Preventive Neurology: Brain Care Today to Protect Tomorrow with Dr. Kellyann Niotis, MD

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Welcome to the Let's Talk Brain
Health podcast, a public health

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educational initiative of the
virtual Brain Health Center.

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I'm your host, Doctor Crystal
Color, and I'm so glad you're

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here.
On this podcast, I sit down with

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incredible guests to explore all
things brain health and

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Wellness.
Together, we'll talk about how

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to care for your total brain
health, mind, body, and spirit

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while sharing the latest brain
Health Science practical tips

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and strategies you can use every
day.

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By prioritizing your brain
health, you're taking an

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important step towards living a
happier, healthier life.

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So let's dive in and welcome
today's guest.

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We'd like to welcome Doctor
Kellyanne the Otis to the Let's

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Talk Brain Health podcast.
Doctor Neotus is the world's

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first fellowship trained
preventative neurologist

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specializing in risk reduction
for neurodegenerative diseases

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such as Alzheimer's,
Parkinson's, and Lewy body

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dementia.
She completed her neurology

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training at New York
Presbyterian Weill Cornell,

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where she served as Chief
resident and the inaugural

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McGraw Fellow in Neurology
Research, followed by a

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fellowship and movement
disorders at the Icahn School of

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Medicine at Mount Sinai.
She is the founder of preventive

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neurology practice in New York
City and Director of Parkinson's

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and Lewy Body Dementia
Prevention Research at the

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Institute for Neurodegenerative
Diseases in Florida, where her

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work focuses on early detection
and personalized risk reduction

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strategies.
Dr. Niotis is passionate about

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advancing the field of
preventive neurology not only

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through clinical care and
research, but also through

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advocacy for policy change and
expanding access to education

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and treatment.
Her expertise has been featured

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in media outlets such as CNN,
and she has received numerous

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honors and awards recognizing
her work.

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Previously, Doctor Niotis led
the preventative neurology

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program at the Doctor Peter
Adias Practice Early Medical and

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oversaw the nation's first
Alzheimer's prevention clinic at

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Weill Cornell New York
Presbyterian, where she launched

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research initiatives in
Parkinson's and Lewy body

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dementia prevention.
Her research has been published

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in Neurology, Nature, Mental
Health, Frontiers and Aging,

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Neuroscience, Aging and Disease,
Movement Disorders, the Journal

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of Alzheimer's Disease,
Alzheimer's and Dementia, and

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the Journal of the Prevention of
Alzheimer's Disease, and she

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also has presented at national
and international conferences.

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Kellyanne, is there any
additional information about

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your background that you'd like
to share with our audience?

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I think you all learned how much
of A nerd I am, so maybe to add

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some character.
I'm also an avid scuba diver.

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I really love the ocean and on
side really am passionate about

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conservation there.
And I'm a dog mom to a lovely

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goldendoodle who's six years old
and who is obsessed with ball,

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so he keeps me really busy.
Nice, we're so.

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Grateful you're here.
We are all fellow dog lovers,

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all three of us.
Today we have at least one

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thread in common and I think for
many of us tuning in share the

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mutual excitement around the
brain.

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I think it would be great though
after hearing your extensive

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bio, you've mentioned this
buzzword that has probably

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sparked a lot of our listeners
interest.

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What is a preventative
neurologist and what drew you to

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this emerging field?
Yeah, great question.

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Preventive neurology isn't a
fully recognized field yet.

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The American Academy of
Neurology put out a position

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statement in 2023, Which aims to
have preventive neurology being

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this thriving field by the year
2050.

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I think we can do more for our
patients and we can do more

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sooner.
But just to give you some

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background, what is preventive
neurology?

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It's a field really dedicated to
the early detection and early

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intervention of at risk
individuals who are at risk for

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diseases such as Alzheimer's,
Parkinson's, neurodegenerative

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diseases, but all neurological
diseases on a whole.

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That could be Ms. that can be
stroke.

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The vision is really broad.
My particular niche is in

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neurodegenerative diseases,
Alzheimer's, Parkinson's, Lewy

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body.
But again, there's lots of

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different neurodegenerative or
neurological diseases that ought

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to have a more prevention
focused mind.

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And really what drew me to this
space was thinking and seeing

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patients in the later stages of
dementia and a Parkinson's

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disease and realizing how little
options we had for them.

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And seeing this kind of
explosion of research,

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specifically at the time in the
space of dementia and how there

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was more evidence coming out
that there are things that we

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could be doing earlier on in
disease to potentially delay or

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even hopefully prevents their
progression.

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Yet no physicians that I trained
with at the time, we're really

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focused on that.
And I was lucky enough to find

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an amazing mentor, Richard
Isaacson, who really showed me a

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new way towards prevention and
learn so much from him and only

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continue to bring that work to
other diseases like Parkinson's

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and Lewy Body.
You've worked with some of the

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most forward thinking brain
health clinics and you still are

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continuing that work now.
How is this shaped your current

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approach to care that you'd like
to highlight for us today?

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Yeah, I never stopped learning.
Pretty much feel like I'm a

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continuous student even now.
I'm always learning, but I've

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been fortunate enough to have
amazing mentors, like I

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mentioned, Richard Isaacson,
Peter Tia is another amazing

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mentor.
A lot of my mentors happened to

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be men, which I feel very
fortunate enough because they

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really did elevate and showed me
a way towards prevention that I

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never thought about.
But as a woman, I have other

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interests that maybe don't
always align with those of the

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opposite sex.
I've been able to gain my

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understanding of prevention
through them, but then also

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bring this lens of female health
and what that means and how

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women may be disproportionately
impacted by some of these

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diseases.
And how our care has to differ

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based not just on factors like
people's genetics, but also

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their biological sex.
Getting into genetics or these

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new diagnostic tests that are
starting to come to market and

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there's a lot of research going
on in the different

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neurodegenerate diseases.
What have you seen about the

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blood biomarker test and how do
you think they're going to be

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implemented in the coming years
for the different

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neurodegenerate diseases as
screening tools?

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1st, I'm beyond excited because
it's been a long time coming.

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We haven't had objective outcome
measures to monitor disease

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progression in any real
meaningful way that was easily

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accessible and not invasive and
cost effective.

