Am I Doomed to Alzheimer’s?

“But whenever I have a senior moment, I see myself out there wandering the sugar cane fields, just like Dad did when he couldn’t figure out how to get home. I think: How much longer until that’s me?”

I know how he feels. After all, he’s my brother.

I, too, live with the specter of a family history of Alzheimer’s. But as a gerontologist, I’ve learned that while genes have an influencing role, they are by no means a death sentence for developing the progressive disease that destroys memory and other mental functions — and that modifiable factors matter as much than genes, if not more.

Advancing age, certainly, is the biggest risk factor for developing Alzheimer’s disease (reaching nearly 50 percent of people by age 85), and family history is important as well. Simple gene patterns account for features like eye color or blood type, but when it comes to Alzheimer’s disease, several complex multi-gene patterns are involved and therefore it is no simple matter.

Environment and lifestyle also play an important role, according to Dr. Walter M. Bortz II, a clinical professor of medicine at Stanford University Medical School and author of the book “Dare to Be 100.”

“My overwhelming perspective is that Alzheimer’s is multifactorial. Genes do play a role, but a minor one,” Bortz told LifeZette. “It’s not the cards you are dealt, but how you play the hand.”

Related: The Politics of Alzheimer’s

Bortz, who has long researched the role of a healthy lifestyle in increasing longevity, said, “I have always been conservative about linking lifestyle to brain health because the research wasn’t there. But now the field is exploding. The evidence for the importance of exercise to cerebral functioning is pouring in.”

With early onset Alzheimer’s, which strikes people under the age of 65, evidence for a genetic component is stronger.

With early onset Alzheimer’s, which strikes people under the age of 65, evidence for a genetic component is stronger. Fortunately, only 5 percent of Alzheimer’s cases develop early. Having the disease as young as 30 or 40 is extremely rare. According to the National Institute on Aging, only a few hundred families worldwide are known to carry the atypical genetic mutations that cause early onset Alzheimer’s disease.

Still, reassurance can be hard to come by.

Heidi Palou is a 40-year-old San Francisco artist and designer for high-end parties. Both her father and stepfather have Alzheimer’s, and a documentary about her family’s experience was shown last year at the Legacy Film Festival on Aging in San Francisco. Though Palou was reassured by her father’s doctor that her risk of getting the disease is low because of the age of onset of her father’s Alzheimer’s (over 65), she still worries about it.

“It comes up all the time,” she told LifeZette. “If my mind gets foggy, I go right there. It’s hard not to think about it when it’s in my face all the time with my father and my stepfather,” she said.

Unlike early onset Alzheimer’s, in late onset Alzheimer’s genes do not directly cause the disease, but may increase risk. The Apolipoprotein E (APOE) gene, which has been linked to Alzheimer’s risk, comes in a variety of forms. Since we have genes from both our mother and father, the combination of genes and their effect can be very complicated and unpredictable, just as traits such as hair color or IQ can be murky when it comes to heredity.

Because of the roulette wheel of heredity, genetic testing is far from 100 percent accurate. Results from testing cannot tell an individual if he or she will get the disease. Many other factors influence the development and progression of Alzheimer’s. The National Institute on Aging does not recommend testing and encourages anyone considering testing to seek counseling first, since results can be both confusing and distressing.

Related: Being Godly Guards Against Dementia

Genes are not the only factor to consider. The emerging science of epigenetics focuses on how particular genes are turned on or off by environmental factors such as diet, exercise, smoking, and chemical exposure. Epigenetic factors can be protective or harmful, and may help explain why one family member is affected by the disease while another is not.

In the future, doctors may be able to recommend individualized preventive strategies for individuals based on genetics and epigenetics, but the science is still far from having that degree of predictability.

For now, those with late onset Alzheimer’s disease in their families must come up with their own strategies for dealing with worries about heredity. Eating healthy foods, staying physically active, remaining socially engaged, challenging the brain by learning new things, and avoiding smoking and harmful chemicals are things we can do to ease our worries.

On World Alzheimer’s Day, September 21, a day in which organizations around the globe focus on raising awareness about Alzheimer’s and dementia, we should all remember that dementia is not an inevitable aspect of aging. And if memory issues do present themselves, there may be underlying medical problems that can be addressed and with them, the memory issues as well. A thorough assessment is always recommended.

My brother Paul has an additional strategy for handling his concerns about heredity. He does a daily review of his cognitive functioning and compares how he is doing today to how my father did at the same age. So far he feels that he is ahead of the game.

Watch this space for compelling new articles in this series, Mind Matters, running each Monday.