Dr. David C. Weisman – Is Research Showing Optimism About the Future Diagnosis of and Treatment for Alzheimer's?

In this episode of Boomer Living, we have Dr. David C. Weisman, MD - Founder of the Clinical Trial Center at Abington Neurological Associates. He has become a leading AD trialist nationwide and has conducted numerous clinical trials in mild cognitive impairment and Alzheimer’s disease, working with nearly every major sponsor and investigation to develop disease-modifying drugs in Alzheimer’s disease.

We discuss what Alzheimer's disease is (vs. memory loss, senility, dementia) and how it is diagnosed and is being diagnosed, whether there's hope for a cure for Alzheimer's, what research is being done on Alzheimer's, and how Dr. Weisman managed through the COVID-19 pandemic, and much more...

[00:00] Pre-intro dialogue
[01:15] Introduction
[01:49] Distinguishing between Alzheimer's disease and other cognitive impairments, like memory loss, senility, and dementia.
[03:21] How is Alzheimer's disease diagnosed and then has this method of diagnosis changed at all over the last several years?
[05:30] Details of the Philadelphia Cognitive Exam, the computerized screening system to diagnose and detect dementia that Dr. Weisman invented and validated. What impact has it made on people with dementia?
[07:42] What research are you currently working on, surrounding Alzheimer's?
[09:30] How did you manage doing clinical trials during the pandemic? Did you have to put your research on pause or simply change how it was done?
[12:53] What are the biggest findings that you've uncovered in your Alzheimer's research?
[13:18] What about your research makes you most optimistic about the future of Alzheimer's diagnosis or treatment?
[13:56] You founded a research center and now you conduct research outside an academic center. Explain the difference between the two and why did you do it that way?
[15:38] Would you recommend the COVID-19 vaccines to people with Alzheimer's dementia or other cognitive impairment and are there special side-effects that we should keep an eye on?
[17:58] What advice would you give to a younger version of yourself? Someone who's interested in doing research?
[19:47] What do you think is your biggest strength that enables you to have a unique, impactful effect on older adults or adults with dementia?
[20:41] Wrap-up

David Weisman, M.D., received a BA in philosophy from Franklin and Marshall College, then an MD from Pennsylvania State College of Medicine. After an internship at St. Mary’s Hospital in San Francisco, he completed neurology residency at Yale, where he served as Chief resident. He then went to University California, San Diego for fellowship training in Alzheimer’s disease and other dementias.

You can learn more about Dr. Weisman and his work at: https://www.abingtonneurology.com/providers/weisman/

You can listen to Joe's first appearance on the show (season1, episode8) here: Caring For A Loved One With Dementia with Dr. David C. Weisman MD

Transcript

David: 0:00

I would absolutely recommend the vaccine to anybody who can get it. There is absolutely no reason in the world to avoid a vaccine, especially if you have a dementia. There's recent data that's emerging that shows that this disease, coronavirus and COVID affects old people, the worst. Of course, we all, we know that mortality increases from forties. It's minimal fifties. It's minimal ticks up in the sixties, seventies and eighties. It really escalates. People with Alzheimer's disease are about that age.

Hanh: 1:15

Dr. David Weisman, he is the founder of the Clinical Trial Center at Abington Neurological Associates with multiple clinical trials on mild cognitive impairment and Alzheimer under his belt. He has become a leading AD trialist nationwide. So David has devoted his research career to advancing new therapies for Alzheimer's disease. And his trial center also has advancements in strokes, Ms. And Parkinson's disease. David, thank you so much for joining me today on Boomer Living. Yep. So can we start by distinguishing between Alzheimer's disease and other cognitive impairments, like memory loss, senility and dementia.

