CEimpact Podcast

Alzheimers Disease What Pharmacists Need to Know

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Alzheimer’s Disease remains one of the most pressing challenges in healthcare, with new treatments and research breakthroughs reshaping the landscape of care. This episode dives into the latest advancements, including current medications, clinical trials, and emerging therapies that pharmacists need to know. Stay informed and ready to support patients and caregivers—tune in to expand your expertise and navigate this evolving field with confidence.

HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact

GUEST
James Hoehns, PharmD, BCPS
Clinical Professor
University of Iowa

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CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Describe the current treatment options for Alzheimer's Disease.
2. Identify key considerations for pharmacists when counseling patients and caregivers on Alzheimer's Disease management and emerging therapies.

0.05 CEU/0.5 Hr
UAN: 0107-0000-25-042-H01-P
Initial release date: 2/24/2025
Expiration date: 2/24/2026
Additional CPE details can be found here.

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Speaker 1:

Hey, CE Impact subscribers, welcome to the Game Changers Clinical Conversations podcast. I'm your host, Josh Kinsey, and, as always, I'm super excited about our conversation today. Alzheimer's disease is a devastating condition that not only impacts millions of patients, but also places an immense burden on families and caregivers. In today's episode, we'll discuss the evolving treatment landscape, recent breakthroughs and how pharmacists can play a critical role in supporting patients, navigating new therapies and providing compassionate care. It's so great to have our expert for today, Jim Haines, joining us for this episode. Jim, thanks for joining us. I appreciate you giving us your time today.

Speaker 2:

My pleasure. Thanks for the invitation.

Speaker 1:

Yeah, so before we jump in, just so that our learners know a little bit about you, if you want to take a couple of minutes to tell us about your practice side and kind of what you do and why you're passionate about today's topic?

Speaker 2:

Yeah, thanks, josh. So I'm a pharmacist, you know, by training I'm a clinical professor with the University of Iowa College of Pharmacy. My practice site is off campus up in Waterloo and gosh.

Speaker 2:

For 28 years I was with the family medicine physician residency program up here in Waterloo, which was again a wonderful position, and enjoyed that a lot. And then during that time we did a lot of clinical research studies as well. So I was also the research director there, worked with a lot of great physicians, and then just a year ago I moved to my practice site here in Waterloo to Cedar Valley Primary Care with Dr Jim Polk and also we have Cedar Valley Clinical Research. So we are still doing the clinical research activities, very similar to what we were before, but just at a new site. And I had worked with Dr Polk for 13 years before and excited to be kind of back with him here in this new setting. And one thing I should clarify is truly, I mean again, I'm not an expert in Alzheimer's, I'm just being brutally honest that you know my background and training is really more of a generalist and everything. But I have had some, you know, some neat fun experiences with related to some Alzheimer's research which I'm happy to share those as well.

Speaker 1:

Yeah, absolutely. Thanks for clarifying. I think I usually use the term expert loosely in a sense that you are practicing clinically and are an expert in that realm. So we appreciate you giving us your time and your expertise for today. So, yeah, awesome. So let's go ahead and jump in then. I know that this is obviously, as I mentioned in the segue at the beginning, it's such an impactful disease. It's such a horrible disease that we see impacting not just our patients but the families and the caregivers and anyone that really comes into play. I always like to level set at the beginning of an episode and just make sure that everybody's on the same page. So just remind us a little bit about Alzheimer's disease. What are some of the things that we see typically with that and really kind of the impact that we see that it has on our patients, their caregivers.

Speaker 2:

Yeah, Alzheimer's is a, as you know, obviously is a chronic neurodegenerative disorder of unknown cause and usually kind of gradual or insidious onset that can lead to, you know, to progressive problems with cognition and thinking and behavior and is the number one cause of dementia, you know, worldwide. And, just as you said, it's a you know. It's devastating, obviously, for the individuals affected, but also terrible for the family members and caregivers and a very expensive disorder as well, not to mention the human aspect of it.

Speaker 1:

Yeah, yeah for sure, and also just to remind everyone, and again to set the foundation there is no cure for Alzheimer's. There are some treatment options that are out there. No cure for Alzheimer's. There are some treatment options that are out there. We can, symptomatically, kind of control some things as well, but there is no current cure for Alzheimer's, correct?

