Staying Sharp

Staying Sharp

When you’re in your twenties and thirties, memory loss and Alzheimer’s disease may seem like distant concerns. But taking care of your brain isn’t something you should put off.
Certainly, the vast majority of Alzheimer’s disease is diagnosed in people 65 and older. However, a major health insurance provider recently reported that since 2013, Alzheimer’s cases have tripled among Americans aged 30 to 64.
“We’re now seeing people in their fifties, and even their forties and late thirties, with early signs of cognitive decline,” says Dale Bredesen, MD, an internationally recognized expert in the mechanisms of neurodegenerative diseases and author of The End of Alzheimer’s Program.
“The brain changes that result in Alzheimer’s disease may start 20 years or more before you’re diagnosed,” says Bredesen. Some experts say Alzheimer’s may more appropriately be called a younger and middle-aged person’s disease.
Now, the good news. Though Alzheimer’s disease was once thought to be something you could do little to prevent, scientists are proving that wrong.

Is your brain in trouble?

Dementia can impair your memory, thinking, and speech. Alzheimer’s disease is the most common cause of dementia.

“Dementia can sneak up on people because they don’t like to think about the possibility that something is wrong,” says Bredesen. “So, they write off the warning signs.” Plus, the symptoms of early-onset Alzheimer’s (diagnosed before age 65) may not be what you expect.

Later-onset dementia often starts as purely a memory problem and then spreads to other cognitive dysfunction, explains Bredesen. In contrast, younger people with dementia may first experience difficulty with:

  • speech, such as finding the right words
  • organizing things
  • recognizing faces or objects
  • making calculations, such as restaurant tips

Worsening memory isn’t the only symptom you should be watching out for.

Genetics and risk

Several genes increase your risk for Alzheimer’s disease, but your genetics don’t determine your destiny.

“Scientific evidence shows that several lifestyle changes can reduce your risk of Alzheimer’s disease, regardless of your genetic predisposition,” says Demetrius Maraganore, MD, who leads the Tulane Healthy Brain Aging Initiative in New Orleans.

That said, genetic testing may help you and your health-care provider better focus your prevention efforts.

“Consider getting genetically tested to see if you carry the apolipoprotein-e4 (APOE-e4) risk variant for Alzheimer’s disease,” says Maraganore. “APOE is one of the approximately 25,000 genes that you inherit—one copy from your mom and one copy from your dad.” The APOE-e4 variant is the strongest genetic risk factor for Alzheimer’s.

People with zero copies of APOE-e4, which is the majority of us, have a 10 to 15 percent risk of Alzheimer’s disease. But those with one copy of the gene variant have an estimated 25 to 40 percent risk, and those with two copies have a 40 to 55 percent risk of developing Alzheimer’s disease.

Your doctor can test you for APOE-e4, or you can use an at-home test kit, such as one from . For more information, visit .

A COVID connection

Carrying two copies of APOE-e4 has been linked with double the risk of severe COVID-19. This may be due, in part, to the gene variant’s impact on immune function and increasing inflammation, says Bredesen.

Subtyping Alzheimer’s disease

You may think of Alzheimer’s disease as a single entity. But many different paths can lead to the condition.

Bredesen classifies Alzheimer’s according to the most likely underlying factors in a given individual, including

  • increased inflammation due to APOE-e4 genetics
  • high blood sugar and insulin resistance, as in prediabetes and type 2 diabetes
  • hormonal disruption (such as thyroid issues) and nutritional deficiency
  • toxicity due to factors like air pollution and biological toxins from mold
  • vascular disorders, like heart disease and high blood pressure
  • head injuries, such as those sustained in sports or car crashes

Other factors, including obesity, smoking, excess alcohol intake, poor sleep, certain chronic infections, and impaired hearing can also contribute to your risk. Generally, multiple factors are involved, so prevention should be multipronged.

Eat for your brain

“The importance of diet in preventing dementia cannot be overemphasized,” says Arnold Eiser, MD, adjunct fellow at the Center for Public Health Initiatives at the University of Pennsylvania. He says the Mediterranean diet appears helpful for reducing Alzheimer’s risk.

Notably, the Mediterranean diet may also reduce your risk of obesity, heart disease, and diabetes, which are Alzheimer’s risk factors.

The Mediterranean diet features olive oil, fish, poultry, vegetables, fruit, nuts, and legumes. It limits highly processed foods, red meat, and sweets. The diet may help brain function by providing protective antioxidants and reducing inflammation.

