Alzheimer’s is the second most-feared illness in the USA, following cancer. Studies suggest that our short-term memory peaks at age 25 and begins to decline at age 35. By age 65, approximately one person in seven experiences changes in their brain that may ultimately lead to the symptoms of Alzheimer’s disease (AD) or some other form of dementia. At age 72, one person in three experiences measurable cognitive loss. At 85, up to half of us will be living with some form of dementia.
This data is frightening!! In a few weeks I will turn 71. So far, (knock on wood and thank my lucky stars?) I am not experiencing measurable cognitive loss – YET! My Mom was diagnosed at age 82 with mixed dementia: late-onset AD and vascular dementia. So will my siblings and I develop this disease, too? I ask myself that question from time to time. I have tried to do the things that research indicates to keep my body healthy and my mind active. Here is what I have discovered that gives me some comfort, and I hope also answers my siblings’ concerns.
Scientists are still trying to determine the underlying causes of Alzheimer’s disease. It is a complex and complicated illness. However, it basically comes down to a combination of genetic and environmental factors, and lifestyle choices. Of course it is entirely possible to do everything “right” and still develop dementia, but there is growing evidence that lifestyle choices can make a difference in many cases.
There is hope on the near horizon for identifying and treating the underlying causes of AD. Dale E. Bredesen, MD, who, with his colleagues, has conducted years of cutting edge research and identified new, previously unrecognized causes of AD. More about that later in this article.
Hereditary Genetic Mutation
It has been consistently reported that there are two types of AD: 1) early-onset AD which is rare, affecting people age 60 and younger (less than 5 % of AD cases); and 2) late-onset AD that develops in persons over the age of 60. Researchers have identified two categories of genes that influence whether a person will develop the disease: deterministic genes and risk genes. Deterministic genes directly cause early-onset AD.
One type of early-onset AD is known as familial AD (FAD), also called autosomal dominant AD (ADAD). This type affects less than 1% of all persons with AD. It is unusual because it is caused by a hereditary genetic mutation to one of three deterministic genes: PSEN1, PSEN2, or APP. Mutations are located on one of three chromosomes: 21, 14, and 1.
According to Banner Alzheimer’s Institute, “If a child whose birth mother or birth father carries a genetic mutation of one of these three genes, then the child has a 50% chance of inheriting that mutation from the affected parent.” If they do inherit that mutation, then the chance of them developing AD is nearly 100% certain. The genetic mutation is usually passed down from generation to generation.
APOE Gene and Late-onset AD
Geneticists have identified genes associated with an increased risk of developing AD, but the apolipoprotein E (APOE) gene is the best known risk factor for developing late-onset AD. However, carrying the gene does NOT necessarily mean that the person will develop AD.
The APOE gene comes in three forms: e2, e3, and e4. Each of us inherits an APOE gene from our birth mother and an APOE gene from our birth father. This makes for six different combinations. It is when the person inherits the e4/APOE gene from both father and mother that the likelihood of that person developing late-onset AD by age 85 is 30-55%. Persons with e3/e3APOE genotype have a 10-15% risk of developing AD by age 85. Individuals with e3/e4 APOE genotype are at a 20-25% risk of developing mild cognitive impairment or AD by age 85. The e2/APOE genotype is rare and there is not a lot of information about the risk with this form.
It is important to note that just because an individual has 1 or 2 copies of the e4/APOE gene does NOT mean that they will necessarily develop AD. Likewise, just because a person does not have a copy of the e4/APOE gene, does NOT mean they will NOT develop Alzheimer’s.
Risk Factors Besides Genes
In my research, I have surmised that everyone who has a brain is at risk for developing the disease as they age, whether or not they carry a genetic predisposition. Age is the number one risk. Race is another. Latinos and African Americans are 1½ to 2 times more likely to develop AD than Caucasians. However, there are environmental and health lifestyle factors that can increase or decrease one’s risk.
Factors that MAY decrease risk: 1) no family history of dementia; 2) a high level of education; 3) good cardiovascular health; 4) being male.
Factors that MAY increase risk: 1) a family history of dementia; 2) a low education level; 3) cardiovascular disease and conditions such as high blood pressure and Type 2 diabetes; 4) being female; 5) obesity; 6) depression; 7) smoking; 8) a severe head injury or repeated head trauma.