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But I think these biomarkers
will really pave the way for the

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future of preventive neurology,
not only allowing us to identify

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disease earlier, but also
allowing us to identify who may

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be at risk earlier and then
hopefully allow us to monitor

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the efficacy of the
interventions that we're saving

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people.
A lot of the research in

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prevention has been criticized
because it's so difficult to

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show that you've actually done
something to underlying disease

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progression for diseases that
form over years and decades,

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having some sort of objective
outcome measures going to

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improve clinical trials, give
more evidence for prevention,

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but also better personalized
care.

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My word of caution is that these
new emerging tools are available

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and new ones are coming out
regularly.

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But what I think is really
important to emphasize is that

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these biomarkers have been
studied in people who have

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clinical symptoms, not in at
risk or asymptomatic

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individuals.
We haven't yet identified what a

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normal range is for people who
don't have cognitive symptoms,

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and we don't really understand
how dynamic these biomarkers

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are, how variable they can be
based on the time of day, based

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on if someone exercised that
morning.

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A lot of the research that we're
doing at the Institute of

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Neurodegenerative Disease is on
that because we're of course

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interested in learning how these
biomarkers change with disease

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and affected people.
But it's also really important

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to understand people who are at
risk, whether that's just family

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history or genetics, and
understand how these biomarkers

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may present differently in
different people and what they

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mean for that individual.
One really cool thing, just to

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nerd out for a second that we
found, and we need more for this

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puzzle, but I'm just excited to
talk about it, is that Tau

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levels actually seem to
fluctuate on a monthly basis

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based on women's menstrual
cycle.

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And that's actually super
important to know because the

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time of someone cycle that we're
testing these biomarkers may

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really change what we think
about or how we interpret the

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results.
We have so much to learn.

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They're not ready for prime time
yet, but they are going to be in

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the future.
I really believe that.

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How do you use these blood
biomarker tools to detect risk

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for early interventions given
that what you just said, for

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example, 34 year old patient
comes in the worried I have a

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concern because mom or dad has a
dementia or maybe it's not

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characterized well in an
asymptomatic young person who

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has a concern about these
things?

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1 I try to stay away from the
term worried because everyone's

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at risk.
Everyone with the brain is at

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risk.
I appreciate that they're being

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proactive about their care, but
you make a really interesting

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and important point, which is
that if we start collecting a

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ton of data, there'll be a lot
of noise.

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And how do we sort through that
noise?

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These tools have to be used
appropriately in the right

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clinical context.
Like I mentioned, we are

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studying them in 34 year olds
and 40 year olds and so forth in

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our research cohort.
But more practically speaking,

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if someone comes in to me and
they're really overall healthy

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and I take a family history and
their family members didn't have

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disease until their 70s or 80s,
then the likelihood that we're

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going to detect an abnormal
biomarker finding in a 32 year

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old is pretty low.
That said, it may and in the

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future turn out to be really
valuable to establish a

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baseline, just like we
established baselines for other

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tests like cholesterol panels.
And then we can see how that

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individuals might change over
time and if they start entering

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more of a risk range.
I think the future is a little

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uncertain, but I can see a lot
of potential to use these tools

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and young people, middle-aged
people and older people.

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And getting to the same point
about precision medicine or

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individualized personal
diagnostics or baseline

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following a patient, besides the
blood biomarkers that are being

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studied, does your institute use
any digital tools right now as

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baseline other than what
typically is done like the

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Montreal Cognitive assessment or
some other type of more

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sophisticated neuropsychological
assessment, Any type of short

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tools rather than these very
complicated, sometimes complex

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and very multi hour assessments?
Or are you referring to things

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like vocal analysis and so
forth?

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Yeah.
So vocal analysis, exactly.

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There's some AI tools that are
available and there's some other

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digital AI tools that are
available.

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There's a couple startups in the
northeastern part of the United

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States that are interested in
this area.

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Are you all using any of those?
We aren't using them.

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And that's because, to be
honest, I don't feel like I need

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a tool to tell me who's at risk.
I know based on my clinical

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assessment who's at risk.
And the question for me is not,

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is this person at risk or not?
It's what are we going to do

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about it once we find out that
they're at risk?

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While I think a lot of these new
emerging diagnostics help in

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terms of early identification,
for me, where the bottleneck is

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not in identifying the risk of
these people, it's getting them

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the treatment that they need.
There's a large group of

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potentially asymptomatic
patients that are preclinical

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and whether these tools are
going to pick up something

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they're not even aware of
Whether you're using that

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besides saying, yes, you're at
risk because of family history,

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for example, or you have faulty
lifestyle that needs to be

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adjusted.
Because we know that untreated

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hypertension for the controlled
diabetes, obesity and all those

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other conditions are already
going to put you at higher risk,

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regardless of whether you have a
family history.

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There's a lot of different AI
models that are integrating both

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MRI data, like you said, vocal
data, biomarker data, and giving

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people scores of who's at risk.
I can see the utility in that,

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but I personally don't find that
particularly valuable right now.

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I do think the biomarkers are
extremely valuable, but like I

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said, we don't understand what a
normal threshold is yet.

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We need a lot more research
there.

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I suspect that a lot of your
conversations focus in on the

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research that's probably caught
a lot of our listeners interest.

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And you can pick up probably any
study or news line article now

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that will tell you, you can
mitigate your risk of X

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00:13:39,200 --> 00:13:43,120
lifestyle risk factor by X
number of percentage if you

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00:13:43,120 --> 00:13:47,280
focus on a whole laundry list of
risk factors.

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And you know, we're always
growing more and understanding

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of the X leads to the Y when it
comes to brain health.

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I'm excited to dive into with
you today, Kelly.

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And we're going to focus on one
risk factor in particular that I

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don't think we have really
explored yet on the podcast

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00:14:02,720 --> 00:14:06,920
today in terms of cholesterol.
But before we do that, would you

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00:14:06,920 --> 00:14:10,120
like to give us this overall
view of how much can people

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00:14:10,120 --> 00:14:13,880
actually control through their
lifestyle modifications,

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00:14:13,880 --> 00:14:18,160
especially for those that may
have pre genetic disposition for

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00:14:18,160 --> 00:14:21,280
Alzheimer's disease?
What is this inspiration or hope

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00:14:21,600 --> 00:14:25,040
and why do you spend so much
time talking with people about

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00:14:25,040 --> 00:14:28,680
lifestyle risk factors to
mitigate risk in general for

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00:14:28,680 --> 00:14:30,320
neurodegenerative?
Diseases.

