BEATING ALZHEIMER’S
New research identifies early signs and prevention breakthroughs.
Sometimes I walk into a room and can’t remember why. I lose my keys. I blank on names. So I wonder: Could I be heading for Alzheimer’s, the way my dad and my grandmother did?
Or is there a way I can beat such a fate?
That’s how I found myself in a New York City doctor’s office one recent winter afternoon, playing computer card-matching games and identifying smells like lemon and Play-Doh.These brain tests were part of my extensive workup at Weill Cornell Medicine’s Alzheimer’s Prevention Clinic, the first of its kind in the U.S. and one of only a handful of centers to focus on the emerging science of dementia risk assessment and prevention strategies.
I came in at a great time, clinic founder Richard S. Isaacson, M.D., a neurologist, tells me. Even five years ago, the idea that Alzheimer’s was preventable was laughed at. “In medical school, I was taught that dementia just starts one day,” Isaacson says. “Today we know differently.”
Scientists now think a complex mix of lifestyle, genes, age, environment and health conditions leads to the brain changes of Alzheimer’s—up to 20 or 25 years before obvious symptoms.That’s another reason I came to the clinic at a good time. At age 57, I’m exactly 25 years younger than the average age of my relatives when their memory loss and odd behaviors first showed up.
“There’s been a shift toward changing the progress of disease before symptoms occur that’s really exciting,” says Maria C. Carrillo, Ph.D., chief science officer of the Alzheimer’s Association.
“Alzheimer’s is finally joining the list of diseases we can have an early effect on,” says Harvard neurologist Reisa A. Sperling, M.D. She compares it to heart disease or diabetes, which are treated preventively with a mix of lifestyle fixes (like diet) and targeted medications (like statins), and to cancer, for which there are routine screenings.
The idea of treating Alzheimer’s “upstream,” long before we fail to recognize family or forget what a phone is, was sparked by the ability to finally see and track the biomarkers showing early brain changes. Given that hundreds of drugs have been thrown at cases of full-blown disease, only to wipe out during testing, starting further back makes sense. As with heart attacks, not every case might be avoided—but what if you could delay the onset for five or 10 years? Or until there were a cure?
Predicting Alzheimer’s Risks
At the Alzheimer’s Prevention Clinic, I step on a large machine that looks like a cross between a fancy scale and a treadmill. As I stand still, it “reads” my body fat, lean body mass, muscle strength and more. A clinician measures my waist and asks how it’s changed since my 20s. (Oops, 4 inches bigger.)
These body measures, or “anthropometrics,” represent the A in what the clinic calls the “ABCs of Alzheimer’s prevention.” The B stands for blood biomarkers. Blood tests reveal nutritional, lipid, metabolic, inflammatory and genetic markers of possible problems—everything from my cholesterol numbers to whether I have one of the genes linked to Alzheimer’s risk. And C stands for
cognition (thinking skills), measured by 1½ hours of those brain tests.
I also supplied an intensive health history about my diet, exercise, stress level and more. Among the more curious questions: my high school rank (18 in 650), because early achievement has been shown to be protective, and whether I dream (oh, yes!), a sign of good sleep.
The goal: to assess threats and identify fixable issues known to affect brain health. You can’t do much about some things that raise your risk of Alzheimer’s, like your genes, gender (higher risk for women) or age (about 1 in 3 adults get dementia, but by age 85, the odds are 50-50).The big opportunity lies in modifiable risk factors: what you eat, how you sleep, blood pressure, overall fitness, even your waistline (abdominal fat raises your risk threefold).
“Genes are not your destiny,” Isaacson says.The hot word is epigenetics: changing the expression of our genes by changing how we live.
Fish and Wine Are A-OK
Reviewing my data, Isaacson grades me an A on my A’s, anthropometrics. They show 21.9 percent body fat, “pretty darn good,” if short of optimal. My wider waist is still OK but a spot to watch.Though my legs are superstrong (I walk or run every morning), my core strength is sad (I slouch at a desk all day).
My blood work reveals a few surprises. I eat fish two to three times a week, but I’m low in DHA, EPA and ALA, omega-3 fatty acids linked to brain and heart health. I’m also low in vitamin D and, despite my “clean and green” diet, poorly absorb B vitamins. (My triglycerides rock, though, “so that wine isn’t harming you,” I’m told. Yay!)
At least my cognition scores are great. “I don’t think that extra inch in your waist is affecting your cognitive function,” Isaacson tells me. We all lose keys and forget names due to normal aging, distraction and stress; it’s when mental slips interfere with everyday life that doctors get concerned.
The ABCs are interconnected. Memory and metabolism (indicated by body fat) often go together,for example.Those with an APOE-4 gene, a type linked to higher risk of Alzheimer’s, respond differently to certain drugs and nutrients. (I don’t have it.) So Isaacson bases recommendations for reducing risk on a patient’s individual data picture, an approach called precision medicine.
Up to one-third of dementia cases can be delayed or prevented by steps we already know, found a 2017 Lancet report. But there’s no single “magic bullet,” says Mary Butler, Ph.D., of the Minnesota Evidence-Based Practice Center, whose recent reviews showed no single drug, supplement, exercise or braintraining program has been proven to do the trick. Scientists are also exploring drugs that could, like statins for heart disease, work preventively in high-risk patients. “The body is complicated.The brain is complicated,” says Isaacson.“The roads to Alzheimer’s are different in each individual.”
