Veterans are at a higher risk for Alzheimer’s disease than the general population. A new clinical trial is looking at the effect prescription fish oil has on brain health in veterans and will determine whether the supplement could be used as an effective prevention treatment for the disease. Guest: Cynthia Carlsson, MD, MS, geriatrician, William S. Middleton Memorial Veterans Hospital, and investigator, Wisconsin Alzheimer’s Disease Research Center
Subscribe to this podcast through iTunes, Spotify, Podbean, Stitcher, or Google Play Music.
Transcript
Intro: Welcome to Dementia Matters, a podcast created by the Wisconsin Alzheimer's Disease Research Center. It's our goal to humanize Alzheimer's research so that our community, our patients, our participants at anyone else interested, can get a better understanding of the work that's happening to fight back against this disease. My name is Nathaniel Chin, and I'm a geriatric and memory clinic physician at the University of Wisconsin. I'm also the family member of someone living with dementia. I'll be serving as your host for this podcast and asking the questions I believe on the minds of many in our community. Thanks for joining us.
Chin: Today, I have Dr. Cynthia Carlsson, a geriatrician at the William S. Middleton VA Hospital in Madison, Wisconsin, where she treats veterans with dementia. As an associate professor of medicine at the University of Wisconsin School of Medicine and Public Health, Dr. Carlson conducts research, looking at the effectiveness of medications used to treat and delay the onset of Alzheimer's disease. I'd like to welcome Dr. Carlsson and thank you for joining us today on Dementia Matters. So Dr. Carlson, why Alzheimer's disease?
Carlsson: My interest in Alzheimer's started when I was in junior high. My grandmother developed Alzheimer's disease and at the time, watching my grandfather take care of her, watching the struggle she went through, trying to remember things that were second nature to her, trying to remember words. Seeing those struggles really hit me hard and made me realize how much I wanted to work to help older adults stay active and healthy and functional later in life. So it was then that I chose to do geriatrics and Alzheimer's research.
Chin: And you do more than that. So you were personally affected and you see people in clinic, you were taking care of people with dementia, but you're also in the research world.
Carlsson: Yes.
Chin: And so what exactly do you do in the research world?
Carlsson: In the research world, it compliments what I do in the clinical world. So in the clinical world I'm seeing people who already have memory complaints, have some concerns, and we address those and try to make sure there's nothing contributing. Help protect their memory. In the research world, I try to work with their adult children and try to help prevent Alzheimer's through research.
Chin: And what specific type of research do you do?
Carlsson: I do research chiefly with clinical trials. So trying different medications to see if they'll affect brain health. So we look at different markers that tell us how healthy someone's brain is and if they're at risk for getting Alzheimer's disease.
Chin: And so clinical trials are different than some of the other research that's happening at the ADRC?
Carlsson: Right.
Chin: You are in essence looking at interventions.
Carlsson: Yes.
Chin: And so you will conduct studies that potentially could help the person?
Carlsson: Yes. So the types of research, there's a lot of types of research that are important. So we need to know what happens over time without interventions, but then obviously we want to make sure we know what happens with interventions. So we need to study by giving people either a medication or an intervention like exercise or some other behavioral intervention, a cognitive exercise, etc. to see if that'll make a difference in someone's risk for developing a disease.
Chin: Okay. And it sounds like you have a relatively new study that you're conducting and it's called the BRAVE-EPA study and that's being done, I believe, at the VA Hospital.
Carlsson: Yes.
Chin: Could you explain this study?
Carlsson: Sure. So the BRAVE-EPA study stands for brain amyloid and vascular effects and EPA is a type of fish oil. So this study looks at whether a certain type of prescription fish oil could help protect brain blood flow and reduce the amount of changes in the brain called amyloid to help protect someone against Alzheimer's disease.
Chin: And so this again is a clinical trial. So it's an intervention and you are using a prescription form of fish oil?
Carlsson: Yes. So this study's been done in veterans. So veterans who are 50 to 75, who have a parent with Alzheimer's. So having a parent increases our risk of getting the disease. But these participants have normal memory and thinking functions. But what we're trying to do is to see if the fish oil helps protect or improve their blood flow to the brain, reduce this damaging protein called amyloid, and then help protect their thinking abilities over the period of the study.
Chin: How will you assess the goals of the study?
