COMMENTARY

A Precision Medicine Approach to Alzheimer Risk Reduction

Richard S. Isaacson, MD

Disclosures

December 03, 2018

Hi. I'm Dr Richard Isaacson, director of the Alzheimer's Prevention Clinic at Weill Cornell Medicine and NewYork-Presbyterian. I'm excited to talk today about a new article in Alzheimer's and Dementia, which is the journal of the Alzheimer's Association.

The article is titled, "The clinical practice of risk reduction for Alzheimer's disease: a precision medicine approach."[1] This article underscores what clinicians can do today, in an evidence-based and structured way, to help patients reduce their risk tomorrow. This is a paper that describes the clinical approach at the Alzheimer's Prevention Clinic at Weill Cornell and at the Alzheimer's Prevention Clinic & Research Center of Puerto Rico in San Juan.

This article goes through the ABCs of Alzheimer prevention management, which describe a way for clinicians to evaluate a patient, assess a patient's risk, and then give a patient a personalized plan for risk reduction. The A is for anthropometrics, the B is for blood-based biomarkers, and the C is for cognitive performance. The key here is for any clinician to try to give someone an evidence-based approach. There is no magic pill or magic potion to prevent or cure Alzheimer disease, and until a blockbuster drug comes, clinicians are struggling to figure out what can be done today.

This paper describes a very nice, rigorous approach toward reducing risk for Alzheimer [disease]. First of all, how do you take an Alzheimer prevention clinical history? Clinicians must understand early life education, medications taken, medical problems, and cardiovascular risk (eg, high blood pressure, diabetes, high cholesterol). Clinicians also need to understand inflammatory, metabolism, and nutritional markers. Clinicians need to assess the relative strengths or weaknesses a person may have in cognitive function today, which can help push down a road map for intervention tomorrow.

The key take-home point of this paper is there is not a one-size-fits-all approach to Alzheimer risk reduction. A structured, comprehensive management plan may include a variety of interventions, including pharmacologic (eg, drugs, vitamins, supplements) and nonpharmacologic approaches, such as lifestyle interventions, exercise, nutrition, sleep, [and] stress [reduction]. Again, the non–one-size-fits-all approach and the precision medicine approach to Alzheimer risk reduction is something that can be practiced today.

If you want to learn more, take a look at the paper. It's a very broad-brush overview that is meant for clinicians who want to make active changes in their practice tomorrow.

If you learn something in the article, write about in the comments section. I'll be looking, so if you have questions—no hard questions, please—I'll try to respond. Thanks for reading and thanks for listening.

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