DEAR DR. ROACH: I read about a new treatment for Alzheimer’s disease called NeuralCIM from Cuba. Do you think this is real? — J.B.

ANSWER: NeuralCIM, aka NeuroEPO, is derived from erythropoietin — the hormone that stimulates red blood cell precursors to make more blood cells. However, this intranasal form doesn’t stimulate blood cells; it does act like a similar hormone that is made by astrocytes, which are some of the “support cells” of brain tissue.

Among the activities of NeuralEPO in the brain are decreasing amyloid deposits; reducing programmed cell death (apoptosis); reducing inflammatory molecules; improving brain blood flow; and preventing the loss of synapses, which are the connections between brain cells.

A 2023 trial included 170 patients who were followed for a year. A third of the patients received a placebo, a third received low-dose NeuroEPO, and the remaining third received a higher dose of NeuroEPO. There was a significant improvement in the drug-treated groups (especially in the high-dose group), while the placebo-treated group showed a decrease in improvement. The effect size was much larger than previous studies that used the most common Alzheimer’s drugs, such as donepezil or memantine, although they weren’t compared directly.

Still, this was a relatively small trial, and the authors recommend larger trials to determine the efficacy and safety of this potential new drug, which isn’t approved by the Food and Drug Administration. I’ve seen many promising treatments look great in small trials and fail in larger ones, so I’m cautiously optimistic until additional trial results are available.

DEAR DR. ROACH: Thirty-six years ago, I was in a car crash with major injuries, including a broken sternum and back with injuries to my heart and lungs. Two years ago, I had a pulmonary embolism that revealed undifferentiated liposarcoma cancer, which I then had surgery to remove. Testing was done and determined that the blood clot wasn’t genetic, and there was no tendency to clot.

Two months ago, I had another pulmonary embolism, which resulted in me coding two times in the emergency room. Why did I get this second clot? Is it due to the car crash that happened many years ago? And what is my life expectancy now after these clots and the coding? I don’t want this to happen again. — J.S.

ANSWER: Cancers have long been known to increase the risk of abnormal blood clots. French physician Armand Trousseau noted the association between blood clots and cancer of the stomach and pancreas in 1865. (He subsequently diagnosed himself based on what is now known as Trousseau’s sign.) Any blood clot can then break off and go to the lungs, which is called a pulmonary embolism. Carcinomas (cancer of the gland tissue), especially pancreatic carcinoma, are the most likely to cause blood clotting.

Sarcomas (cancers of connective tissue) are less likely to cause clotting, but they still can cause it, especially when the tumor is large enough to compress the blood vessels. The important point here is that blood clots damage the vessels and always make recurrent blood clots more likely. In my opinion, it’s the cancer from two years ago (and the blood clot it caused) that put you at risk for the second embolism. I don’t think the car crash is a major issue.

For a person with recurrences of pulmonary emboli, especially the life-threatening type you had, most experts recommend lifelong anticoagulation. Although these medicines do increase the risk of bleeding, they reduce the risk of pulmonary emboli, and a balance of the risks and benefits is usually in favor of lifelong treatment. Your regular doctor or hematologist should discuss the options with you.