cognitive tests. Are there any tests
that people can just like download onlineand just check out their memory? Is
there anything easy for people to do? Or that there's a MOCHA which is
(14:58):
the Montreal called Native Assessment that that'svery similar to the Mini Mental State Exam.
Yes, that's the folks can do. And there was a recent debate
about giving the mini mental or themocaut President Biden and other politician. Uh,
(15:28):
is he going to give it tothe Democrats? You got to give
it to the Republicans? Right,it's got to be fair, right exactly
exactly, so equal opportunity And didthey do that? Did he do that?
Or no? They decided not?Right then when an absence of evidence
(15:48):
is not evidence or absence, well, okay, fine, so he's not
going to do that. Uh,you know it must be scary though,
I would think. You know,you mentioned about that brain volume test where
you know it's like that would bean MRI. I correct, the volumetric
brain MRI. And so the doctorcomes back and tells you, well,
you know your parts of your brainare smaller than others or that you know,
(16:11):
what can you do about that?I mean, you know, well,
it raises if there is shrinkage ofparticular parts of the brain, such
as the hippie campus that's involved inshort term memory and is in a part
of the brain that's alsten affected earlyin Alzheimer's disease and also other related neurody
(16:33):
generative disorders, then that that wouldbe something that's potentially worrisome and might trigger
getting additional testing. And here atNYU we have relatively uncommon expertise and the
facilities of obtaining an MRI in aPET at the same time, So those
(16:59):
two imaging modalities are obtained at thesame sitting, and that co registration of
the MRI image to the path givessuperior diagnostic information and can allow a greater
certainty of the diagnosis. And that'ssomething that that that type of imaging is
(17:25):
available really in more academic settings inlarger university hospitals and is more specialized but
offers a greater diagnostic information. Well, that's that's important. I mean,
I'm not surprised the Neurology and NeurosurgeryDepartment or n y U is like number
(17:48):
one in the country. It's alwaysthe neuro radiology here is really outstanding and
unequaled anywhere else. Yeah, soyou can do two tests at once.
It would give you anatomical and probablyfunctional information at the same time. Correct
(18:12):
and how important is that? Wow, you were mentioning these plaques, these
amyloid deposits and plaques. I certainlyhave heard that for many years being associated
with Alzheimer's and you can see thaton imaging. But then there was some
controversy if I'm not mistaken, aboutsome drugs that came out that were supposed
(18:33):
to attack the amyloid that either didn'twork or wasn't or people were thinking maybe
it wasn't related to amyloid. Cancan you give give us some update information
on that? Sure? So thepathology of Alzheimer's disease affects four main lesions.
(18:55):
One is the amyloid plaques, whichis the deposition of a protein called
amyloid beta in the brain perencuma outsideof cells, and those amyloid plaques are
toxic to neurons, so it killsthe thinking cells in the brain. That
same protein, the amyloid beta,can deposit in the blood vessels of the
(19:21):
brain, producing a condition called congophilicamyloid angiopathy, and that damage to blood
vessels can impair the blood float tothe brain the oxygenation and can produce toxicity
on its own, and it alsodamages the viability of the brain blood vessels
(19:45):
and predisposes them to rupture and bleedingand stroke. The other major pathology is
the deposition of a protein called cowspecific an abnormally phosphorylated form of TAO that
forms neurofibrillary tangles and those accumulate inneurons of the brain. And again those
(20:12):
neurofibrillary tangles are very toxic and theylead to neuronal death. And really the
fourth important lesion is neuronal loss inassociation with inflammation. So the amyloid tet
(20:32):
really looks at the quantitation of thoseamyloid plaques, and the amyloid plaques are
thought to start developing quite early inthe disease, in the preclinical period,
even before the early symptoms like mildcognitive impairment, and then eventually when the
(20:57):
amyloid plaques are numerous enough, theywill also drive the TAU pathology. The
neurofibrillary tangles, and all of thisultimately leads to greater and greater corona loss
and the development of the dementia.So there has been testing in clinical trials
(21:22):
for a number of years now atwith different agents that try to reduce amyloid
plaques, and until very recently,the results of those clinical trials have been
