Interesting Article on Diet and AD

This is an interesting one on diet, DunedinPace and Dementia.

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Thank you @medaura, I’m not sure how to ping you but if you’re making a document for RapAdmin I can just wait for that!

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This is just a republication of an old article (“An earlier version of this article was published in April 2023.”). Suvorexant seems interesting, but I haven’t seen anything new since the 2023 paper, so at this stage, it’s still one among many promising treatments. There’s an ongoing phase 2 clinical trial due to finish in May 2026. So we’ll have to wait until early 2027 to have a definite answer on suvorexant for AD prevention.

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Great piece. This is the same Dr Isaacson discussed elsewhere on the forum and who was on Peter Attia’s podcast a few timesx

A few extracts I found good:

Even as a brain surgeon myself, I was surprised at how well the health of your brain can be measured. With the heart, it is pretty well-accepted that a battery of tests can help give us a clear idea of how to predict, prevent and treat heart disease. Until recently, however, we really could not say the same about the brain. Many brain doctors still struggle even to define the criteria for a healthy brain. The general consensus was that the “black box” in your skull was pretty fixed and that there was little you could do to assess it, let alone optimize it.

Dr. Richard Isaacson, a neurologist, convinced me otherwise, and it led to one of the most fascinating — and somewhat frightening — days I have had in my life.

Richard would certainly see me if I were sick, but he preferred to see me now, while I was healthy, fully believing he could help me maintain my brain, reduce my chance of dementia and even optimize my function

Richard told me that issues of metabolism, such as even slight insulin resistance, can accelerate amyloid deposition.), which can lead to amyloid plaques, those telltale signs of Alzheimer’s disease, down the line.

Richard also wanted to address an activity I did on a daily basis: my neighborhood walk with my three dogs. “Keep doing that,” he said, “but now with a weighted vest.” Why? Not having enough lean muscle mass is problematic. He told me people typically do a good job addressing their arms and legs, but loading the spine with additional weight helps activate core muscles, such as abdominals and obliques, as well as stimulating the growth of new bone cells. This could lead to a critical redistribution of the fat, muscle and bone in my body and help drive down any insulin resistance that I may be genetically predisposed to and eventually lower my risk of developing amyloid in the brain.

In the recommendation about brain health, I did not expect an intervention involving my feet, but the nerves that run to the feet are the longest in our body. When you don’t move your toes and feet regularly and freely, Richard says, you can lose sensory awareness, also known as proprioception, leading to a “sensory paralysis.” Over time, the nerve connections that run from your feet to your brain start to disappear. Once your feet are weak, your weight will be unevenly distributed when walking and exercising. The better your feet can tolerate a load evenly, the more options they have for movement, the better and more cooperative things will be up the chain, including your knees, hips and lower back. Consider wearing toe spacers occasionally, he told me. Start with 10 minutes a day every few days, and increase the time as you get used to them.

Nearly all the cognitive testing could be available in the future through a free app.

Even the blood work could be done via finger-prick testing, if all goes as expected with Richard’s research trial.

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Anyone have any experience with this?

And here is a follow up in the series. The whole documentary is out soon, so those who prefer TV version can also take a look at that.

Quite amazing how basically medically guided “biohacking” targeted at being proactive and triangulated with a lot of biomarkers can have this effect.

Will be very interesting to see the clinical trial data when complete.

Some snippets here I found interesting and relate to issues we have been discussing on the forum - including the value of doing the blood based biomarkers for AD and dementia risks:

As part of the trial, Nicholls underwent a battery of tests, including a unique blood test that can track levels of amyloid, tau and other hallmark biomarkers for Alzheimer’s disease and other degenerative conditions. Deposits of amyloid can begin accumulating in the brain decades before symptoms begin, even in a person’s 30s and 40s.

In August 2023, it was time to repeat the blood test for amyloid. By then, the company that administers the tests had added a measurement for tau, another key hallmark sign of Alzheimer’s, frontal lobe dementia and Lewy body disease.

Within six months, Nicholls had dropped the levels of amyloid in his blood from 70 to 53.