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00:14:30,800 --> 00:14:34,640
Great question and I wish that I
had a perfect answer for that.

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00:14:34,640 --> 00:14:38,800
I would be lying if I could say
that I knew exactly X amount was

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00:14:39,040 --> 00:14:42,840
preventable due to lifestyle,
due to medical comorbidities,

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00:14:42,840 --> 00:14:46,400
but I really don't The best data
that we have of course is The

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00:14:46,400 --> 00:14:49,640
Lancet Commission report which
says that at least 45% of

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dementia cases is preventable.
That's not including Parkinson's

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disease.
There's definitely less out

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00:14:55,840 --> 00:14:59,080
there on Parkinson's prevention,
although more studies are coming

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00:14:59,080 --> 00:15:00,920
out.
They're identifying risk

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00:15:00,920 --> 00:15:02,480
factors.
Of course we understand

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00:15:02,480 --> 00:15:06,280
traumatic brain injuries.
Modifiable social isolation

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00:15:06,280 --> 00:15:09,920
could be risk factors for both.
They share a lot in common.

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I think the 45% of dementia
cases being preventable is

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00:15:15,200 --> 00:15:18,560
probably an underestimate.
I think there are a lot of risk

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00:15:18,560 --> 00:15:21,520
factors that are fully addressed
by The Lancet Commission's

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00:15:21,520 --> 00:15:24,000
report.
More than half of dementia cases

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00:15:24,000 --> 00:15:27,520
are preventable.
I believe that I fully empower

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patients to take control of
their brain health as soon as

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00:15:30,960 --> 00:15:32,600
possible.
Yeah.

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And I think for people that may
have followed along in recent

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years, it's the number of
Atlantic Commission reports of

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00:15:38,200 --> 00:15:41,640
preventable cases keeps climbing
as well as the risk factors.

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00:15:41,640 --> 00:15:43,080
Do we add a couple more each
time?

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00:15:43,080 --> 00:15:45,960
Because we finally say after
reviewing the scientific

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00:15:45,960 --> 00:15:49,040
literature of we feel confident
enough that there is enough

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00:15:49,320 --> 00:15:51,840
evidence from all of these
research studies when we pull

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00:15:51,840 --> 00:15:55,920
them together to say yes.
And social isolation was a risk

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00:15:55,920 --> 00:15:57,720
factor that's recently come
online.

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00:15:57,960 --> 00:16:00,600
Hearing loss.
Even though most clinicians, I

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00:16:00,600 --> 00:16:03,200
think would have agreed, like we
could have told you this a while

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00:16:03,200 --> 00:16:06,320
ago, but it was we had enough
research across the board when

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00:16:06,320 --> 00:16:10,200
we pulled these data from all
across the world as well to

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00:16:10,200 --> 00:16:12,040
eliminate some of those risk
factors.

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00:16:12,040 --> 00:16:14,760
I like to think the next couple
years when The Lancet Commission

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00:16:14,760 --> 00:16:17,080
reconvenes, that number may
still go up.

287
00:16:17,200 --> 00:16:20,360
But speaking with experts like
yourself, 2 neurologists at see

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00:16:20,360 --> 00:16:23,920
and treat many patients at
Cutting Edge Institute, we have

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00:16:23,920 --> 00:16:27,120
this confidence now that yes,
there is likely still going to

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00:16:27,120 --> 00:16:30,880
be more that we know and uncover
as well as sums that don't

291
00:16:30,880 --> 00:16:33,880
always make that list because
we're really split on things

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00:16:33,880 --> 00:16:36,400
like nutrition.
I'd suspect you spend a lot of

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00:16:36,400 --> 00:16:38,680
your time talking about
nutrition, but to get enough

294
00:16:38,680 --> 00:16:42,680
evidence where we're going to
globally agree, I don't know, we

295
00:16:42,680 --> 00:16:44,880
may have to agree to disagree on
some of those.

296
00:16:44,880 --> 00:16:48,200
And same things with sleep.
I sure you spend a lot of time.

297
00:16:48,440 --> 00:16:51,080
I always joke with people when
we do education, it's like,

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00:16:51,080 --> 00:16:53,840
here's the scientific evidence
of the Atlanta Commission

299
00:16:53,840 --> 00:16:57,720
report, and then here's also a
long list of risk factors that

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00:16:57,880 --> 00:16:59,960
still have enough evidence
behind that.

301
00:17:00,440 --> 00:17:02,960
Who knows if we're going to
consensus on anytime soon.

302
00:17:02,960 --> 00:17:05,640
But I guarantee if you talk with
your healthcare providers,

303
00:17:05,920 --> 00:17:07,640
they're not overlooking these
big ones.

304
00:17:07,640 --> 00:17:10,640
And they are likely on those
screens that you go down your

305
00:17:10,640 --> 00:17:13,839
laundry list for.
And we know with heart health,

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00:17:14,400 --> 00:17:18,040
cholesterol is a big one.
That's the one that many people

307
00:17:18,040 --> 00:17:20,760
have the connection with is
heart health and brain health.

308
00:17:21,160 --> 00:17:25,000
But can you tell us why that's
so important of a risk factor

309
00:17:25,000 --> 00:17:26,880
that you want to highlight for
us today?

310
00:17:26,880 --> 00:17:30,000
And what should our listeners
know about that risk factor?

311
00:17:30,480 --> 00:17:34,080
Yeah, this is one of my favorite
risk factors because I'm also,

312
00:17:34,080 --> 00:17:36,120
underneath all of this, a lipid
nerd.

313
00:17:36,440 --> 00:17:39,280
I didn't intend to become a
lipid nerd, but my path is

314
00:17:39,360 --> 00:17:41,960
crossed with an amazing
lipidologist.

315
00:17:41,960 --> 00:17:45,840
Doctor Tom Dayspring really
taught me so much about

316
00:17:45,840 --> 00:17:49,320
peripheral lipidology.
And when I kept asking questions

317
00:17:49,320 --> 00:17:52,920
about brain lipidology, he had
no choice but to start diving

318
00:17:52,920 --> 00:17:54,520
deeper in the literature with
me.

