Flávio Henrique de Rezende Costa - Don't Let Alzheimer's or Parkinson's Steal Your Loved One's Dignity

Alzheimer's and Parkinson's diseases are two of the world's most common neurological disorders. Alzheimer's affects approximately 6.2 million people, while Parkinson's affects nearly 10 million, according to the World Health Organization.

These diseases can have far-reaching consequences for both patients and their families. Alzheimer's and Parkinson's disease can cause depression and anxiety in addition to memory loss, confusion, and mobility issues.

These diseases have a tremendous impact on healthcare systems and families, leading to increased burdens on care providers and significantly altering the lives of those affected.

There is no cure for either disease, but there are treatments that can help with symptoms. Medical marijuana is a promising area of study for both Alzheimer's and Parkinson's disease.

While more research is needed, preliminary evidence suggests that cannabinoids may aid in the improvement of sleep, the reduction of inflammation, and the protection of nerve cells from damage.

Another promising area of research is personalized medicine. This method entails tailoring treatment to the individual patient, taking into account factors such as genetic makeup and lifestyle. We may one day be able to develop more effective treatments and even find a cure if we better understand the causes of these diseases.

Until then, we must continue to support patients and their families as they face the challenges of Alzheimer's and Parkinson's disease.
----------

Bio:

Dr. Flávio Henrique de Rezende Costa MD, MSc, PhD, is a neurologist and movement disorder specialist. He is a Professor of Neurology at Rio de Janeiro's Federal University and Director of Movement Disorders at Clementino Fraga Filho University Hospital. He has dedicated his life to teaching and researching the causes and potential treatments of neurodegenerative diseases such as Parkinson's disease, Huntington's disease, dystonia, and non-motor symptoms of Parkinson's disease.

Visit Flávio on LinkedIn: https://www.linkedin.com/in/flavio-rezende-md-msc-phd-a5454972/
ResearchGate: https://www.researchgate.net/profile/Flavio-Henrique-Costa
Google Scholar: https://scholar.google.com.br/citations?user=ULgVLrcAAAAJ&hl=pt-BR

Transcript

[0:00:00]
Hanh Brown: Hi, I'm Hanh Brown, the host of the Boomer Living broadcast. As the baby boomer generation ages, they are increasingly focused on their health and wellbeing.

[0:00:12]
Hanh Brown: However, they face many challenges including senior healthcare, dementia, Parkinson's, caregiving, technology adoption, affordable senior living options, and financial insecurity. These issues can be very difficult to navigate alone, which is why we created the Boomer Living broadcast.

[0:00:32]
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[0:00:44]
Hanh Brown: We also offer a wide range of resources and support to help baby boomers and their families at every stage of their journey.

[0:00:52]
Hanh Brown: Whether you have parents or grandparents who are just starting to think about retirement or are already enjoying your golden years, we're here to help. The aging process is different for everyone.

[0:01:06]
Hanh Brown: And we can learn a lot from each other.

[0:01:08]
Hanh Brown: That's why I love to hear from you.

[0:01:11]
Hanh Brown: If you have any questions or comments about your own aging journey, please don't hesitate to share them with us.

[0:01:18]
Hanh Brown: By sharing your story, we can help others to understand the aging process and feel more confident about the future. Thank you so much for tuning in, and I hope that you'll find our conversation informative and helpful.

[0:01:33]
Hanh Brown: So today's topic is, "Don't let Alzheimer's or Parkinson's steal your loved ones' dignity."

[0:01:41]
Hanh Brown: Alzheimer's and Parkinson's disease are two of the world's most common neurological disorders.

[0:01:48]
Hanh Brown: Alzheimer's affects approximately 6.2 million people, while Parkinson's affects nearly ten million, according to the World Health Organization.

[0:01:58]
Hanh Brown: These diseases can have far-reaching consequences for both patients and their families.

[0:02:04]
Hanh Brown: Alzheimer's and Parkinson's disease can cause depression and anxiety, in addition to memory loss, confusion, and mobility issues.

