Episode 85 - Dementia and Evusheld - a podcast by Rio Bravo Family Medicine Residency Program

Episode 85: Detecting Dementia and Evusheld®. 

Parneeta Singh explained a new blood test to predict Alzheimer’s disease and an artificial-intelligence cognitive test for early detection of dementia. Dr Saito and Dr Arreaza present Evusheld, a monoclonal antibody for pre-exposure prophylaxis against COVID-19.  

Today is March 4, 2022. Today marks the 2-year anniversary of our podcast. We have been bringing you relevant clinical information for 2 years, almost every week. We hope you have found this podcast useful. If you have learned at least one thing from us, our goal has been reached. This podcast started as an experiment and it has become an enriching experience for students, residents, faculty, and all of you who listen to us throughout the world. We look forward to many more years of education, updates, and fun! Thanks for listening.

Introduction: Innovative ways to detect dementia: Alzosure Predict® and CognICA® 
By Parneeta Singh, MD, Ross University School of Medicine; comments by Hector Arreaza, MD.   

Alzheimer’s disease (AD) is a neurocognitive disorder that is the most common cause of dementia. More than 6 million Americans aged 65 and older have the late-onset subtype while many more between ages 30 and 60s have the early-onset subtype although the latter is very rare. 

One of the first signs of AD is memory issues. A decline in other aspects of thinking, impaired judgment or reasoning, visual/spatial problems can also indicate early stages of AD. Mild cognitive impairment (MCI) can also be considered an early sign of AD. However, not everyone with MCI will develop the disease. As the disease progresses, people with AD have trouble performing daily activities such as cooking, driving, managing their finances while some have personality changes as well. 

According to the Alzheimer’s Association, two abnormal structures called plaques (deposits of a protein fragment called beta-amyloid that builds up between neurons) and tangles (twisted fibers of another protein called tau that builds up inside neurons) are most probably responsible for the damaging effects seen in AD. Patients with AD develop plaques and tangles initially in parts of the brain involved in memory, such as the entorhinal cortex and hippocampus, before affecting other parts of the brain such as the cerebral cortex which is responsible for reasoning, social behavior, and language. 

Today, AD is at the forefront of biomedical research with earlier diagnoses and interventions improving drastically. New research conducted by Diadem (a diagnostic company that focuses on AD research) exhibited that a novel blood test called Alzosure Predict® identifies a variant of the protein p53 which seems to predict AD’s progression up to 6 years before a clinical diagnosis is made. 

This blood test measures a derivative of p53 (U-p53AZ) which is implicated in AD pathogenesis. Blood samples from patients aged 60 years and older who had different levels of cognitive function were analyzed which showed that the test predicted a decline from MCI to AD at the end of 6 years. The test can also classify a patient’s cognition stage. The positive predictive value (PPV) and negative predictive value (NPV) were at 90%. Knowing which patients will progress to AD allows them to try treatments earlier on the disease when therapies are most likely to be more effective. 

Additionally, using the test could speed up the approval of prospective drug treatments and allow those patients with a likelihood of developing AD to enroll in clinical studies. Patients can also be monitored during a study instead of relying on costly PET scans and painful lumbar punctures. These findings were presented at the 14th Clinical Trials on Alzheimer's Disease (CTAD) conference in November 2021.

Another way to detect dementia early on is by an artificial intelligence cognitive assessment called Cognetivity's Integrated Cognitive Assessment (CognICA®) which has been cleared by the US Food and Drug Administration in October 2021. It is a 5-minute computerized cognitive assessment that is completed using an iPad. It has numerous advantages over traditional pen and paper-based cognitive tests such as avoidance of cultural or educational bias, absence of learning effect upon repeat testing, its high sensitivity to detect early-stage cognitive impairment, and since it is computer-based, it can be self-administered and performed remotely. 

In conclusion, reliable, simple, cost-effective measures of cognition are critical for providing quality care whether it is in the field of family medicine, neurology, or geriatrics. According to Percy Griffin, Ph.D., MSc, director of scientific engagement at the Alzheimer's Association, the ability of such technologies to detect dementia before significant loss of brain cells “would be game-changing” for individuals, their families, and the healthcare system at large. 

This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it’s sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. 

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Evusheld. 

Written by Brandy Truong, MS4, Ross University School of Medicine. Edited by Hector Arreaza, MD. Collaboration: Steven Saito, MD.