319
00:17:54,560 --> 00:17:58,200
We really started learning about
this together and it really

320
00:17:58,200 --> 00:18:01,960
blows my mind how many
neurologists don't understand

321
00:18:01,960 --> 00:18:06,240
that the lipid system in the
brain is completely distinct

322
00:18:06,240 --> 00:18:11,880
from the peripheral lipid system
and that one of the most

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00:18:12,200 --> 00:18:15,800
significant genetic risk factors
for Alzheimer's disease, which

324
00:18:15,800 --> 00:18:19,440
is APOE, is a lipid transport
gene.

325
00:18:19,760 --> 00:18:23,800
The thought that cholesterol
isn't somehow related to brain

326
00:18:23,800 --> 00:18:27,160
health is really wild.
Doctor Alzheimer's realized this

327
00:18:27,160 --> 00:18:30,480
when he did autopsies on
Alzheimer's patients when he was

328
00:18:30,480 --> 00:18:33,440
first described describing the
disease, how there were these

329
00:18:33,440 --> 00:18:36,720
little lipid droplets stuck
inside the astrocytes of

330
00:18:36,720 --> 00:18:38,280
patients that were affected by
this.

331
00:18:38,280 --> 00:18:41,560
The reason I want to highlight
this is because so many people

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00:18:41,720 --> 00:18:46,160
carry this high risk gene a
Bowie and those people a Bowie

333
00:18:46,200 --> 00:18:51,960
four and those people who carry
a Bowie 4 have known higher risk

334
00:18:51,960 --> 00:18:55,360
of cardiovascular disease,
atherosclerotic disease, heart

335
00:18:55,360 --> 00:18:59,640
attack, but also higher risk of
stroke and also higher risk of

336
00:18:59,640 --> 00:19:02,720
neurodegenerative diseases like
Alzheimer's and Lewy body.

337
00:19:03,040 --> 00:19:05,920
And a lot of that has to do with
peripheral cholesterol

338
00:19:05,920 --> 00:19:08,440
transport.
We understand these people are

339
00:19:08,640 --> 00:19:12,640
more likely to throw down
atherogenic LDL or APO B

340
00:19:12,640 --> 00:19:16,640
particles to cause blockages in
the vessels that lead to the

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00:19:16,640 --> 00:19:21,600
brain and inside the brain.
But also APOE 4 changes the way

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00:19:21,600 --> 00:19:24,600
that the brain transports
cholesterol.

343
00:19:24,760 --> 00:19:28,240
People who carry this APOE 4
gene are not as efficient at

344
00:19:28,240 --> 00:19:31,680
getting cholesterol between
brain cells, between astrocytes

345
00:19:31,680 --> 00:19:35,720
and neurons, and the cholesterol
gets stuck inside these

346
00:19:35,720 --> 00:19:39,040
astrocytes and can cause a lot
of neurotoxicity and

347
00:19:39,040 --> 00:19:42,360
cytotoxicity.
And this is one way that APOE 4,

348
00:19:42,360 --> 00:19:45,280
for example, can lead to
neurodegenerative diseases.

349
00:19:45,760 --> 00:19:49,640
It is a sore subject for me
because a lot of patients will

350
00:19:49,640 --> 00:19:52,600
come in and they'll say my
cholesterol numbers all look

351
00:19:52,600 --> 00:19:54,960
great.
And I look at them and I'm like,

352
00:19:55,120 --> 00:19:58,480
who said that these look great?
For what do these look great?

353
00:19:58,760 --> 00:20:03,000
If we're in the business of
preventing disease, then we

354
00:20:03,000 --> 00:20:06,880
can't let you walk around in
your 30s and 40s with.

355
00:20:07,360 --> 00:20:11,640
An apo B level of nearly 100 or
an LDL cholesterol of nearly

356
00:20:11,640 --> 00:20:14,840
100, It's just a matter of time
before that's going to start

357
00:20:15,120 --> 00:20:18,080
causing issues for the heart,
but also for the brain.

358
00:20:18,080 --> 00:20:21,600
I think there's a lot of fear
amongst patients in terms of

359
00:20:21,600 --> 00:20:24,320
getting their cholesterol
treated and the thought of them

360
00:20:24,320 --> 00:20:27,880
being on a medication for the
rest of their life can be a

361
00:20:27,880 --> 00:20:31,120
little overwhelming.
But I really, and I would hope

362
00:20:31,120 --> 00:20:35,400
that the listeners here today
are taking away this message

363
00:20:35,400 --> 00:20:38,600
that we can be equal
opportunists and sometimes

364
00:20:38,600 --> 00:20:41,040
because of our genetics, we need
medications.

365
00:20:41,040 --> 00:20:43,720
And these medications can be
wildly helpful.

366
00:20:44,080 --> 00:20:46,920
And the earlier that we start
addressing this risk factor, the

367
00:20:46,920 --> 00:20:50,400
better.
That was my question for you was

368
00:20:50,400 --> 00:20:53,680
for the person that's hesitant
because this seems to be a

369
00:20:53,680 --> 00:20:57,320
lifestyle risk factor that can
actually present very early in

370
00:20:57,320 --> 00:20:58,920
life.
Because I look back to even

371
00:20:58,920 --> 00:21:03,200
being an undergrad when having
peers have this first factor

372
00:21:03,200 --> 00:21:06,960
come on in our late teens and
early 20s.

373
00:21:06,960 --> 00:21:09,560
And that can be a very quick
barrier that comes up because

374
00:21:09,560 --> 00:21:13,320
this is a very atypical thing.
But yet when you have a genetic

375
00:21:13,640 --> 00:21:18,400
predisposition, that's not
actually that uncommon at times.

376
00:21:18,400 --> 00:21:21,440
And yet that can be 1 where we
become very resistant.

377
00:21:21,440 --> 00:21:25,280
And also it happened to the ones
that were like athletes.

378
00:21:25,280 --> 00:21:28,520
I remember college athletes that
ran track that see the

379
00:21:28,520 --> 00:21:31,520
nutritionists that are doing the
lifestyle things, and it becomes

380
00:21:31,520 --> 00:21:35,040
that conversation of where does
the interplay of lifestyle and

381
00:21:35,040 --> 00:21:39,160
genetics almost come online?
And it was very strange, right?

