Alzheimer's symptoms were apparent. Miraculously, his brain showed signs of recovery.
I was taken aback. I needed to catch my breath. In accordance with Isaacson, head of research at the Institute for Neurodegenerative Diseases in Boca Raton, Florida, "Simon's blood tests on his brain had normalised."
Was this an outcome of a state-of-the-art wonder drug designed to battle dementia? On the contrary, it was a tale of good old-fashioned resilience and tenacity.
"Simon was on a mission, as if Death itself was looming above his head. He was hellbent on wreaking havoc and causing suffering," said Isaacson.
Nicholls, guided by Isaacson, brought about lifestyle changes to reduce his chances of developing dementia, comprising diet, exercise, stress reduction, and adequate sleep, along with some carefully chosen vitamins and medications prescribed by his cardiologist.
"I was enormously apprehensive," Nicholls told CNN's Chief Medical Correspondent Dr. Sanjay Gupta in his fresh documentary, "The Last Alzheimer's Patient," aired on "The Whole Story with Anderson Cooper."
"I have a young three-year-old son and an eight-year-old. It's really essential for me, as I age, to strive and remain in their lives," he said."There are numerous alterations in lifestyle you can make to perhaps push the disease back and provide yourself more time, which is everything we need until a cure is found."
Difficult Genes
In terms of genetics and dementia, Nicholls fell into the unlucky bracket. He possessed two copies of the APOE4 gene, one from each parent, which might enhance the likelihood of developing Alzheimer's by at least tenfold.
"Regretfully, my mother passed away due to what we presume was Alzheimer’s in her 70s," Nicholls recalled. "For the last decade of her life, she merely sat in a chair, rocking, while taking about 14 meds. I'd rather have a longer life span and then simply expire promptly."
Not every person with one or even two copies of the APOE4 gene develops Alzheimer's, though, opening up a captivating potential. Could a person lessen their genetic risk for Alzheimer's through lifestyle modifications and varying medical interventions if started early, prior to significant harm?
Isaacson, battling his own family history of Alzheimer's, asserts that yes, it's possible. He established the first US clinic dedicated to Alzheimer's prevention in New York City in 2013 before moving it to Florida in 2021. His studies indicate that applying a dozen or more lifestyle initiatives within 60% of the time could boost cognitive performance, particularly in females.
Currently, scientists across the globe are also delving into the effects on the brain of lifestyle changes such as a nourishing plant-based diet, stress relief, strength training, aerobic exercise, and sleep habit improvement—habits that Isaacson and his team highlighted in a recent study published in Nature.
"I don't use the phrase 'reverse.' I have no idea what 'reverse' signifies when it comes to the Alzheimer's field," Isaacson commented. "But the results we've witnessed with Simon and a few other patients in our investigation are exceptionally exhilarating."
The Interlinking of the Heart and Brain
Alzheimer's isn't the sole route to a life devoid of memory and the inability to think, deliberate, and bond with cherished ones.
Vascular dementia, the second most common form of dementia after Alzheimer's disease, can be a consequence of atherosclerosis, a buildup of plaque in the arteries that can ultimately trigger heart attacks, strokes, blood clots, and additional ailments, all of which can impair both body and mind.
Families can be plagued by poor hearts and their consequences over several generations, as Nicholls well knew.
"My entire family was tormented by a myriad of heart attacks, leading to my grandfather on my mother's side passing away around age 50," he said. "My mother underwent three heart attacks, the first one at age 50 then a triple bypass before enduring a different form of dementia."
Possessing an APOE4 gene amplifies the risk for heart disease as well as dementia, according to experts.
"My sister had three heart attacks, and when I was 40, I was informed that I had atherosclerosis with an off-the-charts coronary artery calcium score of around 1,500 and blockages in nearly all my arteries." Fittingly, a standard coronary artery calcium score equals zilch.
