Did you know that making changes to the way you live your life can lower your risk of Alzheimer’s disease by as much as 40%? In this episode, we look at how the things we do can affect our brain health. We also talk about the risks of getting Alzheimer's from the genes we inherit from our parents.
Our guests explain that Alzheimer's and dementia are partly modifiable, meaning that certain lifestyle changes can decrease the risk of developing these conditions. Our guest Kelly O'Brien, who has a family history of Alzheimer's, shares her relief after learning that genes are risk factors, but not absolute predictors of the disease.
We learn what factors put people at a higher risk for Alzheimer’s disease, and discuss strategies available to potentially reduce the risk of developing Alzheimer's. We highlight the importance of a "brain-healthy lifestyle," which includes managing risk factors such as heart disease, diabetes, and high cholesterol through diet, exercise, and social interaction. We also discuss the significance of genetic factors, like the APOE4 gene, but remind listeners that these do not guarantee the development of Alzheimer's.
We highlight disparities in healthcare and how they affect Alzheimer's risk and treatment, particularly in Black and Latino communities. Efforts to address these disparities and include diverse populations in clinical trials are mentioned as critical steps toward providing equitable healthcare.
This episode underscores the importance of early detection and proactive health management. Despite the genetic risks and the inevitability of aging, individuals can take significant steps to protect their brain health and possibly reduce their risk of Alzheimer's. Tune in to learn how to adopt a healthier lifestyle, and seek medical advice to navigate the risks for Alzheimer's.
For links to resources and information covered in this series, visit our website at HealthUnmuted.com/resources
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Rethinking Alzheimer’s Disease was made possible with support from Eisai Inc.
[02:07] The role of genes like APOE4 in Alzheimer's disease
[03:56] How to detect APOE4 through a genetic test
[04:57] What is the benefit of having a genetic test?
[05:48] What role does age and gender have in developing Alzheimer’s disease?
[07:10] What are the modifiable risk factors for Alzheimer's?
[09:39] Healthcare disparities and Alzheimer's risk
[11:34] What is the role of race and ethnicity in developing Alzheimer’s?
Disclaimer: The content provided in this podcast is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard on this podcast. Reliance on any information provided by this podcast or its guests is solely at your own risk.
©2024 Mission Based Media Ltd • April 2024 • AD-M2059
[00:00:01] Jason Resendez: The most exciting thing about our understanding of Alzheimer's, and dementia more broadly, is understanding that it's modifiable.
[00:00:11] Dan Kendall: Did you know there are things you can do today to improve your brain health?
[00:00:16] Dr. Sharon Cohen: There are modifiable risk factors for Alzheimer's disease. And we do believe that if people look after themselves well and adopt what we call a brain healthy lifestyle, then one can reduce the risk of dementia, including Alzheimer's disease.
[00:00:34] Kelly O'Brien: I'm checking off the list of the risk factors and seeing how I'm doing. That's my approach at the moment.
[00:00:40] Dan Kendall: In this episode, we explore the risk factors of Alzheimer’s, as well as lifestyle changes that can help maintain a healthy brain.
I'm Dan Kendall, and this is the Rethinking Alzheimer's Disease Podcast.
The Rethinking Alzheimer's Disease Podcast was created by Mission Based Media with support from Eisai. This series is for educational purposes only, and is not a substitute for formal medical advice, diagnosis, or treatment. The opinions expressed are the individual views of the speakers themselves and do not necessarily represent those of any organizations. If you have questions about a medical condition, talk to your qualified healthcare provider. For our list of resources about Alzheimer's disease, please visit healthunmuted.com/resources. All guests participated voluntarily and did not receive any form of compensation for their involvement.
We met Kelly, a triathlete in episode one. She was a caregiver for her father who had Alzheimer's disease, and she has other family members who have also been diagnosed. With so many family members affected, Kelly was concerned about how that affects her chances of developing it too. She told me about a visit to her doctor where she learned something that changed her life.
[00:01:50] Kelly O'Brien: They were doing like a TED talk type thing and I remember going and they said, "Genes are a risk factor, they're not a determining factor." And I burst into tears. I just thought, "Oh, my God, I thought that I was going to get this because my dad had it."
[00:02:02] Dan Kendall: Kelly was relieved to hear that a family connection doesn't mean that you'll automatically develop Alzheimer's. With Alzheimer's, researchers have found that there are multiple genes that increase the risk of developing the disease.
[00:02:12] Dr. Sharon Cohen: There are definitely genetic risk factors that impact Alzheimer's disease development. We talk about genetics in two broad categories, genes that put one at risk for disease, and then genes that, when mutated, can actually cause the disease.
So if we look at the risk genes for Alzheimer's, these don't guarantee that one develops Alzheimer's, but they put one at a higher risk. And there are at least two dozen of these risk genes that we know about, but the one we talk about the most because it confers the highest proportion of risk is the APOE4 gene and specifically the APOE4 allele or the APOE4 variant of that gene. It confers a dose-dependent, risk. And what I mean by that is if you have one copy of APOE4, you have about threefold higher risk of developing Alzheimer's disease. Twenty-five percent of the population have one copy of APOE4.