On Halloween 2023, the next APS2 score arrived. Amazingly, Nicholls had reduced the amount of amyloid and tau in his blood to 40: He was testing negative in blood for signs of Alzheimer’s.

Shocked and amazed, Isaacson remained skeptical. “I was very cautious. You know, promise not to overpromise. I needed to retest.”

A few days before Christmas, the repeat test results arrived. When it too was a negative finding of 40, Isaacson decided to tell Nicholls in person.

Even lower amyloid levels and a larger hippocampus

It appears Nicholls is well on his way toward that goal. In March, his APS2 score had dropped to 25, an unbelievably low number.

Even more startling: Brain volume scans showed that the hippocampus, the tiny seahorse-shaped organ responsible for memory, had actually grown in volume in Nicholls’ brain since he started the intervention.

In early Alzheimer’s stages, the hippocampus loses tissue rapidly and then atrophies as the disease progresses.

Despite these amazing outcomes, Isaacson remains cautious. After all, this is one person, and similar findings have not been been replicated in a larger, more controlled sample and published in a peer-reviewed journal.

That doesn’t stop his wonder at the results and his gratitude to Nicholls for his continuing dedication to the study and the personalized interventions.

“I still can’t believe it. I’d seen this before, but only in people who are taking anti-amyloid medications,” Isaacson said. “When you work your entire career and are told by everyone, ‘It’s not possible to do this,’ and then you see it — well, I’m still humbled and amazed.”

Elevated homocysteine, which is an amino acid used by the body to make protein, is a risk factor for brain atrophy, cognitive impairment and dementia. A September 2010 randomized controlled trial found that supplementation slowed brain atrophy in people with mild cognitive impairment.

Consider joining Isaacson’s latest online clinical trial, designed to provide cognitive assessments and personalized advice via smartphones. People over 21 who meet certain criteria can sign up for the study at Retain Your Brain.

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I liked the image provided in the report. It shows you the supplements, diet and other interventions that proved useful in preventing AD.

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Dr. Richard Isaacson is really good. His recent paper (already posted in another topic) on preventive neurology presents the state of the art on the field: Alzheimer’s disease risk reduction in clinical practice: a priority in the emerging field of preventive neurology | Nature Mental Health

I’d like to see an update of the paper mentioning SGLT2i, telmisartan (but ARBs are already mentioned), low-dose lithium, ezetimibe and obicetrapib, and TMS/tDCS/red light therapy.

I guess Isaacson was more conservative in this paper. Do we have the whole list of interventions (both pharmaceutical and non pharmaceutical) he recommends to his patients?

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I developed Hallux rigidus, or stiff big toe in both feet. My own opinion is that came from being in western narrow toe shoes while running. I went to a podiatrist and PTs - either a surgery to fuse the joint or try running shoes like Hokas. On my own I sort of figured out the toe spacer remedy. Our bones are pretty malleable (think braces as an example). It works. Slept with the spacers overnight and also used while in wide forefoot shoes. Pretty good range of motion now in the big toe which is really important for being able to jump and balance. Highly recommend it. (Side note: never underestimate the things in our environment that are causation for certain morbidity - a pox on western shoes!)

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Yeah, would be great to have - perhaps we can see some of it in the documentary. There is some of that in the two CNN articles and perhaps there will be more of those.

Btw - interesting to note that he does seems to focus on Hcy. Including the MTHFR genes (see @DeStrider post above) - has anyone looked into those mutations?

Thanks for sharing this experience

Which specific options/brands would suggest one looks into?

and also used while in wide forefoot shoes. Pretty good range of motion now in the big toe which

Btw, what are these - some special type of shoes?

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I used something like the following. See Amazon But any variation would work given one’s preferences. Find various sizes to fit all the spaces. Go cheap. It feels oddly relaxing just spreading the toes - who knew :slight_smile:

Altra is probably one of the better known brands for a wide forefoot. They also design the shoe for “zero-drop” which just means no heel raise like normal western shoes. So a little less force on the forefoot and theoretically a more natural gate for walking and running. That can also cause people to strain their achilles which is not used to the strain with “normal” western raised heel shoes. So start slow if trying.

