Who is Dr. Richard Isaacson?

In today’s post, we examine the work and of Dr. Richard Isaacson, a specialist in dementia prevention, and get inspired to take health into our own hands.

1. Know Your Numbers

What can we learn from Dr. Richard Isaacson? He is a world renowned neurologist, the Founder of the Alzheimer's Prevention Clinic, a first-of-its-kind facility at the Weill Cornell Medical Center. His focus is on preventative brain medicine, an emerging field with only a handful of practitioners in the entire country. The American Academy of Neurology even coined a term, “newrologists”, to describe the doctors working on preventative care efforts and novel therapies for the brain.⚭

He has the exact voice and mannerisms of Jason Bateman (if you don’t believe me, listen to his interview on Armchair Expert).⚭ His sense of humor keeps the conversation light, but his points are serious and I’m inspired by his approach to dementia care.

Dr. Isaacson likes to say, “know your numbers!” A patient at his Alzheimer’s Prevention Clinic would be put through a series of tests to establish the baseline numbers for their brain and body health. The “numbers” are measured using a system that he calls the ABCs:

• A is for anthropometrics - BMI, body measurements.

• B is for blood-based biomarkers - genetics, metabolism, inflammation, and nutrition.

• C is for cognition - memory, attention, language.

Once the baseline is established, the clinicians make personalized suggestions from a list of about 25 protocols. The suggested protocols aim to improve the specific markers of each patient. Then, six months later, they repeat the testing to see if the protocols are working.

Does this sound expensive? It’s not the level of care that most of us are getting, or will ever get. I tried to find what exactly they test, but the details were kept under lock and key. A single PET scan showing Amyloid buildup in the brian can be upwards of $3,000. Alzheimer’s drugs are $26,500 a year.

So, what can we learn from Dr. Isaacson, one of the most prominent figures in this field of dementia prevention, that can be used by the masses?

2. The Rise of Citizen Scientists

As of now, the spring of 2025, there is no magic bullet for dementia prevention. One day that will change. Until then, Dr. Isaacson’s approach is all about personalized intervention, knowing what changes your body needs to be as healthy as it can be.

He performs experiments on himself, which he calls N of 1 experiments (N being the number of patients in the study). In one interview he discussed checking a biomarker (blood pressure and cholesterol), then making a change (taking three doses of the GLP1 Terzepatide over a few weeks), then checking the biomarker again. 

This is similar to what he does with his patients - checking the numbers, making a change, and then checking the numbers again to see how it worked. If you can’t afford to do it in his clinic then do it yourself (in a safe and careful way of course) and become a citizen scientist!

There are citizen scientists in my family. My husband Will had eczema his whole life. Growing up, his dermatologist put him on steroid creams, Prednisone pills, and, for most of his youth, coal tar ointment for his hands that was so thick he wore gloves at night so he wouldn’t get tar on his pillow. 

At age 25 he decided that steroids and coal tar were not effective. He ordered a blood allergy test online using a service called Everlywell, then followed an elimination diet where he cut out every food that showed up on his test (milk, butter, bread, and coffee were the big ones). His eczema, which he had on and off his whole life, went away within a week. Will then introduced the foods back into his diet one at a time. When he ate dairy, the eczema came back, so now he doesn’t eat dairy. 

What get’s measured gets managed

Dementia is a brain disease, unlike Will’s eczema. So how does a citizen scientist begin even thinking about preventing dementia?

Your primary care doctor should be able to help you establish your baseline numbers. Start there and write them down. What are your cholesterol numbers, your blood pressure, your BMI. Discuss lifestyle and behavioral changes your doc recommends and medications you can take to improve your health. Make another appointment six months from now and see how your numbers have changed!

This is individualized clinical management, and it’s what Dr. Isaacson suggests for all of us. He believes that the brain, like the heart and the liver, is the one of the end organs that suffers when there are ailments in the body. Blood sugar, cholesterol, blood pressure, weight - these markers of body health are also markers of brain health. Its very possible that if these markers are telling you that your body is unhealthy, they are telling you the same thing about your brain.

Just give me a pill please!

The recommended approach is to find the lowest hanging fruit, the thing that is easiest to change, and work on that first. For some of us, sticking to a behavioral and lifestyle changes is never going to be easy. If it were easy, we would have already done it!

Fortunately, in addition to seemingly easy but often very difficult lifestyle and behavioral changes, there are two new FDA approved drugs for dementia prevention. There are also a growing number of drugs, not specifically for dementia, that are showing promise in the research of dementia prevention.

We wrote a separate post here on the advances in dementia medicines, it was too much to include in this post! Some of these drugs may be a good fit for your personalized approach to dementia prevention. It all depends on what your ABCs (and your doctor) are telling you.

3. Is Any of This True?

Dr. Isaacson’s work, and the field of dementia prevention in general, is subject to considerable criticism. In 2017, the National Academy of Medicine concluded that there is no evidence to warrant a public health recommendation for dementia prevention.

When looking for a protocol to follow for dementia prevention, it’s not always clear how you should proceed. Even the first FDA approved drug to treat early Alzheimer’s disease, Luqembi, is contested. I talk more about this in our post about dementia drugs, but sadly it is not clear among neurologists that the benefits of this drug outweighs the negative side affects.

While the medical research on new protocols for people experiencing dementia may not be conclusive, what Dr. Isaacson promotes is taking care of your body and brain now, before symptoms begin to show.

I like preventative medicine, especially in the case of dementia. They say an ounce of prevention is worth a pound of cure, but in this case there is no cure so an ounce of prevention is all you’ve got.

Dr. Isaacson is telling you to test your numbers, make what you think are healthy choices, and then re-test your numbers to see if your choices are actually making you healthier. He’s also telling you that Alzheimer’s disease and related dementias begin silently in the brain decades before memory loss and other symptoms begin. Starting these tests now, even if you are in your 30s, 40s, or 50s, feels like the right ounce of prevention to take.

4. Hope for the Future

“In terms of the ‘textbook’ of Alzheimer’s prevention, the first chapter is written and we are making progress on chapter two, but we still have a long way to go.” said Dr. Isaacson in 2018.

Perhaps he literally wrote chapter two in 2019, when he published an article in Alzheimer’s and Dementia reporting that his individualized approach to dementia care and prevention was showing measurable improvements in patients.⚭ 

Chapter three was likely written over the course of 2021, 2023, and 2024 - when three separate early Azheimer’s drugs came to market.

Chapter four will perhaps come out in September 2025, when the results of the Evoke study on GLP1s are published.

The textbook is still being written, and we will continue to send you updates when we read them. Until then, talk to you doctor, learn your numbers, and, if you’ve always dreamed of wearing a lab coat, become a citizen scientist.

Your body and mind are deeply connected, and together they are a responsive machine. If you change the inputs to the machine, the mac it will change if you change the inputs.

SOME NICE SIGN OFF, B.

Want to keep reading? Check out the links below.

Watch Dr. Isaacson’s Mastering Brain Health Series