If you have two copies of APOE4, one from mom, one from dad, then your risk goes up about 10 to 12 fold over the general population. That's the rare situation. Then you have a tenfold increase of risk of Alzheimer's.
[00:03:32] Dan Kendall: Only about 2 percent of the U. S. population has two copies of APOE4. This recently got a lot of attention when actor Chris Hemsworth, who plays Thor in the Marvel Cinematic Universe, disclosed that he carries two copies of the APOE4 gene.
[00:03:46] Dr. Sharon Cohen: So the number of APOE4 alleles you have determines your risk and may also determine your response to treatments that are under development.
[00:03:55] Dan Kendall: APOE4 can be detected through a genetic test.
[00:03:59] Sharon Cohen: There is an ingenious technology, a cheek swab that allows us to get the result in an hour, right in the clinic. The other way that genetics plays a role is that in rare cases there are gene mutations that actually cause Alzheimer's disease and they're inherited from parent to child.
[00:04:19] Dan Kendall: These gene mutations lead to what is known as familial Alzheimer's, meaning you inherit it from your family. It causes early onset Alzheimer's, where symptoms show much earlier in life, between early-40's and mid-50's. This type of gene affects about one percent of the cases of Alzheimer's.
[00:04:36] Sharon Cohen: And for that scenario, it's not a matter of if you'll develop Alzheimer's, but when, because those gene mutations will definitely cause disease. And there are trials going on now for people who carry those genes. Clinical trials, looking at trying to keep people at mild stages or preventing them from becoming symptomatic.
[00:04:58] Dan Kendall: If one of your parents has this familial gene mutation, you and your siblings have a 50 percent chance of also having it. Like APOE4, gene mutations can be detected through a genetic test. If you have multiple generations of Alzheimer's in your family, Dr. Cohen recommends getting tested for these gene mutations. You can get testing for the familial gene or the APOE4 gene at any age. Some people decide to get tested at an early age so they can get ahead of a potential diagnosis. Although some healthcare providers suggest that early testing can worry patients, studies show an early diagnosis can also change your life in a positive way.
[00:05:33] Sharon Cohen: People in the end, and this has been studied, end up looking after themselves better. Either they join a trial or they embrace healthy lifestyle strategies to a greater degree, because once you know you're at risk for something, the next step is to look after yourself better.
[00:05:48] Dan Kendall: Although many people develop Alzheimer’s late in life, it’s not caused by simply getting older.
[00:05:54] Sharon Cohen: Alzheimer's disease is not caused by age, but it's what we call an age-associated disease. So the older you are, the greater chance of having Alzheimer's disease.
[00:06:04] Dan Kendall: Gender also seems to play a role. Women are diagnosed with Alzheimer's more often than men. In fact, almost two-thirds of the people diagnosed with Alzheimer’s in the US are women.
[00:06:14] Sharon Cohen: Women are disproportionately affected by Alzheimer's disease in two ways. They tend to get Alzheimer's disease more often than men, and they also end up being caregivers more often, so it's kind of a double whammy. We're not 100 percent sure why, there's something in the biology and there may be something environmental about this.
Originally the thinking was women live longer, they have a longer lifespan, this is an age-related disease, Alzheimer's, so they're more likely to live to the age where you get Alzheimer's and men die off from cardiovascular disease earlier.
[00:06:44] Dan Kendall: But after further studies, scientists realized age didn’t paint the full picture for women. When looking at biology, a clue arose: hormones.
[00:06:53] Sharon Cohen: During menopause, women have this very dramatic drop in estrogen. And that's around the time when preclinical Alzheimer's disease is starting to take hold. There are other hormones being looked at. So there's a whole host of biologic reasons still being worked out.
[00:07:11] Dan Kendall: The genetic risk factors for developing Alzheimer’s disease can’t be changed, however there are other factors that can be changed which can lower the risk of developing Alzheimer’s disease.
[00:07:24] Jason Resendez: The most exciting thing about our understanding of Alzheimer's and dementia more broadly is understanding that it's modifiable.
[00:07:33] Dan Kendall: That's Jason Resendez, the president and CEO of the National Alliance for Caregiving.
[00:07:38] Jason Resendez: The Lancet Commission did an analysis to identify modifiable risk factors for Alzheimer's and other dementias, and what they determined was that between 40 to 60 percent of cases of Alzheimer's are modifiable.
[00:07:54] Dan Kendall: Several health conditions that affect the heart and blood vessels seem to increase the chances of developing Alzheimer's. These are conditions like heart disease, diabetes, stroke, and high cholesterol, which are also related to lifestyle factors like unhealthy eating habits, lack of sleep and exercise, high alcohol intake, and obesity.
[00:08:13] Douglas Panto: I'm trying to do all the right things.
