Advances in Alzheimer’s Disease Clinical Care with Ahmad Sajjadi MD,PhD

Steve and Virginia sit down with Ahmad Sajjadi, MD, PhD, associate professor of Neurology at UC Irvine and research clinician at UCI MIND, to discuss some of the recent advances that have been made in Alzheimer’s disease research and care. He discusses the newly approved drugs, diagnostic tests and coverage of some of those tests, and care navigator programs. 

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Advances in Alzheimer’s Disease Clinical Care with Ahmad Sajjadi MD,PhD

Outro  00:06

From the University of California, Irvine, this is UCI MINDs, spotlight on care, the podcast where we share stories, experiences, tips and advice on caring for loved ones affected by Alzheimer's and other dementias. 

Steve  00:22

Welcome to another episode of spotlight on care. Today, we have a terrific podcast that we're going to do talking about some really exciting things going on in the advances of Alzheimer's clinical care. And with us is Dr. Ahmad Sajjadi. And he's with UCI mind, he has a MD and a PhD, which you don't always see. So he's really got both both sides of the equation. He's very active in cognitive research. And he also works with patients as a clinician, so he really sees both sides of the spectrum. So I'm going to talk just a little bit of a my experiences with some drugs that I've I've experienced. But before I do, Virginia, do you want to talk a little bit about, you know, some of the drugs we've been through? 

Virginia  01:13

Yes, sure. When mom got diagnosed with MCI, in 2000- Well, it was really 2006. They didn't do much except put her on both Aricept and Namenda. And I didn't know anything about this disease. I didn't have any opinions about that. So hey, go for it. But looking back seven years she was on both of those. And i dont know in my very unprofessional opinion. I don't know if they did any good at all. So that's that's my only experience with drugs having to do with helping dementia or Alzheimer's.

Steve  02:05

Yeah, and I would have to concur, I think and unfortunately, back in the stage where Patti was diagnosed in 2010. We started on similar drugs. And unfortunately, it didn't feel like we saw an a progression. But then again, it wasn't a clinical trial. So it really wasn't being measured against anything. But I guess that's why I'm so excited about what's been happening now because there's some real proof that these drugs can have a benefit. So Dr. Sajjadi, welcome. Thank you for taking some time out of your busy schedule. Dr. Sajjadi. He works with UCI MIND and with UCI health, right? So you're really covering many bases. So 2023 has been described as a banner year for Alzheimer's research and for care. Could you maybe just kind of give us an overall why this year is so special, at least from your perspective.

Dr. Sajjadi  03:00

Absolutely. Thank you for having me excited to be here. I think the 2023 has been a special year from two different standpoints. And both of them are very important and relevant. One is the standpoint of diagnostics, and the other one is the standpoint of therapeutics. And I think 2023 has been a special year on both fronts. On the diagnostics front, we have finally had the kind of Medicare accepting to cover the amyloid PET scan, which has been an FDA approved way of establishing somebody who has diagnosis of Alzheimer's disease for years and years. The problem was that it was not covered and it's a prohibitively expensive test to do if somebody were to pay out of their own pocket. So it is substantial and important that Medicare has finally came out come out and said that they are going to cover the cost of the amyloid PET scan. From a diagnostic standpoint, that was a major milestone. The other one was the advances made in the basically discovery of blood biomarkers of Alzheimer's disease. We don't have an any one of them FDA approved as yet, but they are making significant progresses. And I think it's not inconceivable that in the near future, we will have these blood tests available and useful in our clinical practice. So from a diagnostics standpoint, those were the two main developments. And from a therapeutic standpoint, of course, many of us have heard about the drug Leucanamab that was approved by FDA as a sort of proper approval as opposed to an accelerated approval or a traditional approval, which means that Medicare will basically cover the cost of this medication. I'm sure we can and we will talk more about the medication but from the standpoint of therapeutic I think this has been the major milestone.

Steve  04:54

And this is really the first time in some time that a new drug has been approved. Is that correct? 

