Is Alzheimer’s an Inevitability?

Statistics

Here are some statistics:

• As many as 5.8 million Americans are living with Alzheimer’s disease.
• A person with Alzheimer’s disease will live an average of 8-10 years and as many as 20 years or more from the onset of symptoms.
• Official death certificates recorded 122,019 deaths from AD in 2018, the latest year for which data are available, making Alzheimer’s the sixth leading cause of death in the United States and the fifth leading cause of death among Americans age 65 and older.
• 19 million Americans said they had a family member with Alzheimer’s, and 37 million said they knew someone with Alzheimer’s.
• Between 2000 and 2018, deaths resulting from stroke, HIV, and heart disease decreased, whereas reported deaths from Alzheimer’s increased 146.2%. 
• It is projected that the number of Americans with Alzheimer’s disease could more than triple to 16 million by mid-century.
• The incidence of Alzheimer’s disease is about the same for all races, but women are more likely than men to develop the disease, in part because they live longer.
• Two-thirds of Americans with Alzheimer’s disease are women.
• Women in their 60’s are two times more likely to develop Alzheimer’s than Breast Cancer.
• Of Americans age 65 and over, 1 in 10 has Alzheimer’s disease, and about one-third of people age 85 and older (32%) have the disease.
• One in three seniors dies with Alzheimer’s or another dementia.
• Older African-Americans are about twice as likely to have Alzheimer’s or other dementias as older whites.
• Hispanics are about one and one-half times as likely to have Alzheimer’s or other dementias as older whites.
• Another American develops Alzheimer’s disease every 67 seconds. In 2050, an American will develop the disease every 33 seconds.
• Those with Alzheimer’s are three times more likely to face hospitalization and eight times more likely to need skilled nursing care.
• One-fourth of all home care involves care for an Alzheimer’s patient.
• Although Alzheimer’s disease is not a normal part of aging, the risk of developing the illness rises with age. Current research from the National Institute on Aging indicates that the prevalence of Alzheimer’s disease doubles every five years beyond age 65.
• Alzheimer’s disease accounts for 50% to 80% of dementia cases.
• It is estimated that one to four family members act as caregivers for each individual with Alzheimer’s.
• In 2019, more than 16 million family members and other unpaid caregivers provided an estimated 18.6 billion hours of care to people with Alzheimer’s or other dementias. This care is valued at nearly $244 billion, but its costs extend to family caregivers’ increased risk for emotional distress and negative mental and physical health outcomes.
• More than 7 of 10 people with Alzheimer’s disease live at home. Almost 75% of home care is provided by family and friends.
• More than 60% of Alzheimer’s and Dementia caregivers are women.
• Three out of five people needing care are cared for at home.
• In 2013, family members and friends provided 17.4 billion hours of unpaid care to those with Alzheimer’s and other dementias — care valued at $220.2 billion. In 2014, Medicare and Medicaid were expected to pay $150 billion for health care, long-term care, and hospice for people with Alzheimer’s and other dementias. 

Alzheimer’s disease is already one of the most costly diseases in the world. With increasing life expectancies and the aging baby-boom generation, Alzheimer’s will be a major public health issue for decades to come. It sounds like some pretty dismal prospects, but in reality, there are a number of things we can do to substantially reduce our risk.

Risk Factors

There is a core list of risk factors, most of which can be controlled fairly easily.

• Genetics – There are two aspects to genetics that affect your risk for Alzheimer’s.  To some degree, your unique genetics will govern how severely your body reacts to all of the other factors on this list.  But most significantly, is the presence of genes with very high correlations to Alzheimer’s. 

First is the APOE-e4 gene. An estimated 20-30% of individuals in the U.S. have one or two copies of APOE-e4; approximately 2% of the U.S. population has two copies of APOE-e4. If you received the APOE-e4 from one parent, then your risk of Alzheimer’s is raised, if you received this gene from both parents then your risk is greatly increased. 65% of those patients with Alzheimer’s have at least 1 APOE-e4 gene.  

Secondly, there are additional genes contributing to early onset familial (hereditary) Alzheimer disease (eFAD). Genetics researchers studied eFAD families to discover the three known genes that cause familial AD: amyloid precursor protein (APP), presenilin-1 (PS1), and presenilin-2 (PS2). Of these, PS1 mutations account for most eFAD, while APP and PS2 are more rare. Having a pathogenic mutation in one of these three genes virtually guarantees that one will develop early onset Alzheimer disease. Tests can determine which gene is at faulty (see Diagnosis). There are also cases of eFAD that cannot be linked to one of these three genes.

