Family history with Alzheimer’s has healthy man in 60s worried

Dear Dr. Roach: I am a 64-year-old male in excellent health. My mom and dad both developed dementia.

Dad died from a stroke at 76, a few months after diagnosis.

Mom is 85 and has severe shortterm memory loss and sudden-onset dementia. She will be evaluated for Alzheimer’s disease soon.

If genetics might be an indicator for dementia, should I be on something such as Aricept now? I’ve read that Alzheimer’s takes about 20 years to develop fully. C.C.J.

Many people are justifiably afraid of developing Alzheimer’s. The strategies with the best evidence for prevention are the following:

Diet: Eat a diet low in saturated fat from meat and high in fruits and vegetables, whole grains, legumes, nuts and seeds. Fatty fish is likely to reduce incidence of dementia and slow its progression if it occurs.

Exercise: There may be a limited role for exercise in prevention of dementia.

Alcohol: Small amounts of alcohol may have a protective role, but more than moderate use does not, and is not recommended.

Puzzles and mind games: There is good evidence that these can improve function. Different types of mental exercises, such as word-based puzzles (crosswords, etc.), number-based puzzles (like Sudoku or KenKen), memory exercises and visual/special exercises (colouring books are a recent trend) can have multifaceted benefits. It's not proven that these actually reduce dementia, but they seem likely to keep older people functioning at a higher level for longer.

As far as medications go, based on my current reading of the vast amount of literature, I think that medications like donepezil (Aricept), although they can slow progression, are unlikely to prevent the brain changes in Alzheimer’s disease.

I don’t recommend it for people with no evidence of dementia. There is better evidence that statin drugs may influence dementia, but not enough that I would recommend taking them only for that purpose. Dear Dr. Roach: I’ve been caring for an aging parent for almost 18 years. She is 94 years old. She takes two types of blood pressure medicines and three thyroid meds per day, plus four supplements. Until two years ago, her doctor sent her to the hospital each year for a mammogram. The hospital asked the doctor, “Why is this woman still getting mammograms?” He stopped ordering them. For her first visit in January of 2017, he had her get bloodwork prior to this visit, with numerous blood and urine tests. All her bloodwork came back in the normal range with the medication she takes daily. The doctor has ordered the same blood and urine work again for two months from now.

How much is too much? At her age, couldn’t she just go twice a year?

Anon. It is my practice to minimize the amount of blood testing as people get older. However, that needs to be a decision made with the patient (or her family, if she can’t make the decision). While I want to minimize the harm of going in for frequent blood draws, the risk of complications in a 94-year-old who is on multiple medications (especially if one of those blood pressure medicines is a diuretic) is high enough that a periodic check is wise.

It’s about finding the right balance, but to me, I think the balance is probably much closer to every six months than every two months. Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth @med.cornell.edu