Signs of Alzheimer’s were everywhere. Then his brain improved

Editor’s note: Dr. Sanjay Gupta, CNN’s chief medical correspondent, is a practicing neurosurgeon and bestselling author on brain health. “The Last Alzheimer’s Patient” will premiere on “The Whole Story with Anderson Cooper” on Sunday, May 19 at 8 p.m. ET/PT on CNN and air on MAX on June 18.


Preventative neurologist Dr. Richard Isaacson looked at the numbers on the fax in astonishment. Blood biomarkers of the telltale signs of early Alzheimer’s disease in the brain of his patient, 55-year-old entrepreneur Simon Nicholls, had virtually disappeared in just 14 months.

“I had to catch my breath. It was a complete shock: the blood tests on his brain had normalized,” said Isaacson, director of research at the Institute for Neurodegenerative Diseases in Boca Raton, Florida.


Dr. Richard Isaacson, left, discusses test results with Simon Nicholls, participant No. 34 in his clinical trial.

Was this astonishing result the result of a new wonder drug designed to combat dementia? No way. It’s a story of old-fashioned courage and determination.

“Simon was on a mission, as if the Reaper was looking over his shoulder. He was going to kick ass and take names,” Isaacson said.

Nicholls reduced her risk of developing Alzheimer’s disease through lifestyle changes recommended by Isaacson, including diet, exercise, stress reduction and sleep optimization, as well as a few strategically placed supplements and medications. chosen by your cardiologist.

“I was very concerned,” Nicholls told CNN chief medical correspondent Dr. Sanjay Gupta in his new documentary, “The Last Alzheimer’s Patient,” which airs on “The Whole Story with Anderson Cooper.”

“I have a 3 year old son and an 8 year old child son. It’s really important to me, as I get older, to try to be there for them in the future,” he said. “There are many (changes) in your lifestyle that you can do to hopefully reverse the disease and give you more time, that’s all we need until we let’s find a cure.”


CNN chief medical correspondent Dr. Sanjay Gupta, left, interviews Simon Nicholls for his documentary “The Last Alzheimer’s Patient.”

When it came to genetics and dementia, Nicholls had drawn the short straw. He carried two copies of the APOE4 gene, one from each parent, which could increase the risk of developing Alzheimer’s disease at least tenfold.

“Sadly, my mother died at the age of 70 from what we believe to be Alzheimer’s disease,” Nicholls said. “For the last 10 years of her life, she just sat in a chair, rocking, while taking about 14 medications. I would much rather have a longer lifespan and then go fast.

Not everyone owns one or even two copies of APOE4 however, develops Alzheimer’s disease, creating a tempting opportunity. Can a person lower their genetic risk of developing Alzheimer’s disease through lifestyle and various medical interventions, especially if started early, before too much damage is done?

Isaacson, who also has a family history of Alzheimer’s disease, thinks the answer is yes. He opened the first U.S. clinic dedicated to Alzheimer’s disease prevention in New York in 2013 before moving his program to Florida in 2021. His research has shown that following a dozen or more lifestyle interventions , when practiced 60% or more of the time, can improve cognitive function, especially in women.


Isaacson, second from right, brings in a team of specialists from almost every profession to discuss each case.

Today, scientists around the world are also studying the impact on cognition of lifestyle changes such as a healthy plant-based diet, stress reduction, strength training, aerobic exercise and quality sleep habits — behaviors that Isaacson and his team described in a recent study. published in Nature.

“I don’t use the term ‘reverse’. I don’t know what the opposite means in Alzheimer’s,” Isaacson said. “But the results we’ve seen with Simon and other patients in our research are extremely exciting.”

How the heart and brain are linked

Alzheimer’s disease is not the only path to a life characterized by memory loss and an inability to think, plan, and interact with loved ones.

Vascular dementia, the second most common type of dementia after Alzheimer’s disease, can be caused by atherosclerosis, a buildup of plaque in the arteries that can lead to heart attacks, strokes, blood clots, and more. more, all of which can further damage the body and brain.

Bad hearts and their consequences can run through a family over generations, a fact Nicholls knew all too well.

“My whole family had endless heart attacks, which led to the death of my maternal grandfather around the age of 50,” he said. “My mother had three heart attacks, the first at age 50, then a triple bypass before developing dementia.”


Simon Nicholls reads with his 3-year-old son, Sylver, at home in Miami.

According to experts, carrying an APOE4 gene further increases the risk of heart disease as well as dementia.

“My sister had three heart attacks and when I was 40 I was told I had atherosclerosis, with a ridiculously massive coronary artery calcium score of around 1,500 and blockages in around 96 % of my arteries.” A normal coronary artery calcium score is zero.

For a man in the prime of his life, the news was shocking. Doctors tried using lifestyle changes and statins to reverse the plaque buildup, but ultimately resorted to surgery, opening three of Nicholls’ arteries with stents. He also began using an injectable drug called evolocumab, designed to boost the liver’s ability to remove “bad” low-density lipoproteins, or LDL, from the body.

Slowly, Nicholls’ heart condition began to improve, but the bad news didn’t stop there. A brain scan revealed telltale signs of vascular damage in Nicholls’ brain, which occurs when smaller blood vessels lack oxygen.

“The doctors said I had too many white matter lesions. I figured since I now had my heart more or less under control, it was time to turn to my brain,” Nicholls said.

In January 2023, Nicholls became participant No. 34 in a new clinical trial at the Isaacson Center in Florida. The trial is designed to uncover cognitive risk factors and counter them with a personalized plan of attack. (Full disclosure: I am participant #20 in the same trial; you can read about my experience here.)

As part of the trial, Nicholls underwent a battery of tests, including a unique blood test to track levels of amyloid, tau and other substances. reference biomarkers for Alzheimer’s disease and other degenerative diseases. Amyloid deposits can begin to build up in the brain decades before symptoms appear, even between ages 30 and 40.

“Simon’s first test gave a score of 70. Anything over 58 was positive for amyloid in the brain,” Isaacson said. “The results confirmed the amyloid PET scan that Simon had done in 2019, where I could see the plaque in his brain.”

The first intervention was to place Nicholls on tirzepatide (the active ingredient in the drugs Mounjaro and Zepbound), one of the newer injectable drugs that suppress appetite by stimulating the hormones that control blood sugar.

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 exercises, in which you walk briskly, ruck, jogging or cycling 60% to reach your goal. 70% of your heart rate.

“I love going for a sunrise walk every morning for an hour and a half with a podcast. I take 10,000 steps or more every day. I’m very consistent,” Nicholls said. “I also do a very slow full body workout with weights three times a week for an hour.”

Avoiding sugar, artificial sweeteners, alcohol and ultra-processed foods is essential, as is following a plant-based diet like the Mediterranean diet.

“When I first saw Simon, he had a bit of a middle, like most guys in their 50s,” Isaacson said. “When I saw him at nine weeks, I did a double take. He was totally muscular, even ripped.

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