7 Things To Do In Your 30s & 40s To Protect Your Brain From Alzheimer's, From A Preventive Neurologist
It may feel like Alzheimer's suddenly appears in your 60s and 70s, but the changes behind it can actually start in your 30s or 40s. This makes those busy career-and-family years the best window we have for prevention. That was the take-home message from the recent conversation I had with preventive neurologist Kellyann Niotis, M.D., on the mindbodygreen podcast.
"What we know for sure is that Alzheimer's is a preventable disease. It's not destiny. Your genes don't dictate whether or not you will get this disease," she told me. You know the classic brain health habits—eat better, exercise more, sleep more—but it isn't much of a plan. Here are 7 concrete steps that Niotis recommends to protect your brain, starting now.
1. Get a full cholesterol workup
What's good for your heart is good for your head, but Niotis calls cholesterol one of the most underappreciated factors in brain health. She often sees people in their 30s and 40s with borderline numbers get told they're fine, but those numbers should be further investigated to ensure your are preventing future heart and brain disease. When thinking about cholesterol, here are a few thinks Niotis recommends:
- Go beyond LDL. Ask your doctor about ApoB, the protein that carries LDL cholesterol through your blood. Niotis uses the Boston Heart panel to go deeper into patients' lipid profile (I'm a huge fan).
- Know your genes. APOE4, the best-known Alzheimer's risk gene, is a cholesterol transport gene. For carriers, diet and exercise can only go so far.
- Ask about ApoA1. This protein carries HDL cholesterol and is small enough to slip past the barrier that protects the brain. Observational studies suggest people with the highest levels seem protected from Alzheimer's and Parkinson's. Mine is 171, which Niotis says is helping me.
2. Stay open to medication
Heart disease runs in my family, so I have been on top of my cholesterol for a while. I tried to lower my ApoB naturally, but I could never get it below 71, even when I was basically just eating sardines and lettuce. My doctor knew I'm an over-absorber of saturated fat and suggested ezetimibe, a cholesterol-lowering medication with very minimal side effects. At around 50, I finally relented. My ApoB is now 51, and I wish I'd started five years earlier.
"If you need a medication, great," Niotis says. "We're equal opportunists when it comes to the brain. We'll do lifestyle, medication, supplements, whatever works."
3. Pay attention to how you move
Niotis's background is in movement disorders, and she believes the way you move says a lot about your brain. She runs assessments with Beth Lewis, a personal trainer who is first in class for functional movement, to reveal warning patterns that appear in the way people moving starting in their 30s and 40s. They look at all aspects of movement, including...
- Walking: Speed, arm swing, rib rotation, and how you shift weight side to side all offer clues.
- Eye movement: Many patients struggle to keep their eyes focused on something close up (which can actually explain a hip or ankle that keeps getting injured).
- Coordination: Symmetry, fine motor skills, and speed of movement all matter.
Niotis calls these measurements motor reserve, which is a lesser-known cousin of cognitive reserve. It encapsulates how efficient, mobile, and coordinated your body is.
If you want to test it yourself, try her at-home test. Close your eyes, put your hands out in front of you, and touch the tip of your nose with your right index finger. How close you get shows how well you sense where your body is without visual cues. (I nailed it, for the record.)
4. Prioritize cardio alongside strength
Strength training is getting all the attention right now, but Niotis says cardio is just as important, especially for APOE4 carriers. "If I can say the one thing that my patients notably benefit from in terms of cognitive function, it's when they get on a strict cardio programming," she told me. "Don't sacrifice your cardio to put on muscle mass."
My takeaway is to pursue a mix of rougly 50% cardio, 50% strength training. You really want to be doing a variety of things, to get your brain working in different ways. For example, if you only run, try rowing. If you typically stick to low-impact workouts like yoga or pilates, try bumping up the intensity with a HIIT session.
5. Get your hormones checked around perimenopause
The shift in female sex hormones during perimenopause is believed to be one reason women are disproportionately affected by Alzheimer's. Hormones aren't the whole story, Niotis says, but getting them right can also improve sleep, mood, cholesterol, and blood pressure.
6. Make room for your mental health
Depression and anxiety take a bigger toll on women's brain health, Niotis says, while men are more harmed by cardiovascular risk factors. There are lots of ways to support your mental health, and it doesn't have to mean medication, or even traditional therapy. A spiritual practice counts, and so does setting aside one hour every two weeks to process what's going on in your life. Journaling, meditation, and yoga can all be beneficial. Even mild, everyday anxiety has an impact, and is worth paying attention to.
7. Treat biomarkers as data, not a diagnosis
Direct-to-consumer blood tests now measure proteins linked to Alzheimer's, like amyloid and p-tau 217. Elevated levels are signs of higher disease risk, but Niotis is confident that people caught at the right stage can change course. She says people often get caught up in these numbers and consider them to be diagnoses, but she wants people to remember that Alzheimer's is a clinical diagnosis. "If they're cognitively normal, they don't have Alzheimer's disease, like full stop," she says.
Plus, these numbers can also shift with kidney health, viral infections, and even the phase of a woman's menstrual cycle. My p-tau 217 is very high, but I have no amyloid, I'm APOE2/3, and my brain imaging came back clean. Instead of considering myself destined to get Alzheimer's, I'm optimizing my life to prevent it.
The takeaway
Niotis is happy to share information like this with her patients and the public, but she can't pull the levers for you. "I wish there was the one magic thing that we did, but it's impossible to isolate one thing," she says. Her best advice is to pick one bucket to focus on at a time. Pick one move to make this month: ask your doctor about ApoB, add a cardio session, or block yourself off an hour to decompress. If you can make these into habits, you will be preparing your brain as best you can to fight off Alzheimer's.