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Melanie: Welcome to Back To Health, your source for the latest in health, wellness, and medical care. Keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back To Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine.

I'm Melanie Cole, and I invite you to listen as we discuss Alzheimer's disease awareness. Joining me is Dr. Kellyann Niotis. She's an instructor of Clinical Neurology at Weill Cornell Medical College and an assistant attending neurologist at New York Presbyterian Weill Cornell Medical Center.

Dr. Niotis, it's a pleasure to have you join us today. And, you know, wow, what a great topic this is. So many people have so many questions. So as we get into this, tell us a little bit about Alzheimer's disease. How is it different from dementia? How do we differentiate? Is there an umbrella term? Tell us a little how this all works so we can understand the terminology and then understand the disease itself.

Dr. Kellyann Niotis: Well, thank you so much for inviting me to talk. It's really a pleasure and a privilege to be on this podcast. So you appropriately used the word umbrella, and that is what dementia is. It's really an umbrella term for several different diseases that affect memory and thinking. And Alzheimer's disease is one specific type of dementia, but there are many other types like Lewy body dementia and vascular dementia. Parkinson's disease even has a dementia and some infectious diseases like mad cow disease can cause dementia.

Melanie: So a spectrum now we can really call it of these dementia conditions. Now, one of the things about Alzheimer's and people are pretty scared of this, and it seems a life-limiting disease, do we even know what the cause is? Is it hereditary? Do women get it more than men? Tell us a little bit about what we know and who is at risk.

Dr. Kellyann Niotis: Right. Okay. Well, this is an area that I am heavily versed on. So at the Alzheimer's Prevention Clinic at Weill Cornell, we really do a lot to understand what causes Alzheimer's disease and what someone's risk is. And the truth is that we don't fully understand the exact cause of Alzheimer's disease. But there are many factors that are involved.

Genetics definitely play a huge role and family history plays a huge role, but lifestyle and environmental factors also contribute. Actually, 40% of Alzheimer's disease is preventable just based on simple lifestyle modifications. And also, as you mentioned, biological sex, like gender plays a huge role. Females are more likely to get Alzheimer's disease due to unknown hormonal issues, is the hypothesized explanation, but it's really unknown and an area that we're actively investigating.

Melanie: It's such a mysterious disease. To me, anything regarding the brain and how it functions is so mysterious, but fascinating. So tell us a little bit about symptoms and the age that those things start to present themselves because I'm 57, Dr. Niotis, and we all lose our keys or we all walk into a room and go, "Wait, why did I come in here?" But I think that's the biggest fear among my age group and older, is when do those symptoms mean something worse?

Dr. Kellyann Niotis: Definitely. That's really common for people to have minor lapses in memory and start feeling like, "Oh no, I'm on this path that I don't know if I could reverse." Usually, the classical symptoms of Alzheimer's disease, which are the memory loss symptoms, don't start until people are 65 or older. But in rare cases, it can start in younger people, younger than 65, usually in the 50s.

But when this happens, there's usually a strong family history and many, many family members had Alzheimer's disease and at a younger age. It's difficult for most people, even for doctors to know what the difference is between those subtle memory lapses and Alzheimer's disease. And we often have that challenge of people coming to us and saying, "Hey, I walk into a room all the time and I forgot what I was in there for. Do I have Alzheimer's disease?" And it can be really, really challenging to tease out, but a good history and a good neurological exam can usually help sort that out.

Melanie: So then let's talk about treatments. Is there anything that can reverse or stop the process. You mentioned there is really no cure. So can you tell us about some of the exciting advancements that are made to either slow down the progression or really anything? Are there any game changers you can tell us about?

Dr. Kellyann Niotis: Well, to try to avoid the controversy, the inevitable controversy of aducanumab, which is as many people have read the news and media, a lot has gone into covering aducanumab because it is the first new Alzheimer's disease medication that has ever hit the market in decades at least. And it's the first medication that has been implicated in impacting the disease course.

Again, this is an area of controversy and there will need to be more studies over a longer period of time to see if changing the abnormal proteins that build up in Alzheimer's disease actually changes people's memory and cognitive function and changes how long it takes for the disease to fully take hold of someone.

But that sounds dooming to put it that way, but there are a lot of new clinical trials ongoing, a lot of promising new medications using old medications for new purposes, ultrasounds and deep brain stimulation. There is a lot of active research in this area. It's very challenging because the disease can be very different depending on the person.

Melanie: So interesting. And, you know, I have hope. I think that you all brilliant geniuses are going to come up with things. Now, as far as someone who has been diagnosed and they're going through these stages, it can be very difficult on the caregivers. And you mentioned the Alzheimer's Prevention Clinic at Weill Cornell Medicine. Can you tell us a little bit about that clinic and how you help the caregivers with their stress or behavioral strategies that you encourage people to try at home, to optimize functioning? Tell us about the clinic, Dr. Niotis.

