WEBVTT

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Welcome to today's webinar.

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Breaking the Stigma Around Dementia.

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I'm your host, Janet Barker Evans

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and Dementia

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is a difficult diagnosis

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for a family to go through,

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but future breakthroughs may

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bring hope to patients and families.

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So join us today for a conversation

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about recent research

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advancements in the field.

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All right, let's jump in

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and meet our speaker

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Dr. Heather Snyder.

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Hello, Dr. Snyder.

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Hi there.

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As Vice President,

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medical and scientific relations

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of the Alzheimer's Association

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Dr. Heather Snyder oversees initiatives

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that accelerate innovative

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Alzheimer's research

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and provide opportunities

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for the global dementia community

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to connect and collaborate.

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She leads the Association's

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International Research

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Grant Program,

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which is the vehicle through

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which the association funds

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promising investigations

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that advance understanding of Alzheimer's

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and move the field

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toward solutions

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to the global Alzheimer's crisis.

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So to kick it off

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Dr. Snyder.

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Alzheimer's

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is a really difficult diagnosis.

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What new advancements

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are giving hope

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to families who are

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living with Alzheimer's?

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Thank you so much, Janet,

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for hosting today

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and Brookdale

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for bringing this webinar together.

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But really, for all of you

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that are joining us today

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and Janet's question is one

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I think all of us ask,

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especially for those of us

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that have personally gone

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through this journey.

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So I thought I would maybe start

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with just a few slides, a short

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a short presentation to not over

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overdo it with the discussion

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because we want to make sure

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we have lots of time for discussion.

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So hopefully you can all now

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see my slides

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quite clearly

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and you're able to see them.

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And so it's really a pleasure to be here

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with all of you.

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And as Janet said,

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I am the Vice President of Medical

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and Scientific Relations

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at the Alzheimer's Association.

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So did want to start by

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just sharing a little bit

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with you about who

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the Alzheimer's Association is.

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We are the world's

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largest voluntary health

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organization dedicated to Alzheimer's

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and all other dementia.

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We have a vision of a world

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without Alzheimer's disease.

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I do want to note that we have a 24 hour,

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seven day

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a week,

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52 weeks a year helpline for families

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and individuals

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that have questions

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about how to navigate circumstances.

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And you can see that number here,

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because I do think that's

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such an important resource

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for so many of us.

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So within the Alzheimer's Association,

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we have a services

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and resources within communities

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all across the country.

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I saw on the chat

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so many of you are joining us.

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Some from Montana, some from Kansas,

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as well

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as Minnesota

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and many other places, Texas.

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And there are resources

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in your community,

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whether it be the Alzheimer's Association

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or other resources, that

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if this is a journey

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that you're on right now

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with somebody in your life

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as a caregiver,

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if it's a journey you're experiencing

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or have experienced,

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there are resources,

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or opportunities

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to get engaged in your community.

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Maybe advocate, raise awareness

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or tell your story,

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all of which are incredibly important.

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So I did want to make sure

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to mention those resources.

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Now at the Alzheimer's Association,

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we have also

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a big part of our work

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is focused on research

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and the work that we do on research.

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And so I wanted to spend

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because of the role

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that I play, a little bit of time

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talking about our research strategy

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in the context

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of where research is going.

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So the Alzheimer's Association,

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we look at where our opportunities

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for us to seed new ideas,

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to speed things forward

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for both the development

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of new therapies,

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but also tools for early

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and accurate diagnosis.

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How can we scale things up

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so that they're accessible

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broadly in all communities?

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And part of that I mentioned previously,

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one of the things we can all do is

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we can advocate.

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One of the things that we are very active

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in with our public policy arm

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or the Alzheimer's Impact Movement,

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is advocating for increased

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research resources

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at the federal level.

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And we've been incredibly successful.

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Our advocates are amazing

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at telling their stories

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and sharing

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how the need to increase research

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funding is going to allow us

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to get ahead of this disease

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to understand the biology,

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to have new ways

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of detecting those earliest changes

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early and accurate

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diagnosis,

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how that will build us into a broad

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and diverse

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pipeline of possible clinical trials

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and thinking about

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ultimately risk reduction

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and prevention across the board.

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The Alzheimer’s Association

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also has a large

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portfolio of funded research

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of Alzheimer's in all dementia

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research with around $310 million

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that's active in 48 countries.

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So one of the big questions

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I often get is

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how is the global community

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working together?

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So everything I'm going to talk about

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today is really that global community

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continuing to come together,

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share information,

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share ideas

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and move us forward

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as fast as we possibly can.

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For any of us

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that have lived this journey,

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we know we needed to be there

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yesterday or, you know, long before.

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But we are moving in that direction

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and there's a tremendous

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amount of momentum.

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So what are the facts?

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Where are the numbers?

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What do we know?

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Uh, just a few that I know

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often resonate with so many of us.

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There are more than 6 million Americans

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today that are living

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with Alzheimer's disease.

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There are over 11 million individuals

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that are providing care and support

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for somebody with Alzheimer's

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or another dementia.

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And what we have seen

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is we've also seen

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that deaths due

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to Alzheimer's

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have significantly increased

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in recent years.

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I often get a question as to why,

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and there are maybe

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a lot of different reasons.

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One is maybe a greater awareness,

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but also one is that

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we're as a society, living longer

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and we have the baby boomer population,

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which is really into that over age,

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moving into that over age 65.

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Now at this point in time,

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so that the numbers of individuals

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that may be at increased

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risk are also increasing

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for this as age

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is the greatest risk factor.

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So I've already used some of these terms

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interchangeably.

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So I did want to set the stage

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a little bit.

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We often talk about Alzheimer's

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and we often talk about dementia.

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And so I'll sometimes

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have people say, 'Well,

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I  didn't have Alzheimer's.'

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My mom didn't have this,

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She had dementia,

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or she had this type

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of Lewy body dementia.

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And that's very you know,

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that's very different.

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And so I wanted to just set the stage.

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Dementia is that umbrella term.

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It's really describing the symptoms

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a person is

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is experiencing

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those changes in memory,

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thinking and reasoning.

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And there are different

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causes of dementia.

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So Alzheimer's is a

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cause of dementia, vascular

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dementia, Lewy body

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dementia, frontotemporal dementia.

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And each of these causes

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of those symptoms

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that a person may be

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experiencing

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are really defined by specific biology.

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We often will say cancer.

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Well, what kind?

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There might be breast cancer

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or bone cancer or lung cancer.

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And those are defined

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somewhat by the biology,

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but also the location

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of where they may be.

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Dementia is the umbrella term

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and then the cause - Alzheimer's,

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vascular dementia, Lewy body

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dementia, frontotemporal dementia

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- there are other causes.

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And increasingly

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we understand that

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some people may have multiple causes

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or multiple brain changes

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that are contributing

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to their memory changes as well.

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And it's this increased understanding

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about that biology,

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about what's happening

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that is really driving

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investigation of

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what might be the biology,

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what are the biological underpinnings.

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And the goal is that can inform us

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in interventions

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that can inform us

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with those diagnostic tools

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for the most early and accurate.

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So in Alzheimer's disease,

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we often talk about beta amyloid and tau

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because those are two of the hallmark

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brain changes that we see present.

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So we see large clumps of proteins

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between the brain cells,

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those are known as plaques.

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00:07:40.251 --> 00:07:42.295
And the primary component of those

298
00:07:42.295 --> 00:07:43.504
is beta amyloid.

299
00:07:43.504 --> 00:07:44.881
We also see clumps of proteins

300
00:07:44.881 --> 00:07:46.382
within the brain cells.

301
00:07:46.382 --> 00:07:47.717
The primary component of those

302
00:07:47.717 --> 00:07:49.135
is known as Tau.

303
00:07:49.135 --> 00:07:50.845
Now tau is also in those clumps

304
00:07:50.845 --> 00:07:52.263
that happen within the brain cells.

305
00:07:52.263 --> 00:07:53.639
That's actually a brain change

306
00:07:53.639 --> 00:07:54.390
that we also associate

307
00:07:54.390 --> 00:07:55.475
with Lewy body dementia,

308
00:07:55.475 --> 00:07:57.894
frontotemporal dementia as well.

309
00:07:57.894 --> 00:07:58.978
But in Alzheimer's,

310
00:07:58.978 --> 00:08:00.897
there is much more happening.

311
00:08:00.897 --> 00:08:03.524
We also see changes in the immune system

312
00:08:03.524 --> 00:08:05.401
and neuroinflammation in the brain,

313
00:08:05.401 --> 00:08:06.777
the way the vascular system

314
00:08:06.777 --> 00:08:09.822
is responding both to the flow of blood,

315
00:08:09.822 --> 00:08:10.948
but also the strength

316
00:08:10.948 --> 00:08:13.201
of the blood vessels within the brain,

317
00:08:13.451 --> 00:08:14.952
the way the brain is making

318
00:08:14.952 --> 00:08:15.870
or breaking down

319
00:08:15.870 --> 00:08:17.580
energy or food processes

320
00:08:17.580 --> 00:08:19.665
for its energy and its everyday process.

321
00:08:20.041 --> 00:08:21.626
Neurotransmitters really that cell

322
00:08:21.626 --> 00:08:22.710
the cell communication

323
00:08:22.710 --> 00:08:23.753
and how the brain cells

324
00:08:23.753 --> 00:08:25.505
are talking to one another.

325
00:08:25.505 --> 00:08:26.172
And so these are just

326
00:08:26.172 --> 00:08:27.924
some of the brain changes

327
00:08:27.924 --> 00:08:29.425
that we see in Alzheimer's,

328
00:08:29.425 --> 00:08:31.552
as well as some of these other dementias

329
00:08:31.719 --> 00:08:33.387
that are informing with the symptoms

330
00:08:33.387 --> 00:08:35.181
a person may be experiencing

331
00:08:35.181 --> 00:08:37.141
throughout the disease progression.

332
00:08:37.141 --> 00:08:38.851
So when I talk about disease progression,

333
00:08:38.851 --> 00:08:40.102
what does that mean?

334
00:08:40.102 --> 00:08:40.978
Well, for a long time

335
00:08:40.978 --> 00:08:41.854
we really talked about

336
00:08:41.854 --> 00:08:43.314
Alzheimer's disease as

337
00:08:43.314 --> 00:08:45.233
the more significant memory changes

338
00:08:45.233 --> 00:08:47.276
that impacted a daily life

339
00:08:47.276 --> 00:08:48.736
and we now understand

340
00:08:48.736 --> 00:08:50.821
Alzheimer's is more of a continuum,

341
00:08:50.821 --> 00:08:52.532
that there is a window of time where

342
00:08:52.532 --> 00:08:54.534
someone may have early memory changes

343
00:08:54.534 --> 00:08:56.410
that are due to the underlying biology

344
00:08:56.410 --> 00:08:57.662
that might be called mild

345
00:08:57.662 --> 00:08:59.664
cognitive impairment due to Alzheimer's.

346
00:08:59.664 --> 00:09:01.582
But there could also be a window of time

347
00:09:01.582 --> 00:09:02.333
where somebody may have

348
00:09:02.333 --> 00:09:03.834
no noticeable

349
00:09:03.834 --> 00:09:04.919
cognitive symptoms,

350
00:09:04.919 --> 00:09:06.963
but the underlying biology

351
00:09:06.963 --> 00:09:08.339
may be changing.

352
00:09:08.339 --> 00:09:09.715
And this is because the research

353
00:09:09.715 --> 00:09:10.550
has telling us

354
00:09:10.550 --> 00:09:12.176
that the brain changes may begin

355
00:09:12.176 --> 00:09:15.930
20 years or more before symptoms appear.

356
00:09:15.930 --> 00:09:17.723
So think about heart disease, right?

357
00:09:17.723 --> 00:09:19.642
We know when you go to your health care provider

358
00:09:19.642 --> 00:09:21.352
they're going to check your blood pressure

359
00:09:21.352 --> 00:09:22.103
your cholesterol.

360
00:09:22.103 --> 00:09:23.521
Those are actually markers

361
00:09:23.521 --> 00:09:25.314
of our underlying biology.

362
00:09:25.314 --> 00:09:26.649
Those are markers of things

363
00:09:26.649 --> 00:09:27.650
that may be putting

364
00:09:27.650 --> 00:09:29.151
us at an increased risk.

365
00:09:29.151 --> 00:09:31.237
We're on that continuum of heart disease,

366
00:09:31.237 --> 00:09:32.280
and they may be putting us

367
00:09:32.280 --> 00:09:33.823
at an increased risk for a heart attack

368
00:09:33.823 --> 00:09:35.241
or stroke in later life.

369
00:09:35.241 --> 00:09:36.659
And there are things that our health care

370
00:09:36.659 --> 00:09:38.035
provider might tell us

371
00:09:38.035 --> 00:09:40.288
lifestyle interventions, medications,

372
00:09:40.288 --> 00:09:41.163
but more likely

373
00:09:41.163 --> 00:09:42.957
combinations of approaches

374
00:09:42.957 --> 00:09:44.875
that will change that trajectory.

375
00:09:44.875 --> 00:09:46.335
Can we think about Alzheimer's

376
00:09:46.335 --> 00:09:47.920
in that same kind of way?

377
00:09:47.920 --> 00:09:48.462
Where you are

378
00:09:48.462 --> 00:09:50.881
maybe on that continuum with the biology

379
00:09:51.173 --> 00:09:52.216
where we can intervene

380
00:09:52.216 --> 00:09:53.134
at an earlier time

381
00:09:53.134 --> 00:09:55.094
point and change that trajectory.

382
00:09:55.094 --> 00:09:57.138
And so there's a lot of work going on

383
00:09:57.138 --> 00:09:59.640
in this particular area, in this space.

384
00:09:59.974 --> 00:10:01.475
Now, one of the things

385
00:10:01.475 --> 00:10:02.727
that's really advanced

386
00:10:02.727 --> 00:10:05.438
in this area has been biomarkers.

387
00:10:05.438 --> 00:10:06.814
This idea of these tools

388
00:10:06.814 --> 00:10:09.358
that allow us in a living person to see

389
00:10:09.358 --> 00:10:11.319
what are those earliest changes.

390
00:10:11.319 --> 00:10:11.819
So our

391
00:10:11.819 --> 00:10:14.071
our brains are a very protected organ

392
00:10:14.322 --> 00:10:15.656
and it's not quite something

393
00:10:15.656 --> 00:10:17.658
you can just open up and take a look

394
00:10:17.658 --> 00:10:19.410
at what might be going on.

395
00:10:19.410 --> 00:10:21.287
So the field has been very creative

396
00:10:21.287 --> 00:10:22.496
with funding from the Alzheimer's

397
00:10:22.496 --> 00:10:23.581
Association, as well

398
00:10:23.581 --> 00:10:24.874
as with the federal funding

399
00:10:24.874 --> 00:10:25.499
that has been made

400
00:10:25.499 --> 00:10:27.209
possible with tools like

401
00:10:27.209 --> 00:10:29.378
Can you take a picture of the brain

402
00:10:29.378 --> 00:10:31.005
and see some of these brain changes

403
00:10:31.005 --> 00:10:33.174
in a living person over time?

404
00:10:33.174 --> 00:10:34.884
And while that has been incredible

405
00:10:34.884 --> 00:10:36.927
and informing the work that we're doing

406
00:10:36.927 --> 00:10:38.721
and also has been really instrumental

407
00:10:38.721 --> 00:10:40.097
in moving trials forward

408
00:10:40.097 --> 00:10:41.098
and for individuals

409
00:10:41.098 --> 00:10:42.433
that may present

410
00:10:42.433 --> 00:10:44.644
in a way that's not

411
00:10:44.644 --> 00:10:46.354
what you might typically expect.

412
00:10:46.354 --> 00:10:47.813
Maybe younger in age

413
00:10:47.813 --> 00:10:49.815
and other specific instances.

414
00:10:49.815 --> 00:10:51.984
Imaging is really valuable in increasing

415
00:10:51.984 --> 00:10:53.694
the certainty of a diagnosis,

416
00:10:53.694 --> 00:10:54.945
and we do know that

417
00:10:54.945 --> 00:10:56.238
and accurate...When there's

418
00:10:56.238 --> 00:10:57.865
an increased certainty of a diagnosis

419
00:10:57.865 --> 00:10:59.992
that may change or impact care plans.

420
00:11:00.368 --> 00:11:01.994
But ultimately we want something

421
00:11:01.994 --> 00:11:04.288
that's lower cost and more readily

422
00:11:04.288 --> 00:11:06.415
available in clinicians’ offices

423
00:11:06.415 --> 00:11:07.958
that can then identify who should go

424
00:11:07.958 --> 00:11:09.877
for that more invasive

425
00:11:09.877 --> 00:11:11.712
and more expensive procedure.

426
00:11:11.712 --> 00:11:13.172
So something like a blood test,

427
00:11:13.172 --> 00:11:14.757
or can we use our eyes

428
00:11:14.757 --> 00:11:15.549
as a window into

429
00:11:15.549 --> 00:11:17.009
what's happening in the brain?

430
00:11:17.009 --> 00:11:18.928
I just heard right before this call

431
00:11:18.928 --> 00:11:19.679
that there was

432
00:11:19.679 --> 00:11:21.180
there was a large article

433
00:11:21.180 --> 00:11:22.932
or an article in The Washington Post,

434
00:11:22.932 --> 00:11:23.683
and I think it was in

435
00:11:23.683 --> 00:11:25.476
a couple of other places around

436
00:11:25.476 --> 00:11:26.852
where we are in blood tests.

437
00:11:26.852 --> 00:11:28.854
And there's a lot of work happening.

438
00:11:28.854 --> 00:11:30.147
There is a lot of exciting work

439
00:11:30.147 --> 00:11:32.858
happening and moving us forward into

440
00:11:33.234 --> 00:11:35.361
when they will be ready for prime time.

441
00:11:35.444 --> 00:11:36.862
And we're not quite there.

442
00:11:36.862 --> 00:11:37.988
There are a couple of tests

443
00:11:37.988 --> 00:11:39.573
that are available from a provider.

444
00:11:39.573 --> 00:11:41.283
A provider could order them to increase

445
00:11:41.283 --> 00:11:42.910
the certainty of a diagnosis

446
00:11:42.910 --> 00:11:45.204
or to inform their diagnostic workup.

447
00:11:45.413 --> 00:11:46.706
But it's important to note

448
00:11:46.706 --> 00:11:48.958
that they're not necessarily

449
00:11:48.958 --> 00:11:50.126
validated in large

450
00:11:50.126 --> 00:11:51.377
and diverse populations.

451
00:11:51.377 --> 00:11:53.212
And so that's coming, though.

452
00:11:53.212 --> 00:11:55.381
Where we are seeing these tools.

453
00:11:55.381 --> 00:11:57.299
we are seeing them being incorporated

454
00:11:57.299 --> 00:11:58.592
into clinical trials.

