Ep 100: 2025 Year in Review and Predictions for 2026 with George Vradenburg

BrainStorm guest Vradenburg, Chairman and Founder of UsAgainstAlzheimer's, sits down with host Meryl Comer for a comprehensive look at the state of Alzheimer's research, advocacy, and care in 2025.

Vradenburg addresses critical challenges facing the Alzheimer's community, including threats to NIH funding and the impact of funding instability on researchers and clinical trials. The discussion covers key advocacy efforts like the CHANGE Act and ASAP Act, which aim to make cognitive checkups and blood-based diagnostic tests more accessible through Medicare coverage. Vradenburg also highlights UsAgainstAlzheimer's expanding initiatives, from the BrainGuide platform offering direct-to-consumer cognitive assessments to educational programs training healthcare professionals on brain health.

Looking forward, Vradenburg makes a bold prediction: within the next decade, we could see preventive treatments for Alzheimer's, potentially including a vaccine. This episode offers both a candid assessment of current challenges and an optimistic vision for the future of Alzheimer's prevention and treatment. This is a must listen episode!

Produced by Susan Quirk and Amber Roniger

Transcript

George Vradenburg: 00:01

I will persuade those Americans that have been touched by this disease, they understand the pain. They understand the suffering. This is a disease that lasts eight to ten years. At least, in your case, it was 24 years with your husband and 10 years with your mother at home. American people have seen this up close. What mission is better in life than to have cured this disease? So get active politically, get active in your community, get active by contributing. Do whatever you can to assure that the next family does not get this disease.

Introduction: 00:34

Welcome to BrainStorm by UsAgainstAlzheimer's, a patient-centered nonprofit organization. Your host, Meryl Comer, is a co-founder, 24-year caregiver, an Emmy Award-winning journalist, and the author of the New York Times bestseller, Slow Dancing with a Stranger.

Meryl Comer: 00:51

This is BrainStorm and I'm Meryl Comer. Joining us for our year in recap of 2025 and a look ahead is George Vradenburg, Chairman and Founder of UsAgainstAlzheimer's, and co-convener of its multiple affiliated global initiatives, from the CEOi to DAC, the Davos Alzheimer's Collaborative, and GAP, the Global Alzheimer's Platform. Welcome, George. Always great to catch up.

George Vradenburg: 01:19

Meryl, always good to be with you.

Meryl Comer: 01:20

Let's recap 2025 with a reality check. 15 years ago, we were fighting to put Alzheimer's disease on the policy map, seed basic research. Today NIH funding for Alzheimer's and related dementias has increased more than sevenfold to roughly $3.8 billion annually. What current threats in 2025 to NIH funding are we now fighting to correct?

George Vradenburg: 01:47

Well, 2025 has been a mixed year. We've had a major sort of setback in terms of the NIH, the FDA and CDC. NIH struggled for the first six months of the fiscal year, the one that ends in September, with a refusal on the part of the administration to spend the money that had been allocated to it by Congress, and then had to hurry up and spend that money rapidly in the second half of the year. As a consequence, they put it out in big chunks of money rather than distributing it as they had in the past. As a consequence, we've lost a lot of grants to a lot of smaller institutions or in a lot of projects that should have been funded this fiscal year. Second, Trump proposed a budget during the course of the year in which he recommended a 40% cut in NIH in fiscal 26, which started on October 1 and would go to September 30, 2026. And that obviously would threaten really the whole sort of edifice that we have established over the last 20 years in terms of NIH investment generally and with respect to Alzheimer's. We're pushing back. We've responded with a fairly significant multipatient organization coalition from across Alzheimer's to cancer to a variety of other health conditions that touch American people in something called United for Cures and have pushed back. That is what has got us into the positive position in Congress, but we are yet to correct all of the impediments that have been put in place for NIH for 2026 because of the way that 2025 money was spent. So we're working hard on that defensive posture with the U.S. government. That has been a negative so far in 2025.

Meryl Comer: 03:32

What about the loss of brain power, that scientific knowledge that has left NIH? And what happens to the next generation of scientists in the brain space?

George Vradenburg: 03:44

Particularly at the FDA, where we have very, very skilled drug assessors and scientists, their loss there is significant because those people can get a job in industry. And if in fact we lose that talent, either in NIH or in the academic institutions which NIH funds, there's a long-term impact. Quite frankly, depending on what happens with the 2026 budget, we'll find out whether this is repairable in the short term or whether we've suffered long-term damage. But the threat is that if in fact this continues for much longer, this instability, this lack of consistency in funding, that we will set ourselves back by years, if not a decade. I think we're in the middle of the fight right now to try and preserve NIH's standing, its funding levels, and FDA stability. So I don't know that we can assess this yet as a serious red light, but there's no question that we have to fight back as hard as we can in order to preserve that stability and that continuity.

