In this episode, Brain & Life Podcast hosts Dr. Daniel Correa and Dr. Katy Peters highlight some of their favorite articles from the most recent edition of Brain & Life Magazine! They discuss updates on new Alzheimer’s drugs and what they mean for patients, the links between oral hygiene and brain health, and how cosmetics brands are creating more accessible makeup for all people. If you would like to read these articles and more, be sure to subscribe to Brain & Life Magazine for free!

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Episode Transcript

Dr. Daniel Correa:
From the American Academy of Neurology. I'm Dr. Daniel Correa.

Dr. Katy Peters:
And I am Dr. Katy Peters. And this is the Brain & Life Podcast.

Dr. Daniel Correa:
Welcome back to the Brain & Life Podcast. Katy. Girl, so great to see you today.

Dr. Katy Peters:
It's great to see you.

Dr. Daniel Correa:
Well, today we are again doing something a little different than our typical episodes. We won't be having a guest, we're going to be having a discussion and highlighting some of the articles out in the latest issue of the Brain & Life Magazine. This last issue came out for December, January 2023, and we'll be discussing topics ranging from some of the new medications for Alzheimer's disease, the links that are starting to be found between dental health and our brain health and accessible solutions for makeup application. So that one, a little outside my expertise, I'll have to rely on you, Katy, for your thoughts.

Dr. Katy Peters:
I'm ready.

Dr. Daniel Correa:
So we have a wide potpourri of topics to share with you and we hope you enjoy the discussion. Katy, what were your thoughts when you were looking over the Alzheimer's disease article?

Dr. Katy Peters:
Well, I think it's really a good thing that we have new advances in the field of Alzheimer's because we all know this is a progressive brain disorder. It affects memory, thinking and behavior and it's really the most common cause of dementia. We do have treatments that included oral medications in the past or older medications and they were thought that they could improve those neurons from talking to each other, the ones that were lost in Alzheimer's, and these were classically drugs like Donepezil and Memantine.
In Alzheimer's disease though, the pathology is due to very specific changes in the brain. And what happens is it's these abnormal clumps of a protein called beta-amyloid and along with twisted tangles of another protein called tau. And both of these really build up in the cells and lead to cell death. And when this happens and you get these accumulations, the brain cells just can't communicate. So these three new drugs, instead of really working at that neural transmission level, they're targeting really the pathology of what's causing the problem and that's that amyloid plaque accumulation. But there are some challenges and maybe some discussions we should have about these medications. So Daniel, what do you think about the medications from the article?

Dr. Daniel Correa:
For our listeners, I would draw your attention back to a recent episode we had at the early December with Walt Dawson and Cynthia Stone. And the second part of that episode, I have a discussion with one of the experts, Dr. Bruce Miller. And in that we specifically talk about some of these new monoclonal antibodies or MABs as we refer to them in short. These MABs or MABs that have come out for Alzheimer's, as you mentioned, they're targeted towards this protein that many researchers and scientists have been trying to aim medications and therapies for. And in the studies that came out, there were some findings that showed a slowing of the progression of the impacts of dementia on an individual's life. And those are findings that for that person and their family may be very significant. And I think in large part we have to be thankful to the advocacy organizations that have really pushed forward these medications and the work towards these trials.
But that number of slowing things down for 18 months, so a little bit over a year, I think is still far short of what we want for our family members and what we want for the patients that we help care for as physicians. We would love to see an intervention and a medication that clearly shows that it slows the progression for years in earlier stage of living with Alzheimer's or dementia. And/or we all hope for the future when we actually have a medication that stops the progression or starts to reverse it. But we're not there yet. And I think that's an important thing to remember what these medications are. Beyond that, there is the challenge of new medicines, especially this type of medication, are going to be very expensive. It's challenging to see and consider which people's insurance companies are going to be covering it. And there's even some nuances about the challenges of getting it covered if you have a government-supported health insurance program.
So if you're interested in participating in trial or continued research or getting on one of these new medications for either you or a family member who's living with early Alzheimer's dementia, I still encourage everyone to have that discussion with their neurologist and their doctors. There may be even other opportunities that you're not as aware of. But these unfortunately are not the targets and the holy grails that many people have been looking and working towards for our family members living with dementia. I mean, it's impacted my family in multiple ways and with different dementias over years. And so I'm looking forward to the future when we really have a target that's going to make the kind of impact that I think some of us would've wanted for my family members.

