Video 17: Precision Medicine for Alzheimer’s Disease
In collaboration with BrainMind, Dr. Isaacson reviews precision medicine for Alzheimer’s
Disease

About Dr. Richard Isaacson:
Dr. Richard Isaacson is the founder and former Director of the Alzheimer’s Prevention Clinic at the Weill Cornell Memory Disorders Program. He is currently the director of Brain Health at the Atria Institute. A leading expert on Alzheimer’s Disease (AD), Dr. Isaacson is passionate about providing the latest evidence-based options for treatment and risk reduction. His research focuses on individualized clinical management of AD using emerging principles of precision medicine. He also oversees a robust AD therapeutics and education research program.

How Alzheimer’s differ from persons to persons
● Pathologic Perspective: people have the same disease (ex: amyloid buildup and
progressive cognitive changes)
● People with Alzheimer’s show different symptoms, including:
1. Memory Loss
2. Vision Loss
3. Depression
4. Slower Executive/ Higher Order Function

Alzheimer’s Precision Medicine Approach
A. Anthropometrics
B. Blood-based Biomarkers
C. Cognitive Function
Precision Medicine: a practice that takes a patient’s individual biology, risk factors, and genes into account in clinical decision-making. (i.e. What are the genes involved, what are early or mid-life factors?)

Anthropometrics: body composition
● Body fat/ Waist Circumference
○ As belly size gets larger, the memory center of the brain gets smaller
○ Visceral fat slows metabolism and speeds up inflammation and memory loss
● Muscle mass
● Blood sugar

Blood-based Biomarkers
● Cholesterol Markers
○ Ex: HDL, LDL, triglycerides, total cholesterols
○ Cholesterol Fraction Examples (advanced preventive cardiologist approach): APOB, LDLP, APOE1
● Inflammatory Markers
● Metabolic Markers
○ Ex: Fasting Blood sugar, hemoglobin A1c, fasting insulin
● Nutritional Markers
○ Ex: Omega-3 levels
● Homocysteine level: common amino acid in the blood
○ People who have elevated homocysteine levels have accelerated brain aging over time
■ B-complex vitamins (i.e. B12, folic acid, B6) in specific combinations can delay brain aging and improve memory function BUT not for people with normal homocysteine level
■ An omega-3 level may also be required in addition to the homocysteine level for optimizing prevention plan
● They also help to optimize the uptake of b-complex vitamins
● Other blood tests: B12 levels, cortisol, cystatin C

Cognitive Function
● Which area of cognitive function should be optimized? Which biomarkers can be
changed to improve it?

Takeaways:
1. Need to understand ABCs for innovative, forward thinking plans for precision medicine
(giving a specifically targeted recommendation in a precise, individualized way).
2. Follow up every 6 months
3. Understand responses and refine accordingly

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