Family history and 3 questions

[Newtothis3/4]

I have been dealing with anxiety for the last 6 months. It started with panic attacks out of nowhere and from there, I began to be consumed with health related fears. My unrelenting anxiety caused brain fog, which I still have but not as great. My fears of health issues would shift from one thing to another, all based on nothing other than just a belief that something was wrong. I have started an antidepressant for GAD and depression. I am a few weeks into it, so it has not fully taken effect. A month ago, I found out from my psychiatrist that there was a dna swab test that I could take to let me know which medicines would be most beneficial for me to use from psychiatric to blood pressure, etc. What I did not anticipate was the other genetic information including that I am E3/E4. As soon as I got the results, i freaked out. I assumed one, that the brain fog I’ve had for months is early onset AD. I ordered the Bredesen book and should receive it in the next few days. I run two miles everyday, lift weights 4-5 days a week and adhere to a strict paleo diet for the last month. Before that my diet was always “clean” but nothing to the degree I have gone to now. Despite being in good shape, I’ve had to take BP pills and a statin. My numbers with the meds are now in line and very good but the E4 I’m guessing is the culprit for not having a better blood profile considering my excercise and diet. On my mother’s side, my grandmother lived to 92 with no AD, my grandfather to 84, no AD and my two uncles and mom, 71,67 and 65 show no signs either. My fathers side I knew nothing about because I had not seen him since being 5. I reached out to an aunt of mine (she was surprised to hear from me) and asked if I could ask about some family history. My grandfather died in his 50s due to being a heavy alcoholic, my father died at 64 from being a huge drug abuser and alcoholic as well. My uncle died at 55 from having two strokes and my grandmother died in her early 80’s with no AD. I have two aunts remaining I’m good health. One mid 60s and the other one is 71. My fathers side of the family came from a very low socio-economic background and health and education were not practiced at all on that side of the family. Living with my mom, I was given a wonderful education and went to college.
Now my questions...

One, my fears of early onset AD. Would they usually come with a family history of early onset AD?

Second, thankfully I did not inherit the addiction gene from my father’s side. I have enjoyed using cannabis for many years and having a 3-4 glasses of red wine over the course of a week. However, for over a month I have ceased using both entirely. My question is whether using cannabis at night to sleep being an E3/E4 is a good or bad idea. The same for drinking wine. Where I live marijuana is legal so that is not an issue. I want to “live” but also don’t want to jeopardize increasing my propensity for starting AD. I have read that drinking is a “no,no” and have read very conflicting information regarding the use of marijuana. Testimonial and empirical information would greatly be appreciated.

Last, I am on TRT (testosterone therapy) under the guidance of a physician. I was curious as to whether TRT was cognitively a beneficial thing to be on for people with E4? I had read that it might be. Curious to see what the concensus is with like minded friends.

Thank you for this support group. I had been feeling very alone until I came across it.

[samspade]

Second, thankfully I did not inherit the addiction gene from my father’s side. I have enjoyed using cannabis for many years and having a 3-4 glasses of red wine over the course of a week. However, for over a month I have ceased using both entirely. My question is whether using cannabis at night to sleep being an E3/E4 is a good or bad idea. The same for drinking wine. Where I live marijuana is legal so that is not an issue. I want to “live” but also don’t want to jeopardize increasing my propensity for starting AD. I have read that drinking is a “no,no” and have read very conflicting information regarding the use of marijuana. Testimonial and empirical information would greatly be appreciated.

Welcome to you. First, relax. Don't let the anxiety get you uptight. Your sleep will be disturbed by the stress hormones. Second, Alcohol will help you get to sleep but the quality of sleep is greatly diminished even with a little more than one glass. I'm a 3/4 and decided to just give up the wine. As for cannabis, I would search for peer-reviewed studies on sleep quality.

Other than that I'm not yet very informed as I just found out I am 3/4.

[Fiver]

Hello New,

Welcome. I'm typing fast, as I have meeting coming up. But I wanted to let you know that anxiety about health issues - real or feared - is a common part of GAD. It is good that you are addressing the anxiety through a combination of therapy and medication. It can indeed take time to find that right combination of approaches (specifically, the most effective medications and dosages).

