A New Treatment for Alzheimer's? It Starts With Lifestyle


Sending a Signal

Treating Alzheimer’s has been a challenge because, until now, little
meaningful progress has been made. Neurologists on the front lines have
felt powerless, watching their patients disappear into the sinkhole of
forgetfulness.

Big Pharma’s focus on a one-size-fits-all anti-amyloid drug, and the
billions in funding that went with it, largely eclipsed a dramatically
different story that was quietly emerging from independent academic studies
over the past decade: Other health conditions, such as our sedentary
lifestyles, poor eating habits, Type 2 diabetes, insulin resistance and
skyrocketing obesity, play a huge role. “But you can’t package or patent a
lifestyle,” Galvin dryly observes.

In his darkest moments, Galvin wondered if he was doing anything for
anybody. He had so few weapons in his treatment arsenal — only a handful of
marginally beneficial drugs approved decades ago that can temporarily
enhance thinking and functioning. Studies that linked Alzheimer’s to a
range of modifiable lifestyle factors prompted him to make subtle changes
in his practice, and he began to more aggressively treat the health
conditions that contribute to the disease. He’d prescribe medication to
lower his patients’ blood pressure, statins to control cholesterol, or
suggest exercise regimens or dietary changes to lessen insulin resistance
and improve brain health. “I started to see that my patients seemed to
progress much slower than my colleagues’, and the families would tell me
the same things,” Galvin recalls. He discovered some of his fellow
neurologists were taking a similar tack: “The same lightbulb is going off.”

At the University of Alabama at Birmingham, Geldmacher gives each patient a
detailed and personalized risk assessment that encompasses family history,
performance on tests of mental acuity and results of MRI scans. “By
controlling their risks, people can maintain their well-being through
physical exercise, mental stimulation and a healthy diet,” says Geldmacher.
“Those three things may help lower their risk for the disease or slow it
down. That’s where the field is going.”

Richard Isaacson, the founder and director of the Alzheimer’s Prevention
Clinic at New York Presbyterian Weill Cornell Medical Center, spends hours
with each patient doing a thorough health analysis. He uses cognitive
tests, body measurements and brain health computer assessments, as well as
lab tests and imaging exams (MRI or PET scans) to pinpoint areas that can
increase the odds of developing Alzheimer’s. “We look at genetics, we look
at cholesterol, we look at glucose metabolism, we look at body fat,” says
Isaacson, who was inspired to do this work after watching four family
members succumb to the disease. “Then we triangulate this information,
using each data point with the context of one another.”

Based on their risk factors, patients are prescribed a regimen of exercise,
methods to reduce stress and get more restorative sleep, prescription and
over-the-counter medications, and even nutritional supplements to
compensate for their deficits. In people who dutifully follow the program,
Isaacson says early research indicates that cognitive function does improve
in critical areas such as executive functioning and processing speed, or
how fast information can be absorbed. “Intuitively, we thought this would
work,” says Isaacson. “But now we actually have proof.”

While the evidence remains largely preliminary, these individual cases have
reached a critical mass, which indicates something is happening that needs
to be explored in a more rigorous way. In September, nearly a dozen
physicians — from Puerto Rico, Kansas City, Alabama and New York — met in
Chicago to share what they’ve learned, what seems to work and what doesn’t,
and begin the arduous process of figuring how best to test a treatment
platform that can be used everywhere. “We’re trying to lay the groundwork
for Alzheimer’s prevention and figure out what tools we should be using and
what works best,” says Isaacson. “But the field is still in its infancy, so
we literally learn every day.”

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