Dr. Richard Isaac and His AD Masterclass - Episode 1
The Alzheimer’s Hub of Hope has four sections: Heroes, Highlights, Headlines and Helpers/Caregivers. This post is aligned to the Highlights section.
When I started this blog my planned approach was to shed light on individuals that bring hope to AD sufferers, caregivers and those who don’t want to become an AD sufferer (us). I knew there had to be people in the medical, research and other fields working on the AD problem. Through my investigation I’ve identified eight people that are making positive strides in understanding, preventing and treating the disease and caring for its sufferers. I called these people the “Alzheimer’s Heroes of Hope” for their positive go-forward approaches. An overview of these heroes can be found here.
So far I’ve posted on heroes Deborah Kan and Being Patient, Dr. Dale Bredesen and the Functional Approach, Dr Nate Bergman and Kemper Cognitive Wellness, and Teepa Snow's Positive Approach to Care. This and several future posts will highlight the work of hero Dr. Richard Isaacson.
Dr. Isaacson is a Harvard trained neurologist, the Director of the Alzheimer’s Prevention Clinic and a member of the research team of the Alzheimer’s Universe (ALZU).
ALZU hosts free online lessons that provide the latest tips, brain activities and cognitive tests to help reduce AD risk and delay the onset of the disease.
Dr. Isaacson created a free Mastering Brain Health Course with over three hours of content spread over 19 videos. I’ve listed the topic of each video with its link below. You may want to watch the videos for yourself, however, I’ll pullout the most important points from my perspective over this and future posts. I’ll cover the first five course topics in this post.
1. Course Overview
The video educational series will discuss what you can do today to minimize AD risk or even prevent the disease.
46 million American have AD but many don’t know it (yet) since it takes decades before symptoms emerge.
This long runway (of having the disease without its symptoms) provides a window of opportunity to make specific changes in lifestyle.
The course will provide the most cutting edge information available in advanced brain science.
AD research has hit the “valley of death” and needs a little investment push to get over the hump to provide broad scale global public heath impacts.
2. What is Cognitive Aging?
The brain ages just like other parts of the body ages. This is called cognitive change or cognitive aging and isn’t AD.
Forgetting words “at the tip of your tongue” isn’t a memory issue but is a processing speed issue. It takes longer for signals to move within the brain.
Cognitive aging not only slows down remembering things but also slows down learning new things.
Cognitive aging is not dementia and there are things that can be done to “ensure that the brain does not change as we age”.
It is possible to build up cognitive resilience / reserve which build brain pathways that protect against cognitive aging.
Life style changes, brain training, brain stimulation, can prompt and encourage brain pathways to fire more quickly and efficiently.
3. Alzheimer's Diagnosis and Standard Treatments
AD is the most common form of dementia but not all dementia is AD. Up to 75% of dementia is AD.
AD symptoms are progressive cognitive decline, especially progressive short-term memory loss, that includes changes in behavior and sleep.
A doctor can diagnose AD with 80% accuracy from reviewing a person’s medical history and asking the patient questions. Blood tests can identify AD mimicking issues such as vitamin B12 and thyroid deficiencies about 8% of the time.
Brain imaging (CAT, MRI scans) can provide more certainty in diagnoses. For example MRI scans can identify brain shrinkage and other changes. A FDG PET scan identifies brain glucose metabolism which correlates to brain activity (or lack of activity).
A spinal tap draws fluids that are tested for tau and amyloid which are associated with AD.
All of these assessments can be used in combination to produce an accurate diagnosis of AD. Some tests can identify AD even before symptoms occur.
“There’s only a handful of FDA approved therapies” but there are other interventions that we can do today such as vitamins, supplements, sleep, exercise, dietary, behavioral changes, cognitive training and music therapy.
4. APOE4 and Alzheimer's Risk
Genes impact AD risk. The APOE variant is the most commonly studied gene that impacts AD. A person has two copies of this variant, one from each parent.
There are three types of APOE. APOE2 is the least common type and protects against AD. APOE3 is the most common type and is neutral for AD risk. APOE4 increases AD risk.
60% of the population have two APOE3 types (one from each parent).
One copy of APOE4 increases AD risk by a little but two copies increase the risk substantially.
25% of people have at least one copy of APOE4 and 1% of people have two copies.
APOE4 appears to increase the risk for women more than for men.
Life style changes may be able to neutralized the impact of APOE4.
Some people respond differently to drugs (pharmacogenomics) or food (nutrigenomics) based on their individual biology.
Understanding a person’s biology and genetics has the advantage of supporting individualized care which is called precision medicine.
5. Polygenic Risk for Alzheimer's
Although APOE4 is the most commonly understood gene that impacts AD but there are dozens, if not hundreds, of other genes that either decrease or increase the risk of AD.
Dr. Isaacson can calculate how much each of these genes contribute to AD risk for individuals. This calculation requires whole gene sequencing and is called the polygenetic risk score.
The work to determine the polygenetic risk score is time consuming, labor intensive and expensive but is becoming less so over time.
A better understanding of a person’s genetics will support precision medicine and allow better individualized approaches to be developed.