[0:02:14]
Hanh Brown: These diseases have a tremendous impact on healthcare systems and families, leading to increased burdens on care providers and significantly altering the lives of those affected. There is no cure for either disease, but there are treatments that can help with symptom management. Medical marijuana is a promising

[0:02:33]
Hanh Brown: area of study for both Alzheimer's and Parkinson's disease.

[0:02:38]
Hanh Brown: While more research is needed, preliminary evidence suggests that cannabinoids may aid in the improvement of sleep, reduction of inflammation, and the protection of nerve cells from damage.

[0:02:51]
Hanh Brown: Another promising area of research is personalized medicine.

[0:02:56]
Hanh Brown: This method entails tailoring treatment to the individual patient, taking into account factors such as genetic makeup and lifestyle.

[0:03:06]
Hanh Brown: We may one day be able to develop more effective treatments and even find a cure if we better understand the causes of these diseases.

[0:03:15]
Hanh Brown: But until then, we must continue to support patients and their

 families as they face the challenges of Alzheimer's and Parkinson's disease.

[0:03:23]
Hanh Brown: So today, my guest is Dr. Flavio Costa. He is a neurologist and a movement disorder specialist. He's a professor of neurology at the Rio de Janeiro Federal University and director of movement disorders at the Clementino Fraga Filho University Hospital.

[0:03:43]
Hanh Brown: He has dedicated his life to teaching and researching the causes and potential treatment of neurodegenerative diseases such as Parkinson's, Huntington's, Dystonia and non-motor symptoms of Parkinson's disease.

[0:04:01]
Hanh Brown: So, Dr. Flavio, welcome to the show.
Flavio H: Well, thanks for having me. I'm honored to be here with you. Thank you, thank you so much. I appreciate the work that you do and

[0:04:14]
Flavio H: "appreciate the opportunity that we have to bring awareness."

[0:04:19]
Flavio H: On these horrible diseases, so thank you so much.
Hanh Brown: Thank you. Yeah, so um, please tell us a little bit about yourself both personally and professionally.

[0:04:39]
Flavio H: Okay. I'm forty five years old. I'm, as you mentioned, a professor of neurology at the Federal University of Rio de Janeiro. I became a professor at the age of thirty eight and before this, I was a professor in a private university here in Rio de Janeiro. I've trained in neurology in Rio de Janeiro and I also have a fellowship in movement disorders.

[0:05:06]
Flavio H: For the last fifteen years, I have been dedicated to the study of movement disorders and Parkinson's disease. My master's degree was in studying the quality of life of patients with Parkinson's.

[0:05:28]
Flavio H: We concluded that a lot of symptoms are very important for patients with Parkinson's and depression is the main factor for the loss of quality of life. In my PhD, I studied cognition in patients with Parkinson's disease.

[0:06:09]
Flavio H: We have shown that patients with Parkinson's have cognitive impairment, even at very early stages. So it's been a long road, but I'm very happy and proud to be with you.

[0:06:42]
Hanh Brown: I'm honored. The global prevalence of Alzheimer's and Parkinson's disease is very alarming, with millions of people suffering from these debilitating neurological conditions and putting a strain on healthcare resources and family's lives. So let's start out with what's the difference between Alzheimer's disease and...


[0:07:02]
Flavio H: Yes, well, both diseases, Parkinson's and Alzheimer's, are considered neurodegenerative diseases. But Parkinson's disease's main feature is bradykinesia, a term that was described by James Parkinson.

[0:07:18]
Flavio H: It was first identified in 1817 as patients with slow movements and symptoms such as tremor at rest, rigidity, and postural instability.

[0:07:28]
Flavio H: Along with Parkinson's, patients also experience other symptoms that we call non-motor symptoms like depression, apathy, insomnia, and cognitive decline.

[0:07:41]
Flavio H: Parkinson's disease generally occurs in the late 50s or early 60s. The first sign is the tremor. There are hallucinations that patients can experience, and falls are hallmarks of cognitive decline and progression of the disease.

[0:07:48]
Flavio H: Alzheimer's disease is primarily a disease that affects cognition. The main feature is memory loss, but patients with Alzheimer's disease can develop other symptoms like apraxia, aphasia, which are problems speaking or language and motor skills too.