Another highly studied diet for brain function is the ketogenic (keto) diet. It’s a very low-carbohydrate, high-fat diet intended to shift your body toward using fat to make ketones. Those are an alternative fuel source for your brain, which normally relies on glucose (sugar) for energy.

Your brain’s ability to use glucose for energy may be impaired for decades before symptoms of Alzheimer’s disease surface. Ketones are a work-around for fueling your brain.

Scientists at the University of Kansas Medical Center have shown that with good planning, a keto diet can be nutrient-rich and healthful. Many aspects of the Mediterranean diet can be adapted to the keto diet (within carb limits).

Finally, healthy plant-based diets have also been associated with a reduced risk of cognitive decline. Vitamin B12, a brain-supportive nutrient, should be consumed via fortified products or supplementation if no animal products are eaten.

Exercise regularly

Getting regular aerobic exercise, such as moderately paced walking, jogging, cycling, or swimming, may reduce your risk of developing Alzheimer’s disease.

“Aerobic fitness actually causes the memory structures in the brain to grow in size,” says Maraganore. “Exercise increases growth factors in the brain and inhibits age-related nerve cell death.”

In addition, aerobic exercise promotes ketone production to fuel your brain. It may also help your brain better utilize glucose for energy.

New research also suggests strength training (think using dumbbells or weight machines) helps protect brain function.

Optimize your sleep

“When you sleep seven to eight hours a night, it may reduce your odds of dementia by slowing the rate that beta-amyloid accumulates in your brain,” says Maraganore. Beta-amyloid plaque can interfere with brain function.

Sleep is important for “taking out the trash” that accumulates in your brain during the day. While you sleep, beta-amyloid and other debris are removed via the glymphatic system in your brain.

Also, be alert to the risk of sleep apnea, which impairs sleep quality and lowers the oxygen available to your brain, says Bredesen. Sleep apnea is associated with more beta-amyloid in the brain and increased risk of Alzheimer’s disease.

Loud or frequent snoring is the most common symptom of sleep apnea.

Reduce your toxin load

A recent scientific report from the Lancet Commission noted traffic exhaust, secondhand tobacco smoke, and fine particulate matter among the sources of toxins linked with an increased risk of dementia.

Fine particulate matter consists of tiny inhalable particles, which include heavy metals (like mercury) and mold. Mold produces toxins (mycotoxins) that can harm your brain.

Finland has the highest death rate from dementia in the world. Eiser says a combination of high exposure to mycotoxins (due to the cold, humid climate and well-insulated homes); mercury-polluted fish; and other toxins may contribute to dementia risk in Finland’s population.

Americans are also commonly exposed to mycotoxins in their homes. Do-it-yourself tests, such as those from and , can help determine if your home has a mold problem.

Eiser says working up a sweat, via exercise or in a sauna, can help with detox. He also recommends resources from the Environmental Working Group () to help limit your toxin exposure from personal care products, water, food, and more.

Bolster your brain

The more you build up your brain through education and challenging mental activities, the more resilience your brain has against dementia, says Bredesen.

One helpful tool is BrainHQ (, a subscription-based online service offering interactive brain exercises. The exercises were designed by neuroscientists and tested to confirm they help with aspects like memory and brain processing speed.

You can also exercise your brain with sudoku, crossword puzzles, and the like. Social activities can support healthy brain function too.

Healthier brains ahead

An increasing number of specialty clinics are focusing on Alzheimer’s risk assessment and early intervention. Free online resources, such as those at , are also emphasizing prevention.

“We encourage people to get on prevention so that everyone can stay sharp to 100,” says Bredesen. For best results, work on the many facets that can increase your risk of Alzheimer’s, rather than just one factor.

Smart supplements

These supplements support brain health. Based on your individual risk factors, other supplements may also be helpful.

B-complex vitamins

Taking B vitamins, including vitamin B6, folate, and vitamin B12, throughout young adulthood has been linked with better brain function in midlife.

Vitamin D

Blood tests show people are commonly low on this vitamin that may help prevent amyloid buildup in the brain.


Docosahexaenoic acid, an omega-3 fat, may be particularly beneficial for the brain and is anti-inflammatory.


The main active ingredient of turmeric, curcumin has anti-inflammatory actions and may help prevent amyloid buildup in the brain.


This is a potent supplemental source of choline, which is needed to make acetylcholine, a brain messenger critical for memory.

By the numbers

  • One in five women and one in 10 men develop Alzheimer’s disease in their lifetime.
  • Alzheimer’s disease kills more Americans annually than breast cancer and prostate cancer combined.
  • One out of six millennial caregivers are helping someone with dementia.
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