largely negative, that they've not shownclinical benefit, and those not encouraging results
(21:51):
have led to some questioning of thisamyloid cascade hypothesis. But those failures were
linked to a combination of the agentsbeing tested not being effective enough and not
(22:12):
reducing the amyloid significantly. Also inthe selection of patients, that some of
the patients who entered these earlier clinicaltrials in fact didn't have Alzheimer's disease,
(22:33):
that they were not amyloid plaque positive. Or thirdly, the therapeutic approach was
tried too late in the disease andthose individuals already had a lot of neurofibillary
tangles. Removing the ameloid just isn'tgoing to do any good. Is there
(22:56):
a new Is there a new drugout now? Absolutely, and this great
excitement in the field that in Julyof last year, the SDA approved the
first disease modifying therapy for Alzheimer's diseasewith a drug called la can Be or
(23:17):
lay canamat. And that's a drugthat's given by intravenous infusion every two weeks
for an eighteen month period. Andwho gets that? Is that the earlier
ones or that's people that are lateron? Absolutely, yeah, you're quite
right. It's folks with mild cognitiveimpairment due to Alzheimer's disease and early dementia
(23:45):
due to Alzheimer's disease. So thefolks that can potentially benefit substantially from this
therapy are at the beginning stages ofAlzheimer's disease when they have plenty of amyloid
plaques, which again can be viewedwith the amyloid pet study, and they
(24:08):
don't have so much of the TAELrelated pathology. So one hopes that removal
of the amyloid plaques with this treatmentwill lead to uh substantial cognitive benefits for
these And have you used it inpatients and what is your experience then?
(24:30):
So we've been extensively prescribing what canbe to patients with these criteria, So
early Alzheimer's disease associated with just mildcognitive impairment of early dementia. And it
(24:51):
certainly is quite a safe treatment andit is linked to clear cognitive of benefits.
And that's what was shown in thePhase three clinical trial of the KEMBI
that ultimately led to the FDA approvalof this new pratt. Yeah, we
(25:14):
only have a minute left. Isthis covered by insurance this medication? So
yes, Medicare does cover eighty percentof the costs of this treatment. Other
private insurance may or may not coverit. Okay, And in the last
twenty seconds, I just have toask you anything, anything at all if
(25:37):
you are at risk to take interms of diet, things that you would
take, things that you wouldn't take. In twenty seconds, I'm sorry,
but is there anything any evidence soa Mediterranean diet is coadly brain protective and
things that are good for the heartare good for the brain and good for
the prostate. So there you go. It's great. I'm sorry to end
(26:02):
the show. At the end ofthe show, doctor Vishnevski, you are
terrific. We'll definitely have you onagain because there's so much more that we
could talk about in this field ofmemory and aging and dementia. It's all
tidy, and I want to thankyou so much, doctor Thomas Vishnevski,
who is the director of the NYUAlzheimer's Disease Research Center. You've been a
(26:23):
terrific guest with loads of information thatis so important for everyone, and we'll
certainly have you back again. Thankyou very much, sir for coming on
Greasure, thank you for inviting me. It's been a great pleasure, and
I'm little toward and speaking to youagain. We'll have you on again for
sure. That's the end of theshow. Everyone. I wish you all
have a wonderful Sunday. Tune inevery Sunday here in Katser's Corner. We'll
be back next week. But thegreat show this is doctor Aaron Katz.
(26:47):
You've been listening to Katzer's Corner.Come back every week to hear more straight
talk on a wide range of men'shealth topics and advice on on how to
live your healthiest life. The proceedingwas a paid podcast. iHeartRadio's hosting of
this podcast constitutes neither an endorsement ofthe products offered or the ideas expressed,
The following is a paid podcast.iHeartRadio's hosting of this podcast constitutes neither an
endorsement of the products offered or theideas expressed. The following program is brought
to you by NYU Land Going Health. It's Katz's Corner with doctor Aaron Katz.
You're trusted expert in men's health,providing straight talk on a wide range
(00:21):
of men's health topics and advice onhow to live your healthiest life. Now
on seven ten WOOR. It's theChairman of Urology at NYU Land Going Hospital,
Long Island. Here is doctor AaronKatz. Well, good morning everyone,
and welcome again to Katz's Corner hereon wr iHeartRadio. So glad you
(00:42):
could join us this morning. Wehave a wonderful show for you today.
