hello I’m Dr David Haase and I’m at the Maxwell clinic in Nashville Tennessee
and we’re going to talk today about dementia prevention of dementia
treatment of dementia at Maxwell clinic so first of all I’m a Vanderbilt Mayo
Clinic trained physician I’ve been working in this field of how do we
figure out what creates health for nearly a quarter Century now and one of
my major interests is dementia because it really is the worst of the
degenerative conditions losing one’s sense losing one’s mind losing the
ability to care for oneself and seeing all this erode at a very slow fashion is
incredibly difficult for the individual that’s going through it but really for
tremendously for the family and the loved ones of those people around it but
there’s hope okay I want to let you know that we’re making incredible progress
and there are things available even now that I’ll go over some of those today
that can make a difference and I want to encourage you to engage
so um we are a center for dementia
treatment and research at Maxwell Clinic here in Nashville Tennessee we’re one of
only four centers or excuse me six centers selected for a landmark clinical
trial looking at the effect of precision medicine on reversing cognitive decline
we have multiple other IRB approved trials going and we take a very
comprehensive systems viewpoint on understanding this thing we call
dementia so what is dementia so if you D meant that it literally means unbrain
dementia is an unbraining and just like every brain is unique every dementia is
unique for a person this is why it’s very hard to diagnose
somebody until they have a very late stage in their process to give them a
name for what they’re going through but as hard as it is to diagnose and say oh
this is the one right name that describes this person
um it’s it’s actually much simpler to dig into what are the underlying causes
that may be perpetuating this unbraining from happening
and it’s really important to start early whether you’re working with a family
member a loved one or yourself Dead brain is Dead brain now we can cause
some neurodegenerate neuro regeneration to happen but it’s so much better not to
lose brain cells so starting early is incredibly important I mean we joke you
know we can work to heal the sick but we can’t raise the dead and and so that’s
why we need to slow stop and reverse this process for neurodegeneration as
much as we possibly can
now the the current method of treating dementia in the standard medical
practice was really a couple of medications that will rev up the amount
of acetylcholine or improve the function of nmda channels all of these
are to decrease the symptoms of the progression of Alzheimer’s disease or in
the case of Parkinson’s giving l-dopa to decrease the symptoms thereof but
there’s not a lot of attention paid to how did we get here in the first place
and are there some causes that are present that we can unwind
um and they’re very frequently are things that we can do so
um there’s also some new medications that are coming out for the treatment of
Alzheimer’s disease that are focused on the amyloid model of disease you know
kind of blaming this molecule called amyloid for the cause of dementia and
many of these medications have been trialled
um and they have all shown to have very high toxicity
and we I want to hint all of these things to succeed okay
um I do I am all for everything that works and but there is a treatment that
is actually showing to be substantially beneficial in slowing and even reversing
dementia we’ll talk about regarding plasma exchange shortly
so um when plasma exchange is
a technique that mimics a process of parabiosis now parabiosis I’m sure you
haven’t heard of before but it’s one of the most interesting pieces of science
that exists because it actually shows how the body can regenerate itself with
multiple tissues across the entire body including the brain
so this is what parabiosis is it was a study done many studies where they took
cloned mice an old mouse and the young Mouse and they surgically attached them
to each other an old mouse and a young Mouse and they ran around the cage
together for a while after about a week a really remarkable thing happened that
old mouse started to turn young you know the fatty
liver starts to reverse osteoporosis starts to reverse the if a muscle is
injured it heals better and can grow better
the sense of smell came back for these mice the T cell and B cell meaning those
are cells of the immune system became more
focused and targeted and able to do their job
there was improvements in the skin and hair of these mice and what was even
most remarkable is there was new neurogenesis new neurons sprouted in
that area of the brain that controls memory for these mice and so that was an
amazing thing and then they separated the mice after a time and the young
Mouse lived to its normal expected age and really wasn’t harmed but that old
mouse lived closer to the lifespan of the young Mouse really the potential for
age extension there so when why is this important because
what this study showed us and the subsequent studies afterwards where they
