Time to step up my game!

[Quantifier]

I am Quantifier, 54 year old ApoE 3/4 woman, 2 times cancer survivor, working in molecular biology research.

1st cancer was stage 1 breast cancer at age 35. Did surgery, chemo, radiation. Oncologist had me stop hormonal birth control (copper IUD worked fine) and warned me against HRT. I have been following up with mammograms, and so far so good!

I became aware of my ApoE status in 2011 when 23&me started reporting it (our family tested months before that). Back then all I knew about prevention was to remain intellectually active. Some years later I became aware of Dale Bredesen's studies through work. I found his first book in late 2017. Unfortunately around that time it became necessary to deal with 2nd cancer, stage 3 melanoma. The treatment involved immunotherapy, that is I received medication that was supposed to unleash my immune system against the cancer - so not a good time to start a protocol that included reducing inflammation! 1st immunotherapy (systemic treatment) failed, but 2nd one (localized treatment) worked. Melanoma spread disappeared and has shown no signs of returning since then. 

Back when I got my initial genetics result I had no family history of dementia. My parents were in their early 70s and cognitively intact. Both my grandmothers had died in their early 90s, cognitively intact. My grandfathers both died much younger, one in his 50s, the other in his 60s, from unrelated causes. It is entirely possible that one or both of them would have developed dementia had they lived longer, but I can't know. I encouraged my parents to do genetic testing as well, but they were not interested. Then in 2015 my mother was diagnosed with some form of cognitive decline. In 2018 her situation became full-blown dementia. I have no idea if it was definitely AD or some other form - she did have a history of multiple strokes since her late 50s, following a long history of blood-pressure problems. She died last summer of COVID19. My current hypothesis is that I got my ApoE4 copy from her, down from her father, but who really knows? I have shared my test results with my brothers, but so far they are reluctant to get tested (one says he fears a positive result will make him fatalistic, the other doesn't want a commercial company to have his genetic information).

In summer 2018 I decided to start incorporating elements of Bredesen's protocol into my lifestyle. I have been doing intermittent fasting since August 2018 - I started with 14 hours and nowadays I'm doing 17-18 hours. Fasting was a life-saver: it enabled me to lose weight consistently and keep it off. No more yo-yo dieting! I am back to what I weighed in my 20s and have been maintaining that for the last 16 months. 

I have made many additional changes over the years, and have now gotten to the place where I need the help of professionals and experienced co-journiers to step up my game further. I will start posting my various questions in the near future.

(And yes, I did read Stavia's most excellent Primer! Thank you so much, Stavia!)

[floramaria]

In summer 2018 I decided to start incorporating elements of Bredesen's protocol into my lifestyle. I have been doing intermittent fasting since August 2018 - I started with 14 hours and nowadays I'm doing 17-18 hours. Fasting was a life-saver: it enabled me to lose weight consistently and keep it off. No more yo-yo dieting! I am back to what I weighed in my 20s and have been maintaining that for the last 16 months. 

I have made many additional changes over the years, and have now gotten to the place where I need the help of professionals and experienced co-journiers to step up my game further. I will start posting my various questions in the near future.

(And yes, I did read Stavia's most excellent Primer! Thank you so much, Stavia!)

Welcome , Quantifier, and thank you for sharing your story here. Congratulations on the success you have had with fasting, ending yo-yo-dieting, and getting your weight where you want it~ and keeping it there! Great steps. At age 54 and already incorporating elements of the Bredesen protocol , including IF, you are already intervening to support your longterm cognition.
You have joined a community that has many fellow travelers! It is great that you have already found the primer. Since you mention having many questions, I want to refer you to another of my favorite tools on the site, in case you are not aware of it. To see all previous posts on any topic, you can use the Search function, which you access through the magnifying glass to the left of your user name. Seeing what has already been posted on a topic can give you a jump start towards finding the answers you are looking for and also allows you to add questions as well as your own knowledge and experience to “discussions” that are already underway.
Happy travels!

[msdorney]

Welcome to the community Quantifier! Than you for sharing, as I too have found intermittent fasting very helpful, with long term benefits for weight loss, energy levels and digestive health. I am glad that you found the Primer. Using the search function was a great suggestion. Please also check out the How To Guide for more useful tips on getting the most out of the site. You may be interested in some of the Meet Ups, as they are another way to get connected to the community.

[NF52]

I am Quantifier, 54 year old ApoE 3/4 woman, 2 times cancer survivor, working in molecular biology research....

