Clinical Trial

. 2018 Dec;14(12):1663-1673.

doi: 10.1016/j.jalz.2018.08.004. Epub 2018 Nov 13.

The clinical practice of risk reduction for Alzheimer's disease: A precision medicine approach

Richard S Isaacson¹, Christine A Ganzer², Hollie Hristov³, Katherine Hackett⁴, Emily Caesar⁵, Randy Cohen⁶, Robert Kachko⁷, Josefina Meléndez-Cabrero⁸, Aneela Rahman³, Olivia Scheyer³, Mu Ji Hwang⁹, Cara Berkowitz¹⁰, Suzanne Hendrix¹¹, Monica Mureb³, Matthew W Schelke¹², Lisa Mosconi³, Alon Seifan¹³, Robert Krikorian¹⁴

Affiliations

¹ Department of Neurology, Weill Cornell Medicine and NewYork-Presbyterian, New York, NY, USA. Electronic address: rii9004@med.cornell.edu.
² School of Nursing, Hunter College, City University of New York, New York, NY, USA.
³ Department of Neurology, Weill Cornell Medicine and NewYork-Presbyterian, New York, NY, USA.
⁴ Department of Psychology, Temple University, Philadelphia, PA, USA.
⁵ Loyola School of Medicine, Chicago, IL, USA.
⁶ Department of Cardiology, Crystal Run Healthcare, Middletown, NY, USA.
⁷ Inner Source Health, New York, NY, USA.
⁸ Department of Neurology, Weill Cornell Medicine, San Juan, PR, USA.
⁹ Weill Cornell Medicine-Qatar, Doha, Qatar.
¹⁰ Weill Cornell Medicine, New York, NY, USA.
¹¹ Biostatistics, Pentara Corporation, Salt Lake City, UT, USA.
¹² Department of Neurology, Columbia University College of Physicians & Surgeons, New York, NY, USA.
¹³ Compass Health Systems, Miami, FL, USA.
¹⁴ Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA.

PMID: 30446421
PMCID: PMC6373477
DOI: 10.1016/j.jalz.2018.08.004

Clinical Trial

The clinical practice of risk reduction for Alzheimer's disease: A precision medicine approach

Richard S Isaacson et al. Alzheimers Dement. 2018 Dec.

. 2018 Dec;14(12):1663-1673.

doi: 10.1016/j.jalz.2018.08.004. Epub 2018 Nov 13.

Authors

Affiliations

¹ Department of Neurology, Weill Cornell Medicine and NewYork-Presbyterian, New York, NY, USA. Electronic address: rii9004@med.cornell.edu.
² School of Nursing, Hunter College, City University of New York, New York, NY, USA.
³ Department of Neurology, Weill Cornell Medicine and NewYork-Presbyterian, New York, NY, USA.
⁴ Department of Psychology, Temple University, Philadelphia, PA, USA.
⁵ Loyola School of Medicine, Chicago, IL, USA.
⁶ Department of Cardiology, Crystal Run Healthcare, Middletown, NY, USA.
⁷ Inner Source Health, New York, NY, USA.
⁸ Department of Neurology, Weill Cornell Medicine, San Juan, PR, USA.
⁹ Weill Cornell Medicine-Qatar, Doha, Qatar.
¹⁰ Weill Cornell Medicine, New York, NY, USA.
¹¹ Biostatistics, Pentara Corporation, Salt Lake City, UT, USA.
¹² Department of Neurology, Columbia University College of Physicians & Surgeons, New York, NY, USA.
¹³ Compass Health Systems, Miami, FL, USA.
¹⁴ Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA.

PMID: 30446421
PMCID: PMC6373477
DOI: 10.1016/j.jalz.2018.08.004

Abstract

Like virtually all age-related chronic diseases, late-onset Alzheimer's disease (AD) develops over an extended preclinical period and is associated with modifiable lifestyle and environmental factors. We hypothesize that multimodal interventions that address many risk factors simultaneously and are individually tailored to patients may help reduce AD risk. We describe a novel clinical methodology used to evaluate and treat patients at two Alzheimer's Prevention Clinics. The framework applies evidence-based principles of clinical precision medicine to tailor individualized recommendations, follow patients longitudinally to continually refine the interventions, and evaluate N-of-1 effectiveness (trial registered at ClinicalTrials.gov NCT03687710). Prior preliminary results suggest that the clinical practice of AD risk reduction is feasible, with measurable improvements in cognition and biomarkers of AD risk. We propose using these early findings as a foundation to evaluate the comparative effectiveness of personalized risk management within an international network of clinician researchers in a cohort study possibly leading to a randomized controlled trial.

