← The Peter Attia Drive

#18 - Richard Isaacson, M.D.: Alzheimer's prevention

Oct 1, 2018 2h 24m 32 insights
<p>In this episode, Richard Isaacson, a neurologist and director of the Alzheimer's Prevention Clinic at Weill Cornell Medicine and NewYork-Presbyterian, discusses strategies for staving off Alzheimer's disease. Richard shares a wealth of insight for people who want to know more about Alzheimer's and what you can do to help yourself and your loved ones – starting today and continuing throughout the entire lifespan.</p> <p> </p> <h2>We discuss:</h2> <ul> <li>Richard's fun-facts (and alter egos): "bling" phones, Doogie Howser, and DJ Rush [<a href="">8:00</a>];</li> <li>Richard's impetus to focus on Alzheimer's disease: Uncle Bob [<a href="">18:20</a>];</li> <li>Starting an Alzheimer's Prevention Clinic [27:00];</li> <li>How Alzheimer's is diagnosed [30:00];</li> <li>Short-term memory, processing speed, executive function and how they're tested [35:45];</li> <li>Prevention vs reduction of Alzheimer's [44:00];</li> <li>What is the prevalence of Alzheimer's in America? [49:30];</li> <li>How do people actually die from Alzheimer's or dementia? [51:30];</li> <li>How can people do everything right and still get Alzheimer's? It's all about AGE [55:15];</li> <li>The <em>APOE</em> gene [58:15];</li> <li>Why is the risk of Alzheimer's higher for women? [<a href="">1:13:00</a>];</li> <li>How many different paths lead to Alzheimer's? [1:15:45];</li> <li>What role does <em>MTHFR</em> play in Alzheimer's? [1:19:45];</li> <li>What are the "ABCs" of Alzheimer's prevention? [1:26:45];</li> <li>Baptists, Tauists, Syners, and Apostates [1:36:30];</li> <li>Concerns with statin use for high-risk patients [<a href="">1:45:00</a>];</li> <li>The use of Theracurmin [1:48:45];</li> <li>What are the five actionable things one can do to reduce the risk for Alzheimer's today? [1:54:30];</li> <li>The cognitive reserve [2:14:15]; and</li> <li>More.</li> </ul> <p> <span> Learn more at <a href="http://www.peterattiamd.com/"><span><u>www.PeterAttiaMD.com</u></span></a></span></p> <p> <span>Connect with Peter on <a href=""> <span> <u>Facebook</u></span></a> | <a href=""> <span> <u>Twitter</u></span></a> | <a href=""> <span> <u>Instagram</u></span></a>.</span></p>
Actionable Insights

1. Adopt Precision Medicine Approach

Implement a personalized Alzheimer’s prevention plan by triangulating genetic, anthropometric, biomarker, and cognitive data to address individual risk factors. This comprehensive strategy ensures interventions are tailored to your unique biology.

2. Educate on Brain Health

Learn extensively about brain health through free online resources like ALZU.org, which offers interactive educational content. This foundational step empowers you to make informed incremental changes throughout your lifespan.

3. Engage in Regular Exercise

Make regular exercise your top priority, as it is the most impactful intervention shown to reduce or slow amyloid accumulation in the brain. Aim for at least 150-180 minutes of mixed aerobic and strength training weekly.

4. Manage Vascular Risk Factors

Aggressively control blood pressure, cholesterol, and diabetes, aiming for a systolic blood pressure of 120 mmHg, to significantly reduce the risk of mild cognitive impairment. This is a major, tangible step for brain health.

5. Prioritize Quality Sleep

Ensure you get adequate and quality sleep, as it is crucial for overall health, effective fat loss, and healthy aging. Poor sleep can accelerate brain aging and negatively impact cognitive function.

6. Optimize Brain-Healthy Nutrition

Adopt a nutrition plan that emphasizes lower ‘good’ carbohydrates, abundant green leafy vegetables, and includes blueberries for their antioxidant benefits. This dietary approach supports metabolic health and brain function.

7. Monitor Key Health Biomarkers

Know your numbers by regularly monitoring key health metrics such as blood pressure, pulse, body fat, weight, cholesterol (including advanced panels), and blood sugar. This data provides critical insights for personalized interventions.

8. Build Cognitive Reserve

Pursue lifelong learning, higher education, and musical experience to build cognitive reserve and resilience against Alzheimer’s disease. Staying mentally engaged helps strengthen brain pathways.

9. Reduce Sedentary Time

Minimize prolonged sitting, as it is considered detrimental to brain health, similar to the risks associated with smoking. Incorporate more movement throughout your day.

