Episode Transcript

Trevor: Kirk. We're back.

Kirk: Hey, Trevor. How's it going?

Trevor: Good.

Kirk: So? So we're going to talk about dementia.

Trevor: Yes.

Kirk: I really enjoyed this conversation. Introduce this gentleman.

Trevor: All right. Apologies. I'm getting better at his name, but I still don't know if I have it right. Laszlo Mechtler, he is a neurologist. Yeah, he's many other things. He is a professor of neurology and oncology at Suny Buffalo. He is a chief of neuro oncology at a hospital called Roswell Park. And sort of the most relevant to our conversation. He is the chief medical officer at the Dent Institute for the last 35 ish years. And, they are the largest private neuroscience center in the US. And some numbers you were even throwing to me before we went out there. 13,000 neurological patients per day. In Canada, we just don't have anything even remotely of the scale. Well, we don't have big private clinics, and we certainly don't have anything remotely on the scale of the Dent Clinic.

Kirk: Yeah, yeah.

Trevor: Dent institute.

Kirk: It's quite interesting. I, I found, I found he's also a doctor who got pushed into cannabis.

Trevor: Neurologist. Yeah

Kirk: Neurologist but he got pushed into cannabis because his patients wanted to know about cannabis. And wasn't it that it wasn't that New York had legalized cannabis, medical cannabis. And within a day, he started getting phone calls?

Trevor: Yeah, I think the number of the sticks out for me was something like they were getting 500 calls a day. So, I guess we got to do something about this. And, private medicine, love it or hate it, they didn't have to go through a whole bunch of, you know, rigamarole to pivot. They just said, all right, people seem to be interested in that there medical cannabis let's do something. And that's, you know, a private clinic. They they can do that.

Kirk: Yeah. And essentially, they pivoted overnight. And one day they're not doing cannabis, one day they are. And he's a individual who is skeptical about cannabis and stumbles his way into the cannabis field. And now presenting at a CannMed about the stuff that he has discovered through his research in cannabis. Yeah. Trevor:, this is a very short conversation. You fit a lot of stuff into this conversation.

Trevor: I was going to say short, but whether you want to call it dense or efficient, Doctor Laszlo covered a lot of ground in a short amount of time. So you might have to listen to this one a few times. But yes, he's got a lot to say. And, he gets it through. Gets through it very succinctly.

Kirk: Yeah, yeah. So let's, let's hit it and, come out and discuss what we what we got us.

Trevor: Absolutely. Here's doctor Laszlo Mechtler. So Trevor: Shewfelt CannMed24 we actually have one of our the keynote speakers here, Doctor Laszlo Mechtler.  I'm going to I'm going to get you to say your name properly. So we get on there and we're going to talk about, cannabinoids and dementia and Alzheimer's. Doctor Mechtler, I'll get you to introduce yourself with your full name first.

Dr. Laszlo Mechtler: Hi. My name is Laszlo Mechtler. I'm a professor of neurology and oncology at Suny at Buffalo. Chief of neuropsychology at a cancer hospital called Roswell Park. And my position in regard to cannabis research is that I'm the chief medical officer of the Dent Neurologic Institute. The Dent Institute is the largest private neuroscience center in the United States. To give you a feel for the size, we see it 1300 patients every day in the neurosciences. Wow. So by far, we the largest. It's a private institute. I'm proud to say I'm the director of that institute. And we pride ourselves that not only are we private, we do 102 clinical studies, a year at the institute, mostly with pharmaceutical companies. But at times we do work with, regulatory bodies such as the NIH NCI . But most of our research is drug based research in the field of neurology and psychiatry.

Trevor: That is very impressive. Now, the talk I went to of yours this morning, we can't redo the whole thing here. But can you tell us a little bit about cannabinoids, neuro protection and what good things might happen if we get the right cannabinoids in to someone with early dementia?

