Exploring the connections between the microbiome and Alzheimer’s disease with Dr. George Grossberg
Release Date: 02/17/2021
The Psychcast goes on hiatus | Clinical Correlation
Psychcast
In this segment of Clinical Correlation, Dr. Renee Kohanski completes part 2 of her review of the most effective treatments for patients with severe anxiety. She also announces that, after almost 200 episodes, the Psychcast is taking an indefinite pause. To reach Dr. Kohanski, email her at . To reach Dr. Lorenzo Norris, host of the Psychcast, email him at lnorris@mfa.gwu.edu. Clinical Correlation was published every other Monday on the Psychcast feed. You can email the show at , and you can learn more about MDedge Psychiatry here: .
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Creative approaches to treatment during the COVID-19 pandemic with Dr. Craig Chepke
Psychcast
Craig Chepke, MD, speaks with Lorenzo Norris, MD, about changes he made to his practice during the COVID-19 pandemic, and plans to make some of those changes permanent. is a psychiatrist in Huntersville, N.C., and adjunct associate professor at Atrium Health and adjunct assistant professor at the University of North Carolina at Chapel Hill. He disclosed serving as a consultant and speaker for Otsuka and Janssen, and as a speaker for Alkermes. is associate dean of student affairs and administration at George Washington University, Washington. He has no disclosures. Take-home points Dr....
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Examining a model for intervening in gun-related violence in the US with Dr. Jack Rozel
Psychcast
John “Jack” Rozel, MD, MSL, returns to the Psychcast to talk with Lorenzo Norris, MD, about American gun violence and steps clinicians can take to disrupt it. is medical director of the resolve Crisis Network. He also serves as associate professor of psychiatry and adjunct professor of law at the University of Pittsburgh. Dr. Rozel is also past president of the American Association for Emergency Psychiatry. He has no disclosures. is associate dean of student affairs and administration at George Washington University, Washington. He has no disclosures. Take-home points Mass violence with...
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Crawling in my skin | Clinical Correlation
Psychcast
In the first part of a two-part series on anxiety disorder, Dr. Kohanski shares what may be some surprising facts information about prescribing of the tried-and-true agents of anxiety, along with some clinical pearls. Clinical Correlation is published every other Monday on the Psychcast feed. You can email the show at , and you can learn more about MDedge Psychiatry here: .
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Changing the culture in medical schools to meet the mental health needs of physicians, students, and residents with Dr. Omar Sultan Haque
Psychcast
Omar Sultan Haque, MD, PhD, talks with Lorenzo Norris, MD, about the need for medical schools to become responsive to physicians, medical students, and residents with mental disabilities. is a physician, social scientist, and philosopher who is affiliated with the department of global health and social medicine at Harvard Medical School, Boston. He disclosed founding Dignity Brain Health, a clinic that seeks to provide clinical care for patients struggling with major depressive disorder. Dr. Haque also serves as medical director of Dignity Brain Health. is associate dean of student affairs...
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Understanding Zoom fatigue and how to make videoconferencing less anxiety provoking with Dr. Géraldine Fauville
Psychcast
Géraldine Fauville, PhD, joins Lorenzo Norris, MD, to discuss some of the causes of Zoom fatigue and strategies that can make videoconferences productive. is the lead researcher on the Zoom Exhaustion & Fatigue Scale project. She also is assistant professor in the department of education, communication, and learning at the University of Gothenburg (Sweden). Dr. Fauville has no disclosures. is associate dean of student affairs and administration at George Washington University, Washington. He has no disclosures. Take-home points Dr. Fauville started her research on Zoom fatigue in the ...
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Patients can read our notes now? | Clinical Correlation
Psychcast
In this week's installment of Clinical Correlation, Renee Kohanski, MD, unpacks the new Open Notes mandate. Clinical Correlation is published every other Monday on the Psychcast feed. You can email the show at , and you can learn more about MDedge Psychiatry here: .
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Precision medicine and mental health: Implementing pharmacogenomics into your private or institutional practice with Dr. Vicki L. Ellingrod
Psychcast
Guest host Vicki L. Ellingrod, PharmD, talks with Kristen M. Ward, PharmD, and Amy Pasternak, PharmD, about integrating pharmacogenomic testing into psychiatric practice. is senior associate dean at the University of Michigan College of Pharmacy, Ann Arbor, and professor of psychiatry in the medical school. She is also section editor of the savvy psychopharmacology department in Current Psychiatry. Dr. Ellingrod has no relevant financial relationships to disclose. and are clinical assistant professors of pharmacy at the University of Michigan. Dr. Ward and Dr. Pasternak report no...