Dr. Katy Peters:
I completely agree with you, Daniel. And I really appreciate you sharing your experience about what has happened with your family because I think it's so important because it's happening with so many different families. And whenever I think of a new drug and of course the new drugs, I'm usually are chemotherapy because I treat patients with brain tumors, but even patients with seizure disorders that need to go on seizure medications, I think of the three aspects of what is required for the drug to be successful for the patient. And I think of efficacy, tolerability and accessibility. So does it work? Can you tolerate it? And can you get it?
And I think there's some challenges with these new medications. They are intravenous infusions. There's also some side effects that are serious. I'm pretty scared of the side effects up in the brain, the brain swelling and the brain bleeds, severe infusion-related reactions, falls and even allergic reactions, headaches. And there is that other form of toxicity, I like to call financial toxicity. These infusions annually cost over $25,000. And that's a lot. And I'm so glad you got to speak with Dr. Miller about these medications and what are all the nuances in prescribing them and for our caregivers to manage for those patients and for the patients to even get. I don't know if you have any other thoughts really about the toxicities themselves or that financial toxicity.

Dr. Daniel Correa:
Yeah. And I think it's important to remember in terms of the possible adverse reactions or complications that someone could get on these new medications. So the swelling and the small brain bleeds that can occur. Remember this is also in a selected group of people for these trials, people who already were known to potentially be at greater risk of bleeding or who have other neurologic conditions that might worsen or might be impacted by that bleeding weren't included necessarily in these trials. So these are a lot of the things that we have to balance in having the discussion as a neurologist with family members or considering for our own family members. So if the individual who's being considered to go on one of these medicines, if they've already had some past brain bleeds, if they have a medical condition that puts them at greater risk for bleeding or if they're on a medicine that thins their blood, this raises our level of concern.
If they are already taking medicines for anti-seizures and have epilepsy, we might get concerned if you're already at greater risk for more inflammation and bleeding now being on this other new additional medicine and how that might impact your risk of seizures and other complications. It's important to consider the possible complications and some of the other medical conditions that we don't still yet understand as well how they're going to be impacted by these medicines because they're not the groups of people who are typically included in the clinical trials. And then there is that financial toxicity number like you mentioned. I mean $25,000 is a lot. And granted, okay, if your insurance is covering the medication, then maybe that's not going to be $25,000 out of your pocket, but I'm guessing still for a lot of people it's not going to be a small copay. And so some amount of that money is going to be coming out of our pockets.
And it really raises that question of, is the value of slowing things down for a little over a year or about a year and a half enough? And what does that mean for the person and for their family members? Like we've had in previous discussions in our trials and the importance of clinical trials and research design, when we did an episode on ALS, we talked about in some situations just that value of some added time and slowing things down may open the possibility of those individuals being on newer things as science continues to move forward. And it's a strategy that has occurred within cancer treatments and other progressive conditions. So some family members might really want to be on the forefront and see whatever they can do to slow things down now to open the potential for more interventions later. And I can completely understand that. But it is definitely a balance of the access and limitation issues of the cost.
And then as we were mentioning and suggesting before, unfortunately some of the federally backed insurances and many other countries aren't covering these because they're concerned about there not being enough of a time and functional benefit for some individuals on these new medications. Now it remains to be seen when it starts to be a medicine that's accessible to much more of the population and more people are placed on it, if the level of functional improvement that we notice in our family members and our community is more than what was initially seen and if it lasts longer. And so I think maybe we'll be more excited about this, but I think there's some caution to be had with these new medicines. And it's exciting and great to see that these things are moving forward. It's exciting to see that it is making progress finally at this point.

Dr. Katy Peters:
I agree and I think with every little step you can imagine that to cure Alzheimer's is a very large bucket and we're just adding pieces and grains of information to that bucket. And someday we will have a cure and we will have better treatments. And this may not be the one that works for the patients today to the highest degree, but I'm quite confident that we'll continue to move forward.

Dr. Daniel Correa:
Now, Katy, for our next article, do you have a nightly care routine right now?