455
00:11:58.592 --> 00:12:01.470
They're part of what might be evaluating

456
00:12:01.470 --> 00:12:03.472
whether somebody has the biology

457
00:12:03.723 --> 00:12:04.682
and then going for that

458
00:12:04.682 --> 00:12:05.850
more invasive test

459
00:12:05.850 --> 00:12:07.768
like an image, to say, okay,

460
00:12:07.768 --> 00:12:08.728
they have the biology

461
00:12:08.728 --> 00:12:10.020
we're looking to target.

462
00:12:10.020 --> 00:12:11.439
They're ready for a clinical trial.

463
00:12:11.439 --> 00:12:12.773
And so that's really exciting

464
00:12:12.773 --> 00:12:14.942
and allows us to validate in much larger

465
00:12:15.151 --> 00:12:16.652
and more diverse populations

466
00:12:16.652 --> 00:12:18.320
at a faster time period.

467
00:12:19.447 --> 00:12:21.073
So in that idea, where

468
00:12:21.073 --> 00:12:22.491
are we with clinical trials?

469
00:12:22.491 --> 00:12:23.576
And one of the things

470
00:12:23.576 --> 00:12:24.994
and don't try to memorize

471
00:12:24.994 --> 00:12:26.746
each of these pictures on this graph

472
00:12:26.746 --> 00:12:28.372
Because what would I really want

473
00:12:28.372 --> 00:12:29.248
you to take away from

474
00:12:29.248 --> 00:12:30.541
this is this walks

475
00:12:30.541 --> 00:12:31.751
you through the different stages

476
00:12:31.751 --> 00:12:32.710
of phase one,

477
00:12:32.710 --> 00:12:33.836
which is looking at safety,

478
00:12:33.836 --> 00:12:35.796
phase two, which is looking at safety,

479
00:12:35.796 --> 00:12:37.298
but also dose and phase three.

480
00:12:37.298 --> 00:12:38.966
That's looking at is it effective?

481
00:12:38.966 --> 00:12:40.634
What I want you to really take away from

482
00:12:40.634 --> 00:12:43.012
this is just the numbers of trials.

483
00:12:43.387 --> 00:12:44.180
And, you know,

484
00:12:44.180 --> 00:12:46.682
this is an incredible growth year over year

485
00:12:46.682 --> 00:12:47.725
We're seeing more

486
00:12:47.725 --> 00:12:49.477
and more unique therapies

487
00:12:49.477 --> 00:12:50.436
or new therapies

488
00:12:50.436 --> 00:12:52.062
moving into the pipeline

489
00:12:52.062 --> 00:12:54.190
of what's being explored for Alzheimer's.

490
00:12:54.190 --> 00:12:55.733
The Alzheimer's Association has

491
00:12:55.733 --> 00:12:57.902
been a large funder of a number of these

492
00:12:57.902 --> 00:12:59.320
to move them from the bench,

493
00:12:59.320 --> 00:13:02.114
these ideas, over into clinical trials.

494
00:13:02.406 --> 00:13:02.907
And in fact,

495
00:13:02.907 --> 00:13:04.867
what we are also seeing as we understand

496
00:13:04.867 --> 00:13:06.619
more and more about the biology,

497
00:13:06.619 --> 00:13:07.620
the opportunity

498
00:13:07.620 --> 00:13:08.829
to leverage things

499
00:13:08.829 --> 00:13:10.748
that have been actually developed

500
00:13:10.748 --> 00:13:12.041
for other diseases

501
00:13:12.041 --> 00:13:13.751
and bringing them into Alzheimer's

502
00:13:13.751 --> 00:13:14.627
and dementia

503
00:13:14.627 --> 00:13:16.837
and exploring them as possible therapies.

504
00:13:16.837 --> 00:13:18.339
So the big takeaway here is

505
00:13:18.339 --> 00:13:19.715
there's a lot of momentum.

506
00:13:19.715 --> 00:13:21.217
We're not where we want to get to.

507
00:13:21.217 --> 00:13:22.051
We need to continue

508
00:13:22.051 --> 00:13:23.511
to increase this pipeline

509
00:13:23.511 --> 00:13:24.720
and the diversity.

510
00:13:24.720 --> 00:13:26.806
There's a lot going on in this biology.

511
00:13:26.806 --> 00:13:28.182
The idea of possible

512
00:13:28.182 --> 00:13:29.809
combination approaches

513
00:13:29.809 --> 00:13:31.602
is really where the field is thinking.

514
00:13:31.602 --> 00:13:33.395
What might be the biology

515
00:13:33.395 --> 00:13:35.481
in a given person, and how do we

516
00:13:35.481 --> 00:13:37.900
how do we target that biology to slow

517
00:13:38.025 --> 00:13:40.444
or stop that progression overall?

518
00:13:41.570 --> 00:13:42.905
So where are we today in

519
00:13:42.905 --> 00:13:43.989
terms of treatments?

520
00:13:43.989 --> 00:13:45.407
There are several

521
00:13:45.407 --> 00:13:47.576
medications that have been approved

522
00:13:47.576 --> 00:13:48.786
by the FDA.

523
00:13:48.786 --> 00:13:50.496
Many of them are symptomatic,

524
00:13:50.496 --> 00:13:51.497
meaning that they're addressing

525
00:13:51.497 --> 00:13:52.998
the underlying symptoms.

526
00:13:52.998 --> 00:13:55.543
In 2021, we had the first drug

527
00:13:55.543 --> 00:13:57.545
that was approved by the FDA called

528
00:13:57.545 --> 00:13:58.921
Aducanumab or Aduhelm

529
00:13:58.921 --> 00:14:00.965
that targets the underlying biology.

530
00:14:00.965 --> 00:14:03.008
So a little bit different in its approach

531
00:14:03.217 --> 00:14:03.884
with the idea

532
00:14:03.884 --> 00:14:05.177
that has a reasonable likelihood

533
00:14:05.177 --> 00:14:06.804
for clinical benefit.

534
00:14:06.804 --> 00:14:08.931
Now, many of you may be aware

535
00:14:08.931 --> 00:14:10.391
or familiar with this is as it did

536
00:14:10.391 --> 00:14:12.059
make a lot of headlines.

537
00:14:12.059 --> 00:14:13.352
There is some challenges

538
00:14:13.352 --> 00:14:14.979
in terms of accessibility

539
00:14:14.979 --> 00:14:16.230
and availability of this drug,

540
00:14:16.230 --> 00:14:18.816
and there are safety considerations, too,

541
00:14:19.149 --> 00:14:20.359
to have

542
00:14:20.568 --> 00:14:21.277
that conversation

543
00:14:21.277 --> 00:14:22.778
with your health care provider.

544
00:14:22.778 --> 00:14:23.279
But I think what

545
00:14:23.279 --> 00:14:24.363
I really want to talk about

546
00:14:24.363 --> 00:14:26.490
is that recently in September

547
00:14:26.699 --> 00:14:28.576
and then in 2023,

548
00:14:28.576 --> 00:14:29.618
there are other drugs

549
00:14:29.618 --> 00:14:31.370
that are targeting beta amyloid

550
00:14:31.370 --> 00:14:32.746
that are a little bit different,

551
00:14:32.746 --> 00:14:34.790
that are, for instance, Lecanemab

552
00:14:34.957 --> 00:14:36.876
which reported out in September,

553
00:14:36.876 --> 00:14:38.460
topline results

554
00:14:38.460 --> 00:14:39.795
demonstrating a positive

555
00:14:39.795 --> 00:14:41.171
phase three trial.

556
00:14:41.171 --> 00:14:43.257
Now we'll see more data in a couple weeks

557
00:14:43.257 --> 00:14:45.134
about this particular trial

558
00:14:45.134 --> 00:14:46.927
and the particular work that they've done

559
00:14:46.927 --> 00:14:48.721
at whether they were able to

560
00:14:48.721 --> 00:14:50.681
they did in their top line results,

561
00:14:50.681 --> 00:14:52.474
they did say they were able to lower

562
00:14:52.474 --> 00:14:54.184
beta amyloid effectively

563
00:14:54.184 --> 00:14:55.811
and then they saw a clinical benefit,

564
00:14:55.811 --> 00:14:58.272
a slowing of clinical decline

565
00:14:58.272 --> 00:14:59.440
in the individuals.

566
00:14:59.440 --> 00:15:01.108
There is another drug also targeting

567
00:15:01.108 --> 00:15:02.860
beta-amyloid called Donanemab

568
00:15:02.860 --> 00:15:04.236
that in late stage development

569
00:15:04.236 --> 00:15:06.113
expected to report out in

570
00:15:06.113 --> 00:15:08.157
early 2023.

571
00:15:08.157 --> 00:15:10.409
And that is also targeting beta-amyloid

572
00:15:10.618 --> 00:15:11.911
I do want to note

573
00:15:11.911 --> 00:15:13.203
that while these three

574
00:15:13.203 --> 00:15:15.205
are targeting the same biology,

575
00:15:15.205 --> 00:15:17.124
they're all in late stage development.

576
00:15:17.124 --> 00:15:18.918
And that graph that I just showed you,

577
00:15:18.918 --> 00:15:19.376
it's really

578
00:15:19.376 --> 00:15:20.628
the diversity of things

579
00:15:20.628 --> 00:15:22.129
that are looking at metabolism

580
00:15:22.129 --> 00:15:23.464
and the immune system

581
00:15:23.464 --> 00:15:25.591
and tau in some of these other biologies,

582
00:15:25.591 --> 00:15:26.759
the vasculature

583
00:15:26.759 --> 00:15:27.927
that we're seeing moving

584
00:15:27.927 --> 00:15:29.720
through that same pipeline.

585
00:15:29.720 --> 00:15:30.554
And these three,

586
00:15:30.554 --> 00:15:32.389
while they're all targeting beta-amyloid

587
00:15:32.389 --> 00:15:33.807
they're all a little bit different

588
00:15:33.807 --> 00:15:34.850
in the biology

589
00:15:34.850 --> 00:15:36.393
of what they're actually targeting.

590
00:15:36.393 --> 00:15:37.978
So these are really exciting

591
00:15:37.978 --> 00:15:39.021
to see move forward.

592
00:15:39.021 --> 00:15:40.898
But there are just over 140

593
00:15:40.898 --> 00:15:41.523
other things

594
00:15:41.523 --> 00:15:42.691
that are in clinical development

595
00:15:42.691 --> 00:15:43.692
that are targeting

596
00:15:43.692 --> 00:15:46.445
multiple aspects of the biology as well.

597
00:15:46.779 --> 00:15:48.405
Because it's this idea

598
00:15:48.405 --> 00:15:50.282
that there is this underlying biology,

599
00:15:50.282 --> 00:15:51.659
there are different brain changes

600
00:15:51.659 --> 00:15:52.826
that are happening in a

601
00:15:52.826 --> 00:15:53.994
in an individual

602
00:15:53.994 --> 00:15:56.163
beta-amyliod and tau are just two of them.

603
00:15:56.163 --> 00:15:58.248
There's also changes in immune system,

604
00:15:58.248 --> 00:15:59.291
how the brain cells

605
00:15:59.291 --> 00:16:00.751
are talking to each other,

606
00:16:00.751 --> 00:16:03.128
the vascular changes, and so many others.

607
00:16:03.420 --> 00:16:04.588
These tools, such

608
00:16:04.588 --> 00:16:06.006
as taking a picture of the brain,

609
00:16:06.006 --> 00:16:07.257
looking in our blood,

610
00:16:07.257 --> 00:16:09.259
looking in other ways to understand

611
00:16:09.259 --> 00:16:10.511
what's the biology in

612
00:16:10.511 --> 00:16:11.720
a given person

613
00:16:11.720 --> 00:16:12.638
will inform

614
00:16:12.638 --> 00:16:14.515
where we might be on that continuum.

615
00:16:14.515 --> 00:16:15.599
And then ultimately

616
00:16:15.599 --> 00:16:16.934
having different interventions

617
00:16:16.934 --> 00:16:18.394
that allow us to intervene

618
00:16:18.394 --> 00:16:20.312
throughout this entire continuum

619
00:16:20.312 --> 00:16:21.897
and putting that in the context

620
00:16:21.897 --> 00:16:23.899
as we think about risk reduction,

621
00:16:23.899 --> 00:16:25.901
what might be those factors

622
00:16:25.901 --> 00:16:27.069
that individually

623
00:16:27.069 --> 00:16:28.946
we could modify to reduce

624
00:16:28.946 --> 00:16:30.531
or impact our risk overall?

625
00:16:30.531 --> 00:16:32.282
And there's a lot of really exciting work

626
00:16:32.282 --> 00:16:34.743
going on in that space as well.

627
00:16:34.743 --> 00:16:36.954
And so where we are in the field, it's

628
00:16:36.954 --> 00:16:37.913
this intersection

629
00:16:37.913 --> 00:16:40.165
of where treatment, care and research

630
00:16:40.165 --> 00:16:40.958
come together.

631
00:16:40.958 --> 00:16:42.459
And it's really an exciting time

632
00:16:42.459 --> 00:16:44.086
as we enter this new phase.

633
00:16:44.086 --> 00:16:46.046
I know for any of us that are living this

634
00:16:46.046 --> 00:16:47.965
journey, it's it's challenging

635
00:16:47.965 --> 00:16:49.299
because we want to be further down

636
00:16:49.299 --> 00:16:50.050
the road.

637
00:16:50.050 --> 00:16:51.385
There's a lot of momentum.

638
00:16:51.385 --> 00:16:53.095
There's a lot of hope going forward.

639
00:16:53.095 --> 00:16:54.722
We're not where we ultimately want to be,

640
00:16:54.722 --> 00:16:56.098
but we're moving in that direction.

641
00:16:56.098 --> 00:16:57.141
So really

642
00:16:57.141 --> 00:16:58.267
and it's an exciting time

643
00:16:58.267 --> 00:16:59.184
and hopefully that

644
00:16:59.184 --> 00:17:01.353
that's a little bit of the landscape.

645
00:17:01.353 --> 00:17:04.148
So whatever you do, whether you're somebody

646
00:17:04.148 --> 00:17:04.732
that participates

647
00:17:04.732 --> 00:17:06.025
in the Walk to End Alzheimer's

648
00:17:06.025 --> 00:17:07.109
the longest day

649
00:17:07.109 --> 00:17:08.027
and advocate

650
00:17:08.027 --> 00:17:09.695
volunteering in a clinical trial

651
00:17:09.695 --> 00:17:10.946
sharing your story

652
00:17:10.946 --> 00:17:13.240
with your friends and your family.

653
00:17:13.240 --> 00:17:14.324
You are helping

654
00:17:14.324 --> 00:17:15.409
move the cause forward

655
00:17:15.409 --> 00:17:16.285
ultimately

656
00:17:16.285 --> 00:17:17.327
to where we want to get to

657
00:17:17.327 --> 00:17:19.288
with that first survivor

658
00:17:19.288 --> 00:17:20.247
as we move forward.

659
00:17:20.247 --> 00:17:21.540
And so I know hopefully

660
00:17:21.540 --> 00:17:22.458
that's set the stage

661
00:17:22.458 --> 00:17:23.167
a little bit

662
00:17:23.167 --> 00:17:23.917
as we

663
00:17:23.917 --> 00:17:26.003
think about this disease

664
00:17:26.003 --> 00:17:27.546
and the underlying biology

665
00:17:27.546 --> 00:17:29.423
and where we are with the idea

666
00:17:29.423 --> 00:17:31.258
that there is a lot happening

667
00:17:31.258 --> 00:17:32.801
and I know there's a lot of details

668
00:17:32.801 --> 00:17:34.053
that we might get into more

669
00:17:34.053 --> 00:17:35.387
with some of our discussion.

670
00:17:37.097 --> 00:17:38.015
Thank you so much.

671
00:17:38.015 --> 00:17:40.684
That was such great information.

672
00:17:40.684 --> 00:17:41.268
Let's dive

673
00:17:41.268 --> 00:17:42.436
into some of the specifics

674
00:17:42.436 --> 00:17:43.228
of what we were discussing

675
00:17:43.228 --> 00:17:45.481
so you were talking about

676
00:17:45.481 --> 00:17:46.148
some of the causes.

677
00:17:46.148 --> 00:17:47.316
Can you expand a little bit

678
00:17:47.316 --> 00:17:49.026
more on the causes of Alzheimer's

679
00:17:49.026 --> 00:17:50.861
and how we might prevent it

680
00:17:50.861 --> 00:17:52.488
if if we're seeing things

681
00:17:52.488 --> 00:17:54.364
20 years before,

682
00:17:54.364 --> 00:17:55.324
what are these causes

683
00:17:55.324 --> 00:17:57.659
we might be able to prevent?

684
00:17:57.785 --> 00:17:57.993
Yeah.

685
00:17:57.993 --> 00:17:59.453
So when we think about causes, you know,

686
00:17:59.453 --> 00:18:00.120
we don't know that

687
00:18:00.120 --> 00:18:01.413
there's one single cause,

688
00:18:01.413 --> 00:18:03.207
but there really is this intersection

689
00:18:03.207 --> 00:18:04.083
throughout life

690
00:18:04.083 --> 00:18:05.042
that there may be things

691
00:18:05.042 --> 00:18:07.211
that are contributing to our risk.

692
00:18:07.211 --> 00:18:08.212
So we do know that

693
00:18:08.212 --> 00:18:09.630
there is a genetics component

694
00:18:09.630 --> 00:18:11.965
that if you have a parent

695
00:18:11.965 --> 00:18:12.758
that had

696
00:18:12.758 --> 00:18:14.218
or has Alzheimer's, for instance,

697
00:18:14.218 --> 00:18:15.594
you are at a greater risk.

698
00:18:15.594 --> 00:18:17.554
But there have actually been over 100

699
00:18:17.554 --> 00:18:19.306
different kind of variations of genes

700
00:18:19.306 --> 00:18:20.307
that have been identified

701
00:18:20.307 --> 00:18:21.475
as being associated

702
00:18:21.475 --> 00:18:22.851
with either increased risk,

703
00:18:22.851 --> 00:18:24.603
as well as some that have been associated

704
00:18:24.603 --> 00:18:26.105
with decreased risk.

705
00:18:26.105 --> 00:18:27.898
And we don't completely understand

706
00:18:27.898 --> 00:18:30.025
the role that all of those play.

707
00:18:30.025 --> 00:18:31.985
So while it may be an increased risk,

708
00:18:31.985 --> 00:18:34.655
it is certainly not a guarantee, right?

709
00:18:34.738 --> 00:18:35.364
In terms

710
00:18:35.364 --> 00:18:36.865
of thinking about that.

711
00:18:36.865 --> 00:18:37.908
Throughout the life course,

712
00:18:37.908 --> 00:18:39.451
there are also contributions

713
00:18:39.451 --> 00:18:41.537
in terms of our cardiovascular health

714
00:18:41.537 --> 00:18:42.746
or metabolic health.

