Inside NYP: Dr. Richard Isaacson

The neurologist's family history inspires his career and informs his pioneering Alzheimer's disease research.

My dad sold sofa beds, and my mom was a travel agent, so I’m not sure how my brother and I both became neurologists. My brother is 13 years older than me, and when he was a neurology resident at Mount Sinai Hospital, I spent the night on call with him when I was 12. He probably had something to do with me becoming a doctor.

I went to an accelerated six-year B.A./M.D. program at the University of Missouri–Kansas City School of Medicine at age 17, finished my B.A. at 19 and got my medical degree at 23. I became interested in studying Alzheimer’s disease because of my Uncle Bob. When I was 3, I fell into my aunt’s pool and sank to the bottom. Uncle Bob, who was in the Navy, jumped in and rescued me, so he and I always had this connection. When I was in high school and applying to medical programs, he was diagnosed with Alzheimer’s disease at age 70. It just was like, “Wow, we can’t do anything? There’s no treatment?” In all, four of my family members have been diagnosed with the disease — including my dad’s cousin, whom I helped treat and eventually diagnose.

My family history definitely started me down the path to specializing in treating Alzheimer’s. But more so, it changed the way that I approached the overall management of the disease. As with many other chronic diseases, such as hypertension and diabetes, comprehensive management is much more than “a pill.” Having a few Food and Drug Administration-approved drugs on the market was marginally helpful, but what about lifestyle changes, exercise, nutrition, sleep, and stress management? And there is a saying, once you have seen one person with Alzheimer’s, well, you have seen one person with Alzheimer’s. What is meant by this is that from a clinical perspective, Alzheimer’s is a very heterogeneous disease. In my mind, I didn’t feel comfortable with a one-size-fits-all approach and started looking deeper, considering genetic variations and the person’s individual biology, in crafting a targeted plan.

Why did I come to NewYork-Presbyterian? In 2011, I went to a Yankees game with a peer who worked at the hospital and he made a joke like, “Yeah, we’re the official hospital of the New York Yankees and we’re hiring.” I’m like, “Hmm, interesting.” I interviewed here in 2012. At the time, the dean of Weill Cornell Medicine had heard my idea for an Alzheimer’s prevention clinic and thought that it sounded crazy — Alzheimer’s has been considered unpreventable. I had 15 minutes to make my case. Given my long curriculum vitae she expected someone older, with a beard and a bow tie — not someone barely 30 years old. When we met, she started asking me how I had accomplished so much at a young age. Then, in the last three minutes, I finally had the chance to talk about the Alzheimer’s clinic, and she said, “OK, I’ll let you do the screening thing.”

Today, I’m the director of the Alzheimer’s Prevention Clinic, and I oversee more than 30 people who build tech applications, assist with the myriad aspects of our research programs, and develop new methods of cognitive testing. We’re taking a different approach to managing Alzheimer’s prevention because we’ve learned that the disease builds up over 20 or 30 years before the first symptoms appear. We’ve created a free online course for the public on Alzheimer’s prevention and treatment, and done prospective studies that preliminarily show that changes in lifestyle — exercising more and eating a healthy diet — can maintain or improve cognition, and reduce a person’s calculated risk. Just because most people are diagnosed in their 70s and 80s doesn’t mean that you shouldn’t be treating them 20 to 30 years before. Since Alzheimer’s prevention is in its infancy and our patients are in their 30s and 40s, our next steps are to incorporate biomarker tests to more definitively assess the effectiveness of our clinical precision-medicine interventions. Before receiving our recent National Institutes of Health funding, the cost of biomarker testing was prohibitive, but now, with sufficient funds, we are on our way to determining the long-term impact.

Essentially, everything I tell my patients to do, in terms of making the right lifestyle choices, I do myself. Quite honestly, I firmly believe that the totality of evidence is overwhelming that these changes can reduce my own personal risk, as well as my patients’ risk, while also benefiting overall health.

I exercise a solid three days a week, at least twice with high-intensity interval training (like spinning classes), and once a week I do resistance training. I don’t eat more than 1,800 to 1,900 calories a day. I got my body fat measured, and I’m at 17 percent. I should probably get down to 16 percent, but I’m a firm believer in staying balanced and making your brain and belly happy, so I occasionally have chocolate ice cream and add some agave or brown sugar to my coffee and iced tea.

Using the words “Alzheimer’s” and “prevention” in the same sentence, oh, gosh. I used to get tomatoes thrown at me. Like, can you really prevent a heart attack? No, you can reduce a person’s risk. Same thing with Alzheimer’s. If we don’t use the word “prevention,” though, people think there’s nothing you can do, so they go on living their usual lifestyles, and guess what? One out of three cases of Alzheimer’s disease may be preventable based on lifestyle changes. A landmark study indicated that exercise, diet changes and cognitive training had a positive impact on cognitive function over time. And guess what again? These interventions are even more effective in those people who have the most common gene for late-onset Alzheimer’s disease. So, not only do we have some control over our destiny, it may even be possible to win the tug-of-war against your genes.

Dr. Richard Isaacson, M.D., specializes in neurology at NewYork-Presbyterian/Weill Cornell Medical Center. He is the founder of the Alzheimer’s Prevention Clinic (APC), Weill Cornell Memory Disorders Program, and a trustee of the McKnight Brain Research Foundation. He is also the author of two best-selling books, The Alzheimer’s Prevention & Treatment Diet and Alzheimer’s Treatment Alzheimer’s Prevention: A Patient & Family Guide.