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Healthy Lifestyle Changes Improve Cognition for People With the AP0E4 Gene

Sherry Christiansen
By Sherry ChristiansenJune 1, 2018

The strongest genetic predictor of Alzheimer’s disease is the AP0E4 gene. Recent studies published in JAMA Neurology show that healthy lifestyle changes can improve cognition and protect against cognitive decline in seniors who carry this gene.

Read more about these lifestyle changes and the impact they have on AP0E4 gene carriers.

The APOE4 Gene

To get a clear understanding of the genetic predisposition for Alzheimer’s, one must understand that the AP0E4 gene is responsible for the genetic risk for the disease. It is estimated that 1 in 4 people have the AP0E4 gene. However, having the AP0E4 gene does not necessarily mean a person will get Alzheimer’s.

Having just one copy of the gene (from one parent) results in twice the likeliness of a person getting Alzheimer’s. Having two copies of the gene (from each parent) increases the risk of Alzheimer’s 12-fold.

The AP0E4 gene creates a protein in the body called the AP0E4 protein, which does not function properly. It is broken down into disease-causing fragments that result in the build-up of amyloid plaques and neurofibrillary (tau) tangles — hallmark symptoms of Alzheimer’s. These plaques and tangles interfere with normal nerve transmission in the brain and lead to premature death of neurons (brain cells).

Ways to Improve Cognition

The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), a randomized control study, conducted research on over 1,100 older adults, 362 of which had at least one copy of the APOE4 allele. The study focused on comparing those who carried the AP0E4 gene to those who did not carry the gene.

Participants were randomly assigned to engage regularly in one of the following lifestyle activities:

Cognitive Training

Cognitive training involved group sessions (lasting 60-90 minutes), facilitated by psychologists. Computer-based training (involving memory activities) program was implemented three times per week for 10-15-minute sessions. Social activities were encouraged for all group sessions.

Dietary Changes or Nutritional Intervention

The nutritional intervention component of the study included nutritional counseling, with a diet involving 10-20% of daily calories from proteins, 25-35% from fat (less than 10% from saturated or trans-fat), and 45-55% from carbohydrates (less than 10% from refined sugars). The study participants were instructed to eat 25-35 grams of dietary fiber daily. Foods that were recommended were fruits, vegetables, low-fat dairy and whole grains, as well as vegetable sources of oil (or grapeseed oil) instead of butter and at least two servings of fish each week.


In the study, aerobics, balance and strength training exercises were taught by physiotherapists. Each study participant selected their preferred method of aerobic exercise from a list, including gymnastics, jogging, Nordic walking, swimming and more. Hour-long balance and strength-training sessions were performed by the participants 2-3 times per week and 45-60 minutes of aerobics were implemented 3-5 times per week during the entire study period.

Vascular Risk Management

Metabolic (body and weight disposition) and vascular (blood pressure and cholesterol level) management involved an initial risk factor assessment by a nurse, who assessed blood pressure, body and weight measurements of each participant. A physician ran lab tests to evaluate for the presence of diabetes or high cholesterol. Any participant with positive screening assessment results (such as diabetes, high blood pressure or obesity) was referred to their primary care physician for treatment (management).

In the beginning of the study, there was no difference noted between those who carried the AP0E 4 gene and non-carriers.

After two years, the APOE4 carriers who made healthy lifestyle changes were found to improve in cognitive function when compared to APOE4 carriers in the control group — the group that did not implement lifestyle changes.

Cognitive function also improved for non-carriers who made lifestyle changes.

Findings from the FINGER study were considered groundbreaking evidence that specific diet and lifestyle changes could impact cognitive decline in people at risk for Alzheimer’s. The findings were consistent with the seven steps recommended for brain health by the Alzheimer’s Drug Discover Foundation.

“Whether such benefits are more pronounced in APOE4carriers, compared with non-carriers, should be further investigated,” wrote Dr. Solomon of the Institute of Clinical Medicine/Neurology at the University of Eastern Finland, Kuopio, and her associates.

Future studies will be conducted during a follow up on the FINGER clinical research trial. This new data will be used to help researchers gather even more information on how effective lifestyle changes are in preventing dementia. In addition, scientists will investigate whether the benefits of diet and lifestyle changes have a bigger impact on individuals who carry the AP0E4 gene, compared to non-carriers.

Have you found healthy lifestyle changes to improve cognition in yourself or a senior loved one? We’d like to hear your stories in the comments below.

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Sherry Christiansen

Sherry Christiansen

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