Dr. Katy Peters:
Oh, yes. I have a nightly care routine. I like to take a bath and wash my face. I always brush my teeth. I'm very big into flossing. I actually would say that I'm a little manic about brushing my teeth. I brush my teeth at least three to four times a day, every time after I get a meal. So I was really excited about this article. And I also see the dentist regularly. How about you? Are you a fan of your dentist?

Dr. Daniel Correa:
I am now much more of a fan. I'm paying a lot more attention to these things over time. I think over years, I had some of those bad habits that were accumulated as being a late night student and medical student and resident working in the hospitals. And it's interesting now to see, through this article and other research that's being discussed, that there's growing evidence that linking how poor oral hygiene or oral health may be related to a higher risk of Alzheimer's disease and other dementias. So if I needed more inspiration to really make sure that I'm taking care of these things every day because not only is it important to me to keep and to have healthy teeth, but how much it impacts the rest of our heart and health. It's important after some years of falling asleep, maybe sometimes after a long day on the couch and not getting to it and then making my way eventually to the bed. This kind of news definitely has gotten me flossing much more regularly and with positive feedback from my dentist recently.

Dr. Katy Peters:
I'm so glad you don't have dentophobia. That's extreme fear of going to your dentist. We all need to have healthy teeth and I guess we'll have healthy brains. There's an adage in developmental neurology, I'm sure you remember this, that the face predicts the brain. Well, it could be that in fact it's the teeth that predict your brain health. So I'm going to have good dentition, good gums, keep on flossing.

Dr. Daniel Correa:
It's always good to have a few more things to be able to do to keep our brains healthy. And through this article in the latest issue with the magazine, they review 11 dental care tips that anyone can do and incorporate into their daily routine to help boost your own brain health and take care of your oral health. And in that article, they also link to some more information about the science and research that has been going on.

Dr. Katy Peters:
And I also will say that for our dental professionals, our dentists, our dentist hygienists, they're actually some of my favorite colleagues, they're so good to our neurology or neurologic patients. They always ask very good questions. They're always very responsive to any questions and concerns. They're actually some of my favorite providers to work with and have really given a lot of great care to my patients. In fact, I found my dentist through one of my patients. They referred me to my dentist when I moved to the North Carolina area and he's an awesome dentist.

Dr. Daniel Correa:
Now, in our next discussion and article, it talks and points out how there are so many day-to-day things that can impact an individual living with neurologic conditions. Whether it's a tremor or a challenge with coordinating their movements, weakness from a stroke or some other injury or even challenges with a person's vision. How someone is impacted by their neurologic condition can affect things like eating and getting dressed and all these daily activities is being much more of a challenge. And there are things I think that many of our family members even may not be as aware of that someone might live with day to day. And it's great to see now that some fashion and cosmetic brands have been teaming up with advocates and other people to push and address the needs of these individuals further. Our team at the Brain & Life Magazine recently covered this more in the latest issue in an article, How Cosmetic Brands Are Creating More Accessible Makeup. What are your thoughts, Katy?

Dr. Katy Peters:
Well, I feel like we went from the bathroom to now getting all dolled up. And I just love this article about accessible makeup. I think it's very exciting that cosmetic brands want to bring not the makeup just to the cover girls or the models, but to everyone. You know how important it is, the makeup sign in our patients. Tell me you know what the makeup sign is.

Dr. Daniel Correa:
I think I've heard it, but I'm excited to hear how your description of the makeup sign is.

Dr. Katy Peters:
So traditionally the makeup sign is that if you have a patient that's been really sick in the hospital and if they start to get better, what you notice is that they'll start to put their makeup on. And you usually know you can safely discharge that patient because they're getting better because they're able to maybe care for themselves in those care routines. And that goes with dental hygiene, with cleaning themselves. The shower sign, when the patient can get up and actually take a shower or bathe themselves are all really important. So that makeup sign has always been something that I remember when I was an intern and it still translates today as I'm an old crusty attending on the ward service.

Dr. Daniel Correa:
Yeah, there is some extent of almost anticipation and hope that these kinds of things demonstrate, that someone really feels like they have an understanding of what's going on and they're prepared and armored up to be able to go home and manage whatever they're living with from here. And some of those things may have been that they've had some recuperation from symptoms that they came in with or if nothing else, that they have a better understanding of what brought them to the hospital, what steps they're going to be taking and now they're ready to go back out to the world. And it's always a heartwarming part of the rounds and arrival when you see that, okay, you can really help fulfill someone's outlook at getting home. Had that experience this morning actually with a patient. And it was clear we had some things we could do another day in the hospital for or she could leave today. And when you came in the room, you could tell she was ready and hopeful and didn't have any more concerns and didn't want to stay any longer in the hospital.

