Original subtitles

[Music]

hi I'm Diana Seville I'm the president

and co-founder of brain mind and we're

here with Dr Richard Isaacson and we're

going to be talking about how he is

revolutionizing brain health care so

Richard uh would you care to introduce

yourself a little bit sure so my name is

Richard Isaacson I'm a preventive

neurologist and for those of you who

have not had heard that term before um

it's really um I'm a neurologist that

focuses on preventing neurological

disease uh most brain disorders

Alzheimer's Parkinson's Louis body

dementia among many others star in the

brain decades before symptoms and it's

our job to try to um figure this out

before symptoms begin so we can uh have

an early intervention plan um I

currently direct the uh Institute for

neurod degenerative diseases in Florida

and uh Focus my work on brain health so

can you tell me a little bit more about

how your work is different from a

typical brain health center sure so

um you know the field of preventive

neurology is um one that doesn't exactly

exist yet there's only a handful of

neurologists um and you know in the

United States and abroad that that think

about this or practice in this way um

but really this has to be the future um

you know we're a sick Care Medical

system and I think our goal is to

transition to a Ware uh medical system

and a preventative health care System uh

because if we try to treat a disease

that's been going on for decades uh the

progress and the impact is just going to

be minuscule if we can treat a disease

that's just starting before symptoms

begin um you know prevention to me is a

cure and and when you um really are

moving towards the goal of the Holy

Grail of preventing uh neurodegenerative

disease you have to startch decades

early so our goal is to see people

before symptoms people with a family

history of Alzheimer's Louis body

dementia Parkinson's disease uh and then

also our goal is to study all of these

somewhat related but not exactly related

conditions in the same way in the same

group in the same you know research

structure so that we can compare the

trajectories of each patient and we can

compare various markers in the blood um

over time in these individual groups and

your work is very data driven can you

talk a little bit about how you leverage

data sure so um you know in the past we

would say um exercise eat a healthy diet

Mediterranean style diet um get your

sleep um you know modify stress and we

would tell people to do this and they

would feel better and we would check

their cogni function and their cognition

would stabilize or improve and their

biomarkers their cholesterol their

nutrition markers would also look better

so we felt like we were making an impact

if you can impact a person's modifiable

risk factors for brain disease or neurod

degenerative disease or cognitive

decline uh biomarkers like cholesterol

insulin resistance nutrition markers

inflammation um well if cognitive

function is also improving or

stabilizing that means we're having an

effect but the Holy Grail with

neurodegenerative disease prevention or

risk reduction is can we actually impact

the disease pathology that we're trying

to Target so our group has really um you

know pivoted uh quickly and strongly uh

towards using blood-based biomarkers um

most people don't think that there's a

way to diagnose Alzheimer's disease or

Louis body or Parkinson's disease from a

blood test um I would disagree um yes

there are fancy tests like pet scans and

spinal taps lumbar punctures looking at

the fluid that bathes the brain and

having to do more of an invasive

procedure but the future to me of

Alzheimer's Louis body Parkinson's

disease prevention are really going to

rely on blood testing and uh using what

we call proteomics which is looking at

um you know very small amounts of

protein in the blood we spin the blend

down we freeze the blood we put it in a

a in a what we call a bio repository so

we can store the samples for decades

literally um and um as new tests are

developed we can always go back in time

to understand where the person was at

and then what the trory of change was

over time uh what we do is we look for

these markers um something called amalo

protein it's a sticky protein that

builds up in the brain of Alzheimer's

patients as well as Louis body and other

patients we look at a protein called Tao

we look at a protein called Alpha

sunclean in different forms phosphorated

versus aligo Alpha sunclean numbers here

are complicated the the the metrics here

are complicated and then we look at um

really non-specific markers something

called neurofilament light we've been

looking at neurogranin and neurofilament

heavy chain and there's all this gobble

dek but the goal of our work um and

really the goal of um the projects that

brain mind um has supported that we

would have never been able to do without

the support uh it's just it's just too

high risk High reward but but also way

too high risk um is to try to develop

the co what we colloquial call the

cholesterol test for the brain just like

everyone every year or two gets a total

cholesterol an HDL cholesterol and LDL