For someone in the prime of his existence, the news was disheartening. Specialists attempted to use lifestyle adjustments and statins to reverse the plaque deposits but ultimately opted for surgery, opening three of Nicholls’ arteries with stents. He also began administering an injectable drug called evolocumab, designed to raise the liver's capacity to expel undesirable low-density lipoprotein (LDL), or "bad cholesterol," from the body.
'It was time to direct my attention to my brain'
Little by little, Nicholls' heart condition showed signs of healing, but the misery didn't cease there. A brain scan found indicators of vascular damage in Nicholls' brain, which transpires when the tiniest vessels are short of oxygen.
"The doctors stated I had far too many white matter lesions," Nicholls said. "I told myself that since I had now solidified my heart situation, it was time to focus on my brain." ^
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In January 2023, Simon engaged in a pioneering clinical trial hosted by Isaacson's center in Florida, marking his spot as participant number 34. This trial aims to uncover contemplative risk elements and counter them with tailored interventions. (On a personal note, I'm participant number 20 in the same trial; you can read my take on it here.)
The trial included a series of tests, one of them being a distinctive blood test that assesses the levels of amyloid, tau, and other biomarkers for Alzheimer's and degenerative ailments. These amyloid deposits are known to gather in the brain long before symptoms appear, sometimes in individuals as young as their 30s and 40s.
"Simon garnered a score of 70. Anything over 58 points toward the presence of amyloid in the brain," Isaacson revealed. "The results matched his amyloid PET scan from 2019, which unveiled the plaques in his brain."
Stepping it up: 'I'm very consistent'
The first step was to prescribe tirzepatide, one of the newer injectable medicines that curb appetite by triggering hormones that regulate blood sugar amounts. Concurrently, Simon was prompted to enhance his physical activity with strength training sessions three times a week and an extra 45 to 60 minutes of daytime exercise, where you engage in brisk walking, rucking, jogging, or cycling at 60% - 70% of your heart pace.
"I really enjoy strolling outdoors every morning during sunrise for an hour and a half while listening to podcasts. I easily reach 10,000 steps daily, and stay consistent," Nicholls expressed. "I also do a slow, full-body workout with weights three times each week for an hour."
To ensure optimum health, he was advised to stay away from sugar, artificial sweeteners, alcohol, and ultraprocessed foods. In addition, Nicholls should follow a vegetarian food plan, like the Mediterranean diet.
"When I initially met Simon, he had a moderate middle, which is typical for men in their 50s," Isaacson commented. "After nine weeks, I did a double-take. He was in incredibly good shape, exceptional indeed."
Burying his weight loss achievements and building muscle mass lowered Nicholls' fasting blood sugar levels, preventing him from developing diabetes. Some minor adjustments to his cholesterol prescriptions further fine-tuned his good and bad cholesterol percentages.
In August 2023, it was Nicholls' turn for the second round of the blood test for amyloid. The testing facility had incorporated a tau measurement, another indicator of Alzheimer's frontal lobe dementia, and Lewy body disease.
"Simon's amyloid probability score, now called APS2 test, had plummeted to 53, simply amazing," Isaacson remarked. "However, his status was still positive, as values varying from 48 to 100 denote a high probable risk of brain plaques on a scan."
'Tightening the screws'
Having taken care of issues concerning cholesterol, insulin, diet, and exercise, it was time to amplify his healthcare regimen with personalized recommendations, Isaacson stated.
"We reviewed Simon's omega-3 fatty acid levels, particularly impactful for individuals with APOE ε4 as they require higher amounts of omega-3, and included B complex vitamins in his regimen to manage his elevated homocysteine levels," Isaacson elaborated. "Nevertheless, we would not suggest B complex vitamins to anyone lacking higher homocysteine."
Homocysteine, an amino acid utilized by the body to generate proteins, is a hazard factor connected to brain atrophy, cognitive impairment, and dementia. A September 2010 randomized study confirmed that adding these vitamins slowed brain atrophy in individuals with mild cognitive impairment.
In the meantime, Nicholls experimented with various health practices at home.