Dr. Sajjadi  05:00

Correct. So the last traditional FDA approval for a drug related to Alzheimer's disease goes back to my memantine, which if I'm correct, it was back in 2004. And we have not had any kind of medication for Alzheimer's disease therapeutics approved with a traditional approval ever since, of course, we had the Aducanumab or Aduhelm, drug that was approved prior to like Leucanamab, but that was an accelerated approval and the way things worked out basically, it was almost impossible to prescribe it for patients. So Leucanamb was a special instance that it got their traditional approval.

Steve  05:36

Why so long? Why such a gap between a drug being approved, and now a new drug being approved?

Dr. Sajjadi  05:44

Yeah, that's a great question. I think part of it is the mechanism of action and how these drugs work up until now. Basically, those two medications that we discussed the Aricept Donepezil or memantine Namenda, these are symptomatic treatments. So the idea behind those medication is not that they are going to slow down the progression of the disease, they are there to help with the symptoms of the disease. Whereas with the newer medication, for example, Leucanamab, the idea is that we will slow down the progression of the disease. And as you will appreciate, there is a significant difference between the two in terms of the importance and the significance of what they do. And potentially that's the reason it has taken so long for us to get to the next drug from Memantine. Back in the day, it has been a very problematic and very eventful path to get to this stage with so many failed clinical trials of various basically, the so called disease modifying therapy hopefuls throughout. So I think it has not been through a shortage of trial, it has been because of how difficult Alzheimer's disease as a disease is to kind of deal with is,

Steve  06:56

is this new drug? I know it as leqembi. But because it's shorter for me to say, but is is it actually starting to deal with the symptoms and allow for a delay in the progression earlier in the process is that one of the things that's helped make it get approved? 

Dr. Sajjadi  07:17

Yes, that's that's basically the crux of it. So throughout the years, and throughout the clinical trials that were unsuccessful, we came to realize that basically, if you want to treat these conditions, especially Alzheimer's disease, you have to act early and you have to act fast. So part of the reason part of the reason I will repeat of the failure of previous trials was possibly inclusion of patients who were farther advanced into the course of the disease. So I think what we have established over the past few years is that to stand the chance of success, these conditions need to be dealt with pretty early on. Now we're for Leucanamab, the evidence that we have for these phase for this phase three clinical trial, that was the basis for approval of Leucanamb was that patients had to have mild cognitive impairment or early stages of Alzheimer's disease dementia to be included. And that's our best hope for kind of making a difference in the path of these conditions to treat them early at those stages. And we can talk later more about clinical trials that are ongoing on patients or participants who are at even earlier stages of their condition. But the standard practice at this point is inclusion of patients with MCI mild cognitive impairment, or early stages of Alzheimer's dementia.

Steve  08:35

What Why don't we talk about that? That's, I think, a good segue in. Actually, I tried to be a part of the ahead study, which I think is what you're referring to, which is a study that's even earlier in the diagnosis of Alzheimer's. What's that study about?

Dr. Sajjadi  08:52

So I think to take a step back, I have to tell you a bit about what we think or Al- Alzheimer's disease, basically how we think it develops. So our best theory at this point is that Alzheimer's disease is starts by accumulation of abnormal protein called amyloid on the brain. And based on our best understanding at this point, again, we think this starts perhaps 20 to 30 years prior to patients becoming symptomatic. So that accumulation of amyloid is a very early phenomenon. Now, the idea behind Leucanamab or Leqembi, and basically medications like that is to get rid of amyloid. And as you would imagine, the time course of doing that could be as early as possible and potentially before patients are symptomatic, which is the stage of amyloid starts to accumulate. So that's the idea behind that ahead study to identify people who have those abnormal levels of amyloid on their brains, but are yet to become symptomatic. So hopefully by getting rid of their amyloid accumulation at that very early pre symptomatic stage, we will hopefully prevent them from getting the disease To begin with, so it's the sort of prevention trial, if you like

Virginia  10:04

I keep hearing that this drug simply slows the process of developing Alzheimer's, you're talking about the possibility of it, maybe preventing it, if you get it early enough?

