9/16/2014

Alzheimer's Prevention for 30-Somethings With No Symptoms - WSJ

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YOUR HEALTH

Alzheimer's Prevention for 30Somethings With No Symptoms

Max Lugavere Exercises, Cuts Out Shellfish, Takes Cocoa Supplements

By SUMATHI REDDY
Sept. 15, 2014 7:21 p.m. ET

Max Lugavere is 32-years-old and is already taking steps to prevent Alzheimer's disease. Mr. Lugavere and
WSJ's Sumathi Reddy discuss on Lunch Break with Tanya Rivero. Photo: Cassandra Giraldo for The Wall
Street Journal

Max Lugavere seems an unlikely patient to be sitting in an Alzheimer's clinic.

The fit, 32-year-old, dressed in Converse All-Star sneakers and a white T-shirt, eats a carefully
calibrated diet and exercises regularly. He takes supplements of omega-3 fatty acids and vitamins B
and D. He also has zero symptoms of memory or cognitive loss.
"I generally like to feel I have a handle on my health," Mr. Lugavere says during a session with
Richard Isaacson, director of the Alzheimer's Prevention Clinic at NewYork-Presbyterian/Weill
Cornell Medical Center in Manhattan. "My mother is 62 and she has memory loss and cognitive
difficulty. So when I came across this idea of dementia prevention, it was eye-opening," says Mr.
Lugavere, a filmmaker who lives in Los Angeles and New York.
Alzheimer's experts increasingly are researching ways to prevent or delay memory decline instead of
just focusing on treating patients who have the disease. There have been encouraging results from
some studies of preventive strategies, including lifestyle interventions in people at risk for
dementia. Some 5.2 million people in the U.S. had Alzheimer's in 2014, a number that is expected to
about triple by 2050.
While Alzheimer's prevention is being widely studied, prevention programs at large medical centers
are rare. Some of the field's leading experts say there isn't sufficient evidence to support making
recommendations beyond eating a heart-healthy diet and exercising regularly, advice that everyone
should heed. There is no cure or particularly effective treatment for Alzheimer's.
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Alzheimer's Prevention for 30-Somethings With No Symptoms - WSJ

"There is growing evidence that lifestyle modifications do have an impact on our cognitive aging,"
said Ronald Petersen, director of the Alzheimer's Disease Research Center at Mayo Clinic in
Rochester, Minn. "But to really say that we can prevent Alzheimer's disease is a bit of a stretch."

'The idea that I can take steps today

that could benefit my brain and prevent
the onset of any kind of neurological
issue, I'm all about that,' Mr. Lugavere,
left, says. CASSANDRA GIRALDO FOR
THE WALL STREET JOURNAL

Dr. Isaacson, of Weill Cornell Medical, opened the Alzheimer's Prevention Clinic just over a year ago.
Many of his patients are in their 30s or 40s, much younger than the typical age of onset for dementia.
And many, like Mr. Lugavere, have a family history of dementia.
Dr. Isaacson doesn't believe physicians should wait for additional randomized controlled trials
before working with patients on Alzheimer's prevention. He takes a personalized approach that
factors in age, gender, race, family history and lifestyle, in addition to physiological markers such as
inflammation, metabolism and genetics.
During the session with Mr. Lugavere, Dr. Isaacson poses wide-ranging questions: Do you dream?
What did you get on your SAT exams? Do you play music? Mr. Lugavere also is tested for his sense of
smell, and is instructed to touch his nose and tap his feet.
A genetic test found Mr. Lugavere has two gene variations that could put him at increased risk for
eventually developing Alzheimer's. Dr. Isaacson says this could explain why Mr. Lugavere's
homocysteine level is slightly elevated and why some of his LDL cholesterol particles are smaller and
denser than optimum, both of which are risk factors for coronary heart disease. The remainder of his
lab results look good.

You can't beat all your genes but you can do something.

Dr. Richard Isaacson

The University of Alabama at Birmingham Hospital started an outpatient Alzheimer Risk
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Alzheimer's Prevention for 30-Somethings With No Symptoms - WSJ

Assessment and Intervention Clinic in July after hearing from relatives of dementia patients
concerned about their own health. The clinic offers a two-visit program open to people 45 years of
age and older with no symptoms of memory loss. Participants are given a risk assessment as well as
cognitive tests and an MRI scan of their brain to look for brain shrinkage or stroke-related damage.
"Rarely a week goes by in my memory-disorder clinic when I'm not counseling a family member
about risk," said David Geldmacher, medical director for neurology at UAB Hospital. "There's
growing evidence that we can delay the onset or reduce an individual's risk," he said.

Max Lugavere, 32 and healthy, but with

a family history of dementia, consults
with Dr. Richard Isaacson on
Alzheimer's-prevention strategies.
CASSANDRA GIRALDO FOR THE WALL
STREET JOURNAL

At the Mayo Clinic, a long-term study is seeking to develop a formula to help predict a person's risk
for Alzheimer's. The study, which involves 4,000 randomly selected people ages 50 to 89, regularly
evaluates the participants' health, mental status and other traits such as gait speed. Genetic tests
also are done.
By following the participantsthe study has been under way for 10 years so farthe researchers
hope to find associations between those who develop Alzheimer's and what physiological and mental
signs they have exhibited over the years, said the Mayo Clinic's Dr. Petersen. Preliminary results of
the study are currently under review for publication in a scientific journal, he said.
Weill Cornell's Dr. Isaacson, who is 36, has four relatives who have had Alzheimer's. "I don't want to
say I'm not worried but I'm obviously going to do things" for prevention, he says.
About five years ago Dr. Isaacson decided to get serious about his brain health and made a number of
lifestyle changes, including cutting his intake of sugar and carbohydrates. He also began playing bass
guitar in a rock band. (Playing a musical instrument on a regular basis is one of his universal
recommendations for people at risk.)
Studies have found playing a musical instrument delays the onset of cognitive and auditory decline
but what goes on in the brain isn't fully understood.
"I do all the things I tell my patients to do," Dr. Isaacson said. "I eat berries like crazy. I drink coffee. I
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have mocha in the morningCocoaVia, the same [supplement] I tell my patients to use." Dr.
Isaacson says there is enough evidence showing that each of these can help protect against cognitive
decline. He also recommends moderate alcohol consumption.
In his session with Mr. Lugavere, Dr. Isaacson tells him mutations in one of his genes changes the
way his body metabolizes B vitamins. So the doctor recommends different versions of vitamin B-12
and folic acid.
Mr. Lugavere's other genetic variant requires him to be especially careful about elements of his diet,
Dr. Isaacson tells him. Copper in his diet, for example, is a no-no. That means cutting out things like
liver, clams and oysters. Fruits and vegetables grown outside of the U.S., if they aren't organic, also
should be avoided because of potential DDT residues.
"You can't beat all your genes but you can do something," Dr. Isaacson says.
Other recommendations for Mr. Lugavere include reducing saturated fat in his diet by 10% to 15%
while increasing his intake of lean protein. And, because of Mr. Lugavere's genetic makeup, the more
exercise the better, Dr. Isaacson tells him.
"The idea that I can take steps today that could benefit my brain and prevent the onset of any kind of
neurological issue, I'm all about that," Mr. Lugavere says.
Write to Sumathi Reddy at sumathi.reddy@wsj.com

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