In May, a published study revealed that alterations indicative of Alzheimer’s disease (AD) were identified at the age of 24 through a blood test, which is becoming more accessible. These alterations might commence earlier, but these were the youngest individuals in the study. There are no medical treatments available for these initial signs, and apart from offering insight into a potential future and possibly inducing anxiety, what benefit does the test provide? Unless a person exhibits symptoms, which is improbable for most until their 70s or beyond, and the test is ordered by a clinician, it is unlikely that health insurance will cover the estimated $412 expense. Nevertheless, surveys indicate that a significant number of younger adults are interested in the test. Since it can be self-ordered, it is advisable to use a certified laboratory experienced with this test. If the outcomes are positive, they should consult their family physician to contextualize the findings.

A positive outcome may encourage the creation of end-of-life (EOL) documents and provoke discussions with family members regarding the treatments one may desire or reject for Alzheimer’s or other health conditions. It is never too early for these steps, as one cannot predict when a serious illness or an accident might make them incapable of making decisions for themselves. These documents should be revisited every three to five years and updated as needed. Provide copies to your primary healthcare provider, hospital, or other pertinent institutions. Also, ensure that your hospital or other facility will adhere to your directives and remind staff to reference the document with each admission. The test can further assist in determining who should make decisions on your behalf when you are unable to do so. Many people automatically presume that the individual they select will fulfill this role, but without discussion, you cannot ascertain whether they will do so or agree with your preferences, necessitating a different choice. You should not sidestep this process and have relatives arguing about your treatment at your bedside. This can harm family connections, and worse, it can leave you trapped in your body in a state that many older individuals have termed “a fate worse than death”; a state that may endure for a decade or more with AD.

Visiting a nursing home can be a stark reminder when observing individuals with AD sitting still and gazing blankly into space. I have witnessed this professionally, which influenced my EOL choices, documents, and dialogues. If possible, I recommend that everyone undertake this visit, as reading about the condition does not impart the same impact. Taking family members along may be beneficial if they resist the notion that you may not want to exist in that condition, even when surrounded by a loving family at home. Caring for someone with advanced AD is taxing, and no one who has not participated in caregiving can fathom its severity. It demands constant attention and physical effort, affecting the caregiver’s physical and mental wellbeing, potentially shortening the caregiver’s lifespan.

There is a potential way for someone with a positive test result to delay the onset of AD. Unsurprisingly, it aligns with recommendations for many chronic ailments: maintaining a healthy lifestyle. Dismiss the headlines urging you “to eat this one food” or “steer clear of this one activity.” These are misleading claims wrapped in pseudo-scientific jargon from sources seeking your money. Adopting a Mediterranean-style or DASH-style diet while avoiding prolonged inactivity, ideally paired with light exercise, can be advantageous. Furthermore, refraining from smoking, limiting alcohol intake to occasional and minimal levels, consuming very little processed food, and avoiding illegal substances are also beneficial. However, the correlation between diet and AD is correlational rather than causational, and the duration these actions will postpone AD remains uncertain and unpredictable, as the disease manifests at varying ages, with additional factors such as genetics also playing a role.

In light of this recent information regarding how early the precursors of Alzheimer’s may begin to appear, the ideal situation would involve initiating lifestyle changes even sooner and maintaining them for at least 50 years. How probable is this scenario? These suggestions are not novel and have been recommended for many years concerning conditions like heart disease, obesity, and diabetes, where they prove effective. How many individuals have embraced that guidance? Consequently, the likelihood of adoption for delaying AD, particularly since it would need to be sustained over decades with unknown outcomes, is minimal. Indeed, another study indicated that regardless of whether an individual received a positive or negative test result, they were less inclined to embrace a healthier lifestyle.

People will likely wait until a treatment is developed that can address pre-AD. Currently, this is not even on the horizon, and it may not become a reality for many years, as further research is necessary to ascertain when the condition first materializes. When these medications become accessible, they will, hopefully, be less toxic than the existing treatments for early-stage AD. Therefore, while these lifestyle modifications carry weight for various chronic conditions, the connection between diet and AD remains speculative for those at an early age, and the question