Dr. Laszlo Mechtler: So, dementia is country countries is going to be an epidemic as the population of the country, not just the United States in the world is getting older. We're living longer, and we're a healthier 75-year-olds than we were ever in history. So right now in the United States, there's about 6 million patients with Alzheimer's disease. We have about 12,000 patients with MCI, mild cognitive impairment. What that means the difference between the two is in Alzheimer's disease, you have cognitive dysfunction that affects your quality of life. In MCI, you may have some short-term memory difficulties, but it hasn't affected your daily life. You still driving? You may still go to work, but MCI, unfortunate, can develop into Alzheimer's disease. So the first step is when we see a patient with cognitive decline to rule out reversible dementias. Depression, tumors, vasculitis, strokes, and you go through B12 deficiency. That's the first step. They're called reversible dementias, which are potentially treatable. After you have, after you ruled reversible dementia, then you focus on 70% of dementias today are Alzheimer's disease. Now Alzheimer's disease diagnosis has changed over the last ten, 15 years. Initially it was neuro-psychometric testing, which is intense testing over several hours to evaluate parts of the brain. MRI in the past it was CT, but now MRI is more sensitive. Looking for specific defects in the brain. For example, in Alzheimer's you have hippocampal amygdala or medial temporal lobe atrophy, as well as parietal lobe atrophy.

Trevor: Okay.

Dr. Laszlo Mechtler: That's pretty specific for Alzheimer's disease. Now, not every dementia is Alzheimer's disease. For example, frontal lobe dementia, a frontal temporal lobe dementia used to be called Pick's disease that has, superior temporal frontal lobe attributes, a little bit different region. So MRI is very useful to rule out secondary diseases. Also very helpful to diagnose primary degenerative disorders such as Alzheimer's disease. The next step is to do, you can do this, Medicare and the insurance companies don't like it. It's expensive. Is do PET scanning. In the past used to be fluorodesoxyglucose FDG, PET scanning to look at abnormal uptake of sugar within the temporal lobe and parietal lobe. Classic for Alzheimer's disease. We have amyloid PET right now. Amyloid PET is expensive, but it's doable to see if there is amyloid deposition because Alois Alzheimer at the turn of the previous century was a psychiatrist as well as a pathologist. And he developed he wrote an article actually called, Presenile Dementia, a 68-year-old, and they found, beta amyloid plaque, neurofibrillary tangles, and these this is the classic abnormality. Now, I have to tell you that if you do a biopsy or have a autopsy on the 85 year old, the chances that they have pathology similar to that is very common. I would say about 40-50%.  The problem is how severe is the degree of changes pathologically. And number two, the location. Where is it located?  But we don't do pathology. Let's be fair. That's only if somebody has a car accident and or medical legal reasons. But rarely we do autopsies on patients with Alzheimer's disease. So how else? Now you can check, this is something new, spinal fluid. Look for, tau, or look for amyloid, beta amyloid. So you could do that also. So how do you diagnose Alzheimer's? Clinical history? Neuropsychiatric testing, MRI, potentially PET and potentially spinal fluid. Now you have the diagnosis. And the question is, the problem is, in patients who are overtly demented, overtly. There's not much you can do somebody with moderate to severe dementia. So you have to catch it early. You have to catch it on the MCI level as it gets into mild. Now 15, 20 years ago we had acetylcholinesterase inhibitors. We used them for years. Did we see major results? No. It was the only thing we had. These are medications, such as the Donepezil, Aricept or Namenda. And so we still have those drugs and may be worthwhile using it at the earliest stages. Now we have these new drugs that have come out. Biogen had recently drug pulled from the market because the results weren't overly encouraging. But we do have 1 or 2 and about four in the pipeline. These are monoclonal antibodies against amyloid beta. And so, which is senile plaques, but they have complications, plus 35% of them have swelling in the brain, area edema. And, and, percentage of them have bleeds, micro bleeds.

Trevor: Which is not good.

Dr. Laszlo Mechtler: Not major bleeds but micro bleeds so further. So in people on these drugs they have to have MRI's regularly. So that's, that's basically the diagnosis and treatment. We're still a long way from having cures. Now cannabis the problem with patients with dementias who are admitted to nursing homes when they're agitated or sundowning, they're put on really strong medications such as, major tranquilizers, antipsychotics.