[0:08:08]
Flavio H: Patients with Alzheimer's can develop behavioral problems and sleep problems. What both diseases have in common is that when they are diagnosed, both diseases have a phase that we call preclinical or prodromal.

[0:08:22]
Flavio H: At the moment of diagnosis, both diseases have been present for at least ten to fifteen years, which is a very challenging issue. We are diagnosing conditions that start very, very early, like ten to fifteen years before. That's the main challenge.

[0:08:38]
Flavio H: In terms of pathology, both of these diseases are completely different. Alzheimer's disease is considered a tauopathy, which means it's related to tau protein accumulation.

[0:08:48]
Flavio H: Tau is a protein that's responsible for maintaining the structure of neurons. There are also other markers of beta-amyloid plaque accumulation in Alzheimer's disease.

[0:09:00]
Flavio H: Parkinson's disease is a condition where the main feature is the accumulation of what we call alpha-synuclein, so it's in the group of the synucleinopathies diseases. 

[0:09:12]
Flavio H: Which also includes other conditions like multiple system atrophy and Lewy body dementia. So in terms of pathology, these are completely different conditions.

[0:09:24]
Hanh Brown: I'm personally living my life with loved ones with dementia and Parkinson's, and I think that's one of the reasons why I'm very passionate about this topic to bring awareness, educate and inform people that you know, like it or not, it's part of life.

[0:09:39]
Hanh Brown: The sooner that you get educated and informed, perhaps even take ownership of your health because I think our conversation should influence people, I hope, to how they live their lives and choices that they make day to day. 

[0:09:53]
Hanh Brown: Thank you for your input. So now, how do you think healthcare will be impacted by these diseases in the future?

[0:10:04]
Flavio H: Yes, it's been observed that these diseases are very prevalent and very debilitating. We have a lot of new cases and the main risk factor is the aging process.

[0:10:15]
Flavio H: My view and

 my perception is that countries with low income and larger older populations will be the most impacted. So we're talking about Asia and Latin America, specifically Brazil.

[0:10:28]
Flavio H: It's a huge challenge because as the populations are getting older, better healthcare systems and all the resources we know are limited. It's a major problem. So in the United States too, I think it's a huge problem because the United States doesn't have a universal coverage system.

[0:10:47]
Flavio H: It's like basic insurance. And the costs are skyrocketing in the United States. I think that countries with universal healthcare systems will do better in managing the healthcare issue.

[0:11:02]
Flavio H: Access is more open. Generally, we have a base at the days of the system. They are what we call GPs, General Practitioners, that can do the first follow up with patients. 

[0:11:14]
Flavio H: We can provide education and tools for GPs to at least think about these diseases and they can follow up the majority of patients. So, in nations with insurance, I think the care is more fragmented.

[0:11:29]
Flavio H: Patients don't have the same access and they may have some quality of access in research institutions and clinical trials, but I think the base is even harder than when you work in a country with a universal coverage healthcare system. That's my perception.

[0:11:47]
Hanh Brown: Sure, sure. I think the last time I saw at least in the U.S., to care for someone with dementia in his lifetime is a little less than four hundred thousand. And yes, it's.


[0:13:13]
Hanh Brown: It's tragic, indeed. Now, in Brazil, we have a universal healthcare system; it's like a hybrid system.

[0:13:23]
Flavio H: What I observe from this is that patients have better access when you have universal coverage, as in the UK with the NHS. I think patients do better in this type of system and specifically when you have a general practitioner taking care of their patients.

[0:13:43]
Hanh Brown: Absolutely, I know for us in the U.S. we're going through the renovation of the healthcare system to get ready for such diseases like these. So, I think, you know, what can we do to then support those affected by Alzheimer's and Parkinson's? What's your take?

[0:14:02]
Flavio H: Yes, I think everything starts with a good, an accurate diagnosis. It is very sad when a patient makes it to the late stage without a doctor even considering the diagnosis. Sometimes a family might think that their loved one is just getting a bit more forgetful as they age, but those are early signs.