And many times in my practice anddealing with men, the issue of memory
comes up. And along with memory, there is also concern from the patient
with loved one about the possibility ofdeveloping dementia and Alzheimer's. And you know
(01:07):
this does affect obviously many many peoplehere in the United States, both the
men, women and younger people wereseeing this and I thought that we would
have an interesting discussion about this thismorning, and I've asked doctor Thomas Vishnevsky,
who is the professor of Neurology,Pathology and Psychiatry three departments. He's
a professor at NYU School of Medicine, and he is the director of the
(01:33):
NYU Alzheimer's Disease Research Center and theCenter of Cognitive Neurology and the Barlow Memory
Disorders Centers. He's been the fieldchief editor of Frontiers in Aging Neurosciences,
and he does have a laboratory thathas developed specific targets in the area of
(01:56):
Alzheimer's and of neurodegenitive orders. DoctorVishnewski, thank you so much for joining
us here on Katsus Corner. Ireally appreciate you coming on. Thank you.
I'm delighted to be on your program. Thanks for inviting me. So
let's get right into it. Andperhaps you know the myth of you know,
dementia affecting older people. I certainlyhave seen younger and younger people in
(02:22):
my practice. Is that is thatyour experience as well? Is it something
that is it changing or is itsomething that we're just recognizing earlier because we
have different diagnostic techniques so Alzheimer's diseaseand related dementia's our disorder is mainly affecting
(02:43):
elderly individuals and their emergence is agedependent. But you're absolutely correct that Alzheimer's
disease can affect young individuals, andthis specifically early onset Alzheimer's disease forms that
(03:05):
are much less common. They affectperhaps five percent of the total of Alzheimer's
disease, and those earlier onset formsof Alzheimer's are more likely to be genetic.
I've had very unusual subjects who havehad the onset of dementia and Alzheimer's
(03:30):
disease as early as age twenty eight, so it can affect very young individuals.
And a situation where Alzheimer's disease typicallyaffects a much younger population is in
the setting of Down syndrome. Soindividuals with Down syndrome one hundred percent of
(03:54):
them will develop Alzheimer's disease pathology,and that can stop at a very early
age when they're just teenagers. Andthat because of their trisomy twenty one having
three copies of chromosome twenty one,and that particular chromosome has a gene the
(04:18):
amyloid precursor protein that can drive Alzheimer'sdisease pathology and Down syndrome individuals because they
have that extra copy of that gene, they all get Alzheimer's disease. I
did not know that. I betmost of the listeners didn't know. I
never knew that. I mean,certainly have seen in my life many people
(04:43):
with Down syndrome, but never realizethat is there anything that can be done,
knowing that they're going one hundred percentto do it to either slow it
down or prevent it, Is thereanything that the treatments that are available for
Alzheimer's disease that can be applied toDown syndrome individuals, And in fact,
(05:03):
Down syndrome is the most common geneticform of Alzheimer's disease, also being the
most common chromosomal abnormality in the UnitedStates. So there's a move now to
initiate and develop clinical trials for Alzheimer'sdisease in the Down syndrome population, because
(05:29):
that's quite a substantial population where youknow Alzheimer's disease for sure will occur and
it's very age dependent. The degreeof Alzheimer's disease decade by decades in Down's
syndrome individuals, And that's an areathat I study, looking at biomarkers and
(05:53):
the neuropathological legions in Down syndrome folks. Just thinking about the on the patient
and on the patient's family, itbecomes a very difficult situation because imagine syndrome
individuals are often taken care of bytheir parents, sure, and as they
(06:15):
become developed a dementia, which isoften in their early fifties, then their
parents are perhaps no longer in aposition to be able to take care of
them, and other family members andcaregivers have to step in, and that
can be quite a tricky situation andvery burdensome to imaginaly members and difficult for
(06:46):
the affected individual. Well, Ididn't expect our early conversation in the show
to go this direction, but certainlysomething that is fascinating I didn't know about.
