A systematic review55 found that exercise has a positive effect on overall cognitive function and may slow the rate of cognitive decline in people with Alzheimer’s dementia. • A systematic review56 found that cognitive stimulation had beneficial effects on cognitive function and some aspects of well-being in people with Alzheimer’s dementia. Another systematic review57 reported that cognitive stimulation was associated with improved scores on tests of depression in people with mild-tomoderate Alzheimer’s dementia. A summary of systematic reviews58 reported that cognitive stimulation, music-based therapies and psychological treatment (for example, cognitive behavioral therapy) improved depression, anxiety and quality of life in people with dementia. • A summary of systematic reviews59 of cognitive training for people with mild-to-moderate dementia found cognitive training may show some benefits in overall cognition that may last for at least a few months. The Lancet Commission 2020 report60 on dementia prevention, intervention and care recommends postdiagnostic care for people with dementia that includes physical and mental health, social care, and support; management of neuropsychiatric symptoms, noting that multicomponent interventions are the treatments of choice to decrease neuropsychiatric symptoms; and care for family caregivers, pointing out that specific interventions for family caregivers have long-lasting effects on depression and anxiety symptoms, increase quality of life, are cost-effective and might save money (see Caregiving section, page 35). Active Management of Alzheimer’s Dementia Studies have consistently shown that active management of Alzheimer’s and other dementias can improve the quality of life of affected individuals and their caregivers.61-63 Active 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. Overview 13 • Participation in activities that are meaningful to the individual with dementia and bring purpose to his or her life. • 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 Dementia 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,64-65 genetics66-67 — especially the apolipoprotein e4 gene (APOE-e4) — and having a family history of Alzheimer’s.68-71 Age Age is the greatest of these three risk factors. The percentage of people with Alzheimer’s dementia increases dramatically with age: 5.3% of people age 65 to 74, 13.8% of people age 75 to 84 and 34.6% 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.72 However, it is important to note that Alzheimer’s dementia is not a normal part of aging,73 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. The APOE-e4 gene is the gene with the strongest impact on risk of late-onset Alzheimer’s. APOE-e4 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. Researchers have found differences in the frequency of these pairs in different racial and ethnic groups. For example, data show that a higher percentage of African Americans than European Americans have at least one copy of the e4 allele (see Table 3).74-76 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.