#164 - Amanda Smith, M.D.: Diagnosing, preventing, and treating Alzheimer’s disease, and what we can all learn from patients with dementia

47 snips

Jun 7, 2021

Dr. Amanda Smith, a geriatric psychiatrist with extensive expertise in Alzheimer's treatment, dives deep into understanding dementia. She discusses the challenges of diagnosing Alzheimer's, the crucial role of amyloid and tau proteins, and the significance of the ApoE genotype. Amanda highlights advancements in clinical trials, including promising new treatments, while emphasizing the emotional complexities faced by patients and caregivers. They wrap up with insights on healthy aging and the life philosophy shaped by understanding dementia.

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ANECDOTE

ER Ageism

Amanda Smith witnessed a doctor dismissing an elderly woman's chest pain in the ER.
The woman's dentures were missing, but she was coherent, highlighting ageism in healthcare.

INSIGHT

Awareness and Suffering

Some dementia patients are blissfully unaware of their condition, while others are acutely aware.
Those aware of their decline often experience the most suffering.

INSIGHT

Dementia Diagnosis

Diagnosing dementia requires a thorough clinical interview with the patient and an observer, separately.
Cognitive tests, brain imaging, and lab work help confirm the diagnosis and rule out other conditions.

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Amanda Grant Smith is a geriatric psychiatrist with decades of experience treating patients with dementia and Alzheimer's disease. In this episode, Amanda shares how she developed a passion for geriatric psychiatry as a means to support dementia patients. She explains how to recognize, define, and diagnose dementia—a process that still remains somewhat elusive. They also talk about the significance of ApoE genotype and compare the various forms of dementia including differentiating between Alzheimer’s disease and Lewy body dementia. They discuss the current landscape of clinical trials, the drug pipeline, and talk about a very promising monoclonal antibody directed at amyloid beta that has the potential to be a disease-modifying drug. They conclude with a discussion about how to define “healthy aging” and reflect on how understanding dementia can shape one’s life philosophy.

We discuss:

How Amanda developed a passion for geriatric psychiatry [3:15];
Defining and diagnosing dementia and Alzheimer’s disease [13:30];
Medical tests for dementia and their relationship to clinical symptoms [22:45];
The pathology of dementia, and the role of the tau and beta-amyloid protein in Alzheimer’s disease [33:15];
The significance of ApoE genotype, and differentiating Alzheimer’s disease from Lewy body dementia [43:15];
The evolution of Alzheimer’s disease prevention, care, and medications over the last 20 years [52:45];
Psychiatric support for dementia patients (and caregivers) with depression and anxiety [1:02:45];
Drug pipeline, clinical trials, and major challenges to overcome [1:13:45];
Redefining Alzheimer’s disease and designing effective trials [1:23:00];
The promise of monoclonal antibody treatments for Alzheimer’s disease [1:34:15];
How we should measure outcomes in dementia trials and define “healthy aging” [1:42:30];
How understanding dementia can reshape our life philosophy [1:53:45]; and
More.

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