What a Modern Alzheimer's Prevention Evaluation Looks Like: Inside My Visit to RetainMed (powered by RetainYourBrain)

After years of tracking my own biomarkers as an APOE4/4 carrier, I finally decided it was time for my first p-tau blood test - and I wanted experts I trusted to help me interpret the results.

Over the past eight years, I've tried to be thoughtful - not reactive - about every new Alzheimer's test that has come along. Just because a test exists - it doesn't mean it's useful - and just because you get a result doesn't mean you'll know what to do with it. I've always wanted to understand not only what a biomarker measures, but how reliable it is, what it actually means for me, and whether it should change the decisions I make. For that reason, I’ve deliberately held off on getting a blood test for Alzheimer’s pathology until I could discuss the results with clinicians who work in this field every day.

Last week, I traveled to Boca Raton, Florida, for a comprehensive Alzheimer’s prevention evaluation. The program was engineered under the guidance of Dr. Richard Isaacson, one of the pioneers of preventive neurology and founder of one of the first Alzheimer’s Prevention Clinics in the United States while at Weill Cornell Medicine.

Many of you will also be interested to know that Dr. Isaacson has led the NIH-funded Retain Your Brain initiative, a free online brain health assessment designed to help people identify modifiable Alzheimer’s risk factors and receive personalized recommendations. If you’re looking for a place to begin assessing your own risk, I highly recommend taking a look at RetainYourBrain.com. The program is part of an NIH-funded effort to make evidence-based brain health guidance available to far more people than could ever be seen in specialty clinics.

The site is loaded with comprehensive information that is a “must” for anyone serious about AD prevention!

Why I Went

Being an APOE4/4 carrier means I have one of the highest known genetic risks for developing Alzheimer’s disease.

At 73, I’m already beyond the average age at which symptoms begin in many APOE4 homozygote studies. While genetics are certainly not destiny, I wanted to know whether the lifestyle changes I’ve been making over the past several years are reflected in today’s most advanced biomarkers.

I’ve spent years focusing on nutrition, exercise, sleep, metabolic health, hormone optimization, inflammation, and careful tracking of laboratory values.

Eventually, however, the question becomes:

Is what I’m doing actually making a difference?

That was my motivation for making the trip.

What the Evaluation Included

The initial visit included:

● Going over my medical history

● Body composition analysis using an InBody 970

● Grip strength testing

● An extensive blood draw

● A tour of the research laboratory

● A scheduled one-hour follow-up consultation once all laboratory results are available

● One year of blood sample storage in a deep freezer (in case their lab develops new tests in the future, we can go ‘back in time’ to test my samples later and track changes over time)

●some genetic variant testing, including a-Klotho

The Blood Biomarkers

One of the most exciting aspects of the evaluation is that it includes several of the new blood biomarkers that are transforming early detection of Alzheimer’s-related brain changes in the brain.

P-tau

Phosphorylated tau (typically measured as p-tau217 or p-tau181) is currently considered one of the most promising blood biomarkers for Alzheimer’s disease.

Tau is a normal protein found inside nerve cells. In Alzheimer’s disease, abnormal chemical changes cause tau to become phosphorylated, making it more likely to form the tangles that are one of the disease’s defining features.

Elevated p-tau doesn’t diagnose Alzheimer’s by itself, but it may indicate that Alzheimer’s-related changes are occurring in the brain - often years before symptoms develop.

GFAP

GFAP (Glial Fibrillary Acidic Protein) reflects activation of astrocytes, the brain’s support cells.

Researchers have found that GFAP may become elevated very early in the Alzheimer’s process, making it a useful marker for detecting early brain changes.

NfL

Neurofilament Light Chain (NfL) is a marker of neuronal injury.

Unlike p-tau, it isn’t specific to Alzheimer’s disease. It can increase in several neurological conditions. However, when interpreted alongside p-tau, GFAP, cognitive testing, imaging, and clinical history, it helps build a more complete picture of brain health.

ApoE4 protein Expression Test

One of the surprising new blood tests that I learned about was a new APOE4 protein expression test, and another related APOE blood test, to measure overall APOE function in real-time. Genes are only one part of a person’s risk equation and don’t change over time, but the amount of protein made (or expressed) by a gene can fluctuate. Using a car analogy, the APOE4 genetic variant is like a car engine (that you can’t readily change) but a protein test like this is like an engine light that may go on or off depending on how the car is running. Put in high quality fuel (e.g., nutrition) and perform routine maintenance (e.g., medical care), and the car runs in peak performance. Otherwise, if lifestyle and other medical risk factors are not optimized, it is theorized that more APOE4 protein would be produced, fast-forwarding amyloid accumulation, and the engine warning light may turn “on” - signaling a potential problem in the future.

More Than Just Blood Tests

One aspect I particularly appreciated was that this wasn’t simply a laboratory evaluation.

The team also measured body composition with an InBody scan and tested grip strength.

Those may seem unrelated to Alzheimer’s at first glance, but maintaining muscle mass, preserving strength, and minimizing visceral fat are increasingly recognized as important components of healthy brain aging.

Readers of this newsletter know I’ve become a firm believer in measuring what matters.

A Look Behind the Scenes

After my blood draw, I was given a tour of the laboratory.

It was fascinating to see where much of this work actually happens.

I was especially impressed by the number of Alamar Biosciences ultra-sensitive detection platforms in the laboratory. These research-grade instruments are capable of measuring proteins present in extraordinarily small concentrations - exactly what’s required for today’s advanced Alzheimer’s blood biomarker testing.

I also consented to participate in a research study to one day be able to test my brain biomarkers from home with just a few drops of blood and a fingerprick card that the team is investigating. In fact, I was the 4th participant in this new phase of the study that aims to bring costs down and further expand access to preventive neurology care.

Seeing that level of technology under one roof reinforced my confidence that this is a serious research-driven program.

Now Comes the Waiting

The laboratory results take approximately one month.

Once they’re available, I’ll return for a one-hour consultation where we’ll review every result in detail and discuss what each marker means in the context of my risk profile. My recommendations will be personalized and based on my unique biology, biomarker results, health history, and individual risk profile, not my APOE4 genetics alone!

More importantly, if anything requires attention, we’ll develop a personalized action plan. To me, that’s where the real value lies.

A laboratory result without expert interpretation is simply a number.

Understanding what that number means - and whether it should change anything I’m doing - is what I’m really paying for!

Was It Worth It?

The tests/evaluation and follow-up consultation cost $3,000 (This is special early access pricing).

That certainly isn’t inexpensive.

However, considering the depth of testing, the expertise involved, the advanced biomarkers being measured, and the dedicated one-hour follow-up consultation, I felt it was a reasonable investment for someone with my genetic risk profile.

Interested in Learning More?

If you’re curious about the comprehensive Alzheimer’s prevention assessment I underwent, additional information is available at RetainMed, or reach out to them at info@retainmed.com

And if you’re simply looking for a free place to begin understanding your own brain health risk factors, I encourage you to explore RetainYourBrain.com.

Looking Forward

When my laboratory results are complete and I’ve met with the clinical team, I’ll write a follow-up article sharing what my biomarkers showed, what they mean, and- most importantly- what changes, if any, I’m planning to make.