Dr. Sajjadi  10:18

Yeah. That's a great question. So the story about Alzheimer's or their story of Alzheimer's underlying abnormal proteins is the story of two abnormal proteins. One is amyloid and the other one is called tau t au. Now, we know that when patients become symptomatic, they already have abnormal levels of tau as well. So we think, again, based on our best models, at present time, we think that accumulation of amyloid actually facilitates the spread of tau to the brain structures that are important for memory and thinking and all the important actions of our cognition. And tau is the one that causes the manifestations of the disease. Now, if you treat somebody with mild cognitive impairment slash early Alzheimer's disease, tau is already out and is already spread. So our best hope in this sort of situation will be by getting rid of amyloid to hopefully slowing down the progression of that tau, abnormal protein, or potentially preventing it from further spreading, but it is already spread, we know and potentially some of the damage is already done. The idea with a study like ahead study is that although assessment of tau is not part of the design of the study, but the idea and the hope is that by removing amyloid at very early stages, you would have prevented basically propagation of tau and spread of tau to cause the cognitive issues. Now, with the current sort of selection criteria that we have, it's a sort of damage limitation exercise, because we think the tau is already out and has already caused the symptoms. So hopefully, we will prevent it from further worsening by wiping the amyloid out. Whereas if you catch the amyloid before it has affected tau, you might have hope for prevention of the disease. Although this is I want to be very clear that this is not proven. And this is the idea of the clinical trial, which is being conducted at this present time and UCI is a site for it.

Steve  12:17

Yeah, just to make sure this study is going on at UCI mind and at other locations, correct? 

Dr. Sajjadi  12:22

Yes. 

Steve  12:23

Okay. Let's go back to this CMS, which is Center for Medicaid services. Right. Yeah. As a caregiver, you talked about the fact that there's been the approval of two important things. One, the payment for a Leqembi right. And well, that's sorry, that you said for the approval of PET scan. And what does the PET scan actually do? If I'm a caregiver, what what what's involved in me taking a loved one in for a PET scan?

Dr. Sajjadi  12:56

Absolutely. So the idea behind so let's start with PET scan. So pet stands for positron emission tomography, it's a kind of brain imaging that involves some radioactive material or radio ligands. And the idea is based on what kind of radio ligand we use, we get different types of information. So the commonest form of PET scan that has been applicable to degenerative brain diseases and to the to cancer patients has been a kind of PET scan called glucose, PET scan, or FDG PET scan. So the idea behind that kind is that by showing the amount of energy different parts of the body and the brain consume, you can make inferences about which parts are kind of evolved by cancer and which parts are going through degeneration through increased consumption of glucose, or decreased consumption of glucose. So glucose, PET scan, or FDG. PET scan provides indirect evidence now, based on the kind of like, and you can also get direct evidence. So we have ligands for amyloid, which is the abnormal protein, that basically by injecting those ligands to the patient's veins, that ligand goes to the brain gets taken up by the neurons. And basically, it can show up if patients have abnormal levels of amyloid on the brain. So that is the use of an amyloid PET scan to show that somebody has abnormal levels of amyloid on the brain. And in somebody who is already symptomatic with memory problems and so on, that will make a diagnosis of Alzheimer's disease.

Steve  14:24

Whereas before when Patti was diagnosed, she wasn't confirmed until there was a you know, a brain tissue exam after she passed away. Yeah, so this is huge. This is a huge opportunity. And what's the cost for a PET scan? Approximately,

Dr. Sajjadi  14:42

I unfortunately, I don't think I can quote any numbers because it very much depends on where you end up going and which facility and this and that. I can tell you that it is in the realm of 1000s of dollars. Now how many 1000s of dollars it pretty much depends where you go.

Steve  14:57

Okay, so still as a caregiver or, let's go ahead and finish this because I want to come on to what you would suggest as a caregiver. Okay, so that got approved this PET scan. And then you also mentioned that there's these biomarkers. And that sounds like it's even an earlier diagnostic tool. Is that possible? 

