Preventive neurologist Dr Richard Isaacson stared at the numbers on the fax in astonishment. Blood biomarkers of telltale signs of early Alzheimerās disease in the brain of his patient, 55-year-old entrepreneur Simon Nicholls, had all but disappeared in a mere 14 months.
āI had to catch my breath. It was a complete shock: The blood tests on his brain had normalized,ā said Isaacson, director of research at the Institute for Neurodegenerative Diseases in Boca Raton, Fla.
Was this stunning result the work of some new miracle drug designed to combat dementia? Not at all. This is a story of old-fashioned grit and determination.
āSimon was on a mission, as if the Grim Reaper was peering over his shoulder. He was going to kick ass and take names,ā Isaacson said.
Nicholls reduced his risk of developing Alzheimerās via lifestyle changes recommended by Isaacson, including diet, exercise, reducing stress and optimizing sleep, along with a few strategically chosen supplements and medications prescribed by his cardiologist.
āI was very worried,ā Nicholls told CNN Chief Medical Correspondent Dr. Sanjay Gupta in his new documentary, āThe Last Alzheimerās Patient,ā which is airing on āThe Whole Story with Anderson Cooper.ā
āI have a three-year-old son and an eight-year-old son. Itās really important for me, as I get older, to try and be there for them in the future,ā he said. āThere are many (changes) in lifestyle you can do to hopefully push the disease backwards and give yourself more time, which is all we need until we find a cure.ā
Unlucky genes
When it came to genetics and dementia, Nicholls had drawn the short straw. He carried two copies of the one from each parent, which may increase the risk of developing Alzheimerās at least tenfold.
āSadly, my mum passed away from what we think is Alzheimerās in her 70s,ā Nicholls said. āFor the last 10 years of her life, she just sat in a chair, rocking, while on about 14 medications. Iād much rather have a longer health span and then just go quickly.ā
Not everyone with one or even two copies of APOE4 develops Alzheimerās, however, creating a tantalizing opportunity. Can a person diminish their genetic risk for Alzheimerās via lifestyle and various medical interventions, especially if started early, before too much damage is done?
Isaacson, who also has a family history of Alzheimerās, believes the answer is yes. He began the in New York City in 2013 before moving his program to Florida in 2021. His has shown that following a dozen or more lifestyle interventions, when practiced 60 per cent or more of the time, can improve cognitive function, .
Today, scientists around the world are also investigating the impact on cognition of such lifestyle changes as a healthy plant-based diet, stress reduction, strength training, aerobic exercise and quality sleep habits ā behaviors that Isaacson and his team outlined in a recent review published in Nature.
āI donāt use the term āreverse.ā I donāt know what reverse means when it comes to the field of Alzheimerās,ā Isaacson said. āBut the results weāve seen with Simon and some other patients in our research are extremely exciting.ā
How the heart and the brain are intertwined
Alzheimerās isnāt the only pathway to a life of dwindling memory and the inability to think, plan and interact with loved ones.
the second most common type of dementia after Alzheimerās disease, can be caused by atherosclerosis, a buildup of plaque in the arteries that can lead to heart attacks, stroke, blood clots and more, all of which can further damage the body and brain.
Poor hearts and their consequences can run rampant in a family over generations, a fact Nicholls knew all too well.
āMy whole family had endless heart attacks, resulting in my grandfather on my motherās side dying around age 50,ā he said. āMy mother had three heart attacks, the first at age 50, then a triple bypass before she went on to develop dementia.ā
Carrying an APOE4 gene further increases the as well as dementia, experts say.
āMy sister had three heart attacks, and when I was 40, I was told that I had atherosclerosis, with a ridiculously massive coronary artery calcium score of like 1,500 and occlusions in about 96 per cent of my arteries.ā A normal coronary artery calcium score is zero.
For a man in the prime of his life, the news was crushing. Doctors tried to use lifestyle changes and statins to reverse the plaque buildup but finally resorted to surgery, opening three of Nichollsā arteries with stents. He also began using an injectable drug called evolocumab, designed to boost the liverās ability to remove ābadā , or LDL, from the body.
āIt was time to turn to my brainā
Slowly, Nichollsā heart condition began to improve, but the bad news didnāt end there. A brain scan found telltale signs of vascular damage in Nichollsā brain, which occurs when the tiniest blood vessels are starved of oxygen.
āThe doctors said I had too many white matter lesions. I told myself that since I now had my heart more or less under control, it was time to turn to my brain,ā Nicholls said.
In January 2023, Nicholls became participant No. 34 in a novel clinical trial at Isaacsonās Florida centre. The trial is designed to uncover cognitive risk factors and counter them with a personalized plan of attack. (Full disclosure: I am participant No. 20 in the same trial; you can .)
