I was recently moderating a support group for families caring for a parent or sibling with Alzheimer’s disease. One of the participants was 60 years old and after some discussion of her mother she turned and asked: “What about me?” She is noticing changes in her memory and concerned as was her 39 year old daughter sitting next to her. She reported no clear memory deficits but was worrying about her future and whether her current memory concerns were normal for her age, a result of the stress of caregiving, or signs that she may one day develop Alzheimer’s disease. I am hearing this question more and more.

Clearly, there is an increased risk for developing Alzheimer’s if someone in your family is diagnosed with the disease. For example, I recall a retired physician who sought evaluation as he was one of seven children and each of his siblings had Alzheimer’s. He was having clear decline in his short-term memory but otherwise doing well cognitively. We put together a proactive plan to protect his future. However, the genetic link is not always this clear. There is no established genetic test for Alzheimer’s disease. Furthermore, the majority of those diagnosed with Alzheimer’s do not have a family history of the disease. To make things even muddier, I once assessed a 65 year old identical twin whose sister was in a skilled nursing home with Alzheimer’s. The well sister had an excellent memory. If it were all genetics, she would be in the bed next to her sister. Despite all of the advances in genetics, the greatest risk factor for developing Alzheimer’s remains age.

The good news is that Alzheimer’s takes at least 15-20 years to unfold. You have lots of time to plan for how to handle possible changes if they occur sometime in the future. This plan needs to be written and included as part of advanced directives. The plan needs to cover anticipated needs and decisions like driving, assisted living, transfer of financial decisions. Additionally, start life style enhancements but realize there are no guarantees. The clearest directive is to exercise; don’t smoke; drink alcohol in moderation; eat a diet that is heavy in fruits, vegetables, vegetable oils, and fish; and stay intellectually and socially engaged.

The other good news is that Alzheimer’s starts with a reduction in short-term memory – the ability to learn and retain new information. These changes progress slowly and begin years before a diagnosis of Alzheimer’s disease can be made. There is so much you can do about your short–term memory if you don’t wait until you forget that you forget. Not everyone with poor short-term memory will develop Alzheimer’s but the risk is considerably higher for those that do. We think nothing of routine medical evaluations for various diseases like diabetes, cancer, hypertension, heart disease, and thyroid disease but we don’t consider having routine memory evaluations (screenings are insensitive to mild changes in memory). There is so much you can do if you know you are vulnerable. If you have a family history of Alzheimer’s, start with a thorough memory evaluation that allows you to plan and be proactive with your memory and life style.