Alzheimer’s Prevention Clinic: A New Approach to Disease Management Shows Benefits

VBCN - November 2016 Volume 3, No 3

The Alzheimer’s Prevention Clinic, a specialized program that focuses on the latest treatments for patients with Alzheimer’s disease and state-of-the-art prevention strategies, is helping to reduce the risks associated with the disease. With an emphasis on nutritional approaches, patients at the program receive a personalized plan based on risk factors, genes, medical conditions, and the latest scientific research.

According to first-year data from the Comparative Effectiveness Dementia & Alzheimer’s Registry (CEDAR) Project, the program is working—patients have seen significant improvements in executive function, processing speed, and even memory.

“We talk to our patients and make a clinical diagnosis of a preclinical disease, based on the patient’s history, cognitive testing, and body measurements, such as body fat percentage and waist-to-hip circumference,” said Richard S. Isaacson, MD, Director of the Alzheimer’s Prevention Clinic, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York City, at the 2016 American Academy of Neurology annual meeting.

“We’ve come up with a construct called ‘detectable cognitive impairment,’ where the person has no memory loss, but we can detect cognitive impairment on highly sensitive, computer-based testing,” he added.

Based on laboratory assessment (ie, nutritional, lipid, and genetic markers), clinicians at the clinic formulate an individualized plan.

“We try to get under the hood, look at the gauges, and give personalized attention to every patient. We modify risk factors, treat risk factors, and track our patients’ cognitive health with a follow-up visit every 6 months,” said Dr Isaacson.

Nutrition Is Key

There has been an exponential growth in the evidence linking brain health and nutrition, Dr Isaacson reported.

“People have heard of a heart-healthy diet, but we’re just beginning to deduce the benefits of an Alzheimer’s-healthy diet,” he said. “Nutritional approaches can absolutely move the needle on Alzheimer’s disease,” he said.

One study that randomized patients to the Western diet or to a brain-healthy diet (high in omega-3 fatty acids) showed that within 8 weeks, people with mild memory loss were able to improve their cognition by changing what they ate. Another study showed that patients on a high-carbohydrate diet versus a high-fat (or ketogenic) diet improved in every metric examined in merely 6 weeks.

Although nutritional interventions are not a one-size-fits-all approach, when it comes to Alzheimer’s prevention, there are specific targeted approaches that work, Dr Isaacson explained.

“Eating patterns, the amount that someone eats, and the intake of specific nutrients are absolutely correlated with Alzheimer’s disease. More precisely, supporting the mitochondria in a very specific way, with personalized approaches to diet, is the future of Alzheimer’s prevention,” he said.

Another important aspect of Alzheimer’s prevention is body mass; physical exercise improves overall health as well as reduces amyloid in the brain, Dr Isaacson reported.

“Targeted exercise is key,” he emphasized. “We look at body fat percentage and waist-to-hip circumference. Because insulin resistance is one of the roads to Alzheimer’s disease, it’s important for patients to reduce their body fat. We do this by increasing lean muscle mass through weight training.”

Participation in musical activities can also delay the onset of Alzheimer’s, Dr Isaacson noted, as can social interaction. Finally, reducing stress, particularly neuroticism, can also help reduce brain aging.

Prevention More Effective Than Treatment

Although preliminary results from the CEDAR Project have shown that the program’s approach is effective, clinical responses are more robust to the prevention of Alzheimer’s disease than they are to the treatment of the disease. Of the 523 patients enrolled in the registry, 274 (average age, 68 years) received treatment for clinically diagnosed Alzheimer’s disease, and 229 (average age, 56 years) received preventive strategies.

“If patients comply with their personalized plans, we’ve shown that at 6 months, executive function, processing speed, and memory are improving. However, judgment, planning, and processing speed are responding more so than memory,” said Dr Isaacson.

“Prevention patients respond much more robustly than treatment patients, which is why it’s so important to get to patients early….I don’t know yet if we’re preventing Alzheimer’s, but we may be able to improve brain health with multimodal interventions,” he added.

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