Abstract ID: 3367

Primary Topic: Clinical skills-building
Secondary Topic: State of the science/evidence base for integrative modalities

Cognitive Impairment and Alzheimer's Disease: Integrative Approaches to Prevention and Treatment
George C. Wang, MD, PhD; Mikhail Kogan, MD, , WASHINGTON, DC, United States

Late Breaker: No

Overview

Dementia is one of the greatest health care and social challenges in the 21st century. Alzheimer’s disease, accounting for 60-80% of dementia cases, affects more than 4 people in the U.S. and nearly 44 million globally. Current pharmacologic treatments do not halt or reverse the progression of dementia. In this session, we will first discuss the state of the science in understanding the pathogenetic mechanisms of cognitive impairment and Alzheimer’s disease, and risk factors for developing dementia. We will present a whole-person framework for understanding the complex mix of etiologies and perpetuating factors that underlie the temporal spectrum encompassing cognitive impairment and dementia. Through this framework, we will discuss integrative approaches to prevention and treatment. Case examples will illustrate the use of a systematic approach to successfully halt or reverse the progression of dementia. The session will conclude with an expert panel and interactive questions and answers with the audience. Three faculty presenters, comprising geriatricians and integrative medicine physicians from Johns Hopkins University and George Washington University with research and clinical expertise in the field, will foster an appreciation of the important roles that integrative health practitioners can play in addressing the global dementia challenge through prevention and whole-person therapeutic plans.

Rationale

Dementia is one of the greatest health care and social challenges in the 21st century. Alzheimer’s disease is responsible for 60-80% of cases of dementia. The estimated number of people with Alzheimer’s disease is more than 4 million in the United States and nearly 44 million worldwide. These numbers are projected to triple by 2050.

The annual cost of dementia care is estimated to be $150-$215 billion in the U.S., and $600 billion globally. The annual direct cost of dementia care has already exceeded those for heart disease and cancer.

Currently available pharmaceutical treatments do not address the underlying pathology and do not halt or reverse the progression of cognitive impairment in Alzheimer’s disease. Understanding Alzheimer’s disease through the pathophysiologic lens of amyloid beta protein and tau protein has not led to a successful therapeutic agent in humans. In fact, cognitive impairment and Alzheimer’s disease comprise a complex mix of etiologies and perpetuating factors and represent a temporal spectrum of pathological progression with opportunities for intervention and varying potential for reversal across time points. A whole-person approach is required for optimal treatment.

Objectives

1) Recall mechanisms of pathogenesis in cognitive impairment and Alzheimer’s disease

2) Recognize risk factors for developing cognitive impairment and dementia

3) Discuss integrative approaches to prevention of cognitive impairment and dementia

4) Outline a whole-person functional approach to the care, treatment, and reversal of cognitive impairment and Alzheimer’s disease

Methods/Session Format

The session will be organized into two presentations and will conclude with an interactive, question-and-answer, panel. Drs. George Wang and Mikhail Kogan will co-moderate.

1) “Cognitive impairment and Alzheimer's disease: pathogenesis and integrative approaches to prevention” will be a 25-minute, PowerPoint-driven presentation given by George C. Wang, MD, PhD.

Dr. Wang is a board-certified geriatrician and integrative medicine physician and is licensed to practice acupuncture. He cares for individuals with cognitive impairment and dementia across various care settings. Dr. Wang is Adjunct Assistant Professor of Medicine in the Division of Geriatric Medicine and Gerontology at the Johns Hopkins University School of Medicine, a former recipient of multiple National Institutes of Health grants, an alumnus T. Franklin Williams Research Scholar, and an alumnus scholar of the John A. Hartford Foundation’s Center of Excellence in Geriatric Medicine. He previously served as Medical Director of the Sussex County Department of Human Services’ Transitional Care Program and Director of the Center of Excellence in Geriatric Medicine, Newton Medical Center, Atlantic Health System in New Jersey. He will be joining the faculty in Cornell’s Integrative Health and Wellbeing Program.

2) “Whole-person approach to the care and treatment of persons with cognitive impairment and Alzheimer's disease: rationale and case examples” will be a 30-minute presentation given by Mikhail Kogan, MD, and will include short videos. Dr. Kogan will also present successful case examples of a whole-person approach to dementia care, resulting in halting of dementia progression or reversal of dementia. 

After completing a fellowship in Geriatrics at George Washington University, Dr. Kogan stayed as full-time faculty serving as Medical Director of the GW Center for Integrative Medicine and providing inpatient and outpatient geriatric consultations. In addition to Geriatrics and Internal Medicine training, Dr. Kogan has been involved in longitudinal osteopathic studies through The College of Osteopathic Medicine at Michigan State University. In 2011, Dr. Kogan founded GW Integrative track program within Geriatric and Palliative Medicine fellowship training. Dr. Kogan is the editor of Oxford University Press’s Integrative Geriatrics Textbook. In addition to serving as Associate Director of GW Geriatrics and Palliative Care fellowships, he has served as a founding Board Member of American Board of Integrative Medicine.

3) Interactive Q & A panel

Drs. Wang and Kogan will co-moderate a 20-minute interactive panel, taking questions from the audience. This panel discussion will offer further opportunities for appreciating the important roles that integrative health practitioners can play in addressing the global dementia challenge through prevention and effective therapies that understand the complex factors underlying the pathophysiologic spectrum encompassing cognitive impairment and dementia.

Outline

The session will be organized into two presentations and an interactive panel: 

1) Cognitive impairment and Alzheimer's disease: pathogenesis and integrative approaches to prevention

We will present the state of the science in the current understanding of the pathogenesis of cognitive impairment and Alzheimer’s disease. We will provide a brief history of the development of amyloid beta and tau protein hypothesis and biologic/pharmacologic interventions that have been developed.

We will discuss the epidemiology of cognitive impairment and dementia. Data from population studies that have identified risk factors for dementia will be summarized. We will present a whole-person framework for conceptualizing the pathogenesis of cognitive impairment and dementia and discuss integrative approaches to prevention. This framework serves as a crucial foundation for understanding the critical roles that primary care and integrative health practitioners can play in addressing the global challenge of dementia in the decades to come.

2) Whole-person approach to the care and treatment of persons with cognitive impairment and Alzheimer's disease: rationale and case examples

Cognitive impairment and Alzheimer’s disease comprise a complex mix of etiologies and perpetuating factors and represent a temporal spectrum of pathological progression with opportunities for intervention and varying potential for reversal across time points. A systematic, whole-person, functional approach is important in making the proper diagnosis and formulating an effective treatment plan. We will outline the rationale for such a whole-person approach, and will outline a systematic approach to uncovering the etiologies and perpetuating factors in these persons.

We will review Dr. Dale Bredesen’s work, including his 2014 and 2016 case series of 10 patients who had reversal of Alzheimer’s disease. Dr. Kogan will present a number of case examples from the GW memory clinic documenting reversal or arrest of Alzheimer’s disease progression. 

Additionally, we will present a framework for engaging the public, funding agencies, and academia in advancing the understanding and clinical practice of this treatment approach.