My colleague Bruce Goldman recently wrote an expansive blog entry and article based on research by Mike Greicius, MD, about how the ApoE4 variant doubles the risk of Alzheimer's for women. I followed up Goldman's pieces in a podcast with Greicius, who's the medical director of the Stanford Center for Memory Disorders.
I began the conversation by asking about the state of research for Alzheimer's: essentially, what do we know? As an aging baby boomer, I'm interested in the differences between normal, age-related cognitive decline versus cognitive declines that signal an emerging disease. Greicius said people tend to begin losing cognitive skills around middle age:
Every cognitive domain we can measure starts to decline around 40. Semantic knowledge - knowledge about the world - tends to stay pretty stable and even goes up a bit. Everything else… working memory, short term memory all tends to go down on this linear decline. The difference with something like Alzheimer's is that the decline isn't linear. It's like you fall off a cliff.
Greicius' most recent research looks at the certain increased Alzheimer's risk ApoE4 confers on women. As described by Goldman:
Accessing two huge publicly available national databases, Greicius and his colleagues were able to amass medical records for some 8,000 people and show that initially healthy ApoE4-positive women were twice as likely to contract Alzheimer’s as their ApoE4-negative counterparts, while ApoE4-positive men’s risk for the syndrome was barely higher than that for ApoE-negative men.
In addition to the increased risk of Alzheimer's for women with the ApoE4 variant, I asked Greicius how he advises patients coming into the clinic who ask about staving off memory loss. At this point, he concedes, effective traditional medication isn't really at hand. "Far and away our strongest recommendations bear on things like lifestyle and particularly exercise," he said. "We know, in this case from good animal models, that physical exercise, particularly aerobic exercise, helps brain cells do better and can stave-off various insults." So remember, a heart smart diet along with aerobic exercise.
One last question for Greicius: What about those cognitive-memory games marketed to the elderly and touted as salves for memory loss - do they have any benefit? He's riled now: "I get asked that all the time, and smoke starts coming out of my ears." He says the games are nothing more than snake oil. His advice when he gets asked the question: "Give that money to the Alzheimer's Association or save it and get down on the floor with your grandkids and build Legos. That's also a great cognitive exercise and more emotionally rewarding."
Previously: Having a copy of ApoE4 gene variant doubles Alzheimer’s risk for women but not for men, Common genetic Alzheimer’s risk factor disrupts healthy older women’s brain function, but not men’s and Hormone therapy halts accelerated biological aging seen in women with Alzheimer’s genetic risk factor