How Worried Should We Be?
Relief! My assessment reveals that most of my modifiable risk factors seem under control, with some room for improvement. I could still, of course, get Alzheimer’s; who knows what genes lurk undiscovered? And what if I’m among the 47 million Americans who, according to a new UCLA study, have no disease symptoms but already have neurodegeneration or buildups of amyloid protein in their brains?
Normally this protein is routinely cleared away, but if that doesn’t happen it forms clumps that, for some, lead to Alzheimer’s. Increasingly researchers think any brain can become less efficient at “clearing out the trash” over time.
It’s impossible—too costly—to scan every brain for amyloid right now.
Luckily what’s already known about prevention is cheap and safe. Isaacson employs a “tech team” exploring digital ways to spread this info and more quickly train more doctors how to do assessments.
Meanwhile, I’m really motivated to tweak what I can. A supplement skeptic, I’m giving omega-3s and my prescribed vitamins a trial run. Since tests show I’m an overabsorber of cholesterol, I’ve cut back on cheeses and switched my beloved whole-milk vanilla Greek yogurt for nonfat plain (with berries, it’s still sweet!). I haven’t tried sitting on a balance ball while working, but at least I’ve located the muscles to strengthen my core. I’m determined to shrink my waistline to “optimal” size.
My No. 1 takeaway: The little things we do add up—for our bodies and our brains. So why wait?
Beating Alzheimer’s is not one size fits all, says Weill Cornell’s Alzheimer’s Prevention Clinic director Richard Isaacson. About 40 percent of riskreduction strategies depend on factors unique to you, like genetics and physical condition. “Some people can do everything right and still get Alzheimer’s,” he says.
Still, the other 60 percent of ways to lower your risk apply to everyone. Start here:
Know your “numbers.” Get basic blood tests to find out your cholesterol (including HDL, LDL and triglycerides), blood glucose and homocysteine. Learn your blood pressure (hypertension in midlife is a key dementia risk), body-mass index (BMI) and waist circumference.
The good news: All are risk factors you can change if you’re outside normal ranges; any doctor can show you how.
Take a cognitive test. It’s useful to have a baseline of your current thinking skills, to compare over time. There’s no single best test, though it ideally should be less simplistic than the basic mini-mental state exam (MMSE) used to screen for AD. One you can try at home: the 15-minute SAGE test (for a link, go to alzu.org). Hang on to your muscle. We lose 1 percent of muscle mass a year if we don’t do anything about it. A mix of aerobic and resistance/ weight training helps burn the fat that leads to a more risky apple-shaped body. Maintain a healthy weight. There may be no such thing as “fat but fit,” recent studies say. Eat “green, lean and clean.” Almost every brain benefits from a plant-heavy diet (veggies, beans, whole grains, nuts, seeds) with lean protein (fish, especially) and low-fat dairy. Sourcing seems to matter: Grass-fed dairy and meat have less fat, and more of it is healthy. Use extra-virgin olive oil for everything.
Go fishing. It really is brain food. Fatty fish to eat twice a week include salmon, albacore tuna, mackerel, lake trout and sardines. Some people benefit from omega-3 supplements with DHA and EPA; they’re pricey and are best used under a doctor’s supervision.
Pass on late-night eating. At least a few times a week, try to hold out from after dinner until breakfast for 12 to 14 hours of no eating, or at least no carbs. This helps your body burn stored fats.
Put devices to bed. Sleep is likely as influential as diet and exercise, researchers think. Hit the hay in time to get at least 8 hours. Stop texting, checking email and watching TV at least 30 to 45 minutes before bedtime.
Balance stress with downtime. Every 4.5 years of work stress lead to one additional year of brain aging, Isaacson says. Yoga, acupuncture and regular vacations all help.
Keep busy and connected. Hobbies and friendships both relax and challenge the brain to learn new things. Social contact protects it. The word on brain games and crosswords is mixed— remember there’s no one magic bullet.
Visit the dentist and eye doctor. Surprise: Untreated tooth and gum problems can cause problematic inflammation. And if you’re having vision or hearing loss, treatment can spare you the resulting social isolation that is its own risk.
Take up the ukulele. Isaacson swears by the growing body of research on music’s benefits to the brain (he joined a band himself). Even listening revs you up for exercise and calms stress, but playing or singing is even better. Don’t smoke. But you knew that.
Consider genetic testing. Let’s be clear: It won’t tell you whether you’ll get the disease. Only a few genes have been linked to Alzheimer’s so far. The best studied is APOE, which helps regulate fats. We get one copy of it from each parent. The rarest variation, APOE-2, is protective against Alzheimer’s. APOE-3 is neutral. APOE-4 slightly elevates your risk. But you can have two copies of APOE-4 and still avoid Alzheimer’s, or not have any and get it.
So why find out? It can be a good motivator. “Our preliminary, unpublished data suggests that when people find out, their compliance to interventions increases,” Isaacson says. “Knowledge is power.” Doctors also use this info to shape treatments.
Join a clinical trial. Early-intervention research is “our best chance to cure the disease,” says Harvard neurologist Reisa A. Sperling. “The first person cured of Alzheimer’s disease will be in a clinical trial.” Search for studies you might qualify for at clinicaltrials.gov.