715
00:18:42.746 --> 00:18:44.456
We do see that there are

716
00:18:44.456 --> 00:18:45.374
there's an increased risk

717
00:18:45.374 --> 00:18:46.667
for people with heart disease

718
00:18:46.667 --> 00:18:48.168
and diabetes, for instance.

719
00:18:48.168 --> 00:18:49.294
And so manage your numbers,

720
00:18:49.294 --> 00:18:50.337
know your numbers,

721
00:18:50.337 --> 00:18:51.505
do things to manage

722
00:18:51.505 --> 00:18:52.923
those, be physically active.

723
00:18:52.923 --> 00:18:54.591
There seems to be a linkage

724
00:18:54.591 --> 00:18:56.009
with being physically engaged,

725
00:18:56.009 --> 00:18:56.844
finding something

726
00:18:56.844 --> 00:18:58.971
you're going to do and keep doing,

727
00:18:58.971 --> 00:18:59.847
and that it never seems

728
00:18:59.847 --> 00:19:01.056
to be too late to start,

729
00:19:01.056 --> 00:19:02.015
that there's a benefit

730
00:19:02.015 --> 00:19:04.476
of engaging in physical exercise

731
00:19:05.102 --> 00:19:06.854
or physical activity that gets your

732
00:19:06.854 --> 00:19:08.355
your your heart pumping,

733
00:19:08.355 --> 00:19:08.689
your blood

734
00:19:08.689 --> 00:19:10.190
pumping through your body,

735
00:19:10.190 --> 00:19:11.233
even if you're already

736
00:19:11.233 --> 00:19:12.526
experiencing cognitive

737
00:19:13.652 --> 00:19:14.153
challenges.

738
00:19:14.153 --> 00:19:15.028
So, for instance,

739
00:19:15.028 --> 00:19:16.989
there was a study this past summer

740
00:19:16.989 --> 00:19:18.031
that was presented

741
00:19:18.031 --> 00:19:18.949
that was in people

742
00:19:18.949 --> 00:19:20.701
with mild cognitive impairment.

743
00:19:20.701 --> 00:19:22.077
So all causes not just mild

744
00:19:22.077 --> 00:19:23.704
cognitive impairment due to Alzheimer's,

745
00:19:23.704 --> 00:19:24.371
but individuals

746
00:19:24.371 --> 00:19:26.915
that had those early memory changes.

747
00:19:26.915 --> 00:19:28.167
And they tested,

748
00:19:28.167 --> 00:19:30.085
they evaluated aerobic exercise

749
00:19:30.085 --> 00:19:31.587
compared to strength training.

750
00:19:31.587 --> 00:19:32.880
And they actually found that

751
00:19:32.880 --> 00:19:34.047
in the interventions

752
00:19:34.047 --> 00:19:36.466
that they did not see individuals decline,

753
00:19:37.134 --> 00:19:38.760
as they would have maybe expected

754
00:19:38.760 --> 00:19:39.678
one of the groups

755
00:19:39.678 --> 00:19:41.638
potentially to do, suggesting that

756
00:19:41.638 --> 00:19:43.140
it's really that getting active.

757
00:19:43.140 --> 00:19:45.267
So certainly need to see that

758
00:19:45.267 --> 00:19:46.518
in a in a larger study

759
00:19:46.518 --> 00:19:48.270
with more diverse participants.

760
00:19:48.270 --> 00:19:48.937
But it's really that

761
00:19:48.937 --> 00:19:50.939
first kind of head to head comparison

762
00:19:50.939 --> 00:19:52.274
in that population that we've seen.

763
00:19:52.274 --> 00:19:54.276
And so exciting too, to know

764
00:19:54.276 --> 00:19:55.152
there are things we can do

765
00:19:55.152 --> 00:19:56.612
wherever we might be.

766
00:19:56.612 --> 00:19:58.947
The same advice that keeps us healthy

767
00:19:58.947 --> 00:20:00.657
everywhere seems to keep our brain healthy too then, right?

768
00:20:00.657 --> 00:20:01.533
If we do, then right

769
00:20:01.533 --> 00:20:03.744
It's the same advice.

770
00:20:03.911 --> 00:20:05.495
Our brains are part of our body.

771
00:20:05.495 --> 00:20:06.371
We don't always, you know,

772
00:20:06.371 --> 00:20:07.748
we sort of think sometimes like,

773
00:20:07.748 --> 00:20:08.165
well, here's

774
00:20:08.165 --> 00:20:08.916
all this stuff to keep,

775
00:20:08.916 --> 00:20:10.209
but it's really it's

776
00:20:10.209 --> 00:20:11.043
they're all connected

777
00:20:11.043 --> 00:20:12.002
and they're all intertwined.

778
00:20:12.002 --> 00:20:13.295
Our brain is the command center,

779
00:20:13.295 --> 00:20:14.588
so let's do what we can

780
00:20:14.588 --> 00:20:16.131
to keep it as healthy as we can.

781
00:20:16.131 --> 00:20:17.883
It's a good reminder.

782
00:20:17.883 --> 00:20:19.927
You know, you mentioned biomarkers.

783
00:20:20.093 --> 00:20:21.470
Can you explain a little bit

784
00:20:21.470 --> 00:20:23.013
about more of what those are

785
00:20:23.013 --> 00:20:24.723
and how they've helped in the field

786
00:20:24.723 --> 00:20:26.016
of Alzheimer's research?

787
00:20:27.100 --> 00:20:27.392
Yeah.

788
00:20:27.392 --> 00:20:28.936
So a biomarker is a

789
00:20:28.936 --> 00:20:30.229
measure of biological change,

790
00:20:30.229 --> 00:20:31.855
so things that we might be more

791
00:20:31.855 --> 00:20:33.357
used to talking about when we talk about

792
00:20:33.357 --> 00:20:35.192
biomarkers are like insulin levels

793
00:20:35.192 --> 00:20:37.402
with diabetes or

794
00:20:37.402 --> 00:20:38.612
cholesterol is a

795
00:20:38.612 --> 00:20:39.613
is a pseudo biomarker,

796
00:20:39.613 --> 00:20:40.948
but cholesterol levels

797
00:20:40.948 --> 00:20:42.783
as it relates to heart disease could be,

798
00:20:42.783 --> 00:20:45.035
you know, in that in that vein as well.

799
00:20:45.327 --> 00:20:46.203
So in Alzheimer's disease,

800
00:20:46.203 --> 00:20:47.162
there's a lot of work

801
00:20:47.162 --> 00:20:48.830
going on in trying to identify

802
00:20:48.830 --> 00:20:50.874
what are the earliest biologies

803
00:20:50.874 --> 00:20:52.084
and how can we detect them

804
00:20:52.084 --> 00:20:54.294
accurately and consistently

805
00:20:54.294 --> 00:20:55.295
in individuals.

806
00:20:55.295 --> 00:20:56.338
And so there's a lot of work around

807
00:20:56.338 --> 00:20:57.047
some of the biology

808
00:20:57.047 --> 00:20:58.882
specific to Alzheimer's, beta-amyloid

809
00:20:58.882 --> 00:21:00.384
and tau, for instance.

810
00:21:00.384 --> 00:21:01.551
But there's others.

811
00:21:01.551 --> 00:21:03.220
Looking at certain immune markers,

812
00:21:03.220 --> 00:21:05.931
looking at certain markers of cell death,

813
00:21:05.931 --> 00:21:07.766
because as the disease progresses,

814
00:21:07.766 --> 00:21:08.725
that's what's happening.

815
00:21:08.725 --> 00:21:10.394
Some of these brain cells are dying.

816
00:21:10.394 --> 00:21:11.853
Can you measure those changes?

817
00:21:11.853 --> 00:21:14.147
And if you see less a based in a

818
00:21:14.147 --> 00:21:15.357
in a particular prevention,

819
00:21:15.357 --> 00:21:16.775
is that having a benefit on

820
00:21:16.775 --> 00:21:18.610
on some of that progression?

821
00:21:18.610 --> 00:21:19.403
What does that look like?

822
00:21:19.403 --> 00:21:21.321
And so there's some work going on in that

823
00:21:21.321 --> 00:21:22.364
and that's just in Alzheimer's.

824
00:21:22.364 --> 00:21:22.864
But actually,

825
00:21:22.864 --> 00:21:24.241
if you look at Lewy body dementia

826
00:21:24.241 --> 00:21:25.784
and Parkinson's disease dementia,

827
00:21:25.784 --> 00:21:27.160
there's some work going on.

828
00:21:27.160 --> 00:21:28.203
Is can you measure

829
00:21:28.203 --> 00:21:30.122
one of their primary biologies is

830
00:21:30.122 --> 00:21:32.040
is a clumping of proteins

831
00:21:32.040 --> 00:21:33.667
known as Alpha Synuclein

832
00:21:33.667 --> 00:21:35.669
that forms a very specific brain change.

833
00:21:35.669 --> 00:21:37.254
Can you measure that over time

834
00:21:37.254 --> 00:21:38.964
and start to see some of those changes?

835
00:21:38.964 --> 00:21:40.924
So there's looking at really this idea

836
00:21:40.924 --> 00:21:42.301
you could imagine a future

837
00:21:42.301 --> 00:21:44.344
where we will get to having a series

838
00:21:44.344 --> 00:21:46.138
of different types of tests.

839
00:21:46.138 --> 00:21:47.014
That if something's,

840
00:21:47.014 --> 00:21:48.098
you know, maybe there's a signal

841
00:21:48.098 --> 00:21:49.182
that something's not right.

842
00:21:49.182 --> 00:21:51.268
Trying to get more definitive

843
00:21:51.268 --> 00:21:52.728
follow up again, very much

844
00:21:52.728 --> 00:21:54.229
like how we think about cancer treatment

845
00:21:54.229 --> 00:21:56.732
today or cancer diagnosis today

846
00:21:56.732 --> 00:21:58.859
or heart disease today.

847
00:21:58.859 --> 00:22:00.027
We're moving in that direction.

848
00:22:01.737 --> 00:22:02.904
That's great.

849
00:22:02.904 --> 00:22:03.989
Um, yeah.

850
00:22:03.989 --> 00:22:04.489
Prevention

851
00:22:04.489 --> 00:22:06.450
obviously is like a big focus

852
00:22:06.450 --> 00:22:08.243
of knowing when it's happening.

853
00:22:08.243 --> 00:22:10.287
You shared a lot about 140

854
00:22:10.287 --> 00:22:11.371
different therapies or whatever,

855
00:22:11.371 --> 00:22:13.248
all these different treatments coming.

856
00:22:13.248 --> 00:22:14.333
What can you tell us about

857
00:22:14.333 --> 00:22:15.459
the current treatments

858
00:22:15.459 --> 00:22:17.044
that are FDA approved?

859
00:22:17.044 --> 00:22:17.794
I know you said they're

860
00:22:17.794 --> 00:22:19.504
targeting the underlying biology,

861
00:22:19.504 --> 00:22:21.214
but how much can they slow down

862
00:22:21.214 --> 00:22:24.426
the progression of the disease?

863
00:22:24.426 --> 00:22:25.385
Yeah, so there are

864
00:22:25.385 --> 00:22:26.303
there are actually three

865
00:22:26.303 --> 00:22:27.220
different classes

866
00:22:27.220 --> 00:22:28.055
if you will, of drugs

867
00:22:28.055 --> 00:22:29.973
that have been approved

868
00:22:31.141 --> 00:22:33.393
for by the FDA at this point in time.

869
00:22:33.393 --> 00:22:34.770
So there are clusters,

870
00:22:34.770 --> 00:22:36.271
cholinesterase inhibitors.

871
00:22:36.271 --> 00:22:38.106
So that's like Aricept (Donepezil)

872
00:22:38.523 --> 00:22:39.941
as one example.

873
00:22:39.941 --> 00:22:41.401
There's the glutamate moderators

874
00:22:41.401 --> 00:22:42.527
or Namenda

875
00:22:42.527 --> 00:22:44.529
I think is the primary example.

876
00:22:44.529 --> 00:22:46.531
And then there is the MABS

877
00:22:46.531 --> 00:22:47.699
that are the

878
00:22:47.699 --> 00:22:48.867
one of the monoclonal antibodies

879
00:22:48.867 --> 00:22:50.452
targeting beta-amyloid.

880
00:22:50.452 --> 00:22:51.661
So let me just talk through those

881
00:22:51.661 --> 00:22:52.913
a little bit more.

882
00:22:52.913 --> 00:22:54.956
So cholinesterase inhibitors

883
00:22:54.956 --> 00:22:56.583
one of the glutamate moderators,

884
00:22:56.583 --> 00:22:57.167
they have some

885
00:22:57.167 --> 00:22:59.336
although opposite in context

886
00:22:59.336 --> 00:23:00.504
they have similar ways of

887
00:23:02.047 --> 00:23:03.090
of working.

888
00:23:03.090 --> 00:23:03.757
is that as

889
00:23:03.757 --> 00:23:05.175
the disease progresses,

890
00:23:05.175 --> 00:23:06.343
the brain cells are dying,

891
00:23:06.343 --> 00:23:07.594
as I mentioned.

892
00:23:07.594 --> 00:23:08.762
And so they're really helping

893
00:23:08.762 --> 00:23:09.846
as the brain cells

894
00:23:09.846 --> 00:23:11.098
die, there's maybe less,

895
00:23:11.098 --> 00:23:12.224
they're further apart.

896
00:23:12.224 --> 00:23:13.600
They turn up the volume

897
00:23:13.600 --> 00:23:14.518
so that the brain cells

898
00:23:14.518 --> 00:23:16.436
can talk to one another longer.

899
00:23:16.436 --> 00:23:17.854
So not unlike a hearing aid. Right.

900
00:23:17.854 --> 00:23:19.564
So as hearing loss progresses, right,

901
00:23:19.564 --> 00:23:20.357
you can continue

902
00:23:20.357 --> 00:23:21.566
to turn up the volume

903
00:23:21.566 --> 00:23:23.819
on a on a hearing aid to help

904
00:23:23.819 --> 00:23:25.362
with that communication.

905
00:23:25.362 --> 00:23:25.987
Eventually,

906
00:23:25.987 --> 00:23:27.447
the loss may become to the point

907
00:23:27.447 --> 00:23:28.907
beyond the capability

908
00:23:28.907 --> 00:23:30.283
of those particular

909
00:23:30.283 --> 00:23:31.743
of the tools that you might be using,

910
00:23:31.743 --> 00:23:32.577
whether it be these drugs

911
00:23:32.577 --> 00:23:33.787
or a hearing aid,

912
00:23:33.787 --> 00:23:35.455
as an example.

913
00:23:35.455 --> 00:23:36.415
There is no evidence

914
00:23:36.415 --> 00:23:37.541
that they're stopping or slowing

915
00:23:37.541 --> 00:23:38.417
the underlying progression

916
00:23:38.417 --> 00:23:39.000
of the disease.

917
00:23:39.000 --> 00:23:40.627
They're truly treating the symptoms.

918
00:23:40.627 --> 00:23:42.045
They're helping a person

919
00:23:42.045 --> 00:23:42.921
maintain function

920
00:23:42.921 --> 00:23:45.006
and some level of cognition

921
00:23:45.006 --> 00:23:47.426
for a longer period of time

922
00:23:47.426 --> 00:23:48.718
as they go forward.

923
00:23:48.718 --> 00:23:49.594
It is important to note

924
00:23:49.594 --> 00:23:50.971
that not everybody

925
00:23:50.971 --> 00:23:52.055
has the same benefit

926
00:23:52.055 --> 00:23:54.266
or impact of these medications.

927
00:23:54.266 --> 00:23:55.559
It's really a based on

928
00:23:55.559 --> 00:23:56.435
where they might be

929
00:23:56.435 --> 00:23:57.561
in the disease progression,

930
00:23:57.561 --> 00:23:58.979
their particular circumstances.

931
00:23:58.979 --> 00:23:59.855
And so it's something

932
00:23:59.855 --> 00:24:01.148
to very much discuss

933
00:24:01.148 --> 00:24:02.232
with their health care provider

934
00:24:02.232 --> 00:24:04.151
about whether these are right for them

935
00:24:04.151 --> 00:24:05.402
or for you

936
00:24:05.485 --> 00:24:06.736
in where you might be

937
00:24:06.736 --> 00:24:08.029
in the progression and

938
00:24:08.989 --> 00:24:10.323
uh, and

939
00:24:10.323 --> 00:24:12.159
also understand what the potential impact

940
00:24:12.159 --> 00:24:13.743
or benefit may be for you.

941
00:24:13.743 --> 00:24:14.786
Some of them have side effects

942
00:24:14.786 --> 00:24:15.787
like GI side effects.

943
00:24:15.787 --> 00:24:17.164
Some of them are available

944
00:24:17.164 --> 00:24:18.457
in pill form

945
00:24:18.457 --> 00:24:20.041
and patch form and liquid form.

946
00:24:20.041 --> 00:24:20.959
So again, part of why

947
00:24:20.959 --> 00:24:22.294
there's such a discussion

948
00:24:22.294 --> 00:24:23.670
that needs to happen.

949
00:24:23.670 --> 00:24:26.006
The monoclonal antibodies targeted ...

950
00:24:26.006 --> 00:24:28.216
I saw someone say the drugs all end in MAB

951
00:24:28.216 --> 00:24:29.050
and so I might

952
00:24:29.050 --> 00:24:29.468
just add

953
00:24:29.468 --> 00:24:30.635
that I'm going to answer that one

954
00:24:30.635 --> 00:24:32.846
while we are talking here.

955
00:24:32.846 --> 00:24:33.555
So these are

956
00:24:33.555 --> 00:24:34.764
because they're monoclonal antibodies,

957
00:24:34.764 --> 00:24:36.183
which I think we've heard a lot about

958
00:24:36.183 --> 00:24:37.851
in the last two years with COVID. Right.

959
00:24:37.851 --> 00:24:39.686
And how they're made and what they are.

960
00:24:39.686 --> 00:24:42.147
And so they are

961
00:24:42.147 --> 00:24:43.440
they can be delivered

962
00:24:43.440 --> 00:24:44.691
either as an infusion or

963
00:24:45.734 --> 00:24:46.276
one of the

964
00:24:46.276 --> 00:24:46.776
other ones that we

965
00:24:46.776 --> 00:24:49.196
tested was an injection in the skin,

966
00:24:50.113 --> 00:24:51.531
although they were that particular

967
00:24:51.531 --> 00:24:52.240
one reported it,

968
00:24:52.240 --> 00:24:53.450
it didn't see

969
00:24:53.492 --> 00:24:55.911
a benefit in their top line results.

