Costantino Iadecola, MD

“In the sporadic cases [of Alzheimer], it is much more complex. I don’t think that the single approach is going to work. If you look at the brain of someone who died from sporadic Alzheimer disease, you’ll see 5 or 6 pathologies at the same time.”

The understanding of Alzheimer disease and its various pathologies has been a growing and shifting process in the last few decades. Despite failures in amyloid-beta targeted treatments in clinical trials, the knowledge of the disease’s pathways in the brain has allowed for physicians such as Costantino Iadecola, MD, to take on a different perspective in their approach.

Iadecola, who is the Ann Parish Titzell Professor of Neuroscience and director of the Feil Family Brain and Mind Research Institute at Weill Cornell Medicine, noted that in cases of familial Alzheimer disease, the approach required may be slightly more simple because the ability of therapies to clear amyloid can theoretically fix the disease, particularly now that modulators of key enzyme processes are being developed. In sporadic disease, however, a number of pathologies are often at play, requiring a more tailored and multifactorial approach.

, Iadecola offers his perspective on the current understanding of these approaches and what he believes needs to happen to increase the physician awareness of some of the vascular risk factors that can be at play in this disease, as well as the public health issue it brings to light.

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The director of the Feil Family Brain and Mind Research Institute at Weill Cornell Medicine discussed the role amyloid plays in various types of Alzheimer disease and its impact on vascular dysfunction.

Costantino Iadecola, MD: Awareness of Vascular Risk Factors in Alzheimer Disease

“Amyloid also has an effect on the blood vessels, as it does neurons, by kind of stunning them, making them unable to work—to deliver oxygen and glucose, and remove the waste. It promotes accumulation.”

The amyloid theory in Alzheimer disease and dementia has long been a targeted pathology for treatments. While many of these therapies have failed, many specialists have speculated that this may be due to the timing of therapy, often pointing to a patient being already too far along in the disease process by the time they are first treated in clinical trials. And in fact, one amyloid-targeting agent, aducanumab, is poised to become the first to gain approval from the FDA later in 2020.

For physicians like Costantino Iadecola, MD, the Ann Parish Titzell Professor of Neuroscience and director, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, the complications of treating this disease do not stop at the challenges of identifying patients earlier. There are additional challenges in the variance between those with familial Alzheimer compared to those with sporadic disease.

, Iadecola explains the differences between these 2 sects of patients and details the importance of the vascular processes in disease as it relates to amyloid buildup. He offered his insight on the how cardiovascular disease and other comorbidities can play a role in amyloid-driven disease.

Costantino Iadecola, MD: The Impact of Amyloid on Vascular Dysfunction

“Doing, for example, an amyloid scan or a tau scan to detect some of the things that could once only be seen in pathology—now we can do that early. The problem is that a lot of normal people, the non-cognitively impaired, also seem to have those things in the brain.”

Advancements in imaging technology and research have allowed for physicians treating patients with Alzheimer disease to now detect the presence of proteins which are essential to the pathology of the disease much earlier than ever before. This has made diagnosing Alzheimer disease easier and allowed for treatment to begin sooner—a vital step.

Although, there is a remaining issue. Many patients who are cognitively normal also have levels of amyloid beta in their brains. The difference is that they have a larger cognitive reserve, hinting at, potentially, a better ability for their brains to maximize the performance of damaged resources. As Costantino Iadecola, MD, would point out, this is a complicating issue.

To discuss how to make the decision about who will end developing Alzheimer and who will not when amyloid buildup occurs, the Anne Parrish Titzell Professor of Neurology and Neuroscience at Weill Cornell Medicine’s Feil Family Brain and Mind Research Institute sat down with 

The Anne Parrish Titzell Professor of Neurology and Neuroscience at Weill Cornell Medicine’s Feil Family Brain and Mind Research Institute discussed how to make the decision about who will end developing Alzheimer and who will not when amyloid buildup occurs.

Costantino Iadecola, MD: Cognitive Reserve in Alzheimer Disease

“If dementia was an industry, a company, its business production would be similar to the gross domestic product of Canada, to give you an idea of how much this costs the general population.”

With an increasing number of aging patients in the United States and the world, dementia has become one of the most serious and widespread medical conditions ever. According to the World Health Organization, 5.2% of those over the age of 65 have dementia globally, accounting for roughly 50 million people.

Costantino Iadecola, MD, the Anne Parrish Titzell Professor of Neurology and Neuroscience at Weill Cornell Medicine’s Feil Family Brain and Mind Research Institute, knows this all too well. His work in dementia extends back as far as the early 1980s. 

With prediction models estimating the prevalence of dementia to more than double in the next few decades, Iadecola knows there is work to be done. Not only for the sake of the patients but their caregivers and family as well, as the cost of caring for these patients has only grown.

At the American Neurological Association’s 143rd Annual Meeting in Atlanta, Georgia, Iadecola sat with 

 to discuss the increasing prevalence of dementia, as well as what is being done globally to address it.

1. Prince M, et al. World Alzheimer’s Report 2015, The Global Impact of Dementia: An analysis of prevalence, incidence, cost, and trends. 

The Anne Parrish Titzell Professor of Neurology and Neuroscience at Weill Cornell Medicine’s Feil Family Brain and Mind Research Institute spoke about the cost the condition has for patients and their families.

Costantino Iadecola, MD

Articles

Costantino Iadecola, MD: Awareness of Vascular Risk Factors in Alzheimer Disease

Costantino Iadecola, MD: The Impact of Amyloid on Vascular Dysfunction

Costantino Iadecola, MD: Cognitive Reserve in Alzheimer Disease

Costantino Iadecola, MD: The Cost of Dementia's Increasing Prevalence

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