Maybe we can twitch gears a littlebit towards the gen population that people
that are somewhat I guess concerned abouttheir memory. When would it be time
(07:08):
to escalate it? You know,I mean if you start, you know,
at what point in your memory lossphase would you say is should there
be a concern. I mean,all of us say, oh, you
know, I was, well,I can't remember what I had for breakfast
this morning? What did I havefor breakfast? Or what did I do
last night? Or what was thelast book I read? Or what was
(07:30):
the last movie I saw? OrI can't remember that actor that was in
that movie I saw. I knowthat actor, it's just a tip of
my tongue, but I can't.And then you say, well, you
know, I didn't remember that.I didn't remember a couple of other things.
So when when is it concerning orthose things just like normal aging memory
and it's okay, or or therecertain signs that you should Yeah, the
things that you have just described.Really our part and parcel of normal aging
(07:58):
memory dysfunction, so called the ninthescent forgetfulness, and our raw memory power
does decline a bit as we getolder in our fifties and sixties. It
peaks in our twenties or so,and then very steadily declines, and that
(08:18):
decline is a little bit more markedin later decades. But really it's when
there's the beginnings of the memory lossinterfering with some day to day activity and
when your family members or close friendsstart noticing a change in your memory and
(08:43):
your memory becomes worse than that ofyour age match tiers, then at that
point it's perhaps worth getting a medicalevaluation. Yeah, it's often difficult to
know that you know age match piersand you don't know. Sometimes you get
a little nervous, you know,I mean, certainly the things that I
(09:05):
was mentioning are seen benign. ButI guess if you are with a friend
then you can't remember their name,or a family member you can't recognize,
or but for certain things, likeyou know, you go into a room.
Let's say, I mean I've hadthis myself. I'll go out there
right and say it. I've walkedinto a room and I'm like, okay,
know why did I come in here? I know I came in.
I know I'm here for a reason, but I just forgot it. And
(09:26):
then it might take you a fewseconds to remember, and you use those
you know, you go deep intoyour mind and you figure it out.
Right, as long as that normalback after a few seconds or a few
minutes, even that's perfectly fine.It becomes more problematic when that memory do
(09:48):
just does not come back, andfor example, you completely forget where you
park your call, or you keepon losing your car keys and or misplace
your wallet and can't find it.So it's it's normal just to have those
(10:13):
slips of memories, and it's thedifficulty in retrieving the information and there's a
little bit of a delay. Butif it does eventually come back with that
delay, it's really not of concern. It's more problematic when they're a growing
(10:33):
number of episodes where that memory justfails to come back. Yeah, you
say about the parking the car,you know, when I was just thinking,
when I go to the gym,I always park in the same section
so I won't have that problem.And I take a picture of the locker
so that after an hour and ahalf, if I'm working out, i'll
(10:54):
know which locker because I have iton my phone, you know, and
I probably could remember it. Timestry not to look at the phone to
try to just use my memories.Okay, I know which which number it
is, but I see oftentimes inthe locker room, even young guys that
are there, they're asking the attendantfor the keys because they can't figure out
which locker they're in. So Iguess that that gives me a sense of
(11:18):
Okay, maybe I'm still okay,right, but you're doing five you know.
Yeah, but those little things can'thelp with with memory. Uh So,
if you needed to see someone,what would what would the testing be
like? Would it would it belike an image like a cat scan,
MRI or some other testing that we'redoing today. What's what's what, what's
(11:41):
the standard and what's kind of newout there? Well, so what one
would have done is just a regularmedical examination, a neurological examination, and
then some sort of cognitive test.The Mini Mental eight exam is something that
(12:03):
is very commonly done a thirty pointscale to get an assessment of one's memory
and cognitive function. And then typicallythis blood work that gets done to make
sure hormone levels, vitamin levels,electrolytes, all of those things are okay.
