Revolutionizing Dementia Diagnostics With AI

James Hamet

Thank you so much for having me. Heather, it’s a pleasure.

Heather Sandison, ND

This is an exciting conversation on the very cutting edge of dementia care, especially in the diagnostics field. There is so much confusion and nuance around the idea that beta-amyloid plaques are proteins. These misfolded proteins are the cause of dementia, but there’s a lot more to it than that. I think of technology, as the pharmaceuticals. As the research continues to evolve, we’re going to want more precision in how we diagnose the different reasons for dementia. Of course, using Dr. Bredesen’s approach, we do that. But you have a unique perspective on patients as well. Can you just dive into what exactly the lab does and how you get the information?

James Hamet

Sure. We’ve created a new way of measuring functional biomarkers of cognitive decline. What we look at is how the person’s perception is changing as early as it relates to their brain disease, which could be, of course, damaging their brain and thereby reducing their ability to see the world. We look at how the person’s brain processes visual information, and from that, we can localize damage in the brain. We can assess severity, and that’s how we are trying to make it easier for doctors and patients to more quickly identify which type of disease is affecting them. 

To measure the effects of therapy on that patient and just to help doctors deal with these patients in a way that’s more efficient or easy, we need to take a lot of the guesswork out of the equation. There’s so much to know about a person’s health when you’re trying to deal with a complicated situation like Alzheimer’s disease, Parkinson’s, or ALS. You need to know a lot of information. Some of this information isn’t available, especially for a patient who just walks in the door and says, Hey, I think I have a problem. We try to make it so that the doctor has everything they need on that first day and on that first visit to heal that patient.

Heather Sandison, ND

Walk us through. How does a patient get this testing? Is it a blood test? Is it urine? Is it a stool? Is it an EEG? What is it?

James Hamet

It’s a good question. It’s going to sound very simple. But I think that most great inventions are very simple. You watch a video, and while you’re watching the video, the patient is wearing an EEG. The EEG is looking at how the person’s brain, is responding to the different stimuli that we show. The different stimuli are designed to target certain areas of the brain, spatially in the brain. We can essentially see how the person is responding to that video and, therefore, where there might be damage. If there’s a certain image or animation that the person’s brain is not responding to. In the way that we’ve characterized healthy people, that’s how we’re able to see that, oh, there might be something interesting there. We have a very large database of patients for whom we’ve used this method. We’ve been able to use AI and machine learning to correlate those deficits with the other endpoints that we have. That was the first way that we demonstrated that this approach was viable and had clinical utility. Now we’re taking it even further by showing a direct measurement of brain damage. If we can show that a person’s ability to see is reduced by a certain fraction, we can assume that a fraction of those neurons are not functioning as well as they should. That’s the exciting new direction we’re going in.

Heather Sandison, ND

This depends on visual perception. What if someone already has issues? If they wear glasses or if they have some age-related macular degeneration or other eye issue that will affect their vision,?

James Hamet

That’s a good question. We require corrective lenses if the person has less than 20/20 vision. In the case of macular degeneration, likely, this test won’t be effective for that person. We do require that the person have a pretty perfect vision because we want to make sure that our system’s not biased by optical issues. We’re looking for those visual processing deficits.

Heather Sandison, ND

Then what if someone has symptoms of dementia but it’s not affecting their visual fields or their visual cortex?

James Hamet

Yes. That’s fascinating with all of the patients that we’ve seen, including those who you would call subjectively cognitively impaired patients who believe that they have some level of symptom; maybe they are somewhat forgetful or something like that. They believe that they’re sick. For those patients, it’s not always clinically evident that they are sick. Often, these patients don’t have a diagnosis. The patient believes that they’re unhealthy.  For those patients, we can even find these very small visual deficits. We’re not looking for the traditional sense of blindness. We’re not looking for someone unable to see a picture that’s held in front of their face; that’s probably not even going to happen in their lifetime. But what we can see is that we’re able to see the very tiny signs of visual impairment. Maybe the person’s reading is not necessarily affected by this visual impairment, but it does affect their ability to see things more clearly. We show very small images with very high complexity. 