[0:14:22]
Flavio H: So I think early diagnosis is very important. But I'm not just talking about a mapped diagnosis. I'm talking about clinical skills. We need to educate healthcare providers to provide an accurate diagnosis and to be a profound support for patients and families.

[0:14:42]
Flavio H: We can never forget about the family. Because when you give a diagnosis of, for instance, Parkinson's, it affects the whole environment of the patient, it affects the family's lives. So it's very important to plan. And when we think about Alzheimer's, for example, we have to think about a plan.

[0:15:02]
Flavio H: This plan involves treatment and a caregiver, who might be someone from the family or a professional, or maybe in a hospital or hospice. But these plans must be shared. So I think it is crucial to consider the caregiver as your partner. You, as a doctor, and the family.

[0:15:23]
Flavio H: So when you have both caregivers and doctors working together to find solutions, I think the treatment is much better and you can navigate the process in a better way. Yes, you will encounter turbulence when you are given a diagnosis of Parkinson's or Alzheimer's, but the most important thing is to be prepared for this and to work together. That's my view.

[0:15:43]
Hanh Brown: I echo that. When it comes to Parkinson's and Alzheimer's, degeneration is not just within the purview of neurology, it involves caregivers, social work, multiple key stakeholders.

[0:16:01]
Hanh Brown: I mean, there are multiple key stakeholders intertwined in providing care to the loved ones at a healthcare medical level. It's all these key players working together, not just depending on your primary care or your neurologist.

[0:16:16]
Hanh Brown: And I learned that the hard way on a personal level. I can't stress enough that we need to normalize this kind of conversation and educate people because sooner or later, maybe sooner than what they want, they're going to be hit with something.

[0:16:33]
Hanh Brown: That's why I advise folks to get educated. Now, for example, Parkinson's affects around one percent of the population over 65 years old and Alzheimer's is around thirty percent of the population around 84 years old, so it's very common.

[0:16:50

]
Flavio H: It's something that we must educate people about. We have tools to make life more comfortable and more effective for families and patients, so that's the point.

[0:17:05]
Hanh Brown: You mentioned we don't have a cure. Do you think that we'll ever find a cure and what do you think it'll take to find a cure?

[0:17:14]
Flavio H: It's a loaded question, yes. But I have a clear view about it. I think we will have a cure for these diseases, but it's going to take time. It's not a matter of money or power.

[0:17:28]
Flavio H: I can assure you, we've had former presidents of the United States like Ronald Reagan who had Alzheimer's disease and George H. W. Bush who had Parkinson's. And we've had a former prime minister of the UK, Margaret Thatcher, who died with Alzheimer's. 

[0:17:44]
Flavio H: So it's not about money or resources that research can provide. I think it's about following the right path.


[0:19:06]
Hanh Brown: Or does, and in my view, we're going to move to a more personalized, either civilized, that approach in the coming years. Watching him, but when you buy or sell lives of approach, so we're going to collect all many formations from patients that know old can change the course of the disease.

[0:19:26]
Hanh Brown: Like clinical markers, biomarkers, we're going to story what because pharmacogenomics to understand what drugs, what symptomatic drugs kick in better for those patients and probably we're going to develop at what we call disease-modifying drugs based on genetics. 

[0:19:46]
Hanh Brown: So it went with with talk about Parkinson's, for example, we know that there are many gene factors, mutations that can predispose or cause Parkinson's like our team yea, many, many, many genes. So, I see.

[0:20:07]
Hanh Brown: Start by doing genetics about average because I'll give you an example, we have some stories with what we called you be able to some patients with Parkinson's. It's a mutation or what they should that also calls a disease calls L et al. of and you sure disease and.

[0:20:27]
Hanh Brown: Probably we're going to start giving them medication solutions for these specific imitations just giving you an example. We can move for larger solutions, so I'm very optimistic about what we call protein infusions in the future. 

[0:20:52]
Hanh Brown: I think it might be a very interesting solution and a hope for patients, but I think it will be like what Coutinho though approach know we're going to have to understand each of you blow each clinical feature of the bugles to make a personal that's my view.

[0:21:12]
Hanh Brown: Thank you. Now, what can we do are there ways to reduce the risk of Alzheimer's and Parkinson's disease?