(12:28):
And then getting brain imaging is oftenpart of the workup, and that
can be a regular MRI at thebrain, but of what also gets done
is a volumetric MRI where the differentparts of the brain are compared to age
(12:54):
controls and one can get an ideaof the specific volume of different parts of
the brain. And in Alzheimer's diseaseand related dementias, this shrinkage of particular
parts of the brain that starts tooccur at the beginning of the disease process
(13:16):
and progresses further. And then alsoa clinician might order a PET study,
a positron emission tomography brain scan thatlooks at the function of the brain with
a fluoridoxy glucose PET, and morerecently, one can also order PETS that
(13:43):
look directly at the pathology that occursin Alzheimer's disease, the amyloid plaques,
So one can image amyloid plaques inthe living patient, something that in the
past required having a piece of braintissue, but now with modern imaging techniques,
(14:09):
we can obtain the quantitation of amyloidplaques using a PET study. Well
that's good. You don't have togo through a brain biop so you're saying,
if you just wake it up inthe morning. We're talking with doctor
Thomas Vishnevsky, who is Professor ofNeurology, Pathology and Psychiatry at NYU School
of Medicine and the director of theNYU Alzheimer's Disease Research Center, and also
(14:35):
intimately involved with the Barlow Memory DisorderCenter and the New York Center for Excellence
of Alzheimer's Disease. You were mentioningsome cognitive tests. Are there any tests
that people can just like download onlineand just check out their memory? Is
there anything easy for people to do? Or that there's a MOCHA which is
(14:58):
the Montreal called Native Assessment that that'svery similar to the Mini Mental State Exam.
Yes, that's the folks can do. And there was a recent debate
about giving the mini mental or themocaut President Biden and other politician. Uh,
(15:28):
is he going to give it tothe Democrats? You got to give
it to the Republicans? Right,it's got to be fair, right exactly
exactly, so equal opportunity And didthey do that? Did he do that?
Or no? They decided not?Right then when an absence of evidence
(15:48):
is not evidence or absence, well, okay, fine, so he's not
going to do that. Uh,you know it must be scary though,
I would think. You know,you mentioned about that brain volume test where
you know it's like that would bean MRI. I correct, the volumetric
brain MRI. And so the doctorcomes back and tells you, well,
you know your parts of your brainare smaller than others or that you know,
(16:11):
what can you do about that?I mean, you know, well,
it raises if there is shrinkage ofparticular parts of the brain, such
as the hippie campus that's involved inshort term memory and is in a part
of the brain that's alsten affected earlyin Alzheimer's disease and also other related neurody
(16:33):
generative disorders, then that that wouldbe something that's potentially worrisome and might trigger
getting additional testing. And here atNYU we have relatively uncommon expertise and the
facilities of obtaining an MRI in aPET at the same time, So those
(16:59):
two imaging modalities are obtained at thesame sitting, and that co registration of
the MRI image to the path givessuperior diagnostic information and can allow a greater
certainty of the diagnosis. And that'ssomething that that that type of imaging is
(17:25):
available really in more academic settings inlarger university hospitals and is more specialized but
offers a greater diagnostic information. Well, that's that's important. I mean,
I'm not surprised the Neurology and NeurosurgeryDepartment or n y U is like number
(17:48):
one in the country. It's alwaysthe neuro radiology here is really outstanding and
unequaled anywhere else. Yeah, soyou can do two tests at once.
It would give you anatomical and probablyfunctional information at the same time. Correct
(18:12):
and how important is that? Wow, you were mentioning these plaques, these
amyloid deposits and plaques. I certainlyhave heard that for many years being associated
with Alzheimer's and you can see thaton imaging. But then there was some
controversy if I'm not mistaken, aboutsome drugs that came out that were supposed
(18:33):
to attack the amyloid that either didn'twork or wasn't or people were thinking maybe
it wasn't related to amyloid. Cancan you give give us some update information
on that? Sure? So thepathology of Alzheimer's disease affects four main lesions.