Speaker 2:

Absolutely correct, yeah, so no, I think there's still enormous uncertainty, even for the cause. You know overall, and certainly a number of different hypotheses in that regard. But yeah, certainly no cure, I would agree.

Speaker 1:

Yeah. So let's talk a little bit about the treatment landscape. As I mentioned, I think in the most you know, in a few recent years we've had some breakthroughs and some different things that seemed very promising and maybe didn't pan out as much as we had all hoped that they would. But then of course, we've had symptomatic treatment and management for several years now. So maybe let's just level the playing field of what's out there in the realm of treatment options and management of the disease and just kind of go from there.

Speaker 2:

Yeah, no going back. I was just trying to think if we could almost go way back in time to Atacrin or Cognex again a brand name of a drug that now is no longer removed, but was the kind of precursor of the among the class, though that's still available and that's the you know. So the most commonly prescribed drugs are the cholinesterase inhibitors, and these would be medicines like Dinepazil, rivastigmine or Exelon or Galantamine as well would be another one and really they've kind of been the go-to drugs.

Speaker 2:

You know that standard drugs. For the last gosh it almost feels like you know 15 years or so or you know maybe even longer than that.

Speaker 1:

Yeah, I would say it's. I remember them in school so I guess it's been probably pushing 20 now.

Speaker 2:

Yeah, it probably, is it probably?

Speaker 1:

is yeah, and but as of recently, there's been some breakthroughs and some other medications, so you want to kind of mention a couple of those or talk a little bit about those yeah.

Speaker 2:

Yeah. So there are there's. You know it's kind of been an again a resurgence of interest in activity and a lot of clinical trials all around, some new therapies and everything. So two new medicines that are that have received traditional FDA approval, and that's licanumab or lekembe, and then the other one that was approved a year later, I think in summer of 24, was dinanumab or casunla, and so two new monoclonal antibodies. Both are IV medicines and you know I'm sure we'll go through and talk about them, but they have both shown improvement in slowing the loss, if you will, of cognition when studied in some very rigorous clinical trials to evaluate their efficacy.

Speaker 1:

Okay, okay, yeah. So while we're here, let's go ahead and chat about them. So what you'd mentioned too that you'd been involved in some studies and things like that, so let's chat about those as well. What's kind of been your role in that and maybe?

Speaker 2:

what's kind, you know, to decrease the amyloid plaque burden, you know, within the CNS or within the brain that's associated with Alzheimer's disease. So later we'll probably talk about some of the testing. But you know, one of the first prerequisites, you know, for even receiving the medicine is to have some lab evidence or some evidence of amyloid pathology.

Speaker 2:

So, that could be an amyloid PET, or it could be a CSF biomarker or it could be a blood-based biomarker. But that's kind of a prerequisite for even receiving these medicines, because their sole mechanism is to try and decrease the amyloid levels.

Speaker 1:

And that's not seen in all Alzheimer's patients, like not everyone would have that marker. Is that?

Speaker 2:

Well, I should say that that, no, I mean not not all of them, but certainly the vast majority of the patients with Alzheimer's do have that.

Speaker 1:

Because I think and correct me if I'm wrong again this is definitely not anything in my realm of expertise at all, but I think what I remember hearing was that at one point it was thought that that was the cause of the progression of disease. Was the amyloid plaques right? And so now I think it's come about that it's maybe a player, a contributor to the progression, but it's maybe not the sole cause.

Speaker 2:

Yeah, no, I think there's. I think it's fair to say there's still uncertainty plaques would lead to or facilitate the formation of the tau tangles, which could go on and lead to or facilitate some of the neurodegeneration and clinical symptoms then. But I mean again, it's probably an oversimplification to state that and everything.

Speaker 1:

But the key thing is there's two new medicines that are available on the market that are available and uh, you know they've shown uh some, you know some improvement in improving uh cognition over a 18 months period yeah, okay, great, let's talk a little bit about and we can talk further about them when we when we talk about some opportunities for our pharmacists and the education they provide and counseling and so but let's briefly touch on how well are those medications tolerated by the patients? Let's talk about side effect profiles. Is that something of concern or are they pretty well tolerated?

