Watching a loved one go through Alzheimer’s disease or dementia can leave a lasting impact on an entire family. For many people, it also raises a difficult and deeply personal question:
“Will this happen to me too?”
I recently spoke with someone whose mother lived with Alzheimer’s disease for more than a decade. After watching what her family went through, she decided to pursue genetic testing and discovered she carries the APOE4 gene, one of the genetic factors associated with increased Alzheimer’s risk.
When she brought those results to her primary care doctor, she was essentially told: “There’s nothing you can do. You just have to wait.”
Unfortunately, many people receive a similar message.
Others avoid testing altogether because they are afraid of what they might learn. Some think, “I don’t want to know.”
I understand that hesitation. But one of the most important things I want patients to know is this. Risk is not the same as destiny.
While genetics can influence your risk for cognitive decline, they are only part of the picture. More importantly, we now know there are many factors that may influence long-term brain health, especially when addressed early.
That is why conversations around Alzheimer’s prevention, dementia prevention, APOE4, and proactive brain health have become increasingly important.
What Is the APOE4 Gene?
APOE stands for apolipoprotein E, a gene involved in how the body processes fats and cholesterol. There are three common forms of this gene:
- APOE2
- APOE3
- APOE4
APOE4 is associated with a higher risk of developing Alzheimer’s disease. If you inherit one copy of APOE4 from one parent, your risk may increase. If you inherit two copies, the risk may increase further.
However, having APOE4 does not mean you are guaranteed to develop Alzheimer’s disease. This is a critical distinction.
Many people with APOE4 never develop dementia. At the same time, many people diagnosed with Alzheimer’s do not carry APOE4 at all. Genetics matter, but they are only one piece of a much larger puzzle that includes inflammation, blood sugar regulation, cardiovascular health, sleep quality, toxin exposure, exercise, nutrition, stress, and overall metabolic function.
If Alzheimer’s Runs in Your Family, Should You Get Tested?
This is one of the most emotionally difficult questions people face. For some, testing feels empowering. For others, it feels frightening.
I often hear concerns like: “What if I find out I have APOE4?” “What if there’s nothing I can do?” “Would knowing just make me anxious?” These are valid feelings. But in many cases, understanding your potential risk factors can create an opportunity to become more proactive earlier, long before significant symptoms develop. The goal is not fear. The goal is awareness.
When we think about brain health through a preventive and functional medicine lens, we are not simply asking: “Will you develop Alzheimer’s?”
We are asking, “What factors may be influencing brain resilience today, and what can we do to support healthier cognitive aging over time?” That shift in perspective matters.
Does APOE4 Mean You Will Get Alzheimer’s?
No. This is one of the biggest misconceptions surrounding APOE4.
Having APOE4 may increase risk, but it does not guarantee disease. Your daily habits, environment, metabolic health, inflammation levels, sleep quality, cardiovascular health, and overall lifestyle can all influence how the brain functions over time.
Research continues to show that Alzheimer’s disease is multifactorial. In other words, it is often influenced by many interconnected systems in the body rather than one single cause.
That is one reason why prevention strategies are becoming such an important part of the conversation.
Can You Prevent Alzheimer’s or Dementia?
This is where nuance is important.
No ethical physician should promise that Alzheimer’s disease can be completely prevented. However, a growing body of research strongly suggests there are many modifiable factors that may influence cognitive decline risk and long-term brain health.
This is why prevention has become such an important focus. We now understand that changes associated with Alzheimer’s disease may begin years, or even decades, before significant memory loss appears. That creates an opportunity to support the brain earlier rather than waiting until symptoms become severe.
The earlier we begin addressing underlying contributors, the more options we may have.
How to Prevent Alzheimer’s and Support Long-Term Brain Health
When patients ask me how to prevent dementia or reduce Alzheimer’s risk, I explain that there is rarely one single intervention. Brain health is influenced by many systems working together.
Here are several areas that deserve attention.
Prioritize High-Quality Sleep
Sleep is one of the most important foundations of brain health.
During deep sleep, the brain activates important “cleanup” processes that help remove metabolic waste products. Poor sleep over time may contribute to inflammation, impaired detoxification, blood sugar dysregulation, and cognitive dysfunction.
Chronic sleep deprivation is also associated with increased dementia risk.
If you frequently wake up exhausted, snore heavily, struggle with insomnia, or feel mentally foggy during the day, it may be worth evaluating your sleep more closely.
Improve Blood Sugar and Metabolic Health
Blood sugar imbalance and insulin resistance can significantly impact brain function.
Some researchers have even referred to Alzheimer’s disease as “Type 3 diabetes” because of the strong relationship between glucose metabolism and cognitive decline.
Elevated insulin levels, chronic inflammation, obesity, and metabolic dysfunction may all influence the brain over time.
This is one reason nutrition, exercise, and metabolic health are such important parts of prevention-focused brain care.
Exercise Regularly
Physical activity supports circulation, cardiovascular health, insulin sensitivity, mood, and brain-derived neurotrophic factor (BDNF), a protein involved in brain cell growth and repair.