We’re testing to see if all aspects of the visual cortex are fully functioning, including, and this one’s important, the parietal lobe. A lot of people forget that the parietal lobe plays a very important role in navigation. The parietal lobe is one of the areas of the brain that is predominantly affected by Parkinson’s and Alzheimer’s diseases, which is why sometimes these patients have trouble navigating. Often, an Alzheimer’s patient’s first symptom that they notice is that they can’t find their way home when they go shopping. We can look at that as well because our animations are not just here’s a picture; they’re also here’s a picture that’s moving. Is the person able to see where that image has moved and track all of the small movements? It’s going a little bit more into the complex in terms of what the video is showing. But the simple outcome is, yes, we’re able to look at not just can the person see black and white, can see lines and shapes, but can also see complex movements and patterns.

Heather Sandison, ND

This assumes that anyone suffering from dementia has some impact on their ability to perceive through their eyes.

James Hamet

Yes. We haven’t, and we haven’t found any patient who hasn’t had some level of visual impairment.

Heather Sandison, ND

Then what about? I have a couple of patients now who have something called posterior cortical atrophy. I don’t know if you’re familiar with that, but it has a bigger impact on the visual cortex. They tend to have relatively sharp cognition, even good short-term memory, but issues with depth perception, other vision, and orientation—other issues that are quite pronounced. Would this have a different outcome? Would it show that their dementia was worse than what we would get on a MoCA, for instance?

James Hamet

That’s a good question. I believe that that’s a subtype of Alzheimer’s. We worked with a lab in Germany, and a professor there has Alzheimer’s patients. He treats them as different types of Alzheimer’s patients with post-cortical atrophy. It’s very interesting. They have in a way; it’s not their memory that’s being affected. They can see visually. You have to use a different scale when looking at the severity of these two different types of patients. To see how progressed the patient is, for example, you can’t use a ruler to measure their memory. For a patient, this means they’re going blind. I think that with our technology, our ability to differentiate these patients is what’s most interesting and valuable. We wouldn’t confuse the two because the locations of damage would be somewhat different. On top of that, I do think we would be more useful for post-cortical atrophy patients just because that is what we are measuring with the greatest amount of resolution, the visual processing.

Heather Sandison, ND

When you were describing this lab work, to me, it’s almost more imaging than having your blood drawn and getting things like homocysteine or complete blood count or getting blood work done. What can this replace? Instead of doing some other testing, can people use the Vistim Labs?

James Hamet

That’s a good question. What I want to replace with this technology is the need to use crazy procedures like MRIs and CT scans. These devices and machines that aren’t always available—they’re not always available in clinics in certain countries—are not available. The average country doesn’t even have a PET scan, for example. The PET scan is another tool here that we’d like to replace. I see this adds to the future of being able to provide pseudo-MRIs and pseudo-CTs. I do see it as not necessarily needing to replace these tools. I think those tools are very powerful. They give you a powerful image, but the image lacks a 3D element. It cannot show function, and it cannot show how this structure is performing over time. You can have neurons, and they can be visible on an MRI. That doesn’t mean that those neurons are healthy, and it doesn’t mean that those neurons are functional. 

There are many scientists that we talk to about who are frustrated. MRI images sometimes look healthy for these Alzheimer’s subjects, and sometimes it’s because they’re early Alzheimer’s. Sometimes it’s because of something else. Sometimes the MRI is just not able to show the damage because the damage is from a different angle. It’s more nuanced than I can fully explain here. But yes, I don’t necessarily see this as replacing these technologies long-term, but I do see this as a way to have more accessible care. If you’re patient and you have a concern and you don’t know why you have this concern. You’re experiencing a cognitive deficit for the first time in your life. You don’t necessarily want to go get an MRI, a PET scan, or do all of these crazy operations. It would be very helpful to have a tool like ours that could provide a simulation. This is probably how your brain will look in these other tests. This is how your brain should look if it’s healthy, and based on these differences, these are the decisions that we can take, and that thinking, that rationale, is nothing that we want to do on our end. That’s the doctor’s job. The doctor would then look at our images and decide, yes, in which direction we should look. Under a finer microscope.

