Breaking News in Dementia with Dr. Mia Yang

This episode covers recent advances in Alzheimer's research, including the potential link between shingles vaccination and dementia prevention, the biological shifts in aging, and promising biomarkers and treatments like lithium. Dr. Mia discusses how these findings could impact future therapies and personal health decisions.

Shingles Vaccine: The Wales/Australia Natural Experiment in Cell: https://www.cell.com/cell/fulltext/S0092-8674(25)01256-5?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867425012565%3Fshowall%3Dtrue

More Recent Article on Shingles Vaccine and Cardiovascular Risk: https://techfixated.com/shingles-vaccine-drastically-cuts-heart-risk-nearly-in-half-in-new-study/

Massive Biomolecular Shifts: Scientific article in Nature 2024: https://www.nature.com/articles/s43587-024-00692-2

From ruins to research: How an ancient brain survived to help understand Alzheimer’s
https://www.nuscimagazine.com/from-ruins-to-research-how-an-ancient-brain-survived-to-help-understand-alzheimers
Ancient Brain, GFAP and NFL; The Scientific Paper on GFAP and NFL in blood: https://pubmed.ncbi.nlm.nih.gov/41376134/

Lithium as an Alzheimer's Treatment: https://news.harvard.edu/gazette/story/2026/01/an-alzheimers-breakthrough-10-years-in-the-making/ (or the pretty pictures in this: https://hms.harvard.edu/news/could-lithium-explain-treat-alzheimers-disease)
The pilot study in humans: https://jamanetwork.com/journals/jamaneurology/fullarticle/2845746#250915094

Chapters

00:00 Introduction to Alzheimer's Research News
03:34 The Shingles Vaccine and Dementia Prevention
06:03 Shingles Vaccine: Heart Health Benefits
10:43 Timing & Accelerated Aging
14:02 Ancient Brain Discoveries and Alzheimer's
19:33 Exploring Lithium for Alzheimer's Treatment

 
Alzheimer's, dementia, shingles vaccine, biomarkers, lithium, aging, neurodegeneration, Alzheimer's research, health tips