970
00:24:55.911 --> 00:24:56.870
So that that's why

971
00:24:56.870 --> 00:24:58.538
they're all they all end in MABS

972
00:24:58.538 --> 00:25:00.040
they are targeting beta-amyloid

973
00:25:00.040 --> 00:25:01.875
with the idea that that if they're

974
00:25:01.875 --> 00:25:02.959
and that

975
00:25:03.001 --> 00:25:05.545
data when they when they've mapped it out

976
00:25:05.545 --> 00:25:06.963
the totality of evidence

977
00:25:06.963 --> 00:25:08.381
In the case

978
00:25:08.381 --> 00:25:10.926
where the beta-amyloid is reduced

979
00:25:10.926 --> 00:25:12.928
there seems to be a benefit

980
00:25:12.928 --> 00:25:15.514
in terms of the less

981
00:25:15.514 --> 00:25:16.640
clinical decline

982
00:25:16.640 --> 00:25:17.807
in those individuals

983
00:25:17.807 --> 00:25:18.808
over a period of time.

984
00:25:18.808 --> 00:25:20.644
And these are not cures,

985
00:25:20.644 --> 00:25:23.063
these are having a

986
00:25:23.647 --> 00:25:25.440
modest benefit on these individuals.

987
00:25:25.440 --> 00:25:26.191
But again,

988
00:25:26.191 --> 00:25:26.733
what we hear

989
00:25:26.733 --> 00:25:28.109
very clearly from families

990
00:25:28.109 --> 00:25:28.735
and individuals

991
00:25:28.735 --> 00:25:30.529
that are living with Alzheimer's

992
00:25:30.529 --> 00:25:32.697
is that a modest benefit of a few months

993
00:25:32.697 --> 00:25:33.823
being maintained in a

994
00:25:33.823 --> 00:25:35.867
in an earlier phase of the disease,

995
00:25:35.867 --> 00:25:37.619
when they may have

996
00:25:37.619 --> 00:25:38.161
the ability

997
00:25:38.161 --> 00:25:39.454
to maintain their independence

998
00:25:39.454 --> 00:25:40.497
a little bit longer.

999
00:25:40.497 --> 00:25:41.915
But when you have the impact

1000
00:25:41.915 --> 00:25:42.457
of lowering that

1001
00:25:42.457 --> 00:25:43.708
amyloid, there seems to be,

1002
00:25:43.708 --> 00:25:44.793
at least in the clinical trials,

1003
00:25:44.793 --> 00:25:46.294
there seems to be a clinical benefit

1004
00:25:46.294 --> 00:25:47.337
on the individuals.

1005
00:25:47.337 --> 00:25:49.506
Now, I think your question was, you know,

1006
00:25:49.589 --> 00:25:50.882
what does that really mean?

1007
00:25:50.882 --> 00:25:52.676
And that's the idea of this

1008
00:25:52.676 --> 00:25:53.843
The combination is that there's

1009
00:25:53.843 --> 00:25:55.804
a lot of different biologies at work.

1010
00:25:55.804 --> 00:25:58.306
And so this is one biology that we can

1011
00:25:58.306 --> 00:26:00.267
we have these potential

1012
00:26:00.267 --> 00:26:01.184
drugs - one is approved,

1013
00:26:01.184 --> 00:26:02.769
others are in the pipeline -

1014
00:26:02.769 --> 00:26:04.854
that are targeting that one biology.

1015
00:26:04.854 --> 00:26:06.064
But there are other things going

1016
00:26:06.064 --> 00:26:07.315
on, and we need to have tools

1017
00:26:07.315 --> 00:26:09.192
that allow us to impact that biology.

1018
00:26:09.192 --> 00:26:10.110
So again, very much

1019
00:26:10.110 --> 00:26:11.236
think about cancer.

1020
00:26:11.236 --> 00:26:12.153
That when you think about

1021
00:26:12.153 --> 00:26:13.154
interventions of cancer,

1022
00:26:13.154 --> 00:26:14.447
there are different ways

1023
00:26:14.447 --> 00:26:16.157
based on a particular biology

1024
00:26:16.157 --> 00:26:17.450
of a given cancer,

1025
00:26:17.450 --> 00:26:18.660
the location of where it is,

1026
00:26:18.660 --> 00:26:19.828
where you might target

1027
00:26:19.828 --> 00:26:21.329
different biologies in that person.

1028
00:26:21.329 --> 00:26:22.330
There might be a combination

1029
00:26:22.330 --> 00:26:23.373
approach, right?

1030
00:26:23.373 --> 00:26:25.292
It's that same kind of idea

1031
00:26:25.292 --> 00:26:26.251
based on the biology,

1032
00:26:26.251 --> 00:26:27.252
can we move forward?

1033
00:26:27.252 --> 00:26:28.420
So these are really exciting

1034
00:26:28.420 --> 00:26:30.213
firsts in our space,

1035
00:26:30.213 --> 00:26:31.172
but they are the first

1036
00:26:31.172 --> 00:26:32.340
and they're going to lead to the second

1037
00:26:32.340 --> 00:26:34.050
and the third and are going

1038
00:26:34.050 --> 00:26:35.010
forward across the board.

1039
00:26:36.136 --> 00:26:36.845
Yeah, I think it's

1040
00:26:36.845 --> 00:26:37.762
helpful that you shared

1041
00:26:37.762 --> 00:26:39.014
like all the different causes.

1042
00:26:39.014 --> 00:26:39.931
Like I've always thought of it

1043
00:26:39.931 --> 00:26:42.058
as it's like this one thing. It's not.

1044
00:26:42.058 --> 00:26:43.351
And so I think that it's helpful

1045
00:26:43.351 --> 00:26:45.020
to understand, I get it

1046
00:26:45.020 --> 00:26:45.812
different medications

1047
00:26:45.812 --> 00:26:46.646
do different things

1048
00:26:46.646 --> 00:26:48.857
and will help different people.

1049
00:26:48.857 --> 00:26:50.734
I think about our brains,

1050
00:26:50.734 --> 00:26:51.860
our brains are

1051
00:26:51.860 --> 00:26:53.069
I mean, I'm moving my hands.

1052
00:26:53.069 --> 00:26:53.737
You're moving your head.

1053
00:26:53.737 --> 00:26:54.779
We're talking, we're breathing.

1054
00:26:54.779 --> 00:26:56.364
We're, you know,

1055
00:26:56.364 --> 00:26:57.949
we're engaging in a conversation,

1056
00:26:57.949 --> 00:26:58.533
all of that.

1057
00:26:58.533 --> 00:26:59.159
We're blinking,

1058
00:26:59.159 --> 00:27:00.118
we're swallowing, we're,

1059
00:27:00.118 --> 00:27:00.577
you know,

1060
00:27:00.577 --> 00:27:01.328
all of those

1061
00:27:01.328 --> 00:27:03.204
are really driven by our brains.

1062
00:27:03.204 --> 00:27:05.373
Our brains are a complex organ

1063
00:27:05.624 --> 00:27:07.000
that does incredible things

1064
00:27:07.000 --> 00:27:08.877
throughout our entire lives.

1065
00:27:08.877 --> 00:27:10.879
So when disease is present,

1066
00:27:10.879 --> 00:27:12.505
it's a complex disease

1067
00:27:12.505 --> 00:27:14.591
to impact the brain as well.

1068
00:27:14.591 --> 00:27:16.593
With all these therapies

1069
00:27:16.593 --> 00:27:18.178
that are in trials

1070
00:27:18.178 --> 00:27:19.846
Two questions actually. The first one,

1071
00:27:19.846 --> 00:27:21.056
is there anything

1072
00:27:21.056 --> 00:27:23.308
on the horizon for prevention?

1073
00:27:23.308 --> 00:27:24.601
And is there anything that's going

1074
00:27:24.601 --> 00:27:26.353
to help people living with Alzheimer's

1075
00:27:26.353 --> 00:27:28.396
right now or is it just trials?

1076
00:27:29.856 --> 00:27:30.106
Yeah.

1077
00:27:30.106 --> 00:27:30.732
So let's start with the

1078
00:27:30.732 --> 00:27:32.192
first one in terms of prevention.

1079
00:27:32.192 --> 00:27:34.527
So I mentioned just in passing at the end

1080
00:27:35.195 --> 00:27:36.363
of my comments,

1081
00:27:36.363 --> 00:27:37.405
My opening comments that there's

1082
00:27:37.405 --> 00:27:38.698
a lot of really exciting things

1083
00:27:38.698 --> 00:27:39.991
going on around risk reduction

1084
00:27:39.991 --> 00:27:41.326
as we think about risk reduction.

1085
00:27:41.326 --> 00:27:42.035
And in fact, I'm

1086
00:27:42.035 --> 00:27:43.286
I'm really particularly proud

1087
00:27:43.286 --> 00:27:44.788
of one of those studies

1088
00:27:44.788 --> 00:27:46.414
called the US Pointer as the Alzheimer's

1089
00:27:46.414 --> 00:27:47.957
Association is one of the leads

1090
00:27:47.957 --> 00:27:48.750
along with folks

1091
00:27:48.750 --> 00:27:49.834
at Wake Forest University

1092
00:27:49.834 --> 00:27:52.295
and other institutions across the country

1093
00:27:52.587 --> 00:27:56.049
that are evaluating very specific recipes

1094
00:27:56.341 --> 00:27:59.135
of behavioral interventions.

1095
00:27:59.135 --> 00:28:00.387
The risk reduction strategies

1096
00:28:00.387 --> 00:28:01.054
being combined

1097
00:28:01.054 --> 00:28:02.555
in a very specific way,

1098
00:28:02.555 --> 00:28:03.890
Things around nutritional guidance,

1099
00:28:03.890 --> 00:28:05.308
physical exercise,

1100
00:28:05.308 --> 00:28:07.477
health coaching and monitoring,

1101
00:28:07.477 --> 00:28:08.603
cognitive engagement,

1102
00:28:08.603 --> 00:28:10.230
social engagement as well.

1103
00:28:10.230 --> 00:28:11.439
And really putting those together

1104
00:28:11.439 --> 00:28:12.774
in very specific recipes,

1105
00:28:12.774 --> 00:28:13.650
either self-guided

1106
00:28:13.650 --> 00:28:15.694
or structured in individuals

1107
00:28:15.694 --> 00:28:16.444
that are thought to be at

1108
00:28:16.444 --> 00:28:17.946
an increased risk

1109
00:28:17.946 --> 00:28:18.571
for a two year

1110
00:28:18.571 --> 00:28:19.322
intervention to say

1111
00:28:19.322 --> 00:28:21.366
what's the impact on cognition.

1112
00:28:21.700 --> 00:28:24.035
Now this study, US Pointer, is

1113
00:28:24.494 --> 00:28:26.496
is the largest study of its kind

1114
00:28:26.496 --> 00:28:28.081
in scope and scale in the world.

1115
00:28:28.081 --> 00:28:29.582
And it really builds off of work

1116
00:28:29.582 --> 00:28:30.750
that's come before

1117
00:28:30.750 --> 00:28:32.669
it's built off of a study in FINGER

1118
00:28:32.669 --> 00:28:34.170
In Finland called FINGER

1119
00:28:34.170 --> 00:28:36.297
The Finnish Intervention Geriatric Study

1120
00:28:36.297 --> 00:28:37.966
where they saw in a smaller group

1121
00:28:37.966 --> 00:28:39.843
a more homogeneous population

1122
00:28:39.843 --> 00:28:41.219
that those that engaged

1123
00:28:41.219 --> 00:28:43.179
in a combined risk reduction

1124
00:28:43.179 --> 00:28:44.097
strategy compared to

1125
00:28:44.097 --> 00:28:45.014
usual care

1126
00:28:45.014 --> 00:28:46.558
had a benefit on cognition

1127
00:28:46.558 --> 00:28:48.476
after two years of intervention. Right.

1128
00:28:48.476 --> 00:28:49.686
So they continued to follow

1129
00:28:49.686 --> 00:28:51.730
those individuals on over time.

1130
00:28:51.730 --> 00:28:52.480
And they have

1131
00:28:52.480 --> 00:28:53.106
they've continued

1132
00:28:53.106 --> 00:28:53.982
to see a benefit

1133
00:28:53.982 --> 00:28:55.108
of those that engaged

1134
00:28:55.108 --> 00:28:57.360
in that specific recipe.

1135
00:28:57.360 --> 00:28:59.320
So taking that to a larger

1136
00:28:59.320 --> 00:29:01.823
and more diverse population is what U.S.

1137
00:29:01.823 --> 00:29:02.824
Pointer is looking to do.

1138
00:29:02.824 --> 00:29:04.534
So we're in five communities

1139
00:29:04.534 --> 00:29:05.660
across the country

1140
00:29:05.660 --> 00:29:07.078
Rhode Island, Chicago,

1141
00:29:07.078 --> 00:29:08.913
Houston, Wake Forest

1142
00:29:08.913 --> 00:29:10.832
in North Carolina, Winston-Salem

1143
00:29:10.832 --> 00:29:12.876
and Northern California and Sacramento.

1144
00:29:13.126 --> 00:29:15.044
Evaluating in communities

1145
00:29:15.044 --> 00:29:16.296
with an over 30%,

1146
00:29:16.296 --> 00:29:17.505
participants from

1147
00:29:17.505 --> 00:29:19.799
diverse and underrepresented populations

1148
00:29:19.799 --> 00:29:20.925
to say

1149
00:29:21.217 --> 00:29:22.969
What's the impact of these risk

1150
00:29:22.969 --> 00:29:25.138
reduction strategies in individuals?

1151
00:29:25.472 --> 00:29:26.765
And actually we've been

1152
00:29:26.765 --> 00:29:27.432
that funded

1153
00:29:27.432 --> 00:29:28.767
the parent study is fully funded

1154
00:29:28.767 --> 00:29:30.393
by the Alzheimer's Association

1155
00:29:30.393 --> 00:29:31.686
because this is such a big question

1156
00:29:31.686 --> 00:29:32.645
we all have,

1157
00:29:32.645 --> 00:29:33.396
but we've actually,

1158
00:29:33.396 --> 00:29:34.939
with the increase in federal funding,

1159
00:29:34.939 --> 00:29:35.523
being able to get

1160
00:29:35.523 --> 00:29:37.233
additional resources to say,

1161
00:29:37.233 --> 00:29:38.943
can we take a picture of the brain?

1162
00:29:38.943 --> 00:29:41.029
What's the impact on the biology

1163
00:29:41.029 --> 00:29:42.363
of these interventions as well?

1164
00:29:42.363 --> 00:29:44.407
What are we changing about the biology?

1165
00:29:44.407 --> 00:29:45.241
And so that's really,

1166
00:29:45.241 --> 00:29:46.993
I think, exciting to see that work

1167
00:29:46.993 --> 00:29:48.161
go forward

1168
00:29:48.161 --> 00:29:50.705
As of today, the things you can do are

1169
00:29:50.705 --> 00:29:52.123
your overall health, right?

1170
00:29:52.123 --> 00:29:53.249
Think about your heart health,

1171
00:29:53.249 --> 00:29:54.459
learn new things, continue

1172
00:29:54.459 --> 00:29:56.336
to use and use your brain.

1173
00:29:56.336 --> 00:29:57.003
Stay engaged

1174
00:29:57.003 --> 00:29:58.254
Stay involved.

1175
00:29:58.254 --> 00:29:58.797
Engage in things

1176
00:29:58.797 --> 00:30:00.840
that are going to challenge you or,

1177
00:30:00.965 --> 00:30:02.008
you know, get your heart pumping,

1178
00:30:02.008 --> 00:30:02.842
Whatever that might be.

1179
00:30:02.842 --> 00:30:03.885
It could be walking,

1180
00:30:03.885 --> 00:30:04.719
it could be dancing,

1181
00:30:04.719 --> 00:30:05.845
it could be swimming.

1182
00:30:05.845 --> 00:30:06.971
It could be

1183
00:30:06.971 --> 00:30:08.014
lots of different things

1184
00:30:08.014 --> 00:30:08.848
depending on you.

1185
00:30:08.848 --> 00:30:10.141
And of course, before you take on

1186
00:30:10.141 --> 00:30:11.226
any new exercise,

1187
00:30:11.226 --> 00:30:12.060
have that conversation with

1188
00:30:12.060 --> 00:30:12.936
your health care provider.

1189
00:30:13.895 --> 00:30:15.563
Your second question.

1190
00:30:15.563 --> 00:30:16.648
Yeah, I gave.

1191
00:30:16.648 --> 00:30:18.900
You remind everyone

1192
00:30:21.027 --> 00:30:22.821
Do you want to remind everyone, but.

1193
00:30:22.821 --> 00:30:23.822
Yeah. People who are living

1194
00:30:23.822 --> 00:30:26.157
with Alzheimer's right now,

1195
00:30:26.157 --> 00:30:27.659
there's a lot of trials going on.

1196
00:30:27.659 --> 00:30:28.910
Are treatments years away

1197
00:30:28.910 --> 00:30:29.911
because they're still on trial

1198
00:30:29.911 --> 00:30:30.245
or are there

1199
00:30:30.245 --> 00:30:31.955
things coming quickly

1200
00:30:31.955 --> 00:30:32.455
for the people

1201
00:30:32.455 --> 00:30:33.540
that are living with Alzheimer's

1202
00:30:33.540 --> 00:30:34.874
right this minute?

1203
00:30:35.166 --> 00:30:36.584
So as we think about Alzheimer's,

1204
00:30:36.584 --> 00:30:37.210
you and I talked about

1205
00:30:37.210 --> 00:30:38.461
it is a continuum, right?

1206
00:30:38.461 --> 00:30:39.838
So it somewhat depends on

1207
00:30:39.838 --> 00:30:42.006
where in that continuum somebody may be.

1208
00:30:42.257 --> 00:30:43.883
So some of the treatments

1209
00:30:43.883 --> 00:30:45.927
that I mentioned, particularly the

1210
00:30:45.927 --> 00:30:46.845
the MABS,

1211
00:30:46.845 --> 00:30:48.054
some of those are really

1212
00:30:48.054 --> 00:30:49.055
being tested in people

1213
00:30:49.055 --> 00:30:50.390
that are in that earlier stages.

1214
00:30:50.390 --> 00:30:51.349
So mild cognitive impairment

1215
00:30:51.349 --> 00:30:52.016
due to Alzheimer's

1216
00:30:52.016 --> 00:30:53.601
or mild Alzheimer's disease,

1217
00:30:53.601 --> 00:30:55.144
there are other ongoing trials

1218
00:30:55.144 --> 00:30:56.062
that are in the late stage

1219
00:30:56.062 --> 00:30:57.689
that are looking at

1220
00:30:57.689 --> 00:30:59.858
moderate, mild to moderate

1221
00:30:59.858 --> 00:31:02.193
and more advanced disease as well.

1222
00:31:02.402 --> 00:31:04.529
Again, across that entire continuum,

1223
00:31:04.737 --> 00:31:06.030
you may have different outputs,

1224
00:31:06.030 --> 00:31:06.906
so you might be looking at

1225
00:31:06.906 --> 00:31:07.949
can we impact cognition,

1226
00:31:07.949 --> 00:31:09.993
can we improve quality of life,

1227
00:31:09.993 --> 00:31:11.953
can we impact some of the non

1228
00:31:11.953 --> 00:31:12.871
cognitive symptoms

1229
00:31:12.871 --> 00:31:14.289
that a person may be experiencing?

