While a new Center for Brain Health is underway and set to open in 2025, the Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases is already working to advance Alzheimer’s treatment through diverse clinical research trials.
Between 30 to 70 patients are referred to the Biggs Institute every week. Inside the clinic at the UT Health Medical Arts and Research Center, there’s a year-long waiting list for general patient care services.
“There is an enormous need,” said Dr. Sudha Seshadri, professor of neurology and founding director of the Biggs Institute at UT Health San Antonio — and the most vulnerable aging populations include Hispanic and historically disadvantaged or socioeconomically disadvantaged San Antonians, she said.
As the need grows, San Antonio’s Hispanic majority population is helping researchers dig deeper into why Hispanic populations have higher risks of Alzheimer’s and dementia.
According to the Biggs Institute, by 2030, 40% of Alzheimer’s patients in the U.S. will be Hispanic or Black, but Hispanics make up less than 1% of participants in National Institutes of Health clinical trials. Black Americans make up 15% of clinical trials.
“Preventative medicine is key,” said Dianne Teran, program manager for the local Alzheimer’s Association. “When we find a cure, we want to make sure it works for everyone, so we try to encourage those studies also should be as diverse as the prevalence. There really should be diversity in those studies and clinical trials.”
Hispanic populations, specifically Mexican American and those of Native tribal ancestry, have a 50% higher risk of new onset Alzheimer’s and clinical dementia than non-Hispanic populations — at the same time a “tsunami wave” of Alzheimer’s disease is predicted to double its prevalence in the U.S. over the next 20 years.
“If we diagnose it with time, we can definitely slow down the progression of the disease and make the quality of life better for the person with dementia” Seshadri said, “enabling them to continue doing what they’re doing for much longer, … allowing people to stay at home and age in place for much longer.”
There are 10 clinical trials happening out of the Biggs Institute in San Antonio. Two focus on Hispanic people only, though the rest of the studies specifically recommend that Black and Hispanic communities participate because of the higher risk known to those groups.
One research trial studies if nicotine in patch form improves memory, others study the correlation of heart health and brain health, and another trial studies a new approach to dementia treatment: targeting proteins connected to memory loss.
“Alzheimer’s is the term we use when … an abnormal form of amyloid builds up to a level where it starts interfering with the ability of the neurons to talk to each other,” said Seshadri during a panel on aging well in Bexar County last month. “An abnormal form of tau builds up and starts killing the neurons. If you see dementia in the presence of too much amyloid and too much tau, that’s what we call Alzheimer’s.”
Active studies in San Antonio
The Compadre Collaborative Aging in place Research using Technology (CART) is a 36-month study that is recruiting healthy Mexican Americans over age 62 to have home-based technology installed in their home.
The REACH Clinical Trial needs people 55 to 89 with mild cognitive impairment or Alzheimer’s disease. The trial evaluates the effectiveness of a drug called Rapamycin.
The AHEAD 3-45 Study needs people ages 55 to 80 who have had a first-degree relative diagnosed with dementia onset before 75 and that have elevated brain amyloid, which researchers will test for.
The 7T MRI Study of How COVID-19 Affects the Brain needs people ages 45 to 80 who have recovered from COVID-19, has developed an illness other than COVID, and haven’t been hospitalized for an illness in the past two years.
The MarkVCID: Biomarkers for Vascular Contribution to Cognitive Impairment and Dementia study needs people with or without memory loss issues between 60 and 90 to study biomarkers, or signs that Alzheimer’s or dementia leaves on the brain.
The Heart Function and Brain Health Study needs volunteers 60 and older with normal heart function or diastolic dysfunction and no significant memory concerns to study for two visits over two years to study heart function in relation to brain health.
The Viva Mind Study tests if the drug Varoglutamstat is effective in slowing Alzheimer’s Disease and needs people 50 to 89 diagnosed with mild cognitive impairment.
Today, an Alzheimer’s diagnosis depends on checking the cerebrospinal fluid, which requires a spinal tap, but researchers at the Biggs Institute are looking at other ways to provide definitive diagnosis by less invasive means, Seshadri said: plasma signals in blood tests, the way a person walks and a person’s natural speech.