382
00:21:39,360 --> 00:21:42,240
You're late teen and you're in
your early 20s, and we never

383
00:21:42,240 --> 00:21:45,680
heard of anybody with high
cholesterol, let alone taking up

384
00:21:45,960 --> 00:21:48,400
medication for it.
I remember that was like one of

385
00:21:48,400 --> 00:21:52,120
the first things where it just
sounds so atypical and then let

386
00:21:52,120 --> 00:21:56,400
you think when that Fast forward
down the lifespan level of

387
00:21:56,400 --> 00:21:59,480
awareness that could be.
Yeah, absolutely.

388
00:21:59,480 --> 00:22:04,680
And it's not to dismiss diet.
I've been humbled by people who

389
00:22:04,680 --> 00:22:07,880
have come to me and have said
no, I'm going to do a complete

390
00:22:07,880 --> 00:22:11,200
overhaul on my diet and then
we'll recheck my cholesterol

391
00:22:11,200 --> 00:22:14,000
levels.
Diet can move the needle and

392
00:22:14,000 --> 00:22:17,440
especially for people who carry
the safe OE 4 gene because they

393
00:22:17,680 --> 00:22:20,480
tend to absorb more cholesterol
from their food.

394
00:22:20,480 --> 00:22:22,440
It's part of what this gene
does.

395
00:22:22,840 --> 00:22:26,600
They actually do have a pretty
dramatic response to reducing

396
00:22:26,600 --> 00:22:29,800
things like saturated fats.
But at the end of the day,

397
00:22:29,800 --> 00:22:33,040
sometimes we're up against our
genetics and we have no no other

398
00:22:33,040 --> 00:22:35,840
choice.
And no matter how well we live

399
00:22:35,840 --> 00:22:38,720
our life and how great we eat
and how much we're sleeping and

400
00:22:38,720 --> 00:22:41,640
exercising, sometimes we just
need a medication and.

401
00:22:42,160 --> 00:22:44,840
It seems like this is the great
time to have that lifestyle

402
00:22:44,840 --> 00:22:47,840
conversations with your
providers to find what your

403
00:22:47,840 --> 00:22:51,360
options are, to find your
threshold for change, of where

404
00:22:51,360 --> 00:22:54,720
you're willing to try and where
does lifestyle meet medication

405
00:22:54,960 --> 00:22:58,000
opportunities really to support
where you are today and where

406
00:22:58,000 --> 00:23:00,960
your goals are to be.
I think this is the great chance

407
00:23:01,000 --> 00:23:04,480
of many times where provider
education can be really

408
00:23:04,480 --> 00:23:07,800
important, as well as noticing
yourselves where your threshold

409
00:23:07,800 --> 00:23:10,880
is and where you can try and how
far you're able to go.

410
00:23:11,160 --> 00:23:13,320
And that might be the balance of
where you work with your

411
00:23:13,320 --> 00:23:16,840
healthcare providers, where
health coaches might come online

412
00:23:16,840 --> 00:23:19,520
and other supports that you have
on your healthcare team.

413
00:23:19,880 --> 00:23:24,000
But great resources to lean in
on go back to you as well as any

414
00:23:24,000 --> 00:23:27,520
final messages for people on
this particular lifestyle risk

415
00:23:27,520 --> 00:23:30,480
factor that you want to
highlight before we dive into

416
00:23:30,480 --> 00:23:33,440
the next topic area with you in.
Job.

417
00:23:34,120 --> 00:23:36,000
I just think the earlier the
better.

418
00:23:36,200 --> 00:23:40,480
You're never too young to get a
full lab test done which

419
00:23:40,480 --> 00:23:44,600
includes metabolic tests, lipid
tests, nutritional tests.

420
00:23:44,600 --> 00:23:48,280
You just never know until you
start doing the testing what

421
00:23:48,320 --> 00:23:52,440
might be a risk factor for you.
And if this flags on your panel

422
00:23:52,440 --> 00:23:56,000
then I would not ignore it.
So if you have all that on your

423
00:23:56,000 --> 00:23:58,600
annual screen, I believe
cholesterol is one that's pretty

424
00:23:58,600 --> 00:24:02,160
normal on those annual screens
to make sure to to your provider

425
00:24:02,160 --> 00:24:04,360
about it, because now you've
heard it here or at least you

426
00:24:04,360 --> 00:24:07,320
got a little bit more extra
education on even if it's that

427
00:24:07,320 --> 00:24:10,960
higher norm of you still want to
follow up with your providers.

428
00:24:11,280 --> 00:24:14,480
Kellyanne, there's been an
ongoing belief system in the

429
00:24:14,480 --> 00:24:18,280
public that statins are bad,
that they can cause cognitive

430
00:24:18,280 --> 00:24:20,600
issues.
What is the up to date?

431
00:24:20,720 --> 00:24:24,160
You know that in taking it to
statin groups can negatively

432
00:24:24,160 --> 00:24:27,000
affect cognition.
Yeah, good question.

433
00:24:27,280 --> 00:24:31,880
Unfortunately we don't have the
best quality studies in this

434
00:24:31,880 --> 00:24:35,800
space.
Most of the evidence seems to

435
00:24:35,800 --> 00:24:39,400
point to statins being overall
good and protective for brain

436
00:24:39,400 --> 00:24:41,360
health and lower risk for
dementia.

437
00:24:41,360 --> 00:24:43,840
But again, there's no
one-size-fits-all.

438
00:24:44,080 --> 00:24:47,320
It is true that certain people
who get on statins have brain

439
00:24:47,320 --> 00:24:49,680
fog.
They feel they have an attention

440
00:24:49,680 --> 00:24:51,800
slower processing.
That's a fact.

441
00:24:51,800 --> 00:24:55,200
It's a known risk factor side
effect of statin use.

442
00:24:55,640 --> 00:24:58,120
Maybe it happens in 5% or less
of people.

443
00:24:58,400 --> 00:25:01,240
If that happens to you, it's
probably related to the fact

444
00:25:01,240 --> 00:25:03,840
that the statins can cross
through the blood brain barrier

445
00:25:03,840 --> 00:25:06,000
and change cholesterol
production or suppress

446
00:25:06,000 --> 00:25:07,560
cholesterol production in the
brain.