1230
00:31:14.289 --> 00:31:15.456
So there's lots of different work

1231
00:31:15.456 --> 00:31:17.750
that's going on in that space.

1232
00:31:17.959 --> 00:31:19.377
There's also work going on in

1233
00:31:19.377 --> 00:31:20.336
kind of in what we would call

1234
00:31:20.336 --> 00:31:21.421
the psychosocial space.

1235
00:31:21.421 --> 00:31:22.463
So for instance,

1236
00:31:22.463 --> 00:31:24.090
if you are

1237
00:31:24.090 --> 00:31:25.049
receiving care

1238
00:31:25.049 --> 00:31:26.551
you need, you're going to

1239
00:31:26.551 --> 00:31:27.260
an emergency room.

1240
00:31:27.260 --> 00:31:29.095
How do we improve that experience?

1241
00:31:29.095 --> 00:31:30.179
So there's a lot of work

1242
00:31:30.179 --> 00:31:31.222
going on in that space

1243
00:31:31.222 --> 00:31:31.806
as well,

1244
00:31:31.806 --> 00:31:33.641
again, across that entire continuum,

1245
00:31:33.641 --> 00:31:35.101
so that individuals

1246
00:31:35.101 --> 00:31:36.811
both have the care,

1247
00:31:36.811 --> 00:31:37.979
the resources, wherever they may be,

1248
00:31:37.979 --> 00:31:39.105
and that we're really,

1249
00:31:39.105 --> 00:31:41.816
as a community, as a society, more moving

1250
00:31:41.816 --> 00:31:43.026
towards more dementia capable.

1251
00:31:44.777 --> 00:31:45.403
Got it.

1252
00:31:45.403 --> 00:31:47.488
Last question before we go to our Q&A.

1253
00:31:48.072 --> 00:31:51.159
What is giving you the most hope?

1254
00:31:52.869 --> 00:31:53.620
There's so much to

1255
00:31:53.620 --> 00:31:54.287
I mean, I think that's

1256
00:31:54.287 --> 00:31:55.163
why and I hope

1257
00:31:55.163 --> 00:31:56.873
that came through in the comments

1258
00:31:56.873 --> 00:31:58.124
and even in our back and forth, Janet.

1259
00:31:58.124 --> 00:31:59.500
It is so much.

1260
00:31:59.500 --> 00:31:59.918
And I think

1261
00:31:59.918 --> 00:32:01.836
In that I would say this fascinates me.

1262
00:32:01.836 --> 00:32:03.421
It's not any one thing.

1263
00:32:03.421 --> 00:32:05.256
And I you know, I think we often hear

1264
00:32:05.256 --> 00:32:07.467
we see in the headlines this or that

1265
00:32:07.759 --> 00:32:09.260
and actually it's all of it.

1266
00:32:09.260 --> 00:32:11.012
And I hope that's the message

1267
00:32:11.012 --> 00:32:12.138
that all of you see is

1268
00:32:12.138 --> 00:32:13.681
there's so much going on

1269
00:32:13.681 --> 00:32:16.017
in tools for early and accurate diagnosis.

1270
00:32:16.225 --> 00:32:16.809
You know,

1271
00:32:16.809 --> 00:32:18.937
even without an intervention, early

1272
00:32:18.937 --> 00:32:20.647
and accurate diagnosis allow you to plan,

1273
00:32:20.647 --> 00:32:21.773
allow you to do things

1274
00:32:21.773 --> 00:32:23.316
with your family in a new way,

1275
00:32:23.316 --> 00:32:24.734
allow you to have that conversation,

1276
00:32:24.734 --> 00:32:26.235
plan for your own care future.

1277
00:32:26.235 --> 00:32:27.445
You know, all of those types of things.

1278
00:32:27.445 --> 00:32:28.738
Take that trip you've always wanted

1279
00:32:28.738 --> 00:32:30.239
that maybe have been putting off

1280
00:32:30.239 --> 00:32:31.199
Actually, I sat next

1281
00:32:31.199 --> 00:32:32.617
to a couple on a plane,

1282
00:32:32.617 --> 00:32:34.202
coincidentally, and they said they

1283
00:32:34.202 --> 00:32:35.453
they were on their way somewhere.

1284
00:32:35.453 --> 00:32:37.288
And they said, well, actually, our

1285
00:32:37.288 --> 00:32:39.499
the wife had just been diagnosed.

1286
00:32:39.499 --> 00:32:39.958
And they said,

1287
00:32:39.958 --> 00:32:40.959
we've been putting this off,

1288
00:32:40.959 --> 00:32:42.293
we've been putting this off

1289
00:32:42.293 --> 00:32:43.628
and this is where we're going.

1290
00:32:43.628 --> 00:32:44.671
And I said, Well, actually,

1291
00:32:44.671 --> 00:32:45.713
I'm a scientist

1292
00:32:45.713 --> 00:32:47.423
and I work on Alzheimer's disease.

1293
00:32:47.423 --> 00:32:47.840
And so

1294
00:32:47.840 --> 00:32:49.175
we had a very lively discussion

1295
00:32:49.175 --> 00:32:50.009
for the rest of the flight,

1296
00:32:50.009 --> 00:32:51.636
as I'm sure you can imagine.

1297
00:32:51.636 --> 00:32:53.304
But that was a reminder to me

1298
00:32:53.304 --> 00:32:54.138
that it's it's

1299
00:32:54.138 --> 00:32:54.639
you know,

1300
00:32:54.639 --> 00:32:56.307
it's those types of things that an early

1301
00:32:56.307 --> 00:32:58.226
and accurate diagnosis help with.

1302
00:32:58.226 --> 00:33:00.019
But it's also this incredible diversity

1303
00:33:00.019 --> 00:33:00.645
in the pipeline.

1304
00:33:00.645 --> 00:33:02.522
And I see it firsthand in my role.

1305
00:33:02.522 --> 00:33:03.147
As I mentioned,

1306
00:33:03.147 --> 00:33:04.565
the association has a program

1307
00:33:04.565 --> 00:33:05.733
called Parts of Cloud

1308
00:33:05.733 --> 00:33:07.652
that is funding actively funding phase

1309
00:33:07.652 --> 00:33:09.862
one and phase two of early stage trials

1310
00:33:10.113 --> 00:33:11.572
and accelerating them forward.

1311
00:33:11.572 --> 00:33:12.782
And just the diversity

1312
00:33:12.782 --> 00:33:13.533
of what's happening,

1313
00:33:13.533 --> 00:33:14.617
the innovation

1314
00:33:14.617 --> 00:33:16.452
that what's happening in that space,

1315
00:33:16.452 --> 00:33:16.744
you know,

1316
00:33:16.744 --> 00:33:17.620
both new drugs,

1317
00:33:17.620 --> 00:33:19.414
new things that have been developed

1318
00:33:19.414 --> 00:33:20.331
that are being evaluated,

1319
00:33:20.331 --> 00:33:21.958
but also really creative things

1320
00:33:21.958 --> 00:33:23.668
about think this is a biology.

1321
00:33:23.668 --> 00:33:24.168
And in fact,

1322
00:33:24.168 --> 00:33:26.170
this was something that was developed for

1323
00:33:27.422 --> 00:33:28.923
that was developed for cancer.

1324
00:33:28.923 --> 00:33:30.216
And at a lower dose,

1325
00:33:30.216 --> 00:33:32.176
it has this impact on this biology

1326
00:33:32.176 --> 00:33:33.720
and we can test it

1327
00:33:33.720 --> 00:33:34.679
as a potential treatment.

1328
00:33:34.679 --> 00:33:36.014
The biology makes sense.

1329
00:33:36.014 --> 00:33:36.931
You know, if we

1330
00:33:36.931 --> 00:33:38.307
if we change this and this,

1331
00:33:38.307 --> 00:33:39.600
it doesn't have the same impact.

1332
00:33:39.600 --> 00:33:40.309
It doesn't do this.

1333
00:33:40.309 --> 00:33:41.060
But actually, here's

1334
00:33:41.060 --> 00:33:42.186
the impact on the biology

1335
00:33:42.186 --> 00:33:43.479
that we know is important in disease.

1336
00:33:43.479 --> 00:33:44.480
So there's a lot of

1337
00:33:44.480 --> 00:33:46.024
that kind of momentum.

1338
00:33:46.024 --> 00:33:47.150
Wow, that's great.

1339
00:33:47.150 --> 00:33:48.693
Yeah, it sounds like so much help.

1340
00:33:48.693 --> 00:33:50.778
It's mind blowing.

1341
00:33:50.778 --> 00:33:52.155
It's fantastic.

1342
00:33:52.155 --> 00:33:53.614
We don't realize all this is going on.

1343
00:33:53.614 --> 00:33:55.116
So thank you for sharing that.

1344
00:33:55.116 --> 00:33:56.826
If we could pop up the slide

1345
00:33:56.826 --> 00:33:58.411
of all the social media links,

1346
00:33:58.411 --> 00:33:59.912
I want to show everyone the places

1347
00:33:59.912 --> 00:34:00.997
you can learn more about

1348
00:34:00.997 --> 00:34:03.416
Dr. Snyder and the Alzheimer's Association,

1349
00:34:03.958 --> 00:34:04.917
and you can screen

1350
00:34:04.917 --> 00:34:06.419
capture it or remember,

1351
00:34:06.419 --> 00:34:07.295
we're going to send you this.

1352
00:34:07.295 --> 00:34:07.920
So you're going to get

1353
00:34:07.920 --> 00:34:09.088
a recording of this

1354
00:34:09.088 --> 00:34:10.131
to share with your family,

1355
00:34:10.131 --> 00:34:12.050
your loved ones, refer to later.

1356
00:34:12.050 --> 00:34:13.051
But these are places

1357
00:34:13.051 --> 00:34:15.178
where you can like and follow.

1358
00:34:15.511 --> 00:34:16.971
And now it's time to hear

1359
00:34:16.971 --> 00:34:18.139
from all of you.

1360
00:34:18.139 --> 00:34:20.224
So we welcome your questions.

1361
00:34:20.224 --> 00:34:21.350
Jonathan wants to know

1362
00:34:21.350 --> 00:34:22.477
What are the signs

1363
00:34:22.477 --> 00:34:24.604
when someone would qualify for brain

1364
00:34:24.604 --> 00:34:26.981
imaging versus a blood test?

1365
00:34:28.316 --> 00:34:29.400
Yeah, it's a great question.

1366
00:34:29.400 --> 00:34:31.402
And I think it's important to recognize

1367
00:34:31.402 --> 00:34:32.945
kind of where these tools are today.

1368
00:34:32.945 --> 00:34:35.656
So there are tools that are available

1369
00:34:35.782 --> 00:34:36.949
in terms of imaging

1370
00:34:36.949 --> 00:34:38.242
and there's different kinds of imaging.

1371
00:34:38.242 --> 00:34:39.035
So, you know,

1372
00:34:39.035 --> 00:34:39.994
one of the things that's looking at

1373
00:34:39.994 --> 00:34:40.870
the underlying biology

1374
00:34:40.870 --> 00:34:41.913
might be PET imaging,

1375
00:34:41.913 --> 00:34:43.956
that's looking at specifically beta-amyloid.

1376
00:34:43.956 --> 00:34:45.500
And there's three agents

1377
00:34:45.500 --> 00:34:47.293
that have been approved for that

1378
00:34:47.293 --> 00:34:49.087
and one for tau

1379
00:34:49.087 --> 00:34:49.712
They're not approved

1380
00:34:49.712 --> 00:34:51.089
as diagnostic for Alzheimer's,

1381
00:34:51.089 --> 00:34:51.964
though they're approved,

1382
00:34:51.964 --> 00:34:53.841
for looking at the biology.

1383
00:34:53.841 --> 00:34:54.592
And so that's a really

1384
00:34:54.592 --> 00:34:56.344
important distinction.

1385
00:34:56.344 --> 00:34:57.345
And at this point in time,

1386
00:34:57.345 --> 00:34:58.471
the Alzheimer's Association

1387
00:34:58.471 --> 00:34:59.847
had put together

1388
00:34:59.847 --> 00:35:01.390
with the Society of Nuclear Medicine

1389
00:35:01.390 --> 00:35:02.558
and Molecular Imaging.

1390
00:35:02.558 --> 00:35:03.810
Appropriate use guidelines

1391
00:35:03.810 --> 00:35:05.645
and recommendations for their use.

1392
00:35:05.645 --> 00:35:06.187
And it's really

1393
00:35:06.187 --> 00:35:08.648
in only specific instances where

1394
00:35:08.648 --> 00:35:09.565
where it's going to improve

1395
00:35:09.565 --> 00:35:11.067
the certainty of a diagnosis, right.

1396
00:35:11.067 --> 00:35:11.567
And help

1397
00:35:11.567 --> 00:35:13.194
in the certainty of a diagnosis

1398
00:35:13.194 --> 00:35:14.654
for an individual.

1399
00:35:14.654 --> 00:35:16.280
Now, blood tests are coming soon

1400
00:35:16.280 --> 00:35:17.365
and they're coming fast.

1401
00:35:17.365 --> 00:35:18.741
And so actually this past summer,

1402
00:35:18.741 --> 00:35:19.867
the Alzheimer's Association

1403
00:35:19.867 --> 00:35:20.910
International Conference,

1404
00:35:20.910 --> 00:35:22.203
which is the largest

1405
00:35:22.203 --> 00:35:23.913
convening of dementia scientists

1406
00:35:23.913 --> 00:35:25.456
we had about 10,000 people

1407
00:35:25.456 --> 00:35:26.999
from 99 countries,

1408
00:35:26.999 --> 00:35:28.376
10,000 scientists and researchers

1409
00:35:28.376 --> 00:35:30.419
from 99 countries coming together

1410
00:35:30.419 --> 00:35:32.130
to share the latest on science.

1411
00:35:32.130 --> 00:35:33.422
And one of those was appropriate

1412
00:35:33.422 --> 00:35:34.715
use recommendations on blood tests.

1413
00:35:34.715 --> 00:35:35.675
So where are we in

1414
00:35:35.675 --> 00:35:37.385
terms of thinking about research,

1415
00:35:37.385 --> 00:35:38.928
thinking about specialty care

1416
00:35:38.928 --> 00:35:40.596
and thinking about primary care?

1417
00:35:40.596 --> 00:35:41.722
So in research,

1418
00:35:41.722 --> 00:35:43.141
we are absolutely seeing this

1419
00:35:43.141 --> 00:35:44.142
tremendous uptake.

1420
00:35:44.142 --> 00:35:46.853
And it's really it's happening fast.

1421
00:35:46.853 --> 00:35:47.145
Right.

1422
00:35:47.145 --> 00:35:48.396
And these tools

1423
00:35:48.396 --> 00:35:49.564
being used, these blood tests

1424
00:35:49.564 --> 00:35:50.398
being used

1425
00:35:50.398 --> 00:35:51.399
in specialty care,

1426
00:35:51.399 --> 00:35:52.650
there might be a certain places

1427
00:35:52.650 --> 00:35:54.485
that they're being used,

1428
00:35:54.485 --> 00:35:55.444
particularly when they're

1429
00:35:55.444 --> 00:35:56.404
there might be a need

1430
00:35:56.404 --> 00:35:57.905
and there's a clear understanding

1431
00:35:57.905 --> 00:35:58.739
of where they are.

1432
00:35:58.739 --> 00:36:00.408
The recommendations were in primary care.

1433
00:36:00.408 --> 00:36:02.076
We're not quite there yet

1434
00:36:02.076 --> 00:36:03.411
in terms of really understanding

1435
00:36:03.411 --> 00:36:04.662
what these tools are telling us

1436
00:36:04.662 --> 00:36:05.538
and what they might mean

1437
00:36:05.538 --> 00:36:07.874
for an individual in the progression.

1438
00:36:07.874 --> 00:36:09.208
So just to maybe

1439
00:36:09.208 --> 00:36:10.626
give a little bit of landscape of

1440
00:36:10.626 --> 00:36:12.170
of where all of they are,

1441
00:36:12.170 --> 00:36:13.045
there's a lot happening.

1442
00:36:13.045 --> 00:36:13.963
There's a lot of momentum.

1443
00:36:13.963 --> 00:36:15.423
It's exciting,

1444
00:36:15.423 --> 00:36:17.466
but not all of them are necessarily

1445
00:36:18.092 --> 00:36:18.926
in all of our doctor's

1446
00:36:18.926 --> 00:36:19.927
offices across the country.

1447
00:36:19.927 --> 00:36:21.304
And there's appropriate

1448
00:36:21.304 --> 00:36:22.680
appropriate in terms of the

1449
00:36:22.680 --> 00:36:24.932
the the benefit

1450
00:36:24.932 --> 00:36:25.975
for clinical care,

1451
00:36:25.975 --> 00:36:28.227
where they where they may be applied.

1452
00:36:28.227 --> 00:36:29.103
Got it.

1453
00:36:29.395 --> 00:36:29.812
All right.

1454
00:36:29.812 --> 00:36:30.813
We have another question

1455
00:36:30.813 --> 00:36:32.190
coming in from Karen.

1456
00:36:32.190 --> 00:36:33.649
How do we get involved

1457
00:36:33.649 --> 00:36:35.443
in a clinical trial?

1458
00:36:36.444 --> 00:36:37.528
Love that question.

1459
00:36:37.528 --> 00:36:38.863
I love that question, Karen.

1460
00:36:38.863 --> 00:36:41.282
And actually, I was I was in

1461
00:36:42.283 --> 00:36:43.659
Rochester, New York, last week.

1462
00:36:43.659 --> 00:36:44.827
I think I saw someone in the chat

1463
00:36:44.827 --> 00:36:45.453
say Rochester.

1464
00:36:45.453 --> 00:36:46.204
And that was the question

1465
00:36:46.204 --> 00:36:47.580
that I had a chance to meet

1466
00:36:47.580 --> 00:36:49.415
just an incredible couple that

1467
00:36:49.415 --> 00:36:50.833
have been married for 45 years.

1468
00:36:50.833 --> 00:36:51.918
And she's an active participant

1469
00:36:51.918 --> 00:36:52.460
in the trial

1470
00:36:52.460 --> 00:36:53.544
and they share that

1471
00:36:53.544 --> 00:36:54.629
their passion for doing it

1472
00:36:54.629 --> 00:36:56.172
is that they have children

1473
00:36:56.172 --> 00:36:57.215
and they they want

1474
00:36:57.215 --> 00:36:58.591
they want to see a change

1475
00:36:58.591 --> 00:36:58.925
their hope

1476
00:36:58.925 --> 00:37:00.176
she benefits from

1477
00:37:00.176 --> 00:37:01.552
whatever treatments being tested.