Trevor: yeah, Seroquel Risperidone

Dr. Laszlo Mechtler: Exactly. And you know what? After they put on those drugs, their lifespan decreases significantly. So morbidity and mortality is increased with these drugs. It's a way to basically, it's a little bit like hospice care. You put them on seroquel and and they won't last that long. And so cannabis and we did this study at the Dent, we we saw about 185 patients. But after reviewing we had about 118 patients that received cannabis. This was a 20 to 1. About half of them would receive 20 to 1, and the other one received 1 to 1 ratio of THC to CBD. And we noticed that first thing, the pain associated with dementias, which is a lot of them are just lying around. And decreased significantly statistically, as did anxiety, as better sleep. So we feel that the quality of life issues have improved with the use of cannabis. Now, this is not a prospective study. It's just a retrospective study. And we've done a lot of these studies because right now in our cannabis clinic, we have 13,500 patients actively receiving medical marijuana. So it's a large clinic. We treat a lot of disorders in the field of neurology. Mostly, 70% of them is chronic pain. But we see MS, Parkinson's. Alzheimer's. In fact, we've published on all those groups and geriatric population of patients. 103 are still receiving cannabis. So so my story, journey in cannabis started when New York state approved cannabis and I run the largest neurological center and initial indications for cannabis, nine of them were neurological. So I had no choice because we were receiving over 500 phone calls on a daily basis. And after three days, it would have broke the bank because everybody was fixated on do you use cannabis use? So really, overnight, because we're a private institute, we didn't have, you know, we didn't have to turn to a CEO of a hospital or Dean of a university. We just started the cannabis clinic without any experience or knowledge. So the next step after that was that we just built our population of patients. And then with experience, I mean, how did doctors know what to do while they read the literature.  But 100 years ago there was no literature. So they used it by seeing human beings come back and go, and here's this comeback. So it's just experience. So I learned cannabis use just by seeing patients. So I started off very much, and I'll admit this, a skeptic. I had no experience in cannabis. I wasn't a user. In fact, I don't even drink alcohol or smoke. I'm a very boring human being, as you can tell. So I went from a skeptic to an advocate. Why am I not an advocate? I'm an advocate because I'm patients come in and hug you and say you changed my life. I say, that happens once. I'm okay with that. Well, hundreds of people come back and they and so it really impressed me that there is something there that we haven't catch that we can really scientifically figure out because it's a Schedule One Drug, which is ridiculous as you know, and hopefully they'll descheduled it so we can do prospective studies, randomized studies. And we have to find the right compound. And we have to realize that there's that Entourage Effect, which means that maybe it's not just THC, but maybe the combination of THC with the Terpenes and throwing the flavonoids. We have to find that right combination for the right disorder, and we need to do randomized studies.

Trevor: Doctor Mechtler that was fantastic. Thank you very much.

Dr. Laszlo Mechtler: My pleasure.

So what are the other numbers that you liked, was or commented on was 102 clinical studies per year. Now, whether you like it or hate it, and I know you have your feelings, most of them are funded by big pharma companies, big drug companies, which make sense. They fund most medical research in North America, probably around the world. Some through the NIH, the National Institutes of Health and other regulatory bodies. That's a lot of clinical research.

Kirk: That's a lot of clinical research, you know. Again, I come from a Canadian system where a lot of research is funded by universities, funded by government. So in those situations, usually you have to go through an ethical review before you get the funding or the approval to do the studies. There's so many questions I'd like to ask the fellow about, about the research. And, you know, what is the process of doing research in a private, a private, I guess, for profit, research center doing research for pharmaceutical companies that are obviously for profit. So I mean that. So I'm a little suspect on on how they get their ethics or how they get their ethics approved or how their studies going. But but having said that...

Trevor: I may be talking out of my hat here, but they absolutely have ethics review there too. Because especially if it's a if it's a drug that you eventually want to bring to market, you know, the regulators will eventually say, yeah, you did those, you know, take some ludicrous thing from the past. You know, you did those all in prisoners. You should, you know. So there will absolutely. I, I, I've never been around the Dent institute there but I guarantee there is there is an ethics review board there.

Kirk: I don't want to see this criticism. I spoke up front. I'm coming from a Canadian system. So having gone through the system to get ethical research done, I'm curious. I'm very curious on what the process for a private institution to get research done. What is the process from their ethics perspective, that that's my intent. But having said that, what I'm really impressed by Trevor, is the fact that this organization one day knew nothing about cannabis, but could pivot so quickly to have what they've got 13 they got, you said, 13,000 patients a day. They're doing 120 research a year. I, 18,000, a 13,000. They're doing research right now. Why would they got. They got 118 patients receiving cannabis in a in a research of over 185 patients.