447
00:25:07,560 --> 00:25:11,200
And cholesterol is an important
molecule or brain needs

448
00:25:11,200 --> 00:25:14,280
cholesterol for lots of other
things like neurotransmitter

449
00:25:14,280 --> 00:25:16,800
synthesis and cell membrane
health and fluidity.

450
00:25:17,120 --> 00:25:20,640
While that effect of statins,
meaning they're effective

451
00:25:20,720 --> 00:25:23,400
suppressing or reducing
production of cholesterol

452
00:25:23,600 --> 00:25:26,880
everywhere in the brain included
might actually be desirable in

453
00:25:26,880 --> 00:25:29,320
some people, it might not be in
other people.

454
00:25:29,520 --> 00:25:32,120
And we really wouldn't know that
until we put someone on it.

455
00:25:32,120 --> 00:25:35,320
And I would love to say that
we're going to have an amazing

456
00:25:35,320 --> 00:25:37,960
clinical trial that's going to
give us the answers.

457
00:25:37,960 --> 00:25:41,400
But statins are so cheap.
There's very little incentive to

458
00:25:41,400 --> 00:25:44,280
run such a beautiful clinical
trial that's going to last

459
00:25:44,280 --> 00:25:48,000
decades to really test whether
statins are associated with a

460
00:25:48,000 --> 00:25:50,560
lower risk of dementia.
My practice is no

461
00:25:50,560 --> 00:25:53,080
one-size-fits-all.
It might work for somebody, but

462
00:25:53,080 --> 00:25:54,480
it might not work for somebody
else.

463
00:25:55,200 --> 00:25:57,240
Thanks.
I was going to lead into this

464
00:25:57,280 --> 00:26:00,040
next section because I know you
could probably talk about each

465
00:26:00,040 --> 00:26:03,280
one of these for 1/2 an hour.
So I'll make it very brief.

466
00:26:03,320 --> 00:26:06,080
And I was thinking about my own
answer to this question, but

467
00:26:06,160 --> 00:26:08,000
obviously I'm going to let you
say what you think.

468
00:26:08,240 --> 00:26:12,120
Are there particular tools that
are still underutilized in

469
00:26:12,120 --> 00:26:15,400
mainstream healthcare that can
make a big difference in

470
00:26:15,400 --> 00:26:19,240
prevention of brain
deterioration, memory thinking

471
00:26:19,240 --> 00:26:21,560
problems?
Good question.

472
00:26:21,920 --> 00:26:24,840
The first thing that came to my
mind is actually sleep studies.

473
00:26:25,160 --> 00:26:28,760
This is not added to The Lancet
Commission's list yet, but it's

474
00:26:28,760 --> 00:26:31,760
hard for me to believe that
sleep apnea won't be added to

475
00:26:31,760 --> 00:26:33,640
the list of modifiable risk
factors.

476
00:26:33,640 --> 00:26:35,360
I think that's huge for brain
health.

477
00:26:35,360 --> 00:26:37,960
You're depriving your brain of
oxygen during sleep.

478
00:26:37,960 --> 00:26:40,280
Like how could that not be a
problem?

479
00:26:40,560 --> 00:26:43,160
And I really think sleep apnea
is under diagnosed.

480
00:26:43,520 --> 00:26:46,720
There are now ways that we can
do simple at home sleep studies.

481
00:26:46,720 --> 00:26:49,800
And the argument is always from
clinicians that they're not as

482
00:26:49,800 --> 00:26:52,600
good as sleep studies that are
done in sleep labs.

483
00:26:52,600 --> 00:26:55,320
But those aren't that practical
for people.

484
00:26:55,560 --> 00:26:58,000
I think we have now cool
screening tools that we can send

485
00:26:58,000 --> 00:27:00,600
people home with and do an at
home sleep study and get a good

486
00:27:00,600 --> 00:27:03,320
read on one night.
It might not be a perfect test,

487
00:27:03,320 --> 00:27:06,000
and if you have a high clinical
suspicion you might want to do

488
00:27:06,080 --> 00:27:09,880
more extensive testing, but I
think it's a really cheap and

489
00:27:09,880 --> 00:27:13,000
underutilized tool.
What do you think about owning a

490
00:27:13,000 --> 00:27:16,000
blood pressure monitor?
I think it's really smart to

491
00:27:16,000 --> 00:27:17,640
have a blood pressure cuff at
home.

492
00:27:17,920 --> 00:27:20,960
When we go into the doctor's
office, the chance that we're a

493
00:27:20,960 --> 00:27:24,480
little excited and maybe anxious
about the visit is high.

494
00:27:24,640 --> 00:27:27,520
The chance we may get a high
reading is not uncommon.

495
00:27:27,560 --> 00:27:31,520
I find that it's better to get
patients in their home and their

496
00:27:31,520 --> 00:27:34,440
comfortable environment and have
them do about a week long blood

497
00:27:34,440 --> 00:27:38,080
pressure log just so we can see
what the variability in their

498
00:27:38,080 --> 00:27:41,360
blood pressure recordings are
and really determine is blood

499
00:27:41,360 --> 00:27:43,720
pressure an issue for this
person and if so, we should

500
00:27:43,720 --> 00:27:46,240
maybe think about it earlier
rather than later.

501
00:27:46,240 --> 00:27:50,520
So this add on question about.
So there's a series of tests,

502
00:27:50,520 --> 00:27:54,880
some of them are commonly done
by primary care providers such

503
00:27:54,880 --> 00:27:59,680
as hemoglobin A1C or fasting
blood sugars, lipid checks, the

504
00:27:59,680 --> 00:28:03,240
standardized tests, maybe even
vitamin deficiencies, B12,

505
00:28:03,240 --> 00:28:05,280
thyroid tests.
How do you help?

506
00:28:05,280 --> 00:28:08,520
Like the patient comes to your
specialized clinic and they may

507
00:28:08,520 --> 00:28:10,520
have already seen a primary care
provider.