1478
00:37:01.552 --> 00:37:03.262
But they really want to see a change

1479
00:37:03.262 --> 00:37:04.347
in the future for their children

1480
00:37:04.347 --> 00:37:06.015
and their future grandchildren.

1481
00:37:06.015 --> 00:37:06.933
So clinical trials,

1482
00:37:06.933 --> 00:37:09.060
the Alzheimer's Association has

1483
00:37:09.060 --> 00:37:10.228
one of the things we heard very loud

1484
00:37:10.228 --> 00:37:12.271
and clear from our constituents

1485
00:37:12.271 --> 00:37:13.022
was how challenging

1486
00:37:13.022 --> 00:37:14.398
it was to find trials.

1487
00:37:14.398 --> 00:37:15.691
And there are so many different kinds.

1488
00:37:15.691 --> 00:37:16.776
They're not all drug trials.

1489
00:37:16.776 --> 00:37:17.944
There are trials for care

1490
00:37:17.944 --> 00:37:20.112
interventions, for risk reduction

1491
00:37:20.112 --> 00:37:22.114
strategies, online studies

1492
00:37:22.114 --> 00:37:22.448
that you can

1493
00:37:22.448 --> 00:37:24.033
participate in,

1494
00:37:24.033 --> 00:37:26.410
surveys around perception of the disease, etc

1495
00:37:26.786 --> 00:37:28.829
and putting that together in a in a tool

1496
00:37:28.829 --> 00:37:30.206
that's relatively easy to use.

1497
00:37:30.206 --> 00:37:31.165
So we launched

1498
00:37:31.165 --> 00:37:32.792
something called Trial Match

1499
00:37:32.792 --> 00:37:34.627
or Alzheimer's Association Trial Match,

1500
00:37:34.627 --> 00:37:36.837
and I'll put it in the chat in a moment.

1501
00:37:36.837 --> 00:37:37.713
But what this is, is

1502
00:37:37.713 --> 00:37:40.049
it's essentially like a match.com

1503
00:37:40.049 --> 00:37:41.842
for clinical trials, if you will. Right?

1504
00:37:41.842 --> 00:37:42.927
You fill out your profile

1505
00:37:42.927 --> 00:37:43.886
and then it tells you

1506
00:37:43.886 --> 00:37:46.138
what might be going on in your community.

1507
00:37:46.138 --> 00:37:46.681
And again,

1508
00:37:46.681 --> 00:37:48.015
this is not just for individuals

1509
00:37:48.015 --> 00:37:49.350
that are living with Alzheimer's

1510
00:37:49.350 --> 00:37:50.017
or another dementia.

1511
00:37:50.017 --> 00:37:51.602
It's it's the full

1512
00:37:51.602 --> 00:37:53.145
this can be people providing care, people

1513
00:37:53.145 --> 00:37:54.313
that are just concerned, people

1514
00:37:54.313 --> 00:37:56.440
that think that they're at a higher risk.

1515
00:37:56.607 --> 00:37:59.485
You know, individuals that say, I just,

1516
00:37:59.485 --> 00:38:01.237
hey, follow me for a time to see

1517
00:38:01.237 --> 00:38:02.196
what might be the changes

1518
00:38:02.196 --> 00:38:02.947
that happen to me.

1519
00:38:02.947 --> 00:38:04.824
Or I can be a participant in some way.

1520
00:38:04.824 --> 00:38:05.700
So there's a lot of different

1521
00:38:05.700 --> 00:38:07.201
kinds of things that are out there,

1522
00:38:07.201 --> 00:38:08.452
different ways to get involved.

1523
00:38:08.452 --> 00:38:10.579
And I'll put the link in the chat.

1524
00:38:10.579 --> 00:38:10.913
Actually,

1525
00:38:10.913 --> 00:38:11.998
I can't put the link in the text,

1526
00:38:11.998 --> 00:38:13.749
but I will chat it to Brookdale

1527
00:38:13.749 --> 00:38:14.875
and they will put the link in the

1528
00:38:14.875 --> 00:38:15.876
chat. [Perfect]

1529
00:38:16.919 --> 00:38:18.879
So you know as an opportunity to find

1530
00:38:18.879 --> 00:38:20.506
what might be happening in your community

1531
00:38:20.506 --> 00:38:22.383
or if you're

1532
00:38:22.383 --> 00:38:23.843
the person that's living with dementia

1533
00:38:23.843 --> 00:38:24.844
is maybe in a different community,

1534
00:38:24.844 --> 00:38:25.469
or you have siblings

1535
00:38:25.469 --> 00:38:26.220
in different communities

1536
00:38:26.220 --> 00:38:27.471
that might be interested,

1537
00:38:27.471 --> 00:38:28.055
they can find

1538
00:38:28.055 --> 00:38:29.223
what might be going on in their

1539
00:38:29.223 --> 00:38:30.516
in their area.

1540
00:38:30.516 --> 00:38:32.768
Okay, here's a great one from Joyce.

1541
00:38:32.768 --> 00:38:33.936
Does eliminating

1542
00:38:33.936 --> 00:38:36.063
sugars, increasing exercise

1543
00:38:36.063 --> 00:38:39.608
and increasing MCT oil reduce cognitive

1544
00:38:39.608 --> 00:38:42.778
impairment?

1545
00:38:42.778 --> 00:38:43.404
Great question.

1546
00:38:43.404 --> 00:38:43.946
Joyce and I,

1547
00:38:43.946 --> 00:38:44.905
I wish I could tell you

1548
00:38:44.905 --> 00:38:46.574
that there was one,

1549
00:38:46.574 --> 00:38:47.700
you know, one

1550
00:38:47.700 --> 00:38:49.201
kind of specific thing

1551
00:38:49.201 --> 00:38:50.578
that was going to particularly

1552
00:38:50.578 --> 00:38:52.663
from a nutritional piece, right?

1553
00:38:52.663 --> 00:38:53.748
There was one specific thing

1554
00:38:53.748 --> 00:38:54.749
that was going to

1555
00:38:54.749 --> 00:38:56.125
be able to reduce risk

1556
00:38:56.125 --> 00:38:58.502
and that we knew that definitively.

1557
00:38:58.502 --> 00:38:59.587
Unfortunately, we don't know that.

1558
00:38:59.587 --> 00:39:01.047
But what we do know

1559
00:39:01.047 --> 00:39:01.922
is that for instance,

1560
00:39:01.922 --> 00:39:02.882
one of the other studies

1561
00:39:02.882 --> 00:39:04.050
that we saw reported out

1562
00:39:04.050 --> 00:39:05.217
at this past summer's

1563
00:39:05.217 --> 00:39:06.385
Alzheimer's Association's

1564
00:39:06.385 --> 00:39:07.136
international conference

1565
00:39:07.136 --> 00:39:09.388
looked at ultra processed foods

1566
00:39:09.388 --> 00:39:11.515
and suggested that individuals that had

1567
00:39:12.058 --> 00:39:12.725
ultra processed

1568
00:39:12.725 --> 00:39:14.518
foods, that made up a certain component

1569
00:39:14.518 --> 00:39:15.519
amount of their diet

1570
00:39:15.519 --> 00:39:16.896
were at an increased risk.

1571
00:39:16.896 --> 00:39:18.481
And so those are changes

1572
00:39:18.481 --> 00:39:20.024
we might be able to make in our diet

1573
00:39:20.024 --> 00:39:22.234
that may impact or lower our risk.

1574
00:39:22.568 --> 00:39:24.195
So, you know, that might be on a

1575
00:39:24.195 --> 00:39:25.404
on an individual level.

1576
00:39:25.404 --> 00:39:26.906
It may or may not have an impact.

1577
00:39:26.906 --> 00:39:28.199
But on a population level,

1578
00:39:28.199 --> 00:39:29.325
that's where we're going to see,

1579
00:39:29.325 --> 00:39:30.034
you know, an impact

1580
00:39:30.034 --> 00:39:30.868
on those types of things.

1581
00:39:30.868 --> 00:39:32.453
Same with physical exercise.

1582
00:39:32.453 --> 00:39:34.288
The study suggests that on a population

1583
00:39:34.288 --> 00:39:35.998
basis, engaging in physical exercise

1584
00:39:35.998 --> 00:39:37.083
and staying active,

1585
00:39:37.083 --> 00:39:39.210
there's a benefit to that.

1586
00:39:39.210 --> 00:39:41.045
And that's why studies like U.S. Pointer

1587
00:39:41.045 --> 00:39:42.797
are so important is the goal is that

1588
00:39:42.797 --> 00:39:43.381
hopefully they're going

1589
00:39:43.381 --> 00:39:45.216
to give us much more guidance in,

1590
00:39:45.216 --> 00:39:47.009
what are those specific things

1591
00:39:47.009 --> 00:39:47.760
we have to do?

1592
00:39:47.760 --> 00:39:48.636
What are the specific

1593
00:39:48.636 --> 00:39:50.346
aspects within nutrition

1594
00:39:50.346 --> 00:39:51.722
or within physical exercise

1595
00:39:51.722 --> 00:39:53.849
that we need to do to reduce our risk?

1596
00:39:53.849 --> 00:39:54.975
And what does that look like?

1597
00:39:54.975 --> 00:39:56.727
And so we don't have all the answers,

1598
00:39:56.727 --> 00:39:58.020
but that's really where it comes down

1599
00:39:58.020 --> 00:39:59.397
to, you know, eat a balanced diet,

1600
00:39:59.397 --> 00:40:00.064
Make sure you're getting

1601
00:40:00.064 --> 00:40:01.565
your nutrients from your food,

1602
00:40:01.565 --> 00:40:02.525
Low saturated

1603
00:40:02.525 --> 00:40:03.901
fats, reduced sugars.

1604
00:40:03.901 --> 00:40:04.777
Those are all things

1605
00:40:04.777 --> 00:40:06.320
that have been shown to be

1606
00:40:06.320 --> 00:40:07.780
beneficial in reducing risk.

1607
00:40:08.989 --> 00:40:10.324
You know, engage in exercise

1608
00:40:10.324 --> 00:40:11.075
and those types of

1609
00:40:11.075 --> 00:40:12.159
things as well.

1610
00:40:13.452 --> 00:40:14.203
That's great.

1611
00:40:14.203 --> 00:40:15.746
Again, everything that makes us healthy

1612
00:40:15.746 --> 00:40:16.789
in our body makes us healthier

1613
00:40:16.789 --> 00:40:17.373
in our brain.

1614
00:40:17.373 --> 00:40:19.750
So here I have two questions

1615
00:40:19.750 --> 00:40:21.335
that are very similar.

1616
00:40:21.335 --> 00:40:22.586
One person says a family

1617
00:40:22.586 --> 00:40:24.255
member is recently diagnosed.

1618
00:40:24.255 --> 00:40:26.465
What symptoms other than memory loss

1619
00:40:26.465 --> 00:40:27.967
can we expect to see?

1620
00:40:27.967 --> 00:40:29.593
And someone else is similarly saying,

1621
00:40:29.593 --> 00:40:31.095
what's the biggest lifestyle change

1622
00:40:31.095 --> 00:40:32.596
I can expect to see

1623
00:40:32.596 --> 00:40:33.305
when caring

1624
00:40:33.305 --> 00:40:33.973
or living with someone

1625
00:40:33.973 --> 00:40:37.143
suffering from Alzheimer's or dementia?

1626
00:40:37.143 --> 00:40:38.436
Yeah, so they're both great

1627
00:40:38.436 --> 00:40:39.186
at these questions.

1628
00:40:39.186 --> 00:40:40.020
I'm seeing them come through

1629
00:40:40.020 --> 00:40:41.188
and there's a ton, so I don't know that.

1630
00:40:41.188 --> 00:40:41.772
We'll get to all of you.

1631
00:40:41.772 --> 00:40:43.315
We'll try. We'll keep trying.

1632
00:40:43.315 --> 00:40:44.150
But, you know,

1633
00:40:44.150 --> 00:40:45.151
I think the first question is

1634
00:40:45.151 --> 00:40:45.693
I would direct you

1635
00:40:45.693 --> 00:40:46.318
to a resource

1636
00:40:46.318 --> 00:40:47.695
on the association's website

1637
00:40:47.695 --> 00:40:50.322
www.alz.org/alzheimers-dementia/10_signs

1638
00:40:50.614 --> 00:40:52.616
Uh, and the reason is, is that there,

1639
00:40:52.658 --> 00:40:53.159
you know,

1640
00:40:53.159 --> 00:40:54.034
there might be one thing

1641
00:40:54.034 --> 00:40:54.994
that one person would notice

1642
00:40:54.994 --> 00:40:55.619
and something else

1643
00:40:55.619 --> 00:40:56.787
that another person might notice.

1644
00:40:56.787 --> 00:40:57.538
So it's really something

1645
00:40:57.538 --> 00:40:59.081
that's a change, right?

1646
00:40:59.081 --> 00:40:59.498
And that in

1647
00:40:59.498 --> 00:41:00.416
that you've always been doing.

1648
00:41:00.416 --> 00:41:02.293
So an example I am

1649
00:41:02.293 --> 00:41:03.210
A lot of people

1650
00:41:03.210 --> 00:41:03.961
make fun of me for this,

1651
00:41:03.961 --> 00:41:06.881
but I love my paper register for my check

1652
00:41:07.173 --> 00:41:09.216
book and I still balance my checkbook

1653
00:41:09.216 --> 00:41:10.176
with the paper register.

1654
00:41:10.176 --> 00:41:11.302
And I've had people be like,

1655
00:41:11.302 --> 00:41:12.678
There's an app for that,

1656
00:41:12.678 --> 00:41:14.013
but I like my paper register.

1657
00:41:14.013 --> 00:41:16.265
It gives me comfort. I do it every week.

1658
00:41:16.640 --> 00:41:17.933
I always have.

1659
00:41:17.933 --> 00:41:19.977
I don't imagine myself stopping.

1660
00:41:19.977 --> 00:41:22.646
My husband has never done that, ever.

1661
00:41:23.022 --> 00:41:25.232
I he couldn't do it ten years ago.

1662
00:41:25.232 --> 00:41:26.025
He couldn't do it today.

1663
00:41:26.025 --> 00:41:26.901
And he's not going to able to do it

1664
00:41:26.901 --> 00:41:27.776
in ten years.

1665
00:41:27.776 --> 00:41:29.570
So for him, the ability to not do

1666
00:41:29.570 --> 00:41:30.988
that isn't going to be a sign

1667
00:41:30.988 --> 00:41:33.240
that there's an issue going on for me

1668
00:41:33.240 --> 00:41:33.991
as someone that's done

1669
00:41:33.991 --> 00:41:34.950
it weekly

1670
00:41:34.950 --> 00:41:36.535
for years, for decades,

1671
00:41:36.535 --> 00:41:38.037
and plan to keep doing it

1672
00:41:38.037 --> 00:41:40.039
If I have issues with that,

1673
00:41:40.039 --> 00:41:41.707
if that becomes a challenge for me,

1674
00:41:41.707 --> 00:41:42.958
that's a change in something

1675
00:41:42.958 --> 00:41:43.834
that I've done over

1676
00:41:43.834 --> 00:41:45.252
a long period of time. Right.

1677
00:41:45.252 --> 00:41:46.795
So it's not so much forgetting

1678
00:41:46.795 --> 00:41:47.796
where your car keys are.

1679
00:41:47.796 --> 00:41:48.672
I don't even know where mine are

1680
00:41:48.672 --> 00:41:49.507
right now,

1681
00:41:49.507 --> 00:41:50.424
but it's actually forgetting

1682
00:41:50.424 --> 00:41:51.717
what they are for, right?

1683
00:41:51.717 --> 00:41:52.635
It's that kind of thing.

1684
00:41:52.635 --> 00:41:54.178
It's a change in those types of things.

1685
00:41:54.178 --> 00:41:54.929
But some people,

1686
00:41:54.929 --> 00:41:56.555
it might be a visual perception.

1687
00:41:56.555 --> 00:41:57.890
I met somebody in Dallas once

1688
00:41:57.890 --> 00:41:59.850
that told me he was an executive.

1689
00:41:59.850 --> 00:42:01.894
He said it was word retrieval,

1690
00:42:01.894 --> 00:42:02.853
that his challenges

1691
00:42:02.853 --> 00:42:04.647
that he had challenges in terms of

1692
00:42:04.647 --> 00:42:06.774
he was writing memos to his team

1693
00:42:06.774 --> 00:42:07.983
and it was actually word retrieval.

1694
00:42:07.983 --> 00:42:10.152
He had to call his wife and say,

1695
00:42:10.152 --> 00:42:11.987
what's that thing that tells time

1696
00:42:11.987 --> 00:42:13.322
that's got the hands?

1697
00:42:13.322 --> 00:42:14.448
And it was a clock, right?

1698
00:42:14.448 --> 00:42:14.823
It was,

1699
00:42:14.823 --> 00:42:16.200
you know, it's that kind of thing.

1700
00:42:16.200 --> 00:42:17.159
And so I

1701
00:42:17.159 --> 00:42:18.369
it can be different for everybody.

1702
00:42:18.369 --> 00:42:19.203
I saw somebody already

1703
00:42:19.203 --> 00:42:20.246
put the ten signs in there,

1704
00:42:20.246 --> 00:42:21.372
which is great.

1705
00:42:21.539 --> 00:42:22.748
So, you know, that's a

1706
00:42:22.748 --> 00:42:24.208
that's a place to go for.

1707
00:42:24.208 --> 00:42:25.876
And then the other question was around

1708
00:42:25.876 --> 00:42:27.586
what is the biggest lifestyle change

1709
00:42:27.586 --> 00:42:28.254
that you'd expect

1710
00:42:28.254 --> 00:42:29.463
when you're providing care?

1711
00:42:29.463 --> 00:42:31.423
So similarly, other than memory loss,

1712
00:42:31.423 --> 00:42:34.051
what are the big lifestyle changes

1713
00:42:34.051 --> 00:42:34.718
to expect?

1714
00:42:34.718 --> 00:42:36.428
Any tips from you as well?

1715
00:42:36.428 --> 00:42:37.388
Is they

1716
00:42:37.388 --> 00:42:38.430
as they're living with

1717
00:42:38.430 --> 00:42:39.598
and caring for somebody

1718
00:42:39.598 --> 00:42:41.058
who who has Alzheimer's?

1719
00:42:42.685 --> 00:42:43.227
Yeah, it really

1720
00:42:43.227 --> 00:42:44.311
does depend on on

1721
00:42:44.311 --> 00:42:45.354
where someone might be

1722
00:42:45.354 --> 00:42:46.397
and the progression.

1723
00:42:46.397 --> 00:42:48.190
Right. And them

1724
00:42:48.190 --> 00:42:50.317
as an individual as well.