Dr. Katy Peters:
That's a joyous morning for you and for that patient and their loved ones. That's a great thing. So let tell you a little bit about these innovations in the makeup. Again, everybody has a different makeup routine, whether it's foundation or it's a powder blush. They can also have lipstick and eyeliner and eye shadow, along with mascara. So some of the innovations have been computerized makeup applicators. They also have lids with these very easy to grip wings. The next is for our patients with low vision, very high contrast labels because you really want to make sure that what you're putting on your lips is safe for your lips and what you're putting... Because a lot of packaging does look the same and the writing can be very tiny. And I think for all of us, I don't know if you've got readers yet, my husband does.

Dr. Daniel Correa:
No, I have glasses but not readers yet.

Dr. Katy Peters:
My husband has to have his readers or it's definitely a problem. They can also have labels with braille texts, which I think is really good for our patients that use braille. Brushes with built-in finger rests that have more of a balanced posture or heavier handles or longer handles for people with tremors so they can have a better grip. And I also think this is really important, rounded brush tips or tools so that when you're going close to your eye, you don't have as much chance of poking your eyeball. Because that's something that we can even see in clinic when we're doing the finger to nose test in our patients. I've had some scary potential accidents with that finger going straight for the eyeball. So lots of really neat innovation so that patients can feel their best and look their best.

Dr. Daniel Correa:
These are all examples of how innovations to address accessibility often can just improve everyone's safety and access and just our overall use of items, whether it's makeup or anything else. It makes me think of this last summer, I had a discussion and an interview with Ashley Brooks. She's an advocate living with myasthenia gravis and she also advocates and talks about beauty and makeup accessibility, both for people with disabilities and other abilities and living with neurologic conditions, but also people with minoritized backgrounds and skin colors that don't always have the same level of attention from many brands. So it's great to see this now broadening out through the field.

Dr. Katy Peters:
And I predict it's going to continue to thrive. There's such a big community of people showing how they do their makeup online, whether it's in one of the social media apps, and even some of those influencers have neurologic challenges and have shown how they can do things. And this is something that is also discussed in the article. So I predict we're going to continue to see more development in this area and it also could include other self-care parts, whether it's your hair or your nails, not just cosmetics.

Dr. Daniel Correa:
These were all great articles and resources, I think, for everyone listening in our community and great examples of the kind of content that each of you can get from the Brain & Life Magazine. I'll remind our listeners it's available both online or also available as a print edition in both English and Spanish, with varying articles and content. The English magazine comes out each quarter and several times a year, we have a Spanish version in Español. So please check that out. Check out the website. We'll have links to each of these articles in our show notes and you can browse the website both for our podcast episodes and many other great articles.
Thank you again for joining us today on the Brain & Life Podcast. Follow and subscribe to this podcast so you don't miss our weekly episodes. You can also sign up to receive the Brain & Life Magazine for free at brainandlife.org. Don't forget about Brain & Life in Español.

Dr. Katy Peters:
Also, for each episode, you can find out how to connect with our team and our guests along with great resources in our show notes. We love it when we hear your ideas or questions. You can send these in an email to blpodcast@brainandlife.org and leave us a message at 612-928-6206.

Dr. Daniel Correa:
You can also find that information in our show notes and you can follow Katy and me and the Brain & Life Magazine on many of your preferred social media channels. We are your hosts, Dr. Daniel Correa, connecting with you from New York City and online @NeuroDrCorrea.

Dr. Katy Peters:
And Dr. Katy Peters, joining you from Durham, North Carolina and online @KatyPetersMDPhD.

Dr. Daniel Correa:
Most importantly, thank you and all of our community members that trust us with their health and everyone living with neurologic conditions.

Dr. Katy Peters:
We hope together we can take steps to better brain health and each thrive with our own abilities every day.

Dr. Daniel Correa:
Before you start the next episode, we would appreciate if you could give us five stars and leave a review. This helps others find the Brain & Life Podcast. See you next week.

 

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