the bad cholesterol and triglycerides we

want to do the same thing for brain

disease and when we're going to be

hopefully in coming years and we kind of

do this now but hopefully it'll be ready

for prime time soon uh everyone's going

to get that amalo level the various PWS

people that are at higher risk for

Parkinson's or Louis body will get a

alpha sunclean uh in different types in

the blood and and we'll be able to get a

Baseline and then when something starts

changing over time we can then intervene

in a in a personalized way and then what

we can do this is again our goal and we

published on this just just a little bit

um what we've shown is that when we can

actually give people a targeted plan

based on the proteins we find in their

blood based on the risk factors that

they have and based on their family

history in our bio repository we can

track change so yay cognition is

improving yay their cholesterol is

improving but we've also now shown

statistically significant improvements

in both amalo and Tow protein the

biological you know Hallmarks of the

disease um you know across the entire

group as a whole and that was something

that actually shocked me um and we just

Pres presented that um at the American

Academy neurology meeting we'll be

presenting that the Alzheimer's

Association International Conference

this summer so you mentioned these

projects that brain M supported that you

wouldn't have otherwise done could you

expand more on that there is no part of

our work that is fundable by traditional

means um there is no NIH grant that I

could apply for right now or there's

very few foundations that even you know

think this way uh but most grants that

you apply for take six Mons months nine

months to get a review and then you have

to go back in and make changes and then

by the time you submit the grant to have

the final dispersement of the funds it

could be a year and a half later and a

year and a half in in our field it it

way too slow I mean things are moving so

rapidly um you know last summer I I saw

a wow interesting machine wow

interesting technology I'm going to

apply for a grant for this uh well it'll

take a year and a half and by that time

Everything Will Change uh so we we pivot

quickly we have funding we use

philanthropy we use Foundation funds and

we go and we move and in some ways you

know it's it's kind of like you have to

have like a entrepreneurial Spirit when

it comes to research and you kind of

also have to have um you know more of

like like a venture philanthropy kind of

mindset where you make a big bet on a

new technology or A New Path forward and

um without doing that um there would be

delays there would be um you know loss

of um you know opportunities and um you

know using using brain Minds funds we've

been able to take really big risks that

traditional funders aside from not

having like a funding request that you

can apply for because this stuff just

doesn't exist in in this type of

population before a person has symptoms

that's that's the Clincher here there's

lots of Grants you can get when someone

already has dementia when someone

already has dementia they've had that

disease for literally decades uh we're

looking at the the children and the

family members of people with uh

cognitive decline in dementia uh we're

also looking at the people with dementia

and we follow families and uh there's

just no grants or no mechanisms to

support that brain mes allowed us to be

Visionary to take big risks um uh you

know some would say too big risks like

how could you spend that much money on

this big idea well so far things are

working and I can't guarantee that

everything's going to work um and we are

definitely taking big risks on

technology that isn't really entirely

proven never been done in humans before

never been done in you know people in

their 20s 30s 40s you know uh you know

young young people where they may have

minuscule amounts of protein in in the

blood that may we won't even be able to

detect but we're going to take a big bet

we're going to use new technology we're

going to use you know ways to amplify

proteins that have never been used

before um and also in tiny amounts to

make it uh make it more accessible you

know our goal is to democratize access

to brain health care and if people have

to go and pay thousands of dollars for a

pet scan that has radiation a brain scan

if people have to go in get a procedure

a spinal tap that's going to limit

access and our goal is to use blood

tests and eventually our goal is to use

atome testing and and we're really um

trying to Pioneer um uh at home

fingerprint card testing and I I these

are still early days but um I'm really

excited and if we could use the right

Machinery amplify the proteins use tiny

amounts of blood uh and then package it

with an offering uh where people have

access to education to information and

to guidance about their individual risk

factors um that's the way we're going to

reach people that's how we're going to

scale and that's how we'll democratize

brain Healthcare so some of your work

functions like clinic but there's also

an entrepreneurial aspect to your work