I'm guessing at your age, but I think it is very unlikely that you are having cognitive issues caused by AD at this point. Anti-depressants can absolutely cause brain fog, at the start and/or when dosages are changed. Statins can also. I tend to be pro-statin but know personally that they can cause brain fogginess (which I don't notice much if I take them before bedtime). Anxiety itself can cause brain fog.

It's great that you have a healthy lifestyle. You can tweek your lifestyle as you learn more about your situation and educate yourself about apoe3/4. But you will find - happily - that many (many!) of the things recommended to treat depression and anxiety are also good for prevention of AD (and a lot of other diseases) - here i am thinking of exercise, a good diet, low stress levels, good hormone levels, adequate vitamin D, positive social interactions, etc. So every step you take in the right direction is really MANY steps in the right direction.

I would suggest giving yourself time to address the GAD and understand that this will impact how you feel - up and down - for a little while. And know that what you are doing will help lower your AD risk too.

[slacker]

One, my fears of early onset AD. Would they usually come with a family history of early onset AD?

Second, thankfully I did not inherit the addiction gene from my father’s side. I have enjoyed using cannabis for many years and having a 3-4 glasses of red wine over the course of a week. However, for over a month I have ceased using both entirely. My question is whether using cannabis at night to sleep being an E3/E4 is a good or bad idea. The same for drinking wine. Where I live marijuana is legal so that is not an issue. I want to “live” but also don’t want to jeopardize increasing my propensity for starting AD. I have read that drinking is a “no,no” and have read very conflicting information regarding the use of marijuana. Testimonial and empirical information would greatly be appreciated.

Last, I am on TRT (testosterone therapy) under the guidance of a physician. I was curious as to whether TRT was cognitively a beneficial thing to be on for people with E4? I had read that it might be. Curious to see what the concensus is with like minded friends.

Hi Newtothis3/4;

"Early onset" of AD is often defined as onset before age 65. Here's information from Mayo Clinic. It is thought that ApoE4 carriers develop cognitive earlier than those without. Dr Bredesen sees earlier onset with his "type 3" patients (driven by toxins).

Alcohol intake is controversial. Different studies show different results. You can find one of our topics with discussion on alcohol here. Here is another perspective. Our wiki has a separate section on cannabis that you may find helpful.

I haven't spent much time studying on testosterone since my levels are normal for my age and gender. Bredesen recommends testing and treating, but I don't think he has specific advice for ApoE4. There is a little bit of information in his book.

I guess the bottom line is what is true for one person isn't necessarily true for all. It's definitely an experiment of N=1, tweak, monitor, and adjust as needed. We all have to make decisions in an environment of uncertainty.

[NF52]

I have been dealing with anxiety for the last 6 months....
One, my fears of early onset AD. Would they usually come with a family history of early onset AD?
...Thank you for this support group. I had been feeling very alone until I came across it.

Welcome again, my friend. ( I replied to your earlier post on memantine, here: Possible drug to use before symptoms to possibly push off disease)

It must feel like a one-two punch to be trying to find the right medication to deal with panic attacks and anxiety, only to have a test come back with something else to worry about!! My mother-in-law, a wonderfully sweet woman from Maine, was a firm believer in the motto: "Don't go to doctors: they will only find problems and it's better not to know." Of course, the first time she shared this pearl of wisdom was after my son was diagnosed with a congenital heart problem at the age of 5 weeks that required surgery! She had to admit that sometimes it's good to find out things BEFORE they can cause problems!

Having experienced the sudden onset of panic attacks and later generalized anxiety, I can speak only from my own experience. One: it's terrific that you have a doctor who is working hard to figure out how best to manage your symptoms! Two: I found that in addition to medication, what's now called "cognitive behavioral therapy" worked wonders. (In my case it was mostly self-taught, but that was 25 years ago.) Techniques of relaxation breathing and having a "mantra" (ex. "I'm ok; my body is able to calm itself") also work. Knowing that about 20% of the population will have experiences of panic attacks and/or anxiety at some point should be reassuring; our biology primes us to sometimes over-react, but we are more than just our biology! Like many people, I found that I no longer had panic attacks once I dealt with some real situational stress, and eventually no longer needed anti-anxiety pills. But until them, I was glad to be able to take an extended-release medication that allowed me to feel like myself, and continue to do well with a busy career and family.