Exercise is consistently associated with healthier aging and better cognitive function.
Even simple changes like walking more consistently, adding resistance training, or improving overall movement can make a meaningful difference over time.
Reduce Inflammation
Chronic inflammation can affect nearly every system in the body, including the brain. Inflammation may be influenced by:
- poor diet
- chronic stress
- infections
- toxin exposure
- gut dysfunction
- sleep issues
- metabolic imbalance
Many people are surprised to learn how interconnected these systems truly are.
Support Cardiovascular Health
What supports the heart often supports the brain.
High blood pressure, vascular disease, poor circulation, elevated cholesterol particles, inflammation, and metabolic dysfunction may all influence cognitive health.
This is one reason brain health cannot be separated from overall health.
Pay Attention to Brain Fog and Cognitive Changes
Many patients dismiss symptoms like:
- trouble concentrating
- difficulty finding words
- mental fatigue
- forgetfulness
- feeling “foggy”
- slower processing
Sometimes these changes are related to stress, sleep deprivation, hormonal shifts, nutrient deficiencies, or inflammation. Sometimes they may signal something that deserves a closer look.
That does not mean every episode of forgetfulness is Alzheimer’s disease. Occasional memory lapses can happen to anyone, especially during periods of stress or poor sleep.
But if symptoms become persistent, progressive, or concerning, it may be worth exploring further rather than simply assuming it is “normal aging.”
What Is p-tau217 and Why Are More People Talking About It?
You may have recently heard about newer biomarkers like p-tau217 testing. These tests are gaining attention because they may help identify changes associated with Alzheimer’s disease years, and in some cases decades, before memory loss or other symptoms become apparent.
Some community organizations and screening programs are beginning to offer these tests directly to consumers. In many cases, people receive their results and are then told: “Follow up with your doctor.”
The challenge is that many physicians are still unfamiliar with these biomarkers or how to interpret them in a broader prevention-based framework.
As a result, patients are often left wondering:
“What does this actually mean?”
“Should I be worried?”
“What do I do next?”
This is exactly why education and personalized guidance matter.
Testing without context can create unnecessary anxiety. The more important question is how that information fits into the bigger picture of your overall brain health, risk factors, symptoms, metabolic health, inflammation, lifestyle, and long-term goals.
The Problem With Waiting Until Symptoms Become Severe
One of the biggest limitations in conventional cognitive care is that many people are not evaluated until symptoms become advanced. By that point, changes may have been developing quietly for years.
This is where prevention-focused brain health strategies differ.
Rather than waiting for significant decline, the goal is to identify patterns, risk factors, and potential contributors earlier so patients can take a more proactive approach to supporting cognitive function over time.
This is also why conversations around PRECODE and early brain health optimization have become increasingly important, particularly for individuals with:
- family history of Alzheimer’s
- APOE4 status
- brain fog
- metabolic dysfunction
- concerns about cognitive performance
- elevated biomarkers
- cardiovascular risk factors
When to Consider a More Advanced Brain Health Evaluation
It may be worth exploring a more comprehensive brain health evaluation if you:
- have a strong family history of Alzheimer’s or dementia
- carry the APOE4 gene
- are experiencing persistent brain fog
- struggle with word finding or concentration
- have concerns about memory changes
- received abnormal biomarker testing
- want to take a proactive approach to cognitive aging
The goal is not fear-based medicine. The goal is understanding your unique risk factors and creating a more personalized strategy for supporting long-term brain health.
Final Thoughts
If Alzheimer’s disease runs in your family, it is understandable to feel concerned. Watching someone you love go through cognitive decline can be heartbreaking and deeply personal.
But one of the most important things I want people to understand is this: Your genes may influence risk, but they do not define your future. There is a significant difference between being passive and being proactive.
You do not have to wait until symptoms become severe before paying attention to brain health. In many cases, earlier awareness may create more opportunities to support resilience, function, and long-term cognitive wellness.
As a Bredesen Protocol trained physician working with Apollo Health, I take a personalized and prevention-focused approach to cognitive health, looking beyond symptoms to evaluate the many factors that may influence brain function over time.
If you are concerned about your family history, APOE4 status, brain fog, memory changes, p-tau217 results, or overall cognitive health, personalized guidance may help you better understand your options and next steps.
Whether you are looking for answers, interested in prevention-focused brain health strategies, or simply want a more comprehensive understanding of your risk factors, there is a path forward.
To learn more about our brain health and cognitive wellness programs, reach out to our office or visit our PRECODE page to explore proactive strategies designed to support long-term brain health and cognitive vitality.
Dr. Cheri Dersam
Dr. Cheri Dersam is board certified in Emergency Medicine and Integrative Medicine, fellowship trained in Functional Medicine, and a Bredesen Protocol trained physician through Apollo Health. She specializes in brain health, cognitive decline prevention, and functional medicine, helping patients identify and address the root causes that influence long-term health and cognitive vitality through a personalized, evidence-based approach.