#236 ‒ Neurodegenerative disease: pathology, screening, and prevention | Kellyann Niotis, M.D. | The Peter Attia Drive

Intro

In this episode of “The Peter Attia Drive,” Dr. Peter Attia interviews Dr. Kellyann Niotis, a fellowship-trained preventative neurologist specializing in risk reduction strategies for neurodegenerative disorders. They delve into the pathology, screening, and prevention of neurodegenerative diseases such as Alzheimer’s disease, Lewy body dementia, and Parkinson’s disease.

Main Takeaways

Understanding Neurodegenerative Diseases

• Neurodegenerative diseases include Alzheimer’s disease, Parkinson’s disease, and ALS.
• Dementia is a broad term that encompasses neurodegeneration.
• Different types of dementia affect different parts of the brain.
• Parkinson’s disease and Huntington’s disease are types of neurodegenerative diseases.
• Visual impairment is a risk factor for neurodegenerative diseases.

Pathology and Prevention of Parkinson’s Disease

• Parkinson’s disease is caused by the loss of dopamine-producing brain cells.
• REM sleep behavior disorder can be a predictor of Parkinson’s or Lewy body dementia.
• Pesticide exposure is linked to a higher prevalence of Parkinson’s disease.
• Sleep disturbances may predict the beginning of Parkinson’s disease.
• Early intervention and lifestyle changes may delay or slow the onset of Parkinson’s disease.

Pathology and Prevention of Alzheimer’s Disease

• Alzheimer’s disease is a tauopathy, while Parkinson’s disease is an alpha-synucleinopathy.
• Metabolic changes in the brain can differentiate between vascular dementia and Alzheimer’s dementia.
• Sleep disturbances could be an early warning sign of Alzheimer’s disease.
• Cognitive testing is crucial for Alzheimer’s disease diagnosis.
• Oral health and hypertension may be linked to Alzheimer’s disease risk.

Screening and Biomarkers for Neurodegenerative Diseases

• Biomarkers are needed to make prevention the standard of care for Parkinson’s disease.
• Blood-based biomarkers for amyloid and tau are being developed for Alzheimer’s disease.
• FDG PET scan and amyloid PET scan can aid in differentiating neurodegenerative diseases.
• Cognitive testing is challenging to standardize but is crucial for Alzheimer’s disease diagnosis.
• Serum biomarkers for tau may be more sensitive than imaging scans for early Alzheimer’s disease pathology.

Genetics and Risk Factors

• Genetic predisposition accounts for 10% of Parkinson’s disease cases.
• APOE4 is a high-risk gene associated with neurodegenerative diseases.
• Hearing loss and vision loss are risk factors for cognitive decline.
• Oral health and gum health may predict overall health and neurodegenerative disease risk.
• Exercise and movement play a significant role in brain health and disease prevention.

Summary

Understanding Neurodegenerative Diseases

Neurodegenerative diseases encompass a range of conditions, including Alzheimer’s disease, Parkinson’s disease, and ALS. These diseases involve the death of brain cells and can affect different parts of the brain, leading to specific deficits. Visual impairment is a common risk factor for neurodegenerative diseases.

Pathology and Prevention of Parkinson’s Disease

Parkinson’s disease is caused by the loss of dopamine-producing brain cells. Sleep disturbances, such as REM sleep behavior disorder, can be early predictors of Parkinson’s or Lewy body dementia. Pesticide exposure, particularly to certain chemicals, is linked to a higher prevalence of Parkinson’s disease. Early intervention and lifestyle changes, including optimizing sleep and movement, may delay or slow the onset of Parkinson’s disease.

Pathology and Prevention of Alzheimer’s Disease

Alzheimer’s disease is characterized by tauopathy, while Parkinson’s disease is an alpha-synucleinopathy. Metabolic changes in the brain can differentiate between vascular dementia and Alzheimer’s dementia. Sleep disturbances may serve as early warning signs of Alzheimer’s disease. Cognitive testing is crucial for Alzheimer’s disease diagnosis, and oral health and hypertension may be linked to increased risk. Incorporating lifestyle changes, such as exercise and oral hygiene, can help prevent or mitigate the progression of Alzheimer’s disease.

Screening and Biomarkers for Neurodegenerative Diseases

Biomarkers are crucial for identifying individuals at risk for neurodegenerative diseases and implementing preventive measures. Blood-based biomarkers for amyloid and tau are being developed for Alzheimer’s disease, while FDG PET scan and amyloid PET scan can aid in differentiating between neurodegenerative diseases. Cognitive testing, although challenging to standardize, plays a significant role in diagnosis. Serum biomarkers for tau may offer increased sensitivity in detecting early Alzheimer’s disease pathology.

Genetics and Risk Factors

Genetic predisposition accounts for a portion of Parkinson’s disease cases, with APOE4 being a high-risk gene associated with neurodegenerative diseases. Hearing loss, vision loss, and poor oral health are risk factors for cognitive decline and neurodegenerative diseases. Incorporating exercise and movement into daily routines can significantly contribute to brain health and disease prevention.

Conclusion

Neurodegenerative diseases pose significant challenges to individuals and society, but understanding their pathology, implementing preventive strategies, and identifying risk factors can help delay or mitigate their impact. Further research into biomarkers and genetic factors is crucial for early detection and effective prevention. By prioritizing brain health through lifestyle changes and medical interventions, individuals can optimize their chances of maintaining cognitive function and quality of life.