A lot of other companies are offering a wide forefoot. Even Nikes - notorious for a narrow forefoot is offering wide forefoot options.

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I looked a bit at MTHFR mutations (as I have one of those causing high Hcy). From what I understand they’re like high Hcy: a risk factor for many cardiovascular, neurological and psychological diseases. So people with these should probably be even more cautious about high BP, high BPV, sleep, stress management, diabetes, ApoB, etc. And they should also check their B6, B9, and B12 levels and if not “optimal” (TBD…) supplement with the “methyl” form of these vitamins. What is unclear yet to me is whether people with high Hcy but optimal B6, B9, and B12 would benefit from supplementation with these vitamins. I would assume than not (based on the MR studies and trials I posted in the other topic) and that for these people there might be other causes of the high Hcy that need to be addressed via other pathways (which ones? :man_shrugging:).

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Homocysteine is an interesting one - I routinely check it and normalize it. I have some patients that likely have an issue with transport of folate into their cells - whether a defective transport mechanism or antibody to the receptor.
For these folks, and my wife is one of them, Folate is >upper limit of normal, and Homocysteine is still high. It will usually get normalized with Folinic Acid. She had folate>24 and Homocysteine of near 30 - with folinic acid now in the 8’s.
For Hcy, easy to remember, is rule of 3’s, B3,B6,B9,B12 all impact it - if Folate is high, go with folinic acid and this usually works as the activated methyltetrahydrofolate simply is probably not getting into the cell.
For folks without a high folate level, I like the life extension BioActive Complete B complex as it is cheap and a really decent product.

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Effects of intensive lifestyle changes on the progression of mild cognitive impairment or early dementia due to Alzheimer’s disease: a randomized, controlled clinical trial

Full PDF (Open Access) for download here: https://res.cloudinary.com/ornish/image/upload/v1717741018/Lifestyle_Changes_and_Alzheimer_s_study_64f59728fb.pdf

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Has anyone looked into this approach / technology / science? The fact that this technology worked on mice models of Alzheimers is not very compelling… lots of therapies and drugs have worked on Alzheimers mouse models but not translated to humans. There seem to be a lot of problems with the mouse models…

Company Website: (the website is not very professional-looking, with typos, etc., but perhaps not uncommon for small scientist/doctor-led ventures).

The Founder:

https://www.linkedin.com/in/gary-arendash-109b92a9/

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A new test for early identification of Alzheimers:

Open Access Paper:

The McCusker Subjective Cognitive Impairment Inventory (McSCI): a novel measure of perceived cognitive decline

Objective

The psychometric properties of a new SCD measure, the McCusker Subjective Cognitive Impairment Inventory–Self-Report (McSCI-S), are reported.

Methods

Through review of previously published measures as well as our clinical and research data on people with SCD, we developed a 46-item self-report questionnaire to assess concerns on six cognitive domains, namely, memory, language, orientation, attention and concentration, visuoconstruction abilities and executive function. The McSCI-S was examined in a cohort of 526 participants using factor analysis, item response theory analysis and receiver operating characteristic (ROC) curve.

Results

A unidimensional model provided acceptable fit (CFI = 0.94, TLI = 0.94, RMSEA [90% CI] = 0.052 [.049, 0.055], WRMR = 1.45). The McSCI-S internal consistency was excellent (.96). A cut-off score of ≥24 is proposed to identify participants with SCDs. Higher McSCI-S scores were associated with poorer general cognition, episodic verbal memory, executive function and greater memory complaints and depressive scores (P < .001), controlling for age, sex and education.

Conclusions

Excellent reliability and construct validity suggest the McSCI-S estimates SCDs with acceptable accuracy while capturing self-reported concerns for various cognitive domains. The psychometric analysis indicated that this measure can be used in cohort studies as well as on individual, clinical settings to assess SCDs.

The actual self-report test / survey:

The McCusker subjective cognitive impairment inventory-self report (McSCI-S)

https://academic.oup.com/view-large/469637253

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