Why There’s More Hope for Alzheimer’s – Chasing Life with Dr. Sanjay Gupta

There are nearly 7 million Americans living with Alzheimer’s disease. Chances are you probably know someone who’s been affected by it. It’s the most common neurodegenerative condition in the world. I’ve been reporting on this for more than two decades, and any progress in the field has seemed incremental at best, leaving most patients and their loved ones with few options. But in the process of filming a recent documentary called The Last Alzheimer’s Patient, I saw some incredible signs of hope. Meeting people all across the country who had been diagnosed with or at high risk of the disease. And I saw Alzheimer’s slowed, prevented and, yes, even sometimes reversed. Importantly, it wasn’t always about new, expensive or experimental drugs, but lifestyle changes instead. I know it’s hard to believe. So I think you just need to hear it for yourself. Here’s part one of my documentary, The Last Alzheimer’s Patient.

I could use a strong cup of coffee.

This is Cici Zerbe and her husband John, back in 2019.

When you come see Grandma

Cici is best described as the matriarch of a huge tight knit family.

Over her 80 years on Earth, she has created a rich life filled with love and lasting memories.

But in early 2018, her family began to notice something had changed.

She would forget things. Couldn’t remember what we were supposed to be doing. And it slowly got worse until she would repeat herself about three times.

What did I drive you crazy about so much?

At first, she didn’t believe us that she had it. No, that’s no big deal. Just repeat myself once in awhile. Who cares?

John being the kindest husband in the world, He said, to you, do you do your part yourself a lot? But there is something more too. He said, Let’s just go see a doctor.

A neurologist diagnosed Cici with mild cognitive impairment and dementia due to Alzheimer’s. And scans soon confirmed the worst. Her brain showed signs of the disease. Now, Cici was no stranger to Alzheimer’s. She had had loved ones she watched wither away slowly from it.

My grandmother. She would sit for ever and just twiddle her that and stare into space and wouldn’t talk too much.

Her mother. They finally put her in a home because her father couldn’t take care of her. My greatest fears were that she would end up like her mother and grandmother where I couldn’t take care of her.

It was a hard word to hear: Alzheimer’s. It hit really deep. You know you don’t want to lose your grandma.

The worst part was seeing my mom being uncomfortable going to parties and not being herself. The person that we love and not be confident in herself like she was.

When the doctor told you and you got your cognitive testing, how did they tell you?

Well, I had an office visit to get all the results of the tests. And he said, well, there is a memory problem, but I have the best place for you. And that was here in Sausalito.

And that’s where I first met Cici and John five years ago. I’ve made my way to Sausalito, California. I’m going to spend time here with this world renowned doctor who believes he’s figured out a way not just to prevent Alzheimer’s, but to reverse it.

When people get diagnosed with Alzheimer’s, it’s a progressively isolating experience.

In 1990, Dr. Dean Ornish changed the medical world with his groundbreaking work on heart disease. His randomized clinical trial was the first to show that coronary heart disease could be reversed with nothing more than stress reduction, social support, diet and exercise.

Part of the value of science is to increase awareness.

While Ornish’s approach has sometimes been criticized for being too strict, not practical enough. Some others have pointed out a lack of research showing that plant based diets could definitively decrease disease. But Ornish turns to his decades of work as proof.

You really can eat more and weigh less if you know what to eat.

That what is good for the heart is almost certainly good for the brain.

These same lifestyle changes could reverse high blood pressure, high cholesterol, Type two diabetes. Obesity. Early stage prostate cancer can be slowed, stopped, even reversed. And now we’re hoping to show that these same lifestyle changes may reverse the progression of early stage Alzheimer’s.

Five years ago, in the early stages of the study, do you remember what you’re experiencing before your diagnosis?

I couldn’t formulate words.

I spent some time with patients and their support partners for their four hour long three day a week meetings.

And I got a really detailed look at the Ornish Lifestyle Intervention program:the exercise, he yoga and the meditation regimen, socially sitting in on their support groups and eating the provided plant based meals. What do you tell the participants in the tribe?

What we tell them that we don’t know if this is going to work, but we hope that it does. If you’re trying to give people the message that you can reverse something, that you need to have really solid science from randomized trials before doing that.

It all matters. Preserving, even restoring the memories of a life well lived.