Dr. Kellyann Niotis: So most patients that come see us in clinic don't have symptoms themselves or cognitive impairment or cognitive loss, but they have been touched because one of their family or many of their family members suffered from this disease and it really impacts a person and people start wondering, "Is this going to happen to me? And if so, what can I do? And how do I cope during this time?" So we have a lot of experience on this.

And there's two different pathways, I would say. One is, let us help you understand what the disease looks like and what to expect and manage at home because you have to stay healthy for yourself so that you can take care of your loved ones. And two is, let us look at you on an individual level, really assess your risk and what's driving your risk and address the factors that we can to change that risk.

So at the clinic, we really want to encourage people to take power of their own health. And to know that there are things in their control that they can do that can change their risk. So for example, we take a very detailed clinical history and we look at genetic markers and blood biomarkers and see if they need to see a preventative cardiologist, for example, or if they need to see a nutritionist and get better glucose management or if they need a therapist or an exercise physiologist to really get them on the path that they need to be to exercise to ward off disease.

That's important because when they're responsible for taking care of their family members, they need to be armed with the best state of health they can for them. And it can be very distressing for people to see their loved one go through this, and it can be challenging on the family as a whole. A lot of the people that we see really try to maintain a calm environment at home, and they try to understand what their family member's going through and not add to their stress level. And that can mean different things for different people. It can mean playing quiet music, removing really distracting wallpaper or pictures that visually throw people off, making sure they stay on a proper eating and sleeping schedule. There are little lifestyle things that we can do for family members that can really impact how they live day to day and how they function and how that also affects the patients that we are trying to help prevent the disease in themselves.

Melanie: You mentioned that you like to help the caregivers, the families with exercise, and they have to be really good advocates, as you say. What about for the patient? Can diet or exercise affect any of this risk we're talking about? Before we wrap up today, because we've heard about fish oil, antioxidants, resveratrol, caffeine, ginkgo biloba, you know, vitamins like B12 and B6, folic acid. Is there anything in any of those that we should be thinking about discussing with our providers? Is there any truth that some of those can help to maybe stave off some mental decline?

Dr. Kellyann Niotis: I think that there is truth in that. And the studies show that there is some truth that lifestyle modification can actually slow progression in multiple diseases, not just Alzheimer's disease, but Parkinson's disease too. If you think about exercise for one example, getting 30 minutes three times a week actually improves cognition in people with Alzheimer's disease and Parkinson's disease too. And it improves motor function. People are able to walk around better.

Whether or not this is truly impacting the ultimate outcome of the disease in someone that has the disease, it's unknown, but it does improve functioning. And that's really matters most on a day to day basis.

Melanie: It certainly does. And even, you know, we hear about things like math problems and balancing a checkbook without a calculator and these kinds of things because the brain's a muscle, right, Dr. Niotis? I would like you to please wrap this up with your best advice. We're talking about Alzheimer's awareness and even the Alzheimer's Prevention Clinic at Weill Cornell Medicine. Tell listeners what you would like them to take away from this important segment about this devastating condition and the effect it has on families.

Dr. Kellyann Niotis: Well, for anyone who's out there that's personally suffering from the disease or has a family member that is suffering from the disease, we've come a long way in our understanding of this disease. While I was a medical student, we didn't even know that this disease started years before people develop symptoms. So, you know, not so long ago, we were in a different book. Now, we're at a completely different edition of this book. We're so, so far beyond what we once thought. So in such a short period of time, we've come so far. There's so much more that's coming out to help people who are suffering from this disease. And in the next 10 years, who knows what will be available?

So at the current moment, I think it's so important for people who may be at risk or who have early symptoms to do as much as they can to delay and slow their disease course because in 10 years there may be options that aren't available today. So the power is really in your hands and there is a lot that you can do for yourself and for your loved ones to help fight this disease.

Melanie: Thank you so much, Dr. Niotis. What great information today. And Weill Cornell Medicine continues to see our patients in person as well as through video visits. And you can definitely be confident of the safety of your appointments at Weill Cornell Medicine. And that concludes today's episode of Back To Health.

Dr. Kellyann Niotis: We'd like to thank our audience and invite you to download, subscribe, rate, and review Back To Health on Apple Podcast and Spotify and Google Podcast. And for more health tips, we have so many podcasts in our library. Go to weillcornell.org and search podcasts. And parents, definitely don't forget to check out our Kids Health Casts. That's a great show. I'm Melanie Cole. Thanks so much for listening.

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