David: 1:58

Alzheimer's disease is a specific dementia. It's w I use the analogy. It's a type of dementia. The way that arose is a type of flower, okay. There are many different types of flowers. But in this case, we're talking about a Rose is the type and dementia is the big umbrella word that encompasses a lot of other problems. A dementia is almost a vacuous word. It means having a thinking problem that makes one unable to carry on their previous day-to-day life, okay. That could be the case of you're hit in the head really hard and get a traumatic brain injury, knock on wood, okay. You could have a traumatic brain injury and you could be justifiably called having a dementia. It would be a static dementia. Alzheimer's disease is the dementing illness that first of all causes the most dementia up to 80% of all dementing cases are Alzheimer's disease and it's due to proteins that build up in the brain and they start effecting memory mostly, but sometimes other cognitive functions and it slowly gets worse and that's what Alzheimer's diseases is. So, we can distinguish that pretty easily clinically and predict those proteins in about 80 to 90% of the cases.

Hanh: 3:21

How is Alzheimer say diagnosis and then has this method of diagnosis changed at all over the last several years?

David: 3:28

So, the diagnosis is just like anything else in medicine. When you go to your doctor with an earache, they listen to the story."Which ear hurts? How long has it been going on and what even doing have you been swimming?" The doctor elicits a history, sometimes things you're not even aware of. What kind of Q-tips you use to clean your ear. And you may find that information germane or non-germaine. They take a history, and then they do an examination. They look in the ear. Same thing with Alzheimer's disease. Typically, people are presenting with memory loss or their caregivers presenting with memory loss. There's a history."When did it start? How bad is it?" Then they do an examination. Instead of looking at it in the ear, they are doing a cognitive evaluation."Here's some words, try to remember them, while I distract you? What were those words? Draw this thing right here, which is these pentagons.". And problems with that can lead to a diagnosis. And that diagnosis is very good. It's not entirely firm. It's not the pathology, but it does predict those proteins, like I said. Now, recently the change in diagnosis has been the advent of what we call biomarkers for this disease. So, imaging techniques to measure those proteins. And they are being layered in to the normal history and examination to increase the probability that we're talking about, alzheimer's disease as defined by having those proteins. And those are pet scans and lumbar punctures. Those are mostly, almost entirely being done for clinical trials now, because we really want to make sure that we're studying the appropriate population to get into these trials. So, for clinical use, it's really just the history and the, an examination, usually suffices. But that may change with the advent of disease modifying therapies that look like they may be on the horizon now.

Hanh: 5:30

Can you tell us about the Philadelphia Cognitive Exam, the computerized screening system to diagnose and detect dementia that you invented and validated. Now, what impact has that made on people with dementia?

David: 5:43

It is a substitute for many other tests, many other cognitive tests. The only trick of this is that it's digital, it's on an iPad. And so physicians can bill for it. It was designed to really try to increase utilization of a test, to increase diagnosis and disclosures of diagnosis, because that's one of the, underbellies of Alzheimer's disease. That, it's not disclosed and it's not diagnosed. Why? Well in part, because physicians are not only, not incentivized, but they're de incentivized to diagnose Alzheimer's disease. It's a hard diagnosis to make. What happens when they diagnosis? A, tons of questions take time. So, you can see every reason in the world. There's a lot of headwinds, for the diagnosis of Alzheimer's disease. And we know that people are living with Alzheimer's disease, and about only half of them are diagnosed. And of those diagnosed, if you ask the caregiver, the doctor diagnosed Alzheimer's disease, "What did they tell you?" They didn't say Alzheimer's disease, nor did they say a dementia. They use the other, other euphemisms. That you alluded to before. Senility old age, we called it memory loss. And I see that a lot. So the, this Philadelphia Cognitive Exam or Peacock, it was designed to try to get at that. And I have to say it did not work.

Hanh: 7:05

Could you elaborate on that? It did not work?

David: 7:07

Doctors still don't, they don't use it. They are not testing. They are not, diagnosing and not disclosing. I think it's just one solution to a huge problem of disclosure and diagnosis within any memory and thinking problem. That said, we're just, we try to try our best every day to raise awareness of the disease. So, that if there is memory loss or thinking problems, going to a doctor and eventually getting referred to a doctor with some, special, specialization, some expertise can really help.

Hanh: 7:41

Absolutely. So what research are you currently working on, surrounding Alzheimer's?

