KODY KISER: The statistics on Alzheimer's and dementia-inducing brain disease are often frightening to look at. And unlike research into cancer and heart disease, researchers have often been frustrated in their efforts to make progress in understanding these conditions. Dr. Peter Nelson of the University of Kentucky's Sanders-Brown Center on Aging has spent the last 15 years in the Commonwealth helping to lead the fight against Alzheimer's and dementia-inducing brain disease. Nelson says clinical trials are where we're going to make the difference in Alzheimer's disease and dementia research. And if people want to be involved in clinical trial research, this is the place to be.

Welcome to this episode of Behind the Blue. I'm Kody Kiser with UK Public Relations and Strategic Communications. On this episode, UK PR's Carl Nathe talks with Nelson about the work of the Sanders-Brown Center on Aging, the strategies involved in working with such a complex set of diseases, the personal experience that drives his efforts in this research, and more.

CARL NATHE: And we are pleased to be joined on this edition of the Behind the Blue podcast by Dr. Pete Nelson, who is both an MD and a PhD. And he works for the Sanders-Brown Center on Aging here at the University of Kentucky, doing research on all kinds of things related to dementia and Alzheimer's disease and so forth. First of all, Pete, tell us a little bit about your background. Where you came from originally, where you were educated, and how you came to be part of the UK family.

PETER NELSON: Thank you very much for having me here, first off. I appreciate it. It's great to talk to Big Blue Nation at all times. I was recruited here 15 years ago. And I was educated in Chicago, in Philadelphia. And I came here to be among the best, the best of Alzheimer's disease researchers. And so that's what I want to do. I want to be the very best in the world, and I came to where the best is.

The things that they have here, the resources they have for research in dementia and Alzheimer's disease, is unparalleled to anywhere else in the world. And I wanted to be the best of the best, and it's that simple. So 15 years ago I came here. I was humbled to see a enterprise that was built by Kentuckians, and I wanted to just join that tradition of excellence.

CARL NATHE: And when we talk about the Sanders-Brown Center and we talk about our work, we truly are world class. That isn't just a Public Relations person like me saying that. The stats bear it out. First of all, with continuous funding all through these years, the national funding.

PETER NELSON: True. It's not only that. I mean, it's right now you go to a meeting about Alzheimer's disease research in Berlin or Tokyo, anywhere around the world, and something comes up for the University of Kentucky and heads turn. It's something that I'm not bragging on myself, because it's the reason I was here in the first place. It was here before I got here, and I'm just joining in to be a part of a winning team. But it's an exceptional team of amazing researchers really moving the field forward. And I'll talk a little bit more about that, because I think it's worth really bragging on.

Clinical trials are where we're going to make the difference in Alzheimer's disease and dementia research. My colleagues-- this is not me because I do the autopsies and I'm a lab rat myself, basically-- but my colleagues, who do the clinical trials-- who do the most clinical trials of anybody in the country. More than Harvard, more than Stanford, more than UChicago-- the very best in the world.

So if people want to be involved in clinical trial research, this is the place they go. And the emphasis is on people that are at risk for Alzheimer's disease. Not people that are already demented, but trying to prevent the beginning of the disease in the first place. And that's where we're leading the world.

CARL NATHE: Why is this such a problem? Beyond the statistics, which are frightening, but dementia and Alzheimer's and we have people that are now living-- it used to be when I was a kid, boy, if a man lived to be 75 and a woman lived to be 78, that was pretty darn good. They were pretty lucky-- now we have people living into their 80s, their 90s. Well, with that, yes, they're still around, but sometimes they're not all there in terms of the brain function.

PETER NELSON: Well, Carl, you answered the question for yourself. You said why is it a big problem? And the problem is that people are getting to the age where they can try to enjoy their retirement, where they can enjoy their grandchildren, where they can enjoy a world where they're not huffing at the work, but guess what? As you get to that age, you're at risk for these dementia illnesses.

We've made progress in cancer, we've made progress in heart disease. These are the big killers. But we haven't yet-- it's been a frustration to make advancement in dementia research. And I think that that is the disease that's really going to get people as the population ages. And that is for real that the population is getting older, and we need desperately to develop cures and preventive strategies for dementia and Alzheimer's.

CARL NATHE: One of our colleagues in UK Public Relations and Strategic Communications, who covers the health care side, Hillary Smith authored an article recently that was on UKNow and got my attention. And basically, this is a project, if I understand right, you're working with colleagues at the University of Pennsylvania and UK, working on ways to differentiate between subtypes of dementia-inducing brain disease. For the lay person, what is this all about?

PETER NELSON: Well, what it turns out is that you're entitled to have more than one disease as you get old. You're entitled to have more than one disease in your lung, in your liver, but your brain is more complicated than all of them put together, and it turns out that it's complicated. In order to figure out cures, in order to figure out strategies to prevent dementia and Alzheimer's, we're going to have to grapple with a complexity and change it.