Trevor: Yeah, that was that that was one of their studies. So that's 100. But before we go over that one though, just because it was so dense, let's just do a little bit of terminology in case people sort of missed it. So MCI we talk about that a lot. So that is mild cognitive impairment. So this is not yet dementia. You know, you might be forgetting some stuff, but you are still able to function. You're still able to go to work, you're still able to look after your kids, still able to cook, still functioning. And why that's a big deal, at least in Dr. Mechtler's thought is that seems to be the place to intervene, especially with cannabinoids, because that seems to be a place where we can actually do some good. The other and I'm sure it was a miss speak on his point, but he talked about, being about 6 million people in the US having, Alzheimer's. And that's about 70%, 7 zero % of all dementias. That rings true. But he said about 12,000 people with MCI. Quick Google said no, he he meant there it's more like 12 million people with MCI in in the US. So the mild cognitive impairment says lots of those. Yeah. So I just thought I'd throw a couple of those out. There's lots of other cool stuff in there, but just I think some of those, in case you don't talk about people with dementia every day, that some of that terminology might have gone over your head.

Kirk: Yeah. I, this is another good episode on dementia. When you start thinking about how many we've done. We've done episode 99, episode 91, episode 58. These were all about dementia and cannabis. Getting to the cannabis part of this, what I find really cool is some of the things that they have found. You know, they've got the I think the 13,000 patients that are giving you actively using cannabis right now within their studies. 13,000.

Trevor: Yeah. And that that was that wasn't just dementia. So that's dementia and Parkinson's and MS like 13,000 sort of total neuro science patients.

Kirk: Right. Right. But what I liked about it is that what they're finding, what they're finding is people's anxieties are decreased. People are getting more sleep. They're feeling less pain. I mean, I think we have to review people that have listened to the other episodes, understand it heavily, heavily over overtly demented people are often heavily sedated or given very strong medication to control their, their sundowning. Right. So I think we have to remind our remind our listeners that that's one of the biggest problems, with dementia in the current system is how we control them through chemistry.

Trevor: Yeah. We use drugs that weren't intended for dementia. We use drugs like Seroquel and Risperidone. And they do quiet the patients down. But, you know, literally study after study says that if you use these drugs in older patients, you, you decrease how long they're alive. You increase mortality. You kill them off faster. So.

Kirk: Yeah. So cannabis.

Trevor: And no one is no one is trying to kill. Just no one's trying to kill off grandma. I just I'll throw that out there. But you can, you can sympathize with, we'll throw a nurse. You know, if grandma, you know when she's having a bad moment is, you know, picking up her cane and winging it at people again and again and again. What do you do about that? You know, you could spend a you could increase the nursing staff. So grandma has lots of one on one time with a nurse or a nurse's aide. That would be ideal. But more often than not, we they get some of these medications that do sedate grandma, but, you know, decrease her probable length of life as well.

Kirk: Well. And what what he's what he's discussed is how there's these micro bleeds that occur that occur in the brain that are discovered with, MRIs.

Trevor: That was different and interesting. So there are there are new drugs out there which, you know, we throw, monoclonal antibodies at everything now, right? Because, you know, they're very, very specific, targeted. There was a Biogen drug which was pulled off the market, which was an anti amyloid, antibody anti-body thing, a monoclonal antibody, because it was just questionably a be effective. And there's four or more of these monoclonal antibodies in the pipeline. The idea and the idea makes sense. We've got these beta amyloid plaques, these protein tanglily things in the brain. If we could get rid of them, shouldn't that improve Alzheimer's? That's kind of the idea. The problem is, they are having some side effects, including brain swelling and micro bleeds. So, you know, these are the the next, the next great thing. And, you know, they really might be. So let's not throw the baby out with the bathwater. But they are not they're not without their issues.

Kirk: And there's, there's that little baby plant that grows almost anywhere that decreases the pain and, you know, makes it much easier. So as a nurse that's responsible for these people, providing them a medication that that calms them decreases anxiety causes, allows them to live longer. That just seems like a no brainer. And the fact that this organization has pivoted so quickly to focus on cannabis, I'm impressed, especially when they start talking about there's an epidemic coming. I mean, our generation, we will probably be the longest living generation, right, without getting into demographics. But my understanding is our spawn are not going to live as long as we are, right. So our generation is the last of the ones that gets to 105 and 110. And we're the healthiest 75 year olds out there right now. I mean, I'm closer to 75 than I am 30. You know, so, I mean, that's that's, I'm one of those guys that's going to end up in the fields, of these long term care organizations. And hopefully there's enough science to say, you know, give the guy cannabis, keep them off that that sedative, you know? And so I just think from a perspective of a practitioner, cannabis is becoming a no brainer. And it makes me wonder why more and more health authorities aren't advocating for it.