One clinical research trial ongoing in San Antonio studies the white matter hyperintensities, or lesions in the brain associated with dementia in the Diverse Vascular Cognitive Impairment and Dementia study.
Black, Latino and white people between ages 65 and 90 can sign up for the study if they have seen a decline in memory or thinking over the past three years. As part of the study, they participate in research over three visits a year in a four-year period, using a magnetic resonance imaging (MRI) scan to study changes in their brains.
The Compadre CART study follows Mexican Americans older than 65 who volunteer to have their physical activity monitored for the study on why dementia disproportionately affects Hispanics.
The study explores the association between reduced risks of dementia and engaging in physical activity, and exercise’s relationship with cognitive decline or healthy brain aging.
Participants in the Compadre CART study who agree to an in-home system are provided motion sensors to put on doors and inside each room, and use a mobile app and watch-like device to measure activity levels outside the home. Sensors are also added to volunteers’ beds to track their sleep data, heart and breathing rates, and movement activity like tossing and turning. The in-home system can be removed at any point the volunteer wishes to stop participating.
Another clinical trial is actively recruiting people to study if COVID-19 increases the risk for developing Alzheimer’s.
The Biggs Institute has also been able to fill diversity gaps in clinical research by pushing back on the idea that that frontotemporal dementia is rare in Hispanic populations, due to the number of people with frontotemporal dementia the center has seen, and the 250-plus donors who have donated their brains to the Biggs Institute for research, Seshadri said.
As Hispanics make up a far-too-small percentage of NIH clinical trial participants, the local Alzheimer’s Association’s Hispanic Outreach Committee is working to bridge a gap between the Hispanic community and medical researchers created by mistrust.
“There are a lot of studies, and all studies need people to participate, either [those] who have it in their family, even those that don’t have it in their family,” said Ginny Funk, director of programs for the local Alzheimer’s Association.
The nonprofit funds 11 research projects out of San Antonio and South Texas that look into nutrition, health and environment.
There are many opportunities for San Antonians to participate in clinical research studies, including online and observation studies. People who sign up usually wait about four to six weeks or longer to get started, especially if they’re required to get off certain medicines to start the trial.
Funk said prevalence numbers of Alzheimer’s disease show it develops at one and a half times the prevalence rate for Hispanic older adults than it does for Caucasians, and African Americans develop the disease two times more than the rate of their white counterparts.
In Bexar County, 13% of people over 65 are currently living with dementia, according to the local branch of the Alzheimer’s Association — about 33,000 people. Just a few hundred miles south, El Paso County has among the highest prevalence rates of Alzheimer’s in the country.
Seshadri said the Biggs Institute’s clinical care and research capacities are being expanded into cities along the border, like Starr County and the Rio Grande Valley, which has some of the highest prevalence of dementia in Hispanics.
Seshadri said there may be many reasons why there is a higher prevalence of Alzheimer’s and dementia in Hispanic populations, but there is not one “why.”
Researchers in San Antonio are working to determine if Hispanics have an increased risk of clinical dementia because Hispanics have more amyloid and tau (proteins that cause dementia) in the brain, or because of other medical episodes they experience at higher rates that decrease the resilience of the brain, like strokes or diabetes.
Factors that increase the chances of developing dementia include high blood pressure, insulin resistance and high cholesterol, so Seshadri recommends addressing those issues.
Seshadri said researchers have followed 100 Hispanics and 100 non-Hispanic whites over age 65 for for 10 years, and findings show Hispanics are more likely to get clinical dementia, but she could not correlate whether Hispanics have a higher risk because they live longer. In general, she said, living longer comes with a higher risk of dementia.
“The greater longevity, unfortunately, today comes with a higher risk of dementia,” Seshadri said. “What we want is for the longevity dividend to be more healthy years of aging, rather than just more years with illness.”
This story has been updated to correctly state that the clinic is located at the UT Health Medical Arts and Research Center and to correctly refer to the Diverse Vascular Cognitive Impairment and Dementia study in San Antonio.
