After your weekly workout, you stop to chat with a friend as you gather your things to leave the gym. Halfway through your drive home, you realize you’ve left your AirPods behind. Again. You turn the car around, wondering whether these little memory lapses are a sign of Alzheimer’s disease or just part of aging.
An estimated 6.9 million older adults in the U.S. are living with Alzheimer’s disease, and decades of research have helped us understand that the condition is tricky to treat. With people living longer lives, science-backed preventive measures offer a chance to help delay the onset of Alzheimer’s disease while we continue to seek a cure.
The latest research shows that up to 50% of dementia is preventable. By understanding your risk, adopting healthy habits and staying abreast of the latest treatment options, you can keep your brain in the best possible health at every stage of life.
What are the risk factors for Alzheimer’s disease?
There is solid scientific evidence that a number of factors can increase a person’s risk of developing Alzheimer’s disease. Health-related factors include uncontrolled diabetes, elevated cholesterol, high blood pressure, sleep apnea and unhealthy weight.
A history of head trauma, chronic exposure to air pollution, or adverse childhood experience, such as a divorce or emotional or physical abuse, can also increase a person’s risk. A gene called APOE4 and a family history of dementia in a first-degree relative, such as a parent or sibling, can contribute to individual risk.
What can I do to reduce my risk?
Almost everyone has something they can improve on. Physicians and healthcare providers recommend simple guidelines that benefit both the brain and the heart.
Engage in daily physical activity. Eat a varied diet of mainly whole foods with a focus on green leafy vegetables, nuts, olive oil, legumes and fish. Avoid tobacco products and recreational drugs and alcohol and get regular medical checkups. If your blood pressure or cholesterol levels are high, talk with your doctor about reducing them.
Seek professional help with behavior change, such as quitting smoking or improving your diet, as well as for help with depression or anxiety. You can also take steps to strengthen your social network of family and friends to avoid isolation and dabble in new or challenging hobbies to help keep your cognitive abilities engaged.
Research has found that preventive measures taken early and followed consistently could delay the onset of Alzheimer’s disease by as much as five to eight years.
What tests determine individual risk?
There is no one blood or imaging test that will determine a person’s risk for developing Alzheimer’s disease. A thorough risk assessment should include a comprehensive medical history, family health history, a detailed neurologic exam and cognitive testing. Physical examination including assessment of balance, muscle strength and gait is vital, given the connection between frailty and the risk for Alzheimer’s disease.
To obtain accurate information on important risk factors such as blood pressure, sleep and physical activity, digital wearable technology provides continuous data that offers the opportunity for targeted intervention to reduce risk. Genetic testing and blood biomarker testing can provide additional information on future risk for Alzheimer’s disease or other forms of dementia.
What about the newly approved Alzheimer’s disease treatments?
In early summer, the Food and Drug Administration approved an Alzheimer’s disease treatment called donanemab, sold under the brand name Kisunla. This came roughly a year after the approval of a similar drug, lecanemab, sold under the brand name Leqembi.
Both medications have been shown to reduce brain levels of beta-amyloid protein, a key factor contributing to Alzheimer’s disease. While donanemab isn’t yet available, patients are now being treated with lecanemab.
The drugs are similar and have been shown to slow disease progression by around four or five months. Both are expensive and come with the risk of brain bleeding or swelling that could cause symptoms ranging from headache, dizziness, double vision or nausea to weakness and numbness or even seizures.
One important difference between the drugs is that while patients stay on lecanemab for at least 18 months, donanemab treatment can be stopped once beta-amyloid levels have dropped below a certain threshold. So donanemab could be used to temporarily drive amyloid down while patients work on lifestyle factors or are treated with new drugs that might be developed.
Even with successful treatment to slow the disease, there is no known way to reverse the memory loss or stop its progression, so for Alzheimer’s disease, prevention is always better than cure.
Dr. Zaldy Tan is director of the Maxine & Bernard Platzer Lynn Family Memory & Healthy Aging Program at Cedars-Sinai. The program is open to those ages 40-60 with at least two Alzheimer’s disease risk factors and anyone over age 60 who wants to protect their brain health.
Dr. Sarah Kremen is director of the Neurobehavior Program and an associate professor of Neurology at Cedars-Sinai. She also leads the Alzheimer’s Disease Clinical Trial Program in the Department of Neurology at Cedars-Sinai.