Heather Sandison, ND

From a patient’s perspective, they come into a doctor’s office. Now the doctor needs to have some EEG, so they’re going to get the cap on their head. It’s going to create this conductivity.   There’s some wetness; usually, it’s wet; we call them socks, but they connect to the scalp, and they pick up the electrical impulses and brainwaves from the brain so that there’s some way to measure them. Now, there’s no neurofeedback. Nothing is going into the brain. It’s just a measurement of what is happening inside the brain so that we have some baseline, and in the worst-case scenario, there’s no poking. There’s no prodding, but you end up with an interesting hairdo on the other end of this. You said it takes about, what, 20 to 40 minutes? How long does it take?

James Hamet

Yes. Less than 30 minutes.

Heather Sandison, ND

Less than 30 minutes.

James Hamet

As the technology becomes more advanced, our target is less than 5 minutes.

Heather Sandison, ND

Then, can doctors or patients get results immediately? For many MRIs, people have to wait a week or two or three to see their doctor and have that reviewed. Sometimes, that can be nerve-wracking. What do they find? What’s going on? Is this something that gets results pretty quickly?

James Hamet

Yes. That’s a good question. This is designed to give results on the same day. This isn’t a human interpretation. This is using machine learning to create estimated MRI images or PET images. We also have our biomarker of function, but that’s more used for the therapeutic side to see the effects of the therapy, and less so to evaluate the damage. But yes, those results are available immediately. It’s hard to make that claim today in terms of if you’re a patient using Vistim for the first time today, I don’t know if I can tell you for sure that you’ll get your results today just because this is a new technology. We released it only two months ago. We are adding an annual review stage for the reviews and the images before they go out, just to make sure that we trust this report in the hands of the patient. 

But, yes, this is designed to give you answers today that you can understand immediately, not even as a clinician, just as a patient. What is going on with my health and not just some subjective measurement of, Hey, well, we think that you’re doing better than average? None of that. This is what you can expect from an MRI. This is the odds of the MRI showing that you have damage if you were to do a PET scan. This is the result that you should expect from the PET scan. Just to put the power of the agency back in the hands of the patient, because you do have a cornucopia of options and you want to choose the one that is the best one for you, which is the one that’s going to come back conclusive. Which one is going to help me quickly get my diagnosis, quickly get my therapy, and, most importantly, quickly help my doctor get me the therapies from which I can benefit?

Heather Sandison, ND

Would you recommend repeating this pretty regularly so that we can assess if these therapies are working or if we need to change courses?

James Hamet

That’s what I’m most excited about at the moment. It’s so difficult to measure the effects of therapy that most physicians don’t even do it. I understand that at your clinic you do, and I think that’s one of the reasons your clinic is so successful. Yours, also, any clinic that follows Dr. Dale’s method—that’s what we want to do. We want to close the feedback loop and make it easier for every clinician to see the effects of therapy, but most importantly, to see the effects of therapy that are related to the person’s symptoms and quality of life. It’s not enough to say; it’s changed the proteins in your blood that you can’t see. How does that affect my quality of life? It doesn’t. If we can instead show, Hey, guess what? We found these improvements in your ability to see visually. We found these improvements in your brain’s functional ability to do complex math to remember your location in real-time. These are the very important things that help people live better. I know that with Dr. Dale’s method and, of course, with your method, too, since you guys practice together, you guys have succeeded in bringing people back from dementia to healthy living.

