Is Alzheimer’s Disease Genetic?  

genetics and alzheimersYears of research has found that the most common gene linked to Alzheimer’s disease is a risk gene called apolipoprotein E (APOE). Recent research built upon what was already known about APOE, finding that people with two copies of the gene variant APOE4 are almost certain to get Alzheimer’s. This new information could result in patients being diagnosed years before symptoms appear, giving them time to do Alzheimer’s Planning, Estate Planning, Medicaid Asset Protection Planning, and Incapacity Planning well in advance.  

The new study, published by researchers in Spain at the Sant Pau Research Institute, adds to the more than 30 years of investigation into the APOE gene and gives researchers new insight into how it influences a person’s risk of Alzheimer’s disease. The decades of research found that most cases of Alzheimer’s disease are caused by a complex mixture of factors, including our age, our lifestyle, our environment, and our genes.  

Each of us carries two copies of APOE, one inherited from each parent, and this means there are different combinations people can carry. The three most common variants are called APOE2, APOE3, and APOE4. These affect people’s risk of Alzheimer’s in different ways, with the APOE4 form having the biggest impact. About 1 in 50 people carry two copies of APOE4, and according to the study, these individuals have a substantially increased risk of Alzheimer’s disease. 

The Study and Its Findings 

The study was carried out by a team of researchers who analyzed medical records, including results of biomarker tests for Alzheimer’s disease. Records were from over 10,000 people from across the US and Europe, including 519 people who carried two copies of APOE4. Scientists also analyzed over 3,000 brain samples and accompanying medical records from people who had donated their brains to science after they died. This included 273 people who had carried two copies of APOE4. 

The researchers found that by the age of 65, nearly all APOE4 double-carriers showed abnormal levels of amyloid in their cerebrospinal fluid, a key early sign of Alzheimer’s disease, and 75 percent had positive amyloid scans. Their analysis of brain tissue showed that almost all APOE4 double-carriers had signs of Alzheimer’s disease in their brains by the age of 55. 

Researchers also found that APOE4 double-carriers who developed Alzheimer’s disease symptoms did so at around 65 years of age. They found that symptoms can begin 7 to 10 years sooner than in other older adults who develop Alzheimer’s. 

The study suggests that an estimated 15 percent of Alzheimer’s patients carry two copies of APOE4, meaning those cases “can be tracked back to a cause and the cause is in the genes,” said Dr. Juan Fortea, who led the study. Until now, genetic forms of Alzheimer’s were thought to be the only types that strike at much younger ages and were thought to account for less than 1 percent of all cases.  

Those responsible for the study are cautioning that the news doesn’t mean that everyone with a family history of Alzheimer’s disease should get genetic testing. According to researchers, “It’s important not to scare everyone who has a family history of Alzheimer’s because this gene duo isn’t behind most cases. Although APOE4 has long been labeled the biggest genetic risk factor for late-in-life Alzheimer’s, with two copies risker than one, only about 2% of the global population is estimated to have inherited a copy from each parent.” 

What if You Have a Heightened Risk of Alzheimer’s? 

As already mentioned, your risk of developing dementia is made up of many different factors, including your age, genes, lifestyle, and environment. Evidence suggests that there are many things you can do to reduce your risk, regardless of whether you have inherited one or two copies of APOE4. 

One thing that’s very important is to protect your brain health – and that means protecting your heart health. For a healthy brain and heart, here are some tips to follow:  

  • Keep your cholesterol and blood pressure under control; 
  • Be active and exercise regularly; 
  • Don’t smoke; 
  • Maintain a healthy weight; 
  • Eat a healthy diet; and 
  • Drink in moderation. 

An Important and Surprising Medication Finding 

If you do have two APOE4 genes, an important and surprising finding is that you should not use the only drug that has been shown to modestly slow the disease, Leqembi. People with the gene pair are “especially prone to a dangerous side effect,” said Dr. Reisa Sperling of Harvard-affiliated Brigham and Women’s Hospital in Boston. 

What Are the Next Steps? 

Researchers believe that there is still a lot to learn about having two APOE4 genes and their role in the development of Alzheimer’s disease. More research is needed to understand what other factors may interact with APOE4, as genetic and environmental factors are unique for each person. 

Early Diagnosis Is Important When it Comes to Planning in Advance 

The costs of Alzheimer’s disease are more than $400 billion today and are projected to be in excess of $1 trillion by 2050. Families with loved ones who have Alzheimer’s can expect to spend $14,000 – $17,000 per month for nursing homes in Northern Virginia in today’s dollars. An early diagnosis will enable you and your family to proactively meet with a Certified Elder Law Attorney, such as Evan Farr, to plan for your future financial and long-term care needs. 

If you wind up needing long-term care in a nursing home, chances are you’ll need Medicaid at some point, as Medicaid is the single largest payment provider for nursing home care costs in this country. Alzheimer’s Planning, which often involves Medicaid planning at least 5 years in advance of the need for nursing home care, is often imperative to your quality of life. 

If you or a family member has Alzheimer’s you should ideally start Alzheimer’s Planning with an experienced Elder Care attorney as soon as you receive a diagnosis, though Medicaid planning and Alzheimer’s Planning with a Certified Elder Law Attorney can also be initiated by an adult child acting as agent under a properly drafted Power of Attorney, even if you are already in a nursing home or receiving other long-term care services. 

It is never too late to begin your own Estate Planning, Medicaid planning, Medicaid Asset Protection Planning, nursing home planning, Elder Care planning, or other long-term care planning with an experienced Elder Care attorney who specializes in Elder Law and Medicaid and Veterans Aid and Attendance planning. The attorneys here at the Farr Law Firm are experienced Alzheimer’s Planning attorneys, Estate Planning lawyers, Medicaid planning attorneys, Medicaid Asset Protection experts, nursing home planning experts, and long-term care planning advisors. Whenever you’re ready, we’re here to help: 

Fairfax Medicaid Planning: 703-691-1888 
Fredericksburg Alzheimer’s Planning: 540-479-1435 
Rockville Elder Care Attorney: 301-519-8041 
DC Elder Law Attorney: 202-587-2797 

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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.