Hamilton Herald Masthead


Front Page - Friday, July 1, 2022

Searching for the Holy Grail of Alzheimer’s care

Dr. Matt Kodsi is a board-certified neurologist with 20 years of experience and the vice president of medical affairs at CHI Memorial. - Photo by David Laprad | Hamilton County Herald

Every time I read an article about Alzheimer’s disease, I feel discouraged because the outlook conveyed seems grim. Have you ever seen a positive article about Alzheimer’s? Probably not. But I hope this article changes your outlook and leaves you encouraged that there is hope for the future.

I’m familiar with Alzheimer’s because my 84-year-old dad was diagnosed with the disease last fall. His diagnosis came years after I first reported his symptoms to specialists and his primary care physician. The specialists told me to discuss his symptoms with his PCP, who did not address my concerns.

In early 2020, my dad was hospitalized for two weeks with what was ultimately diagnosed as pneumonia. During his stay, he told me he had a conversation with the president. I immediately asked his medical provider to refer him to a neurologist. The medical provider informed me his confusion would likely resolve because he had pneumonia, which can cause confusion in elderly patients.

My dad transferred from the hospital to a nursing home. He did not see a neurologist until 2021 after I reported to nursing home staff that he did not know me. So, I learned the hard way that sometimes even medical providers dismiss the symptoms of Alzheimer’s as a normal part of aging. However, that is not the case.

When you or a family member are diagnosed with a disease, you might immerse yourself in learning about it. I not only became wrapped up in learning about Alzheimer’s but I also spoke with Dr. Matt Kodsi, a board-certified neurologist with 20 years of experience and the vice president of medical affairs at CHI Memorial.

Dr. Kodsi graciously took time out of his busy schedule to answer my questions about Alzheimer’s.

The terms “Alzheimer’s” and “dementia” are often used interchangeably. Dr. Kodsi clarified that Alzheimer’s is a disease. However, dementia is a term used to describe symptoms involving memory and thinking problems that make it difficult to live independently. The most common cause of dementia is Alzheimer’s; however, other medical conditions can also cause dementia.

Currently, the realities of Alzheimer’s are harsh. Dr. Kodsi explained that Alzheimer’s is a degenerative condition that significantly atrophies, or shrinks, the brain over time. This happens because the disease kills certain types of brain cells that are tied to the memory circuits.

The brain is already permanently damaged by the time a person exhibits symptoms. As described by Dr. Kodsi, these include difficulties in processing information and solving problems and/or a noticeable change in a person’s baseline condition.

Statistically, a March 2022 Alzheimer’s Association report identified Alzheimer’s as the fifth leading cause of death in Americans who are 65 or older. Although it’s not clear why, Dr. Kodsi said women are more likely than men to develop Alzheimer’s. Likewise, he explained that others at increased risk include people who have a first-degree relative, such as a parent, diagnosed with Alzheimer’s.

Genetic testing is not yet a reliable indicator of who is likely to develop late-onset Alzheimer’s. However, testing is available that can show whether a person has the APOE ε4 gene.

Dr. Kodsi confirmed that having the gene might triple the likelihood of developing the disease compared to a person who does not have it. To be clear, having that gene does not mean a person will develop Alzheimer’s. Since a person can have the gene and never develop it, the testing is unreliable.

For early-onset Alzheimer’s, genetic testing might be used to test family members of diagnosed patients. Dr. Kodsi noted that early-onset Alzheimer’s occurs before age 65. It is typically hereditary and only occurs in approximately 1-5% of all people diagnosed with Alzheimer’s.

Having the genetic mutation for early-onset Alzheimer’s does not necessarily mean a biological child will develop it. However, the National Institute on Aging’s website reflects that a biological child “has a very strong probability of developing [it].”

Presently, Dr. Kodsi stated that doctors rely on diagnostic biomarkers, which can detect or confirm the presence of Alzheimer’s. Examples of diagnostic biomarkers include MRIs, CTs, PETs, SPECTs and spinal taps, all of which are FDA-approved tests.

Once diagnosed, Dr. Kodsi noted the standard of care for treatment is a combination of a cholinesterase inhibitor (Aricept, Razadyne ER or Exelon) and Namenda. Dr. Kodsi clarified that while those medications have not been proven to slow the disease, they can stabilize it, potentially for years, in some people.

Further, Dr. Kodsi cautioned that people should not assume the medications are not working if the patient’s memory does not improve because it might still be slowing down the progression of the disease.

