Five Questions to Ask Your Doctor If You Have a Family History of Alzheimer's Disease
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A family member's Alzheimer's disease diagnosis can present a variety of concerns and unknowns about their future and about your own health and risk factors. Understanding what you can do to slow (or prevent) cognitive decline is an important step toward long-term health.
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Is Alzheimer's disease inherited?
Researchers have identified uncommon genes that cause early-onset Alzheimer's disease with certainty in several hundred extended families worldwide, but this familial form is exceedingly rare, says Dr. Kyan Younes, a neurologist and professor at Stanford University School of Medicine. "The more common cohort starts in a patient's 70s or 80s," he says. While there are genes associated with the risk of this form of the disease, there isn't a specific gene that causes it. "If a person has a family history of Alzheimer's disease in parents or siblings, there is a slight increase in the possibility they will have it," says Dr. Younes, "but there is no conclusive evidence. A lot of people think that because their parents get the disease, they expect they're going to get it, but that's definitely not the case."
How do genetics affect the risk of developing Alzheimer's disease?
One specific risk gene, APOE-e4, has been associated with Alzheimer's, but "it's not a one-to-one correlation," shares Dr. Younes. "In the population, about 20 to 30 percent of people have APOE-e4, but when you look at Alzheimer's disease patients, about 40 to 60 percent have the gene. A lot of people with the gene don't have Alzheimer's disease, and vice versa—there are people that don't have the gene and still develop Alzheimer's disease." More than 20 other genes have also been correlated with increasing a patient's risk of Alzheimer's by one percent or less, notes Dr. Younes.
How is Alzheimer's related to other types of cognitive decline?
Cognitive decline and dementia are general terms, says Dr. Younes, that indicate a patient is having cognitive problems—memory loss, confusion, trouble with daily routines—but don't specify the cause of those issues. The pathology behind Alzheimer's disease, which includes a buildup of beta-amyloid protein in the brain, can be one part of the bigger picture, but isn't always the sole culprit. "Think about it as a pie," explains Dr. Younes. "In some people, a piece of the pie is due to Alzheimer's disease, but they also have some previous silent strokes, or vascular risk factors, that contribute to their cognitive decline. They could be drinking more than is tolerable or be on the wrong medication—all of that takes up some of the pie."
Are my diet and exercise habits supporting cognitive health?
If you have a family history of Alzheimer's disease, you should also consider environmental and lifestyle factors that could be learned behaviors—the result of your family's nurture, and not just your nature. "The Mediterranean diet is recommended," Dr. Younes, "with lots of fruit, vegetables, legumes, and not too much processed food." Developing an exercise habit that elevates your heart rate for 30 minutes five times a week strengthens your heart, lowering your risk of vascular disease and literally clearing your head by flushing out toxins and pathologies from your brain, says Dr. Younes. "Usually with lifestyle modifications—healthy eating, regular exercise—people can reduce the risk they get from their parents back to the normal population," explains Dr. Younes.
What other health changes could I make to help prevent cognitive decline?
Research has connected cardiovascular health with cognitive health, which means any habit or disease that puts your vascular system at risk could affect your brain, too. "Smoking, alcohol, diabetes, high blood pressure, and high cholesterol all need to be addressed," notes Dr. Younes. "Years ago, it was okay for elderly people to have high blood pressure—now aggressive blood pressure control is associated with a better cognitive outcome. Many elderly people have heart problems, like irregular heart rhythm, and need to be treated because this could cause strokes that worsen cognition."