[00:08:16] Dan Kendall: That’s Douglas Panto. He’s the Community Programs Manager for the southeastern Virginia chapter of the Alzheimer's Association. Knowing he has Alzheimer’s in his family, he’s doing everything he can to make healthy lifestyle changes to reduce his risk.
[00:08:30] Douglas Panto: If I'm destined to get it, I'm still destined to get it. However, it will reduce that risk tremendously by living that healthy lifestyle.
[00:08:38] Dan Kendall: Among the modifiable risk factors, there’s a common theme.
[00:08:42] Jason Resendez: What's good for your heart is good for your brain. And that's a really important message because it then enables you to think about what things am I going to do for my heart health that's going to have ripple effects for my brain health? We're learning more and more about the importance of diet and exercise in reducing risk for Alzheimer's. We're learning more and more about the role of social interaction in promoting brain health.
So there's a lot that we can do now when it comes to just living a healthier lifestyle. Making better choices at the grocery counter, making better choices when you're thinking about how to spend your weekend.
[00:09:22] Dan Kendall: Risk factors impact everyone differently. To learn more about the modifiable risks that affect you personally, start a conversation with your healthcare provider. You can also check out our website for links that can help you make better decisions for your brain health.
[00:09:39] Leslie Fontenot: Across the country, especially in black neighborhoods, a lot of the hospitals and medical centers that were catering to this population have closed.
[00:09:49] Dan Kendall: Another risk factor is healthcare disparity – that’s the difference in health outcomes across different racial, ethnic, socioeconomic, and geographic groups. It often results in these groups experiencing worse health outcomes and receiving poorer quality of healthcare compared to other groups.
[00:10:06] Leslie Fontenot: My name is Leslie Fontenot, and I am the VP managing director for Black Health Matters.
A lot of times, with African Americans, they don't want to admit that they have a problem. They get along to go along, but they're really looking to just keep their life moving forward. And then you have low income situations in terms of people not really having access to proper insurance and not getting the care they need. Some people are just trying to survive every day. They don't have the luxury of being able to go to a doctor that's across town.
[00:10:42] Dan Kendall: People like Jason Resendez, the president and CEO of the National Alliance for Caregiving, are working hard to fix these healthcare disparities.
[00:10:50] Jason Resendez: I'd say at the national level we are prioritizing equity and understanding and addressing disparities like we've never done before; Black and Latino Americans, for example. So from a research perspective, there's still a lot more that can be done, but we're certainly seeing progress there. When it comes to a treatment perspective, we're seeing industry step up, and start to place a greater emphasis on inclusion in clinical trials to ensure that new breakthrough therapies are going to be as effective in African American and Latino people as they are in the white men that traditionally these drugs have been tested in. And that's a really critical issue that deserves continued attention.
[00:11:34] Dr. Sharon Cohen: Race and ethnicity are important factors in many diseases, and they're not always well understood. We're starting to pay closer attention to the role of race and ethnicity in Alzheimer's disease. We think that certain races may have a greater propensity to develop Alzheimer's disease, and this is complicated.
Is it because they haven't had the appropriate health care opportunities, educational opportunities to build brain reserve and protect the brain over the lifespan? Is it because of something in their genetics that makes them more prone to accumulation of amyloid protein? Or are there other diseases they're more likely to have, for example, hypertension and stroke, that themselves can cause dementia? So it becomes very complicated, and one shouldn't assume that races all have the same type of dementia or the same prevalence of dementia and will respond in the same way to treatments. So we need to be very careful when we look at race and ethnicity that we're being very careful to know the limits of our understanding.
[00:12:51] Dan Kendall: Changes in the brain can occur up to 20 years before symptoms of Alzheimer's appear. Completely preventing Alzheimer's isn't possible, but there are things we can do to improve our brain health and physical health. It's important to recognize the risks and what you can do to improve your overall health because some of the risk factors simply aren't avoidable. However, genes do not equal destiny. A healthy lifestyle may help reduce your risk of developing Alzheimer's disease. Knowing there's a way to modify the risks of Alzheimer's gives people like Kelly hope.
[00:13:22] Kelly O'Brien: I can't control the risk, but there's lots of other things I can control. And to me, I was so relieved and so excited and it just changed my life. I'm focused on preventing this thing from happening in the first place.
[00:13:34] Dan Kendall: On the next episode of the Rethinking Alzheimer's Disease Podcast.
[00:13:39] Yaakov Stern: You can have someone come in with their spouse and their spouse will say, “it's really subtle, but I'm really thinking that he's not doing quite as well as he should be.” And then on testing, this person really is very impaired.
[00:13:54] Dan Kendall: When should you be concerned about Alzheimer's disease? We'll learn about the early signs and symptoms and the life changing importance of early detection.
This is the Rethinking Alzheimer's Disease Podcast, hosted by me, Dan Kendall. This show is part of the Health UNMUTED audio library by Mission Based Media and was created with support from Eisai. To listen and learn more, visit healthunmuted.com/resources and follow our show on your favorite podcast player.