That no matter what happens, if I don’t get better, just know that somewhere deep down outside my brain, I will always love him.

After the break, Dr. Ornish is ready to release his findings. It seems like a lifetime has passed since I first met Dr. Dean Ornish in Sausalito, California. It was five years ago, but since then, a global pandemic shut down the world, drove up loneliness, drove up disconnection. But in 2024, we finally got word that Dr. Ornish was ready to release his findings to us. Five years ago, one of the things that you were trying to figure out is could those lifestyle changes in some people actually lead to a reversal of Alzheimer’s disease?

What’s the answer?

The answer is in many people it did.

I mean, it’s extraordinary in reversing something that seems so preordained. It’s fixed. This is my life now. It sounds extraordinary.

It is the first randomized controlled clinical trial showing that some Alzheimer’s patients could experience cognitive improvement in just five months, with intensive lifestyle changes alone. .

And importantly, those who did not make any changes in the trial worsened.

So the more you change, the more you improve. But to get reversal, you have to make really big changes.

Which again, the big change is we’re talking about a vegan diet.

Yeah. And it’s not just a vegan diet. You know, Twinkies are vegan. You know, it’s a healthy vegan diet. It’s fruits, vegetables, whole grains, legumes, soy products as close to possible as they come in nature.

Half an hour to an hour of moderate or brisk activity or three times a week. And groups support. And there was yoga slash meditation. You could do it in a secular way or you could do it however you wanted to do it.

For an hour a day, for an hour. It’s a big commitment.

A big commitment, but also doable. She did it and now I wanted to see how she was doing. It has been five years since she first joined that study. How are you?

I’m good. I’m better. Yes, I’m.

Good to see you.

Same here in five years. I can’t believe it.

How have you been?

I’ve been great. I’ve been fine. I live with this man who has the patience of a saint. And that helps. That helps.

Cici is doing very well. She goes out in the morning, she’ll go for a walk almost every morning. She was for a walk. I think she’s doing very well. Does it surprise you?

Yes. After seeing her mother and grandmother? Yes. Because I was certain by this time she’d have been at home or something.

How are you doing now? Do you think, as compared to five years ago?

Much better. Much better.

Did this help reverse some of the symptoms of Alzheimer’s?

I guess the question is why? Right. What do you attribute this to?

The program. The meditation, The diet. The exercise. My choice of a meal. Before this was a breaded veal cutlet. I haven’t had 1 in 5 years.

And there is this other crucial element. Got to have a partner. John did every step of the program right alongside Cici. The food was a little bit hard to get used to.

I miss my biscuits and gravy. Just doing without for now.

Cici is now 85 years old. John 92.

For Cici, she was initially randomly assigned to the comparison group of our study, so she didn’t make changes for the first 20 weeks and she got worse and then she crossed over, got the program. Since then, she’s shown improvement in three of the four tests and no change in one of them.

So for the first 20 weeks, she was sort of living her life and everything worsened.

It also shows you how dynamic these biological mechanisms are in both directions. You can get better quickly and get worse quickly.

Okay. And really good. I got to say, this is a good looking family here. I had a chance to sit down with a few members of the Zerbe family. Cici’s done well.

We’re including their daughters, Frannie and Alisha. Alisha, I don’t want to overstate the impact of this or understated. I want to be just really fair about this for people who may be dealing with this. How would you describe the impact that this program has had on Cici?

Tremendous. It’s really helped. It’s, I think, slowed it down. It’s just amazing, in my opinion. I mean, how many people five years into dementia get to go outside and go for a walk by themselves every day? Not very many. Take a moment to gather your awareness in this body, in this moment.

Cici I remember when we spoke back in 2019, you were very clear with me that one of your greatest fears was going through the same thing you had seen with your mom and your grandma. Do you still fear that?

No. I think I passed that a long time ago.

That’s kind of incredible.

So we’ve made our way to Miami now. By the year 2050, it is expected that more than 152 million people around the world will be diagnosed with Alzheimer’s. It’s part of the urgency of these researchers and why they’re working so hard and so fast to try and get things done. That vital work is happening at places like the University of Miami, Miller School of Medicine. So every brain that we’re seeing here, we inhabit or have these brains at one point had Alzheimer’s disease.

Is that right? That’s correct. The majority of these brains. Yes.

