Editor's Note: September is World Alzheimer's Month

DEAR MAYO CLINIC: I am part of what I hear called the Sandwich Generation. I have kids living at home and an aging parent in ill health. My mom is 83 and in an assisted living facility with physical and cognitive problems. She has been diagnosed with mild dementia due to Alzheimer's disease. It makes me sad for my mom and also concerned for myself. Whenever I can't remember something, I think I'm getting dementia too. I'm only 47. Is this how it starts? Does my family history mean I will have Alzheimer's? Is it too late for me to avoid what feels inevitable?

ANSWER: With a busy family and feeling anxiety over your mother's diagnosis, this can be a stressful time. It can be helpful to arm yourself with more information about Alzheimer's disease, a complex process that begins in the brain years before symptoms develop.

Some of the earliest symptoms may be short-term memory difficulties. People may ask repeated questions or forget recent events or conversations. However, Alzheimer's disease can result in a variety of neurologic symptoms, and different conditions also can affect memory. And it's important to know that not all forgetfulness is Alzheimer's. In fact, other causes of cognitive symptoms may be preventable or even reversible.

Most patients diagnosed with Alzheimer's disease first show symptoms in their 60s and 70s, but the age of symptom onset can vary widely across patients with this diagnosis.

It's always a good idea to discuss any concerns directly with your doctors.

As with other common medical conditions, most cases of Alzheimer's disease likely do not develop due to any one single cause in isolation. Increasing age is the strongest known risk factor for Alzheimer's disease, but genetics and lifestyle also influence risk and protection against disease.

Through research, we know about some but not all of the risk factors for Alzheimer's disease. While having a family history of the disease does increase one's personal risk to a degree, it is important to remember that less than 1% of Alzheimer's cases are determined by genes that cause the disease, according to the Alzheimer's Association.

These genetic cases typically are diagnosed when a person is extremely young, roughly 30 to 50 years old, when cognitive symptoms, such as memory loss, develop. Having multiple first-degree relatives – your parents, siblings or children – affected by the genetic mutation also is a risk factor.

Those mutations typically are found in three genes related to processing of amyloid, a protein that clumps into sticky plaques in the brain, representing an early marker of the disease process. There are other genes (such as the APOE gene) that influence risk of Alzheimer's disease but which do not solely determine whether someone gets the disease.

Alzheimer's disease is highly individualized, meaning there is not a one-size-fits-all barometer of how it proceeds for a given person.

The general expectation is that the disease causes gradual worsening of memory and other cognitive functioning over time. However, all patients are different, having a range of symptoms and rates of progression. Past trajectory on an individualized basis is generally the best guide for future trajectory, meaning if the disease has progressed slowly, it likely will continue that way for the near future. If it has progressed rapidly, that likely will continue.

One takeaway message for all of us is that many daily activities and habits promote the health of the brain no matter our individual risk for Alzheimer's disease. These habits include:

• Staying mentally and socially active. Try to learn new things or reinvigorate old interests that are enjoyable and engaging. This might include going to social events, reading, dancing, playing games, creating art, playing an instrument or other activities.
• Exercising regularly. That can mean walking, swimming or other aerobic activity to increase your heart rate. Aim to exercise at least 150 minutes a week. That could be five times a week for 30 minutes each or three times a week for 50 minutes each.
• Getting regular, high-quality sleep. Sleep is thought to clear abnormal proteins in the brain and consolidate memories. Aim for seven to eight consecutive hours of sleep a night rather than fragmented sleep of short increments.
• Maintaining a healthy and balanced diet. The Mediterranean diet is associated with a lower Alzheimer's disease risk. That's a diet rich in vegetables, fruits and lean protein, particularly protein sources containing omega-3 fatty acids.
• Managing other medical conditions. That includes vascular risk factors like high blood pressure and high cholesterol.

As you handle your family's care needs – your children's and your mother's – do make sure to also take care of your own physical and mental health. Friends and family and community resources can offer support to help patients and families manage Alzheimer's disease. – Vijay Ramanan, M.D., Ph.D., Neurology, Mayo Clinic, Rochester, Minnesota

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