Alzheimer’s: What You Can Do presents a lifestyle treatment model designed to reduce multiple personal risk factors correlated with the development of Alzheimer’s disease (AD). Derived directly from the new, rapidly developing field of precision medicine, the paradigm recommends abandonment of “one size fits all” treatment approaches for persons at risk for AD, as well as for those already diagnosed with the disease. In Part 1 of my review (Scheidt, 2022), I present the rationale and evidence offered on behalf of this new approach by respected AD researchers, geriatric physicians, neurologists, and gerontologists. At base, these experts argue that AD has multiple potential lifestyle causes that enhance our risks of developing the disease. Each of us has a unique “risk profile” identifying the number, type, and potential influence of these factors.

Preventive and ameliorative treatments to reduce and, perhaps, reverse affects of these risk factors involve designing “precision protocols” tailored specifically for each person. Dale Bredesen, Chief Science Office at Apollo Health, stresses the importance of early health risk assessments and treatment applications. His research shows that the very first step is for people to get into the evaluation and treatment system before they get symptomatic: “The (involutional or brain shrinkage) process goes on for years. Even if you do develop symptoms, get in as soon as possible and get on ‘active prevention’. When I see people in early stages who have relatively early symptoms, they all get better when you do the right things. The earlier the better, which is true of all chronic illnesses.” (The film does not present direct clinical evidence in support of this hopeful and powerful claim.)

Alzheimer’s: What You Can Do places heavy emphasis on both evaluation and treatment processes associated with this precision approach to AD. I offer illustrations of key information shared for each area in the last half of the video. Dr. Bredesen proposes five categories of AD useful for guiding patient-centered evaluation and treatment targeting: Inflammatory, Atrophic, Toxic, Vascular, and Traumatic. He states: “We no longer say, oh, it’s Alzheimer’s. We say, ‘You’re in this space, in this profile and we are going to change that to a profile that’s associated with excellent cognition’.” The film does not elaborate on these subtypes; however, the labels suggest they are derived from distinguishable underlying causes for cognitive loss.

The film illustrates the critical importance of an early and thorough evaluation process. Bredesen: “Most can be done with blood testing, some of them are urine tests. If you have symptoms, you want to include imaging―typically an MRI with volume metrics. You also want to include functional testing, simple online neurological quantitative assessment. When you turn 45 or older, you should have a ‘cognoscopy’ and especially if there’s any family history of cognitive decline. We look at the status of your vascular system. We look at your history of head trauma. We look at your genetics. If you are going to reverse that involution, you need to know what’s causing the involution―and then you need to optimize each of those factors.” The convenience of a home-like office evaluation is demonstrated by Dr. Gayatri Devi, Director of Park Avenue Neurology in New York City, as she works with a male patient diagnosed with Mild Cognitive Impairment (MCI). In voice-over narrative, she affirms that “absolutely there are things that can be done, and they can actually change the trajectory of what your future looks like in a way that really makes a difference.” These are lifestyle changes that need to be communicated to patients.

What are the possible lifestyle factors targeted by this approach? Dale Bredesen explains: “There are dozens and dozens of things. For each person, we typically find between 10 and 25 abnormalities that need to be addressed by ‘precision protocols’―precisely set up and personalized for why you got the cognitive decline. You then say, ‘okay, here are the things that are critical’. Then you translate that into a workable practical program. What you need to eat, to do as far as sleeping, to do for your stress level, for your exercise, for specific herbs and supplements, appropriate pharmaceuticals, appropriate brain training―with appropriate follow-up. You don’t just treat and stop. We want to address the things that are actually causing the problem, and that’s what’s being published as getting the best results so far."

Alzheimer’s: What You Can Do presents a lifestyle treatment model designed to reduce multiple personal risk factors correlated with the development of Alzheimer’s disease (AD). Derived directly from the new, rapidly developing field of precision medicine, the paradigm recommends abandonment of “one size fits all” treatment approaches for persons at risk for AD, as well as for those already diagnosed with the disease. In Part 1 of my review (Scheidt, 2022), I present the rationale and evidence offered on behalf of this new approach by respected AD researchers, geriatric physicians, neurologists, and gerontologists. At base, these experts argue that AD has multiple potential lifestyle causes that enhance our risks of developing the disease. Each of us has a unique “risk profile” identifying the number, type, and potential influence of these factors.