You know, the most amazing thing is when I was in medical school in the early 1990s, the conventional wisdom was you got a certain number of brain cells and that was it. Over your life you could drain the cash. Things like alcohol might speed up that process. But you got what you got. By the time I finished in the year 2000, everything had changed. We realized that you could continue to grow new brain cells, which was kind of incredible.

Our goal is to make sure that we get high quality donations that could be used by investigators all around the world.

Dr. David Davis is the associate director of the Brain Endowment Bank.

All in the cause of better understanding the progression of the disease and potentially, hopefully finding therapies and cures.

I started training in neurosurgery 30 years ago, and still every time I look at the human brain, I am still filled with honor. Everything we are is located right here. Every love, every memory. Every desire. All here in this enigmatic three and a half pounds of tissue.

Are you able to remember my name, for example?

What you are watching is from 1966. Fact is, we’ve been talking about Alzheimer’s disease for a long time now. The first known case of the disease was reported in 1906. But before the early 2000s, there was only one way to be sure someone actually had the disease or not. The only way.

To definitively diagnose the disease is by an autopsy after death.

So we’ve come a long way since then. We can now peer into the brain when the patient is very much alive.

These are Pet scans that pick up the two proteins in the brain that define Alzheimer’s disease amyloid and tell the redness indicates that the amyloid protein is present. So that’s the protein that makes up the plaque, one of the defining features.

Dr. Ronald Petersen is director of the Mayo Clinic Alzheimer’s Disease Research Center.

The amyloid protein that gets laid down in the brain, this can happen up to ten, 15, 20 years before a person becomes symptomatic. So many people are out there walking around with some amyloid in the brain, but they’re doing fine clinically.

Connie Grumdahl is one of those people. Lots of amyloid in the brain, but zero symptoms.

So I know that I do have plaque in my brain. I don’t understand how that affects some people and not others. Nice to meet you as well.

We first met Connie at Dr. Peterson’s clinic five years ago in 2019. And at the time, 69 year old Connie was halfway through a highly anticipated Alzheimer’s study called the A4 trial. It was designed for those with plaque in their brains, but so far living a normal life.

So I’m one of 19 children. Wow. Number 18.

Okay.

And three of my sisters have died. I have two in memory care. So it’s personal.

Hi. Hello. How are you? You look so beautiful today. You have a lot of pictures from today.

We listen in on an extraordinary visit to the memory care ward.

Connie has come to see her sister, Vera, who is 12 years older.

Again in a family of 19 children.

This is what you wrote a long time ago for your doctorate. When you read this, I put it in here. Yep. This is all your work? Yes, yes, yes.

Vera was once a trailblazing psychology professor at the University of Minnesota. A loving mother. Grandmother. About seven years ago, though, her memory started to fade and the decline was steep.

One night, she left the house in the middle of the night, and we didn’t find her until noon the next day. Today with Vera? It was one of the most special days that I’ve had in a long time with her. Looking at my family history. My brothers are fine. My sisters are not. But some of my sisters are. Will I be a lucky one? I don’t know.

Those confusing unanswered questions are what fuel, Connie, and what fuels the scientists who are caring for her?

In 2019, she was midway through the four and a half year study to try and prevent what she had seen happen to her older sister.

Even during the pandemic, Connie would drive more than an hour each way from her home in Minneapolis to the Mayo Clinic in Rochester, Minnesota. She would undergo cognitive, motor, and general health testing.

And almost every month, she would receive this IV transfusion.

So this is, what, about an hour? It’s time consuming. I feel like I’m contributing, even if it’s not for me. It’s for research. And it might help my kids, might help my grandkids or the greater good.

When you’re dealing with people who get enrolled in a clinical trial, it’s important to really be realistic. Say, we’re hopeful that the drug that you may receive is going to help us with treating this underlying disease. But there’s a possibility it could go in the other direction.

You either agree to that risk or you don’t. I don’t have an alternative right now. I love you.

In September 2022, Vera passed away after her long battle with Alzheimer’s. Then in 2023, news came after a decade of research. After tracking more than 1100 study participants.

I’m Dr. Risa Sperling and the principal investigator of the A4 study.

The long awaited results were finally in.

We did not, unfortunately, slow the cognitive decline with this particular antibody.

Disappointing findings for patients like Connie, who is now 74 years old.