can you talk about the different

workflows there yeah sure so I'm a

neurologist I'm a clinical neurologist

have a very small clinical practice and

uh the patients that we see um get very

deep very attentive very Hands-On uh

personalized care based on emerging

principles of precision medicine we're

going to look at um you know deep

phenotyping we're going to look at blood

biomarkers we're look at detailed

neurocognitive testing we're going to

look at uh body composition measures

brain MRIs with volumetrics we are going

to characterize the person sitting in

front of us in every way shape or form

at every time point we're going to look

at um also these new emerging

blood-based biomarkers of

neurodegenerative disease and we're

going to track these people um you know

entirely precisely and closely people

will get comprehensive plans uh again

based on emerging principles of

precision medicine that's not scalable

but that's that's our feeding ground

that's our learning ground to to really

understand what is the is the minimum

amount of data that we need to get to be

able to provide this access to care in a

democratized fashion at lower costs at

broader scale so in a typical clinic

setting I'll see one patient in a

day we'll spend hours dozens of hours on

that one patient discussing with a team

of multi-disciplinary experts I'm a

neurologist but we have a preventative

Health Physician family practice nurse

practitioner we have Consultants across

basically every spere of medicine

Psychiatry neurology psychology and and

Primary Care Al also Cardiology

everything

Endocrinology we can then learn from

that as our prototype and then what we

try to do is democratize access in two

ways and this is really where I think

the entrepreneurial Spirit comes in

number one how do you reach people um

well one way to do that at scale is to

use software and what we've done is uh

created a digital therapeutic or

automated software solution that

includes um basically anyone with a cell

phone can access a risk

assessment funded initially by the NIH

and then um other funding afterward a

risk assessment um online uh then using

the phone can do cognitive assessments

and then based on what the software

learns about that person the software

can give automated feedback and have uh

really a conversation with the user to

try to reduce that reduce that person's

risk over time and a subset of patients

we actually had an army of mobile FLOTUS

all throughout the United States uh and

we sent FLOTUS into the home to draw

blood and we are actually able to track

um basically blood-based biomarkers um

in a way that not only you know is risk

going down by a calculated risk measure

that we can track online at low cost or

no cost is co is cognitive function

improving or stabilizing well that's all

digital but sending mobile FLOTUS into

the home of of you know dozens and many

dozens of people in the throughout the

United States to check well what is it

truly impacting is it actually impacting

amalo or TOA um that's really the the

proof is in the pudding uh so one of the

the key ways that we're trying to

democratize access is to make it

accessible to all through the comfort of

their own cell phone the other thing

that we're trying to do is we're trying

to bring the blood testing uh into the

home in an even better way uh mobile

photomy is is doable but again is that

truly scalable um the cost is expensive

um you know mailing these samples on dry

ice very complicated spitting it down in

a very specific way um mailing it to a a

place a bio repository a research site

has a negative 80° freezer you know

these are these are these are

complicated things again what we're

trying to do is take what we're learning

in the small population and then take

what we're you know we're trying to you

know refine in the lab and we're trying

to instead of sending a mobile flomist

what about sending a little fingerprint

card um Believe It or Not fingerprint

cards are are used used all the time uh

for omega-3 fatty acid testing um you

know people can check their blood and

check their blood sugar that's obviously

you know everyone known you can we a

continuous glucose monitor um but there

are fingerprint card tests out there for

cholesterol and for a variety of things

that people are I bet aren't even aware

about but for brain biomarkers the

technology doesn't exist at all the

problem with brain biomarkers is the

proteins in the blood are in such a a

minuscule you know tiny amount that a

tiny amount of blood going into the card

plus a tiny amount of protein in the

blood sample is just not enough so what

we've done is we've used the newest

technology to try to amplify these blood

proteins and detect them in a way that's

really again never been done before so

high risk High reward um and basically

our goal is to uh democratize access

through software and democratize Care

through at home fingerprint card uh

testing um again early days uh but in

terms of the software we uh enrolled

almost patients in our first NIH funded

study our second study um at last look

we had over 1,400 patients so it's over

2500 people our first study uh was