Meryl Comer: 04:45

Georgia's advocates, we encourage people to raise their hands to participate in research. What happens to those in current clinical trials that have abruptly lost funding?

George Vradenburg: 04:55

Well, obviously, if a clinical trial is stopped in the middle, those people leave and the ability to re-recruit them is impacted. Most of the clinical trials are funded by industry, and those clinical trials are continuing. No question that to the extent that the NIH funding has been cut off to a particular study or to the clinical trials that they do support, that eroded the trust that people will have in whether or not they can go into these clinical trials and get the benefits that they might get by taking a drug, even if they're on placebo, at least the hope that they would get the drug in an open labeled extension. I am not a doomsayer here. We are fighting back against a real problem and challenge to the medical enterprise and the research enterprise that the United States has been at the forefront for so many years. I don't know that we know the result of that yet, but we're fighting back and we'll continue to fight back to make sure that we maintain the medical enterprise generally and with respect specifically to Alzheimer's.

Meryl Comer: 05:53

With the full court press to encourage early diagnosis, Us Against Alzheimer's has long advocated on Capitol Hill for passage of the Change Act. George, where are we right now?

George Vradenburg: 06:04

Well, we continue to push the Change Act because it basically would require that anyone that comes to Medicare for their annual wellness exam get a cognitive checkup with an approved digital tool. It would improve rapidly, I think, people's attention to the brain and would increase the rate at which we can get people assessed for their brain health and thus potentially for medicines that either are now or will be coming on market in the next few years. And so I think we continue to press this. There recently was introduced a bipartisan bicameral level, a new act, ASAP Act, as soon as possible act, which would mandate that Medicare cover blood tests that have been approved by the FDA.

Meryl Comer: 06:45

Let's pivot to advancements. What are the most important headlines from the recent CTAD meeting in San Diego?

George Vradenburg: 06:53

This was not a particularly exciting year. There haven't been real significant advances this year, new advances, and there haven't been any particular disasters. There was a trial of GLP1s, this weight-reducing anti-diabetic, anti-obesity set of drugs that have become so popular. They were being tested as an independent intervention that might prevent Alzheimer's. That trial was negative. So at the moment, at least the first stab at whether or not we can use GLP1s against Alzheimer's has been negative. But we've suffered a lot of negative results in trials over the years against Alzheimer's, and nobody in industry is pulling back. And I think there will be other efforts at using GLP1s maybe earlier in the course of the disease and patient populations that have not yet become symptomatic. I think we will find that GLP1s will have a benefit in slowing, mitigating, or preventing Alzheimer's. But the first stab at this was negative. The really interesting news was the results of studies of what's happening to one of these first new medicines, Leqembi, Lecanemab, depending on whether you want to use the current commercial name or the scientific name, which demonstrates that the continued use of Leqembi will extend the time between when you have MCI and when you get to a moderate stage of the disease where heavy caregiving responsibilities are needed, uh to two and a half years. So the benefits of the existing drugs have now been demonstrated to be much greater than initially thought, and the incidence of the side effects less than what were initially thought. So this is good news for the field that in fact the real experience in the field with these drugs is that they are potentially more powerful, more clinically beneficial to patients, and less adverse impact than originally thought. Those things are positive. But there's no lack of excitement in the field, and there's no lack of investment from industry. And so, so far, the efforts to tear down NIH are not having an effect on industry investment or on industry commitment to the field, and that's all good news.

Meryl Comer: 09:01

When it comes to brain health, George, how was the pointer study received?

George Vradenburg: 09:06

The pointer study, which is a large-scale study of a lifestyle set of interventions with coaching support, were positive last year and they continue to be positive now. I think the next stage of evolution on whether or not lifestyle interventions are successful and how successful they can be, will be in the implementation work. So there will be implementation work on whether or not we can introduce technologies and coaching techniques to really encourage people to take on lifestyle changes during the course of their life, which actually will mitigate or prevent a significant percentage of Alzheimer's cases. The current estimate is that up to 45 to 50% of Alzheimer's cases can be prevented or mitigated by simply taking a much more positive attitude towards your brain health during the course of your life. I think it may be higher than that, as we study even earlier interventions and other risk reduction tactics. But the challenge here is to get people to change their lifestyle. And it may be that the GLP1s are the major first initiative in doing that in ways that whatever one's independent view of whether or not they will reduce the incidence of Alzheimer's directly, they will do so because by reducing diabetes and reducing obesity, that we will actually have a positive benefit in mitigating the incidence of Alzheimer's.