Preventive and ameliorative treatments to reduce and, perhaps, reverse affects of these risk factors involve designing “precision protocols” tailored specifically for each person. Dale Bredesen, Chief Science Office at Apollo Health, stresses the importance of early health risk assessments and treatment applications. His research shows that the very first step is for people to get into the evaluation and treatment system before they get symptomatic: “The (involutional or brain shrinkage) process goes on for years. Even if you do develop symptoms, get in as soon as possible and get on ‘active prevention’. When I see people in early stages who have relatively early symptoms, they all get better when you do the right things. The earlier the better, which is true of all chronic illnesses.” (The film does not present direct clinical evidence in support of this hopeful and powerful claim.)

Alzheimer’s: What You Can Do places heavy emphasis on both evaluation and treatment processes associated with this precision approach to AD. I offer illustrations of key information shared for each area in the last half of the video. Dr. Bredesen proposes five categories of AD useful for guiding patient-centered evaluation and treatment targeting: Inflammatory, Atrophic, Toxic, Vascular, and Traumatic. He states: “We no longer say, oh, it’s Alzheimer’s. We say, ‘You’re in this space, in this profile and we are going to change that to a profile that’s associated with excellent cognition’.” The film does not elaborate on these subtypes; however, the labels suggest they are derived from distinguishable underlying causes for cognitive loss.

The film illustrates the critical importance of an early and thorough evaluation process. Bredesen: “Most can be done with blood testing, some of them are urine tests. If you have symptoms, you want to include imaging―typically an MRI with volume metrics. You also want to include functional testing, simple online neurological quantitative assessment. When you turn 45 or older, you should have a ‘cognoscopy’ and especially if there’s any family history of cognitive decline. We look at the status of your vascular system. We look at your history of head trauma. We look at your genetics. If you are going to reverse that involution, you need to know what’s causing the involution―and then you need to optimize each of those factors.” The convenience of a home-like office evaluation is demonstrated by Dr. Gayatri Devi, Director of Park Avenue Neurology in New York City, as she works with a male patient diagnosed with Mild Cognitive Impairment (MCI). In voice-over narrative, she affirms that “absolutely there are things that can be done, and they can actually change the trajectory of what your future looks like in a way that really makes a difference.” These are lifestyle changes that need to be communicated to patients.

What are the possible lifestyle factors targeted by this approach? Dale Bredesen explains: “There are dozens and dozens of things. For each person, we typically find between 10 and 25 abnormalities that need to be addressed by ‘precision protocols’―precisely set up and personalized for why you got the cognitive decline. You then say, ‘okay, here are the things that are critical’. Then you translate that into a workable practical program. What you need to eat, to do as far as sleeping, to do for your stress level, for your exercise, for specific herbs and supplements, appropriate pharmaceuticals, appropriate brain training―with appropriate follow-up. You don’t just treat and stop. We want to address the things that are actually causing the problem, and that’s what’s being published as getting the best results so far.”

The practitioners of the paradigm do not offer us overall criteria for improvement within the film; I assume these will vary from person to person. The general protocol works, according to spokesperson Bredesen, “because we cast such a wide net.” Gerontologist John Zeisel of the Hearthstone Institute sums up the value of the approach: “I don’t have an answer to what people should be doing to find out what chance they have of getting dementia or if they have already got it. Now, if it’s to change your life and eat better, sleep longer, have less stress, do more exercise, and maintain a purpose in your life, I’m all in favor. But I don’t need to know that I have a chance of dementia to do those five things. We should do those five things anyway. That’s the best thing we have to put off dementia and to live better with it, whenever it appears.”

The last 20 min of Alzheimer’s: What You Can Do are the most interesting. The video offers prescriptive advice for preventing and reducing the risk of cognitive loss in six specific life domains: Food, Stress, Life Engagement, Exercise, Sleep, and Brain Stimulation. All are major targets of practitioners who use the precise protocol approach. Most of the film’s prescriptions require social and behavioral (lifestyle) changes. Like me, viewers will likely “self-rate” their current social and behavioral preferences and habits against the healthy options offered by the film. Here are a few highlights of each.

