My guest today is Dr. Richard Isaacson, Director of the Alzheimer’s Prevention Clinic at Weill Cornell Medical College, and head of the Weill Cornell Memory Disorders Program and Neurology Residency Training Program. Dr. Isaacson has written multiple New York Times best-selling books on Alzheimer’s Disease (AD), and also makes regular appearances on the Dr. Oz show.
Dr. Isaacson joins me today to talk about a recent study from Weill Cornell in which patients with a family history of Alzheimer’s wore WHOOP Straps to evaluate for possible relationships between their sleep patterns and cognitive performance. We discuss the results of the study, the role WHOOP played, and what it means for future research when it comes to detecting and preventing AD.
With November being Alzheimer’s Awareness Month, we also explore how the disease works, who’s affected by it and the number of people who have it, as well as what we can do to prevent it in the future.
4:07 - Why Study Alzheimers? “Alzheimer’s for me is personal. My uncle Bob was diagnosed when I was in high school.” Several other members of Dr. Isaacson’s family have had it as well.
4:38 - Are You at Risk? “We now know it starts 20-30 years before the first symptom of memory loss begins. … Exercise is by far the No. 1 thing a person can do to reduce their risk.” Check out his book, The Alzheimer’s Prevention and Treatment Diet.
6:06 - How Prevalent is Alzheimer’s? “Probably 5.8 million Americans currently have Alzheimer’s Disease dementia, but over 46 million Americans have Alzheimer’s in their brain right now but have no symptoms. … This is not just a public health urgency, it’s a public health emergency.”
7:18 - Early Signs Prior to Symptoms. “People’s sleep patterns change, their mood changes, and this happens years or decades before symptoms. … We’re trying to develop new and innovative tests where we can detect maybe something is wrong before that first symptom.”
8:27 - 3 Stages of the Disease. “We now know Alzheimer’s occurs over decades. Stage 1 is preclinical or pre-symptomatic. … Stage 2 is called ‘mild cognitive impairment due to Alzheimer’s Disease.’” Dr. Isaacson refers to this as “senior moments.” Stage 3 is dementia.
9:53 - Stage 0. “When we’re trying to prevent the disease from happening in the first place.”
10:51 - “The ABCs of Alzheimer’s Prevention Management.” A: Anthropometrics (body composition). “As the belly size gets larger, the memory center in the brain gets smaller.” B: Blood-based biomarkers. C: Cognitive tests.
12:54 - Passively Collected Data. “Wouldn’t it be amazing … if someone could wear a WHOOP device or whatever that can actually detect whether or not a person may be having cognitive changes by using a peripheral biosensor?”
15:06 - Motivation from Uncle Bob, who saved his life as a 3-year-old when he fell into a pool. “To this day I don’t go near water, I hate water, it freaks me out.” They always had a special bond. “He became a shell of himself [due to Alzheimer’s] ... that’s just heartbreaking, and this happens to millions of people. It really has given me the motivation to keep pushing forward, to do something against this disease.”
17:21 - Rationale for Study. “In the never-ending quest to try to detect Alzheimer’s Disease as early as possible, because if we can do that then we can intervene as early as possible, my gut told me that there’s something about the cardiovascular system, and something about sleep, that are intimately related to Alzheimer’s.”
18:19 - Why Look at Sleep? “Sleep is just so important when it comes to brain health. Deep sleep is the ‘garbage disposal’ time of the brain. During deep sleep is when the trash gets taken out and the amyloid (the bad protein that gets built up in a person’s brain with Alzheimer’s) gets removed. When people are not having sufficient deep sleep their repair mechanisms just aren’t working. … REM sleep is when the short-term memories that happen during the day get translated into long-term memories. To me, if that’s doing well then maybe your memory function is better the next day.”
19:49 - Cost Effective & Non-Invasive Monitoring, a “way that patients don’t mind.” That was the logic behind using WHOOP for the study. “I bought a WHOOP for myself in 2017, literally within a week I said ‘Ah, this is what I needed.’ After about a month I said ‘I need to contact these people.’ … I met some people [at the company] and was blown away.”
23:10 - Study Basics. “We decided to slap WHOOP Straps on people and see if there was anything we could detect in the data to figure out if their brain is working well or not. I honestly thought we could detect a person’s cognitive function by looking at their cardiovascular function plus or minus sleep function, that was my hypothesis, that was what my gut told me. Fast forward two years and we actually have proof now that that is the case. … To make more progress we need to be able to track brain and body health in a passive, cost-effective way, and the promise with using a wrist biosensor like WHOOP is really exponential in terms of that.”
25:45 - Methodology. Dr. Isaacson credits Dr. Peter Yan, the other lead author on the paper. “We actually got down and deep into the engine and saw ‘Holy cow! What do we do with this [WHOOP] data?’ … Peter and his team figured out the different metrics that were most correlated with the cognitive measure that we were collecting in the clinic.”
28:50 - Cognitive Tests the subjects did. “We look at not just memory function, but also learning. We basically try to assess all the different parts of the brain. We also look at blood-based bio markers. … The goal of the study was to try to correlate with whether WHOOP-collected metrics could predict whether someone did well or not as well on the cognitive tests.”
29:56 - Conclusion. “Using the WHOOP-collected measures, we were able to predict whether a person would fall into one of two buckets--someone with above-average executive function … or someone who’s cognitive function was below expected.”
31:31 - 89% of Participants Wanted to Stay on WHOOP. “We planned this as a 6-month study and then we were going to say ‘OK, give us the device back,’ yeah, that didn’t work. And these were people of all ages.” Dr. Isaacson tells a story of one participant who still texts him about his WHOOP data long after the study concluded. “Literally the study ended over a year ago, and the whole leaderboard is still active.”
34:29 - Future Research. “There is so much more data, I know so much more about what these metrics can do. We’ll use this to inform the next phase of our work.” They’ve applied for a grant to fund a study with 100 patients. “We applied for half-a-million dollars through the [Bill] Gates allotment … My hypothesis is that WHOOP-collected measures may predict whether or not a person has amyloid in their brain.”
37:54 - A Safer Measure of Detection. “You can’t even have more than two or three PET scans a year because it increases risks of cancer.”
38:52 - Personal Learnings from WHOOP. “I’ve learned a ridiculous amount from wearing WHOOP,” including how even half a beer can destroy his recovery. “I had to really do a better job at getting myself ready for sleep.” He’s also lowered his resting heart rate significantly.
42:03 - Motivation & Teams in the WHOOP App. “The fact that we’ve been able to use WHOOP to motivate people and each other is a really important break through.”
43:05 - Tips for Preventing Alzheimers. “Exercise and sleep are easily two of the most important things.” Dr. Isaacson also says that “nutrition is key,” and to “know your numbers,” like resting heart rate, heart rate variability, etc. “Know every single little thing about you.”