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New strategies can help to ID early Alzheimer’s


High blood pressure, diabetes, heart disease and obesity are risk factors that may raise a person’s chances of experiencing the type of brain blood vessel damage that often underlies strokes and other neurovascular disorders including Alzheimer’s disease. There are more than six million Americans living with Alzheimer’s disease.

Among African-Americans 70 years and older, 21.3% are living with Alzheimer’s, according to the 2020 report from the Alzheimer’s Association “Race, Ethnicity and Alzheimer’s in America.”

While older African-Ameridans are twice as likely as Whites to have Alzheimer’s or dementia, higher rates of cardiovascular (heart and blood vessels) disease may play a role.

Now, a gene called FMNL2 may play a critical role in linking these factors to the brain damage seen in some cases of Alzheimer’s disease. A recent Columbia University study, funded by the National Institute on Aging, suggests that FMNL2 encodes a protein that is known to help build the structures (cytoskeletons) found in cells through the body. The findings may confirm that FMNL2 can help to reshape a protective barrier between the brain and blood vessels, and that this process may speed the removal of damaging proteins.

For decades, some scientists have strongly suspected that Alzheimer’s is, in many ways, a blood vessel disorder. About 70% of patients show signs of the types of brain blood vessel damage often observed after strokes, and many of the above risk factors that raise the chances of developing heart disease do the same for Alzheimer’s.

The Columbia University study looked at the health and genomic data of 14,669 individuals of diverse racial and ethnic backgrounds who participated in several aging and Alzheimer’s studies conducted nationwide. The average age of the participants was approximately 80 years old, and nearly 38% had been diagnosed with Alzheimer’s.

The researchers used four factors to calculate a cerebrovascular risk score: Diabetes, heart disease, obesity and hypertension (high blood pressure). Multiple previous studies have indicated these factors are often associated with experiencing strokes and other cerebrovascular diseases, as well as with Alzheimer’s. The study found that 70% of participants had hypertension, 33% had heart disease, and 21% had diabetes. Based on body mass index scores, the average participant could also be classified as obese. Hypertension and diabetes were both highly correlated with and strongly influenced the Alzheimer’s risk scores.

Alzheimer’s disease is a progressive disorder that destroys memory and other important mental functions. The National Institute on Aging describes Alzheimer’s disease as “a brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks. Alzheimer’s disease is the most common cause of dementia in adults.”

Dementia is a decline in mental function that is usually irreversible. To be called dementia, the disorder must be severe enough to interfere with your daily life. Dementia is not the typical forgetfulness caused by aging–such as having trouble remembering the name of an acquaintance. Experts contend that the earliest stage of dementia (mild cognitive impairment) is  widely considered “forgetfulness beyond what is expected from aging.”

To be diagnosed with dementia, a doctor must find that you have two cognitive or behavioral areas in decline. These areas are disorientation, disorganization, language impairment, mood change, personality change and memory loss. “Mild cognitive impairment” is a familiar term in contrasting Alzheimer’s disease with dementia. With mild cognitive impairment, a person is still functioning normally (e.g. paying bills, driving well enough, doing taxes, etc.) though performing some of those tasks may take a little longer than they used to. Experts at the Alzheimer’s Association stress “that gets into the dimensional range.”

When checking for Alzheimer’s disease, a doctor will often check for irritability, depression and anxiety often to flag dementia before memory issues do. Doctors may also ask close relatives about changes in mood or personality. A doctor will also ask whether a person is experiencing “just forgetfulness” or if they’re having trouble figuring out the simplest tasks such as operating a kitchen appliance, washer/dryer or even if you may sometimes forget why you entered a room in your house. With Alzheimer’s disease, experts say the progression and timing of symptoms is very important. To identify this degenerative brain disease, doctors will look for “a gradual, insidious onset that is slowly getting worse,” according to the Alzheimer’s Association.

Many people who have relatives with this disease may worry that it may run in the family. A frequent question is: “If I have an immediate family member with Alzheimer’s disease, does that mean I’ll get it too?”

“There’s a truly inherited form of the disease called familial Alzheimer’s disease, early on-set Alzheimer’s disease,” said Dr. Ronald Petersen of the Alzheimer’s Disease Research Center at Mayo clinic. Petersen said people with this rare, genetic form of Alzheimer’s have a “50-50 chance” of contracting the disease, often at an early age around their 40s or 50s.

“The vast majority of the disease is called sporadic, but even in sporadic cases, there can be a familial tendency,” he said. Sporadic cases tend to happen after age 65, so even if you don’t have a known genetic link but do have relatives with Alzheimer’s disease, your risk could be double or possibly triple that of the general population.

“In general, people 65 years and older, the risk of getting the disease is perhaps 10%,” Petersen  said.

While the disease has no cure, any advances in prevention and/or management of cognitive decline are deserving of attention. There are preventative measures that could be taken to prevent Alzheimer’s disease. Recent studies have revealed that a yearly flu shot can cut your risk of Alzheimer’s disease by as much as 40%.

“More than 6 million Americans have Alzheimer’s,” says the Alzheimer’s Association which notes that as people get older the cases will continue to rise. “By 2050, the number of people aged 65 and older with Alzheimer’s may grow to a projected 12.7 million, barring the development of medical breakthroughs to prevent, slow or cure Alzheimer’s disease.”