A new Alzheimer's drug costs $26,500 a year, needs an IV infusion every two weeks plus repeated MRIs, can cause bleeding in the brain — and slows decline by less than half a point on an 18-point scale. If a cardiologist pitched those numbers, they'd be laughed out of the room. So why did neurology say yes?
We take apart the anti-amyloid story, then build the evidence-based playbook for protecting an aging brain — the stuff that actually works, and is mostly free.
In this episode:• The real trial math behind lecanemab (Leqembi): a 0.45-point change on an 18-point scale, ~13% brain swelling and ~17% microhemorrhage (rising to 39% in people who carry two copies of APOE4) — and why a daily blood thinner takes the drug off the table for many older patients• Why the 30-year, roughly $75-billion "amyloid hypothesis" may have been chasing smoke — what the genetically engineered mouse got wrong, what autopsies (mixed pathology) show, and the Nun Study's "super-agers" with plaque-filled brains and razor-sharp memories• What does work: aerobic exercise growing the hippocampus through BDNF; strength training and the brain's insulin connection; the honest MIND-diet reality check; social purpose (the Baltimore Experience Corps); hearing aids; and the FINGER and U.S. POINTER trials• The geriatrician's playbook: deprescribing, hunting for reversible causes, and using the older drugs (like donepezil) with eyes open• Separating the evidence-backed "ingredients" from the marketed "package" — a fair look at the Bredesen protocol
Hosted with Marc Arenas, MD.
—This episode is part of an educational series for the general public. The content is AI-generated and reviewed by a physician before release. It is intended for a general audience as educational discussion only. This is not CME-accredited and does not confer continuing-education credit. Nothing in this episode is individual medical advice, nor a substitute for independent clinical judgment, current guidelines, or the care of a qualified professional for any specific patient. Clinicians remain responsible for verifying all dosing, recommendations, and evidence against primary sources before applying them in practice.