[0:21:19]
Flavio H: Yes, my view about this disease is that we have a very complex interaction between the environment, genes, and clinical features. 

[0:21:41]
Flavio H: You see very clearly that there is no one Parkinson's patient who is equal to another. We have like different clinical profiles, different clinical phenotypes, and we can work with an understanding these clinical phenotypes with a move forward. So I'll give you an example. 

[0:22:21]
Flavio H: We already have pretty good data showing that patients with Parkinson's disease that are younger and tremors have a better prognosis than patients with Parkinson's disease that are older and have balance problems, so at the same disease in terms of pathology but two different clinical phenotypes. 

[0:22:41]
Flavio H: So, we need to understand better at the clinical phenotypes and interact with these patients in a very personalized way that's my view about this.

[0:22:49]
Hanh Brown: Thank you. So, neither disease has a cure and treatments can only relieve the symptoms. As a result, patients can lose cognitive and physical function. Both diseases are very costly to treat, and many patients frequently require long-term care. So, as our population ages the number of people living with Alzheimer's and Parkinson's is going to rise. 

[0:23:29]
Flavio H: Yes, I think the biggest challenge is that when we do like a clinical trial we only focus on that drug. So I'm giving a clear example: For the last twenty years, the theory about

 Parkinson's disease and Alzheimer's is that the buildup of these proteins were toxic to the brain. 

[0:23:51]
Flavio H: So we developed antibodies that were meant to clear the brain from those proteins. And we spent a lot of money and resources based on this theory, because all of these drugs failed. 

[0:24:20]
Flavio H: So I think the challenge is to make the right questions and make the right assumptions about what we are researching, and also to make the right connections with other therapies. One of the limitations is that when we develop a drug, we don't consider other things that are going on with the patient.

[0:24:51]
Flavio H: And that's not enough, you know, and what we have to do, what we need to do is to break down these barriers from clinical development problems and try to connect with other solutions, and this cannot rely only on the industry. We must involve what we call...


[0:25:11]
Flavio H: Neutral parties like the universities, which should be neutral in doing research, and also other players like government, like agencies, like AI.

[0:25:25]
Flavio H: Well, specialists panels to find the solution so that's my view, so that's why we didn't reach, yeah, it's like a good outcome in terms of research because I don't think we have an effective oversight between these players, it's that the system is inefficient in my view.

[0:25:48]
Hanh Brown: The challenges only increase with these appearances, you know. How I see it is that everybody, like the key stakeholders that you mention, I think they all need to collaborate with an open mind and with a common objective. Too often our views might be biased because we come in with certain motives.

[0:26:09]
Hanh Brown: I'm just putting it out there, right, I think if, principally, if everybody's aiming to have the same objective, then I think collaboration is very useful. So, yes, I think it's all about operational efficiency. You told it right.

[0:26:29]
Hanh Brown: We can't achieve big things in life alone and I think the industry also needs to understand this. I think that the collaboration with universities, for example, is key. And having money or power does not necessarily mean that your views are more valid.

[0:26:49]
Hanh Brown: Right or not, yes, it's all crucial.

[0:26:52]
Hanh Brown: Okay, so let's talk about some research. What kind of research is being done to find new therapies for Alzheimer's and Parkinson's? Let's talk about that.

[0:27:12]
Flavio H: Yes, as a matter of fact, unfortunately, the monoclonal antibodies, most of these have failed, so we are, I think, in a position where we look back and ask if we posed the wrong questions. All of these clinical development problems and as you've noted, my personal view, I'm pretty much sure that it can be shared with other leaders in the field, but in my view, the monoclonal antibodies are not the way to go forward.

[0:27:48]
Flavio H: I'm very excited about the studies around what we call protein replacement therapy. We have good preclinical data that show as the brain degenerates, these proteins aggregate. Like amyloid-beta and alpha-synuclein, these are what we call end products of a molecular dysfunction.

[0:28:10]
Flavio H: This molecular dysfunction can be a result of many factors. For example, mitochondrial dysfunction, and there are many hypotheses and one recent paper showed that some environmental factors like pesticides can start the process in some patients. So it's a very complex interaction at the molecular level and environmental problems.