Dr. Sajjadi  15:19

So blood biomarkers is what you're referring to. And yes, it is potentially a, basically an earlier tool in the sense that, so let me again, take a step back. Like imagine when we do mammography for breast cancer diagnosis, the idea behind all screening tests and mammography is one of them is that basically you use a test that is very sensitive, it might not be too specific. So by using a sensitive test for a screening, you basically pick up and identify people who are at high risk of some health outcome, that health outcome might be a cancer, for example. And then you use a more sensitive test as a next step to basically identify those people who would had that first abnormal test who actually have the disease. So you do a screening test as your first test, and do a confirmatory test as your second test. Now, at this point in time, our best sort of model that we have for utility of blood biomarkers of Alzheimer's disease is that sort of screening test to identify patients who are individuals who are at higher risk of having Alzheimer's disease. So basically, are based on our best models. Currently, these blood tests are going to be those sensitive tests that might or might not be specific, but they will be your first step for identification of individuals who have abnormal levels of amyloid. And once you identify those individuals, you can go ahead and have the complement confirmatory test, which has amyloid PET scan, for example. So that's the model we are basically thinking about at this point. Now, if the blood tests become specific as well, then it might alleviate the need for a confirmatory test. But at this point in time, based on what we have, and the knowledge we are gaining, that seems to be the model that might be the most suitable at this point, is

Steve  17:10

this blood biomarker test now approved by CMS?

Dr. Sajjadi  17:15

No, it has not been approved yet, by CMS. Now, this is a confusing situation, because we have different types of approval for these tests. So one kind of approval, which is referred to as CLIA approved, or approval is when the laboratory doing the test or running the experiment is approved. Whereas for a test to be actually FDA approved, that test itself should be approved. So at this point, we have labs that are client approved who are doing these tests, but these tests are yet to be FDA approved for this sort of purpose. So this could be confusing.

Steve  17:49

Yes. And isn't somebody out marketing themselves as being able to provide direct to consumers this biomarker blood test? 

Dr. Sajjadi  17:51

Yes, absolutely. Which we are not very happy as a community about this, because we don't think first of all, these blood tests are ready for primetime. And more important than that, we think patients or people who are worried about their status should not be left on their own devices to make basically decisions and judgments about the meaning of these blood tests that are far from black and white, at this point, and potentially, they will stay and remain far from black and white, no matter how much progress is made. And, as I said, even if that was not the situation, interpretation of the tests in putting it into the into the context of clinical presentation, and what that test result means for a given patient is not something that I think patients, or people who are worried about their symptoms should be left on their own devices to me. 

Steve  18:50

So very interesting. You did a great job of explaining a very difficult process. I've now heard it two or three times and I'm getting better at it myself. But if I'm a caregiver, and I'm trying to figure out exactly what what I should do, what what would you recommend?

Dr. Sajjadi  19:05

Thank you. So my first recommendation I think, would be to start with a healthcare professional who can help in this journey. Now based on what kind of scenario we are dealing with whether this is the first time I'm becoming concerned about my loved one being having some memory issues or whether there is a diagnosis already, the approach will be different in the former situation that there is no diagnosis. I think starting with the family physician, the internist or the geriatrician who is the physician we typically see would be the appropriate first step and then they will be familiar with the next steps that are required. If a diagnosis already made of mild cognitive impairment, for example, or early Alzheimer's disease, then referral to sort of higher level of care might be required to see a neurologist or a behavioral neurologist, which is the more specialized type of neurologists who deal with these kinds of situations. Oh, or to geriatricians who deal with Alzheimer's disease and similar situations? 

Steve  20:04

Very good. Sometimes you're dealing though with a physician, who really doesn't have a lot of understanding. And that was my experience, you know, 10 years ago, which is a different experience today. But isn't it the job of the caregiver to kind of, you know, make sure that some type of cognitive evaluation is being conducted? If they think there's a problem?

