A type of drug called antipsychotics may be prescribed to treat severe hallucinations, aggression and agitation in people living with dementia. However, research has shown that antipsychotics are associated with an increased risk of stroke and death in individuals with dementia.54-55 The decision to use antipsychotics to treat individuals living with dementia must be considered with extreme caution. The potential dangers of using antipsychotic drugs to treat behavioral and psychiatric symptoms of dementia are so severe that the FDA requires manufacturers to label the drugs with a “black box warning” explaining the drug’s serious safety risks. Only one drug, suvorexant, has been specifically approved by the FDA to treat a behavioral or psychiatric symptom of Alzheimer’s disease. This drug treats problems with falling asleep and staying asleep that can arise in Alzheimer’s. It does this by blocking chemicals that cause wakefulness. Unlike the other drugs, suvorexant is prescribed for a wide range of individuals with sleeping problems, not just those with Alzheimer’s. The Lancet Commission 2020 report56 on dementia prevention, intervention and care recommends care that addresses physical and mental health, social care, support, and management of neuropsychiatric symptoms, noting that multicomponent interventions are the treatments of choice to decrease neuropsychiatric symptoms. 4.5 2.4 e2/e2 0.7 0.2 *Percentages do not total 100 due to rounding. Created from data from Rajan et al.84 Percentage of African Americans and European Americans with Specified APOE Pairs table Active Management of Dementia Due to Alzheimer’s Disease Studies have consistently shown that proactive management of Alzheimer’s and other dementias can improve the quality of life of affected individuals and their caregivers.57-59 Proactive management includes: • Appropriate use of available treatment options. • Effective management of coexisting conditions. • Providing family caregivers with effective training in managing the day-to-day life of the care recipient. • Coordination of care among physicians, other health care professionals and lay caregivers. • Participation in activities that are meaningful to the individual with dementia and bring purpose to their life. • Maintaining a sense of self identity and relationships with others. • Having opportunities to connect with others living with dementia; support groups and supportive services are examples of such opportunities. • Becoming educated about the disease. • Planning for the future. To learn more about Alzheimer’s disease, as well as practical information for living with Alzheimer’s and being a caregiver, visit alz.org. Risk Factors for Alzheimer’s The vast majority of people who develop Alzheimer’s dementia are age 65 or older. This is called late-onset Alzheimer’s. Experts believe that Alzheimer’s, like other common chronic diseases, develops as a result of multiple factors rather than a single cause. Exceptions are cases of Alzheimer’s related to uncommon genetic changes that greatly increase risk. Age, Genetics and Family History The greatest risk factors for late-onset Alzheimer’s are older age,60-61 genetics62-63 — especially the e4 form of the apolipoprotein E (APOE) gene — and having a family history of Alzheimer’s.64-67 Age Age is the greatest of these three risk factors. The percentage of people with Alzheimer’s dementia increases dramatically with age: 5.0% of people age 65 to 74, 13.1% of people age 75 to 84 and 33.2% of people age 85 or older have Alzheimer’s dementia (see Prevalence section, page 18). The aging of the babyboom generation will significantly increase the number of people in the United States with Alzheimer’s.68 However, it is important to note that Alzheimer’s dementia is not a normal part of aging,69 and older age alone is not sufficient to cause Alzheimer’s dementia. Genetics Researchers have found several genes that increase the risk of Alzheimer’s. Of these, APOE-e4 has the strongest impact on risk of late-onset Alzheimer’s. APOE provides the blueprint for a protein that transports cholesterol in the bloodstream. Everyone inherits one of three forms (alleles) of the APOE gene — e2, e3 or e4 — from each parent, resulting in six possible APOE pairs: e2/e2, e2/e3, e2/e4, e3/e3, e3/e4 and e4/e4. Having the e4 form of APOE increases one’s risk of developing Alzheimer’s compared with having the e3 form but does not guarantee that an individual will develop Alzheimer’s. Having the e2 form may decrease one’s risk compared with having the e3 form. The e3 allele is thought to have a neutral effect on Alzheimer’s risk. Those who inherit one copy of the e4 form have about three times the risk of developing Alzheimer’s compared with those with two copies of the e3 form, while those who inherit two copies of the e4 form have an eight- to 12-fold risk.70-72 In addition, those with the e4 form are more likely to have beta-amyloid accumulation and Alzheimer’s dementia at a younger age than those with the e2 or e3 forms of the APOE gene.73-74 A meta-analysis including 20 published articles describing the frequency of the e4 form among people in the United States who had been diagnosed with Alzheimer’s found that 56% had one copy of the APOE-e4 gene, and 11% had two copies of the APOE-e4 gene.75 Another study found that among 1,770 diagnosed