In recent years, researchers are beginning to close some of the knowledge gaps preventing better treatments of Alzheimer disease and 

, Naahaad Mukadam, PhD, Division of Psychiatry, University College London, said there has been an increase in the understanding about how vascular risk factors increase the risk of developing dementia and Alzheimer disease, the main type of dementia.

Mukadam said while there is a better understanding on how the build up of different proteins ultimately leads to the disease, trials testing treatments to remove these proteins have not been fruitful.

With that said, Mukadam recently was part of a research team that added 3 risk factors to a list of 9 modifiable risk factors for dementia, which could help reduce the incidence rate of the disease.

The discovery might be coming at a time of critical mass as the population across the world is aging, leading to a concern that dementia could become a public health crisis.

Mukadam said while treatment trials have sputtered, there should be attention paid to identifying even more ways to reduce the risk of dementia.

"Dementia prevention, intervention, and care: 2020 report of the 

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A team of researchers have added 3 new modifiable risk factors to a list of 9 known factors that increase the risk of developing dementia.

Naahaad Mukadam, PhD: Addressing the Dementia Public Health Crisis

With the population aging, it might become increasingly important to mitigate some of the symptoms of 

Recently, a team of investigators from the University College London (UCL), released a new report summarizing preventative dementia care and what steps should be taken to truly reduce the amount of people diagnosed with dementia.

According to the report, the age-specific incidence of dementia is decreasing in many countries, likely due to improvements in education, nutrition, health care, and lifestyle changes. This lends credence to the belief that there are a number of modifiable risk factors that can reduce the risk of developing dementia.

There were already 9 known risk factors for dementia: less education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and low social contact.

The UCL researchers have added excessive alcohol consumption, traumatic brain injury, and air pollution to the list of modifiable risk factors for dementia.

The investigators believe the 12 risk factors account for approximately 40% of dementia cases around the world and should drive preventative measures to reduce dementia incidence.

, Naahaad Mukadam, PhD, Division of Psychiatry, University College London, explained how the report could yield some policy changes around the world and how dementia patients could be struggling during the ongoing coronavirus disease 2019 (COVID-19) pandemic.

"Dementia prevention, intervention, and care: 2020 report of the 

An expert in Alzheimer disease describes some of the struggles dementia patients might be going through during the COVID-19 pandemic.

Naahaad Mukadam, PhD: The Future of Dementia Care

It’s interesting because what we are seeing more and more with COVID is that being outside is one of the safest places to be—much safer than being inside with a lot of people. -Eugenia South, MD, MSHP, assistant professor of emergency medicine at the Perelman School of Medicine at the University of Pennsylvania

, South said it has been interesting to hear more people talking about spending more time outside and the positive effects it has had on their mental health, stress, and anxiety levels. It is extremely vital for us as a country right now to have a safe place to be outside.

Even for South, she can feel increased levels of stress or anxiety on days she is unable to spend a lot of time outside.

With the benefits of nature, especially now, it is necessary to realize not everyone has a suitable green space outside. There is a need for more green spaces, and health systems can and should invest in local green space in their community.

“It’s important to partner with the community, including Community Development Organizations who are on the ground and thinking about development in their neighbors and other community leaders to figure out what they want, where they want it, and what that looks like,” South said.

Greening, however, could look like gentrification, she added. And in communities undergoing such transformation, it might not be best to add the spaces to those areas, even though it should not be thought of as a tool for gentrification. Instead, there should be a focus on underserved populations and those who are far from gentrification who have worse health outcomes could benefit most from greening.

Being outside is safer than being inside with a lot of people.


Eugenia South, MD, MSHP: COVID-19 and Nature

 reaching the US, emergent medicines and equipment were quickly lacking. As much stress was put on social distancing parameters and protocol to expedite promising agents against the virus, there was an even greater call for often relied-upon resources.

Take, for example, blood. By March 17, the American Red Cross announced a severe blood shortage due to mass cancellation of donor drives. The situation highlighted a significant issue now unique to the COVID-19 pandemic: the virus affected non-patients as severely as it does infected persons.

Blood transfusions, a routinely critical facet of 

 care, were at risk of lacking their most precious commodity.

One way to combat the matter was emphasizing use of therapies that reduced the need for transfusions. Newest sickle cell disease therapy voxelotor (Oxbryta) fit that bill.

In the next segment of an interview with 

, Richard Drachtman, MD, clinical section chief of Pediatric Hematology/Oncology at Rutgers Medicine, discussed how the recently-approved agent came into benefit for prescribing early into the pandemic.

It’s already often the mindset of a hematologist to over-value donor blood. Once COVID-19 began to limit its availability further—especially in hard-hit areas including Drachtman’s New Brunswick, NJ—it became a responsibility to reduce the need for patient transfusions.

“Use of voxelotor has allowed me to do that,” Drachtman said. “In this time, it’s like ‘The Omega Man’ practicing medicine, driving to work in an empty town. It really has helped quite a bit.”