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Providing mental health services and fostering resilience in the wake of mass traumas such as the Jan. 6 Capitol siege
Psychcast
Lorenzo Norris, MD, speaks with Tonya Cross Hansel, PhD, about processing incidents such as the Jan. 6, 2021, siege on the Capitol, and determining how to foster recovery. is an associate professor with the Tulane University School of Social Work in New Orleans. She has no conflicts of interest. is associate dean of student affairs and administration at George Washington University, Washington. He has no disclosures. Take-home points Dr. Hansel’s research focuses on measuring traumatic experiences and implementing systematic recovery initiatives that address negative symptoms by...
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Spectrum vs. narcissism: An unlikely differential | Clinical Correlation
Psychcast
One wouldn't think autism spectrum disorder belonged in the same universe as narcissistic personality disorder. Yet sometimes emotional disconnection and seeming lack of empathy leads to miscommunication. There is one key difference, however. Clinical Correlation is published every other Monday on the Psychcast feed. You can email the show at , and you can learn more about MDedge Psychiatry here: .
info_outlineGeorge T. Grossberg, MD, conducts a Masterclass examining emerging treatment options for Alzheimer’s disease that are tied to the new research on the microbiome.
Dr. Grossberg is the Samuel W. Fordyce professor and director of geriatric psychiatry in the department of psychiatry and behavioral neuroscience at Saint Louis University.
He disclosed that he is a consultant for Acadia, Alkahest, Avanir, Axovant, Axsome Therapeutics, Biogen, BioXcel, Genentech, Karuna, Lundbeck, Novartis, Otsuka, Roche, and Takeda; receives research support from the National Institute on Aging, Janssen, and Genentech/Roche; performs safety monitoring for ANAVEX, EryDel, Intra-Cellular Therapies, Merck, and Newron; and serves on the data monitoring committee of ITI Therapeutics. Dr. Grossberg also serves on the speakers’ bureau of Acadia.
Take-home points
- Dr. Grossberg discusses burgeoning research about treatment of Alzheimer’s disease (AD) by altering the microbiota using diet and medications.
- The microbiome refers to the entirety of microorganisms that live throughout the body. Microbiota are those organisms that live within the gut. Dysbiosis refers to a microbial imbalance, which has been linked to numerous disorders, including inflammatory diseases, psychiatric illness, obesity, diabetes, and more recently, AD.
- The gut-brain axis describes the impact of microbiota and GI tract health on the brain. Periodontal disease, as a marker of inflammation and as part of the microbiome, is linked to AD.
- Increasing research into the role of the microbiome, inflammation, and AD has revealed promising treatments. Sodium oligomannate, a drug approved for mild to moderate AD in China, has been shown to slow the progression of AD by remodeling the microbiota and suppressing the production of specific amino acids that promote neuroinflammation.
Summary
- The microbiota has many purposes, including digestion, communication with the immune system, generation of signaling peptides, refining vitamins, and producing antioxidants. Many factors influence the microbiome, including diet, use of antibiotics, exposure to breast milk as an infant, stress, and old age.
- The gut microbiota can be altered by consuming “prebiotics,” which are food sources that influence the composition of the microbiota. These foods include fermented foods such as yogurt, kombucha, sauerkraut, and kimchi. The Mediterranean diet also has good sources of prebiotics.
- Birthing method (C-section versus vaginal birth) also influences the microbiota; a recent study shows that an infant’s microbiota after C-section can be altered by giving them an early fecal transplantation from the mother.
- As further proof of the link between periodontal disease and AD, a recent study identified the presence of Porphyromonas gingivalis, a bacteria that causes gum disease, in the brain in close proximity to the tau tangles of AD. Gingipain, the toxin secreted by this bacteria, is found in high concentrations in brains of individuals with AD.
- Dr. Grossberg reviewed his “recipe” for AD prevention and treatment:
- Recommend adequate activity in four spheres: Physical, mental, social, and spiritual.
- Treat and control all cardiovascular risk factors, including smoking, obesity, diabetes, hypertension, and hyperlipidemia.
- Recommend good oral hygiene based on the increasing research about the link of periodontal disease and AD.
- Recommend dietary changes, including a prebiotic or probiotic, and the Mediterranean diet. Dietary changes may also include supplements such as curcumin, B-complex multivitamin, and vitamin E.
- Control exposure to air pollution as possible.
- Use a combination pharmacotherapy of an N-methyl-D-aspartate antagonist and a cholinesterase inhibitor for individuals with AD.
References
Jones ML et al. Gut Microbes. 2014 Jul 1;5(4):446-57.
Askarova S et al. Front Cell Infect Microbiol. 2020;10:104.
Beydoun MA et al. J Alzheimers Dis. 2020;75(1):157-72.
Wang X et al. Cell Res. 2019 Oct;29(10):787-803.
Korpela K et al. Cell. 2020 Oct 15;183(2):324-34.
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Show notes by Jacqueline Posada, MD, associate producer of the Psychcast; assistant clinical professor in the department of psychiatry and behavioral sciences at George Washington University, Washington; and staff physician at George Washington Medical Faculty Associates, also in Washington. Dr. Posada has no conflicts of interest.
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