The Reversal of Cognitive Decline May Be at Hand
Every day, researchers are learning more about our amazing brains and what factors contribute to the risk of developing this dreaded disease. One neuroscientist and neurologist, Dale E. Bredesen, MD, offers real hope to anyone looking to prevent and even reverse Alzheimer’s Disease and cognitive decline. Dr. Bredesen seems to have proof that AD is not one disease, as it is currently treated, but several different diseases, and each has a different optimal treatment. His new book, The End of Alzheimer’s, The First Program to Prevent and Reverse the Cognitive Decline of Dementia, outlines 36 metabolic factors (eg., certain micronutrients, hormone levels, sleep) that can trigger “downsizing” in the brain. Bredesen’s protocol rebalances these factors using lifestyle modifications, like taking B12, eliminating gluten, or improving oral hygiene.
After decades of research, the results have been so impressive that Dr. Bredesen published his extensive study and the results on ten patients in 2016 in the journal Aging (June, Vol. 8, No. 6). The therapeutic approach/protocol used was dubbed metabolic enhancement for neurodegeneration (MEND). Patients who had to discontinue working, were now able to return to work. Those patients struggling at work were able to improve their performance. Of the first ten patients on the protocol, nine displayed significant improvement with 3-6 months. Since that time, the protocol has yielded similar results in over a thousand patients now.
Dr. Bredesen’s protocol brings new hope to a broad audience of patients, caregivers, physicians, and treatment centers. His book provides a fascinating look inside the science, as well as a complete step-by-step plan that fundamentally changes how we treat and even think about AD. I have ordered the book and will share some of the insights I glean in upcoming blog articles.
Everyone is at risk of developing AD, even without a family history, and if you are at risk to develop AD from genetics and family history, as in my case, there are still many things that we can do to decrease our risks. Here are several recommendations mainly in the areas of lifestyle and health choices that will help you take control and take charge:
- Eat a healthy diet;
- Maintain a healthy weight;
- Exercise regularly;
- Don’t drink too much alcohol;
- Stop smoking (if you smoke);
- Get adequate sleep;
- Be conscious about safety by regularly using seat belts;
- Make sure to keep your blood pressure at a healthy level.
We can choose lifestyles that accelerate brain vitality rather than those that promote brain atrophy and dementia. What are we waiting for? It’s never too late to start!
I wish you peace, patience, compassion and joy in your caregiving today and every day!
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Disclaimer: This article is strictly an informational one. It is not meant to provide medical advice, diagnosis, or treatment. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified health professional.
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You can watch an interview with neurologist David Perlmutter, MD, discussing with Dr. Dale Bredesen the breakthroughs that this pioneer in Alzheimer’s research has documented in treating and reversing Alzheimer’s in 1,000 patients: https://www.drperlmutter.com/the-empowering-neurologist-david-perlmutter-md-and-dr-dale-bredesen/.
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The Alzheimer’s Association offers a 14-minute video, “Genetics in Alzheimer’s,” by John Hardy, Ph.D., of the National Institute on Aging, and Gerard Shellenberg, Ph.D., University of Pennsylvania. They discuss how genes cause disease, the difference between deterministic and risk genes, and which genes of each type are implicated in early-onset and late-onset Alzheimer’s: https://www.alz.org/research/video/alzheimers_videos_and_media_genetics.asp.
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“Early-onset AD and Genetics” is a video that offers a profile of the DeMoe family, in which five of six siblings carry one of the rare genetic mutations that cause inherited, early-onset Alzheimer’s disease. The family is partnering with doctors at the University of Pittsburgh to understand the course of early-onset Alzheimer’s. Watch the video here: https://www.alz.org/research/video/alzheimers_videos_and_media_early.asp.
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The video, “Late-onset AD and Genetics,” profiles the Nanney-Felts family, in which all seven siblings in the mother’s generation had late-onset Alzheimer’s disease. The family is working with Columbia University’s Richard Mayeux, M.D., to help understand the complicated genetics of late-onset Alzheimer’s. Go here to watch it: https://www.alz.org/research/video/alzheimers_videos_and_media_late.asp
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AARP published an article by Elizabeth Agnvall, March 1, 2011, titled, “Mother’s Alzheimer’s Increases Your Risk.” Agnvall reports on a study that was published at that time in the journal Neurology. To read the article, go here: http://www.aarp.org/health/brain-health/info-02-2011/health-discovery-mothers-alzheimers-increases-your-risk.html.