In this episode, neurologist Dr. Alberto Espay shares a bold new vision for treating Alzheimer's—beyond plaques and toward personalized care. We discuss limitations of current drug strategies and the potential of the Cincinnati Cohort Biomarker Program to individualize treatments for patients with neurodegenerative disease.

Find his book Brain Fables here: https://www.amazon.com/Brain-Fables-Neurodegenerative-Diseases-Blueprint/dp/1108744621

References:

#1: β-Amyloid accumulation in the human brain after onenight of sleep deprivation: https://pubmed.ncbi.nlm.nih.gov/29632177/

Episode chapters:

00:00:00 Introduction & Dr. Espay's Neurology Speciality

00:01:05 Cincinnati Cohort Biomarker Program (CCBP) Goal

00:02:04 Placeholder Diagnoses: How we Choose Clinical Labels for Diagnoses

00:05:28 Precision Medicine Goal: Individualized Diagnostics and Treatments

00:08:27 Dr. Espay's Critique of the Amyloid Hypothesis

00:11:42 Lecanemab: Validation of the Amyloid Hypothesis?

00:13:56 On the Toxicity of Amyloid Plaques

00:18:05 Monoclonal Antibody Issues: ARIA, Swelling & Bleeding

00:20:18 Data Presentation vs Manipulation: Relative vs. Absolute Risk Reduction

00:27:52 Interpreting Research Data: Sleep Deprivation & Amyloid Example

00:30:23 Amyloid Structure and Toxicity

00:32:27 Preclinical Anti-Amyloid Trials (4 Studies)

00:36:40 CCBP: A Precision Medicine Research Programme

00:39:06 Developing Divergent & Therapy-Linked Biomarkers

00:43:02 Focus on Biological Subtypes, Not Clinical Diagnoses

00:48:03 CCBP as Exploratory Research: A 'Fishing Expedition'

00:50:50 Identifying Outliers (Uric Acid Example)

00:54:28 Skepticism in Medical Research

00:55:40 About the Book 'Brain Fables'