Preventive neurologist Dr Richard Isaacson stared at the numbers on the fax in astonishment. Blood biomarkers of telltale signs of early Alzheimer’s disease in the brain of his patient, 55-year-old entrepreneur Simon Nicholls, had all but disappeared in a mere 14 months.
“I had to catch my breath. It was a complete shock: The blood tests on his brain had normalized,” said Isaacson, director of research at the Institute for Neurodegenerative Diseases in Boca Raton, Florida.
Was this stunning result the work of some new miracle drug designed to combat dementia? Not at all. This is a story of old-fashioned grit and determination.
“Simon was on a mission, as if the Grim Reaper was peering over his shoulder. He was going to kick ass and take names,” Isaacson said.
Nicholls reduced his risk of developing Alzheimer’s via lifestyle changes recommended by Isaacson, including diet, exercise, reducing stress and optimizing sleep, along with a few strategically chosen supplements and medications prescribed by his cardiologist.
“I was very worried,” Nicholls told CNN Chief Medical Correspondent Dr. Sanjay Gupta in his new documentary, “The Last Alzheimer’s Patient,” which is airing on “The Whole Story with Anderson Cooper.”
“I have a 3-year-old son and an 8-year-old son. It’s really important for me, as I get older, to try and be there for them in the future,” he said. “There are many [changes] in lifestyle you can do to hopefully push the disease backwards and give yourself more time, which is all we need until we find a cure.”
Not everyone with one or even two copies of APOE4 develops Alzheimer’s, however, creating a tantalizing opportunity. Can a person diminish their genetic risk for Alzheimer’s via lifestyle and various medical interventions, especially if started early, before too much damage is done?
Isaacson, who also has a family history of Alzheimer’s, believes the answer is yes. He began the first US clinic devoted to Alzheimer’s prevention in New York City in 2013 before moving his program to Florida in 2021. His research has shown that following a dozen or more lifestyle interventions, when practiced 60% or more of the time, can improve cognitive function, especially in women.
Today, scientists around the world are also investigating the impact on cognition of such lifestyle changes as a healthy plant-based diet, stress reduction, strength training, aerobic exercise and quality sleep habits — behaviors that Isaacson and his team outlined in a recent review published in Nature.
“I don’t use the term ‘reverse.’ I don’t know what reverse means when it comes to the field of Alzheimer’s,” Isaacson said. “But the results we’ve seen with Simon and some other patients in our research are extremely exciting.”
Alzheimer’s isn’t the only pathway to a life of dwindling memory and the inability to think, plan and interact with loved ones.
Vascular dementia, the second most common type of dementia after Alzheimer’s disease, can be caused by atherosclerosis, a buildup of plaque in the arteries that can lead to heart attacks, stroke, blood clots and more, all of which can further damage the body and brain.
Poor hearts and their consequences can run rampant in a family over generations, a fact Nicholls knew all too well.
“My whole family had endless heart attacks, resulting in my grandfather on my mother’s side dying around age 50,” he said. “My mother had three heart attacks, the first at age 50, then a triple bypass before she went on to develop dementia.”
Carrying an APOE4 gene further increases the risk for heart disease as well as dementia, experts say.
“My sister had three heart attacks, and when I was 40, I was told that I had atherosclerosis, with a ridiculously massive coronary artery calcium score of like 1,500 and occlusions in about 96% of my arteries.” A normal coronary artery calcium score is zero.
For a man in the prime of his life, the news was crushing. Doctors tried to use lifestyle changes and statins to reverse the plaque buildup but finally resorted to surgery, opening three of Nicholls’ arteries with stents. He also began using an injectable drug called evolocumab, designed to boost the liver’s ability to remove “bad” low-density lipoprotein, or LDL, from the body.
Slowly, Nicholls’ heart condition began to improve, but the bad news didn’t end there. A brain scan found telltale signs of vascular damage in Nicholls’ brain, which occurs when the tiniest blood vessels are starved of oxygen.
“The doctors said I had too many white matter lesions. I told myself that since I now had my heart more or less under control, it was time to turn to my brain,” Nicholls said.