[0:28:50]
Flavio H: The idea is to provide patients with what we call foldable proteins, and we hope that maybe if we can restore these proteins in patients' brains, it might stop or slow down the disease.

[0:29:16]
Flavio H: But it's probably just part of the solution, not the whole solution, and we also can study the inflammation profile like cytokines, and try to find a way to use anti-inflammatory products to restore what we call homeostasis.

[0:29:36]
Flavio H: Also, what's been very interesting is what we call "omic studies" such as genomics and microbiome studies. This is very interesting

 because one of the things that has been studied in the last ten to fifteen years is the gut-brain connection. We now know that our gut, our intestines, are linked to the brain in many ways.

[0:30:17]
Flavio H: A chronic inflammation in the gut can trigger neurodegeneration, so going back to the microbiome, it's something that I think is very promising in this industry. So, as I mentioned, it's not like one solution. What we call a "multi-omics" approach includes genetic analysis, protein replacement therapy, microbiome analysis, and also using clinical biomarkers to guide and monitor the progress of these patients.

[0:30:57]
Flavio H: Also, I'd like to bring up what we call pharmacogenomics, which is the study of how an individual's genetic makeup affects their response to drugs. This can help us offer the safest and most effective treatment for patients. I think that's the way to go.


[0:31:14]
Hanh Brown: Do you think there's any one of those that have the most promise?

[0:31:18]
Flavio H: Ah, I'm very, very excited about protein replacement therapy.

[0:31:24]
Flavio H: I'm also very excited about studying the role of the endocannabinoid system. I feel bad because with Alzheimer's and Parkinson's it's a system that we have like the respiratory system or the cardiovascular system.

[0:31:37]
Flavio H: We have cannabinoid receptors in the brain and endocannabinoids that modulate various brain functions and we know that to summarize that endocannabinoid system is a crucial part of our organism's function.

[0:31:58]
Flavio H: I'm very, very much interested in studying the function of the endocannabinoid system in diseases like Parkinson's and Alzheimer's.

[0:32:10]
Hanh Brown: That's great. What do you think are some of the most unmet needs that Alzheimer's and Parkinson's patients' families have?

[0:32:21]
Flavio H: A lot of unmet needs you probably can share with us, but my perception as a doctor is, the first unmet need is the fear of the diagnosis, the uncertainty about the prognosis we give to a lot of patients.

[0:32:39]
Flavio H: For instance, imagine I see a patient who is 45 years old with early onset Parkinson's disease.

[0:32:46]
Flavio H: He's an engineer, has two kids and a family. So, I think dealing with the fear, the fear about the future, is one of the things that we have to address with families and what's the best way to do that is through good patient-doctor relations.

[0:33:06]
Flavio H: Not only doctor-patient relationship but also making sure that the patient will have access to what he needs or she needs. I think dealing with that is the most challenging at the beginning.

[0:33:23]
Flavio H: And after this, I think what we call behavioral symptoms is a very problematic issue. So, when patients have psychosis-like jealousy or some patients with what we call reckless generosity, dealing with these behavioral issues is very problematic.

[0:33:45]
Flavio H: There are also sleep disturbances in patients with dementia. So when patients don't sleep well, it causes a lot of disruption in the family environment.

[0:33:57]
Flavio H: And another aspect is to have access to the healthcare system. I think it's fragmented in many, many places so patients have to navigate through the system, they might not have access to a neurologist when they want or might have access to speech therapy.

[0:34:25]
Flavio H: Or physical therapy. So I think to provide access to these basic needs, which is a multidisciplinary team, is one of the biggest challenges for these patients and families, and also because of the cost, that's another problem.

[0:34:45]
Hanh Brown: That's true. And I hope that anyone listening now, months or years to come, don't feel that they have to hide, that they should feel no shame, right?

[0:34:57]
Hanh Brown: I think those are very natural feelings that patients, families, and caregivers may have, but there's no need for them to hide, we need to normalize these kinds of conversations. Too often, myself included, my family and I have gone through the journey too often, and in the beginning, we were in denial, not understanding what it is, and you want to hide. It's not something you put out there to your neighbors or people at school.