Heather Sandison, ND

I wish I could say that I practice with Dr. Dale Bredesen. But just to clarify, I have my practice. 

James Hamet

You have your practice, yes.

Heather Sandison, ND

He has been a mentor, and I feel very, very fortunate to call him a mentor. But I don’t want anyone to think that we practice together. Just to clarify there, I wish.

James Hamet

Thank you for the clarification. But, still, he’s at least published evidence of bringing patients back from dementia to full, healthy living. With the number of Americans who today suffer from dementia and with the availability of methods like his, which you practice, I just think it’s a shame that we still have patients who end up going to nursing homes and don’t end up getting the care that they need and end up having the end of their lives without any sense of control. It’s painful not only for them but also for their family, and I’ve heard so many stories now, even in my family, of people who, Hey, my mom doesn’t recognize me, and I’m caring for her every day. It’s just heartbreaking.

Heather Sandison, ND

It is heartbreaking.

James Hamet

I used to build for this company called Neurobiol, which you introduced me I’m from. My goal there was to help people in wheelchairs control things with their minds. That was to give them agency. Because once you’re in that situation, you have no agency. You’re dependent on others to move you around. Here, it is the same mission. It’s to prevent people from being in those wheelchairs. Over half of wheelchair users today in the U.S. are there because of neurodegeneration that was untreated. I’m hoping that with this type of technology, we can detect neurodegeneration early. We can administer therapy, measure the effects of therapy, and ideally prevent people from going into that wheelchair state. That’s my true mission here. Keep the elderly young. Keep them out of the nursing homes, out of the wheelchairs, and in control of their lives.

Heather Sandison, ND

I love it. Now everyone knows why I invited you on. We share the same passion and vision for making this an optional state of having dementia and Alzheimer’s, not an option. Another important consideration is cost. How much does this cost the patient?

James Hamet

That’s a very good question. It’s something that we’re working on. Our long-term goal is for this to be fully covered by insurance. We have a plan for that. We’re executing on that plan. We believe it’ll be fully reimbursed by 2025. At the moment, it’s out-of-pocket. That is going to depend on the clinic. I can’t say that for sure on this recording. But what I can tell you is that it’s not more than a couple hundred dollars.

Heather Sandison, ND

Nice. Trying to make it accessible, and if you’re considering paying out of pocket for something like an MRI or a PET scan, plus the potential for using contrast and the risks associated with that, Also, for MRIs, many people feel claustrophobic, so they choose not to do them, which can delay care. Having this as another option and maybe as a complement to the imaging or as an alternative, potentially, if you’re concerned about doing the radiation that comes with the PET CT, the contrast that comes with the MRI, or the claustrophobia that comes with an MRI.

James Hamet

Yes. I think that the biggest challenge that I see is the high rate of inconclusive testing. Doctors want to help patients, and I think that part is very clear and understood. The challenge is when you have someone who comes in and says, Hey, I can’t remember my way from the grocery store back home. I can’t remember how to walk around my neighborhood. It’s very difficult for anyone, let alone a physician, to figure out what to do with that information. What type of blood test do I need to do? Should I do a spinal tap? Should I do a PET scan? An MRI is pretty easy to do because you want to rule out a stroke. But besides that, there is very little guidance in terms of what to do with these tests because you have to go in with the test. If you do a PET scan, for example, and you’re using a tracer, a contrast, you need to know which one you want to use to look at which protein. because they only look at one protein at a time. 

You have to know in advance which of these proteins are going to be present so that you’re doing a good test. There’s nothing more frustrating, I think, than doing a spinal tap or a PET scan, looking at the wrong endpoints, getting an inconclusive result, and then you’re back at square one. I didn’t learn anything new other than that this biomarker is not there, and potentially it’s not there yet. Potentially, I have to do this test again, but in a year. That is who I am, and when I say guesswork originally, we want to remove the guesswork because there’s more information to be had before making a costly decision. Do I need to pay out of pocket for a PET scan? I’d love to ask you, Heather, what do you see with your patients when they choose to go through with these procedures? If I choose to get an MRI, how much am I paying out of pocket?

