Updated: Feb 25
As a primary care doctor I’ve been privileged to be involved in the care of many Alzheimer’s dementia (AD) patients over decades. It has been heartbreaking to bear witness to the devastation wrought by the tragic loss of memory/ identity/ self inflicted by this insidious and terrifying condition.
As an Integrative Medicine specialist one of the questions I’m asked most is, “How can I prevent dementia?” with a subtext that seeks the magic supplement or foods that will ward off risk. Unfortunately they do not exist.
The grim reality is that 44 million people worldwide have been diagnosed with AD, and because of the aging population in most countries that number is expected to grow to 130 million over the next 3 decades. There is no silver bullet thus far that can help, but there are a host of evidence-based interventions that will prevent or delay the onset of AD.
Alzheimer’s Disease Facts and Figures . Projected number of people age 65 and older (total and by age) in the U.S. population with Alzheimer's dementia, 2010 to 2050. Created from data from Hebert et al https://doi.org/10.1002/alz.12068: Alzheimer’s Association
State of the science
The last 20 years have seen tremendous progress in our understanding of dementia in terms of diagnosis, but sadly no cure and few therapeutic breakthroughs.
What we know for sure is that AD begins with changes in the brain at least 20-30 years before the first symptoms of memory loss. Which means that if you have a family member who developed AD at the age of 70, you could possibly already have signs of brain changes in your 40s or 50s.
Using the analogy of heart disease, atherosclerotic plaque begins accumulating in coronary arteries for at least a couple of decades before we see the clogging of arteries that lead to heart attacks. Similarly in the brain we can find early accumulation of toxic beta amyloid plaques and neurofibrillary tangles caused by tau protein, decades before clinical symptoms of AD begin to manifest.
For most dementia patients AD is often a mixed diagnosis with other pathology present in the brain such as clogging of brain arteries with atherosclerosis or perhaps a history of
traumatic brain injury or exposure to toxic chemicals.
Preserving brain health
We are beginning to see that our brains are complex and delicate structures: certain behaviors will improve risk, whereas others are almost certainly causing undue stress. In other words, like cardiovascular disease and diabetes, AD may just be the way that our brains are showing the injurious effects of our modern lifestyle,
We owe it to ourselves and our loved ones to enjoy and preserve our optimal brain performance
Risk for AD also involves nonmodifiable risk factors such as age, gender, and family history. Genes such as ApoE4 are also nonmodifiable, but we are only just beginning to understand that multiple genes can contribute to dementia risk. What we know for sure is that we can influence the expression of genes through epigenetics.
The good news is that there are a huge range of modifiable risk factors. We are learning that there are actually many safe interventions that can help to mitigate risk. Most of these include lifestyle modifications with which you are already familiar.
Weill Cornell Medicine’s Alzheimer’s Prevention program specializes in sharing leading edge scientific research on how to reduce your individual risk. Founder Dr Richard Isaacson estimates that AD can be prevented in up to 1 in 3 high risk people and delayed in many more. Check out the free content on their website Alzheimer’s Universe.
As I have learned more about Dr Isaacson’s work, I have become inspired to learn more about brain health and to help others to prevent Alzheimer’s. Because of my own ApoE4 status I feel called to share not only the science with others at high risk, but also to build a community that will support the behavioral changes needed to improve our odds.
My wish is for our work to come from a place of love and compassion, rather than fear or desperation. We cannot predict what the future will bring but we owe it to ourselves and our loved ones to enjoy and preserve our optimal brain performance, for now and for the future.
Alzheimer’s Universe is an education website hosted by Weill Cornell Medicine providing free educational material on dementia prevention based on research evidence. Take assessments to test your memory or learn more about personal risk.
Weill Cornell Medicine’s Alzheimer’s Prevention Clinic provides precision medicine consultation to individuals at high risk for dementia due to genetics or family history. A number of affiliate institutions are also listed at AlzU.org.