Genetics 102: Slowing the Deterioration of Alzheimer’s

In last month’s blog post, I addressed the impact of genetic risk in developing Alzheimer’s disease. In this post, I explain the importance of genetic testing, and how hope is NOT lost, should you have a higher risk genetic profile.

Studies show that when people start showing signs of early Alzheimer’s, medical and lifestyle interventions have only modest, if any benefit; however, the same interventions applied before onset of brain changes could have profound benefit. The healthcare field is focused on treating the five million Americans with Alzheimer’s. I respect that. But we need to shift the paradigm from brain disease to brain health. We must focus on the 48 million Americans who may get Alzheimer’s later in their lives.

If we want to get ahead of the curve, we must modify risk factors much earlier in your life. This is the reason to get screened for genetic risk factors for Alzheimer ’s disease: if you understand your genetic risk, you can make more informed decisions earlier in life, altering the trajectory of your lifetime risk.

 

When do I need to think about prevention?

The short response is NOW.

When people start to show early signs of Alzheimer’s – forgetting the name of a friend for a moment, or misplacing their car keys more frequently – the brain is already ravaged by shrinkage (atrophy), abnormal deposits of a protein (called amyloid), and tangling and death of brain cells (neurodegeneration). A recent study published by the Journal of the American Medical Association found that people with the highest risk genotype (carrying two copies of the APOE gene “e4” variant; see our previous blog [hyperlink]) begin to accumulate amyloid in their brains in their 20s! That is 20 years earlier than when the next highest homozygous (3/3) risk group begins to develop amyloid deposits. Even persons with lower genetic risks have amyloid deposits beginning in their 30’s or 40’s. These findings suggest that early interventions could delay – perhaps even prevent – Alzheimer’s disease later in life. This is why genetic testing is helpful to fully understanding your risk. Once your APOE genotype is determined, you and your family will be better equipped to build a customized brain health plan, taking into account the magnitude of the risk and the anticipated age of Alzheimer’s onset.

  If I’m at risk, how can I protect my children – and grandchildren?

The best thing that we can do to prevent Alzheimer’s in the generations to follow is to model brain health in our own lifestyles and behaviors, and to encourage our offspring to make brain healthy choices. This at the very least includes strict adherence to the Mediterranean diet, intense aerobic exercise (e.g., for at least 30 minutes four times a week), non smoking, moderate alcohol use, adequate sleep, annual medical check ups (to early detect and manage chronic diseases like hypertension, diabetes, hypercholesterolemia), annual dental check ups (to prevent chronic gum inflammation), annual gynecological assessments (in women, to detect and manage early menopause), and a lifelong commitment to learning and social relationships.

 

If there is a strong family history of Alzheimer’s disease, especially at an earlier age at onset, it may be worthwhile for your adult children or grandchildren to speak to an expert in brain health regarding possible genetic testing.