"I have steam and sauna rooms and usher them frequently. I adore it," Nicholls mentions. "I've also attempted cold water plunges, as well as gathered a mix of activities from podcasts, ranging from walking to yoga to sleep habits to dining routines."
One component Nicholls did not share with Isaacson was his decision to have stem cell injections twice yearly. "Unfortunately, I have arthritis in my hands, and stem cells seem to alleviate my hand discomfort," he admitted. "I believe they might also be assisting my brain, which is a bonus."
The final challenge was addressing Nicholls' poor sleep quality, a known instigator of cognitive decline and Alzheimer's.
"With global business ventures, Nicholls constantly travels and endures disruptive sleep schedules due to jet lag and insomnia. In addition, he's a worrier," he acknowledged.
All in all, Nicholls' story imparts valuable insights into maintaining cognitive health. With practical lifestyle modifications and good company, he managed fat loss, bolstered muscle, and safeguarded his brain.
Providing a sleep aid authorized for treating insomnia aided in the situation, yet Isaacson expressed that Simon should address his sleep by enhancing his sleep hygiene with a consistent sleep pattern.
The update came on Halloween 2023, when Nicholls demonstrated a magnificent shift - his amyloid and tau levels in his blood decreased to 40, a negative result for Alzheimer's.
Isaacson displayed great caution, "I was very careful. Don't overpromise. I needed to retest." He obtained the retest outcomes just before Christmas. Upon receiving another negative result of 40, Isaacson decided to inform Nicholls in person.
"Dr. Isaacson drove down from Boca Raton to Miami, really happy and excited," Nicholls mentioned. "We strolled along a beach together and were beyond thrilled that we'd gone from positive to negative for amyloid."
Nicholls, though overjoyed by these improvements, is modest regarding his attempts to enhance his health.
"To comply is horrendously difficult, right? Of course, I want to have a beer or a hamburger or something unhealthy. I simply adore gummy bears and awful food," he reminisced.
"I've been rather lucky to have fantastic doctors, but to be honest, my greatest motivator is my children," Nicholls added. "I'd love to see my sons get married and have their own children, and I need to commit to staying as I am to accomplish that."
Reduced amyloid levels and enhanced hippocampus
Nicholls seems to be well on course for this ambition. In March, his APS2 score touched an astonishing low of 25.
The fascinating part is that Nicholls exhibited negative blood test results for amyloid and tau. Besides, the test highlighted the probability of normal brain amyloid without any noticeable signs of the disease. The only method to confirm this is by repeating the amyloid PET scan, Isaacson said.
"The amyloid value truly reduced it," Isaacson explained. "It normalized at .101, which is extraordinary. That's not a matter of discussion; for amyloid, .101 or above is normal."
Another surprising fact is that brain volume scans displayed an increase in the volume of the hippocampus, a seahorse-shaped organ responsible for memory, in Nicholls' brain since the study began.
In the early stages of Alzheimer's, the hippocampus shrinks rapidly and then atrophies as the condition advances.
Although these achievements are impressive, Isaacson takes a cautious approach. Since this is one singular event, and similar findings haven't been reproduced or published in a peer-reviewed journal, he is hesitant to use the term "reverse".
"I don't believe in the term 'reverse' because I don't know what will happen if the person stops performing the intervention," Isaacson clarified. "I also don't know whether the brain might normalize for a short time and then, five years later, catch up. How much data do I have? Not enough to consider it reversal."
Despite the cautious tone, Isaacson cannot contain his astonishment at the positive outcomes and his deep appreciation for Nicholls' dedication to the investigation and adhering to personalized interventions.
"I'm still in awe. I've encountered this before, but only from individuals receiving anti-amyloid medications," Isaacson reflected. "I'm still humbled and amazed."
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In light of his turnaround, Nicholls was eager to incorporate wellness practices into his routine to further safeguard his brain.
Embracing a holistic approach to wellness, Nicholls added meditation, breathing exercises, and sauna sessions to his regimen, further bolstering his mental and physical health.
Source: edition.cnn.com
