This series of bite-sized episodes contains important information you need to navigate the evolving world of Alzheimer’s disease (AD) research. Dr. Marc Agronin and Dr. Richard Isaacson discuss the recent advances in AD and provide practical approaches for prevention, diagnosis, and treatment.
Prevention of Alzheimer's Disease
Prevention of Alzheimer's Disease
Welcome to CME on ReachMD. This episode is part of our MinuteCME curriculum.
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This is CME on ReachMD, and I'm Dr. Marc Agronin. I'm here today with my colleague Dr. Richard Isaacson.
Dr. Isaacson, I know you've been really passionate about prevention of Alzheimer disease. You've done so much work in that area. Let's have a discussion about what's meant by prevention, what we can do now. What do we know? And what are we looking for in the future?
Yeah, so I think the word “prevention” in Alzheimer's, you know, and when I used to use those terms in the same sentence over a decade ago, I used to get tomatoes thrown at me. But I think, really, where that term has evolved is that if we can do something to reduce a person's risk of Alzheimer's disease and that person can basically modify their risk factors to the point where they won't experience Alzheimer's disease during their alive years, and if they can delay the disease long enough, then that's really the essence of prevention. And based on the 2020 Lancet Commission, based on just a dozen or so risk factors, 4 out of every 10 cases of dementia may be preventable if that person does everything right. And in that 1 study alone, there's things that were missing. There's a lot of risk factors, for example, nutrition wasn't even really included in that.
So I think the take-home point is that while we certainly cannot prevent Alzheimer's disease in 100% of cases, not even close, and I think in a lot of cases of Alzheimer's, people can do everything right and still be affected by progressive dementia. I think there's at least 40%, 50%, maybe even 60% of cases where we can take actionable, targeted advice that during that person's life, whether it's vascular risk factor modification, exercise on a regular basis, sleep modification, stress, as well as targeted therapies using emerging principles, precision medicine, and that's really where our work is focused on, I really do believe that we can grab the bull by the horns and have improvements both in cognition as well as clinical outcomes. And a lot of our research has certainly shown that, both in people before they have symptoms in the preclinical Alzheimer's disease stage, as well as even in mild cognitive impairment as long as they follow a bulk of the recommendations.
When it comes to prevention, there's no 1 magic pill. I wish there was. But it takes a village; it takes a lot of things. And on average, we recommend, on average, 21 different things. And people with MCI needed to follow at least 60% of those recommendations in order to move the needle in terms of having better outcomes.
When it comes to why certain people respond and certain people don't, well, that's all about genetics in this era of precision medicine and personalized medicine. We do, for example, APOE ε4 testing. APOE ε4 is the most common genetic risk factor for Alzheimer's disease. And if you have the gene, we're going to give you therapies A, B, and C. But if you don't have the genetic variant, we're going to give you therapies X, Y, and Z. And the goal here is to personalize care. And it's not just about APOE ε; we can look at other genes and we can understand a person's polygenic risk, and then we can target therapies accordingly.
When it comes to a person's risk of Alzheimer's, if someone's stressed out and worried, we tell them to take a deep breath. You know, the earlier you start, the better people will do. Alzheimer's begins in the brain decades before the first symptom of memory loss begins. You know, it's a big topic, lots to unpack. But I'm really hopeful that the future of our field is prevention. And the future of our field is precision medicine and genetics.
This is such great information. I guess I have to ask, when should someone think about doing this? And where did they go? I know we both talked about this, that prevention is not such a common endeavor for clinicians and clinics alike.
Yeah. So, if Alzheimer's begins, say 20, 30 years before the first symptom of memory loss begins, that's when a person should be seen by a clinician. If their average age is about their family members getting Alzheimer’s in the 60s or 70s, then they should be seen in the clinics in the, you know, their 40s and 50s at the latest. And I think the earlier you start, the better you do. And even if you can’t go to see someone specializing in Alzheimer’s prevention, there’s only really a dozen practices all around the world that specialize in this sort of thing, and waiting lists are quite long. See your primary care doctor, talk about vascular risk factor modification, high cholesterol, high blood sugar. You know, these are critical things. Getting someone's blood pressure and really tight control. The key with prevention is not just focusing on a borderline level which can really accumulate damage over time, but focusing on normal and optimal levels of blood pressure and cholesterol and blood sugar and exercise and nutrition. Really, I think we just all need to kind of do this together, do this with our primary care doctors, do this with a preventative health specialist or preventative cardiologist. And I think that's the way we're going to have the most modicum of success.
That sounds good. And it sounds like really the best news is that a brain-healthy lifestyle is open to everyone. It's not expensive. There are more details that people, over time, need to get into, especially given the risk. But the bottom line is this brain-healthy lifestyle is good for the entire body.
So, great few minutes listening to your expertise and having a discussion about this. Unfortunately, our time is up. Everyone, thanks for listening.
You have been listening to CME on ReachMD. This activity is provided by Prova Education and is part of our MinuteCME curriculum.
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In accordance with the ACCME Standards for Integrity and Independence, Global Learning Collaborative (GLC) requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any ineligible company. GLC mitigates all conflicts of interest to ensure independence, objectivity, balance, and scientific rigor in all its educational programs.
Marc E. Agronin, MD
Senior Vice President, Behavioral Health
Chief Medical Officer, MIND Institute
Miami Jewish Health
Consulting Fees: Eli Lilly and Company, Otsuka America Pharmaceuticals Inc.
Contracted Research: AgeneBio, Alzheon, Inc, Avanir Pharmaceuticals, Inc, Eli Lilly and Company, F. Hoffman La-Roche Ltd, Janssen Global Services, LLC, Sage Therapeutics, Inc.
Richard S. Isaacson, MD
Director, Center for Brain Health
Florida Atlantic University
Boca Raton, FL
No relevant relationships reported.
- Cindy Davidson has nothing to disclose.
- Amanda Hilferty has nothing to disclose.
- Nick Lombardi has ownership interest in Vertex Pharmaceuticals.
- Libby Lurwick has nothing to disclose.
- Colleen Resnick has nothing to disclose.
After participating in this educational activity, participants should be better able to:
- Contrast how the slowing of Aβ plaques, as shown in recent clinical trial endpoints of slowing cognitive decline with immunotherapies, differs from current standard of care results in Alzheimer’s disease (AD)
- Recognize the positive impacts of earlier identification of AD in slowing the course of the disease
- Analyze how the mechanisms of action of newer investigational therapies relate to the molecular mechanisms that drive AD progression
- Analyze biomarkers for functional impairment, neuronal loss, and protein deposition that are assessable by neuroimaging or cerebrospinal fluid analysis for diagnosis, staging, and treatment outcomes
- Compare the monoclonal antibodies currently under study to treat AD
- Evaluate new agents that may be appropriate for patients with mild cognitive impairment (ie, the role of imaging)
This activity is designed to meet the educational needs of neurologists, primary care physicians, and other healthcare professionals that diagnose and treat patients with Alzheimer’s Disease.
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Global Learning Collaborative (GLC) designates this enduring activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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