Transcript

0:01

Welcome back to Ask Dr. Mia, and I'm excited to bring you a slightly different format of the podcast today. I am going to be going through a couple of recent news that is related to memory, Alzheimer's disease, and dementia. Some of these are from my patients, bringing them in, and others have been suggested. by my producer, Builder Librarian. I hope that this can summarize some of the exciting things that are going on in the field of Alzheimer's disease and related dementias and just make it relevant and a little bit different from the other episodes. So the first uh news uh article that I wanted to share is about shingles. And this is one that made quite a lot of splash a couple of months ago. Even Reddit had a page about how the shingles vaccine might be the new Alzheimer's vaccine. I think what is interesting about this particular study was that it was done in Wales and Australia. in the sense that they used what's called a light, a natural experiment, just looking at the timing of when people got the vaccine and how in a population, because of the age cutoff date of starting the vaccination program, the authors were able to compare a group of people who really only differed in terms of their birthday by a day or very closely together. And that this allows for a comparison that is similar to a randomized controlled trial because both groups only differed in the sense that one was eligible to get the shingles vaccine and the other one was not purely because of their birth date. And the vaccine specifically that was studied was the live attenuated shingles vaccine, also called the Zosta Vax. And the Zosta Vax is actually discontinued in the United States as of 2020. The shingles vaccine that is currently being given is called Shingrix, which is a not live vaccine. Shingrix uses a combination of particles from the virus itself to generate a stronger immune response. And it's usually given in two forms. Generally, shingles vaccine is recommended for adults 50 years and older, which is kind of where the age cutoff came in for those who. were introduced to the shingles vaccine in Wales and Australia or for people who are immune compromised and that uh most of the time people did quite well with the shingles vaccine like in many other vaccines with common side effects including some pain and redness and maybe some muscle ache and fatigue. So the study that showed the difference between the two groups in terms of the shingles vaccine in Wales and Australia found that people were much less likely to develop dementia among those who were able to get the vaccine compared to those that did not get the vaccine. And this study was only able to be done in countries like Wales, uh and Australia because they had national demographic data that is much easily collected and analyzed compared to the data resources in the United States. And that it found that they were protective against the development of both dementia as well as even possibly new diagnosis of mild cognitive impairment. So uh for those who don't already know, mild cognitive impairment is an earlier stage of memory loss where people do have objective memory changes that are not just due to aging, but are independent in their more complicated daily activities like driving, managing their finances and medications. So I think when this article came out, a lot of people were very excited and wanted to take the shingles vaccine, but were simultaneously disappointed in finding out that at least within the United States, this particular vaccine that was studied in the study is no longer being given. And the reason why Zostavax was discontinued, was because it was actually less effective compared to the Shingrix. And in fact, it was also was less effective as time went on, uh where it lost efficacy by the second year compared to Shingrix, uh which was still over 90 % effective at protecting against uh developing shingles. uh Because Zostavax was also a live vaccine, it could be more dangerous for people who are immune compromised in terms of uh potentially introducing shingles, uh introducing the herpes virus in people who have never gotten oh the virus before. All right. And I think my conclusion from this study is that people should be getting Shingles vaccine and Shingrix is probably just as good as Dysostravax, even though it was not the specific vaccine that was studied. oh And mainly that's just because Shingrix wasn't available to be studied as the initial vaccine being introduced around the world. Zostavax was the older one and that was the one that was studied. This was not a randomized controlled trial. This was really just a natural experiment based on the date of when someone is born as to whether they were eligible versus those who were just below the cutoff of eligibility. And I think the shingles story is also relevant beyond the brain and that there is a more, even more recent article. This one came out of the American College of Cardiology conference where people who, they looked at people who have gotten the shingles vaccine. This was done in the United States where they looked at how likely they were to have heart attacks, strokes, and death, in that they found that shingles vaccine uh is protective because shingles, the infection itself, can cause blood clots to form, which raises someone's risk of developing heart attacks, stroke, and blood clots in the lungs, what's called a pulmonary embolus. or in the body, usually in the leg, which is called a deep venous thrombosis or DVT. And in this study, they looked at a very large database of records of millions of folks who are 50 years and older who have existing uh cardiovascular disease, atherosclerosis. This was fairly recent between 2018 and 2025. And they saw that people who were able to receive shingles vaccine were a lot less likely, 32 % less likely to suffer a heart attack, 25 % less likely to suffer a stroke, 25 % less likely to have heart failure and The problem with this particular study is that