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Brain Health
4 Min Read
Last Updated: 28.06.23

Kellyann Niotis: Neurodegenerative Disease — Pathology, Screening, and Prevention

Attia presents Kellyann Niotis, a neurologist specializing in neurodegenerative disorders. Kellyann provides an overview of diseases like Alzheimer’s, Parkinson’s, and Lewy body dementia. She discusses pathology, early signs, anxiety’s role, and sleep in Parkinson’s disease. Kellyann covers Alzheimer’s screening, genetics, prevention tools/​​strategies, and emphasizes the significance of early screening and risk reduction.

Key Takeaways

High level takeaways from the episode.

Neurodegenerative diseases: third leading cause of death

  • Includes Alzheimer’s disease, vascular dementia, Lewy body dementia, frontotemporal dementia, Parkinson’s disease, Huntington’s disease, ALS, progressive supranuclear palsy, multiple system atrophy, and corticobasal degeneration

Frontotemporal dementia and vascular dementia: primarily affects the frontal lobe, responsible for executive functions like planning, problem-​​solving, and speed of processing.

Alzheimer’s disease: affects the temporal lobe, responsible for memory and language.

Lewy body dementia: affects the parietal and occipital lobes, responsible for visual-​​spatial processing, depth perception, and hallucinations.

Visual impairment is a risk factor for neurodegenerative diseases

  • Visual processing is needed to reinforce neuronal circuitry
  • Sensory input and stimulation are necessary to maintain neuronal circuits

Intranasal insulin injections temporarily alleviate some symptoms of dementia.

Improving serum biomarkers like high apob can lead to improved speed of processing in patients.

Parkinson’s disease affects dopamine-​​producing brain cells

  • Dopamine is necessary for movement and mood regulation

Possible causes of cell loss in Parkinson’s disease:

  • Immune system and inflammation
  • Mitochondria and lysosome function
  • Impaired autophagy

Genetic models for Parkinson’s disease:

  • GBA gene: glucose cerebrosidase enzyme gets stuck in the endoplasmic reticulum
  • Buildup of chemicals triggers inflammatory cytokines and a vicious cycle

Causative triggers of Parkinson’s disease:

  • Pesticide exposure
  • Solvent exposure

REM Sleep Behavior Disorder: acting out dreams (punching, kicking, moving) during sleep

  • Over 90% positive predictive value for developing Parkinson’s or Lewy body-​​like disease
  • Diagnosis can be made through polysomnography or by asking if a bed partner notices excessive movement during sleep

Higher prevalence of Parkinson’s Disease in rural areas in the US

  • Epidemiological studies show a “Parkinson’s Disease belt” in the Midwest
  • USDA and FDA do not acknowledge the connection between pesticides and Parkinson’s Disease

10% of Parkinson’s Disease cases have a clear genetic etiology

  • GBA and LRRK2 are common genes associated with Parkinson’s Disease
  • Genetic understanding of Parkinson’s Disease is far behind that of Alzheimer’s Disease

Assessing abnormal movement patterns, and reinforcing neglected movements can help address early warning signs of Parkinson’s.

Knowing about disrupted REM sleep can be helpful, especially for Parkinson’s patients

  • Melatonin signaling pathway is off in Parkinson’s disease
  • Lightbox therapy can help regulate melatonin signaling and improve REM sleep

Neurodegenerative diseases share underlying mechanisms, such as neuroinflammation and autophagy problems.

At least 6 million people in the United States have Alzheimer’s disease.

Sleep is a powerful tool to clear amyloid.

Percivity test: a serum biomarker for amyloid

  • Shows amyloid beta 40 to 42 ratio
  • Encompasses someone’s APOE status
  • Provides an amyloid probability score
  • 80–81% accuracy at predicting a positive amyloid scan

Tau 217: a new biomarker for research purposes

  • Looking at ratios of phosphorylated to non-​​phosphorylated ptau to 17
  • Increases accuracy to around 90% for amyloid scans

Association between hearing loss and all forms of dementia

  • Causative relationship implies treating hearing loss reduces dementia risk

Oral Health and Alzheimer’s

  • Certain red complex pathogens associated with higher risk of amyloid deposition, tau deposition, and inflammation
  • High colonization of these bacteria in the mouth increases peripheral inflammation

Poor oral hygiene and dental implants, root canals, and external hardware in the mouth can contribute to bacterial colonization -> higher risk of amyloid deposition, tau deposition, and inflammation

  • Flossing, water picks, and interproximal brushes can help remove bacteria

APOE4 gene increases the risk of Alzheimer’s and related neurodegenerative diseases

  • APOE4 is not the sole determinant of risk; genes are not destiny

APOC1 and TOMM40: tightly associated with APOE4, can swing the balance of risk

  • Clotho (Klotho): offers a protective role against APOE4, affects the rate of cognitive decline 
    • Heterozygous individuals with one protective variant (KL-​​VS) have a more optimistic prognosis
    • Whole genome sequencing required to identify this variant

Future developments in AI and CRISPR technology could streamline the identification and potential modification of Alzheimer’s risk genes.

Mitochondrial haplotype: not a gene, but a classification based on variants in mitochondrial DNA

  • Mitochondria have their own genome, related to energy production
  • Over 4000 mitochondrial haplotypes exist

Mitochondrial haplotypes can indicate risk for Alzheimer’s and Parkinson’s

  • Haplotype H increases risk, especially for APOE4 carriers
  • Haplotype K seems protective, especially for APOE4 carriers

Knowing haplotype can help tailor preventative strategies

  • Example: if mitochondria are inefficient energy producers, focus on increasing mitochondrial density through exercise

Exercise increases BDNF (brain-​​derived neurotrophic factor), which protects and grows new brain cells, especially in memory centers

  • Lower blood pressure (e.g., 120/​​70) is better for cognitive outcomes

Alzheimer’s disease affects women two to one compared to men

  • Hormone reduction, such as estrogen and testosterone, may contribute to this disparity

Lewy body and Parkinson’s disease affect men two to one compared to women

  • The exact reason for this disparity is unclear, but hormones may play a role
  • Diversifying cognitive experiences and managing vascular risk factors can help optimize brain health


Addressing Early Warning Signs of Parkinson’s Disease


Cognitive Testing for Neurodegenerative Disorders


Oral Health for Alzheimer’s



We recommend using this distillation as a supplemental resource to the source material.

  • Kellyann Niotis: Neurodegenerative disease: pathology, screening, and prevention

    Attia The Drive #236

    Attia presents Kellyann Niotis, a neurologist specializing in neurodegenerative disorders, discussing diseases like Alzheimer’s and Parkinson’s, their pathology, early signs, and prevention strategies.

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