enrolled in just over two months and our

second study of over almost 1500 people

enrolled in 48 hours 48 hours amazing

wow uh believe it or not the statistics

show that per site Alzheimer's studies

recruit one person per month per site

across the United States and these are

studies where people have to come into

the office get a blood draw get an IV

infusion or whatever the thing is so

that's 12 subjects per site per year on

average in 48 hours we recruited almost

1500 people into an online software

study this is how we have to democratize

care this is how we have to bring down

costs this is how everyone whether

you're in the United States or across

the world whether you have insurance or

you don't um this is the way we have to

get get access to brain health care and

I think we've shown that software can do

that uh but now we have to try to prove

um you know can we um you know uh you

know definitively demonstrate

neuroprotective effects of what the

software is telling the person to do

using atome testing it's a big goal uh

it's a tough one but we're getting

closer so how might someone get involved

in the work that you're doing you said

that there was at some point there was

trial enrollment is there something

going forward yeah uh great question so

um you know uh huh did I really think a

thousand people we the second study we

um put together was because the first

study was filled and we had tens of

thousands of people on a waiting list uh

we launched a second study and

uh the challenge here is um uh you know

the cost to to do these studies are

actually relatively low but when you

have 1,500 people people that join a

study in in in 48 hours the customer

service aspect and the questions and the

the the the the you know all that kind

of stuff uh gets a little challenging so

you know right now I'm thrilled that we

have 2 200 people um using our software

um like literally as we speak um I can

go to bed at night and I have 2 200

people that are receiving automated care

based on the kind of philosophy and and

and and and stuff that we've proven in

science we can now translate into um you

know online education um but I'm not

sure how we um scale this U massively um

without you know continued investment

continued scaling of the team um and um

you know the challenge here also is

right now these are these studies are

funded by research um there are no

valid foolproof ways to fund this type

of care because the reimbursement

Paradigm in the American Medical system

uh does not uh account for uh these

types of digital therapies digital

Therapeutics you know Germany is the

most mature Market when it comes to this

uh you know digital therapeutic uh

potential but even in Germany companies

that create this these types of tools

and software just don't get the types of

reimbursements that I think you know

they deserve so unfortunately um the

technology is there the outcomes are

there The Innovation is there but the

medical health and Healthcare System and

insurance companies just haven't uh

really caught up um is this going to be

a year or two away two or three years

away um I'm not really sure could it be

3 to 5 years away probably so until the

reimbursement path even $20 a month or

$10 a month the the the return on

investment for using a software solution

that costs you know pennies uh could be

you know gigantic could be multiple

orders of magnitude but until we have

some sort of reimbursement Paradigm to

just fund the basics you know just a

customer service person to fund the

technology team to fund you know the the

big data people that are trying to look

at the analyses you know these

fingerprint cards cost $1 a piece you

know mailing price of stamps keep going

up but you know these these the cost of

these tests are not um astronomical you

know it's our goal um you know as a

company and as a you know a mission

driven company to provide the bare

minimum access for free or at cost so if

someone just wants to know they a single

biomarker one time to figure out what

their risk could be we want to offer

that at cost that may not be like the

best business model but that opens up

the doors and for those people that have

the funding to invest in their own brain

health then there's a lot that they can

do they can get panels they can get

access to more content they can get

access to more lab tests they can you

know take lab test they can go exercise

in a different way for for four to 5

weeks recheck their blood and see does

that exercise pattern impact their blood

biomarkers does it impact cognition you

know people can be their own citizen

scientists they want to change their

diet they want to maybe they started on

a new drug and they want to just get a

sense of hm could this drug be you know

helping or harming me in in terms of a

brain health way where other doctors and

the medical system just hasn't paid

attention um it's our goal to provide

access to as many people as possible but

also allow people that do want to go

deeper um to do that so what is

something that people have gotten wrong

about Alzheimer's prog depression and

neurod degeneration you know our our

