What We Know About Your Alzheimer’s Risk

We are all at risk for Alzheimer’s disease, a disease for which there is absolutely no meaningful pharmaceutical treatment. Previously, the relationship between Alzheimer’s risk and modifiable lifestyle choices, like physical inactivity and smoking have been well described. Nonetheless, despite efforts to provide this information with the hope of people making better lifestyle choices, the prevalence of Alzheimer’s disease continues to increase.

A new study was just published in the prestigious Journal of the American Medical Association and is entitled: Risk Factors Associated with Alzheimer Disease and Related Dementias by Sex and Race and Ethnicity in the US.

This is a fascinating study that looked at close to 400,000 individuals, evaluating various risk factors as they related to the presence of Alzheimer’s disease or related dementias. These are the risk factors identified in the study:

• Physical inactivity 
• Current smoking
• Depression
• Low education 
• Type-2 diabetes
• Midlife obesity
• Midlife hypertension
• Hearing loss

The adult population in this study was equally balanced with reference to gender. Approximately one in three cases of Alzheimer’s disease or related dementia (37%) were associated with at least one of the eight modifiable risk factors described above. Interestingly, the most powerful risk factor related to the development of Alzheimer’s or related dementia, was midlife obesity followed by physical inactivity and then low educational attainment.

The relationship between the risk factors was higher in men, 35.9% then women, 30.1% and higher in black individuals at 40% in comparison to white participants (29%.)

Let’s take a closer look at the various risk factors that were explored. We certainly spend a lot of time  discussing how valuable physical activity is at helping to stave off Alzheimer’s disease. Smoking on the list is not a surprise, for a multitude of reasons. We can’t consider depression to be necessarily a lifestyle “choice,” but nonetheless, we do know that lifestyle factors can be modified to reduce the likelihood of depression. Low educational status is actually very interesting these days when the level of a person’s educational achievement may now be threatened by events having occurred with the COVID pandemic. The reduction in educational achievement that has occurred in a widespread distribution over the past few years as a consequence of COVID may play out as an increased risk for Alzheimer’s disease in the years to come.

Both midlife obesity and midlife hypertension are actually very important because typically we don’t associate Alzheimer’s disease with the midlife age group. We generally think of Alzheimer’s as a disease of elderly individuals. And what we’ve learned from this study, and others, is that obesity and/or hypertension during our midlife years sets the stage for future Alzheimer’s development. The take-home message here is that even though a person may be cognitively intact during their midlife years, being overweight and/or hypertensive may have important long-term cognitive implications.

Finally, inclusion of hearing loss is important as it was significantly related to Alzheimer’s risk and is easily modified with hearing assistive devices. 

I have spoken quite extensively about the fact that we don’t have any meaningful treatment for Alzheimer’s. I really wish such a treatment existed. Nonetheless, in its absence, our efforts should be directed at disease prevention which is why we continue to publish these blogs revealing scientifically validated information about modifiable risk factors. My hope is that this information will be taken seriously in the context of disease prevention. 

Finally, as I have quoted before, President Kennedy stated in his presidential inaugural address: 

“The time to fix the roof is when the sun is shining.