Speaker 2:

Dr Joseph McNaughton. Yeah, when I think back about training that I received and you probably had the same thing, josh we're always kind of told to evaluate drugs from you know efficacy, side effects, you know cost, ease of use or you know as well, and so side effects are always important, you know, to adverse events, to look at them and these drugs they do have some unique side effects. You know, in general we'd always say hey, you know, as a platform. You know monoclonal antibodies are usually pretty well-tolerated drugs.

Speaker 2:

You know overall, but with their mechanism that these have, you know, targeting the amyloid plaque or some of the kind of the precursor protofibrils of amyloid, that there's really two main side effects that you hear talked about and these are, again to my thinking, kind of newer phrases, newer terms that we talk about AREA-E or AREA-H or AREA-E or AREA-H, and the acronym stands for amyloid-related imaging, abnormality-edema, kind of a vasogenic edema within the CNS, or the ARIA-H, and the H would be hemorrhage or hemocytarin, meaning some small, usually again, which would include such things as microhemorrhages, usually again, which would include such things as micro hemorrhages. So really the two big side effects you know, the principal ones of interest are the ARIA-E and ARIA-H, related to these anti-amyloid monoclonal antibodies.

Speaker 1:

Okay, Okay, and are those? Are they? Is that fair? Are they fairly common side effects, or you know?

Speaker 2:

it's, yeah, they, they are. Yeah, I would say common, because the you know the frequencies that we're seeing. You know it's, yeah, they, they are. Yeah, I would say common, because the you know the frequencies that we're seeing. You know they do differ a little bit between the two compounds, uh, but you're seeing frequencies, you know, anywhere from 15 percent up to 30 percent. You know.

Speaker 2:

Yes, that's um yeah, and and it's, but it may. There's a lot of very interesting aspects around them. You know, hey, what are the risk factors from it and there are some things that are well described, you know, for some risk factors and also just the aspect that even for the majority of patients who experience these are actually are asymptomatic. So they, you know, the patient may have no symptoms you know related to it and may not be aware of any of this, but it's picked up on the MRI scans that are part of the routine imaging follow-up. But some patients will have symptoms. Some patients will have symptoms of headache, dizziness, confusion et cetera, and usually those will resolve better on their own. Excuse me, I'm assuming, over time, over, you know, over, you know, over two to three months, they'll get better on their own, you know, and will. Would stop therapy with some of these-H. You know that would affect maybe when or if a patient's restarted on these drugs.

Speaker 1:

Sure sure. So you mentioned one with potential confusion.

Speaker 2:

I feel like that is like wouldn't that be hard to To distinguish and everything. Yeah, I think it would be, you know it would be new, you know to me it would be. But I mean to be clear. Yes, I mean it can be hard to distinguish, but again, I think the chronology and kind of maybe a little bit of some, you know, new and greater severity of worsening would be some key things.

Speaker 1:

Would be a key thing to look out for, yeah, okay, well, let's move into thanks for all the background and just to kind of set the stage and make sure that we're all on the same page as to what's out there and kind of what's coming out in the last few years. But what I really want to dig into now for the last half of our discussion is you know what are those I always like to give our listeners, you know, the tips and the tricks or the take-home points and things like that. So let's talk about some of the opportunities and challenges. What are some of the things that our pharmacists can be on the lookout for, what they can do? So one of the things as we were talking kind of in the green room before we got started with the recording is you know, I remember when I had my pharmacy get to know your patients really well, and so it was easy for me and my head tech, who was always by my side, my right-hand person it was easy for us to identify when a patient was just not the same.

Speaker 1:

They weren't acting the same, they seemed to be declining in their memory or they seemed to just not be as happy as they used to be or whatever, and so it was easy to kind of be like you know what Mr Jones is just not himself lately and to kind of watch out for that. So I think it's probable to assume that one of the things that we as pharmacists can do is look for the early diagnosis and look for the opportunities to kind of raise the flag that hey, you know, we may be in early stages or it looks like dementia is on set, you know whatever. What are your thoughts on that being an opportunity for a pharmacist?

Speaker 2:

Yeah, oh, absolutely. You know, just to Josh, as you said, in your community pharmacy you know examples a great one that you know few people, few health care professionals, interact with patients or see them as frequently, frequently, as pharmacists do and so he said the pharmacist is in a great position to to pick up on and observe, you know, changes in, you know in, in in functional status or activities or behaviors of patients and everything.