people who get vaccinated, particularly when it's not a mandated uh national vaccination program, like in perhaps other countries where most, if not 100 % of people who are eligible get the vaccine, in the United States, the folks who get vaccinated may have healthier behaviors. that compared to those who are not vaccinated, even though the study authors try to control for health behaviors and socioeconomic factors. So in short, Dr. Mia's recommendation is that if you're over the age of 50 and that, or if you're immune compromised, then getting the shingles vaccine could be good for your heart and good for your brain in addition to protecting against the development of shingles, which can be quite painful. I think this has to do with the inflammation that is caused by viruses like chickenpox or herpesvirus, where once you get it, it stays dormant in the neurologic system and can reoccur later in life. which is why it's oftentimes painful and usually in people whose natural immunity wanes as we get older. So a solid recommendation for shingles vaccine based on that. All right. The next article that I wanted to highlight is uh about the different biologic and molecular shifts that happen in our 40s and our 60s. This one was a little bit older in terms of the date of publication in 2024, but it's something that I have not heard of until fairly recently in that uh the researchers at Stanford found that our biologic aging is not necessarily gradual and linear. and that there are uh major rapid changes around the age of 44 and around the age of 60. People were looking at the microbiomes, all of the bacteria, viruses, and fungi that live on us or within us. uh And this was published in Nature Aging. And they found that particularly in midlife, as many of the listeners are sandwich generation folks around age 44, oh they were able to find that this was a really uh really a period of rapid change within a very small amount of time. And some people might think that, well, mid-40s, maybe it's particularly in women because of paramenopause or menopause, but interestingly, these changes also happen in men in their mid-40s as well. ah So this is something that biologically uh we are aging. And I think in the early 60s is perhaps not surprising because generally after the age of 65 is when we start having more age-related diseases later in the last quarter of our life perhaps. I think this is particularly relevant in the sense that for sandwich generation caregivers, this can be a really important phase of our life. to adjust our lifestyles to be as healthy as possible, including things like eating healthy in terms of the Mediterranean diet, as well as increasing exercise to protect not just our brain, but also maintaining muscle mass. This also can be a period when the metabolism of various things change, where uh For example, whether it's alcohol or caffeine or carbohydrates, the amount that we used to be able to metabolize may not be something that we could metabolize as we get older. so this is also where, especially as it relates to alcohol, I say that what people are used to able to tolerate when they were younger. is not what they're able to tolerate as they age later. And it really, even a little bit of alcohol, by a little I mean more than one drink per day for women or more than two drinks per day for men can be not good in terms of memory as well as the risk of dementia. The next article that I wanted to highlight, this one I thought was uh fun in that uh the original article actually came out in 2020, but I recently saw this in a uh article within the National Geographic magazine that I subscribe to and enjoy reading actually with my son uh from time to time. This one is about uh how an ancient brain helped uh survive to help us better understand Alzheimer's disease. So most of the time, people do not find intact brains uh because brains get decomposed shortly after someone dies. But this article came out in August 2025 that found that there was a skull that was discovered in the UK in 2008 that is estimated to be several thousands of years old, between 673 and 482 BC. The reason why this was such a unique situation is that there were aggregates or clumps of protein that were found in high amounts that basically folded themselves tightly around each other and protected the brain from the outside in the outer great matter of the brain, which then protected what ever that's inside from the process of decomposing or autolysis after someone dies. And interestingly, these protein clumps are also found in a number of neurodegenerative diseases, including Alzheimer's disease. Specifically, proteins that were found One is called GFAP or glial fibrillary acidic protein, G-F-A-P. And then the other one is an abbreviation, NFL, uh not the National Football League, but neurofilament light chain. Both of these are biomarkers that are available in our spinal fluid. as well as uh can be now detected in some blood tests as well. So for GFAP, it's really elevated pretty early in the Alzheimer's disease continuum oh in response to amyloid beta pathology versus NFL or neurofilament light chain is sort of a general marker. for damage to the neurons. And you can see increased amount of NFL across multiple different types of dementia. uh GFAP is something that's also related to TAU, T-A-U, the protein that is much more associated with the onset of symptoms in dementia compared to amyloid, where people may have elevated amount of amyloid but do not necessarily have symptoms of memory change and could be walking around perfectly fine. The reason why I thought this was really cool is that uh GFAB and NFL are probably going to be proteins and uh abbreviations we hear more about in the next couple of years as research on blood-based biomarkers really increase over time. I think this has been a pretty dramatic shift in memory clinics all around the world and certainly in this country where we are now able to measure biomarkers in the blood in a much more convenient