Back when I got my initial genetics result I had no family history of dementia. My parents were in their early 70s and cognitively intact. ...Then in 2015 my mother was diagnosed with some form of cognitive decline. In 2018 her situation became full-blown dementia. I have no idea if it was definitely AD or some other form - she did have a history of multiple strokes since her late 50s, following a long history of blood-pressure problems. She died last summer of COVID19. ...

I have made many additional changes over the years, and have now gotten to the place where I need the help of professionals and experienced co-journiers to step up my game further. I will start posting my various questions in the near future.

Welcome Quantifier!

Let me first say how sorry I am that you lost your mother last summer to COVI-19. Each death from COVID-19 is a tragedy whose ripples are often unseen and worsened by the family's inability to mourn and support one another together. My godmother died last April of COVIV-19; I hope to be able to see her daughters (my cousins) who live 500 miles from me this summer to hug them and remember her love.
Secondly, may I point out the amazing strengths you bring to the challenge of having ApoE 3/4? You know them, but sometimes it helps to have them shouted from the rooftops!

1) You work in molecular biology research! At almost 15 years older than you, I had a biology teacher in HS who told us that "women in medicine are taking a spot that men could have". Today I know women running multi-million dollar NIH grants on aging, women coordinating national AD Clinical Trial Consortium, women who participate in clinical trials to find answers to why AD affects women more than men, women who started this forum (Julie Gregory, Stavia and others) and women who prove every day that our brains are meant to be used every single day of our lives!

2) You have the experience of being on the patient side of the equation and know that statistics are both essential and yet not predictive for any one individual. Being able to advocate and partner with medical professionals, and sometimes being an "impatient patient" as my PT once called me, is a gift we give our future selves.

3) You have found a lifestyle pattern for eating that works for you and kept a significant amount of weight loss off for 16 months! That puts you in the exalted group of people who have done that in mid-life!

As for your mother, it sounds to me (not a medical professional) like her cognitive impairment may have been a form of vascular dementia, or what is termed "mixed dementia" of the AD/ vascular types. Given her history of strokes starting in her late 50's, she showed some real brain resilience herself to make it another 15 years or so before experiencing cognitive decline! High blood pressure is now recognized as a real driver of vascular dementia through damage to the blood-brain barrier and development of ischemic lesions called white-matter (WM) hyper intensities orWM disease. The "gold standard" SPRINT-MIND trial reported in 2018 that

In adults with increased risk for cardiovascular disease but without diabetes, treating to a systolic blood pressure (BP) target less than 120 mmHg, as compared to a target of less than 140 mmHg, may reduce the risk of mild cognitive impairment (MCI) and the combined risk of MCI and dementia, according to preliminary results from the SPRINT MIND trial presented June 25 at the Alzheimer's Association International Conference in Chicago.

SPRINT MIND Trial Finds Lower Risk of MCI and Dementia With Lower BP According to the researchers, it didn't matter HOW doctors got the BP to < 120, using diet, drugs, etc. just that it got there for people seen as at high risk due to family history or co-morbid factors.

Like you, my mother had poorly managed BP, since in the 1980's and 90's it was thought that a BP of "100+ your age" was a good target, and fewer heart medication and monitoring tools were available. As someone with that on the maternal side and a father who died of cardiac arrest at age 67 (each had ApoE4), I was happy to pay for a coronary artery scan in 2017 that found zero calcium and awarded me a cardiac age of "39". You may be similarly cheered if you get a CAC and a carotid artery scan.

You may also be encouraged by the conclusion of a multi-variate analysis of a very long-running population study in the Mayo Clinic Study of Aging. While Rochester MN has a population that is more heavily Scandinavian than most, they also have 30% ApOE 4 carriers, a fairly high level of education and a wonderful willingness to be studied for decades! Here's the conclusion of a 2019 peer-reviewed article:

An important result...was the association between higher education/ occupation and greater..FA [fractional anisotropy, an imaging measure of vascular health and WM hyperintensities] ... explained through better systemic vascular health.

Amyloid, Vascular, and Resilience Pathways Associated with Cognitive Aging. So cognitive reserve seems to improve vascular health and vascular health probably maintains a high level of cognitive reserve. Amyloid can still be a factor for those of us with ApoE4, but a recent talk by Dr. Reisa Sperling, a leading researcher who leads AD prevention clinical trials of anti-amyloid AD therapies, included her statement that amyloid beta plaques are not sufficient to trigger tau tangles, requiring maybe vascular injury, inflammation or another factor. And then she added "And some people just have so much darn cognitive reserve that their brains can handle anything!"

Thanks for finding us; we need smart women researchers like you!

[Quantifier]

Thank you all for the warm welcome!