Speaker 2:

So, and historically, dementia, you know, is a woefully underdiagnosed, you know, condition. So, yes, I very much so think that the pharmacist can do a lot for identifying those changes. One other thing for the pharmacist that we definitely shouldn't discount or forget is, hey, just the importance of doing, if somebody has new onset, you know, apparent uh, difficulties with, uh, with cognition or thinking, that you know it's certainly time to double down and do another check on the medication profile. Right, you know so there's a lot of meds that can lead to worsening cognitive ability, and so I think a lot of times they get glossed over, forgotten. Meds like opioids, benzos, anything that's anticholinergic, even meds like topiramate and so many, any CNS depressant meds can lead to worsening thinking.

Speaker 1:

Yeah, that's a great call, Jim. You know the fact that another role that we can play as pharmacists is med history and, you know, looking at anything that we could deprescribe or, you know, decrease dose on or something. Yeah, that's a really great call out. What about? You know, we always like to say that we're the medication experts, so obviously I think it's important for us as pharmacists to be sure that we're also in the know, which is a reason why for this episode to kind of get everybody up to speed on what's happening in this space. But that's another thing, if you can speak to like, why it's important for us to stay in the know about what's going on with treatment options for Alzheimer's.

Speaker 2:

Yeah, I think these medicines are intended. You know the anti-amyloid drugs are designed as disease modifying therapy. You know that we think of them and you know these MABS in that fashion, just like we think of MABS in similar fashion, you know, for other conditions. But that's a novel concept because we don't have currently any other disease modifying therapy for related to Alzheimer's. The meds are expensive.

Speaker 2:

The manufacturers, for each they do have a lot of resources up on their websites but it's a lot of moving pieces on their websites.

Speaker 2:

But it is a you know it's a lot of, a lot of moving pieces in terms of involvement, you know. So not only do they have to be approved but for Medicare to cover these, you know they're going to have to patients have to get entered into a registry, you know as well, for that to be covered, but, man, there's a lot of it's a heavy lift for for a lot of other, you need the infusion centers, we need the MRI scanners that are, you know, required. Most of these patients really are going to have, you know, three to four to five MRIs. You know, within the first 12 months. You know that they have, you know, after starting the medicine. So a lot of cost. You know some estimates I've seen have said that total costs, you know, including all of the imaging and the doc visits required, could be up to 70 or $80,000 per year. And so if you think about a 20% Medicare copay for part B after somebody meets their deductible, you know so the expenses could be significant, you know, for patients as well and everything.

Speaker 1:

Sure, yeah, no, and you segued perfectly into some of the challenges, which is navigating the cost and the coverage and the access to it and whatever. So I think it's also important to note that these are not medications that you are going to really be dispensing in the pharmacy setting, so it's not necessarily something that you need to be in the know about for actually dispensing there. You may be in a certain setting, the one dispensing it, but you know if we think of a traditional community setting or whatever, but I think what's important is to know that your patient is on one, because you know of any sort of other interactions with other medications and the fact of just the continuity of care, just making sure that we're aware of what's going on with our?

Speaker 2:

patients, absolutely, you know. I mean there's, there are a lot of patient selection things to be mindful about, you know. So one, one big unknown is the relationship between patients that are on anticoagulants, and you know should they, should they not, you know, be allowed to?

Speaker 2:

you know to be on these medicines and there've been some different criteria in some of the different trials and some different analyses that have said, you know, are patients on anticoagulants at a higher risk of having significant head bleeds? You know, while they're on these medicines, Some analyses say no, some say yes, but that's an area of some uncertainty and where we need more information as well some uncertainty and where we need more information as well.

Speaker 2:

One thing I was going to mention now, just because I kind of keep forgetting to mention it, was the especially with the thought of the game changer aspect with the podcast.

Speaker 2:

You know one thing that I have been very, very impressed by, just with the reading that I've, you know, done over the last several years that are involved with some of the different studies, but the it seems like a true game changer for Alzheimer's is the increased role of blood-based biomarkers. Okay, dr, and so historically, some of the gold standard modalities that are used for helping diagnose Alzheimer's disease, maybe some PET scans, which are expensive, those could be looking at a host of different things, or even analyses of amyloid or tau from CSF fluid, which, again, we know is very invasive to get CSF fluid.

Speaker 1:

Who wants to do that, who wants to sign up for that and everything but the thing that's been really new is is the significant steps forward in terms of the blood-based testing and one in particular that I think deserves some special mention is a blood test called for P tau 217.