Heather Sandison, ND

Yes. I don’t tend to do a lot of imaging because I don’t always see it change the course of treatment. Most patients, by the time I’ve seen them, have seen a neurologist. It’s not my area of expertise in terms of MRI’s and CT’s. That isn’t, and I’m not doing acute things. If someone potentially has a stroke, then hopefully they’re going in through the emergency room and getting that addressed right away. Strokes need to be treated immediately so hopefully, those are identified and treated in the emergency room. When I see someone, they’ve typically been to a neurologist, potentially had some workup, or they’ve been to their primary care, and they’ve been offered the traditional medications for cognitive decline. 

We were running NeuroQuant for a while. But my understanding around those was that you wanted to use the same MRI machine and you wanted the same radiologist, hopefully looking at those. NeuroQuant are quantitative. They’re measuring the different parts of the brain—the hippocampus and the ventricles. They’re measuring these different parts of the brain so that over time you can see, okay, are these things atrophying? Are they getting smaller? Are they getting bigger? At what rate are they changing? What you want is to be able to compare serial images. Compare them from year to year. If you don’t have the same machine being used and you’re not potentially using the same radiologist, even though you’re using the same software, you might get differences that draw the wrong conclusion. That was my understanding. then these were quite costly out of pocket. They were running anywhere from $600 to $1200, depending on which imaging center was doing them, and it kept changing. 

One imaging center would have it available for a while, and then they would let their licensing for the software lapse, and we’d have to go to a different imaging center. so it became less valuable from my perspective. Many times, it was something that we were using to track changes. I always caution patients: if this isn’t going to change the course of treatment, if you are concerned about resources, if you’re allocating dollars to this and you don’t have it, must apply, then let’s make sure we focus first on the labs that are going to change the course of treatment. That’s when we wanted to focus more on the toxins, the potential infections, and the nutrient imbalances because those direct the treatment plan. There’s a lot to consider. I talk patients through that, and I feel what you were offering, particularly when it’s covered by insurance. It becomes a no-brainer. If you don’t have it and there’s no out-of-pocket cost to it, then, of course, we want to get this done. 

I think if the cost is a couple hundred dollars, that makes a lot of sense for people. They don’t have to go through and schedule the MRI. It’s a very easy thing to do. If it takes less than 30 minutes and it’s under a couple hundred dollars, that’s a pretty accessible test. I love the idea of being able to track changes over time. A picture, even if it’s an AI-generated picture, can say a thousand words. There’s so much communicated, and it’s inspiring, and motivating to see your brain grow. As you mentioned, Dr. Bredesen and Kat Toups, Anne Hathaway, and Deb Gordon did a clinical trial that was published in the Journal of Alzheimer’s Disease in 2022, and they showed MRIs where the brain tissue was increasing. Of course, when patients see that, it is so motivating to stay on track and to continue with the therapy.

James Hamet

I remember going through a weight loss program where I would get frustrated, stepping on the scale every day. Why isn’t it changing? But when you do that over months, when you do that with therapy, when you do that with a real intervention, whether it’s dietary or metabolic, and then you start to see the long-term changes, it’s just so motivating. It keeps you on it. I remember struggling with specifically the different types of diets, and then the moment I started to see real progress was when I felt the strength to stick to something. 

One of the reasons that I started this technology as well is that my parents are physicians. My dad is a neuroradiologist. The story that you’re telling me now about how, looking at the different machines and making sure to use the same neurologist or radiologist, my dad and I talk about that all the time. You do have to look at these images in serial to make use of them. How do you connect that to therapy? It’s still difficult. It takes significant changes in the brain to see changes in an MRI. That’s one of the reasons that I wanted to try to build this technology here.