This monoclonal antibody is for pre-exposure prophylaxis (PrEP) of COVID-19, which means it is given prior to exposure to the virus. Evusheld is not a replacement for COVID-19 vaccines, and everyone eligible to receive one of the safe and effective COVID-19 vaccines should do so.

It is meant to give protection to those who are unable to mount an adequate immune response against COVID 19 after vaccination. It was given an emergency authorization use by FDA on December 8, 2021. EVUSHELD is tixagevimab co-packaged with cilgavimab, two long-acting antibodies. This medication may be effective for pre-exposure prevention up to six months.

It was designed to be given to the immunocompromised population and for anyone who cannot receive the vaccine, as long as the patient is older than 12 years and more than 88 pounds.  (We totally make the cut). If your patient has a health condition that won’t allow their immune system to develop a strong enough response to the COVID-19 vaccine, for example, they are immunocompromised because of cancer, they can receive Evusheld. 

If they are taking medications that prevent a strong enough response to the COVID-19 vaccine, for example, chemotherapy or transplant anti-rejection medications, they can receive Evusheld.

If they are unable to get the vaccine due to anaphylaxis to all of the COVID-19 vaccines or their ingredients, they can receive Evusheld.

Monoclonal antibodies are lab-made proteins that mimic the immune system’s way of fighting off infections. The two antibodies in Evusheld are long-acting and are made to specifically fight off against SARS-CoV-2. Evusheld is administered by two injections immediately given one after another.

In a recent study done looking at how effective Evusheld was, it showed a 77% reduced risk of developing COVID-19 compared to individuals who received placebo. This study was a randomized, double-blind, placebo-controlled trial in adults older than 59 years old or with a prespecified chronic medical condition or at increased risk for COVID-19 and for other reasons didn’t receive the vaccine and have no prior history of COVID-19. 

Some side effects of the medication include hypersensitivity reactions, bleeding at injection site, headache, fatigue, and cough. 

If you would like to provide this monoclonal antibody Evusheld to your patients, as well as other treatments such as Paxlovid, Molnupiravir, sotrovimab, and bebtelovimab, consult the COVID-19 Therapeutics Locator provided by the office of the Assistant Secretary for Preparedness & Response. You can do a Google search for HHS COVID-19 Therapeutics locator or you can find the link in the notes of this episode. [https://covid-19-therapeutics-locator-dhhs.hub.arcgis.com/]

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Now we conclude our episode number 85 “Detecting Dementia and Evusheld” You listened to Dr Singh present some new promising ways to recognize Alzheimer’s disease early and detect those who are at risk of progression. We are all hoping for a simple way to diagnose Alzheimer’s, and in the near future, we may have a blood test that can help us diagnose this devastating disease. Also, you heard about Evusheld, the new monoclonal antibody given Emergency Use Authorization by FDA for pre-exposure prophylaxis for COVID-19. Consult the Therapeutics Locator to see the availability in your area. Even without trying, every night you go to bed being a little wiser.

Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created for educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Parneeta Singh, Brandy Truong, and Steven Saito. Audio edition: Suraj Amrutia. See you next week! 

 

References:

Alzheimer’s Association: What is Alzheimer’s Disease? https://www.alz.org/alzheimers-dementia/what-is-alzheimers, accessed on 30 December 2021. 

 

National Institute of Aging: What is Alzheimer’s Disease? https://www.nia.nih.gov/health/what-alzheimers-disease, accessed on December 30, 2021. 

 

New Blood Test May Detect Preclinical Alzheimer's Years in Advance, https://www.medscape.com/viewarticle/963509?uac=242448MJ&faf=1&sso=true&impID=3825884&src=WNL_trdalrt_211126_MSCPEDIT#vp_1, accessed on 30 December, 2021.

 

FDA Clears 5-Minute Test for Early Dementia, https://www.medscape.com/viewarticle/961277?uac=242448MJ&faf=1&sso=true&impID=3729166&src=wnl_newsalrt_211020_MSCPEDIT, accessed on 30 December, 2021.

 

Cognetivity Neurosciences, https://cognetivity.com/cognica/, accessed on December 30, 2021. 

 

Evusheld Antibody Treatment for COVID-19 High-risk Groups, South Carolina Department of Health and Environmental Control, December 8, 2021, https://scdhec.gov/covid19/monoclonal-antibodies/evusheld-antibody-treatment-covid-19-high-risk-groups.

 

HHS Therapeutics Locator, office of the Assistant Secretary for Preparedness & Response,  https://covid-19-therapeutics-locator-dhhs.hub.arcgis.com/

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