David: 7:45

Alzheimer's disease is thought to be extremely druggable, even though there is no drug, yet. Those proteins I alluded to before, they build up in the brain 20 years before the onset of any memory or thinking problems. And so we think that we can get rid of them with a variety of therapies. And currently there are four drugs that are in development that all basically do that. There's a lot of good data to show that they remove this protein called Beta- Amyloid, and get it out of the brain. The way that they do that, they target it for removal by the immune system. With these antibodies have been in the news a lot. We make antibodies to pathogens like the coronavirus. We can measure them, but when we give people antibodies, we can actually make them in a VAT and give people antibodies and make them attack the protein. Not the, COVID. Not another pathogen, but make them bind to and stick to Amyloid. And then the natural immune system clears it out. It's pretty amazing. And that has been shown that we can do that, now with these medications. People have the amyloid, with a positive pet scan and they convert to negative. And the first time that was shown, that was like astounding! Like a beautiful data. We didn't know that, that impacts cognition yet, and we still don't know that fully, but it does look like there's a lot of silver linings here that even though there have been a lot of negative drug trials. Looks like getting rid of Beta-Amyloid does slow down the disease and that's now been shown. Again, four drugs in development and three have basically shown it in a phase two or phase three study.

Hanh: 9:29

That's Great. Now, how did you manage doing clinical trials during the pandemic? Did you have to put your research on pause or simply change how it looks or?

David: 9:38

It changed a lot. So, during the beginning of the pandemic. It was actually about a year ago that we started getting really concerned about this. We didn't know how the virus spread. We had no clue what was going on and, in these clinical trials, usually trial integrity and patient wellbeing are exactly the same thing. What's good for the trial is good for the patient. They're getting a drug or placebo, but either way, they're getting a shot at something. They get a lot of safety things. But here in the pandemic, trial, integrity and patient wellbeing, we're not a agreeing. They were almost adversarial ideas. Patient safety coming in for a trial where they could get exposed to a novel coronavirus where they have high susceptibility of mortality. Could we know, we now know we knew always that coronavirus affects older people, the worst. And Alzheimer's disease is a disease of aging. So, people who are older, are our trial participants. So, the way that we handled it, obviously we kept everything very clean. We scrubbed things between patients and everyone wore a mask always onsite. And that's still the case, but it was also an individual conversation with trial participants. We did not even consider stopping the trials. The trials are important. We have obligations to science. We have obligations to the sponsor. We have obligations to the subjects. So, that was off the table. We had to continue. We have to get this data. That is a grand, I cannot imagine the pandemic that would have to occur for us to stop. It would have to be a societal breakdown, frankly. So, we kept going. We didn't enroll anymore. We didn't enroll any new, but any, anybody new into a trial. And we put all new trials on hold, but the people that we had, we kept them going, as safe as we could. And again, it was an individual decision, an individual conversation with each participant."Do you want to continue? Do you want to hold off? Can you come in? Do you feel safe? What's your caregiver health? Who else do you live with in the house?" Maybe they are susceptible. You may not want to because everybody's individual situation is different. I live with my in-laws, who actually got COVID and gave it to me. But that was on the other hand. We can't have people living with susceptible people. It's a public health problem. They can't come in and feel like they're endangering their entire family. So, some people went on a hiatus. I'm pleased to say most people made it through and kept going.

Hanh: 12:15

Yeah, it has impacted, everyone in the globe in some form or another. Economics, health, relationships. So, I'm very optimistic with the vaccine being available, rolling out and our economy to consistently stay open. Thank you.

David: 12:31

Oh, yeah. I, my heart breaks for like people like bar owners and restaurantere's, and, creatives. That's just horrible. That the suffering that they've had to endure is been unbelievable, economic suffering. And then my heart breaks for the people who went out to those restaurants and took a risk and got coronavirus and died.

Hanh: 12:52

Yeah. Now, what is the biggest findings that you've uncovered in your Alzheimer research?