and accessible way that can help distinguish Alzheimer's-based dementias compared to other types of dementia and other neurologic conditions. But I think GFAP and NFL hold promise in terms of identifying other types of dementias that are not Alzheimer's. We have not necessarily gotten to the point where these are used across the board in clinical practice, but certainly I can see where we might get to that point in the next couple of years. So I just thought that this brain that is being found from thousands of years ago was only able to be preserved. because of the stability of these proteins that covered the brain and this particular skull that was found in the UK. It makes me wonder, you know, what do these proteins do and what could happen if we start removing them if they were so stable that they were literally covering and protecting the brain from the outside within this thousand year old skull. or maybe it was more than 2000 year old skull. So that's a rare uh situation, but more to be learned. OK. So the next story relates a little bit to the biomarkers. And this one has to do with lithium. I don't know why this article uh in particular, has come out uh more commonly among my patients. Within a series of weeks, I have had four, five families ask me about low dose lithium uh for curing Alzheimer's disease, even though this particular article came out in the summer of 2025. uh And this was in KFF News and as well as Boston Globe and a number of different uh publications around the country. And so in terms of lithium, this work was originally found and studied in mice where people found it was in the Journal of Nature where if you uh uh They found that there were just a little bit of depletion of trace metals such as lithium in the brains of people who have very early changes of Alzheimer's disease. And they also found that when they fed tiny amounts of lithium to mice that were low in terms of their lithium and showed signs of dementia, it actually restored their memory. Now people might ask, how do you measure memory in a mice? uh And it's funny because that they make these mice go through uh mazes to really track how well they can find their way around a maze. When I told my husband this, he said that I would very confidently fail this test if I were a mouse because I have no sense of direction, but act like I know exactly where I am going. Anyway, so. Back to lithium, uh several people came up and uh patients and families asked me what I thought about lithium and particularly is uh called lithium orotate. uh This is a subtype of lithium and uh right now what was studied in the mice study is it's a slightly different form of lithium. than a newer article that was just published in March of 2026 in JAMA Neurology. The reason why I bring this up is because the newer article shows the uh clinical study that was testing low dose lithium for people who have mild cognitive impairment. And this was a uh very early pilot study that just looked at how tolerable and how safe it is oh to give low dose lithium to older adults who have cognitive impairment. It was not necessarily a study that was big enough to test for whether lithium is effective at treating Alzheimer's disease. It's really just a safety uh study because this was very specifically monitored and had regular lab work as well as uh careful dosing of the lithium at a very, very tiny dose. People were m not surprisingly, I didn't find it surprising that people were able to overall tolerate it fairly well. The most common side effects were changes in people's kidney function. um and diarrhea, as well as some fatigue and maybe possibly tremors. But a lot of these were also found in the placebo group as well. So in terms of whether or not m I recommend for folks to be taking lithium, I would say definitely do not recommend, at least not right now. And the reason is because Lithium itself has been used for a long time to treat severe psychiatric illnesses such as bipolar. uh because lithium orotate, even in the supplement form, is not necessarily regulated. Where I understand, you know, in terms of supplements, uh sometimes what is stated on a bottle may not be what is actually in the in the pill itself and that uh we also don't know how lithium will actually affect humans who have memory changes and whether the improvements that we saw in mice necessarily translate to human. I think over many years, we have found that things that showed promise in early studies in uh non-human animals such as mice have been very exciting, but then a lot of times we don't see those same positive results in humans. And I find that usually if people are accidentally taking too much lithium, uh that can potentially be quite dangerous for one's kidney function, liver function. And people can actually become lithium toxic and actually need to go to the hospital. So I think right now the potential harm of taking lithium orotate in a supplement form outweighs the potential benefit, especially when it really has not been proven to be helpful in humans. It is safe within the context of that pilot randomized control trial. uh but that is within a very carefully monitored environment with basically accurate doses of the lithium versus whatever you can find on the internet. All right. So I think that concludes today's discussion about all of the interesting news that I have heard. Please let me know by emailing me at ask at miayangmd.com or just by texting me through the link to text back in the show notes. And these texts are anonymous, so I won't know your name, but you can let me know what you think about this style of episode, as well as send me any other news and things you wanted me to comment on from what you read on the internet. So thank you all. If you enjoyed this episode or find it useful, please share with other folks in your life and leave me a review on whichever platform that you listen to podcasts so that other people may also be able to find this podcast. Thank you again. See you next time.