Meryl Comer: 10:26

How has UsAgainstAlzheimer's continue to meet the moment? So, for example, advancing early detection or reaching people at scale through our brain guide platform?

George Vradenburg: 10:38

Well, our corporate roundtable, uh, the Global CEO Initiative on Alzheimer's has been very active in the blood test marketplace. We have provided a side-by-side comparison to the field of how each of these blood tests perform and how they should be used and can be used in clinical practice. And we're seeing a very, very rapid increase in the use of blood tests across the field. With that said, the health system generally has been, one could say, stubborn in terms of the degree to which they can get people through a diagnostic pathway and get people's assessments. Wait times are a year or more in most parts of the country. Next on the scale is digital cognitive assessments, which is basically the ability to take a test at home or on the recommendation of your clinician to assess your own cognition, and if in fact you have some cognitive concerns to actually get diagnosed for what the cause of those cognitive concerns might be. BrainGuide has been a leading element in this direct-to-consumer digital cognitive assessment. By calling mybrainguide.org, you can actually get a quick assessment of your cognitive status. And also in the coming months in 2026, we expect a million new people to come to BrainGuide. And we'll be partnering with one of these new virtual neurology clinics, which will allow you to get faster access to a neurology appointment and potentially information if you don't have any cognitive symptoms but still are worried, access to materials about your brain health and how to maintain your brain health.

Meryl Comer: 12:11

What about the whole issue of making sure that the healthcare professionals are up to date?

George Vradenburg: 12:17

Brain Health Academy has been on the forefront of educating healthcare professionals below the physician level, nurse practitioners and professionals in the brain health field about brain health. But we do it as well with physicians. So we've been very active both through our global CEO initiative on Alzheimer's and educating about brain health, but also with our brain health academy, with professionals in the field, and actually through our program with nurse practitioners in the African American and Latino communities. So we have been very active across the board, across all professional levels in the health systems about how to basically mind your brain, get a brain checkup, do it regularly, pay attention to your brain, just like you pay attention to other parts of your body, because it's one of the most important, if not the most important, organ of the body.

Meryl Comer: 13:05

How long have you been talking about a checkup from the neck up?

George Vradenburg: 13:09

Since we started, Meryl, back 15 years ago. We started this organization, you and I and John Dwyer in 2010, and we've been talking about getting a brain checkup from the neck up, making it as routine and common and as normal as a checkup from the neck down.

Meryl Comer: 13:22

George, share the progress made by UsAgainstAlzheimer's in its collaboration with the business sector around the notion of brain capital. What is it?

George Vradenburg: 13:32

The business community, even without really thinking about it as an Alzheimer's issue, are thinking about these things on retention, socialization, productivity, motivation, purpose in life, all of those things that provide some beneficial effect on your brain. They are focused on this. So we're now trying to get measures of how to do that. So we have worked with companies now that are working with a brain health index that can be actually used by business to assess whether or not their employee populations are brain healthy so that we can then associate it with competitive and financial performance and stock market performance of those companies that do a better job with brain health than those that do not. So we're pressing early detection because the next major strategic step for the industry is finding a medicine that could be introduced and used before you get symptoms that it would actually prevent symptoms from arising. And we're likely to see in the next six months a medicine that will do that coming out through clinical trials. And as a consequence, getting earlier detection of cognitive impairment, getting earlier detection through blood tests of the fact that you might have the pathology of the disease, but not yet the symptoms, is going to be ever more important.

Meryl Comer: 14:46

We now have the first generation of disease-modifying drugs, but they're complex, expensive, not reaching everyone. Over the next decade, as advocates, how do we balance pushing for better treatments and pushing for better care and support? Can we do both at the same time?

George Vradenburg: 15:05

Of course. We're patient-focused organizations, so we have to focus on what is coming down the pike, anticipating that, pressing for improvements, pressing for greater speed, drugs that have improved clinical benefit, that are safer, easier to use, and at the same time make sure that we do what we can to preserve Medicaid support for home and community-based services and Medicaid nursing homes and other things that are in the care field as well. So, yes, we have to do both. There's no choice, really, if you're a patient-focused organization, to focus on everything that is of concern to the patients.

Meryl Comer: 15:40

When you look at who is actually able to access early diagnosis, biomarker testing, and who gets helped and access to the new therapies, are we closing gaps or accidentally widening them?