David: 12:59

I think the biggest finding that's is yet to come. The biggest finding will be a disease modifying therapy that slows down the progression of Alzheimer's disease and keeps it mild. There's no reason why these people, why someone with Alzheimer's disease needs to progress. We think that we can slow it down to a glacier pace. We have not proven it.

Hanh: 13:18

What about your research makes you most optimistic about the future of Alzheimer diagnosis or treatment?

David: 13:26

I think we're finally getting the appropriate people into these trials, with the protein at the right stage of the disease, and treating them appropriately with the right target, of the right drug, and the right dose. That just seems so intuitive. But, it is a massive discovery process that takes years, and has taken many dozens of years since 1980s, when we discovered that these proteins collect in the brain.

Hanh: 13:56

Now, you founded a research center and now you conduct research outside an academic center. So, can you explain the difference between the two and I guess why did you do it that way?

David: 14:07

Academic places are huge, are enormous institutions. And if, you like that, then that's great. Okay. But, there's a huge institutional overhead, red tape, people looking over your shoulder. And it's clunky. It's hard. It's harder to get things done. You call people and they don't have an answer. They don't have decision rights. You can't find someone with decision rights within a huge institution. So, I didn't like any of that. And when I was at a big institution, I thought you could do this outside. And I'm very fortunate. I went into private practice and I started doing these clinical trials. And I was the right person at the right time. And I started doing one and it took off. We showed our metal and now we get more, and that is wonderful. They were bringing these trials to my, at my site to this population here. So, it's been a terrific ride and I'm very happy with what we've accomplished, outside um, a big institution. And it's a little bit more rare. It's been done before. There are standalone sites and the private practices that do clinical trials, but it's usually someone who came from academia first and got fed up with the big institution and left. And that's our story, but I just started doing research right out of fellowship

Hanh: 15:34

Congrats, congrats on your journey and your success now. Now, would you recommend the vaccines to people with Alzheimer dementia or other cognitive impairment and are there special, side-effects that we should keep an eye on?

David: 15:49

I would absolutely recommend the vaccine to anybody who can get it. There is absolutely no reason. In the world to avoid a vaccine, especially if you have a dementia. There's recent data that's emerging that shows that this disease, coronavirus and COVID affects old people, the worst. Of course, we all, we know that mortality increases from forties. It's minimal fifties. It's minimal ticks up in the sixties, seventies and eighties. It really escalates. People with Alzheimer's disease are about that age. They are older because we know that one at 65, 1% of the population has it, but then Alzheimer's doubles every five years. So again, it's a disease of aging, but it's low. It does look like preliminary data shows that dementia itself may be a risk factor for added mortality and morbidity, from the coronavirus. Now, who knows why that is, right? That could be because they're living in a nursing home when they get their first exposure of coronavirus, maybe more. Okay. Maybe they're more bedbound. Maybe they have more comorbidities. But it does look like a marker for worst disease. So, should anyone with dementia? Get the vaccine? Yes, any human should get this vaccine? The vaccine safety profile is unbelievably good. Unbelievably good. They've now given millions of doses with very few reactions and very few that we can actually attribute to a vaccine. Meanwhile, the vaccines are way, are performing way better than expected. Their reduction of severe disease is incredible. Yes, please, if the vaccine is available to you. If you're vaccine hesitant, that's totally normal. Let me just say, put that one out there as well. I am hesitant when I step into a plane because I'm a nervous flyer. Do be hesitant, but know that it's totally safe. Get the vaccine.

Hanh: 17:46

Thank you. Great. Now, what advice would you give to a younger version of yourself? Someone who's interested in doing research?

David: 18:04

I have to tailor that advice to the person I was. It has to be like a key that kind of gets into your brain. So, that's a trick if advice is actually to give good advice at that time, so the person can actually hear it, right? For my, for myself, I think what I needed to hear was that people who are, people are good in three levels. They're good with people. They're smart, and they're hard-working. If you're smart and hardworking, you tend to blow off the other one. If you're good with people, you may ease off on your diligence. You can get away with it. People are going to give you a pass, right? So, usually people are not like all three wheels. And I wish somebody had really put in front of me that, try to make friends. Cause I, I definitely erred on the hard work being diligent, being smart. And I thought that was the way to be good. To be good with people was to be smart. That turns out to be false. That was a mistake that I had when I was young. I wish I could have heard that it's better to make friends, with everybody to never burn a bridge, to never come across as anything other than a nice person. I still struggle with that.