Importantly, a diagnostic biomarker that’s currently under study and available to doctors is a blood test. In a press release titled “Blood test for Alzheimer’s highly accurate in large international study,” the Washington University School of Medicine in St. Louis touts an international study that indicates that the blood test the school developed is highly accurate in detecting amyloid plaques commonly associated with Alzheimer’s.

Impressively, the test even detected the amyloid plaques in patients not yet exhibiting Alzheimer’s symptoms. Currently, most insurance companies do not cover the $500 cost. However, it’s significant that this blood test received certification in 2020 under the Clinical Laboratory Improvement Amendments program run by the FDA and Centers for Medicare & Medicaid Services.

One widely publicized FDA-approved medication, Aduhelm, became available last year. The Mayo Clinic’s website described Aduhelm as “the first drug approved in the United States to treat the underlying cause of Alzheimer’s.” It noted that the FDA conditionally approved the drug and required researchers to conduct additional studies.

Dr. Kodsi confirmed that Aduhelm was approved by Centers for Medicare & Medicaid Services for research studies, but a number of researchers still feel more data is needed to confirm the drug’s effectiveness.

Aside from medications, Dr. Kodsi discussed other measures people can take that might help slow the development of Alzheimer’s, including doing anything that’s “good for your brain.” Helpful measures include exercising regularly, eating a healthy diet, getting enough sleep and staying mentally active.

Conversely, Dr. Kodsi said excessive alcohol consumption and traumatic brain injuries can increase a person’s risk of developing Alzheimer’s.

Interestingly, Dr. Kodsi mentioned the 1986 “Nun Study” when discussing factors that might slow the development of Alzheimer’s. Dr. David Snowdon’s research, which he documented in “Aging With Grace,” focused on nuns living together in a convent.

Dr. Kodsi recalled that some of the nuns had brain changes consistent with Alzheimer’s disease but did not exhibit symptoms while alive. He then explained that the theory derived from Dr. Snowdon’s study is that individuals can have a cognitive reserve based on how mentally active the person was that might protect them from being symptomatic until a later stage in disease.

The cognitive reserve theory means people can potentially build up enough mental skills that Alzheimer’s will not affect them as much if they develop it.

Encouragingly, Alzheimer’s became a national priority Jan. 4, 2011, when the National Alzheimer’s Project Act was passed. The purpose of NAPA was to create a national strategic plan to address how to overcome Alzheimer’s and coordinate efforts within the federal government.

In 2011, the federal government earmarked only $448 million annually for Alzheimer’s research, according to the Alzheimer’s Association. More recently, President Biden signed into law H.R. 2471, the “Consolidated Appropriations Act, 2022,” which included a $289 million increase for Alzheimer’s and dementia research, making the total federal funding $3.5 billion, reports the Alzheimer’s Association.

In a March 15, speech, Biden explained that the bill also created an Advanced Research Project Agencies of Health, or ARPA-H, whose sole purpose is to conduct breakthrough research for the prevention, detection and treatment of various diseases, including Alzheimer’s.

The hope for the future is to continue working toward diagnosing Alzheimer’s early and to eventually diagnose the disease before patients exhibit symptoms.

Doctors are already able to diagnose it earlier than in the past. Dr. Kodsi explained that an early Alzheimer’s diagnosis from a research perspective means doctors can more easily study the disease and more successfully find a treatment.

Importantly, he believes doctors are getting closer to having an effective treatment. Looking forward, Dr. Kodsi said finding ways to diagnose Alzheimer’s early and start a treatment that prevents progression is “the holy grail for the disease.”

We might not have the holy grail for Alzheimer’s yet, but my research and conversation with Dr. Kodsi left me hopeful for the future. I’m probably the most excited about the groundbreaking blood test that’s available. It’s a “highly accurate” test Dr. Kodsi said can detect Alzheimer’s in asymptomatic people, which means it can provide an early diagnosis.

Likewise, the newly approved medicine, Aduhelm, is another step in the right direction in treating the underlying cause of Alzheimer’s. Perhaps most importantly, we now have $3.5 billion in federal funding for Alzheimer’s and dementia research! We’re almost there.

The Court of Workers’ Compensation Claims appointed Audrey Headrick as a judge in 2015. Before her appointment, Headrick was a workers’ compensation specialist IV and staff attorney for 10 years in the Chattanooga office of the Bureau of Workers’ Compensation.

Headrick previously spent two years in private practice working as a defense attorney, where her primary concentration was in workers’ compensation law. She received her juris doctor from the University of Memphis in 2002 and her bachelor’s degree from the University of Tennessee at Chattanooga in 1997.