508
00:28:11,040 --> 00:28:14,000
I presume most of these tests
have already been done, but how

509
00:28:14,000 --> 00:28:18,680
do you prioritize which tests
are the most valuable for a

510
00:28:18,680 --> 00:28:22,040
person's personal risk profile?
I presume most of it's

511
00:28:22,040 --> 00:28:24,600
historical and just there's
certain tests that are typically

512
00:28:24,600 --> 00:28:27,240
done on somebody who has a
concern, but now we're dealing

513
00:28:27,240 --> 00:28:30,040
with maybe somebody who may have
symptoms.

514
00:28:30,040 --> 00:28:32,960
That's where I'm thinking about
the asymptomatic patient who's

515
00:28:32,960 --> 00:28:35,960
concerned about their brain
health in terms of the testing

516
00:28:35,960 --> 00:28:38,720
to do, routine blood testing and
things like that.

517
00:28:39,160 --> 00:28:42,080
I think that everyone should
have those basic things checked,

518
00:28:42,080 --> 00:28:44,920
and they probably have had them
checked with their primary care

519
00:28:44,920 --> 00:28:48,120
doctor, but their primary care
doctor, because they're the

520
00:28:48,120 --> 00:28:50,840
guardian of every other organ
system, they can't be the

521
00:28:50,840 --> 00:28:54,080
guardian of the brain.
So us neurologists have to be

522
00:28:54,320 --> 00:28:56,760
the guardian of the brain.
And that means that we have to

523
00:28:56,760 --> 00:29:01,280
go to the basement of the brain
sometimes and help weigh in on

524
00:29:01,280 --> 00:29:04,720
risk factors that affect what's
happening outside the brain.

525
00:29:05,000 --> 00:29:07,360
All of these things that you
mentioned like metabolic

526
00:29:07,360 --> 00:29:10,840
screenings, nutritional
screenings, maybe even hormonal

527
00:29:10,840 --> 00:29:15,040
screens for the right person can
be informative to someone's

528
00:29:15,040 --> 00:29:18,360
risk.
What I do in my practice and

529
00:29:18,560 --> 00:29:21,360
many ways to do this is I really
look to the person's family

530
00:29:21,360 --> 00:29:25,560
history, ask them about their
family member who is affected by

531
00:29:25,560 --> 00:29:29,080
whatever disease, Alzheimer's,
Parkinson's, whatever it was,

532
00:29:29,080 --> 00:29:32,160
and really try to understand
their family history and try to

533
00:29:32,160 --> 00:29:35,600
figure out what potential things
in their family history led to

534
00:29:35,600 --> 00:29:38,120
their disease.
Did they have high cholesterol?

535
00:29:38,560 --> 00:29:41,480
Were they overweight?
Did they have diabetes?

536
00:29:41,480 --> 00:29:45,160
Like those are clues for the
individual that's sitting in

537
00:29:45,160 --> 00:29:46,880
front of you.
What could it be potentially

538
00:29:46,880 --> 00:29:50,400
driving their risk?
Great answer by a neurologist.

539
00:29:51,080 --> 00:29:55,000
Thank you.
Don't know how our time went by

540
00:29:55,000 --> 00:29:58,640
so quickly, but we're getting to
the end of our conversation and

541
00:29:58,640 --> 00:30:01,760
we like to make sure we get to
give our listeners some rapid

542
00:30:01,760 --> 00:30:03,680
takeaways from their brilliant
brain.

543
00:30:03,680 --> 00:30:06,280
Kellyanne.
So some surprise questions

544
00:30:06,280 --> 00:30:09,600
because we know the brain love,
novelty and challenge and

545
00:30:09,880 --> 00:30:12,480
probably a little bit of a
challenge for you because you

546
00:30:12,480 --> 00:30:14,360
were a self-proclaimed brain
nerd.

547
00:30:14,360 --> 00:30:17,720
I'm sure people already saw your
bio, but we're going to see how

548
00:30:17,720 --> 00:30:19,560
you do.
OK.

549
00:30:19,800 --> 00:30:24,760
One book or a possibly Seminole
research study that shifted your

550
00:30:24,760 --> 00:30:28,040
thinking on brain health that
you'd like to share with our

551
00:30:28,040 --> 00:30:31,680
audience today.
Oh, OK, great question.

552
00:30:31,960 --> 00:30:34,720
I'm going to go with a mentor of
mine, Lisa Moscone.

553
00:30:34,960 --> 00:30:39,040
While I was working with her at
Weill Cornell, she was working

554
00:30:39,040 --> 00:30:43,040
on estrogen scans and following
women through perimenopause and

555
00:30:43,040 --> 00:30:45,880
menopause.
And she published amazing work.

556
00:30:45,880 --> 00:30:48,520
And if you haven't checked it
out, I'm a huge fan of hers

557
00:30:48,760 --> 00:30:52,000
showing how the brain going
through menopause actually up

558
00:30:52,000 --> 00:30:55,120
regulates estrogen receptors,
which is something we thought,

559
00:30:55,240 --> 00:30:58,400
wait, how?
But it's like the brain's effort

560
00:30:58,400 --> 00:31:01,640
to try to suck in as much of the
remaining estrogen from the

561
00:31:01,640 --> 00:31:05,080
blood as possible because
estrogen so neuroprotective.

562
00:31:05,560 --> 00:31:10,600
When I first started down the
prevention path, I recognize

563
00:31:10,600 --> 00:31:14,240
that there was this difference
between men and women in terms

564
00:31:14,240 --> 00:31:16,960
of men being at higher risk for
Parkinson's, women being at

565
00:31:16,960 --> 00:31:19,960
higher risk for Alzheimer's.
But how do you wrap your head

566
00:31:19,960 --> 00:31:21,880
around that?
And there's probably so many

567
00:31:21,880 --> 00:31:26,040
avenues to explain that.
But because hormone replacement

568
00:31:26,040 --> 00:31:30,200
therapy for women has been so
shut out, the work of people

569
00:31:30,200 --> 00:31:34,200
like Doctor Moscone who are
showing us that, hey, hormones

570
00:31:34,200 --> 00:31:38,000
are important for brain health,
something's happening in our

571
00:31:38,000 --> 00:31:43,200
brains during mid, mid life or
later in life related to

572
00:31:43,200 --> 00:31:45,400
hormonal shifts.
That's really changed the way

573
00:31:45,400 --> 00:31:48,960
that I think about hormones and
really why I integrate them so

574
00:31:48,960 --> 00:31:52,600
heavily in my practice.
We will include a link to that

575
00:31:52,600 --> 00:31:55,880
research in her book in the show
notes below so people can find

576
00:31:55,880 --> 00:31:58,600
that.
As a preventative neurologist,

577
00:31:58,720 --> 00:32:02,720
what is your one non negotiable
for caring for your own

578
00:32:02,720 --> 00:32:05,360
brilliant brain?
I love it.