[0:35:20]
Hanh Brown: Yes.

[0:35:23]
Flavio H: That's exactly right. But yeah, I think the best way to deal with this is to have open and honest conversation and never hide, so we can bring the solution.

[0:35:40]
Hanh Brown: Right, let's move on to the role of cannabis, medical cannabis. What is its place in Parkinson's disease and dementia? So I guess, do you think that medical cannabis can help to delay the onset of Parkinson's disease and dementia?

[0:35:56]
Flavio H: That's a very good question. We already have some good preclinical data, but we don't have any clinical data showing that medical marijuana or cannabinoids can change the course of Alzheimer's or Parkinson's disease. But we have some preclinical models that indicate that these substances can impact neuroinflammation.

[0:36:27]
Flavio H: We know that THC can promote neurogenesis in animal models.

[0:36:35]
Flavio H: And we also know that these substances can influence the deposition of proteins. So if you have less deposition of proteins in the brain, it means that probably you are acting on some molecular level. So I think we already have enough data to show that we should and must proceed with clinical trials.

[0:36:55]
Flavio H: But what's the main issue about this is that people often conflate what we call recreational use of cannabis with medical use, they are completely different areas. We have to be very clear about that.


[0:37:15]
Hanh Brown: First, let's split the discussion.

[0:37:17]
Flavio H: Yes, thank you.

[0:37:19]
Flavio H: Also, one of the challenges with these substances is that they can't be patented, so most of the players in our system are looking for patented substances. These are natural substances, you can't patent them. So, we don't have enough resources to put into understanding the impact of these substances on the clinical evolution of these diseases.

[0:37:43]
Flavio H: For example, I would love to be able to test these substances on high-risk patients transitioning to Parkinson's.

[0:37:59]
Flavio H: For instance, we could work with a signal we call REM Sleep Behavioral Disorder. It is known to be a preclinical sign in patients with Parkinson's and other age-related diseases. After 65 years, these patients have a 75% risk of converting to Parkinson's or Lewy body dementia after a few years.

[0:38:27]
Flavio H: These patients might be good targets to study the use of these substances and see if we can influence the progression of the disease. We also know that these substances can have some interesting symptomatic effects.

[0:38:50]
Flavio H: We already have small clinical trials. The Michael J. Fox Foundation recently released a paper on cannabinoid-related disorders with 1,800 Parkinson's patients, showing that these substances and formulations can relieve pain and stiffness in these patients.

[0:39:16]
Flavio H: Some patients with Parkinson's, with small or medium doses of cannabinoids, have some relief in terms of rigidity and tremor.

[0:39:32]
Flavio H: So, I think it's a very interesting paper and I invite our listeners to go read it. I think it opens up a path for clinical development. I'm very excited about cannabinoids in patients with Parkinson's and Alzheimer's.

[0:39:56]
Hanh Brown: So, what would you say to someone considering using medical cannabis to treat Parkinson's and dementia? What advice would you give them?

[0:40:10]
Flavio H: I think my first advice would be to share your intentions with your doctor. In the April report from the Michael J. Fox Foundation, they found that 30% of patients using cannabinoids didn't mention their use to their doctors. 

[0:40:34]
Flavio H: I think this is because they are probably ashamed or afraid of being criticized by their doctors. There's a clear issue in the doctor-patient relationship here because I believe as a doctor, patients should feel comfortable sharing their plans with me.

[0:41:06]
Flavio H: So, the first step is to share this with your doctor. We have to keep in mind that we don't have enough evidence to support that cannabinoids can halt or cure Parkinson's or Alzheimer's.

[0:41:31]
Flavio H: However, if it can help alleviate symptoms like sleep, pain, and anxiety, we already have enough information showing that it can reduce hallucinations and dyskinesia. So, if patients have these symptoms, they should talk to their doctor about it.

[0:41:52]
Flavio H: The challenge in the United States is that cannabinoids are not classified as drugs, so doctors can only advise on their use, not prescribe them.