Dr. Sajjadi  20:28

Absolutely. So that will be the first step basically, to get some objective evidence of presence of cognitive issues. Because a lot of times, especially as we get older, we are aware of sort of memory lapses and not remembering names and so on, which can very often be a normal process of aging. So it's, it's the job of a clinician, and basically, they will, it will be a requirement to do some sort of objective assessment. So establish the presence of a degree of cognitive impairment beyond the level you would expect for a given age. So it is an absolute requirement to do that kind of assessment.

Steve  21:06

I think sometimes we hear well, everything's fine. And maybe it if your experiences as the caregiver, it isn't fine, then you need to make sure you advocate for something a little further down the line in terms of a test.

Dr. Sajjadi  21:18

Absolutely. And the other thing to add here, I mean, even at times, even after those kinds of objective assessments, especially I mean, the more brief versions of those objective assessments, which is the ones that we are more likely to get, we are still of the opinion that there is something wrong. And there is a name for that stage of the condition, which we call subjective memory complaint. And we know now that the subjective memory complaints mean something and pay and patients and who are aware of them, and especially if they are confirmed by their caregiver, or their loved one to have these kinds of problems are more likely to develop cognitive problems and memory issues in the future. So it should be taken seriously even in the presence of a normal or so called normal cognitive assessment. 

Steve  22:02

Well, given all that's going on right now, wouldn't this concept of subjective memory complaint be even more important? If we're trying to figure out earlier and earlier, what's happening with memory issues? Acting on these things, rather than waiting on them? Seems to me to make more sense. Would you agree? 

Dr. Sajjadi  22:19

I do agree, I do agree as especially as we are understanding these conditions more. And of course, we don't, we don't want to make people anxious. And we don't want to make people kind of worry about development of dementia or possibility of development of dementia in the future, so much so that they cannot enjoy their lives anymore. So there should be a balance. But I think it makes sense to be more sensitive about these matters. 

Steve  22:45

Sensitive, good idea. Okay, let's talk about this thing called care coordination programs. What are those and what benefitted that in terms of a development that's going on?

Dr. Sajjadi  22:58

I think they are hugely important. Because as we all know, some of us as clinicians, somewhat some of us as caregivers, getting a diagnosis of Alzheimer's disease or such like is just the start of a journey, a journey that is very difficult, very complex and very long, at the same time and requires support. Now that support can be of course provided by different people by different means. But these care coordination programs are basically an attempt to make the journey a bit easier and a bit more manageable for caregivers. Now, different places provide the sort of care coordination in different ways. And there is a hopefully, there is a new incentive and a new program supported through Medicare, that will try to unify the provision of this kind of care across the centers who basically participate in this scheme, which I think will be a huge step.

Steve  23:54

So it's something to look forward to as a caregiver, that there may be actually a pathway or a plan or a process that you can participate in this going to give you a clearer picture about how this all works together.

Dr. Sajjadi  24:06

Absolutely. And there are some principles, no matter which program you look into, you need somebody to be your contact person. And this these sort of programs, it could be a social worker, or they could have any other name, care navigator or whatever else they might be called. Because there are so many pieces to the sort of puzzle of the journey through this, this condition that you need somebody to help you, to orient you in terms of when to seek help, where to go, who to speak with and all of these matters. So having a care navigator of some sort, would be hugely important in this. And I think through these programs that are going hopefully to be offered by Medicare and such like I think these journeys are going to be more manageable and more unified across the country. 

Virginia  24:51

When is this going to happen? 

Dr. Sajjadi  24:53

So it's a great question, actually. We call it RFA or Request for Application, the RFA They from Medicare is just out. And centers who are interested can apply for it. And here we are at UCI, we will definitely apply for one of these, they call them guide model for Alzheimer's disease. So we will definitely apply for them. And we will hopefully be able to implement them here at UCI as well.

Steve  25:20

Sounds pretty exciting. People have used the term transformative period is that because not a lot has happened or is it because the future looks a lot brighter?