As for your questions, I'd like to try to answer your first question, and offer a possible window into your dad and grandfather. As someone with ApoE 3/4, you are NOT considered at risk for Early Onset Alzheimer's Disease (diagnosis of EOAD is usually in the 40's and 50's). Most "classic" cases of EOAD are strongly evident in families who share a rare, autosomal dominant mutation--meaning that anyone who gets one copy of the "bad" gene will get EOAD. With your grandparents living to their 90's and healthy aunts and a mother in their 60's and 70's, I don't think that's on your mother's side of the family. What you dad's side may have had is a complex situation with some or all of these factors:
a difficult childhood, poor quality education, few opportunities to observe and learn from healthy family relationships, exposure to industrial pollution and poor water quality, family and/or cultural patterns of heavy drinking, lack of access to good health care and knowledge of prevention that we have now.

Any or or all of those factors may have combined with a genetic susceptibility to addictions and anxiety or depression, which your grandfather treated with alcohol and and your father with alcohol and drugs, as men often did in the past. You, however, have key "protective" factors that have been consistently associated with a reduced risk of dementia: a college education, a supportive family, terrific exercise, a healthy diet, and access to good health care to monitor your blood pressure and cardiac health.

So let me give you some very recent (2017) and very specific news from a large meta-analysis of population-based data on people with ApoE 3/4 ages 60-75, not your age (which I am guessing is 30's or early 40's):

The Generation Study elected to disclose the following “lifetime” risks of [mild cognitive impairment] MCI or dementia to its potential participants: 30%–55% for individuals with APOE-e4/e4; 20%–25% for individuals with APOE-e3/e4 and -e2/e4 (with a note that risk might be lower for those with APOE-e2/e4); and 10%–15% for individuals with APOE-e3/e3, -e3/e2, and -e2/e2 (with a note that risk might be lower for those with APOE-e2/e3 and -e2/e2).

APOE-related risk of mild cognitive impairment and dementia for prevention trials: An analysis of four cohorts

These estimates are not "personalized"; they don't take into account that you have a higher education level than most people, that your diet is definitely better than mine was at your age (to say nothing of the Velveeta and hot dog upbringing I had!)

Your brain fog is a side effect of your anxiety. Think of it as your amygdala, the center for rapid emotional response, sending out a fire alarm in every room in your house while you're trying to read. You'd have some brain fog there too. Having worked with lots of teens with concussions up to severe brain injuries, they were able to precisely say that they felt they were in a fog for about 6 months to 2 years after their injuries--but it eventually lifted. Yours will probably lift much faster once you are on the right medication or combo of meds.

I'm sure your mother and aunts are looking forward to your continued good health and enjoyment of life. You should also; you are well-equipped for the journey.

[mike]

I have been dealing with anxiety for the last 6 months. It started with panic attacks out of nowhere and from there, I began to be consumed with health related fears...
Second, thankfully I did not inherit the addiction gene from my father’s side. I have enjoyed using cannabis for many years and having a 3-4 glasses of red wine over the course of a week. However, for over a month I have ceased using both entirely. My question is whether using cannabis at night to sleep being an E3/E4 is a good or bad idea. The same for drinking wine. Where I live marijuana is legal so that is not an issue. I want to “live” but also don’t want to jeopardize increasing my propensity for starting AD. I have read that drinking is a “no,no” and have read very conflicting information regarding the use of marijuana. Testimonial and empirical information would greatly be appreciated.

Newtothis, CBD oil can be very effective at reducing anxiety, and sometimes for sleep. In the past, when I've had issues sleeping, the Indica form of THC has been a great help. So far as I've been able to see in the research, there is not much downside for health and Alzheimer's. I also wouldn't think a few glasses of red wine a week would be an issue, but could get an argument on that. I was getting brain fog, but that tended to be around glucose fluctuation - do you have any issues there?