[0:42:12]
Flavio H: My view is that the United States should change the way it views cannabinoids and  I think blood runs Asian and should be should include at cannabinoids are as prescription medicines to patients a resume just did this years ago, so impersonal Eric and I'm like that person children.

[0:42:32]
Flavio H: It's so you don't buy you pets, seven eleven or your, you have to go to your doctor and to share display on with bottoms, and my view is that it's you pass changing the way the boxer's view cannabinoids because you go when neutral saw.

[0:42:52]
Flavio H: Arab populations, a prescription for relations for patients and give value to is, so you gonna have the prescription other doctors.


[0:43:03]
Flavio H: And I've seen a revolution in Brazil in terms of care for patients with Parkinson's, not only with Parkinson's but also in children with autism and epilepsy. So, if I can give one piece of advice, I think the United States should move fast to prescribe and adopt these treatments. Obviously, there have to be minimum standards in terms of quality, concentrations, and limits of use, but I think it's the way to go.

[0:43:41]
Hanh Brown: It sounds like there is so much potential in personalized medicine. Is there anything else you would like to add about personalized medicine and its best practices?

[0:43:47]
Flavio H: Yes, I think the endocannabinoid system should be included in the evaluation of patients with the problem of future neurodegenerative diseases. It is one of the tools we have, what we call endocannabinoid tonus. The main molecule, anandamide, is an endocannabinoid that interacts with the cannabinoids. They didn't know how to name it, so they called it anandamide, which means "bliss" in Sanskrit. It has been found to play a role in regulating the levels of other neurotransmitters. So, it might be one of the targets. We already know that when we have neurodegeneration, the levels of anandamide are reduced, so you have to adjust the levels of cannabinoids to address this dysfunction. So, anandamide could be included in some neurodegenerative panels as part of the personalized medicine approach for patients.

[0:45:29]
Hanh Brown: Dr. Flavio, thank you so much for your time, expertise, wisdom, and dedication in this field. In closing, is there anything else you would like to add?

[0:45:49]
Flavio H: I just want to thank you so much for the opportunity to be here for the first time with you. I work in Brazil and do research in Brazil, and I remember the first time I said, "Look, this is a worldwide problem, so to have a solution, we must include everybody, not only people in the United States, but people from around the world." So, your invitation makes me feel part of it. Thank you so much for inviting me. I'm honored to have been part of this conversation.

[0:46:29]
Hanh Brown: Thank you so much. I'm honored to have you here on the show. In this conversation, we clearly see that Alzheimer's and Parkinson's diseases are serious global issues. While there is still much to learn, new technologies and treatments are likely to improve the diagnosis and treatment in the years to come. In the meantime, it's critical that patients' families stay informed about new research so that they can make informed decisions. So, next week, the topic will be nutritional tips for brain health, longevity, and healthy aging.

[0:47:07]
Hanh Brown: It's no secret that what we eat has a significant impact on our overall health, but many people don't realize that what they eat can also have a major impact on their brain health. The truth is, your brain is the most important organ in your body, and you need to do everything you can to keep it healthy. Our diet can have a significant impact on our mental and physical health, affecting everything from mood and energy levels to our susceptibility to Alzheimer's and dementia. So, tune in next week.

[0:47:38]
Hanh Brown: We hope you enjoyed this conversation. Please make sure to subscribe to our Boomer Living podcast on iTunes, Spotify, Google Play, and other

 platforms. Also, subscribe to our YouTube channel, Aging Media Show. Thank you so much, and have a great day. Take care. Bye-bye.

[0:48:05]
Hanh Brown: Thank you for listening to another episode of the Boomer Living podcast. I know you have a lot of options when it comes to podcasts, and I'm grateful that you've chosen this one. Please share this podcast with your friends and family, write a review on iTunes, Spotify, and Google Play. It helps others discover the show. You can also contact us at 346-350-6884 to leave a review or request content for the show. We love hearing from our listeners. Check out our TikTok, Instagram, and YouTube channel, Aging Media Show, and subscribe to our weekly tips on how to best serve the senior population. We want to help them have a great experience as they age. Thanks for tuning in. Until next time.