Trevor: No, I agree, and we didn't have time to get into it. He had a great big long talk that went to before. So but we've sort of covered this ground before, which is, instead of giving you Risperidone to people in care homes who have dementia to calm them down, cannabis is seems to be a good alternative. And safer. And, you know, like you said, even in their study of those 118 people with cannabis, they had half with a 20 to 1 CBD THC and half 1 to 1. And yeah, they were finding, you know, less pain, less anxiety, less sleep. So all the things that would make you agitated. And so that's all good. But there is also far from proven. But if we give the right cannabinoids to these MCI people, these mildly cognitively impaired people, some cannabinoids seem to have some neuroprotective effects that might actually delay or prevent Alzheimer's dementia. Now, that's a whole lot of mights and maybes, but that is another thing that people, that people like at the Dent are looking at. And that might be even more exciting than treating people with dementia, with cannabinoids to keep them happy. Maybe if we treat people who are mildly cognitively impaired with cannabinoids, maybe they will get dementia later or not at all. So that's cool. A cool thing that might be happening.

Kirk: There's a lot of stoners who are going to, who are going to say, told you so, man, it's only the short term memory that goes.

Trevor: Yeah.

Kirk: So another good one, Trevor:, it adds to our library.

Trevor: Like I said, very dense. Go, go listen to that again. He goes through a lot of stuff but, yeah an efficient use of your time.

Kirk: It was a good interview. And it goes. It just goes once again, as a nurse to my practice, you know, cannabis has a role. And you know what? We're so cautious sometimes because, you know, we want those random trials and random controlled trials, but we're starting to get enough experiential, subjective research, that suggest cannabis is worth trying, right. So if you do have an elderly relative or friend in a long term care facility who's showing signs of dementia. Start educating the staff on cannabis. Hey, they could refer them to this podcast, Reefer Medness -The Podcast.

Trevor: They, could.

Kirk: I have a story to tell you.

Trevor: Sure.

Kirk: I'm going to Namedrop. Dan McKay. McKay Yardwork and Pressure Washing. He does yard work stuff.

Trevor: Yes.

Kirk: My backyard today, so it's been very wet. So the yard is full of grass and so I was out mowing mine and my neighbor had hers done by Dan by McKay's garden works. And he listens to our podcast. 

Trevor: I knew I like Dan before that I like more now.

Kirk: Yeah yeah yeah yeah. Well, Dan and I used to work in Corrections together, back in the day before they closed the local jail, which I'm sure in one of the podcasts we talked about four years ago. But yeah. So Dan and I know each other, and he's now he's pivoted into a new business, and he's very successful. McKay yard works a little namedrop. And what he basically said he came up in, in in a classic Dan where he goes, yeah, you know, been listening to that there podcast yours. Yeah. Yeah Dan. He goes, boy I learned a lot. You had that one about that person I think from Seattle talking about CBD or something. And I learned a lot. And so he's just he's just started naming off episodes going, I didn't know you could learn so much about cannabis. 

Trevor: Cool. Thanks Dan.

Kirk: He likes our podcast. Yeah. Thanks, Dan. So I thought that would be a nice little plug for Dan. And is unfortunately, is not web based. You'd have to live in Dauphin or the Parkland Region to use the services, but look up the McKay Yard work. He's a podcast listener.

Trevor: And so, Kirk:, I don't have any music picked out for this one. Anything tickling your fancy?

Kirk: Well, well, well, well, we are talking about cannabis research. I don't know, I think it's still yacht rock. I mean, it's still a Florida episode, right?

Trevor: It is.

Kirk: So we should find. Why don't we get. How about Christopher Cross. Sailing.

Trevor: Sure.

Kirk: Is that just. Is that just too Yacht Rock?

Trevor: And I don't know.

Kirk: Well remember that. Well, you can do it.

Trevor: Well yeah. Wrap up yacht rock with Come sail away.

Kirk: Sure. No well that's different band come sail away.

Trevor: Okay. Sorry.

Kirk: We'll let Rene figure it out. Hey, I'm Kirk: Nyquist, I'm the registered nurse.

Trevor: I'm Trevor Shewfield, the pharmacist.

Kirk: We are Reefer Medness - The podcast.

Trevor: All right, there's another good one. See, everyone, next time, have a good day.