In other words, we've got to get people into the clinic, give them medicines that are designed in a way that incorporates the complexity of the brain changes in aging. And that's the key to making them better. We did that about 20 years ago in cancer. We started to really grapple with the complexity of cancer. Cancer or lung cancer. What lung cancer? There are 20 different lung cancers.

In order to get those better, we need to diagnose them during life, treat them tailored to the individual, and have those clinical trials. And so that is the key, is that it's a complex situation where there are more than one disease. It seems almost childish, but even 30 years ago amongst the experts, it was thought that if you have a demented illness, there's only one disease that you can have. It's called Alzheimer's disease. Well, guess what? It's totally not true. And a place that has been at the very cutting edge of changing that perception has been right here at the University of Kentucky.

CARL NATHE: You wanted to talk about and I wanted to talk about with you, we talk about football and basketball and recruiting is very, very important. Well, recruiting is also important in bringing top people. You yourself were recruited to come here 15 years ago. And you're involved, your team is involved in recruiting, because you want to have the best and the brightest working alongside of you.

PETER NELSON: I think that's something that people don't understand. They take it for granted that success follows talent. Talent is different. Coach Cal is different from other coaches. He has talent that other people don't have. You can put a finger up or you can't put a finger up, but it really gets down to his results that he's achieved. So people understand that for football recruiting, you got to get talent to win. For basketball recruiting, and you got to get talent to win. For thoroughbred horses, you got to get talent to win.

The same thing is for research. And so people don't really understand that the University of Kentucky has been at the forefront for dementia research precisely because they've been able to capture and retain abundant talent. Fantastic colleagues work with me. And so that enables me to get stuff done, which enables me to get more recruits. So we have this critical mass of extremely expert individuals here at the University of Kentucky to do dementia research. It's something every bit as special as the thoroughbred horses or the basketball or the bourbon or anything else, where we have been the very best in the world.

And I think that we have been great at telling people in Germany and Tokyo, but we haven't been so great at telling people in our very zip code, right here in the Bluegrass and in the adjoining mountains and everywhere else, that the people here should know that the dementia research here is the best in the world.

CARL NATHE: Very good. Well said. Now, as a follow-up to that, with research and bringing people here, while research can have great rewards in terms I'm not talking financial, but I'm talking about new discoveries. That's what it's all about. But yet it seems to me that the thing that you're involved with, dementia research, Alzheimer's research, related things to that, it's so complex and the progress might have to be measured-- I'm looking at my fingers-- maybe that the tip of my finger, that's progress. Then I move my thumb down the finger a little further, and a little more. But it's not like, oh, we do this and we've solved the problem. It's a complex. Takes a lot of patience and persistence.

PETER NELSON: It does, but on the other hand, we need to make really quantum leaps. And you had mentioned what brought me here and what my story is, and the key element of my story is that my mom's mother had dementia. Her name was Sylvia, and I loved her a great deal. And she went down the tubes with a horrible dementia illness that ripped my mom up.

And so I want to be able to give a medicine to my wife, to my mother, that will prevent that from happening. When that happens, we'll have a quantum leap. Until then, I'm frustrated and my life's goal has not been achieved. So that's what brings me here, to achieve that very quantum goal. Not coming down some finger, but giving a particular drug to people around the world that will enable them to prevent this destruction of their brain. And that's really the goal. It's not incremental, it's actually we're hoping for breakthrough, nothing less.

CARL NATHE: In a little while I'm going to be interviewing Dr. Lisa Cassis, who's Vice President for research here at the University of Kentucky. And one of the things in preparation for this interview I came across and for talking to her, is the fact that here in late September, we're about to go into phase three of our research-- I guess they call it research restart. Well, they really never stopped, but in terms of getting back to normal. What I'm talking about is with the COVID-19 pandemic, how has this impacted how you are able to get things done within the Sanders-Brown Center in terms of trials and in terms of just the whole general approach to your work? Has it changed?

PETER NELSON: Well, the very first basic tenet of research in general is first do no harm. So we have to make sure that it's safe. My clinician colleagues, Dr. Jicha and his colleagues at the Clinical Core of the Alzheimer's Disease Research Center, have been extremely careful. On the other hand, they've been very proactive in terms of starting the clinical trials enterprise again. Things have to be weighed very carefully, because we don't want to hurt anybody. On the other hand, dementia is a horrible disease, and I wouldn't wish it on anybody. We need to cure it.

So we've been very proactive and very careful about restarting even the COVID era. As you know, many of the care facilities around town have been impacted by COVID cases. And the very last thing we want to do is introduce anything to anybody. But on the other hand, we need to get back on track, and get it so that we can test the medicines that will ultimately prevent dementia.

