Ronald Primas, MD, FACP, FACPM, DABIHM, CTH

Risk Factors For Alzheimer Disease

The primary risk factor associated with Alzheimer dementia is age, with the likelihood of developing the disease increasing significantly as one grows older. While genetics do play a role, they are less common than many assume; most cases are de novo, meaning they occur without a family history. However, certain genes, such as the 

 variant, are linked to a higher risk. Beyond genetics, lifestyle factors—including social engagement, sleep quality, diet, exercise, hearing, and vision—are modifiable risks that can influence the disease's onset and progression. Maintaining good cardiovascular health by controlling blood pressure and cholesterol levels is crucial, as cerebrovascular conditions often exacerbate cognitive decline, especially when combined with other brain pathologies.

In clinical practice, early detection and communication of risk factors are vital. Physicians often perform cognitive assessments like the Mini-Cog or MoCA on patients over 65, followed by neuroimaging and blood tests to identify early signs of neurodegeneration. They also rule out other conditions that mimic dementia, such as medication interactions, substance abuse, or metabolic disorders. When patients show signs of cognitive decline, caregiver input becomes invaluable, especially in advanced stages. The emphasis is on proactive management—detecting issues early to intervene effectively—since early diagnosis can help improve quality of life and prolong productivity, even if the disease cannot be cured.

Lifestyle choices further influence dementia risk. Alcohol consumption, for example, is generally discouraged because it promotes inflammation and can worsen brain health. While moderate red wine intake is sometimes considered acceptable, the consensus is that alcohol should be limited or avoided altogether to reduce its inflammatory effects. Overall, understanding and managing these risk factors—age, genetics, lifestyle, and cardiovascular health—are essential in the effort to prevent or slow the progression of Alzheimer disease, highlighting the importance of early detection and holistic care approaches for aging populations.

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Panelists discuss how age remains the primary risk factor for Alzheimer dementia, but modifiable lifestyle and cardiovascular factors—such as social engagement, sleep, diet, exercise, and blood pressure—play a crucial role in influencing disease onset and progression, emphasizing the importance of early detection, proactive management, and holistic care strategies.

Alzheimer Disease Pathophysiology and Treatments

Over the past decade, the field of Alzheimer disease has undergone transformative advancements, particularly in diagnosis and treatment. Ten years ago, misdiagnosis was a significant issue—even clinical trial participants often lacked true Alzheimer pathology. Today, with the advent of advanced biomarkers and imaging techniques, diagnostic accuracy has dramatically improved, allowing researchers to select appropriate trial candidates. This precision has supported the development of the first disease-modifying therapies, marking a shift from purely symptomatic management to treatments that can alter the disease course at a biological level.

These innovations are reshaping patient care in tangible ways. The possibility of slowing disease progression creates new urgency and motivation for early detection. Patients now have a reason to seek evaluations sooner, opening the door to interventions that can preserve independence for longer. Early diagnosis and timely treatment may help individuals maintain higher levels of functioning—potentially allowing them to live at home, remain socially active, and continue driving. These are not just clinical gains but quality of life improvements that support dignity and autonomy.

On a biological level, Alzheimer is increasingly understood as a disorder of synaptic loss and network breakdown, driven by the accumulation of amyloid plaques and tau tangles in the brain. These pathological proteins disrupt normal cell communication and eventually lead to cell death. Recent understanding also highlights the role of neuroinflammation as a contributing factor. While genetic and lifestyle factors still influence the disease course, this refined model provides a more targeted foundation for developing therapies. As scientific insight deepens and treatments advance, patient care continues to shift toward earlier, more proactive, and biologically informed strategies.

Panelists discuss how advances in diagnostics and the emergence of disease-modifying therapies have transformed Alzheimer care by enabling earlier, more accurate diagnosis and proactive treatment strategies that improve both clinical outcomes and patients’ quality of life.

Ronald Primas, MD, FACP, FACPM, DABIHM, CTH

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