Speaker 2:

And there's different, and this is phosphorylated or hyperphosphorylated tau fragment of 217. That is a blood test. So you know when it's, you know and it performs very, very well in terms of the accuracy of the test of confirming not only you know CSF analyte of the same, but also an amyloid PET scan as well. So to me that's really becoming a game changer here, very, very soon to think about. Okay, so we've got a blood test and this recent work group just came out, even in 24, and said that with some of these plasma tests, if they have the same you know sensitivity and specificity and accuracy of the CSF tests. That a you know some of these can be used for diagnosis of Alzheimer's disease.

Speaker 2:

So, to me it's not hard to say, and it seems like we're in this transition period, then, where hard to say, and it seems like we're in this transition period then, where you know not too far down the road that and some might even argue you can do such now with being able to do, you know, a true blood-based test for Alzheimer's disease. That's interesting.

Speaker 1:

So, jim, where are those tests currently being conducted? Like who are they at a lab setting? Are they in the prescriber setting, like who is yeah? So I mean, I, I think for sure.

Speaker 2:

Yeah, for sure, the you know. So the neurology offices are using them. You know, like for the ones you know that we do here in Waterloo, they're set up for analysis, so they are available and everything, and so I think that's a significant step forward. And maybe one thing we haven't talked as much about is that with these newer drugs, really they've been approved for people with mild Alzheimer's disease.

Speaker 2:

So really patients with early Alzheimer's disease, very mild Alzheimer's related dementia or even MCI or mild cognitive impairment. The prevailing thought is that these newer drugs may turn out to be most effective in individuals who are even earlier than even than that in the continuum of Alzheimer's, the phases of Alzheimer's.

Speaker 1:

Oh sure. So getting in early, really, really early, and the blood tests may be able to be that biomarker.

Speaker 2:

Yeah, the blood tests are being used to identify patients to enroll into studies like these. And one thing just to be excited about because I do think this is an exciting part is that studies that we don't have back yet but are cooking and underway right now are use of these newer drugs in individuals who have preclinical Alzheimer's disease. So preclinical I'm emphasizing biomarker positive, but no symptoms.

Speaker 2:

So, those studies are already underway and it'll be very, very interesting to see, if you know, if they meet their endpoints of showing benefit at a very, very, you know pre-symptomatic stage, to see if they can delay the onset of symptoms.

Speaker 1:

Yeah Well, I don't know if you've followed what I was trying to get to with the who's doing the testing or whatever, but obviously, with the point of care testing expansion for pharmacists now in most states and the ability to do that, I guess my thought was is it going to eventually come down the road to where pharmacists can be the ones who are doing these testing early on for patients and determining whether or not they're candidates or have these biomarkers?

Speaker 2:

So you know, I think it's you know down the road, I think those types of possibilities will be there. Possibilities will be there. It is interesting that Quest had a direct-to-consumer test of you know related to amyloid pathology that they, I think they had it available for about six months and then they kind of changed it back again to where it was only accessible to prescribers and everything. But so I mean, I think there's certainly interest, you know, in those types of tests and everything.

Speaker 1:

Making them more available to the general public.

Speaker 1:

Okay, that's great.

Speaker 1:

So one thing I want to touch on before we kind of wrap up with our time I'm always shocked at how fast our time goes because I'm always just learning so much and then it's like time to go.

Speaker 1:

So one thing I did want to touch on, because we mentioned in the beginning, and it is something that I think is very well known for most everyone, is the burden on the caregivers as well. And I think the one way that you know pharmacists can't be these counselors, and that's not what we are, you know. But what we can do is we can provide patient counseling on education of the things, of medications and different things, and you know some of the side effect profiles or other medications that may be contributing, like we mentioned with the anticholinergics and things like that. So what are, if you can just speak on briefly, what are some ways that we can support these caregivers? What are things that we can do as pharmacists to kind of set ourself up for success there, to really kind of set ourselves up for success there, to really kind of help the caregivers, because ultimately that's going to help the patients as well.

Speaker 2:

So, yeah, I think you know one thing that you, I think you mentioned there was a little bit about expectation setting and I think this is a great thing to keep in mind. So they, these newer drugs, you know, just since we're kind of talking about them as well, there's not an expectation that they improve and function. So I think that is a powerful, you know, thought that we need to make sure that it's clear with people. So, meaning, you know, improvement over again their activities and function over baseline, that's not the expectation, you know. The expectation is to see if they can slow the progression of the disease and everything.

