The chief science officer at the Alzheimer's Drug Discovery Foundation discussed the resource, which consists of more than 200 reports on drugs, development, supplements, food/drink, nonpharmacologics, and risk factors related to brain health.
Howard Fillit, MD
The Alzheimer's Drug Discovery Foundation (ADDF) recently announced that it had launched Cognitive Vitality Reports, a new resource on the Cognitive Vitality website, containing over 200 scientific reports for researchers and clinicians interested in the development of drugs for Alzheimer disease and related dementias.1
Written by neuroscientists, the intention of the reports is to expand the Cognitive Vitality platform with in-depth analyses of drugs, drugs-in-development, supplements, nutraceuticals, food/drink, nonpharmacologic interventions, and risk factors related to brain health. There are also reports on yet-approved interventions, those in development for a wide variety of age-related diseases that may have potential effects on brain health.
To find out more about the reports, how the Cognitive Vitality tool operates, and what advantages it provides health care professionals, NeurologyLive inquired with Howard Fillit, MD, founding executive director, and chief science officer, ADDF.
Howard Fillit, MD: Back a number of years ago, we realized that translating science for laypeople was a real challenge. You look on the front page of USA Today and it reads, “Red wine prevents Alzheimer’s disease.” But what's the evidence? Is it an in vitro thing where you pour some red wine on some cells in a test tube, or is it an animal model where you make old mice drunk all the time? Or is it an epidemiological study where we’re showing an association between red wine and good outcomes or bad outcomes? It’s like the old one that I can prove that bread is bad for you. How? Well, studies show that 95% of all felonies are committed within 24 hours of eating bread.
The first thing is, what is the evidence? I have always had a private practice, and there's always the challenge in the office where people come in and they're on supplements, they ask about lifestyle, they want to know about new drugs, they read about something in the newspaper—where can they go for credible, understandable, and valuable scientific evidence? The first part of Cognitive Vitality that we built—and we have 3 scientists at the foundation to work on this full-time—is the layperson facing aspect of this, which is the Cognitive Vitality Ratings that are there. These are about 150 reports on various lifestyle interventions and supplements and drugs that are out there, where people can go in and search and get understandable reports that evaluate the potential for efficacy and safety of these interventions and drugs and supplements. That's been built and last year, we had 2.7 million unique visitors to the site. It's really kind of exploded in the last couple of years to be quite a successful website for the purpose that it was built.
My vision for this whole thing originally was that you could see a patient and they might be on magnesium for some reason, or curcumin, or whatever, and you could show them the cognitive vitality rating—they could read it for themselves, or you could refer them to read it.
But what about if I was a practicing doctor and I needed a place to go where I could evaluate the evidence myself and get a much more scientific and clinical perspective on everything? So we're writing very in-depth scientific reports. We've accumulated over 220 reports on various supplements, and these were really literature-based, evidence-based reports that included not only the supplements but also a variety of drugs. It also included drugs and development in the context of prevention or treatment of Alzheimer disease and related dementias, and also aging itself. It's a really curated website for looking at interventions for Alzheimer, and these are real scientific reports for not only physicians to read.
Let's say I'm a researcher at the University of Michigan, and I'm interested in some sort of drug that's in development that I've heard about, or that a patient referred to me to learn about. Doctors and scientists can go to that part of the website and get more in-depth information about various drugs and supplements that have been proposed for use for Alzheimer disease and might be in development or even on the market.
With the average patient visit in the United States being 7 or 8 minutes in primary care, the average physician probably is not going to be accessing that part of the website very often. But I think part of it was built for researchers and specialists in the field who might be more interested in Alzheimer. For example, neurologists or geriatricians or geriatric psychiatrists or primary care doctors who are particularly interested in Alzheimer disease. It would be really for that subset of doctors who are caring for patients or doing the research, to whom the cognitive vitality reports would be most valuable.
There are a lot of patients out there that want more technical information, and the key to the whole website—both the cognitive vitality ratings and the part that's really layperson facing, as well as the reports, that I think the key underlying principle here is the pyramid of evidence. The pyramid of evidence is a well-known description of the levels of evidence. You have different levels of evidence, and people need to understand when they see something in USA Today or wherever, where that evidence falls. Sometimes we get very aggressive public relations offices and universities that put out a press release on a new finding that a scientist made, and it doesn't really add much to the pyramid of evidence because it's so preliminary and so far from the clinic and the randomized trial—which is generally considered the gold standard for demonstrating the efficacy and safety of interventions. The underlying principle here is presenting the pyramid of evidence and what the level of evidence is—that's where the ratings and the reports have in common. They describe what evidence is out there.
Another part of the rationale is that because we don't have really effective disease-modifying drugs for Alzheimer disease, people are desperate. The only drugs on the market are only modestly effective, so patients and families are asking doctors all the time, what can we do and what else is out there. People want to know about, for example, repurposing. What drugs might be able to be prescribed for repurposing, where it's using a drug off-label from another indication like Parkinson disease. The drug for Parkinson's disease is already proved—we know the safety profile and because Parkinson's and Alzheimer are related neurodegenerative diseases, patients want to know if there are drugs for Parkinson's that we might prescribe off-label for Alzheimer. The reports and the ratings kind of get at that. People are asking questions. They need information about the evidence, not only about efficacy but particularly safety in that context.
Exactly. That's an important point, that the research reports, in particular, really could stimulate new science and new research because they really are in-depth reports. I think scientists could look at them and use them as a research resource for taking what evidence is out there on molecules that look attractive, and then pursue them for further research. Most of the ones that we have reports on have very limited randomized control trials about them. These research reports that we're presenting also are a very important scientific resource for further research.
Transcript edited for clarity. You can read the full reports on CognitiveVitality.org.
ADDF launches over 200 in-depth Cognitive Vitality Reports [press release]. New York, NY: ADDF; published February 4, 2020. eurekalert.org/pub_releases/2020-02/addf-alo020420.php Accessed February 20, 2020.