Keywords: APOE; Alzheimer’s Prevention Clinic; Alzheimer’s disease prevention; Alzheimer’s precision medicine; Clinical precision medicine; Multidomain interventions; Personalized medicine; Preclinical Alzheimer’s disease.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no conflict of interest exists.

Figures

**Fig. 1.**
ABCs of Alzheimer’s Prevention Management.

**Fig. 2.**
Example biomarker: Intervention paradigm.

See this image and copyright information in PMC

Cited by

Alzheimer's "Prevention" vs. "Risk Reduction": Transcending Semantics for Clinical Practice.
Hodes JF, Oakley CI, O'Keefe JH, Lu P, Galvin JE, Saif N, Bellara S, Rahman A, Kaufman Y, Hristov H, Rajji TK, Fosnacht Morgan AM, Patel S, Merrill DA, Kaiser S, Meléndez-Cabrero J, Melendez JA, Krikorian R, Isaacson RS. Hodes JF, et al. Front Neurol. 2019 Jan 21;9:1179. doi: 10.3389/fneur.2018.01179. eCollection 2018. Front Neurol. 2019. PMID: 30719021 Free PMC article.
Disclosure of Genetic Risk Factors for Alzheimer's Disease to Cognitively Healthy Individuals-From Current Practice towards a Personalised Medicine Scenario.
Galluzzi S, Pievani M, Zanetti O, Benussi L, The Italian-DIAfN Working Group, Frisoni GB, Di Maria E. Galluzzi S, et al. Biomedicines. 2022 Dec 8;10(12):3177. doi: 10.3390/biomedicines10123177. Biomedicines. 2022. PMID: 36551936 Free PMC article. Review.
The Population Attributable Fraction of Dementia From Audiometric Hearing Loss Among a Nationally Representative Sample of Community-Dwelling Older Adults.
Smith JR, Huang AR, Lin FR, Reed NS, Deal JA. Smith JR, et al. J Gerontol A Biol Sci Med Sci. 2023 Jul 8;78(7):1300-1306. doi: 10.1093/gerona/glad117. J Gerontol A Biol Sci Med Sci. 2023. PMID: 37139951 Free PMC article.
Association of rs2062323 in the TREM1 gene with Alzheimer's disease and cerebrospinal fluid-soluble TREM2.
Wang ZT, Fu Y, Chen SD, Huang YY, Ma YH, Wang YJ, Tan L, Yu JT. Wang ZT, et al. CNS Neurosci Ther. 2023 Jun;29(6):1657-1666. doi: 10.1111/cns.14129. Epub 2023 Feb 23. CNS Neurosci Ther. 2023. PMID: 36815315 Free PMC article.
Effects of transcranial direct current stimulation on cognition in MCI with Alzheimer's disease risk factors using Bayesian analysis.
Kang DW, Wang SM, Um YH, Kim S, Kim T, Kim D, Lee CU, Lim HK. Kang DW, et al. Sci Rep. 2024 Aug 13;14(1):18818. doi: 10.1038/s41598-024-67664-9. Sci Rep. 2024. PMID: 39138281 Free PMC article.

See all "Cited by" articles

References

1. Alzheimer’s Disease: Facts and Figures. Alzheimer’s Association (online); 2017. Accessed online February 20th, 2018.
1. Frisoni GB, Winblad B, O’Brien JT. Revised NIA-AA criteria for the diagnosis of Alzheimer’s disease: a step forward but not yet ready for widespread clinical use. Int psychogeriatrics 2011;23:1191–6. - PubMed
1. McKhann GM, Knopman DS, Chertkow H, Hyman BT, Jack CR, Kawas CH, et al. The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimer’s Demen 2011;7:263–9. - PMC - PubMed
1. Mortimer JA, Borenstein AR, Gosche KM, Snowdon DA. Very early detection of Alzheimer neuropathology and the role of brain reserve in modifying its clinical expression. J Geriatr Psychiatry Neurol 2005;18:218–23. - PMC - PubMed
1. Gonneaud J, Arenaza-Urquijo EM, Mézenge F, Landeau B, Gaubert M, Bejanin A, et al. Increased florbetapir binding in the temporal neocortex from age 20 to 60 years. Neurology 2017:10. - PubMed

Publication types

Actions
Actions
Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

The clinical practice of risk reduction for Alzheimer's disease: A precision medicine approach

Affiliations

The clinical practice of risk reduction for Alzheimer's disease: A precision medicine approach

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Similar articles

Cited by

References

Publication types

MeSH terms

Associated data

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Miscellaneous