George Vradenburg: 15:54

Two things are happening simultaneously. The attention to these new medicines is causing more people to ask about their brain and more people to come to health systems to get assessed for the cognitive impairment and/or their readiness for the product. But the health system can't expand fast enough to respond to that. The challenge for us is at the same time as we want more people to get assessed earlier, that increases the demand on the health system and on neurologists to be prepared to receive those people and to give them the best advice on what to do about their brain. And yet we can't expand the number of neurologists or the number of educated primary care physicians fast enough for that demand. So we both have to work on the demand side, but also on the supply side. How do we improve the performance of our health systems so the people that are appropriate for seeing a neurologist see the neurologist? But people who are too early in the disease for these new drugs, how do we get them thinking about their brain health? Takes them out of the health system and into sort of public health, taking care of their own brain, or too late in the process of the disease and thus are too late for the drug. And how do we get them to a care pathway? So that we basically, as patients come into the health system, we can more quickly triage those that may be appropriate for the drugs, and yet take away from the health system those that are not appropriate for the drugs, get them into a brain health channel or into a care channel. So that's what all of our organizations are focused on.

Meryl Comer: 17:26

Looking ahead, George, which gaps in diagnosis, treatment, or caregiver support would you view as unacceptable maybe 10 years out if they don't adequately support underserved communities?

George Vradenburg: 17:39

Underserved communities tend to be in under-resourced areas, fewer access to doctors, certainly fewer access to neurologists, fewer access to the imaging equipment that sometimes is needed is to confirm that you have the pathology of the disease, less access to MRIs that are needed to test for your risk of side effects. We're trying to use new technology and tactics to extend the healthcare system into those communities which are underserved. Black, African Americans, Latinos, other minority populations are adequately served in high resource settings. They're inadequately served in low resource settings, but so are whites. So this is more an economic issue in my view than it is a racial issue per se in terms of care, in terms of access to the health system. We're also terribly underserving women. We have not studied women's brain health as a focus area ever, and as a consequence, we do not know all the risk factors that women are confronting with respect to this disease, and we still don't have an explanation of why it is that women are two-thirds the victims of Alzheimer's. So I think that that is an important area. So, in a sense, the scientific community is underserving women. The diagnostic and healthcare system is underserving blacks and Latinos. So we have inequities across the board here, and we're trying to address all of those in all of our work.

Meryl Comer: 19:01

Let's go to early diagnosis as blood tests and other tools make it easy to label people years before their symptoms. What is our role as advocates in drawing some line around when, how, and in whom preclinical Alzheimer's should be disclosed? Because that is a touchy subject.

George Vradenburg: 19:21

It is a very touchy subject, and it's a touchy subject in several respects. Do you really want to take a medicine before you think you're sick to prevent something? We do this in other areas. If you, in fact, had some opportunity to take a cancer drug, they would prevent cancer. Why wouldn't you? We haven't got that culture inside the Alzheimer's and the brain health community yet. So we basically are going to have to deal with the ethical issue of when do you disclose and in what circumstances, with what conversation do you disclose to somebody they have the pathology of the disease before they have symptoms? That's an individual choice, but that's also a delicate conversation. So I don't think our physician Are you trained to have that conversation here?

Meryl Comer: 20:02

What are you willing to say publicly now about the future of Alzheimer's advocacy that you wouldn't have said five or ten years ago?

George Vradenburg: 20:12

That we have a chance of preventing this disease. A realistic shot of preventing this disease within the next 10 years. And we ought to put heavy weight on that here in the United States, but around the world. It's almost unacceptable that this is not a high priority in the United States and the rest of the world.

Meryl Comer: 20:30

You have poured a major part of your life and philanthropy into this cause. What would have to be true 10 years from now for you to feel that this next chapter was worth all that effort and expense?

George Vradenburg: 20:44

I’ve got two answers to that question. One is at my personal life satisfaction level, I've never felt more purposeful and more positive about my own purpose and meaning in life, which is to cure this disease. But 10 years from now, as I said, I want a vaccine on market around the globe. That's my goal in life now, is to prevent this disease, and that's through vaccines or other medical interventions. I can work on brain health, but that's going to take longer than 10 years to get the world's population to mitigate their way out of this disease, even as I'm going to pursue that in the short term.

Meryl Comer: 21:19

I'm going to give you two minutes to persuade those out there who are undecided about becoming an advocate to the cause.

George Vradenburg: 21:29

I will persuade those Americans that have been touched by this disease, they understand the pain. They understand the suffering. This is a disease that lasts eight to ten years. At least in your case, it was 24 years with your husband and 10 years with your mother at home. American people have seen this up close. What mission is better in life than to have cured this disease? So get active politically, get active in your community, get active by contributing. Do whatever you can to assure that the next family does not get this disease.

Meryl Comer: 22:01

Our guest, George Vradenburg, Chairman and Founder of UsAgainstAlzheimer's, and convener of its multiple affiliated global initiatives. That's it for this edition. I'm Meryl Comer. Thank you for brainstorming with us.

Introduction: 22:16

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