would take an old mouse and they would take out its old plasma and put in clean
plasma replacement fluid that that had the same effect of
attaching a young Mouse to that old mouse and the tissues in the body of
that old mouse started to do a better job of regenerating what happened and we
now know is that these stem cells that were throughout the course of that
Mouse’s entire body became younger they started to behave younger
and because stem cells are out over the course of your whole body this is what
creates a repair process
and so if you can improve the environment a stem cell lives in
then that stem cell behaves younger it’s really it’s this is a really a
kind of no-brainer once you think about it but our cells uh don’t necessarily
act their age they act the age of their environment so if we can make the
environment cleaner and younger the stem cells start to behave younger now with
this understanding we said wow how can we mimic this in a human and it’s it’s
done with a procedure that’s called therapeutic plasma Exchange
now therapeutic plasma change has been around for a long time it’s part of a
field we call apheresis and apheresis is a standard of care in
treating severe Progressive neurologic diseases like multiple sclerosis
Guillain-Barre syndrome neuromyelitis Optica a lot of things you probably
haven’t heard of but what it does is it removes you know therapeutic plasma
exchange is where you can basically get an oil change for your bloodstream and
what does what happens is you have an IV placed in each arm or a larger IV place
in your body and blood comes out one line it gets
cleaned by removing the old plasma that was there and replacing that old plasma
with a clean replacement fluid which then goes back into your body via the
other IV line and that happens continuously it takes about two two and
a half hours to do but at the end of that
an amount that would be equal to the plasma your body started with
uh would be have been exchanged would have been clean
and so this gives your body a new environment in which to do its work of
healing by removing Auto antibodies um molecules that may be toxic like
amyloid fragments it changes the set point of the immune system so that your
body’s ability to regulate infectious disease and autoimmune disease is better
this is a really remarkable therapy and very safe in general and it has a
um so then as we were recognize this it’s like wow wait a second let’s put
this pieces together you mean then this parabiosis studies we know
that these mice can become essentially biologically younger
as a result of having a cleaner environment for their stem cells
this is part of the basic science research that we’re doing we’re actually
conducting one of the most rigorous and extensive tests on how our process of
plasma exchange reverses biological aging very excited on digging into the
finer details of that but
when we come back to neurodegeneration the great thing is we have a clinical
study to talk about we have a very large clinical study that shows us this
therapeutic plasma exchange holds promise for benefit in treating dementia
so this study is very important to recognize it’s called the ambar study it
was published in 2020 and it didn’t get as much attention as it should have and
it showed some remarkable outcomes in that individuals with what we call in
the in this is a mainly European study it was done uh both the United States
and Europe multinational multi-center randomized controlled study looking at
the utility of this plasma exchange process in reversing cognitive decline
and what was shown is that in individuals with what they called
moderate Alzheimer’s disease and I hate to say moderate but that’s a European
term and and that basically means you’re in a nursing home already unable to care
for oneself um and possibly not remembering your
family members Etc I would consider that quite an advanced stage
but even in those individuals their disease progressed 60 percent less fast
than the placebo group did that’s a that is one of the largest changes we’ve ever
seen in trajectory of the Disease by any treatment method and that happened over
14 months and in individuals with mild Alzheimer’s
disease they actually saw improvement from their Baseline over 14 months that
means these individuals who already were classified as having dementia meaning
there’s some part of their life they couldn’t manage by themselves they
already had entered a state of helplessness in some aspect of their
life and um so they were not they were still
living in probably living with some type of support
but it’s still a progressed state I would say
these individuals had improvement over the course of that 14 months of of
plasma exchange therapy that is remarkable and what it does in many ways
number one it gave us very clear data that this therapy of therapy or plasma
exchange should be offered this it should become something that is
available for the treatment of neurocognitive Decline
and it certainly calls for the needs for more studies you know that’s that’s
always what you’re going to find at the end of a scientific paper
