Neurology

Alzheimer's Disease

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Alzheimer’s Disease Lifestyle Risk Factors

patient care perspectives by Vijay K. Ramanan, MD, PhD
Overview

Certain lifestyle factors have been associated with an increased risk of developing Alzheimer’s disease (AD). While some risk factors, such as age and genetics, are nonmodifiable, many lifestyle risk factors for AD may be modified or managed to potentially help reduce the risk of developing the disease or improve the disease course.

“For all these factors, it is not about what you do in terms of intervention on any 1 particular day, but rather it is about building consistently good habits and managing conditions to optimal control. That is a balanced 'recipe' to minimize a patient's risk for further decline.”
— Vijay K. Ramanan, MD, PhD

There is a lot of research on lifestyle risk factors for AD, but sometimes it can seem difficult to put this research into context that we can apply to our daily lives. For example, there are many studies investigating whether vascular risk factors such as hypertension, smoking, obesity, and excessive alcohol intake may impact aspects of the underlying pathophysiology of AD, such as amyloid plaques and tau tangles. However, we do clearly understand that when those risk factors are not well controlled, they can negatively impact brain health in ways that are independent of the nuts and bolts of AD. Therefore, even if it turned out that those vascular risk factors did not directly impact the biological mechanisms of AD, they can absolutely still be expected to impact an individual’s clinical course by affecting brain health more broadly.

 

We also know that environmental and other lifestyle risk factors play a role. Individuals who are active socially, physically, and mentally—and particularly those who have built up healthy habits to consistently challenge their minds and bodies—do better in terms of cognition and function over time, even in the presence of AD. On the other hand, sleep disorders (eg, sleep apnea and chronic insomnia), hearing loss (which can make it difficult for someone to fully comprehend and interact with their environment), repeated head injuries, excessive alcohol use, and uncontrolled psychiatric conditions (eg, depression and anxiety) all can negatively impact cognition and function, with or without AD being present.

 

The good news is that there are evidence-backed intervention strategies. I consider addressing these lifestyle risk factors as being part of the active management of AD. For all these factors, it is not about what you do in terms of intervention on any 1 particular day, but rather it is about building consistently good habits and managing conditions to optimal control. That is a balanced “recipe” to minimize a patient’s risk for further decline.

 

There are some parts of this story for which it truly is never too late. For example, we know that untreated sleep apnea very often contributes to a person feeling fatigued during the day and can also contribute to the exacerbation or development of memory symptoms. It turns out that the consistent treatment of sleep apnea can, in some cases, result in a degree of improvement in those symptoms over time and yield other benefits to brain health.

 

If a patient already has significant chronic vascular changes in the structure of the brain (eg, from uncontrolled hypertension, smoking, or other vascular risk factors), although lifestyle modifications are not going to necessarily reverse those structural changes or their impacts on cognition or function, optimizing the underlying risk factors can help prevent the development of further vascular changes that could accelerate cognitive declines in the future.

 

I strongly believe that the same vigor with which we have promoted good habits for heart health can be applied toward promoting positive habits for brain health. I think that there is a huge opportunity to connect with the broader population on these topics. While lifestyle approaches can be implemented at any time, targeting midlife or even earlier to ingrain healthy habits represents a huge opportunity for many of us. The development of public educational resources and increased attention focused on these issues will be beneficial in our ability to achieve this goal. I am heartened to see a lot of effort moving in that direction.

References

Brett BL, Gardner RC, Godbout J, Dams-O’Connor K, Keene CD. Traumatic brain injury and risk of neurodegenerative disorder. Biol Psychiatry. 2022;91(5):498-507. doi:10.1016/j.biopsych.2021.05.025

 

Bubu OM, Andrade AG, Umasabor-Bubu OQ, et al. Obstructive sleep apnea, cognition and Alzheimer’s disease: a systematic review integrating three decades of multidisciplinary research. Sleep Med Rev. 2020;50:101250. doi:10.1016/j.smrv.2019.101250

 

Frisoni GB, Altomare D, Ribaldi F, et al. Dementia prevention in memory clinics: recommendations from the European Task Force for Brain Health Services. Lancet Reg Health Eur. 2023;26:100576. doi:10.1016/j.lanepe.2022.100576

 

Litke R, Garcharna LC, Jiwani S, Neugroschl J. Modifiable risk factors in Alzheimer disease and related dementias: a review. Clin Ther. 2021;43(6):953-965. doi:10.1016/j.clinthera.2021.05.006

 

Nordestgaard LT, Christoffersen M, Frikke-Schmidt R. Shared risk factors between dementia and atherosclerotic cardiovascular disease. Int J Mol Sci. 2022;23(17):9777. doi:10.3390/ijms23179777

 

Tarawneh HY, Jayakody DMP, Sohrabi HR, Martins RN, Mulders WHAM. Understanding the relationship between age-related hearing loss and Alzheimer’s disease: a narrative review. J Alzheimers Dis Rep. 2022;6(1):539-556. doi:10.3233/ADR-220035

 

Zhang XX, Tian Y, Wang ZT, Ma YH, Tan L, Yu JT. The epidemiology of Alzheimer’s disease modifiable risk factors and prevention. J Prev Alzheimers Dis. 2021;8(3):313-321. doi:10.14283/jpad.2021.15

Vijay K. Ramanan, MD, PhD

    Consultant, Division of Cognitive/Behavioral Neurology
    Director, Alzheimer's Disease Treatment Clinic
    Assistant Professor
    Department of Neurology
    Mayo Clinic
    Rochester, MN
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