10. Implement Stress Reduction Techniques

Actively practice stress reduction techniques such as meditation or deep breathing to support overall well-being and brain health. Managing stress is a key component of a comprehensive prevention strategy.

11. Assess Body Composition

Go beyond just weight and BMI by assessing your body fat, lean mass, and visceral fat to understand your metabolic health. Managing visceral fat accumulation is crucial for protecting hippocampal volume and memory.

12. Target Optimal Fasting Glucose

Aim for a fasting blood sugar below 95 mg/dL for optimal brain health, as this cutoff is considered more appropriate for cognitive function than standard diabetes thresholds. This helps prevent metabolic issues that impact the brain.

13. Understand Family APOE Status

Learn your family’s APOE status, as this genetic information helps assess individual Alzheimer’s risk and guides personalized intervention strategies. Knowing your genetic predisposition allows for a more targeted approach.

14. Rule Out Reversible Causes

If experiencing cognitive decline, ensure you rule out reversible causes such as thyroid dysfunction or B12 deficiency. Addressing these underlying conditions can sometimes improve or resolve cognitive symptoms.

15. Treat Depression for Cognition

Seek treatment for depression, as it can significantly impact attention and memory, sometimes mimicking dementia. Addressing depression can lead to improved cognitive function.

16. Consider Hormone Replacement Therapy

For women in early perimenopause (first 2-7 years) with vascular risks, consider hormone replacement therapy (HRT) for potential brain health benefits. Consult with a specialized physician to balance risks and benefits.

17. Supplement B Vitamins for Homocysteine

If you have elevated homocysteine levels, supplement with B vitamins, using metabolically active forms like methylfolate and methyl B12 if traditional B vitamins are ineffective. This intervention is most effective when combined with optimized omega-3 fatty acids.

18. Supplement with DHA-Rich Omega-3s

Supplement with DHA-rich omega-3 fatty acids for brain health, especially if you are an ApoE4 carrier, as it can take years for effects to manifest. Tailor supplementation to individual needs based on biomarker levels.

19. Consider Theracumin for Amyloid

For individuals with amyloid in their brain, consider using Theracumin, a nanoparticle curcumin, which has been shown to reduce amyloid accumulation over 18 months. Personalize its use based on individual risk factors and biomarkers.

20. Get Diagnostic Brain Imaging

Undergo brain imaging, preferably an MRI, to rule out structural issues like tumors, assess vascular burden, and check for brain atrophy. This provides crucial information for diagnosis and personalized prevention.

21. Personalize Statin Use

If using statins, consider a personalized approach, being cautious with high-potency statins, especially for ApoE4 carriers, and exploring lower doses or alternative types. Different statins may have varied effects on individuals.

22. Consider Intermittent Fasting

Explore intermittent fasting, aiming for 16-hour fasting windows five times a week, for potential brain health benefits. This dietary pattern may support metabolic pathways relevant to cognitive function.

23. Moderate Alcohol Intake

Limit alcohol consumption to a maximum of 4 drinks per week for women and 7-10 drinks per week for men. The evidence on alcohol’s brain health benefits is murky, suggesting less is generally more.

24. Maintain Social Connections

Cultivate and maintain strong social connections and support systems, especially for caregivers, as social isolation and loss can accelerate cognitive decline. Collaborative relationships provide crucial cognitive and emotional support.

25. Utilize 23andMe Data

For deeper genetic insights, consider downloading your raw data from 23andMe and uploading it to services like Prometheus, in consultation with a doctor. This can help uncover additional genetic risk factors.

26. Consider Biomarker Testing

If exploring participation in Alzheimer’s clinical trials, consider biomarker testing (e.g., amyloid/tau scans or spinal fluid analysis) to confirm the presence of Alzheimer’s pathology. This is often a prerequisite for trial enrollment.

27. Seek Prevention Clinics

If available in your area, seek out specialized Alzheimer’s prevention clinics, such as those in the network mentioned, for comprehensive and personalized care. These clinics offer expertise in multimodal interventions.

28. Fund Prevention Research

Consider reallocating philanthropic funding towards Alzheimer’s prevention research, as this area is significantly underfunded compared to treatment research. Even modest contributions can have a remarkable impact.

29. Utilize Podcast Show Notes

Access the detailed show notes for this and every podcast episode on the website for more in-depth information, readings, and links related to the topics discussed. These notes are a valuable resource for further learning.

30. Sign Up for Weekly Email

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32. Visit Peteratiyamd.com

Explore peteratiyamd.com for more information on the podcast, blog posts, and the ’nerd safari’ section. It serves as a central hub for content related to optimizing health and longevity.