The Alzheimer's Prevention Clinic at Weill Cornell Medical College / New York - Presbyterian Hospital: Risk Stratification and Personalized Early Intervention

Abstract

In July 2013, Weill Cornell Medical College founded the first Alzheimer's Prevention Clinic (APC) in the United States, providing direct clinical care to family members of patients with Alzheimer's disease (AD) as part of the Weill Cornell Memory Disorders Program. At the APC, patients seeking to lower their AD risk undergo a comprehensive assessment, receive a personalized plan based on rapidly evolving scientific evidence, and are followed over time using validated as well as emerging clinical and research technologies. The APC approach applies the principles of pharmacogenomics, nutrigenomics and clinical precision medicine, to tailor individualized therapies for patients. Longitudinal measures currently assessed in the clinic include anthropometrics, cognition, blood biomarkers (i.e., lipid, inflammatory, metabolic, nutritional) and genetics, as well as validated, self-reported measures that enable patients to track several aspects of health-related quality of life. Patients are educated on the fundamental concepts of AD prevention via an interactive online course hosted on Alzheimer's Universe (www.AlzU.org), which also contains several activities including validated computer-based cognitive testing. The primary goal of the APC is to employ preventative measures that lower modifiable AD risk, possibly leading to a delay in onset of future symptoms. Our secondary goal is to establish a cohort of at-risk individuals who will be primed to participate in future AD prevention trials as disease-modifying agents emerge for testing at earlier stages of the AD process. The clinical services are intended to lower concern for future disease by giving patients a greater sense of control over their brain health.

Keywords: Alzheimer’s prevention clinic; Alzheimer’s prevention clinical research; Alzheimer’s prevention education; clinical precision medicine; personalized medicine.

Figure 1

The Weill Cornell Medical College / New York-Presbyterian Hospital Alzheimer’s Prevention Clinic Conceptual Framework

Figure 2

Summary of the cycle of longitudinal patient assessment in the Alzheimer’s Prevention Clinic

Figure 3

The APC Comparative Effectiveness Dementia & Alzheimer’s Registry (CEDAR) Project

Figure 4

The APC Dietary Intervention to Slow Memory Loss due to Alzheimer’s (DIPLOMA) Study

Figure 5

Alzheimer’s Universe (www.AlzU.org)