In May, a published report indicated that changes indicative of Alzheimer’s disease (AD) were detected at age 24 via a blood test, which is increasingly available. These changes may begin earlier, but these were the study’s youngest participants. There are no medical treatments for these early manifestations, and aside from providing knowledge of a possible future and potentially causing anxiety, what value does the test hold? Unless a person has symptoms, which is unlikely for most people until their 70s or later, and the test is clinician-ordered, it is unlikely that health insurance will cover the predicted $412 cost. Nonetheless, surveys show that many younger adults desire the test. Since it can be self-ordered, it is recommended to use a certified laboratory with experience in this test. If the results are positive, they should consult their family doctor to place the findings into perspective.
A positive result may spur the development of end-of-life (EOL) documents and initiate conversations with family members about the treatments one may or may not want for Alzheimer’s or other medical conditions. It is never too early for these actions, as one never knows when a major illness or an accident can render them unable to make decisions for themselves. These documents should be reviewed every three to five years and amended, as necessary. Provide copies of them to your primary physician, hospital, or other relevant institutions. Additionally, verify that your hospital or other facility will follow your designations and remind staff to refer to the document with every admission. The test can also help you decide who you want to make decisions on your behalf when you are unable to do so. Most people automatically assume that the person they choose will fill this role, but without discussion, you will not know if they will do so or agree with your choices, and you may need to choose another individual. You should not avoid this step and have relatives at your bedside arguing over your treatment. This can destroy family relationships, and worse, it can leave you trapped within your body in a state labeled “a fate worse than death” by many older people; a state that can last a decade or more with AD.
It can be sobering to visit a nursing home and see those with AD sitting motionless, staring vacantly at nothing. I have seen them professionally, and this aided my EOL decisions, documents, and discussions. If possible, I recommend that everyone make this visit, as reading about the condition does not present the same effect. Taking family members with you may help if they balk at the idea that you may not wish to live in that state, even at home with loving family. Caring for someone with advanced AD is demanding, and no one who has not experienced adult caregiving can conceive of its intensity. It requires around-the-clock attention and physical effort, impacting the caregiver’s physical and mental health, and even shortening a caregiver’s life.
There is a possible means by which someone with a positive test result might delay AD onset. Unsurprisingly, it is the same as for many chronic illnesses: maintaining a healthy lifestyle. Ignore the headlines advising you “to eat this one food” or “avoid this one activity.” These are junk cloaked in pseudo-scientific verbiage from sources wanting your money. Eating a Mediterranean-style or DASH-style diet and avoiding prolonged sitting, ideally combined with light exercise, can be beneficial. Additionally, avoiding smoking, limiting alcohol consumption to occasional and minimal levels, eating very little processed food, and shunning illegal drugs are also helpful. However, the dietary connection with AD is correlational, not causational, and the time these actions will postpone AD is unknown and unknowable, as disease onset occurs at different ages, and other factors, like genetics, are also involved.
Given this new information about how early the precursors of Alzheimer’s may start to develop, the ideal would be to begin lifestyle changes even earlier and continue them for at least 50 years. How likely is this to occur? These recommendations are not new, but have been suggested for many years regarding illnesses such as heart disease, obesity, and diabetes, for which they are effective. How many people have adopted that advice? Thus, the likelihood of adoption for postponing AD, especially as it would have to be maintained for decades, with unknown effects, is minimal. Indeed, another study indicated that whether an individual received a positive or negative test result, they were less likely to adopt a healthy lifestyle.
Likely, people will wait until a medication is developed that can treat pre-AD. Currently, this is not even being considered, and it may not become a reality for decades, as additional research is needed to determine when the condition is first manifested. When these drugs become available, they will, hopefully, be less toxic than the current medicines for treating early-stage AD. So, while these lifestyle changes have merit for several chronic conditions, the relationship between diet and AD remains conjectural for those of early age, and the question remains as to the value of a test for pre-AD.
M. Bennet Broner is a medical ethicist.