entire field um got wrong that when a

person is diagnosed with dementia uh

that's when the disease started um you

know I was never taught I was never

educated that anything related to

Alzheimer's disease and other neurod

degenerative diseases um that start in

you know start in the brain and the body

decades before symptoms that never came

across my desk you know I graduated med

school 20ish years ago nothing I was

neurology residency program director for

over a dozen

years never entered the the the the

educational curricula about neurod

degenerative disease start silently like

we just never were taught that in the

last five to seven years I think things

are are starting to change a little bit

but um you know I think what we've

gotten wrong is that you know there's

nothing we can do um once a person is

diagnosed with dementia they've had the

disease for 30 years but um dementia is

the clinical progression of the disease

um there's a construct um called

pre-clinical or presymptomatic

Alzheimer's disease that means the

disease has started in the brain uh with

no symptoms yet 46 million Americans are

currently estimated to have this

pre-symptomatic pre-clinical phase of

Alzheimer's stage one we were never

taught in medical school or residency

training about about this construct and

um I hate to say it but most

neurologists and and most clinicians

don't even think about this today those

40 6 million Americans are just walking

around with the pathology building at

very high

risk not getting any attention or care

uh so that's I think the the big miss

the other thing that um I think people

are just starting to change on now which

is which is great after 20 years is this

earliest symptomatic phase called mild

cognitive impairment due to Alzheimer's

disease it means that the pathology is

building up there are very mild symptoms

that are beginning but the person can

still fully take care of themselves uh

the definition of dementia is when a

person has cognitive changes and can no

longer kind of do their activities of

daily living or take care of their their

daily needs but this construct of mild

cognitive impairment um you know 20

years ago people would say ah you just

got some memory loss ah it's just age oh

it's no big deal uh you know go I'll see

you back in a year well no a person

that's just having the earliest signs

and symptoms of Alzheimer's that's when

you need to pounce and that's when you

need to do something and again it's all

about disease recognition back then we

didn't have pet scans to look at amalo

you know back then those have only been

FDA approved for the last 10 or 12 years

or so uh back then spinal taps just

people didn't do them um back then there

were no even thoughts about blood tests

let alone um you know actual studies in

investigating these these proteins so

nowadays if someone is just starting to

have the very first symptom of memory

loss before dementia like 10 or 12 or 15

years before dementia we can now do

these tests and I think just now uh the

tide is turning a little bit that's good

makes me happy but the devil is in the

details we really need to shift the

Spectre of diagnosis much earlier and to

me um you need every every day every

week every month every year um on your

side to intervene uh and recognizing the

preclinical presymptomatic phase using a

screening blood test and then coming in

doing a more structured cognitive

assessment again one day we can do this

All Through software and at home um I

think that's really the the missed

opportunity and and the critical window

of opportunity to uh to intervene so you

me you've mentioned diet and sleep and

these other different

interventions that you can track whether

they're effective using these

blood-based biomarkers so so far in your

work what has been the one change that

people have implemented in their lives

that have has made the biggest

difference everyone wants to know what

can I do right if you're at a cocktail

party uh uh what are the three things I

can do right uh well that's the

challenge everyone kind of requires a

different intervention based on their

own individual biology the thing that

really struck me um and this is like you

in the first um uh presentation that we

made on this um at the American Academy

neurology meeting in in 2024 was it was

a group of 15 people small numbers

weren't expecting much did some group

level statistics to see before and after

how did they do and of these 15 people

they all got very interventions so I

believe in that group there were um two

women that started hormone replacement

therapy um because they were just

starting to go undergo the par menopause

transition uh four uh people uh were

just starting to have the earliest kind

of signs of mild cognitive impairment um

and those people four of the 15 were on

anti- amid drugs three on a drug called

L canab one on a drug called aduc canab

um there were people in there that went

on no drugs at all they just exercised

hit a Mediterranean Stu diet um you know

cut down on alcohol one of the cases you

know really really cut down uh and then

other patients had traditional vascular