Food. Drs. Dean and Ayesha Sherzai of the Loma Linda University Medical Center offer an intriguing overview of the connection between diet and the genetics of AD. Food is the most important factor affecting AD genes and their products. They state that plant-centered diets reduce the risk of AD by 53%. The prescription here? Eat lots of vegetables (e.g., broccoli and leafy greens), eat fruit sparingly, eat organic foods as much as possible; drink lots of water (confusion is associated with dehydration); minimize teas, coffee, and sodas; and reduce consumption of sugar and meat. Interestingly, meat should be eaten as a garnish, not a main course. Perhaps a surprise to some viewers, “fat is back”; mostly unprocessed monounsaturated fats (extra virgin olive oil, nuts, and seeds) are associated with a reduced risk of dementia. Finally, these experts discuss the vital importance of “the gut-brain” connection: “What goes on in the gut has a profound affect on what goes on in the brain.” Neurotransmitters and other chemicals affecting brain health are largely manufactured in the gut. Certain medicines (antibiotics and acid blocking drugs) and inappropriate foods may alter gut bacterial function, affecting brain resistance to disease and inflammation.

Stress. Chronic stress is a major cause of inflammation in the body, according to Dr. John Zeisel: “Inflammation in our bodies, when it gets to our brain, makes a difference between Mild Cognitive Impairment (MCI) and more full-blown dementia.” He cites stress sources such as job dissatisfaction, relationships, news, burying oneself in the internet, and “getting trapped in a rabbit hole of ever-increasing stressful and threatening information.” Stress contributes directly to damage of the hippocampus, the brain’s memory center; it plays a vital role in stress regulation as well. Hippocampal damage can cause problems with both long-term and short-term memory. Zeisel does not go deeply into the pathophysiology of the memory losses. He recommends “stress mitigators” that may lower stress and minimize or even reverse hippocampal damage. These include “mindfulness” practice, meditation, and prayer. Older adults in the film offer testimonials about the personal benefits of meditation for memory enhancement. Alzheimer’s: What You Can Do also reviews the benefits of individualized music for improving the sense of well-being for older adults, including its ability to replace the use of antipsychotic, antidepressant, and antianxiety medications. See Scheidt (2015) for a more detailed review of this remarkable intervention.

Engagement with Life. Persons reporting higher degrees of loneliness are twice as likely to develop AD as individuals who report higher degrees of social engagement. John Zeisel reports this fact and offers a psychological laundry list of arenas that reflect engagements with life: Engaging with tasks one loves, taking care of home, taking care of others, taking care of one’s own body, creating a status or role that reflects the real purpose, and developing a sense of community.

Exercise. It is not surprising that Alzheimer’s: What You Can Do reviews the benefits of exercise for overall health, particularly for healthy brain functioning. According to Dr. Ann Hathaway of Integrated Functional Medicine, a recent assessment review finds that the most common treatment recommended by neurologists for those with MCI is “a drug called exercise!” In particular, she cites the benefits of aerobic exercise (as opposed to stretching). Exercise changes DNA expression in the body by turning on brain-derived neurotrophic factor (BDNF). In turn, BDNF turns on the growth of new brain cells, specifically in the hippocampus (the memory center that is an early site of degeneration in AD). Dr. Hathaway: “The data are absolutely profound in terms of how you build a better brain by simply engaging in aerobic exercise. The benefits of exercise are across the board―better sleep, blood sugar control, good for the bones, heart, immune system, and reduced risk of Alzheimer’s disease.”

Sleep. Dr. Dean Sherzai is emphatic about the importance of sleep for a healthy brain: “There’s a strong correlation between loss of restorative sleep and the risk for AD.” The brain requires between 7 and 8 hrs of sleep each night. This includes a combination of REM and deep sleep. In his words, “During deep sleep, you are ‘cleaning your brain’. It is ‘mental floss’. Sleep clears the brain of debris that accumulates in your brain. If you don’t clean your brain, that debris will go on to cause neuroinflammation. That’s when tens to hundreds more nerve cells start to die. Sleep helps to deal with plagues and tangles. Take a nap!”

New Learning. The opportunity for new learning qualifies as a precise treatment intervention. Dr. Rudy Tanzi of Massachusetts General Hospital tells us that “new learning creates new pathways to recall and reinforces old ones.” While brain games and crossword puzzles create focus and attentiveness, Dr. Dean Sherzai recommends new learning that involves greater complexity, requiring more brain activity at several different levels of functioning. Complex learning invites involvement of the entire brain. These could include writing a book, playing a musical instrument, or learning a new language.

In closing, I urge readers to view this hope-filled film and to explore more deeply the tenets and results of the precision medicine paradigm for the treatment of AD and related disorders.

“We are starting with a global program to reduce dementia. We’re seeing unprecedented improvement in this untreatable illness. We can make this a rare disease.”

----Dale Bredesen