Hi, I'm Dr. David Goodman. I'm an assistant professor in the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins School of Medicine. I'm also a clinical associate professor at the State University of New York in upstate.
The Neuroscience Education Institute, NCI for brief, holds the annual conference and it's really focused on psychopharmacology, the latest developments, what the trends are. And one of the major trends now that's very exciting is the new GLP one drugs, glucagon-like- peptide. This was originally developed for the control of diabetes and insulin, but it appears that the insulin regulation has also an effect in the brain and on the inflammatory process in the brain.
So, the companies now are looking at this in a variety of psychiatric conditions, including depression, anxiety and Alzheimer's. And there was a recent meta-analysis for depression that showed the depressive symptoms associated with diabetes 2 are actually reduced when compared to other diabetic patients. And so, what's very exciting is that there's a new mechanism here that has not yet been revealed, but it appears that insulin control in the brain is actually fairly critical in its impact on psychiatric disorders.
One of the areas in adult ADHD that's interesting is looking at ADHD and older adults over the age of 50 who've never been diagnosed before.
This is actually a fairly large population of patients that isn't being looked at only until recently, perhaps in the last ten years, as the research developed both for neuroimaging, neuropsychological testing and clinical detection. What's particularly interesting, though, is we know there's an association between ADHD and the development of Alzheimer's. And I don't mean to scare people, but this is what is developing out of some of the genetic research and some of the clinical research. So, the complication here is, and I presented a case at NEI on this, is someone who has ADHD, never previously diagnosed at the age of 62 comes in complaining about a clinical decline in their ability over the last 2 or 3 years. Now we know ADHD doesn't get worse. So, the question is, how do you separate out ADHD cognitive symptoms from the development of another neurodegenerative process? And the case I presented was someone who had ADHD, never diagnosed, high functioning academic person who also then was diagnosed with early Alzheimer's based on biomarkers in the CSF. And so the question here is not only differential diagnosis of which cognitive difficulties get ascribed to each diagnosis, but what is the pharmacologic sequence? Do you treat the ADHD and have the person remain in their stimulant medication and then deal with the Alzheimer's with either the older Alzheimer's drugs or do you consider the new anti-amyloid medications? And so, this is a challenging field and these patients do exist. But the body of literature providing clinical guidance is almost none at all. So, I find this particularly exciting because if you can identify these patients with ADHD, you can treat the ADHD, improve the cognitive ability. While that won't have an effect on the other neurodegenerative process like Alzheimer's, it does increase the person's cognitive abilities such that they can maintain a level of functioning higher and longer for a period of time while the Alzheimer's gets further diagnosed and treated with the newer agents.
I think the science of detection of new mechanisms of action are important. We spent decades looking at pre- and post-synaptic receptors. Some of the newer agents are looking at cytoplasmic processing. There's a mTOR process that's involved as being targeted by medications on the market. So, it's the ongoing development of looking for new mechanisms of action. It wasn't too long ago where psychopharmacology kind of slowed down tremendously and a lot of the major pharmaceutical companies withdrew and shut down their psychiatric divisions because there weren't any new developments. But I think there's been a resurgence in the identification of new mechanisms of action. And that's going to be that's going to be exciting.