Hanh: 19:22

Well, I'll make sure. I'll give those advice to my children. Um, especially my daughter. Who's going to be starting medical school. So, thank you for that advice.

David: 19:31

Three things, three things, and most people, it to come naturally and they can work on the third. And very few people only have one. Think of it like a tricycle, very few people are unicyclists

Hanh: 19:44

That's true. That's true. Very good. Now, what do you think is your biggest strength that enables you to have a unique, impactful effect on older adults or adults with dementia?

David: 19:55

When I look around at other people who can try to do what I do. There's a lot of front end work explaining the disease state in a clear and kind manner. That is a strength of mine, I believe. And I'm also extremely diligent on email, timely. I get things back. I also credit my staff. I have been extremely lucky with hiring good people. And if you surround yourself with good people on a good team and you yourself are like pretty good, then success will follow. So, I think that's why we've been so successful.

Hanh: 20:33

Great Congratulations on your success, and also your dedication in this area, is much needed. Do you have anything? Yeah. Do you have anything else that you would like to share?

David: 20:43

No, I think we covered so much. Good luck to your daughter.

Hanh: 20:46

Yeah. Oh, I'm so excited. Yeah, she um

David: 20:50

Where's she going to go

Hanh: 20:50

Michigan. Yeah. And what I'm so excited is that we're near, like we're, I'm from Michigan.

David: 20:56

What's your daughter gonna do? Is she gonna, what, does she know? What she going to specialize in?

Hanh: 21:01

I think she's well, here's the thing. Here's what I advise to her. Whatever you do, just make sure you'll be paying off your student loan. She has some interest. She's really not made a decision yet, from what I understand the four years, it's medical school, and then you go into a specialty and then you go into your residency. Let me ask you, do people typically know. Before going into medical school or do they discover that during medical school?

David: 21:28

Some know.

Hanh: 21:29

Oh, really?

David: 21:29

Some know. Very few, I would say. Some people, their father's an orthopedic surgeon, and they're like, if I like orthopedic surgery, I'm definitely going to do it, cause I've just grown up with it. And and that's great if they can do that. And cultivating trust early. I didn't have that. I had no clue. I was just along for the ride and I discovered neurology like my second and third year. So, I think that's true of most people, they have to go in undifferentiated. They have to be interested in everything, and then they discover what they want, and who their tribe is. You got, one of the best advice is just look, it's a long process. You don't have to make an instantaneous decision. You will find your way. And if you don't, there's still room for you. You can stay undifferentiated. You can go into internal medicine, you can go into family practice and be very undifferentiated and then focus on something. People come in hyper competitive and they're like dermatology for me, plastic surgery, orthopedic surgery, ophthalmology, anesthesiology, whatever it is.

Hanh: 22:34

Yeah. Yeah. I do know that, during her undergraduate, she was under a cardiology vascular department at Michigan, and she did a lot of research. So, she had several publication in that area. So, I thought maybe that would be an area of interest. I think she feels very blessed to have that opportunity, but she's interested in. She's doing a lot of volunteer in the geriatrics right now, because of COVID and they're, they don't have visitors, unless go in there. And so, she's enjoying that part and, doing some volunteers and of course tracking. That's a big area. They need people to be tracking folks with COVID. But it's good to know. She did tell me that's decreasing. Thank God that. So, I think she's exploring.

David: 23:16

Yeah, that's the way to go. That's the way to go. I mean, I think that we're going to graduate a bunch of infectious disease people. There's so many doctors who got into COVID, like deep into infectious disease. So, who knows? That could be the wave of the future, but good luck to her. Yeah. Yeah. Thank you very much

Hanh: 23:32

All right you take care.

David: 23:34

Bye bye now.