Individualized clinical management of patients at risk for Alzheimer's dementia

Richard S Isaacson; Hollie Hristov; Nabeel Saif; Katherine Hackett; Suzanne Hendrix; Juan Melendez; Joseph Safdieh; Matthew Fink; Madhav Thambisetty; George Sadek; Sonia Bellara; Paige Lee; Cara Berkowitz; Aneela Rahman; Josefina Meléndez-Cabrero; Emily Caesar; Randy Cohen; Pei-Lin Lu; Samuel P Dickson; Mu Ji Hwang; Olivia Scheyer; Monica Mureb; Matthew W Schelke; Kellyann Niotis; Christine E Greer; Peter Attia; Lisa Mosconi; Robert Krikorian

doi:10.1016/j.jalz.2019.08.198

Individualized clinical management of patients at risk for Alzheimer's dementia

Alzheimers Dement. 2019 Dec;15(12):1588-1602. doi: 10.1016/j.jalz.2019.08.198. Epub 2019 Oct 31.

Authors

Richard S Isaacson¹, Hollie Hristov², Nabeel Saif², Katherine Hackett³, Suzanne Hendrix⁴, Juan Melendez⁵, Joseph Safdieh², Matthew Fink², Madhav Thambisetty⁶, George Sadek², Sonia Bellara², Paige Lee⁷, Cara Berkowitz², Aneela Rahman², Josefina Meléndez-Cabrero⁸, Emily Caesar⁹, Randy Cohen¹⁰, Pei-Lin Lu¹¹, Samuel P Dickson⁴, Mu Ji Hwang², Olivia Scheyer¹², Monica Mureb², Matthew W Schelke¹³, Kellyann Niotis², Christine E Greer¹⁴, Peter Attia¹⁵, Lisa Mosconi², Robert Krikorian¹⁶

Affiliations

¹ Department of Neurology, Weill Cornell Medicine and NewYork-Presbyterian, New York, NY, USA. Electronic address: rii9004@med.cornell.edu.
² Department of Neurology, Weill Cornell Medicine and NewYork-Presbyterian, New York, NY, USA.
³ Department of Psychology, Temple University, Philadelphia, PA, USA.
⁴ Biostatistics, Pentara Corporation, Salt Lake City, UT, USA.
⁵ Jersey Memory Assessment Service, Health and Community Services, Jersey, United Kingdom.
⁶ Clinical and Translational Neuroscience Section, Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA.
⁷ College of Letters and Science, University of California Los Angeles, Los Angeles, CA, USA.
⁸ Department of Neurology, Weill Cornell Medicine, San Juan, PR, USA.
⁹ Loyola School of Medicine, Chicago, IL, USA.
¹⁰ Department of Cardiology, Crystal Run Healthcare, Middletown, NY, USA.
¹¹ Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
¹² School of Law, University of California Los Angeles, Los Angeles, CA, USA.
¹³ Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
¹⁴ Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
¹⁵ Attia Medical, New York, NY, USA.
¹⁶ Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA.

Abstract

Introduction: Multidomain intervention for Alzheimer's disease (AD) risk reduction is an emerging therapeutic paradigm.

Methods: Patients were prescribed individually tailored interventions (education/pharmacologic/nonpharmacologic) and rated on compliance. Normal cognition/subjective cognitive decline/preclinical AD was classified as Prevention. Mild cognitive impairment due to AD/mild-AD was classified as Early Treatment. Change from baseline to 18 months on the modified Alzheimer's Prevention Cognitive Composite (primary outcome) was compared against matched historical control cohorts. Cognitive aging composite (CogAging), AD/cardiovascular risk scales, and serum biomarkers were secondary outcomes.

Results: One hundred seventy-four were assigned interventions (age 25-86). Higher-compliance Prevention improved more than both historical cohorts (P = .0012, P < .0001). Lower-compliance Prevention also improved more than both historical cohorts (P = .0088, P < .0055). Higher-compliance Early Treatment improved more than lower compliance (P = .0007). Higher-compliance Early Treatment improved more than historical cohorts (P < .0001, P = .0428). Lower-compliance Early Treatment did not differ (P = .9820, P = .1115). Similar effects occurred for CogAging. AD/cardiovascular risk scales and serum biomarkers improved.

Discussion: Individualized multidomain interventions may improve cognition and reduce AD/cardiovascular risk scores in patients at-risk for AD dementia.

Keywords: Alzheimer's disease prevention; Alzheimer's prevention clinic; Multi-domain interventions; Personalized medicine; Preclinical Alzheimer's disease.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Alzheimer Disease / therapy*
Biomarkers / blood
Cardiovascular Diseases
Cognition
Cognitive Dysfunction / prevention & control*
Female
Health Education*
Humans
Male
Middle Aged
Patient Compliance*
Prodromal Symptoms*
Prospective Studies
Risk Reduction Behavior*

Substances

Biomarkers

Abstract

Publication types

MeSH terms

Substances

Grants and funding