risk factors we put them on um drugs to

reduce their belly sides their metabolic

syndrome their pre-diabetes and diabetes

you know there gp1s the weight loss

drugs that everyone's talking about but

we use those in a targeted way had

people lose body fat increased muscle

mass we track cholesterol and targeted

cholesterol and then reduced cholesterol

uh you know normalized cholesterol we

use the typical anti-diabetes anti

cholesterol anti blood anti-hypertension

drugs uh and in various patients we just

modified their vascular risk factors so

in these 15 patients it was just kind of

like a little pilot study we didn't

really think anything of it put all the

numbers in the data in and as a group we

showed statistically significant

improvements from pre- to post you know

in the past we showed improvements or

stabil ation in cognition and reductions

in in in calculated Alzheimer's and

cardiovascular risk now for the first

time on the group level with only 15

patients this is the thing that like

really blew my mind absolutely not in

any way shap or form was expecting this

like zero um at the group level we had

statistically significant improvements

in both amalo and to protein so when you

kind of put everything together our 2019

study um you know showed you know

improvements not even stabilization but

improvements in cognitive function in a

subset of the mild cognitive impairment

patients and also in the prevention

asymptomatic patients we showed

statistically significant reductions in

Risk that's great too but for the first

time in humans we actually showed

improvements in the biological markers

of the disease now granted four of the

for 15 cases were on a disease modifying

anti-am therapy but the majority of

cases were not on any anti-id drugs and

they still improved um at the individual

level that's when some of the eye

popping results like really came to

light too um one of our patients Simon

that's kind of come out you know talked

about his story early 50s you know two

copies of the ape4 variant so higher

genetic risk his mom with dementia he

has very you know significant

cardiovascular disease that ended up

kind of you know T taking care of pretty

well in

2019 L was 49 years old and he had a

positive amalo pet scan meaning the Pet

Scan showed amalo in the brain which is

the the diagnostic marker well through

vascular risk factor modification

lifestyle management and other um you

know uh lifestyle changes and and

medications being used too vitamin

supplements Etc personalized for him we

were able to show normalization of both

his amalo and Tow in nine months and in

14 months of treatment when we had kind

of like did a baseline MRI before a

repeat MRI after we look at the brain

volumes when you compared the MRI from

pre- to post and this is just crazy to

me that I can't even talk about this but

it's actually true it all happened the

brain volumes got larger over time so

you have a patient that in late 40s had

pathological signs of Alzheimer's

disease that patient was at high risk

and two years later his brain volumes

are larger and his amalo and Tow in the

blood have normalized has that ever

happened before has there been gains in

brain volume I've never seen this in a

documented way because I've never had

the technology or the funding to

actually look at this in a structured

way um why isn't there funding out there

to look at these things in a structured

way because these things sound

unbelievable they're unbelievable until

you see it um they're unbelievable until

it happens and then it's unbelievable

until you can prove it in science so

what we've done is we've taken these

small groups of people as our pilot as

our proof of you know proof of principle

and what we're showing is both on the

group and individual level um not only

statistical significant improvements and

pathological aspects but also you know

improvements in ways that like we just

weren't taught about a medical school so

what do you wish that every other

neurologist knew about your work yeah I

I think yeah this is crazy but like I

feel like in the last six months

something's changing um you know in the

past I would get tomatoes thrown at me

like literally from across the room I

gave my first leure on you know how I

felt that you know mild cognitive

impairment was a bad term and like you

know it should be called prodromal at

risk for Alzheimer's because no one

knows what the heck mild cognitive

impairment means like what impaired

they're not impaired they have symptoms

but they're not impaired why is it

called MCI and then people would look at

me

like like like I had two heads but like

no really like why mild cognitive

decline is that a better word crickets

right I think um neurologists are

starting to understand that maybe there

is something going going on here uh

they've just seen it too many times

whether it's a study that we've

published you know close to 100 you know

peer-reviewed Publications now like you

have to you know if you doubt something

okay but after a hundred peer-reviewed

Publications and actually real journals

and like you know with with Media stuff

