COMMENTARY

APOE4 Gene Carriers Benefit From Lifestyle Improvements

Richard S. Isaacson, MD

Disclosures

March 26, 2018

I'm Dr Richard Isaacson, director of the Alzheimer's Prevention Clinic at Weill Cornell Medicine in NewYork-Presbyterian. I'm here for Medscape.

A recent study out of Karolinska Institutet showed in JAMA Neurology that maybe we do have some control when it comes to brain health and cognitive decline over time.[1] Not only that, but certain people with a risk gene for Alzheimer disease may respond as well or more than patients who don't have that gene.

Let's talk about the FINGER study. As you may be aware, the FINGER (Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability) study is the first multimodal lifestyle intervention study to determine whether such things as nutrition changes, exercise on a regular basis, regular care by a treating clinician every 3-6 months, and cognitive engagement may have a positive impact on the brain over time. The original study was published back in 2015, and it showed that after 2 years of a multimodal intervention, patients who adhered to the intervention actually had better cognitive outcomes.

This new study published in JAMA Neurology last month actually is very exciting. What it did was for the first time stratified this group of patients into people who had one copy or more of the APOE4 gene and other people who did not have a copy of that gene. The APOE4 gene is not a gene that is deterministic. If you have the gene, it doesn't mean you're going to get Alzheimer disease, and if you don't have the gene, of course you can you get Alzheimer disease. It does increase risk for late-onset Alzheimer disease.

This study was very exciting because when you look at it, both patients who had the gene or didn't have the gene responded in a cognitive way to multimodal lifestyle interventions. This is exciting because sometimes people say, "I have the gene; I'm doomed." That's not true. It may be possible to win the tug of war against your genes, and using lifestyle now is an evidence-based way to do that.

When it comes to interventions, we don't have that blockbuster drug just yet. We have several ongoing studies and exciting therapies that are in clinical trials as we speak. However, any patient who wants to reduce their risk and protect their cognitive health over time may benefit, whether they have that gene or don't have that gene, from lifestyle interventions.

Eating a brain-healthy diet (Mediterranean-style or MIND), regular physical exercise, mixing up cardiovascular as well as some weight training, staying cognitively engaged in life, and regular follow-up with the clinician are absolutely important. Minding one's risk factors, [as well as] keeping one's blood pressure, cholesterol, and blood sugars in check, is a great way to slow down the pathologic processes of Alzheimer disease.

What about sleep? Get as much as you can. Seven to 8 hours is a good target to shoot for. Keeping the brain engaged; socializing; learning something new, whether it's a new language or a musical instrument—all of these are lifestyle and nonpharmacologic approaches that can protect cognitive health over time.

For Medscape. I'm Dr Richard Isaacson.

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