Dr. Sajjadi  25:33

I think a bit of both. To be honest, with care of Alzheimer's disease and dementia, it has been a kind of lottery where you end up being taken care of because in some places, over the at least past decade or so there has been a better sort of network for support and some other places not great. So it sort of has dependent which physician you have seen and which Institute you have been referred to and so on. Whereas with the provision of these kind of more widespread support services, one hopes that things will be more uniform as we go forward. And of course, the availability of these new drugs as they become more available. And as we will have more than one option. Hopefully in the future, we'll make a difference in terms of the care that we can provide to our patients.

Steve  26:20

This may be a tough question for you. But I know you can handle it. On the internet, there's a lot of things that have been promoted as potential cures, take these pills, get these vitamins, and all of a sudden, you're going to be able to cure yourself of Alzheimer's. What would you say about that? All of that information, not specific. But what would be your advice as you look at these proposed or purported drugs? 

Dr. Sajjadi  26:53

that's a great question. And tough one to answer. As you said, the key word in our practice is evidence. So when I've kind of started discussions with my patients about many of these products that are basically promoted is that where is the evidence, and as we know, a lot of a lot of time, there is no evidence. So the standard of our practice, or the way that we establish presence of evidence in our profession is through clinical trials. So clinical trials that are well conducted are hopefully double blind, placebo controlled, and basically done in places that the quality of those trials can be assured. And for many, or most of these agents and drugs and supplements, or whatever they are, there is not such evidence that will support their use, of course, out of desperation, many patients and families basically purchase these and it's multimillion business or billion business maybe. But when it comes to that crucial bit, which is presence of evidence, most of them don't have any evidence to back them up. And that's how I kind of discuss the utility of these things with my patients will always look for evidence. If there is evidence, yes, we can definitely think about them. But when there is no evidence, which is for most of these agents, then I don't think they are even startups.

Steve  28:11

Let me take you back to the blood tests, again, biomarker blood tests. Are we thinking that this is 10 years away? Are we thinking this is a year away? someplace in between? What are we thinking is happening?

Dr. Sajjadi  28:28

Good question. I would say the biggest development in our field over the past maybe two years has been the progression and the advances we have seen on blood biomarker front, of course, leucanamab story has been a fantastic one. But that has been in the making for years and years, as you can imagine. But the speed of sort of progress that we have seen with blood biomarkers of Alzheimer's disease has taken many of us by surprise, to be honest. So I am hopeful that it's not going to be 10 years, it might not be one year, but it will be something closer to two or three years that we will be in a much clearer space in terms of meaning and utility of these blood tests for Alzheimer's disease. I think we have seen a significant buildup of knowledge over the past two years or so. And there is no reason to think that this is going to stop. So hopefully in the next I would say two or three years, we will be in a much, much better space, understanding the meaning of these blood tests. Now, that doesn't mean that every single blood test will come as a black or as a white sort of indication. Because in many situations, we have indeterminant zones for these tests. So in reality, all of these blood tests come up, come back with a number that is a continuous number as opposed to having a positive or negative sign in front of it. And it's our job or the job of the scientists who are developing these basically blood tests to decide if this particular number is in the positive range or isn't a negative range. Meaning is it Alzheimer's, is it not Alzheimer's? Sometimes that distinction is much easier to be made when they are at the two ends of the spectrum. But a lot of times we are closer to that sort of line of differentiation, and it becomes a bit more difficult to be sure about the meaning. And that's the time we will need those confirmatory tests regardless, such as amyloid PET scan, or spinal fluid tests that we have, and so on. So blood tests are going to make huge advances, I think, in the next two or three years, but they might not be the answer to all of the questions. 

Steve  30:28

Do you think that they'll come a time when a biomarker blood test would be a common occurrence for somebody who has a family history of this disease? Or has some of you describe, you know, subjective memory complaints? Do you think that that will be something that a physician will say, let's do one of these just to see if we can find something out?