um there’s one problem with the study and that they they had multiple primary
outcome marketers and secondary outcome marketers looking at how good memory was
and how good function was and uh they missed their primary marker by what I
consider a technicality you know they they put up a line and said all right
you this you have to have greater you have to have less than .005 in order for
this study to be considered this marker this one marker in the study to be
considered statistically significant and they were 0.06 the smallest of margins
and every primary and secondary measure other men otherwise was very positive
this is incredibly encouraging and one of the challenges is this therapy
doesn’t involve an expensive pharmaceutical so there’s there’s not a
big patent that protects any of this so there’s not a lot of big money out there
to run another trial like this so oh but this is where we are we are in a place
that dementia is progressing for people that individuals are having the daily
tragedy of seeing their brain become less or the brain of a loved one
and um and this is a therapy that is
available now um we have the largest private plasma
exchange center in the United States here in Brentwood Tennessee we take care
of people from all over the world from all over the United States and here in
Nashville um the
is you know I was had a great report from one of my patients he came to start
their plasma exchange therapy here and um and a son brought his father I said
you know Dad’s just not able to manage his Affairs any longer he’s forgetting
the names of his grandchildren he is having a hard time he’s being very
irritable about this this is very traumatic for him
um and the whole family is you know grieving what they see coming because
it’s dementia is very much like that train wreck that man you see coming you
can see oh gosh that train is not going to be able to stop on time and it’s
going to be a disaster and that’s the usual way we think about
dementia when said he brought us that in and he went through an initial series of
treatments of plasma exchange here and I got a call back from him and he said you
know dad is so much better and he he had a remarkable response
um he’s back to himself he’s a memory is clear his mood is better but not only
that his skin cleared up he said that’s the most amazing thing you know the back
of his skin at all these age spots and his weird things and his skin looks
better and there’s more spring in his step and he wants to exercise now and
he’s engaging life more and if one comes back and thinks we’re
not really treating Alzheimer’s what we’re doing is we’re enabling better
cellular repair and to the extent that we can do that
um we can start to heal the cells that are sick and maybe even replace some of
those that have died with new neurogenesis
um anyway that gave me incredible
satisfaction to hear that and we have um many more you know stories like that
the the results are individualized and the other thing we’re doing is really
looking into what how do we marry this systems approach to reversing cognitive
decline you know looking at all the factors that may be at play with this
amazing powerful single therapy of plasma exchange and and how do we find
out who’s the best candidate all of that is work that we’re doing and
um we really need people to also be part of the solution to help us figure these
things out for the future um so we’re um
we’re really pleased that we get to do this work
it’s not easy um and we’re being Pioneers in this
field and um and their
are always people who want to say well that doesn’t work well if you look at
the data the data says it does clinical outcomes can be really impressive but
that’s with plasma exchange we do certain types of augmentation that are
highly personalized for each individual and that is that is the potential of
therapeutic plasma exchange for not just the treatment of dementia but really I
believe this is the therapy that treats the process of Aging now it doesn’t make
the Earth you know rotate around the sun backwards that’s not what I’m talking
about it doesn’t turn back time but aging is really when you have more
degeneration than regeneration in any particular time period right that you
you’ve broken down more and you’ve accumulated damage I think that’s a good
way of looking at aging because we all know we can see 60 year olds out there
and so some 60 year olds look like 80 year olds and some 60 year olds look
like 40 year olds so your biological age you know what is the how much damage has
your body accumulated is not necessarily the same as your
chronologic age you know how many times you’ve been around the Sun and so here’s
this opportunity for us to do an intervention that has
um a very good potential for changing the trajectory of your
biological age we we often measure so there’s a test called a methylomic test
where we can measure about 900 000 separate
methyl groups whether single carbon groups on the DNA and by using a large
algorithm we can help determine what one’s biological age is and before and
after testing on that utilizing our plasma exchange approach with
augmentation is really we see that biological age reverse and