In Drachtman’s practice, patient volume has recently begun to increase. But transfusion need has remained low due to agents including voxelotor.

“It gives you one more option of being able to avoid transfusions in this one population of patients,” he said.

The pandemic has burdened blood drives nationally. A new sickle cell drug keeps patients from needing as many transfusions.

How Voxelotor Benefits the Blood Shortage

As nature becomes more seriously looked at as a social determinant of health and a factor that could positively impact a patient’s over well-being, the provider must know their role in how the process can be most beneficial.

While community workers can offer nature counseling and help assess whether particular neighborhoods have enough safe space and green areas, the involvement of the provider varies from practice to practice.

“At the very least, I think talking about nature as a brief part of the interaction with physicians and patients—just like talking about exercise, just like talking about smoking cessation—is important for setting the baseline and expectation that this is something important,” Eugenia South, MD, MSHP, an assistant professor of emergency medicine at the Perelman School of Medicine at the University of Pennsylvania, said in a recent interview with 

After that, patients can spend more time with someone like a community health worker. During any given well visit, it is important where this should be covered.

 has been leading the way in thinking about nature and its health benefits. South would like to see it talked about more in adults.

 it’s the most important place to start,” she said.

There are room in other specialties like 

Pediatrics is leading the way in prescribing nature.

Eugenia South, MD, MSHP: Nature and the Role of the Provider

At the beginning of July, the US Food and Drug Administration (FDA) accepted LEO Pharma’s Biologics License Application (BLA) for tralokinumab for the treatment of adults with moderate-to-severe 

With the acceptance, the agency will formally review the potential treatment. This means physicians and patients will have a second opportunity to treat the condition, likely by the second quarter of 2021, Kim Kjøller, MD, executive vice president of global research & development at LEO Pharma, said in a recent interview with 

Tralokinumab will be the second biologic for the treatment of atopic dermatitis, he said.

“For all of us that have worked in this field for many years, we also welcome more treatments into the play again because we do realize this is a very heterogeneous disease and we will be needing more opportunities to treat patients moving forward,” he said.

The next steps in the process is for the agency to go through all the data and in the months to come to provide clarifying questions to LEO Pharma about the production of tralokinumab and clinical data. Normally that takes 4-5 months until all the questions are answered. During that time, the FDA will also audit a number of the sites that participated in the clinical studies to make sure everything is safe and in order.

The FDA will be working over the next few months to ensure tralokinumab is efficient for atopic dermatitis.

Kim Kjoller, MD: BLA for Tralokinumab and the Next Steps

Kim Kjøller, MD: Comparing Tralokinumab to Other Agents for Atopic Dermatitis

In essence, it’s a little more targeted because it doesn’t touch the IL-4 receptor and you may have some benefits from that downstream. And importantly, it takes IL-13 completely out of the system. -Kim Kjøller, MD, said in a recent interview with 

Along with tralokinumab, other agents like dupilumab can be used for the treatment of moderate to severe 

Dupilumab is a fully human monoclonal antibody that works in a way that it targets the interleukin-4 (IL-4) receptor. By binding there, the cytokine can no longer hit the receptor or the IL-13 receptor to activate it. The biologic was approved by the US Food and Drug Administration (FDA) in 2017 for patients with atopic dermatitis.

Tralokinumab is an investigational biologic that specifically targets the cytokine so the IL-13 does not hit any receptors, which may be important. Speculatively, there are decoy receptors of which the nature is not fully understood by experts. But for tralokinumab to take out the cytokine, it means there will not be any activity through the decoy receptor.

“I think that’s probably the biggest difference between tralokinumab and dupilumab,” he said.

An expert explains differences between tralokinumab and other popular agents for atopic dermatitis.

Kim Kjoller, MD: Comparing Tralokinumab to Other Agents for Atopic Dermatitis

, current research is being challenged by leading organizations to apply more real-world data and truer patient outcomes to interpret next steps in clinical development. It’s been a decade-plus since real efforts have moved the needle on reduced VTE prevalence and burden, experts said.

But what may be necessary to drive it forward it is the advancement of screening—which is much closer to the precipice of real-world use.

, Maja Zaric, MD, interventional cardiologist and assistant professor at Zucker Medical School, discussed how proven tests including d-dimer diagnostics are underused by appropriate physicians.

She also discussed the upcoming blood sample-based tests, which should be more widely available before any new VTE preventive or symptom-treating therapies will be. Currently understood markers of disease do not help differentiate the specifics of VTE disease in individual patients—so improved care waits for improved diagnostics.

“The whole trend is actually going toward this individualized medicine,” Zaric explained. “I think one of the reasons the whole research intent has yielded as much as we hope so far is because it is so multifactorial. You truly have to take into specifics of genetic, environmental, or missing thrombophilia.”

A discussion on how thromboembolism research and care could benefit from progression in diagnostics.