• Age – This is not something we can do anything about.  At age 60 our risk for Alzheimer’s is raised to 10%, at age 70 it is 25%, and at age 80 it is raised to 50%.   But what we can do, is manage all of the following factors to greatly reduce our risk for Alzheimer’s

• Inadequate sleep – lack of sleep is critical as this adds to your overall stress and does not allow your body or mind the proper to recover.
• Stress – Stress in general, and chronic stress in particular can have very detrimental health impacts including  a constant strain on your endocrine system and organs. Prolonged stress leads to hyper physiological levels of cortisol. This alters the effectiveness of cortisol to regulate both the inflammatory and immune response because it decreases tissue sensitivity to cortisol. As the human body heals, inflammation becomes a response to stress.
• Environmental and dietary toxicants – Whether it is smog, commercial chemicals, toxic mold in your home, heavy metals in fish or plant-based protein powders, there are many toxins we may be exposed to every day, yet be unaware of it, nor the resulting inflammatory response from your body.
• Sugars and food with a high glycemic index – Sugars and refined carbs can initiate obesity and insulin resistance.  This is a critical factor leading to Type 3 Diabetes (Alzheimer’s).
• Insulin resistance – This most commonly results from a diet, dense in sugars and refined carbs, and other health conditions that overwhelm your body’s ability to produce and respond to the insulin levels needed to manage your blood glucose levels. Blood tests rarely measure your insulin level, concentrating instead on glucose.  Insulin resistance and inflammation go hand worsening in a vicious cycle. 
• Smoking and tobacco use – This is a huge strain on your body, with countless negative effects including lowering your overall health and contributing to chronic inflammation.
• Alcohol – In general, drinking is harmful to your health. Recent research suggests that alcohol causes inflammation in the intestines and impairs the body’s ability to regulate that inflammation. In turn, inflammation worsens alcohol-related organ damage. Ultimately, excessive drinking can have serious implications for long-term health. However, it is worth noting that there is some evidence to suggest red wine in moderation has some cardiovascular benefits.
• Inflammatory food intake – There are foods such as sugars, simple or refined carbohydrates, dairy, and more, the cause an inflammatory response.  Some of this is universal and some of this based on the individual, such as sensitive to nightshades (e.g., potatoes and tomatoes).  Whatever the case, regular intake of these foods causes chronic inflammation which is a core factor in raising your risk for Alzheimer’s.

What you can do

Here is what you can do:

• Hit the books: Formal education in any stage of life will help reduce your risk of cognitive decline and dementia. For example, take a class at a local college, community center, or online.
• Don’t smoke: Evidence shows that smoking increases the risk of cognitive decline. Quitting smoking can reduce that risk to levels comparable to those who have not smoked.
• Moderate alcohol: Alcohol is a poison, so it is obviously not good for us. Over time, excessive alcohol use can lead to the development of chronic diseases and other serious problems including High blood pressure, heart disease, stroke, liver disease, and digestive problems including insulin resistance and inflammation. Alcohol also leads to cancer of the breast, mouth, throat, esophagus, liver, and colon.
• Cardiovascular health: Evidence shows that risk factors for cardiovascular disease and stroke — obesity, high blood pressure, and diabetes — negatively impact your cognitive health. Take care of your heart, and your brain might follow. It can be as simple as a healthy diet and 30 minutes of cardio exercise a day, such as a 30 minute walk.
• Protect your head: Brain injury can raise the risk of cognitive decline and dementia. Wear a seat belt, use a helmet when playing contact sports or riding a bike, and take steps to prevent falls.
• Eat properly: Eat a healthy and balanced diet that is lower in sugar and refined carbs and higher in vegetables and fruit to help reduce the risk of cognitive decline. Although research on diet and cognitive function is limited, certain diets, including Mediterranean and Mediterranean-DASH (Dietary Approaches to Stop Hypertension), may contribute to risk reduction.
• Get some rest: Not getting enough sleep due to conditions like insomnia or sleep apnea may result in problems with memory and thinking.
• Take care of your mental health: Some studies link a history of depression with an increased risk of cognitive decline, so seek medical treatment if you have symptoms of depression, anxiety, or other mental health concerns. Also, try to manage stress.
• Stimulate yourself: Challenge and activate your mind. Build a piece of furniture. Complete a jigsaw puzzle. Do something artistic. Play games, such as bridge, that make you think strategically. Challenging your mind may have short- and long-term benefits for your brain.
• Be engaged: Staying socially engaged may support brain health. Pursue social activities that are meaningful to you. Find ways to be part of your local community – if you love animals, consider volunteering at a local shelter. If you enjoy singing, join a local choir or help at an after-school program. Or, share activities with friends and family.
• Fasting: Consider how intermittent fasting can help you maintain a lean body mass, reduce your insulin resistance, help you detox, and even initiate cellular renewal through autophagy
• Learn more; Become more knowledgable about how you can reduce your risk for Alzheimer’s by managing the key risk factors listed in this article.

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