ApoE4 Is Not Destiny

“Do you want to receive potentially alarming news about your cognitive health, or would you rather not?”

That was the central question in an article published in the New York Times Sunday Review last month (“What If You Knew Alzheimer’s Was Coming for You?”), related to the development of a potential blood test to detect the early signs of Alzheimer’s. The article also focused heavily on testing for the ApoE4 gene, which carries an increased risk of developing the disease.

The front-page article was disappointing for numerous reasons, not only because it wrongly asserted that the ApoE4 gene is “a time bomb,” but because it traded an opportunity to educate and empower readers in favor of preying on their fear.

The genetics of Alzheimer’s disease is complicated. A small percentage of patients (less than 10 percent) have “early onset” or a form of the disease linked to the inheritance of specific genes. The majority of Alzheimer’s cases are late onset, resulting from a complex interaction of genetic and lifestyle factors. While inheritance of the ApoE4 gene increases risk, it is not destiny.

This means one third of Alzheimer’s dementias could be preventable.

Instead of asking reader to ponder “potentially alarming news,” there is actual good news to consider.

Although science does not yet agree on the amount or types of exercise or the aspects of diet that are most impactful, the link between heart and brain health is increasingly undeniable. Earlier this year, the Lancet Commission reported a landmark study that should have made headlines everywhere, on the nine heart-healthy lifestyle factors that can cut your risk of dementia by a third. This means one third of Alzheimer’s dementias could be preventable.

For the other two thirds of Alzheimer’s dementias, every new avenue of research brings us closer to a cure. In his November 13 blog post (“Why I’m digging deep into Alzheimer’s”), Bill Gates helped to shed light on the dire need for “less mainstream” research, citing the still largely-ignored fact that billions of Alzheimer’s research dollars over the past three decades have funded studies based on a sole hypothesis—the amyloid cascade hypothesis—that has failed to produce a single treatment that can slow or stop the disease.

It bears repeating: The majority of studies (funded by billions research dollars) have all been based on a single hypothesis that has yet to produce a single disease-modifying therapy. We cannot afford, in funds and in lives, to continue on this path. 

Many of us in the field long have cautioned against ignoring the multifactorial causes of Alzheimer’s. Thankfully, the fight against this disease is beginning to move beyond the established dogma. As 2018 begins, new approaches to research and treatment, along with public education on the benefits of a brain-healthy diet and exercise, give us more reason to be hopeful than afraid.

Wishing you a happy and healthy new year ahead.

Executive Director

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