The fourth study. It turned out that the approach is right. The drug was not the right one.

Lessons learned that laid the foundation for newer drugs like one you may have heard of Lecanimab

A potential breakthrough this morning for millions of Americans affected by Alzheimer’s. A new antibody treatment for the disease could slow the progression of cognitive decline by 27%.

There has not been a significant treatment that has had this degree of improvement in these patients really in a long time. If ever. Lecanimab or Leqembi is part of a new class of drugs called monoclonal antibodies. They are given every other week. A similar drug, Donanemab, is administered monthly and is expected to be approved by the FDA later in 2024. Let me show you how they work. Remember beta amyloid? That’s the sticky compound of protein fragments that can accumulate in the brain and can clump together to form amyloid plaques, disrupting cellular communication and eventually cause neuronal death. Well, these new drugs stimulate the immune system to attack some of the building blocks of these amyloid proteins and eventually break up the plaques. But it is important to note that there are potential side effects.

Some of those adverse events were side effects in a small percentage of the Larkana, Mab group, including brain swelling and brain bleeding.

It’s not a home run, but there’s been so little progress when it comes to Alzheimer’s. This incremental progress is important.

Look at them have slowed the rate of progression by about 27%.

27%. It’s enough for someone like 73 year old Barbara

So are you ready for this year?

Alongside her husband, Jim, she is here for her second Alzheimer’s treatment with Lecanamab.

I never thought this would happen to me. Let’s go.

She’ll be coming here every other week for the next eight months.

Both retired teachers. She and Jim read to one another to pass the time.

Kate sat by the fire pit, the flames lighting up her face. Well, I hope to see that my memory is steadfast and everything is in place.

So far, there are approximately 2000 people using the drug in the United States. And it’s not cheap. This price for the medication is $26,500 per year. But Medicare does often cover a good portion of it.

This is the number one priority. So, you know, if we have to sell the place or the house or whatever we have to do if this is a priority. We don’t expect that that’s going to happen. But we do what we’re going to do.

Their teachers. So no surprise, they’ve studied all the data, all the papers, and they know the odds. But here’s the thing. They’re looking for more time to spend together. And a chance for more scientific breakthroughs, maybe even a cure.

If, in fact, you can continue pushing this back. Right. Right. That maybe who knows that maybe that will be opened and you and others can be better.

One update This July, the U.S. Food and Drug Administration did approve Donanemab. Its a monoclonal antibody drug designed to slow the progression of early symptomatic Alzheimer’s disease. I want to be clear this is not a cure, but clinical trials did find that it could slow the progression of Alzheimer’s, which could allow people to live independent lives for longer and also safely participate in everyday activities. I’ll be back next week with part two of the last Alzheimer’s Patient. And as you’ll hear, it gets pretty personal. But first, I’d like to take one of your questions for our segment On Call, and we’ll do that right after the break. Geeta from Houston wants to know can daily mental exercises such as words with friends or crossword puzzles reduce your odds of getting dementia? Well, Geeta, I hate to break this to you because however enjoyable they may be, brain training games like word puzzles and crosswords mostly help improve your ability to be better at word puzzles, games and crosswords. You just get really good at doing that activity over and over again. But they don’t necessarily build up your cognitive reserves or protect you against Alzheimer’s. What does seem to help is doing brand new activities, preferably ones outside your comfort zone. Also, movement is probably the most effective way to grow new brain cells. Think brisk walks, for example. Even better, if you can do it with a friend. So this may sound counterintuitive, but at the end of the day, pick a brisk walk with a friend over a crossword puzzle to get the biggest bang for your brain. I hope that helps. Geeta Thanks for your question. Chasing Life is a production of CNN Audio. Our podcast is produced by Eryn Matheson, Jennifer Lai, Grace Walker and Jesse Remedios. Andrea Kane is our medical writer. Our senior producer is Dan Bloom. Amanda Sealey is our showrunner. Dan Dzula is our technical director and the executive producer of CNN Audio is Steve Lickteig. With support from Jamus Andress, John Dianora, Haley Thomas, Alex Mannessari, Robert Mathers, Lainey Steinert, Nicole Pessaru and Lisa Namaro. Special thanks to Ben Tinker and Nadia Kunang of CNN Health and Katie Hinman.