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New Report Offers Road Map to Reduce Alzheimer's Risk

Researchers at Weill Cornell Medicine and NewYork-Presbyterian present personalized approach for early Alzheimer’s disease prevention.

By Don Rauf

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The Alzheimer’s Prevention Clinic at Weill Cornell Medicine is laying out a road map for preventing Alzheimer's disease.
The Alzheimer’s Prevention Clinic at Weill Cornell Medicine is laying out a road map for preventing Alzheimer's disease.
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November 13, 2019

On Tuesday,Alzheimer's &Dementia:TheJournaloftheAlzheimer'sAssociation,publisheddetailsonacomprehensiveAlzheimer’sdiseaseriskreductionprogramcreatedbytheAlzheimer’sPreventionClinic(APC)atWeillCornellMedicineinNewYorkCity.

TheAPCfocusesonearlypreventionandtailoringtreatmentstotheindividualbyusingavarietyofpossibleinterventions.Inthepaper,theresearcherssharedguidelinesofaworkablemethodfordoctorstopersonalizeAlzheimer’sriskmanagement.

Earlyactionisespeciallyimportant,asrecentestimateshavefoundthatmorethan46millionAmericanscurrentlyhavepreclinicalAlzheimer’sdisease,accordingtothestudyinvestigators.

Alzheimer'sStartsintheBrain20to30YearsBeforeSymptomsAppear

“MostpeoplethinkofAlzheimer’sasanolderperson’sdisease,butitstartsinthebrain20to30yearsbeforesymptoms,”saysRichardIsaacson,MD,studyauthorandthedirectoroftheAPC.“WhensomeoneisdiagnosedwithdementiaduetoAlzheimer’s,theymayhavehadthediseasefor30years.Sowe’veseenpeopleinourclinicfromages25andup,whichsoundsshocking.”

TheAPC’sgoalisnottomanageindividualswhoalreadyhavedementiabuttohelpwithprimarypreventionandpredementiainthosewhoareatrisk.ManyofthepeoplewhovisitthepreventionclinichavenocognitivesymptomsbutdohaveafamilyhistoryofAlzheimer’s.OthersmayhavemildcognitiveimpairmentduetoAlzheimer’s,buttheydon’thavedementiayet.

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NoMagicPill,ButEvidence-BasedStepsPeopleCanTake

“WewanttohelpandreachasmanypeopleaspossibleatriskofAlzheimer’sdisease,andprovethattheclinicalpreventionofAlzheimer’sdiseaseisreal,andwecanbringastructuretoit,”saysDr.Isaacson.

“ThemaingoalofthispaperistotrainandeducatephysiciansonhowtocarefortheAlzheimer’spreventionpatient,”headds.“ThereisnomagicpilltopreventorcureAlzheimer’sdisease,buttherearedefinitelyevidenced-basedprocedurespeoplecanfollow.Wehopethispaperwillserveasaroadmapgoingforwardfordoctorswhowanttolearnhowtocarefortheirpatients,andhopefullythepaperwillgenerateinterestwithdoctorswhowanttocollaborateinamultisitestudy.”

OnlineLearningComponentforDoctorsandPatients

Inadditiontopublishingthisstudy,theAPCislaunchingafreeCME(continuingmedicaleducation)coursefordoctorsontheAlzheimer’sUniversewebsiteabouthowtocareforapersonwithAlzheimer’sriskfactors.Theorganizationisalsointroducingonlinecoursesformedicalstudents,collegestudents,highschoolstudents,andneurologyresidents.

TheAlzheimer’sPreventionClinicalsooffersatoolforindividualstolearnaboutAlzheimer’sdiseaseandtracktheirAlzheimer’sriskovertime.Clinicpatientsareaskedtocompletethe10-lessononlineAlzheimer'sdiseasepreventioncourse,whichisalsoavailableforfreetothepublic.LessonscoverthestagesofAlzheimer’sdisease,diagnosticstrategies,managementapproaches,andgeneticconsiderations,andofferdetailedinstructiononnutrition,physicalexercise,andcognitiveengagement,aswellasvitaminsandsupplements.