um that’s really exciting that’s very exciting because if we’re treating
dementia’s number one risk factor is aging is aging so along with
optimizing nourishment and improving the decreasing the burden of toxins and
infections and allergens and and injury and all of those things those are really
important and those help as well it’s
tremendously important to deal with the most important risk factor for
Alzheimer’s disease and that is the mechanism of Aging itself so I’ve got a
lot more to say about that there are many different Hallmarks of Aging
molecular and structural and it’s interesting that therapeutic plasma
exchange hits on more of those than any other single therapy and this therapy is
available now I think that the people
don’t often reflect on just
how troubling and challenging dementia is because we hide it away many of the
people who are most severely affected are in memory care centers and we don’t
see them in the community they drop out of our awareness and denial may be the
worst risk factor for the progression of dementia if you’re if if you or somebody
you know is having a little bit of memory loss oh my gosh that’s a
five-star alarm you know it’s recognize that that’s the that’s an early symptom
your body’s giving you a little warning sign that hmm we’re not going the right
direction here please be brave please be brave I know it’s so hard because the
thought of losing one’s memory one’s cognitive function one’s ability to move
whether that be is just terrifying and but if you do nothing you are dealing
with a neurodegenerative disease this means these diseases progress forward
continuously you’re on a slope and um and that slope is what we aim to
start changing you know really if we think about it we’re all on a slope
right none of us get out of life alive and what we want to have is just the
best life that we can possibly have we want our days to be as full of
experience and meaning and purpose as possible
that’s you know really what we’re here for and to care and love for those
people around us so that we can experience that with them as well
uh it’s uh so anyway I want to say really encourage
all of or encourage everybody to be brave in the face of dementia to have
courage and be curious what is out there what could we learn
how could we change this movement um I really want to encourage you to to
you may check out my book it’s called curiosity heals the human uh it was a
labor of love for me to put out some ideas about how do we create health and
um and how could we go about thinking of things differently I also invite you to
contact us at Maxwell Clinic go to Maxwell clinic.com you can find more
information and learn about these things there
he’s even set up a consultation if you’re interested in plasma exchange so
we can talk more about it about your particular situation because every every
treatment needs to be individualized right you are not a you are not like
anybody else in the world and how what are the unique characteristics that
could enable your success really should be investigated and pursued
um you know again earlier is better
earlier much earlier is much better and we’ll be you we already are utilizing
many tools to look at the predispositions for dementia and helping
individuals to address these things Upstream and um and the earlier you can
address these things the more uh benefit you can get by slowing the curve of
degeneration
earlier in the lifespan which if you track out a little Improvement you know
a couple of decades ago in your s in how steep your degeneration is it ends up to
be a huge difference a couple of decades later so
um I just want to say thank you for taking this time with me I hope that you
know a little bit more now about dementia as really a process of
unbraining I hope you now recognize that therapeutic plasma exchange is a the way
that we can mimic those mice experiments and be able to
enable stem cells to be able to be healthier not just in the brain but in
the body as a whole and I hope you recognize that
therapeutic plasma exchange is really holds great promise for making a big
difference in changing the trajectory of neurodegeneration both early and late
and um and we want to be a service to you
and most of all I want to encourage you your body is designed to heal
is a great it’s a great thing to be aware of when you cut your hand it just
magically it just it just innately knows how to heal that space it turns on your
stem cells that are inside your tissue making new blood cells making new
um fibroblasts and connective tissue nerves have a mechanism by which they
can repair and
the body knows how to heal what our job is as Physicians I believe is not just
to diagnose and treat a disease and you suppress the symptoms and get some
relief in the short term but also to be very curious about that diagnosis to ask
why did that diagnosis occur where did it come from what what about that
knowledge could help us identify things we could do to change our future
so have hope uh have courage and enjoy every day that you have again there’s Dr David Haase with Maxwell Clinic I wish you well