CARL NATHE: Back to the news story that was written by Hillary Smith of our staff, and I know at the University of Kentucky sometimes and just in the science world, we can be big on acronyms. One acronym, and I'm not talking about the florist company now, FTD. Frontotemporal dementia. And then a common Alzheimer's mimic called L-A-T-E, LATE disease. So let's get a little bit more into these, because this goes back to what you're working on with this the fact of differentiating between subtypes of dementia that you're working on with your colleagues from the University of Pennsylvania.

PETER NELSON: Sure. Dementia basically just means that you're impaired in your ability to think, and you're impaired in your ability to perform the activities of daily living. That's a very not-specific clinical syndrome. And many different diseases underlie that syndrome. In order to be able to treat or prevent them, we're going to need to get a handle on differentiating them during life.

And so what we did, was we generated criteria to differentiate LATE versus FTD. And so for a lot of our listeners, it's going to be a not very important distinction. The important point is that this is a critical prerequisite to enable us to treat the diseases. And the disorder that we're calling LATE, and the implication is it affects late life. It's a late affecting in the spectrum of human aging. And it is very important. It affects up to half of people that are over age 85, and we're trying to prevent it.

We have the very first clinical trial in the world right here at the University Kentucky to prevent the development of dementia in old age that is called LATE that mimics the features of Alzheimer's disease in these very old people. And so anybody who's interested in that should check in with our Clinical Core folks, because this is the very first clinical trial in the world that is to address this very enormous public health problem.

CARL NATHE: I know I've had the privilege to interview several colleagues, including Dr. Jicha and others at Sanders-Brown over the years and--

PETER NELSON: My boss, Dr. Van Eldik.

CARL NATHE: Yes, Dr. Van Eldik.

PETER NELSON: She runs the show.

CARL NATHE: Exactly. And it's always very impressive, but I know you-- and you expressed it before-- but you couldn't do this without the people that are out in the community and out in the state that participate, that are willing to participate in these trials. And talk about that, and there's other ways that people can-- how can people, if they hear this-- and I can get the website. I can announce that. You don't have to get all the detail, but just this is something that you can, if you're so inclined, you can help these researchers. And people like yourself in this work, you could have a direct impact.

PETER NELSON: This place is the best in the world. The strength of it is not just in the experts that we recruit. The most important strength of it is in the enthusiastic research volunteers that have participated for over 30 years in this research group. So the research volunteers are the key. Our job is to help them, our job is to honor them. So everything that we do is towards respecting and honoring the people that are in our research group.

There's been all this talk about Black and White and Republican and Democrat. This is a disease that affects everybody. It affects every Whites and Blacks and Republican Democratic alike. Every single person is at risk for it if they get old enough. Around 2/3 of people are going to have the cognitive impairment as they age. This is something that has been the strength, is these research volunteers. And an ongoing effort to recruit them is very important.

The emphasis is not on impaired people, because that has already generated a lot of disease. The people that are important are people after age 70, 75, who are cognitively normal, but who are at risk for the disease. And that is the people that are our target audience. If you want to sign up, we definitely encourage you to. It's being a part of something special here in the Bluegrass that is oriented towards changing the world. And I think it's very inspirational for me that I get to fight every day the disease that affects my grandmother, and I hope that other people can share that passion.

CARL NATHE: One or two more questions before I let you go and that is, earlier on in the conversation, you said often you're involved with what they call autopsy, which in terms of there are ways that people can help, if you will, if I'm correct, with Sanders-Brown, even when you're not going to be around anymore. In other words, talk about that, because it's important to inform the research what has gone on in somebody who has passed away from Alzheimer's.

PETER NELSON: At this point, the clinicians, the doctors that ask you questions and do tests on you, can only really guess at the combination of diseases that are going on in your brain. It's at autopsy we figured out what this combination really and truly are. And that has really evolved over time, the complexity of what is happening. I perform the autopsies, and it's an amazing group that work with me at the Sanders-Brown Center on Aging. And the complexity of what you see in those brains is remarkable.

We have hundreds and hundreds of people have passed, come to autopsy. And we've collected a lot of data on them. Genetics, imaging, all the clinical information, all the medicines, all the comorbid diseases that are going on. And it enables us to make world beating new observations about dementia, which has changed the world.

CARL NATHE: Dr. Pete Nelson of the University of Kentucky Sanders-Brown Center on Aging has been our guest. I want to give you the last word. Any summary comment or something that you'd like to talk about that I haven't asked you about? Time for our conversation is coming to a close but here you go.

PETER NELSON: People in the Bluegrass are proud of our thoroughbred horses, about our basketball and football. We're proud of our bourbon. We're proud of things that we can do that are best in the world. Dementia research is best in the world right here in the Bluegrass. I'm not just saying it, and it was here before I got here. And this is the reason that I'm here. But people should participate and know about it, because it is a very important thing that is probably going to affect the world in a big way.

CARL NATHE: Thank you, Pete.

PETER NELSON: Thank you.

CARL NATHE: All right. And we will see you next time on the Behind the Blue podcast.