Dr. Sajjadi  30:51

Yeah. For asymptomatic individuals, meaning individuals who don't have memory problems, or don't have cognitive problems, it depends on how these clinical trials that are happening right now pan out in terms of showing any benefit for drugs that we might be able to provide to people who don't yet have the symptoms of the disease. So if, for example, a study like I had to study shows that basically providing these medications to individuals who are not yet symptomatic with MCI or dementia actually benefit from taking these medications early, then there will be an argument for kind of offering those kinds of blood tests to identify individuals who are who are at high risk, so we can treat them so we can prevent development of the disease in the future. So that kind of depends. But in people who are symptomatic already, I think blood tests are going to become commonplace in the years to come because of their easy accessibility and lower cost and less morbidity for the patients in terms of having those tests.

Steve  31:54

Well, that sure sounds very promising, especially for those of us who've been through this challenging journey. Are there any final thoughts you might want to give a caregiver who's listening to this podcast today about Yeah, what the future holds or what you think about things today. 

Dr. Sajjadi  32:11

I think that is one thing that potentially I'm biased that, and that's the reason I'm saying it, but I honestly think it is very important. So all of our sort of discussion has been centered around Alzheimer's disease. But Alzheimer's disease is not the only cause of cognitive impairment in older individuals. So we have so many other diseases that can cause problems and memory issues and cognitive impairments that are similar to Alzheimer's disease, sometimes that sometimes very different than Alzheimer's disease that are also very important. So we have made a lot of progress and discoveries that relate to Alzheimer's disease, the specific disease of Alzheimer's disease. But for all of those other conditions, we are at the beginning stages, basically all of our research and discovery. So that is something that is I think, is important to mention, especially as we as our population gets older, past the age of 80, 85, those other conditions become more and more important. So that is a very active area of research. So it's more of a research perspective on that front. But in terms of Alzheimer's disease, I think as we see the kind of development of these drugs, and through these tests that become available and so on, I am hopeful that we are going to make a significant progress in the next few years in terms of diagnosis and management of Alzheimer's disease. And hopefully all the other conditions that I mentioned will follow suit.

Steve  33:37

I thought you might say that this is a time where diagnostic opportunities and taking being an advocate for more diagnosis would be an important time as the future rolls out. Would you would you say that? Or would you say something else to caregivers?

Dr. Sajjadi  33:53

I agree, I think I think it is important to it's hugely important to get an accurate diagnosis, I think no matter what I mean, even if he cannot cure the condition at present time it is my personal experience as well. That getting a diagnosis is very important. Because that's uncertainty that surrounds a mystery is condition that we don't know what it is and kind of how things are gonna look in one year or two years or five years time. It's it's really bothersome. So getting a diagnosis and get getting a clear diagnosis, I think is a very important step no matter what. And then hopefully as we have more treatment options, of course, it will have an implications in terms of the prospects for treatment as well.

Virginia  34:38

Thank you very much. It was very, very interesting. And it's a it's a tough problem to tackle and you're all working on it. So diligently. Thank you very much.

Dr. Sajjadi  34:53

Oh, absolutely. My pleasure. And I totally agree with you. It's a complex disease. I would say that over the past 50 years or so we have seen The science has has basically dealt with a number of kind of public health issues starting with AIDS pandemic, and then different types of cancers and heart disease and so on. But this one is the toughest of all because potentially, it's more than one disease. It's difficult to diagnose brain is not accessible, and it's really complex. So yeah, I agree with you.

Steve  35:19

What, why did you choose this field?

Dr. Sajjadi  35:24

Well, my, yeah, I, my I have always been passionate about cognition. So my journey with this sort of professional if I can call it started with my obsession with cognition, and then of course, I, the way to study cognition is partly through studying individuals who don't have the cognitive problem, and partly through studying individuals who are developing cognitive issues. And one thing led to another basically, I am where I am now.

Virginia  35:52

Thank you. 

Steve  35:52

Well, thank you. For all you do for this research. I really think it's admirable that you have committed yourself to this. Thank you. 

Intro  36:02

Spotlight on care is produced by the University of California Irvine Institute on memory impairments and neurological disorders. UCI mind interviews focus on personal caregiving journeys, and may not represent the views of UCI mind. individuals concerned about cognitive disorders, prevention or treatment should seek expert diagnosis and care. Please subscribe to the spotlight on care podcast wherever you listen. For more information, visit mind.uci.edu