(18:55):
One is the amyloid plaques, whichis the deposition of a protein called
amyloid beta in the brain perencuma outsideof cells, and those amyloid plaques are
toxic to neurons, so it killsthe thinking cells in the brain. That
same protein, the amyloid beta,can deposit in the blood vessels of the
(19:21):
brain, producing a condition called congophilicamyloid angiopathy, and that damage to blood
vessels can impair the blood float tothe brain the oxygenation and can produce toxicity
on its own, and it alsodamages the viability of the brain blood vessels
(19:45):
and predisposes them to rupture and bleedingand stroke. The other major pathology is
the deposition of a protein called cowspecific an abnormally phosphorylated form of TAO that
forms neurofibrillary tangles and those accumulate inneurons of the brain. And again those
(20:12):
neurofibrillary tangles are very toxic and theylead to neuronal death. And really the
fourth important lesion is neuronal loss inassociation with inflammation. So the amyloid tet
(20:32):
really looks at the quantitation of thoseamyloid plaques, and the amyloid plaques are
thought to start developing quite early inthe disease, in the preclinical period,
even before the early symptoms like mildcognitive impairment, and then eventually when the
(20:57):
amyloid plaques are numerous enough, theywill also drive the TAU pathology. The
neurofibrillary tangles, and all of thisultimately leads to greater and greater corona loss
and the development of the dementia.So there has been testing in clinical trials
(21:22):
for a number of years now atwith different agents that try to reduce amyloid
plaques, and until very recently,the results of those clinical trials have been
largely negative, that they've not shownclinical benefit, and those not encouraging results
(21:51):
have led to some questioning of thisamyloid cascade hypothesis. But those failures were
linked to a combination of the agentsbeing tested not being effective enough and not
(22:12):
reducing the amyloid significantly. Also inthe selection of patients, that some of
the patients who entered these earlier clinicaltrials in fact didn't have Alzheimer's disease,
(22:33):
that they were not amyloid plaque positive. Or thirdly, the therapeutic approach was
tried too late in the disease andthose individuals already had a lot of neurofibillary
tangles. Removing the ameloid just isn'tgoing to do any good. Is there
(22:56):
a new Is there a new drugout now? Absolutely, and this great
excitement in the field that in Julyof last year, the SDA approved the
first disease modifying therapy for Alzheimer's diseasewith a drug called la can Be or
(23:17):
lay canamat. And that's a drugthat's given by intravenous infusion every two weeks
for an eighteen month period. Andwho gets that? Is that the earlier
ones or that's people that are lateron? Absolutely, yeah, you're quite
right. It's folks with mild cognitiveimpairment due to Alzheimer's disease and early dementia
(23:45):
due to Alzheimer's disease. So thefolks that can potentially benefit substantially from this
therapy are at the beginning stages ofAlzheimer's disease when they have plenty of amyloid
plaques, which again can be viewedwith the amyloid pet study, and they
(24:08):
don't have so much of the TAELrelated pathology. So one hopes that removal
of the amyloid plaques with this treatmentwill lead to uh substantial cognitive benefits for
these And have you used it inpatients and what is your experience then?
(24:30):
So we've been extensively prescribing what canbe to patients with these criteria, So
early Alzheimer's disease associated with just mildcognitive impairment of early dementia. And it
(24:51):
certainly is quite a safe treatment andit is linked to clear cognitive of benefits.
And that's what was shown in thePhase three clinical trial of the KEMBI
that ultimately led to the FDA approvalof this new pratt. Yeah, we
(25:14):
only have a minute left. Isthis covered by insurance this medication? So
yes, Medicare does cover eighty percentof the costs of this treatment. Other
private insurance may or may not coverit. Okay, And in the last
twenty seconds, I just have toask you anything, anything at all if
(25:37):
you are at risk to take interms of diet, things that you would
take, things that you wouldn't take. In twenty seconds, I'm sorry,
but is there anything any evidence soa Mediterranean diet is coadly brain protective and
things that are good for the heartare good for the brain and good for
the prostate. So there you go. It's great. I'm sorry to end
(26:02):
the show. At the end ofthe show, doctor Vishnevski, you are
terrific. We'll definitely have you onagain because there's so much more that we
could talk about in this field ofmemory and aging and dementia. It's all
tidy, and I want to thankyou so much, doctor Thomas Vishnevski,
who is the director of the NYUAlzheimer's Disease Research Center. You've been a
(26:23):
terrific guest with loads of information thatis so important for everyone, and we'll
certainly have you back again. Thankyou very much, sir for coming on
Greasure, thank you for inviting me. It's been a great pleasure, and
I'm little toward and speaking to youagain. We'll have you on again for
sure. That's the end of theshow. Everyone. I wish you all
have a wonderful Sunday. Tune inevery Sunday here in Katser's Corner. We'll
be back next week. But thegreat show this is doctor Aaron Katz.
(26:47):
You've been listening to Katzer's Corner.Come back every week to hear more straight
talk on a wide range of men'shealth topics and advice on on how to
live your healthiest life. The proceedingwas a paid podcast. iHeartRadio's hosting of
this podcast constitutes neither an endorsement ofthe products offered or the ideas expressed,
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