“Wehaveshownthatthemorelessonstheytake,themorelikelytheyaretoseeadoctor,joinaclinicaltrial,andmakebrain-healthylifestylechanges,”saysIsaacson.

MeasurableResults:ImprovingCognition,IdentifyingBiomarkers

Startedin2013,theAPChasdevelopedaclinicalframeworkthathasproducedmeasurableresultsinpatientsintermsofcognitionandidentifyingbiomarkersforAlzheimer’sdisease.Theapproachhasalsobeenusedsince2019attheAlzheimer'sPreventionClinicandResearchCenterinSanJuan,PuertoRico.

InastudypublishedinApril2019inTheAnnalsofTheNewYorkAcademyofSciences,Isaacsonandcolleaguesfollowed35patientsoversixmonthsandwereabletodemonstratethatparticipantshadimprovementsinexecutivefunctionandhigher-orderprocessing,aswellasspeedofprocessing,aftercompletingbaselinequestionnairesandassessments,includingcognitivetesting.

Inaposterpresentedin2019attheAmericanAcademyofNeurologymeetingandClinicalTrialsinAlzheimer'smeeting,theinvestigatorsfoundthat120participantsimprovedontestsoflearning,memory,executivefunction,andlanguageoversixmonths.

AttheAmericanAcademyofNeurologymeetinginMay2019,theauthorsplanonpresentingamuchlargerstudythatfollowed154patientsover18months.Thefindingsofthatresearchareyettobeannounced.

TheABCsofAlzheimer’sPreventionManagement

IsaacsonandhiscolleaguescentertheirprogramonwhattheycalltheABCsofAlzheimer’spreventionmanagement:

  • Asaretheanthropometrics,ormeasurementsofthehumanbody,thatplayaroleinAlzheimer’s,suchaspercentbodyfat,waist-to-hipratio,andbodyfatdistribution.Forexample,highabdominalfathasbeenlinkedtocognitivedecline.
  • Bsarebiomarkers,suchasbloodlipids(triglyceridesandcholesterol),inflammation,metabolism,nutrition,andgenetics.
  • Csareforthecognitiveteststhatcanhelpevaluateandtrackbrainfunction.

Basedonmeasurementsinthesecategories,doctorscandevelopanindividualplanforriskreductionthatmayinvolvepatienteducationandcounseling;pharmacologicsolutions,includingmedication,vitamins,andsupplements;nonpharmacologicapproaches,likephysicalexercise,weightloss,andstressmanagementapproaches; and nutrition, such as following a Mediterranean diet.

Medication may include drugs to manage hypertension or diabetes, both factors that have been linked to Alzheimer’s risk. Medication approved to treat dementia, such as Aricept (donepezil), Exelon (rivastigmine), and Razadyne (galantamine), are not included in the prevention management plan because the clinic does not treat those diagnosed with Alzheimer’s disease.

For people who have elevated levels of the amino acid homocysteine in the blood, clinicians may recommend B-complex vitamins. In previous research, high homocysteine levels have been linked with increasing the risk of Alzheimer’s. But according to Isaacson, people with high homocysteine levels respond to the B-complex only if they have adequate levels of omega-3 fatty acids in the blood. Suggesting B-complex vitamins for specific patients provides an example of the precision medicine component of the program, says Isaacson.

In addition to completing the 10-lesson online AD prevention course, patients are also asked to complete all of the activities available on the Alzheimer's Universe site, and every six months to retake the cognitive function test, face-name associative memory test, and the Neurotrack assessment (to gauge memory health).

The researchers assess patient ABCs every six months and refine or fine-tune the intervention based on the results of the repeated labs, body composition, and cognitive tests.

A Call to Action for Alzheimer’s Care Providers

Because Alzheimer’s is such a devastating disease, the Alzheimer’s Prevention Clinic is making these building blocks and tools available for other doctors, geriatric psychiatrists, neurologists, and other medical professionals to build their own clinics.

“This is a call to action. We have 30 collaborators throughout the United States and internationally, but we need to do this in a global international consortium. It’s the process of bringing like minds together. We are really looking for collaborators,” says Isaacson.






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New Report Offers Road Map to Reduce Alzheimers Risk
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Date: 11.12.2018, 01:05 / Views: 92353