1725
00:42:50.317 --> 00:42:51.569
So, for instance,

1726
00:42:51.569 --> 00:42:53.195
for our grandmother, it was

1727
00:42:53.195 --> 00:42:54.530
there was a progression

1728
00:42:54.530 --> 00:42:56.865
and she actually fed herself

1729
00:42:56.865 --> 00:42:58.951
for a long period of time,

1730
00:42:59.660 --> 00:43:01.078
even when she was in the

1731
00:43:01.078 --> 00:43:02.454
very advanced stages

1732
00:43:02.454 --> 00:43:04.832
and was no longer mobile.

1733
00:43:04.832 --> 00:43:05.499
So that was

1734
00:43:05.499 --> 00:43:07.668
that was something that she maintained

1735
00:43:07.668 --> 00:43:09.044
and considered for other people

1736
00:43:09.044 --> 00:43:10.462
that something that may be impacted

1737
00:43:10.462 --> 00:43:10.921
early on.

1738
00:43:10.921 --> 00:43:13.257
So it is really

1739
00:43:13.257 --> 00:43:14.466
dependent on the individual.

1740
00:43:14.466 --> 00:43:15.175
So, you know,

1741
00:43:15.175 --> 00:43:16.218
I think have that conversation

1742
00:43:16.218 --> 00:43:17.011
with your health care provider.

1743
00:43:17.011 --> 00:43:17.720
How about conversation?

1744
00:43:17.720 --> 00:43:18.887
Call the 800 number,

1745
00:43:18.887 --> 00:43:19.471
share more

1746
00:43:19.471 --> 00:43:21.515
about your specific circumstances

1747
00:43:21.515 --> 00:43:23.267
and ask for those kinds of tools.

1748
00:43:23.267 --> 00:43:23.726
And I will say

1749
00:43:23.726 --> 00:43:25.144
wandering is an issue that we hear

1750
00:43:25.144 --> 00:43:25.936
from many people,

1751
00:43:25.936 --> 00:43:26.854
for instance,

1752
00:43:26.854 --> 00:43:27.896
getting lost if,

1753
00:43:27.896 --> 00:43:28.397
you know,

1754
00:43:28.397 --> 00:43:28.939
particularly that

1755
00:43:28.939 --> 00:43:30.274
individual's experiences.

1756
00:43:30.274 --> 00:43:31.150
And we do have tools

1757
00:43:31.150 --> 00:43:32.526
and resources on our website

1758
00:43:32.526 --> 00:43:34.320
and that's just the Alz.org

1759
00:43:34.320 --> 00:43:36.572
that is the front part of the next two

1760
00:43:38.157 --> 00:43:39.116
That the last

1761
00:43:39.116 --> 00:43:40.618
two links that were shared,

1762
00:43:40.618 --> 00:43:41.869
there's a lot of resources

1763
00:43:41.869 --> 00:43:43.078
on there about,

1764
00:43:43.078 --> 00:43:43.954
you know, different ways

1765
00:43:43.954 --> 00:43:45.497
or different tools of supporting

1766
00:43:45.497 --> 00:43:46.832
somebody that's living with dementia.

1767
00:43:46.832 --> 00:43:48.667
And again, our 1-800 number

1768
00:43:48.667 --> 00:43:51.295
1-800-272-3900

1769
00:43:51.545 --> 00:43:52.921
it's on the website as well.

1770
00:43:52.921 --> 00:43:54.506
You can access that and reach out

1771
00:43:54.506 --> 00:43:56.258
for your specific circumstance

1772
00:43:56.258 --> 00:43:57.885
that we can give you tools and resources

1773
00:43:57.885 --> 00:43:59.762
that can help you in your care.

1774
00:43:59.762 --> 00:44:00.971
That's great.

1775
00:44:01.555 --> 00:44:02.848
We just pop it in the chat as well.

1776
00:44:02.848 --> 00:44:03.724
Okay.

1777
00:44:03.974 --> 00:44:04.975
When can you start

1778
00:44:04.975 --> 00:44:06.810
taking medications for Alzheimer's

1779
00:44:06.810 --> 00:44:07.895
and can you take them

1780
00:44:07.895 --> 00:44:11.857
as a preventive measure?

1781
00:44:11.857 --> 00:44:14.526
So to the first question,

1782
00:44:14.526 --> 00:44:15.402
that's really a conversation

1783
00:44:15.402 --> 00:44:15.903
with your health care

1784
00:44:15.903 --> 00:44:17.071
provider based on you,

1785
00:44:17.071 --> 00:44:17.988
your other medications,

1786
00:44:17.988 --> 00:44:18.614
your other conditions,

1787
00:44:18.614 --> 00:44:19.239
your overall health.

1788
00:44:19.239 --> 00:44:21.241
so, that's a discussion

1789
00:44:21.241 --> 00:44:23.327
that should be very specific to you

1790
00:44:23.327 --> 00:44:24.662
or your

1791
00:44:24.662 --> 00:44:25.871
the individual's health

1792
00:44:25.871 --> 00:44:27.665
and health considerations.

1793
00:44:27.665 --> 00:44:28.582
In terms of prevention,

1794
00:44:28.582 --> 00:44:29.875
there's no evidence that

1795
00:44:29.875 --> 00:44:31.960
that these are beneficial for prevention.

1796
00:44:31.960 --> 00:44:32.378
And in fact,

1797
00:44:32.378 --> 00:44:33.170
there are side effects

1798
00:44:33.170 --> 00:44:34.296
and other considerations

1799
00:44:34.296 --> 00:44:35.255
that come into play.

1800
00:44:36.423 --> 00:44:38.258
For instance, the Cholinesterase inhibitors

1801
00:44:38.258 --> 00:44:39.927
There's no indicator

1802
00:44:39.927 --> 00:44:41.053
that they're stopping or slowing

1803
00:44:41.053 --> 00:44:42.971
the underlying biology. Right.

1804
00:44:42.971 --> 00:44:44.640
So you wouldn't necessarily

1805
00:44:44.640 --> 00:44:45.432
expect an impact.

1806
00:44:45.432 --> 00:44:47.226
And then there are side effects.

1807
00:44:47.226 --> 00:44:49.436
They're not approved for that use, etc..

1808
00:44:49.436 --> 00:44:51.021
In terms of some of the drugs

1809
00:44:51.021 --> 00:44:51.939
that are in trials right now,

1810
00:44:51.939 --> 00:44:53.649
there are actually trials that are called

1811
00:44:53.649 --> 00:44:55.109
prevention trials that are in individuals

1812
00:44:55.109 --> 00:44:55.651
for instance,

1813
00:44:55.651 --> 00:44:57.569
might have the biology, but not yet,

1814
00:44:57.569 --> 00:44:59.363
not yet experience the cognition.

1815
00:44:59.363 --> 00:45:00.948
To answer that question, to say,

1816
00:45:00.948 --> 00:45:02.700
are these things that perhaps we can do

1817
00:45:02.700 --> 00:45:03.409
earlier on

1818
00:45:03.409 --> 00:45:05.202
if we have this particular profile

1819
00:45:05.202 --> 00:45:07.287
that may be able to impact the changes

1820
00:45:07.287 --> 00:45:07.830
in cognition?

1821
00:45:07.830 --> 00:45:08.872
So we don't know the answer to that,

1822
00:45:08.872 --> 00:45:10.374
but that is actively being tested

1823
00:45:10.374 --> 00:45:11.709
and evaluated.

1824
00:45:11.750 --> 00:45:13.627
Once you've been diagnosed,

1825
00:45:13.627 --> 00:45:16.463
how quick is the decline for most people

1826
00:45:16.588 --> 00:45:17.798
and how long can you live

1827
00:45:17.798 --> 00:45:20.676
with the disease?

1828
00:45:20.676 --> 00:45:20.968
Yeah.

1829
00:45:20.968 --> 00:45:21.969
So, you know,

1830
00:45:21.969 --> 00:45:23.887
I'm sorry that this is the answer

1831
00:45:23.887 --> 00:45:25.848
I keep saying, but it does depend.

1832
00:45:25.848 --> 00:45:27.224
So the averages that we see

1833
00:45:27.224 --> 00:45:29.017
are 4 to 8 years for individuals

1834
00:45:29.017 --> 00:45:30.519
from the time of diagnosis,

1835
00:45:30.519 --> 00:45:31.895
but some individuals are diagnosed

1836
00:45:31.895 --> 00:45:32.896
in the much earlier stages.

1837
00:45:32.896 --> 00:45:33.605
It could be longer.

1838
00:45:33.605 --> 00:45:34.982
Other individuals have

1839
00:45:34.982 --> 00:45:36.567
other health conditions

1840
00:45:36.567 --> 00:45:37.443
that may make it faster.

1841
00:45:37.443 --> 00:45:38.569
It's with very dependent

1842
00:45:38.569 --> 00:45:39.319
on the individual,

1843
00:45:39.319 --> 00:45:40.070
so it's hard to give you

1844
00:45:40.070 --> 00:45:42.322
a specific number.

1845
00:45:42.322 --> 00:45:43.657
It can be up to 30 years.

1846
00:45:43.657 --> 00:45:46.243
And so it's very

1847
00:45:46.493 --> 00:45:48.078
there's a number of different variables

1848
00:45:48.078 --> 00:45:49.496
that come into play.

1849
00:45:49.496 --> 00:45:51.540
But the average in in terms of reporting

1850
00:45:51.540 --> 00:45:52.458
from diagnosis

1851
00:45:52.458 --> 00:45:53.041
based on

1852
00:45:53.041 --> 00:45:54.209
if you look at Medicare or Medicaid

1853
00:45:54.209 --> 00:45:56.378
claims data is 4 to 8 years.

1854
00:45:57.045 --> 00:45:57.755
Got it.

1855
00:45:58.046 --> 00:45:58.464
All right.

1856
00:45:58.464 --> 00:46:00.966
Here's here's a question I love.

1857
00:46:00.966 --> 00:46:03.427
What are the best kind of computer games

1858
00:46:03.427 --> 00:46:07.389
to help stave off dementia?

1859
00:46:07.389 --> 00:46:08.056
So similarly,

1860
00:46:08.056 --> 00:46:08.932
I wish I could give you

1861
00:46:08.932 --> 00:46:10.642
that specific recipe. Right.

1862
00:46:10.642 --> 00:46:12.019
And where we are,

1863
00:46:12.019 --> 00:46:13.270
I think it's the same kind of thing.

1864
00:46:13.270 --> 00:46:13.604
It's like,

1865
00:46:13.604 --> 00:46:15.272
do something that you enjoy doing

1866
00:46:15.272 --> 00:46:15.898
using your brain

1867
00:46:15.898 --> 00:46:16.774
that's stretching your brain,

1868
00:46:16.774 --> 00:46:17.858
that's teaching you new things

1869
00:46:17.858 --> 00:46:19.568
and continue to do it.

1870
00:46:19.568 --> 00:46:21.570
And while we don't have any evidence

1871
00:46:21.570 --> 00:46:23.864
on any particular game, there have been

1872
00:46:23.864 --> 00:46:24.782
there have been

1873
00:46:24.782 --> 00:46:26.450
I think there was one large study

1874
00:46:26.450 --> 00:46:27.659
or there's been a handful of studies

1875
00:46:27.659 --> 00:46:28.535
that have been

1876
00:46:28.660 --> 00:46:29.578
smaller in number

1877
00:46:29.578 --> 00:46:30.871
that have said suggested

1878
00:46:30.871 --> 00:46:32.706
a benefit or suggested an impact.

1879
00:46:32.706 --> 00:46:32.956
You know,

1880
00:46:32.956 --> 00:46:33.415
I think now

1881
00:46:33.415 --> 00:46:34.666
we're seeing them incorporated

1882
00:46:34.666 --> 00:46:35.584
or being incorporated

1883
00:46:35.584 --> 00:46:37.252
into large scale clinical trials

1884
00:46:37.252 --> 00:46:39.046
to really evaluate that impact.

1885
00:46:39.046 --> 00:46:40.005
So we don't have that

1886
00:46:40.005 --> 00:46:41.423
that kind of specific tool.

1887
00:46:41.423 --> 00:46:42.716
But do what you like to do,

1888
00:46:42.716 --> 00:46:43.801
do what you enjoy doing,

1889
00:46:43.801 --> 00:46:45.219
do what's going to stretch your brain,

1890
00:46:45.219 --> 00:46:46.094
do what's going to keep you

1891
00:46:46.094 --> 00:46:47.221
engaged, keep you active.

1892
00:46:47.221 --> 00:46:48.305
And that's really

1893
00:46:48.305 --> 00:46:50.098
at this point in time what

1894
00:46:50.098 --> 00:46:50.849
what we can tell you.

1895
00:46:51.975 --> 00:46:52.392
All right.

1896
00:46:52.392 --> 00:46:54.561
Here's a great question from Tom.

1897
00:46:54.561 --> 00:46:57.231
Do we see similar conditions in animals

1898
00:46:57.231 --> 00:46:59.274
or is this unique to humans?

1899
00:47:00.818 --> 00:47:01.109
Yeah.

1900
00:47:01.109 --> 00:47:03.028
So there are a couple animals

1901
00:47:03.028 --> 00:47:05.280
that do experience

1902
00:47:05.280 --> 00:47:07.741
cognitive issues or cognitive changes.

1903
00:47:08.492 --> 00:47:09.868
Not all of them

1904
00:47:09.868 --> 00:47:11.036
are the same as Alzheimer's,

1905
00:47:11.036 --> 00:47:11.578
for instance.

1906
00:47:11.578 --> 00:47:12.120
But, you know,

1907
00:47:12.120 --> 00:47:12.704
there are

1908
00:47:12.704 --> 00:47:13.622
there are some

1909
00:47:13.622 --> 00:47:14.289
there is some work,

1910
00:47:14.289 --> 00:47:15.749
for instance, in dogs.

1911
00:47:15.749 --> 00:47:17.209
And I think I heard recently cats.

1912
00:47:17.209 --> 00:47:18.460
But you

1913
00:47:18.460 --> 00:47:19.253
you can see those,

1914
00:47:19.253 --> 00:47:21.213
but it's not quite the same.

1915
00:47:21.213 --> 00:47:21.755
And part of that

1916
00:47:21.755 --> 00:47:22.714
is because of the complexity

1917
00:47:22.714 --> 00:47:24.132
of the human brain

1918
00:47:24.132 --> 00:47:25.050
and some of the differences

1919
00:47:25.050 --> 00:47:27.886
in the human brain compared to others.

1920
00:47:29.555 --> 00:47:31.265
Here's here's a really good question.

1921
00:47:31.265 --> 00:47:33.433
It's it's one I know we all want to know.

1922
00:47:33.433 --> 00:47:35.602
As Alzheimer's progresses,

1923
00:47:35.602 --> 00:47:39.481
does the person who has it suffer?

1924
00:47:39.481 --> 00:47:40.190
Great question.

1925
00:47:40.190 --> 00:47:41.608
And, you know, I mean, I think that's why

1926
00:47:41.608 --> 00:47:42.651
there's so much work on

1927
00:47:42.651 --> 00:47:43.944
how can we improve and support

1928
00:47:43.944 --> 00:47:45.279
the quality of life throughout.

1929
00:47:45.279 --> 00:47:46.905
And so there are things that,

1930
00:47:46.905 --> 00:47:47.197
you know,

1931
00:47:47.197 --> 00:47:48.448
benefiting quality of life

1932
00:47:48.448 --> 00:47:49.867
and ensuring

1933
00:47:49.950 --> 00:47:50.826
that throughout

1934
00:47:50.826 --> 00:47:52.369
those experiences, engagement

1935
00:47:52.369 --> 00:47:53.829
and continuing to be engaged

1936
00:47:53.829 --> 00:47:55.831
and to be part of the community

1937
00:47:55.831 --> 00:47:58.000
or part of a community and activities

1938
00:47:58.000 --> 00:47:58.709
and things like that

1939
00:47:58.709 --> 00:47:59.668
and how to address that.

1940
00:48:00.794 --> 00:48:01.920
I think that's really where

1941
00:48:01.920 --> 00:48:03.088
a lot of that work comes into

1942
00:48:03.088 --> 00:48:04.339
to ensure that really

1943
00:48:04.339 --> 00:48:05.549
there's that high quality of life

1944
00:48:05.549 --> 00:48:07.259
throughout the entire disease progression.

1945
00:48:07.259 --> 00:48:09.011
Are there any initiatives

1946
00:48:09.011 --> 00:48:10.596
for having brain MRI

1947
00:48:10.596 --> 00:48:13.473
scans covered by Medicare, for diagnosing

1948
00:48:13.891 --> 00:48:16.602
any early onsets of cognitive declines?

1949
00:48:16.852 --> 00:48:18.270
Yeah, so maybe let me break

1950
00:48:18.270 --> 00:48:18.854
that down a little bit

1951
00:48:18.854 --> 00:48:19.771
because I'm not completely sure

1952
00:48:19.771 --> 00:48:21.398
I understand the question in the context.

1953
00:48:21.398 --> 00:48:22.941
So oftentimes

1954
00:48:22.941 --> 00:48:23.233
you'll see

1955
00:48:23.233 --> 00:48:24.192
an MRI that's used

1956
00:48:24.192 --> 00:48:26.361
as part of the process of a diagnosis

1957
00:48:26.361 --> 00:48:27.487
because it's often a rule out.

1958
00:48:27.487 --> 00:48:28.280
So you're really looking for

1959
00:48:28.280 --> 00:48:29.573
some vascular changes,

1960
00:48:29.573 --> 00:48:30.824
white matter, what we call

1961
00:48:30.824 --> 00:48:32.534
white matter, hyper intense intensities

1962
00:48:32.534 --> 00:48:33.785
or other things

1963
00:48:33.785 --> 00:48:34.828
that may be changing

1964
00:48:34.828 --> 00:48:35.829
in the vasculature

1965
00:48:35.829 --> 00:48:38.415
the vascular processes in the brain

1966
00:48:39.291 --> 00:48:40.584
to rule out that that's actually

1967
00:48:40.584 --> 00:48:41.960
a contributor to the symptoms

1968
00:48:41.960 --> 00:48:43.211
that an individual may experience.

1969
00:48:43.211 --> 00:48:44.713
And that is something that is

1970
00:48:44.713 --> 00:48:46.089
part of routine care.

1971
00:48:46.089 --> 00:48:47.341
Routine care

1972
00:48:47.341 --> 00:48:48.342
Not care. Routine

1973
00:48:48.342 --> 00:48:49.635
kind of diagnosis that you'll often

1974
00:48:49.635 --> 00:48:51.637
see that as part of it.

1975
00:48:51.637 --> 00:48:52.220
Some of the imaging

1976
00:48:52.220 --> 00:48:52.888
that I'm talking about

1977
00:48:52.888 --> 00:48:54.014
more is like PET scanning.

