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Lifestyle Choices & Alzheimer's Disease: Susceptibility, Not Inevitability

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Knowledge isn't just power -- it can also mean the difference between debilitating stress and the equanimity that nurtures health. Through the experience of producing a documentary film series, The Alzheimer's Project, I lost my fear of developing the disease.

This was not the first time I was confronted with the prospect of facing the realities of Alzheimer's disease. Ten years ago my father, Emanuel Hoffman, died of Alzheimer's at the age of 80. Manny was a newspaper journalist and editor, and his decline into dementia was anguishing. With the sadness of my father's illness came fears about my own future. Would I share his fate? Was his father's senility just another word for the same condition? Not long after Manny's death, an executive at HBO asked if I thought the time was right for a film on Alzheimer's. My gut reaction was to say no. Why would I spend two years immersed in the disease that destroyed my father? But years later, circumstances brought me back to the subject and beginning on May 10, The Alzheimer's Project, a four-part documentary series, will premiere on HBO. The series explores, in great detail, the extent to which science had made advances of which the public was unaware. The more I learned, the less I wanted to hide my head in the sand.

How was it that such advances had escaped me? I read the Science Times avidly, I listen to NPR, I make science films! Yet I believed incorrectly that Alzheimer's disease research was still in its infancy, that the biggest controversy in the field revolved around the risks of cooking in aluminum pots (a long-disproved theory), and that the most I could do to minimize my chance of contracting the disease was to solve crossword puzzles -- which I do anyway.

I now know that I was not alone in my anxiety about developing Alzheimer's. According to a recent study, it's the second most feared illness among the general U.S. population, and the single most feared illness among women. These fears are not baseless. The baby boomers are seeing nearly 50 percent of their parents' generation struggle with Alzheimer's by the time they reach 85 years old, and in 2011 the first boomers will themselves reach retirement age, setting off a precipitous rise in the incidence of the disease, which already affects some five million Americans.

Yet as my colleagues and I sifted through hundreds of research papers and began speaking with more than 200 of the most active American scientists and physicians working on Alzheimer's, my personal qualms about the project subsided. We learned about research being conducted in multiple areas of basic science, drug development, and, to our surprise, lifestyle factors that can mitigate the expression of the disease.

In the course of this project, I discovered that while the general population has a 10 percent chance of developing Alzheimer's disease by age 85, my father's illness increases my risk to 20 percent. Optimist that I am, I interpret this statistic to mean that I have an 80 percent chance of not developing Alzheimer's. I find further comfort in the new term "susceptibility genes" to describe the role genetics plays in personal risk. Late-onset Alzheimer's accounts for 97 percent of cases and is not completely determined by inheritance. Rather, a number of small genetic variations appear to enhance late-onset risk. Susceptibility, not inevitability.

I have also been inspired by the prevailing view that the risk conferred by any single susceptibility gene is modified by the interaction of that gene with the environment. Studies suggest that following a diet low in saturated fats and simple sugars, as well as maintaining normal levels of blood sugar, cholesterol, and blood pressure may delay the onset of Alzheimer's disease or slow its progress. Exciting new research further indicates that aerobic exercise stimulates growth factors in the brain in the very areas initially affected by Alzheimer's disease.

If I had to reduce all the knowledge we gleaned from the scientists to one message, it would be that Alzheimer's is a disease of the entire body. Changes to any one system, such as the ability of insulin to deliver glucose to brain cells, may influence the metabolic pathways involved in Alzheimer's pathology. I'm fortunate that I don't have diabetes, but if I did, I'd be glad to know that there are ways to control the problem. I'm lucky that statins are available to keep my cholesterol in check because, for me, diet and exercise are not sufficient. I've been humbled to learn that my existence is a result of a complex, intricate, and delicately balanced system of metabolic pathways. Will my determination to keep these systems healthy have an impact on my old age? No one can yet be certain, but I find comfort knowing that I'm exerting control wherever I can. The more I learn the less frightening Alzheimer's becomes -- and the more I find myself making lifestyle choices that diminish my risk of contracting the disease.

It is my hope that the public can experience a similar enlightenment, not only by viewing the film, but also by examining our supplemental materials. As part of an overarching educational campaign that accompanies the film series, HBO has published a companion book, The Alzheimer's Project: Momentum in Science. With this, and our other multiplatform initiatives, the Alzheimer's awareness can continue, long after the film premiere.

John Hoffman served as Producer of The Alzheimer's Project, premiering on HBO beginning on May 10.