Carlsson: So what we plan on doing is to compare people who are on the therapy, so on the EPA fish oil compared to those who were on the placebo, which is just a mineral oil tablet, before and after 18 months of therapy. And so they take these two gel caps twice a day for this study and then at baseline in the midway through this study, and at the end of 18 months we try to see do those fish oil capsules help lower that damaging protein in the brain called amyloid? Did it improve blood flow compared to baseline? But also compared to the group that was just on the placebo pill. And if it does look like this is helpful for these things, then we'd go on to a larger study where you follow people for longer and see really if they have a lower rate of developing Alzheimer's down the road.
Chin: So if successful, there will be future studies that will stem from this.
Carlsson: Yes. If this is successful, we'll aim to do larger scale clinical trials. It will be longer in duration.
Chin: Okay. And so I imagine people will be having scans of their brain.
Carlsson: Yeah. So they'll have MRI scans, a procedure called a lumbar puncture, or more commonly known as a spinal tap, to look at the spinal fluid tests and then thinking tests or cognitive tests.
Chin: So in talking about the BRAVE-EPA study, why are you focusing on the veteran population?
Carlsson: Veterans in general, and even more so, veterans who are eligible for VA care, actually have higher rates of high blood pressure, cholesterol, depression, post traumatic stress disorder and traumatic brain injury. And those things together increase individuals' risks for getting Alzheimer's disease. There's not as much research done in veterans, but yet they're probably at a higher risk of getting Alzheimer's. So we really wanted to partner with the VA, and again I've served as a clinician in the VA system for over 10 years. We really wanted to see if we could find a therapy that worked in our veteran population.
Chin: That's excellent. And it's really nice to know considering our VA was one of the first centers to be considered dementia friendly.
Carlsson: Yes.
Chin: And that fits perfectly with your intervention specifically for veterans.
Carlsson: Yes. We're thrilled to be able to partner in this research capacity as well as helping it be a community-based dementia friendly community and to be able to serve veterans in the clinical setting.
Chin: And so for people who can't be in the study, should they take fish oil?
Carlsson: There's a lot of good evidence that fish oil may have some benefits for cardiovascular health and brain health. So there are some people who need to be on them to help protect their cholesterol levels because fish oil helps reduce a certain type of blood fat called triglycerides. So some people are on it for heart protection, other people are on it for brain protection, but we don't know yet fully if it does protect against Alzheimer's.
Chin: Are there any side effects that people should be aware of if they are taking fish oil?
Carlsson: If they take fish oil, they should check with their doctor because it could have some blood thinning effects and if someone's on a blood thinner for other conditions, they should check with their doctor to make sure it's not going to interact.
Chin: And for people who don't like pills in general, and there are those people in our community, can our food provide the equivalent treatments of official oil supplement?
Carlsson: Our food can and some of the studies show that actually getting sources like fish oil and natural foods like the fish themselves maybe even more beneficial than taking a supplement. So a lot of studies looking at vitamin E and vitamin C encourage us to say, well, let's actually just eat a good healthy diet with lots of fruits, vegetables, fish, whole grains. So yes, people who don't like taking pills, eating lots of salmon, usually more of the freshwater caught fish with the oily fish like salmon, mackerel, those can help probably at least protect their heart if not protect their brain as well.
Chin: Well, I think that will be good news for a good percentage of people who prefer food as medicine or pills. And do you eat fish on a weekly basis?
Carlsson: I love fish. I'm not good at cooking it, so I don't eat it on a weekly basis. But living in the Midwest it's harder to get good fresh salmon, but I would recommend people if they enjoy fish and are good at cooking it, to go for it.
Chin: That sounds excellent. Well thank you again for joining us on Dementia Matters. We hope to have you back at a later time.
Carlsson: Thank you.
Credits: Dementia Matters is brought to you by the Wisconsin Alzheimer's Disease Research Center. The Wisconsin Alzheimer's Disease Research Center combines academic, clinical, and research expertise from the University of Wisconsin School of Medicine and Public Health, and the Geriatric Research, Education and Clinical Center of the William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin. It receives funding from private, university, state, and national sources, including a grant from the National Institutes of Health for Alzheimer's Disease Centers. This episode was produced by Rebecca Wasieleski and recorded and edited by Alex Wehrli. Our musical jingle is "Cases to Rest" by Blue Dot Sessions. Check out our website at adrc.wisc.edu. You can also follow us on Twitter and Facebook. If you have any questions or comments, email us at dementiamatters@medicine.wisc.edu. Thanks for listening.