and with social media and YouTube and

whatever else like the message is

getting out there so I think what i' I'd

like my my colleagues to understand is

yes preventive neurology is is real um

it should eventually be a recognized

subp specialty of Neurology uh the

American Academy neurology put out a

statement that by the year 2050 uh

preventive neurology will be a

recognized sub specialty of Neurology ah

2050 I'm like going to be way retired by

then um you know it's you know by 2030

maybe maybe 2035 but but but by 2030 um

I can't understand why preventive

neurology could not be practiced in a

regimented rigorous way as long as uh

outcomes are studied at the same time

that care is being delivered and you

know that's a critical tenant of our

work it's not responsible for me to

practice in a clinical area um where the

data haven't fully been um elucidated

yet or or really the the the construct

has been fully proven so to me um I

think it's incumbent Upon A preventive

neurology clinician to at least aim to

study

outcomes um you know but in 5 years I

I'm I'm already convinced I know we

still need to do more and publish more

and and really prove things in a more

you know rigorous way um but I'd like

prevent I'd like I'd like neurologist to

to to just believe that it's possible

and it's okay to have skepticism and

it's okay to say these are early days

because I would agree but I I would say

that um uh if neurologists um had faith

that you could intervene early and that

these modifiable risk factors once

modified could actually you know lead to

improved outcomes clinically as well as

biologically um I think that's a big

step forward I also have a lot of

empathy um for my neurology colleagues

um you know I have um you know an hour

and a half or more to see a new patient

you know an hour at least to see a

follow-up patient I mean that's just not

reality our Medical Care system is just

entirely broken aside from being a sick

care system where you have to have

diagnostic codes for problem in order to

get reimbursed by insurers um there are

no codes for Alzheimer's or dementia

prevention there are no you know you

know well-recognized way to get

reimbursements and and payments for

preventative healthc care there's just

no incentive for it in any way share or

form a person with memory loss great

let's order all these tests get the

money reimbursed awesome for a person

before they have symptoms there's

nothing there's no structure in place

and that is a major major major blind

spot in our in our Healthcare um um I

have empathy for neurologists because

they have what 15 minutes to see a

patient how do you dig into the details

how do you understand a person's

individual risks how do you order tests

when they're not reimbursed when a

person doesn't have symptoms so our goal

our mission is democratize access to

brain health care whether it's through

software whether it's through at home

testing um I hope that the tools that

we're working on can Empower uh and

really facilitate neurologists out there

in the community to say okay I only got

15 minutes this is a structure of things

I'm going to do these assessments you go

home use this software you go home you

order this test uh and uh until this is

a recognized subp specialty of medicine

uh you know I think uh you know patients

are going to have to kind of grapple by

the horns and and do a lot on their own

citizen scientists watch videos online

you know take control of their brain

health that way it's it's like shocking

and sad that it has to be this way um

but I think if neurologists Um send a

positive message to patients that risk

reduction is possible brain protection

is possible but also promise not to

overpromise meaning you know four out of

10 people at risk of

dementia well if they do everything

right they can prevent their dementia

and that's what the literature shows uh

but there's a lot of people out there

that can still do everything right and

still you know develop cognitive decline

so I think you have to promise not to

overpromise but hey four out of 10 five

six out of 10 if if one out of two cases

on average maybe preventable then let's

let's let's go into this with glasses

half full you know no promises um but I

think counseling and education is

critical so you raised this point about

the fact that investors can help you to

develop your technology but at the end

of the day to truly scale it and

democratize it the problems are the

obstacles there are systemic it's about

payers it's about reimbursement so is

there an Ask perhaps that you have for

the brain mine ecosystem is this a right

your senators and congressman is this a

lobbying effort what would need to

change there oh boy so we've um we've

tried to address this uh uh in Via an

oped that we're kind of shopping around

um and that's uh you know in process um

years ago I spent a lot of time uh the

Senate special committee on Aging um had

a um an initiative to try to you know

talk about these things right around

covid times and unfortunately that just

kind of stalled out and didn't go

anywhere I'm a little jaded when it

comes to some of the advocacy efforts