1978
00:48:54.014 --> 00:48:55.891
So it's the it's looking at specific

1979
00:48:55.891 --> 00:48:57.976
brain changes like the beta-amyloid

1980
00:48:57.976 --> 00:48:58.852
and the

1981
00:49:01.104 --> 00:49:02.356
Tau protein, for instance.

1982
00:49:02.356 --> 00:49:03.815
But there are also lots of other things

1983
00:49:03.815 --> 00:49:05.233
that are being developed.

1984
00:49:05.233 --> 00:49:06.360
Uh, and as,

1985
00:49:06.360 --> 00:49:07.235
and this is why

1986
00:49:07.235 --> 00:49:08.528
I think this might be the question

1987
00:49:08.528 --> 00:49:10.781
that the person is actually asking,

1988
00:49:10.781 --> 00:49:12.032
is that as of today, while

1989
00:49:12.032 --> 00:49:13.742
there are several of those agents

1990
00:49:13.742 --> 00:49:15.452
that are approved by the FDA,

1991
00:49:15.452 --> 00:49:16.411
the Food and Drug Administration

1992
00:49:16.411 --> 00:49:17.162
in the United States,

1993
00:49:17.162 --> 00:49:19.414
they're not readily covered,

1994
00:49:19.414 --> 00:49:21.291
particularly the beta-amyloid images,

1995
00:49:21.291 --> 00:49:22.626
and it's covered under something

1996
00:49:22.626 --> 00:49:23.251
called coverage

1997
00:49:23.251 --> 00:49:24.294
with evidence development.

1998
00:49:24.294 --> 00:49:25.712
So only in the instances

1999
00:49:25.712 --> 00:49:27.214
of particular studies

2000
00:49:27.214 --> 00:49:28.006
and initiatives

2001
00:49:28.006 --> 00:49:28.715
that are collecting

2002
00:49:28.715 --> 00:49:30.926
a different additional coverage

2003
00:49:30.926 --> 00:49:32.344
or additional evidence

2004
00:49:32.344 --> 00:49:33.720
about the impact of those.

2005
00:49:33.720 --> 00:49:34.805
Are they being covered

2006
00:49:34.805 --> 00:49:36.723
within clinical care.

2007
00:49:36.723 --> 00:49:37.641
The Alzheimer's Association

2008
00:49:37.641 --> 00:49:38.558
is actually leading

2009
00:49:38.558 --> 00:49:40.352
they are leading the idea study

2010
00:49:40.352 --> 00:49:41.478
And now the new ideas study,

2011
00:49:41.478 --> 00:49:43.397
which is really

2012
00:49:43.397 --> 00:49:44.648
the initiatives are to collect

2013
00:49:44.648 --> 00:49:45.607
additional evidence

2014
00:49:45.607 --> 00:49:49.528
for the impact of amyloid imaging on care

2015
00:49:49.528 --> 00:49:50.529
and what that is.

2016
00:49:50.529 --> 00:49:51.822
And so I referenced right

2017
00:49:51.822 --> 00:49:52.572
at a high level

2018
00:49:52.572 --> 00:49:53.615
in my comments,

2019
00:49:53.615 --> 00:49:55.409
but that these tools have been shown that

2020
00:49:55.409 --> 00:49:56.702
when you have an accurate diagnosis,

2021
00:49:56.702 --> 00:49:57.452
when you're more certain

2022
00:49:57.452 --> 00:49:59.246
of your diagnosis,

2023
00:49:59.246 --> 00:50:00.747
that there's an improvement in care,

2024
00:50:00.747 --> 00:50:02.165
there's a change in care planning.

2025
00:50:02.165 --> 00:50:03.291
And that's what we've been able

2026
00:50:03.291 --> 00:50:04.292
to see in these studies.

2027
00:50:04.292 --> 00:50:05.961
And I should note ideas within

2028
00:50:05.961 --> 00:50:07.504
18,000 individuals, it's

2029
00:50:07.504 --> 00:50:08.672
the largest study

2030
00:50:08.672 --> 00:50:10.048
of its kind in our space

2031
00:50:10.048 --> 00:50:12.009
and new ideas is now taking place

2032
00:50:12.009 --> 00:50:13.844
in over 7000 individuals.

2033
00:50:13.844 --> 00:50:14.594
Again, to collect

2034
00:50:14.594 --> 00:50:16.179
that evidence that would say,

2035
00:50:16.179 --> 00:50:17.723
having this type of tool

2036
00:50:17.723 --> 00:50:18.640
available to us

2037
00:50:18.640 --> 00:50:20.142
as part of the diagnostic workup

2038
00:50:20.142 --> 00:50:20.976
in instances

2039
00:50:20.976 --> 00:50:22.227
where it will support

2040
00:50:22.227 --> 00:50:24.062
the diagnostic process

2041
00:50:24.062 --> 00:50:26.314
changes and improves care.

2042
00:50:26.314 --> 00:50:26.690
You know,

2043
00:50:26.690 --> 00:50:28.316
and I think your point that, look,

2044
00:50:28.316 --> 00:50:29.818
getting an accurate diagnosis

2045
00:50:29.818 --> 00:50:31.695
so that you can attack it

2046
00:50:31.695 --> 00:50:33.488
the right way is smart.

2047
00:50:33.488 --> 00:50:35.574
We have a question from somebody here

2048
00:50:35.574 --> 00:50:36.742
that says

2049
00:50:36.742 --> 00:50:38.827
from Breane, who says, My mom, 71,

2050
00:50:38.827 --> 00:50:40.620
she has mild cognitive impairment,

2051
00:50:40.620 --> 00:50:42.247
diagnosed for about five years.

2052
00:50:42.247 --> 00:50:44.166
I'm 43 year old female.

2053
00:50:44.166 --> 00:50:45.459
What tests, evaluations,

2054
00:50:45.459 --> 00:50:46.585
What should I advocate

2055
00:50:46.585 --> 00:50:48.253
for myself in the near future

2056
00:50:48.253 --> 00:50:49.838
or is it too early for that?

2057
00:50:51.089 --> 00:50:51.631
Yeah, so I think

2058
00:50:51.631 --> 00:50:52.299
there's different things.

2059
00:50:52.299 --> 00:50:54.134
So, you know, to the question

2060
00:50:54.134 --> 00:50:56.344
around my mom or, you know, and I

2061
00:50:56.344 --> 00:50:58.263
your mom and might come out long term.

2062
00:50:58.263 --> 00:50:59.097
I think having that

2063
00:50:59.097 --> 00:51:00.098
continued conversation

2064
00:51:00.098 --> 00:51:00.599
with your health care

2065
00:51:00.599 --> 00:51:02.059
provider ensure that they know

2066
00:51:02.059 --> 00:51:04.144
they are aware of that where things are.

2067
00:51:04.144 --> 00:51:05.270
There are a lot of causes of mild

2068
00:51:05.270 --> 00:51:06.521
cognitive impairment.

2069
00:51:06.521 --> 00:51:07.564
It's not necessarily

2070
00:51:07.564 --> 00:51:08.440
Alzheimer's disease, right.

2071
00:51:08.440 --> 00:51:09.900
There could be other things going on

2072
00:51:09.900 --> 00:51:10.984
ensuring that

2073
00:51:10.984 --> 00:51:12.527
she has a full workup

2074
00:51:12.527 --> 00:51:13.403
and trying to understand

2075
00:51:13.403 --> 00:51:14.738
what might be impacting

2076
00:51:14.738 --> 00:51:16.490
the cognition in your mom

2077
00:51:16.490 --> 00:51:17.199
is certainly

2078
00:51:17.199 --> 00:51:18.658
if maybe that's already happened,

2079
00:51:18.658 --> 00:51:20.368
already taken place.

2080
00:51:20.368 --> 00:51:21.036
And then I think it's

2081
00:51:21.036 --> 00:51:22.079
some of the same things, right?

2082
00:51:22.079 --> 00:51:22.871
There are studies.

2083
00:51:22.871 --> 00:51:23.914
The study I talked about

2084
00:51:23.914 --> 00:51:25.082
from this past summer

2085
00:51:25.082 --> 00:51:26.708
that suggest being physically active

2086
00:51:26.708 --> 00:51:28.376
is still beneficial or like,

2087
00:51:28.627 --> 00:51:30.253
it suggests that it's still beneficial

2088
00:51:30.253 --> 00:51:32.547
and continuing to find ways of engagement

2089
00:51:32.547 --> 00:51:33.840
and what that looks like

2090
00:51:33.840 --> 00:51:34.633
but it's have that conversation

2091
00:51:34.633 --> 00:51:35.342
with your health care

2092
00:51:35.342 --> 00:51:36.718
provider, know what your baseline is

2093
00:51:36.718 --> 00:51:38.261
and go forward.

2094
00:51:38.261 --> 00:51:39.805
Janet, to your question around, you know,

2095
00:51:39.805 --> 00:51:40.597
what should you be doing?

2096
00:51:40.597 --> 00:51:41.348
I think it's the same,

2097
00:51:41.348 --> 00:51:42.766
you know, be aware.

2098
00:51:42.766 --> 00:51:44.142
But is there any particular test

2099
00:51:44.142 --> 00:51:45.727
right now that's going to tell you?

2100
00:51:45.727 --> 00:51:46.520
Unfortunately, no,

2101
00:51:46.520 --> 00:51:48.271
we're not quite that far back

2102
00:51:48.271 --> 00:51:49.356
in that timeline

2103
00:51:49.356 --> 00:51:50.732
of where things are

2104
00:51:50.732 --> 00:51:51.983
A lot of this is still very much

2105
00:51:51.983 --> 00:51:53.151
in the research phase

2106
00:51:53.151 --> 00:51:54.152
as we try to understand

2107
00:51:54.152 --> 00:51:55.112
what it really means

2108
00:51:55.112 --> 00:51:56.863
and what it really tells you.

2109
00:51:56.863 --> 00:51:58.615
And there's a lot of considerations

2110
00:51:58.615 --> 00:52:00.951
around all of those different pieces.

2111
00:52:00.951 --> 00:52:02.035
And I think that's where,

2112
00:52:02.452 --> 00:52:03.787
participate in a clinical trial.

2113
00:52:03.787 --> 00:52:04.704
Like, you know, fine,

2114
00:52:04.704 --> 00:52:05.497
if there's something right for you,

2115
00:52:05.497 --> 00:52:06.331
we're seeing trials

2116
00:52:06.331 --> 00:52:07.290
move younger and younger,

2117
00:52:07.290 --> 00:52:08.458
which is as we're moving

2118
00:52:08.458 --> 00:52:09.668
kind of back in that

2119
00:52:09.668 --> 00:52:11.545
that timeline of of possible

2120
00:52:12.921 --> 00:52:15.215
contributions to life risk

2121
00:52:15.465 --> 00:52:16.424
what that looks like.

2122
00:52:16.424 --> 00:52:17.884
So participating in a clinical trial

2123
00:52:17.884 --> 00:52:18.969
is certainly something,

2124
00:52:18.969 --> 00:52:20.095
but I think, continue

2125
00:52:20.095 --> 00:52:21.847
to advocate for resources

2126
00:52:21.847 --> 00:52:22.722
for families,

2127
00:52:22.722 --> 00:52:23.932
for increased research funding,

2128
00:52:23.932 --> 00:52:24.766
that's an opportunity

2129
00:52:24.766 --> 00:52:25.767
for you to get engaged.

2130
00:52:25.767 --> 00:52:27.060
If this is a journey

2131
00:52:27.060 --> 00:52:28.728
you've had with your family,

2132
00:52:28.728 --> 00:52:30.063
tell your story, continue

2133
00:52:30.063 --> 00:52:31.898
to raise awareness in your community.

2134
00:52:31.898 --> 00:52:33.024
You know, it's not something

2135
00:52:33.024 --> 00:52:33.942
that we should be

2136
00:52:33.942 --> 00:52:35.068
putting behind closed doors.

2137
00:52:35.068 --> 00:52:35.819
We should be talking

2138
00:52:35.819 --> 00:52:36.695
about these experiences.

2139
00:52:36.695 --> 00:52:37.445
We should be ensuring

2140
00:52:37.445 --> 00:52:38.697
that families have the resources

2141
00:52:38.697 --> 00:52:40.699
they need, access to information.

2142
00:52:40.907 --> 00:52:42.284
The science tells us actually,

2143
00:52:42.284 --> 00:52:43.243
that families

2144
00:52:43.243 --> 00:52:44.703
that have access to resources,

2145
00:52:44.703 --> 00:52:45.829
the Alzheimer's Association,

2146
00:52:45.829 --> 00:52:47.372
AARP,

2147
00:52:47.372 --> 00:52:48.748
you know, in your community

2148
00:52:48.748 --> 00:52:50.750
that has access to these resources,

2149
00:52:50.750 --> 00:52:51.960
there are better outcomes overall

2150
00:52:51.960 --> 00:52:52.878
for the individual but

2151
00:52:52.878 --> 00:52:53.879
also to the family.

2152
00:52:55.297 --> 00:52:55.922
So there

2153
00:52:55.922 --> 00:52:56.673
is a couple of questions

2154
00:52:56.673 --> 00:52:58.758
coming in too about caregivers, right.

2155
00:52:58.758 --> 00:52:59.426
So one of them,

2156
00:52:59.426 --> 00:53:00.468
Pat, wants to know what

2157
00:53:00.468 --> 00:53:01.678
resources are available

2158
00:53:01.678 --> 00:53:03.638
to help caregivers navigate

2159
00:53:03.638 --> 00:53:06.057
all these possible treatments and drugs.

2160
00:53:07.142 --> 00:53:07.392
Yeah.

2161
00:53:07.392 --> 00:53:07.976
So again,

2162
00:53:07.976 --> 00:53:09.060
that's a place

2163
00:53:09.060 --> 00:53:10.520
where the Alzheimer's Association,

2164
00:53:10.520 --> 00:53:11.855
you might have your community area

2165
00:53:11.855 --> 00:53:13.023
on aging. AARP

2166
00:53:13.023 --> 00:53:13.982
There's a lot of resources

2167
00:53:13.982 --> 00:53:14.858
that are available

2168
00:53:14.858 --> 00:53:16.526
so you can access and link to

2169
00:53:16.526 --> 00:53:17.527
we link to all of them.

2170
00:53:17.527 --> 00:53:18.904
So through Alz.org

2171
00:53:18.904 --> 00:53:20.655
there's a lot of resources for caregivers

2172
00:53:20.655 --> 00:53:21.573
and of course we do know

2173
00:53:21.573 --> 00:53:23.033
that sometimes it's reading information,

2174
00:53:23.033 --> 00:53:23.909
but there's also online

2175
00:53:23.909 --> 00:53:25.452
virtual ways of communicating.

2176
00:53:25.452 --> 00:53:26.119
There might be support

2177
00:53:26.119 --> 00:53:27.245
groups in your community.

2178
00:53:27.245 --> 00:53:28.622
Not everyone can physically come.

2179
00:53:28.622 --> 00:53:30.248
I think that's one of the things that we

2180
00:53:30.248 --> 00:53:30.832
we learned through

2181
00:53:30.832 --> 00:53:31.666
the pandemic is actually

2182
00:53:31.666 --> 00:53:32.792
we saw a huge increase

2183
00:53:32.792 --> 00:53:34.920
in people connecting virtually

2184
00:53:34.920 --> 00:53:35.670
in a new way

2185
00:53:35.670 --> 00:53:37.214
and in providing support

2186
00:53:37.214 --> 00:53:38.715
to one another within the community.

2187
00:53:38.715 --> 00:53:40.050
So that's an opportunity.

2188
00:53:40.050 --> 00:53:41.885
And of course, when in those instances,

2189
00:53:41.885 --> 00:53:42.844
when you have questions,

2190
00:53:42.844 --> 00:53:43.803
when you're trying to navigate

2191
00:53:43.803 --> 00:53:45.180
a particular situation,

2192
00:53:45.180 --> 00:53:46.097
you can always reach out

2193
00:53:46.097 --> 00:53:47.098
to the call center.

2194
00:53:47.098 --> 00:53:50.685
The 1-800-272-3900. Share your instances

2195
00:53:50.685 --> 00:53:51.561
Ask for advice.

2196
00:53:51.561 --> 00:53:52.896
There's a master's

2197
00:53:52.896 --> 00:53:54.064
level trained clinician,

2198
00:53:54.064 --> 00:53:56.107
always on staff, always on site

2199
00:53:56.107 --> 00:53:57.067
to help address that

2200
00:53:57.067 --> 00:53:59.194
and to talk that through with a family.

2201
00:53:59.945 --> 00:54:01.321
That's great.

2202
00:54:01.321 --> 00:54:03.907
That's great. Thank you so much.

2203
00:54:03.907 --> 00:54:05.617
You know, we're up at time.

2204
00:54:05.617 --> 00:54:07.369
Thank you, everyone, for joining us.

2205
00:54:07.369 --> 00:54:08.912
Dr. Snyder, I want to thank you guys

2206
00:54:08.912 --> 00:54:10.622
for all your great questions.

2207
00:54:10.622 --> 00:54:12.040
We also ask you to join us

2208
00:54:12.040 --> 00:54:15.126
on January 18th, 2023, at 11 a.m.

2209
00:54:15.377 --> 00:54:16.795
for our next webinar

2210
00:54:16.795 --> 00:54:17.170
to learn

2211
00:54:17.170 --> 00:54:20.924
more about the upside of downsizing.

2212
00:54:20.924 --> 00:54:23.468
Downsizing doesn't have to be scary.

2213
00:54:23.677 --> 00:54:26.137
It can be a great opportunity to sift

2214
00:54:26.137 --> 00:54:27.973
through your memories, connect

2215
00:54:27.973 --> 00:54:30.058
with your kids, and define your legacy.

2216
00:54:30.058 --> 00:54:31.893
So join us for a conversation

2217
00:54:31.893 --> 00:54:33.186
with Matt Paxton,

2218
00:54:33.186 --> 00:54:35.522
host of PBS TV's The Legacy List,

2219
00:54:35.855 --> 00:54:37.315
about de-cluttering

2220
00:54:37.315 --> 00:54:39.818
dealing with family heirlooms, options

2221
00:54:39.818 --> 00:54:41.236
for digitizing memories

2222
00:54:41.236 --> 00:54:42.904
and more as you prepare for that

2223
00:54:42.904 --> 00:54:44.739
next chapter of your life.

2224
00:54:44.739 --> 00:54:45.907
And each of our webinars

2225
00:54:45.907 --> 00:54:47.284
features a different subject.

2226
00:54:47.284 --> 00:54:50.287
So visit Brookdale.com/intheknow

2227
00:54:50.287 --> 00:54:51.538
to discover more.

2228
00:54:52.038 --> 00:54:54.332
And we do hope to see you again soon.

2229
00:54:54.416 --> 00:54:55.625
And until next time,

2230
00:54:55.625 --> 00:54:57.877
we hope you stay safe, happy and well.

2231
00:54:58.044 --> 00:54:59.379
Thank you so much.