Amanda Smith, M.D.: Diagnosing, preventing, and treating Alzheimer's disease, and what we can all learn from patients with dementia

**Peter Attia** (0:11)
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Now, without further delay, here's today's episode.
My guest this week is Dr. Amanda Smith. Amanda is the Director of Clinical Research at the University of South Florida Health Bird Alzheimer's Center and Research Institute. She is also a Professor of Psychiatry and Behavioral Neuroscience at the University of South Florida, and she specializes in the treatment of patients with Alzheimer's disease. She received her MD from Thomas Jefferson University and did her residency and fellowship at the University of South Florida. She specializes in Alzheimer's disease clinical research, along with the diagnosis and treatment of patients with AD and other memory disorders.
She's an active member in the memory disorder community, and I actually met her through our shared interest in a nonprofit that you may have heard of, Hilarity for Charity. In this episode, we talk about a number of things. Obviously, her background and what drew her into a field that many people don't necessarily think of, geriatric psychiatry, as a field pertaining to Alzheimer's disease.
We talk a lot about the clinical diagnosis of Alzheimer's disease, which actually is still somewhat elusive. And while it's easier to make the diagnosis today than say 20 years ago, it's still far from a perfect diagnosis, and a number of other things need to be ruled out. We get into a pretty good discussion around the pharmacotherapy pipeline. There are, at this time, over 100 drugs in the regulatory pipeline for testing, and we get into a discussion of where they are in that phase and what they're targeting. We discuss specifically a drug called Atacanamab, which is a monoclonal antibody directed at amyloid beta. And at the time of this podcast, it is very tenuously awaiting FDA approval, a decision that should be rendered on June 7th. This is a very important moment for the research community, because if approved, it would be the first drug approved, both as a monoclonal antibody, and secondly, as a drug that is a disease-modifying drug, as opposed to a symptom-based drug, which is currently all we have in the quiver. We conclude the discussion by talking about what it means to age in a healthy way. And I think this is the part that probably has the broadest application, because even if you don't develop Alzheimer's disease, you will age, that is inevitable. And the insights that Amanda provides here are going to be valuable for everyone. I certainly feel that way myself. So without further delay, please enjoy my conversation with Dr. Amanda Smith.

**Amanda Smith** (3:16)
Hey!

**Peter Attia** (3:19)
Hey Amanda, thank you so much for making time to chat with me today.
From the first time I heard you speak, I knew I wanted to have you on the podcast. You probably don't even remember when that was, do you?

**Amanda Smith** (3:33)
Well, I think it was that Zoom thing for HFC, right?

**Peter Attia** (3:36)
That's right, that's right. It was Hilarity for Charity, and somehow I was considered an expert. You clearly are an expert, and you and me and Richard Isaacson were a part of a discussion in the days when we no longer do physical panel discussions.
And I just thought, wow, I was really kind of blown away by a lot of your insights, because they went beyond just the obvious topics we discuss, which are the research around what's the cause of Alzheimer's disease, how do you prevent it, what are the treatment, all those things are relevant, and all those things are things that you speak to. But I think what impressed me was the attention you brought to the impact that Alzheimer's disease has on the family just as much as it does the patient. And certainly that's something I wanna talk about today. But before we get to that, tell us a little bit about your background. You specialize in geriatric psychiatry, which are not often things you think about, right? People think about psychiatry, they think about forensic psychiatry, they think about more of the DSM-5 type of psychiatry.