āThe overall goal of the study is democratize access to preventive neurology care by eventually using at-home blood testing to cost-effectively reach the most people,ā Isaacson said.
As part of the trial, Nicholls underwent a battery of tests, including a unique blood test that can track and other hallmark biomarkers for Alzheimerās disease and other degenerative conditions. Deposits of amyloid can begin accumulating in the brain decades before symptoms begin, .
āSimonās first test came back with a score of 70. Anything over 58 was positive for amyloid in the brain,ā Isaacson said. āThe results backed up the amyloid PET scan Simon had taken in 2019, where I could see the plaque in his brain.ā
10,000 steps a day: āIām very consistentā
Nicholls needed to loose weight, so he began taking tirzepatide (the active ingredient in the medications and ), one of the newer injectable drugs that suppress appetite by stimulating hormones that control blood sugar levels.
At the same time, Nicholls was encouraged to step up his physical activity by incorporating strength training three times a week while adding 45 to 60 minutes a day of zone 2 exercise, in which you briskly , jog or cycle at 60-to-70 per cent of your heart rate.
āI love going for a walk every morning at sunrise for an hour and a half with a podcast. I get in 10,000 steps or more every day. Iām very consistent,ā Nicholls said. āI also do a very slow full-body workout with weights three times a week for an hourās time.ā
Avoiding sugar, artificial sweeteners, alcohol and ultraprocessed foods is a must, as is following a such as the
āWhen I first saw Simon, he had a bit of a middle, like most guys in their 50s,ā Isaacson said. āWhen I saw him at nine weeks, I did a double take. He was totally buff, ripped even.
āWithin those nine weeks, he had lost 21 pounds, about 80 per cent of that fat, and put on muscle, which was excellent,ā Isaacson added. āI almost didnāt recognize him.ā
The weight loss and increased muscle mass lowered Nichollsā fasting blood sugar levels, ending his march toward diabetes, while some tweaks to his cholesterol medications further optimized his good and bad cholesterol numbers.
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 Alzheimerās, frontal lobe dementia and Lewy body disease.
āSimonās amyloid probability score on the new APS2 test had dropped to 53, which was phenomenal,ā Isaacson said. āBut he was still positive, as anything between 48 and 100 is considered to reflect a high probability of amyloid brain plaques on a brain scan.ā
'Turn on the screws'
Now that the big concerns of cholesterol, insulin, diet, exercise and fat mass were addressed, it was time āto turn on the screws,ā Isaacson said, with personalized recommendations based on Nichollsā biology.
āWe optimized Simonās omega-3 fatty acid levels, which is especially important for people with APOE Īµ4, as they need more omega-3. We also added B complex vitamins to control elevated homocysteine in his blood,ā Isaacson said. āHowever, we would not give B complex vitamins to anyone who did not have higher homocysteine levels.ā
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.
In the meantime, Nicholls, an avid researcher who loves to read medical journals, was adding some interventions of his own.
āI have steam and sauna rooms in my home, I do a lot of that. I love it,ā he said. āIāve tried cold water plunges, and I have lists of things to do I get from podcasts, from walking to sleeping to gratitude to yoga to sleep routines.
āBut thereās one thing I do that Dr. Isaacson doesnāt agree with: I get stem cell injections twice a year,ā Nicholls added. āSadly, I have arthritis in my hands, and that definitely feels better when I use stem cells, and I like to think they may be helping my brain, as well.ā
There was one more big issue to tackle: Nichollsā sleep, which have shown can hasten and
With business around the world, Nicholls is a frequent flyer with āterrible sleepā due to jet lag and insomnia. āIām also a worrier type of person,ā he confessed.
Adding a sleep medication approved for insomnia helped, ābut Simon really needs to tackle his sleep by improving his sleep hygiene with a more regular sleep schedule,ā Isaacson said.
An unbelievable result
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 “”±ō³ś³ó±š¾±³¾±š°łās.
Shocked and amazed, Isaacson remained skeptical. āI was very cautious. You know, promise not to overpromise. I needed to retest.ā
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.
āDr. Isaacson drove all the way from Boca Raton to Miami excited, very happy,ā Nicholls said. āWe walked on a beach together, and we were ecstatic that weād actually been able go from positive to negative for amyloid.ā
Although Nicholls is ecstatic about the improvements, heās also very humble about his efforts to improve his health.
āIām really not all that compliant. To comply is just horrendously difficult, right? Of course I want to have a beer or a hamburger or something stupid. I love gummy bears and eating crappy food,ā he said.
āItās helped that I have some great doctors to help me, but to be honest, my biggest motivator are my children,ā Nicholls added. āIād love to see my sons get married and have their own kids, and to do that, I have to put in the work to stay the way I am now.ā