and I hate to say that because I'm very

passionate about the science and I'm

passionate about the care delivery and

I'm passionate about you know

interprofessional education but when it

comes to advocacy I've I've I hate to

say it I've tried but I've struck out um

I don't know that I have a perfect

answer on um you know what we can do to

move the needle um insurance companies

um are really not incentivized in any

way shape or form to reimburse or

preventive Healthcare um I don't know

the exact statistics but if you know

insurance company X SP spends you know

$10,000 on preventative health care for

a patient so that they don't develop a

disease later it's most likely that that

patient is going to be on another

insurance carrier in 5 years or 10 or 20

years or Medicare by that time so they

have no incentive to spend the money to

prevent a so you can't even make the

cost savings argument because that

savings actually ends up in another you

got that's exactly it and when it comes

to Medicare that doesn't work either

Medicare starts coverage at 65

these changes need to be made in their

40s 30s 40s 50s and 60s so so Medicare

can okay Medicare coverage 65 we're

going to cover preventative brain health

care too late it's too late for the

majority of people so I don't fully know

how to fix this problem you know the

lobby on you know digital Therapeutics

like like how could there just not be

recognized these like like we're not

trying to make a lot of money here at

scale you don't have to charge that much

there's 46 million Americans that need

this you you don't need to spend these

drugs and rightfully so these drugs cost

billions of dollars of investment to

develop so there's I am I am you know

there's a lot of flack that drug

companies get for charging crazy amounts

of money and I get that I pay a lot of

money for my drugs too because not all

my drugs that I need for my medical

stuff they're not covered either like so

I I feel it and I understand it and it's

it's it's a schlog but these IV infusion

drugs aside from being $20,000 or more a

year you have the cost of the infusion

the doctor's visits the MRIs the spinal

taps like these drugs are really

expensive so like if you can intervene

in a preventative way for a few hundred

doar ,000 doar a year and you prevent

the need for these anti-id drugs or or

something else in the future like I'm

I'm I'm equal opportunity like if it's

if it's a evidence-based drug a

supplement a vitamin A software I don't

care what it is like if it works and

it's safe Let's Do It um but I don't

know how to incentivize I don't know how

to change policy um if there's someone

out there in the brain mind ecosystem

that knows how please uh let me know

maybe that's the ask if someone has you

know bright ideas um and and it's it's

interesting we published our our first

stet on this topic give or take in um

you know may of

2023 and we hope at some point um you

know we'll do a second you know 2024

2025 um and unfortunately there was a

large section in this on on advocacy and

and only a little bit was left in cuz

these you know opets Get shrunk down you

know there was probably a million

eyeballs that saw that and that's

amazing I was went to the number one on

Apple news like an oped like that's

amazing so the interest is there the the

understanding of the need is there um

you know the urgency is there um but how

do you move the needle on an advocacy

perspective I I don't know how to do

that so let's end on a positive note

tell me why you're hopeful about your

work you know neurod degener disease

care is is tough um you know there are

tens of millions of of people out there

that are um affected by Alzheimer's

disease and other neurod degenerative

diseases like Parkinson's and Louis body

dementia um you there's five or six

million Americans with Alzheimer's

couple million with Parkinson's Louis

body you know maybe a couple

million that's a lot of people affected

and that's terrible but every single one

of those people has one or more family

members that you know unpaid caregivers

that are are trying to help um our

medical system is just not set up to

care for people with cognitive uh

decline but we have truly entered a new

era where we can diagnose these

conditions before symptoms we now have

the diagnostic tools the longitudinal

monitoring tools and we have um you know

evidence-based and fairly safe

interventions that we can try um so I'm

I couldn't be more um hopeful uh in the

field of preventative brain health and

and dementia prevention I'm hopeful

because we now have the biomark ERS uh

discovered we have SIMPLE blood tests

and hopefully at home blood tests

that'll bring down cost and we have more

awareness um before you know people

would say there's nothing you can do now

people understand that there are things

that we can do and I think people feel

empowered I think people feel hopeful uh

and now it's just a matter of uh we did

this the science we did the the hard

part and now it's the dissemination

implementation science is the next phase

and I couldn't be more hopeful or

excited about that

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