Speaker 2:

And it also makes it kind of reinforces why there's maybe some excitement and buzz to see what they can do in a population of individuals who have preclinical disease.

Speaker 1:

Because if we're slowing the progression before the side effects or before the decline and everything is showing up then, then we're really making a difference.

Speaker 2:

Yeah, yeah. But other support for Caregivers obviously they need all the support that we can give them for trying to help make the medicine-taking process as easy as we can for patients. Sometimes patients, especially as they get more advanced in Alzheimer's disease, have more difficulty with increased dysphagia as well difficulty swallowing. So we can be mindful about that, with trying to get formulations of drugs that can help people.

Speaker 2:

Uh, also, but I think also a big thing that we could, that we probably should be better about, is inquiring about the uh community resources that patients are tapped into. And uh, you know there's a. You know, definitely we should encourage people to be reaching out um to local resources in their area to to try and help them a, you know, definitely we should encourage people to be reaching out um to local resources in their area to to try and help them, you know, find some things that could help them with direct care and I I'm gonna do a shameless plug, jim, for a product that we have on you know, training for community health workers, which is, you know, a new kind of idea in the pharmacy space where technicians are cross-trained as community health workers and really kind of helping to make some of those connections and really kind of provide the information needed for these patients on varying resources, especially that affect this population.

Speaker 1:

So, yeah, there's certainly I think I make a CHW connection in almost every episode, so the listeners are used to that. That's great, as I show, I mean, it is something that can really benefit your patients in the practice settings, you know, in the pharmacy practice settings.

Speaker 2:

So, yeah, well, again, If you did a shameless plug, I'm going to sneak one in as well.

Speaker 2:

Yeah, sure, so we are actually right now we are recruiting for a phase three clinical trial here in Waterloo at our practice. So if any individuals 65 to 80, if they have concern about their thinking and would like to come in and be screened for a test. It involves involves a monoclonal antibody, also a amyloid plaque. It's a sub-q administration. So that's an attractive aspect of uh. You know. It would be an advance over, you know, maybe just like a once a month uh injection. Um, so yeah, reach out to me, give me a call, I'm sure josh will have my contact info but yeah, yeah, that's great.

Speaker 1:

Thanks, Jim. Well, as I always like to do before we wrap up, is just kind of circle back to the quote unquote game changer that we you know the name of the podcast. So, Jim, is a new class of drugs.

Speaker 2:

I mean, there's a new, you know there's two entries in it now that are available, but I think that's important for people to know that that's a new option. Significant side effects of interest that we have to be mindful about, sure, but we expect to learn more about their long-term effects. You know a lot of the extension. Parts of the studies are still ongoing, so it's good to know that these new drugs are available, but also some of the issues you know, good and bad, related to their use.

Speaker 2:

Sure, and then the other game changer I think to be mindful about truly is the huge increases in the comfort level, maybe with some of the, and use seems to be keep expanding for the blood-based tests to assess whether somebody has Alzheimer's disease.

Speaker 1:

Yeah, and I'll be honest, I think I knew this, but you drove the point home. And so to me, the game changer is reminding patients and caregivers that these new medications are not going to stop or reverse any of the cognitive decline or anything that we're seeing with our patients. They're simply going to slow the progression of disease. So there may not be a noticeable change. It's just almost like, trust us that it's slowing the progression, kind of thing. So I think that's to me that's big, because, again, setting the expectations of those caregivers is just so important in that, in that regard.

Speaker 2:

So I think you're right. But monitoring for clinical, you know effectiveness, you know is going to be very difficult, you know for these. But monitoring for side effects, you know it's probably more clear about. You know best practices for that.

Speaker 1:

Yeah, well, this was great, as always. I'm always walking away with tons of things learned, and I really appreciate you taking time to join us for this episode, jim.

Speaker 2:

Super, super appreciative, josh, my pleasure. Thanks so much.

Speaker 1:

Yeah, if you're a CE Plan subscriber, be sure to claim your CE credit for this episode of Game Changers by logging in at ceimpactcom and, as always, have a great week and keep learning. I can't wait to dig into another game-changing topic with you all next week.