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#18 – Richard Isaacson, M.D.: Alzheimer’s prevention

Original release date: 10/1/2018 In this episode, Richard Isaacson, a neurologist and director of the Alzheimer’s Prevention Clinic at Weill Cornell Medicine and New York-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. We discuss: -Richard’s fun-facts (and alter egos): “bling” phones, Doogie Howser, and DJ Rush [8:00]; -Richard’s impetus to focus on Alzheimer’s disease: Uncle Bob [18:20]; -Starting an Alzheimer’s Prevention Clinic [27:00]; -How Alzheimer’s is diagnosed [30:00]; -Short-term memory, processing speed, executive function, and how they’re tested [35:45]; -Prevention vs reduction of Alzheimer’s [44:00]; -What is the prevalence of Alzheimer’s in America? [49:30]; -How do people actually die from Alzheimer’s or dementia? [51:30]; -How can people do everything right and still get Alzheimer’s? It’s all about AGE [55:15]; -The APOE gene [58:15]; -Why is the risk of Alzheimer’s higher for women? [1:13:00]; -How many different paths lead to Alzheimer’s? [1:15:45]; -What role does MTHFR play in Alzheimer’s? [1:19:45]; -What are the “ABCs” of Alzheimer’s prevention? [1:26:45]; -Baptists, Tauists, Syners, and Apostates [1:36:30]; -Concerns with statin use for high-risk patients [1:45:00]; -The use of Theracurmin [1:48:45]; -What are the five actionable things one can do to reduce the risk for -Alzheimer’s today? [1:54:30]; -The cognitive reserve [2:14:15]; and -More. Show notes page: https://peterattiamd.com/richardisaacson/ About: The Peter Attia Drive is a weekly, ultra-deep-dive podcast focusing on maximizing health, longevity, critical thinking…and a few other things. With over 10 million episodes downloaded, it features topics including fasting, ketosis, Alzheimer’s disease, cancer, mental health, and much more. Peter is the founder of Attia Medical, PC, a medical practice with offices in San Diego and New York City, focusing on the applied science of longevity. The practice applies nutritional biochemistry, exercise physiology, sleep physiology, techniques to increase distress tolerance, lipidology, pharmacology, and four-system endocrinology to increase lifespan (delaying the onset of chronic disease), while simultaneously improving healthspan (quality of life). Learn more: https://peterattiamd.com/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on: Facebook: http://bit.ly/PeterAttiaMDFB Twitter: http://bit.ly/PeterAttiaMDTW Instagram: http://bit.ly/PeterAttiaMDIG Subscribe to The Drive: Apple Podcast: http://bit.ly/TheDriveApplePodcasts Overcast: http://bit.ly/TheDriveOvercast Spotify: http://bit.ly/TheDriveSpotify Google Play: http://bit.ly/TheDriveGooglePlay

Peter AttiahostDr. Richard Isaacsonguest

Jan 1, 20202h 24mWatch on YouTube ↗

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WHAT IT’S REALLY ABOUT

Dr. Richard Isaacson on Precision Alzheimer's Prevention, APOE, and Lifestyle Interventions

Isaacson describes how his family experience with Alzheimer's and his push to use the word prevention led him to found the Alzheimer's Prevention Clinic at Cornell after other institutions resisted.
He and Peter Attia discuss APOE genotypes, polygenic risk, and why having or lacking an E4 allele does not determine whether someone will develop Alzheimer's.
Isaacson lays out his ABC framework of anthropometrics, biomarkers, and cognitive function, used to personalize a multimodal prevention plan rather than offering one-size-fits-all advice.
Both speakers argue that Alzheimer's prevention is badly underfunded relative to treatment research, and Isaacson points to the free alzU.org education resource.
For a hypothetical 30-year-old at a cocktail party, Isaacson prioritizes education, knowing your numbers, exercise, vascular risk control, nutrition, sleep, and stress reduction, while treating alcohol as murky.

IDEAS WORTH REMEMBERING

5 ideas

Prevention research faced institutional resistance over terminology

Isaacson says Harvard would not let him use the term prevention, a journal reviewer asked him to change it to risk reduction, and Cornell's dean let him proceed after a 15-minute meeting.

APOE4 raises risk but does not determine outcome

Isaacson says two E4 copies do not mean someone will get the disease, risk is polygenic, and he cites TNF alpha as an example of a gene that adds risk on top of E4.

Alzheimer's risk is individual and one-size-fits-all studies can mislead

Isaacson argues that lumping everyone together can produce negative results, such as giving omega-3s to people who already have high levels, so interventions should be matched to individual biology.

The perimenopause transition may accelerate brain aging in women

Isaacson suggests hormonal and bioenergetic changes around menopause fast-forward women toward Alzheimer's, but he says the best timing and form of hormone therapy remain unclear.

Exercise and vascular control carry strong evidence

Isaacson calls exercise the top intervention and says SPRINT-MIND showed a 19% reduction in mild cognitive impairment with tighter blood pressure control, while he treats alcohol evidence as murky.

WORDS WORTH SAVING

5 quotes

Alzheimer's disease is a life course disease. At every moment someone is either potentially having silent pathology building up.

— Dr. Richard Isaacson

The day you stop seeing patients is the day you stop getting humbled by and reminded of what the hell you do this for.

— Peter Attia

I am pro statin, period. And I think I'm pro statin, let me just say that. But I'm anti one size fits all.

— Dr. Richard Isaacson

Based on population attributable risk models, being conservative, one out of every three cases of Alzheimer's disease may be preventable if that person does everything right.

— Dr. Richard Isaacson

I think amyloid is the garbage that accumulates, and if you don't take the garbage out, you're going to get sick. But the upstream effect is mitochondrial dysfunction.

— Dr. Richard Isaacson

Alzheimer's prevention versus risk reduction semanticsAPOE genotypes and polygenic riskWhy women have higher Alzheimer's risk and hormone therapyABC framework: anthropometrics, biomarkers, cognitionLifestyle interventions: exercise, nutrition, blood pressureFunding gaps in prevention researchalzU.org and free physician education

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