A large,
ongoing study of a multipart lifestyle intervention (Finnish Geriatric
Intervention Study to Prevent Cognitive Impairment and Disability) has been
investigating the ability of this type of treatment to prevent cognitive
decline in older subjects. One of the
latest analyses in this study sought to determine if the most common genetic
variant that increases Alzheimer’s risk, the apoE4 gene variation, would
prevent these individuals from benefiting from this intervention as persons without
the gene variant.
Subjects between the ages of 60 and
77 were blindly randomized to the intensive management group which included diet,
exercise, cognitive training, and vascular risk management, while the control
subjects received only general health advice.
Equal numbers of participants in each group carried the high risk (3-10
times) apoE4 gene or the normal risk apoE3 gene.
Cognitive
function was measured before the study with a comprehensive neuropsychological
test battery and after 6 years. Those
participating in the intensive management group had significantly better
cognitive scores at the end of the 6 years, and the benefit was the same in both
the normal or high genetic risk subjects.
The two important conclusions are that a comprehensive lifestyle
management program does prevent cognitive decline and that this prevention
occurs both in those with and without the apoE mediated risk.
These
results are reassuring as approximately 1 in 6 adults have the higher risk apoE4
gene. While this genetic variant
increases their risk to the development of the disease, it does not prevent the
benefits of a comprehensive lifestyle management program from helping. The increased risk associated with the apoE4
gene appears to require those with it to be more meticulous about their
lifestyle both to prevent the disease onset as well as to manage it once
cognitive decline appears.
The above
statement does not give a free ride about being less concerned about lifestyle
management to those with the “normal risk” apoE3 gene. The normal risk for Alzheimer’s is still 1
out of 6 by age 65-70, and 1 out of 3 by age 80. Dale Bredesen, MD the innovator of the successful
lifestyle program called ReCODE, explains the relationship between lifestyle
and Alzheimer’s risk best based on extensive research. He comments that Alzheimer’s appears to not
be just a brain disease but rather a brain manifestation of systemic metabolic
disease. An example of this relationship
is the 2-3 times greater risk of Alzheimer’s in those who develop type two
diabetes which is highly related to lifestyle.
ApoE4
remains a risk factor for the development of Alzheimer’s disease. While it increases this risk, it fortunately
does not compromise the ability of a comprehensive lifestyle management program
to help the disease once signs of it are present. Importantly, the apoE4 genotype serves as a
warning of the disease risk and the important preventative role of a
comprehensive lifestyle program before the disease manifests. The best treatment is not to develop the
disease in the first place.
It was a nice article on genetic testing. Genetic testing for Alzheimer's disease help to find out future health and possibility of Alzheimer.
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