In a recent episode of The HealthSpan Podcast, Dr. Robert Todd Hurst sat down with Dr. Jeremy Pruzin, a leading behavioral neurologist from Banner Alzheimer's Institute, to discuss Alzheimer’s disease and dementia prevention. Together, they explored the latest advancements in diagnostic blood tests that are revolutionizing our ability to detect Alzheimer’s early and implement proactive strategies.
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Keep reading to discover how these new diagnostic tests are transforming both the prevention and early detection of Alzheimer’s disease.
Understanding Dementia & Alzheimer’s Disease
Dementia is a broad term that describes a decline in cognitive function severe enough to interfere with a person's life. As Dr. Pruzin explains in the podcast, 'Any condition that affects the brain progressively and results in somebody not being able to do what they need to do in their everyday life is a dementia.'
Alzheimer’s disease is the most common form of dementia, distinguished by the presence of amyloid plaques and tau tangles in the brain. However, Dr. Pruzin notes, 'It's not just one thing, almost never.' A person with Alzheimer’s is very likely to have multiple underlying pathologies, making it difficult to pinpoint a specific cause.
For example, vascular health plays a critical role in cognitive function, and many cases of dementia involve some degree of vascular damage alongside typical Alzheimer’s pathology. Vascular dementia, one of the most common types of dementia, is caused by impaired blood flow to the brain, which can result from strokes, small vessel disease, or chronic conditions like high blood pressure and diabetes.
Conversely, damage to small blood vessels in the brain—caused by conditions like hypertension, atherosclerosis, and diabetes—can exacerbate cognitive decline by reducing oxygen and nutrient supply to neurons. Over time, these silent strokes and microvascular changes lower the brain’s resilience, making it more susceptible to the toxic effects of amyloid plaques and tau tangles.
This combination of mixed pathologies challenges the traditional way of categorizing dementias into separate conditions. Instead of thinking of Alzheimer’s and vascular dementia as distinct diseases, it’s more accurate to consider how vascular health plays a significant role in brain function.
Dr. Pruzin emphasizes, 'If somebody has many strokes, atherosclerosis, hardening of the small vessels—that's bad for the brain regardless. Then on top of that, if you have amyloid plaques, followed by tau tangles, you're sort of already at two hits.'
Ultimately, what affects the blood vessels affects the brain, reinforcing the need for proactive heart and brain health management. 'What's good for the heart is good for the brain,' Dr. Pruzin states. 'But in the dementia world, we like to say what's good for the brain is good for the heart.'
Traditional Early Detection & Risk Assessment
With advancements in medical research, early detection of dementia and Alzheimer’s disease is improving, offering individuals the opportunity to intervene before significant cognitive decline occurs.
One of the most common tools used is the Montreal Cognitive Assessment (MoCA), a publicly available test designed to evaluate memory, executive function, and spatial awareness. “It’s something I give to my mom every Christmas to see how she’s doing,” Dr. Pruzin jokes. “Actually, to be honest with you, it's the one that Trump took and talks about.”
Primary care doctors also use quick screening tests, such as the Mini-Cog, where patients are asked to remember three words and draw a clock. If an individual struggles with these tasks, it may indicate the need for further evaluation.
However, Dr. Pruzin emphasizes that these are just preliminary tools: “If anybody’s worried, getting an expert evaluation where more comprehensive testing can be done and trying to understand what’s normal and what’s not is really important these days.”
Another factor in dementia risk assessment is genetic testing, particularly for the APOE4 gene, which is associated with a higher likelihood of developing Alzheimer’s. Dr. Pruzin explains, “If you have one copy of this risk gene, you're about four times higher lifetime risk of developing dementia. If you have two copies, you're about 16 times higher.” However, he cautions that having the gene does not guarantee someone will develop the disease. “There are lots of people with two copies of the risk gene who never develop dementia.'
Because of the psychological impact of genetic testing, it is generally not recommended as a routine screening tool. “If someone gets this result and it just makes them worry for 20 years, that’s not a useful outcome,” Dr. Pruzin says. However, for individuals who are motivated to make lifestyle changes, knowing their genetic risk may provide an extra push to focus on brain health through diet, exercise, and medical management.
“You can have amyloid in your brain 10, 15, 20 years prior to the onset of symptoms. You can pass away at age 90 with completely normal cognition and a brain full of amyloid.”
Because amyloid accumulation does not always lead to dementia, testing could lead to unnecessary anxiety without actionable treatment options. “People want all this information, but the bigger question is, what are we gonna do with that information? How is it gonna help potentially? How is it gonna harm?” Dr. Pruzin asks.
For now, experts recommend holding off on amyloid testing in symptom-free individuals until more research determines its practical benefits.
When Should You Get Screened?
For those experiencing noticeable memory changes, early testing can be beneficial, particularly because new disease-modifying treatments are most effective in the earliest stages. Dr. Pruzin advises, “Don’t blow off symptoms if you start to experience them… The sooner one starts, the better.”
Ultimately, the decision to pursue screening, genetic testing, or blood testing should be made in consultation with a specialist. Each person’s risk factors, family history, and personal outlook should guide the decision-making process, ensuring that any testing provides value rather than unnecessary distress.
Take Control of Your Brain Health Today
Proactive steps can make a significant difference in managing your cognitive health. With expert guidance and advanced testing options, you can approach these concerns with confidence and clarity.
HealthspanMD is here to help. Schedule a consultation with us today to discuss our cutting-edge, three-pronged approach to healthcare. Let us work with you to develop a personalized plan to improve your physical health, your cognitive function, and your overall well-being.
Frequently Asked Questions
What are neurodegenerative diseases?
Neurodegenerative diseases are conditions that involve the progressive loss of structure or function of brain cells, leading to cognitive decline, memory issues, and other neurological symptoms. Common examples include Alzheimer's disease, Parkinson's disease, and ALS.
Can neurodegenerative diseases be prevented?
While there is no guaranteed way to prevent neurodegenerative diseases, certain lifestyle changes, including maintaining a healthy diet, exercising regularly, managing stress, and avoiding harmful habits like smoking, can lower the risk. Early detection and proactive management also play a critical role.
What types of testing are available for brain health?
There are a variety of tests available, ranging from cognitive assessments to advanced imaging and blood biomarkers. These tests can help identify early signs of neurodegeneration and provide guidance for personalized prevention strategies.
When should I consider testing for neurodegenerative diseases?
You may want to consider testing if you have a family history of neurodegenerative diseases, notice changes in your cognitive abilities, or simply want to be proactive about your brain health. Consulting a healthcare professional can help you decide if and when testing is right for you.
How can HealthspanMD help me with my brain health?
At HealthspanMD, we use a comprehensive, three-pronged approach that combines advanced testing, expert evaluations, and ongoing support. Our goal is to empower you with the tools and strategies needed to optimize your physical and cognitive health.
