One of the biggest challenges facing medicine as populations age is the cognitive decline associated with Alzheimer’s, the target of considerable investment in research which has yet to find a cure for patients with this distressing condition. But a pioneering Alzheimer’s prevention clinic at New York-Presbyterian/Weill Cornell Medical Center offers cutting-edge prevention strategies that can delay its onset.
The clinic was founded in 2013 by neurologist Richard Isaacson, who was motivated by the diagnosis of Alzheimer’s in four family members at a time when there was nothing that could ease their plight. Today, he says, it is possible to talk about interventions for Alzheimer’s and his clinic is treating hundreds of people ranging in age from 27 to 91.
‘We see patients with a family history of Alzheimer’s but no symptoms of the condition. It starts in the brain 20–30 years before memory loss appears: like a heart attack or a stroke, it takes decades to develop. We try to intervene with nutritional and lifestyle measures to delay the emergence of the symptoms.’
There is no ‘one size fits all’ for his approach, he says, but the risk of dementia can be reduced. While some risk factors such as age or genetics cannot be changed, others can.
‘It’s all about treating modifiable risks that can help win the war against genes – genetics are not your destiny. So if there is a gene that increases the risk of Alzheimer’s, the risk can be reduced by taking regular exercise, maintaining muscle mass, doing aerobic exercise and following a healthy brain diet.
‘To determine what a healthy diet is, we look at the patient’s cholesterol and metabolic markers such as blood sugar and insulin. We then select an appropriate brain-healthy diet which typically involves less carbohydrates, more lean proteins and lots of green vegetables, and is high in anti- oxidants such as dark cocoa powder.’
Other elements of the treatment involve intermittent fasting, specially calibrated doses of vitamins to slow memory loss and shrinkage of memory in the brain, and mindfulness techniques such as yoga and meditation to reduce stress. ‘Every four years of work stress equals one extra year of brain ageing.’
Prof Isaacson says that exercise can help create a healthy brain. ‘As you age, the bigger your belly is, the smaller the memory centre in the brain becomes. And it is important to keep the brain engaged – by learning a musical instrument or a new language, for example.
‘Sleep is also important: there are bad proteins in the brain called amyloids which exercise loosens up, but sleep is needed to flush them out. And we encourage patients to participate in clinical trials for products such as vaccinations that could prevent Alzheimer’s.’ This personalised approach is very time-consuming, he adds. With a ten-month waiting list, he encourages potential patients to use an hour-long online prevention course to brief themselves first. Consultations start with a battery of biometric and cognitive tests lasting an hour and a half, followed by a one-hour review of the results after eight weeks. Hour-long sessions every six months then monitor whether cognitive functions are stabilising and risk factors are reducing. ‘Including internal staff discussions, it takes more than six hours to prepare each personalised plan. But we now have a database of 380 patients that allows us to assess the effective- ness of our approach. This shows that our patients feel empowered to take action, they are less stressed and their risk factors are declining.
‘Overall, global cognitive functions seem to be improving, though memory loss is proving toughest to deal with. We will be able to find out if our treatment delays Alzheimer’s only after ten years, but that doesn’t mean waiting that long to use it. If we can delay the onset for six months, one year or five years, that will have a huge impact on patients and society.’