Alzheimer's disease (AD) is a complex neurodegenerative disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out daily tasks. While antiamyloid agents are designed to have disease-modifying effects, their impact on functional and cognitive outcomes remains inconsistent and in question by some in the community. Many of those who treat AD, including Richard Isaacson, MD, believe that the disease will only truly be managed through a combination of therapies that target different aspects of the disease and a mix of behavioral and lifestyle changes.
Richard Isaacson, MD, director of the Center for Brain Health and Alzheimer Prevention Clinic at Florida Atlantic University, has been a leading voice in advocating for a multimodal, multitargeted approach to Alzheimer's disease prevention and management. He emphasizes the importance of addressing vascular risk factors through lifestyle choices, regular exercise, healthy nutrition (particularly a Mediterranean-style diet), and, when necessary, medication to manage blood pressure.
The Importance of Early Intervention
Dr. Isaacson stresses that Alzheimer's disease starts in the brain 20 to 30 years before the onset of symptoms, giving physicians ample time to intervene in an individualized fashion for those at risk. He established the Alzheimer's Prevention Clinic in 2013 with the goal of promoting brain health and reducing risk through a series of multidisciplinary interventions that target lifestyle behavior modifications.
It is estimated that 47 million Americans have preclinical Alzheimer’s disease and are not yet exhibiting symptoms. This offers specialists such as Richard S. Isaacson, MD, the opportunity to intervene early and potentially delay or prevent the progression of the disease.
Individualized Clinical Management: The ABCs of Alzheimer's Prevention
Dr. Isaacson's approach to Alzheimer's prevention is based on the concept of "precision medicine," tailoring interventions to the individual's specific risk factors and needs. He has developed a framework for practice for neurologists in the field of Alzheimer’s prevention. This involves what he calls the "ABCs of Alzheimer's prevention management":
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- A is for Anthropometrics: This involves assessing body composition, including body fat and muscle mass. Dr. Isaacson notes that a larger belly size is associated with a smaller memory center.
- B represents Blood-based Biomarkers: This includes testing for genetics, lipids, metabolism, inflammation, and nutrition.
- C stands for Cognition: This involves extensive cognitive assessments to establish a baseline and track changes in memory, function, attention, and language processing speed.
Patients undergo these assessments every six months, allowing Dr. Isaacson and his team to create a fine-tuned picture of their individual risk profiles and adjust interventions accordingly.
Lifestyle Modifications: A Cornerstone of Prevention
Dr. Isaacson believes that combining a variety of evidence-based low-risk interventions along with lifestyle modifications may help to delay, or in some cases, possibly prevent the progression toward dementia. Observational studies have shown that modifiable vascular, metabolic, and lifestyle-related factors have been associated with dementia risk. These interventions were found to be as effective in individuals who have the most common gene for late-onset Alzheimer’s disease.
Dr. Isaacson puts his beliefs into practice for himself as well. He emphasizes the importance of making the right lifestyle choices, including diet, exercise, sleep, and stress management.
Diet and Nutrition: Fueling the Brain
Dr. Isaacson emphasizes that when it comes to brain health, food isn’t just fuel, it becomes part of you. He advocates for a Mediterranean-style diet, which is rich in fruits, vegetables, whole grains, and healthy fats. This type of diet has been shown to have numerous benefits for brain health, including reducing inflammation and improving cognitive function.
Precision Nutrition for ApoE4 Carriers
The ApoE4 allele is the most well-studied genetic risk factor for Alzheimer's disease. Dr. Isaacson and his colleagues have proposed a precision nutrition approach for ApoE4 carriers, including a low-glycemic index diet with a ketogenic option, specific Mediterranean-style food choices, and a panel of seven nutritional supplements. This approach is based on recent discoveries about how ApoE4 differentially impacts microglia and inflammatory pathways, astrocytes and lipid metabolism, pericytes and blood-brain barrier integrity, and insulin resistance and glucose metabolism.
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Key Principles of Eating for Brain Health
Dr. Isaacson highlights the following key principles of eating for brain health:
- Prioritize whole, unprocessed foods.
- Focus on fruits, vegetables, and whole grains.
- Include healthy fats from sources like olive oil, avocados, and nuts.
- Limit sugar and processed foods.
The Role of Supplements
Dr. Isaacson views nutritional supplements as a potential tool to support brain health, but emphasizes that they should not be used as a substitute for a healthy diet and lifestyle. He suggests that certain supplements may have a positive effect on cognitive decline.
Exercise: Keeping the Brain Active
Regular physical activity is another key component of Dr. Isaacson's approach to Alzheimer's prevention. He notes that exercise helps to improve blood flow to the brain, reduce inflammation, and promote the growth of new brain cells.
Technology also has a major presence in their approach. Clinicians use wrist biosensor devices to measure patients’ exercise frequency and intensity, average pulse rate, maximum pulse rate, as well as REM, deep and total sleep.
Sleep and Stress Management: Protecting Brain Health
Adequate sleep and effective stress management are also crucial for brain health. Dr. Isaacson emphasizes the importance of establishing a regular sleep schedule and practicing stress-reducing techniques such as meditation or yoga.
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The Importance of Clinical Trials
The Alzheimer’s Prevention Clinic at Weill Cornell focuses on promoting brain health and reducing risk thorough a series of multidisciplinary interventions that target lifestyle behavior modifications. Because Alzheimer’s prevention is a nascent field with a paucity of literature, the Clinic’s methods are being rigorously tested in an ongoing clinical research study.
Dr. Isaacson’s team received NIH funding to undertake brain imaging in women ages 40 to 65 in a first-of-its-kind study aimed at defining the “critical window” for risk reduction.
Overcoming Skepticism and Embracing Prevention
Dr. Isaacson’s focus on prevention had its skeptics at first, but it seems like the tide is turning. He notes that the totality of evidence demonstrates that we can reduce risk.
A Personalized Approach to a Complex Disease
Dr. Isaacson's work highlights the importance of a personalized, multimodal approach to Alzheimer's prevention. By addressing individual risk factors through lifestyle modifications, targeted interventions, and ongoing monitoring, it may be possible to delay or even prevent the onset of this devastating disease.
The Future of Alzheimer's Prevention
Dr. Isaacson and his team have developed a framework for practice for neurologists in the field of Alzheimer’s prevention. He believes that we are making progress on understanding and preventing Alzheimer's disease, but there is still a long way to go.
Two out of three people affected by Alzheimer’s are women
Women actually are predisposed for a variety of reasons. First of all, women that have the APOE4 gene, which is a gene that that a lot of people get tested cause you can send away in different commercial tests that you can, you know, anyone can do right now. People who are women that have the APOE4 gene are at a higher risk than men with that gene. The other part where I think is really important is the menopause transition. The peri-menopause transition of women changes energetics - energy in the brain. And sometimes when people are on that perimenopause transition, they can fast forward down on the path to Alzheimer’s disease. And I think we’re just starting to understand why and what the goal is of our program and, and, and our research is to not just help patients as a whole, but also specifically hone in on women and try to understand what we can do during the peri-menopause transitioneto be protective.