579
00:32:05,360 --> 00:32:08,640
So movement.
I try to do something active

580
00:32:08,640 --> 00:32:11,480
every single day.
It doesn't have to be intense,

581
00:32:11,720 --> 00:32:16,360
it just has to be consistent.
We all do a lot of desk work, so

582
00:32:16,360 --> 00:32:19,560
I try my best to get up and walk
around as much as possible if

583
00:32:19,560 --> 00:32:21,840
I'm not able to exercise that
day.

584
00:32:22,840 --> 00:32:27,240
How can our listeners find out
more about you or follow your

585
00:32:27,240 --> 00:32:29,920
own work?
Oh, great question.

586
00:32:29,920 --> 00:32:33,120
You can see my Instagram, I post
pretty regularly on there.

587
00:32:33,120 --> 00:32:36,640
I'm a science nerd, so a lot of
the content that I post is just

588
00:32:36,640 --> 00:32:41,200
about new research in the space.
If you like higher touch, less

589
00:32:41,200 --> 00:32:43,880
maybe accessible content than
follow me.

590
00:32:43,880 --> 00:32:47,640
Although I do try to give some
super helpful tips for the

591
00:32:47,640 --> 00:32:50,320
everyday person.
That's Doctor Kellyanne Niotes

592
00:32:50,720 --> 00:32:53,240
on Instagram and then my
website, which is

593
00:32:53,240 --> 00:32:57,400
www.drkellyanneiotis.
And coming in October, we'll

594
00:32:57,400 --> 00:33:00,560
have our new practice website
fully launched, which will be

595
00:33:00,560 --> 00:33:04,640
preventiveneuro.com.
And we will include links to all

596
00:33:04,640 --> 00:33:07,360
those below in the show notes.
And yes, you do provide

597
00:33:07,360 --> 00:33:10,320
wonderful informative videos.
So I encourage all of our

598
00:33:10,320 --> 00:33:12,680
listeners to be sure to check
those out.

599
00:33:13,160 --> 00:33:17,000
I wasn't sure you have the final
last word with our listeners.

600
00:33:17,000 --> 00:33:20,640
What's the key message you hope
they have from our conversation

601
00:33:20,640 --> 00:33:25,360
today as the take away?
The take away for me always is

602
00:33:25,360 --> 00:33:28,520
that it's never too late to
start caring about your brain

603
00:33:28,520 --> 00:33:30,760
health.
A lot of people worry that

604
00:33:30,920 --> 00:33:34,040
they're in their 60s or 70s and
there's nothing that they can do

605
00:33:34,040 --> 00:33:36,400
anymore, but I just don't
believe that's true.

606
00:33:36,400 --> 00:33:38,880
So never too early, and
definitely never too late to

607
00:33:38,880 --> 00:33:42,080
start caring.
We hope today's conversation

608
00:33:42,080 --> 00:33:45,120
highlights a powerful shift and
how we approach brain health,

609
00:33:45,480 --> 00:33:49,040
one that's rooted in early
detection, personalized care,

610
00:33:49,040 --> 00:33:51,400
and a belief that prevention is
possible.

611
00:33:51,840 --> 00:33:54,040
It's clear that brain health
isn't something we should wait

612
00:33:54,040 --> 00:33:56,240
to think about.
It's something we can take

613
00:33:56,240 --> 00:33:59,640
action on today.
Doctor Niotes, it reminds us

614
00:33:59,640 --> 00:34:03,160
that neurodegenerative diseases
often begin developing decades

615
00:34:03,160 --> 00:34:06,760
before symptoms appear, which
means prevention truly starts

616
00:34:06,760 --> 00:34:10,159
now, not later.
The future of neurology isn't

617
00:34:10,159 --> 00:34:13,360
just about treating disease.
It's about protecting and

618
00:34:13,400 --> 00:34:16,480
optimizing the brain long before
symptoms start.

619
00:34:16,840 --> 00:34:20,600
Doctor Kellyanne Niotis, thank
you so much for letting us pick

620
00:34:20,639 --> 00:34:23,880
your brilliant brain on the
Let's Talk Brain Health podcast.

621
00:34:24,639 --> 00:34:28,239
Thank you for investing your
time and energy into your

622
00:34:28,239 --> 00:34:31,760
personal brain care by listening
to today's episode of the Let's

623
00:34:31,760 --> 00:34:35,159
Talk Brain Health Podcast.
I hope our conversation gave you

624
00:34:35,159 --> 00:34:38,920
fresh insights, a bit of
inspiration, or practical steps

625
00:34:38,920 --> 00:34:42,159
that you can take on your own
personal brain care journey.

626
00:34:42,600 --> 00:34:45,480
If you enjoyed today's
conversation, I'd like to ask

627
00:34:45,480 --> 00:34:48,320
you to please share this episode
with someone who could benefit

628
00:34:48,320 --> 00:34:50,840
from it or consider leaving us a
review.

629
00:34:51,360 --> 00:34:54,600
If you have questions or a topic
in brain health you'd like me to

630
00:34:54,600 --> 00:34:58,480
explore, please e-mail me
anytime at podcast at

631
00:34:58,480 --> 00:35:02,200
virtualbrainhealthcenter.com.
I'd love to hear from you.

632
00:35:02,480 --> 00:35:06,480
We have so many more exciting
topics ahead, and I can't wait

633
00:35:06,480 --> 00:35:09,520
to continue this lifelong
journey of better brain health

634
00:35:09,520 --> 00:35:12,760
together with you and our
growing virtual community.

635
00:35:13,240 --> 00:35:16,320
Until next time, remember to
give your brain the care it

636
00:35:16,320 --> 00:35:19,520
deserves and make your brain
health a priority.