Heather Sandison, ND

To pick up on more nuanced things. I can’t tell you. I’ve had half a dozen times at least someone come into my office with a NeuroQuant, with some imaging, and say, The hippocampus is so small. I don’t know at that point, did they maybe anatomically; they just have a relatively small hippocampus; maybe they started there or did it change? Is there evidence that there’s part of the manifestation of dementia in their brain at an endemic level? I don’t know if I just have a good one. 

James Hamet

Yes. Some people get concussions when they’re kids, or they play sports, and they don’t tell you. They forgot to tell you. By the way, I used to play football in college. Just a minor concussion is going to cause amyloid in the brain.

Heather Sandison, ND

Nights of sleep deprivation will cause dementia because there are so many things that can lead to dementia. I think that’s why it’s so important to be precise. But this is just a powerful tool. that, using AI, it is only going to become more and more so. Also, I’m just thrilled at how accessible you’re making it to patients. If somebody who’s listening wants to get this testing done, how do they go about finding a doctor who’s offering it? Should they tell us how we can find out more?

James Hamet

That’s a very good question. I would say speak with others; speak with Dr. Sandison. Alternatively, yes, we have to make sure that we do this the right way. I’m not technically, I think, allowed to send people to clinics, for example. But what we can do is tell you a list of clinics that have our technology, and then you can pick one that’s close to where you live. We have clinics in California that use our technology. There are clinics in Arizona and southern Florida. We’re mostly starting in the south. But if we don’t have a clinic near you, please let us know, and if you have a neurologist there who you’re working with, we’d love to bring our technology to them.

Heather Sandison, ND

Or a Bredesen-trained provider.

James Hamet

Yes, a Bredesen is a trained provider. This is not a technology that we’re holding back. I didn’t build this company to make money. We’re not. It’s not our goal to charge patients or doctors anything. Our goal is to get the technology out there, even at a cost. If there’s a clinic that wants this technology, we’ll make sure that it happens somehow. Then we’ll bring it to your neighborhood and make sure that you have access to it.

Heather Sandison, ND

The way that you’re getting this out there is by connecting with doctors who are willing to set up the infrastructure in their offices to provide this test to patients. That sounds doable if you can. If you have a Bredesen-trained provider, they’re typically going to be interested in this technology. they might have, especially if they already have an EEG machine. It might just be a matter of plugging in the software so that they can get this test going for you. Let them know, and please let them know about James and his work and direct them to his website so that they can learn more if they’re interested.

James Hamet

I will say that a Bredesen-trained provider believes that they can help you, who believes that they can provide therapies, and who can bring you back to normal living. That’s key to believing in our technology as well. A lot of clinicians see that their job is just to diagnose and then prescribe. That’s not every clinician, and it’s not, I would say, the clinicians that I’ve met in the private practice world, and certainly not the clinicians that are familiar with Dr. Dale Bredesen’s work. Any clinician who wants to improve your condition, not just help you live with the symptoms, is someone we want to work with.

Heather Sandison, ND

Awesome. Tell everyone again how to use your web addresses and how they can find out a little bit more if they’re interested.

James Hamet

Sure. Our Website is vistimlabs.com, and you can email me easily, at  [email protected]

Heather Sandison, ND

Vistim is spelled.

James Hamet

V-I-S-T-I-M and it means visual stimulation. I’ll even leave my phone number. I’m not afraid of telemarketers. My number is 203-940-3751. You can call me directly. I’m a normal human, just like you.

Heather Sandison, ND

James. Thank you so much. It’s always a pleasure connecting with you. I’m so inspired by your passion and also to see your dedication and compassion for people who are struggling. Thank you for doing the work you’re doing to create solutions and get the information out there, the testing out there, so that people can get the help that they need to reverse and prevent dementia. Thank you.

James Hamet

Let’s Reverse Alzheimer’s.