New to board - 3/4

Newcomer introductions, personal anecdotes, caregiver issues, lab results, and n=1 experimentation.
OkieDokie
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New to board - 3/4

Post by OkieDokie »

All,

Just received my 23andme and confirmed 3/4. I had done Ancestry/Promethease years ago and, due to its issue on rs429358 I had never even thought about much other than an apparent risk for hair loss (so far, so good). However, all of that changed in the last 6 months or so when my mother (70) was diagnosed with Alzheimer's... Given that, I took another look at my Ancestry results and quickly realized I was likely 3/4 (or potentially 4/4) based on a crazy few days of researching linkage disequilibrium and various other SNPs.

I had another nice surprise when I loaded my latest results into Promethease and found that I am gs293 (carrying minor alleles for C2/rs1049296 and C282Y/rs1800562) which, per the first couple of lines from snpedia, possibly infers a 37.5x higher AD risk!!! After picking my jaw up off the floor, I read into later studies that indicate perhaps a slightly enhanced risk and then even a couple of others after snpedia's last update in 2017 that use larger populations and apparently do not find these synergistic effects. The 2nd paper even suggests a protective effect from C282Y for APOE4 carriers (which seems odd):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206870/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5843269/

Apparently I'm a pretty rare bird, though it's not really clear what that means at this point. On the positive side I'm rs5882 GG which apparently can be good or irrelevant depending on which paper you read. Anecdotally my mother must carry at least one G and it unfortunately did not provide her much clear benefit.

I'm 41 (male), exercise regularly (both cardio and strength), and so far at least have decent lipid panels though slightly elevated LDL. I had a screening 2 weeks ago that showed my LDL a bit higher than it typically runs (~100):

LDL - 116
HDL - 77
TRIGLYCERIDES - 46
VLDL - 9
GLUCOSE - 90
H1C - 5.5

Pretty sure that's my first H1C I've seen, and from what I'm reading that one (along with LDL) needs some work.

I'm here to keep up with the latest information for both my mother and for prevention for both me and my brother. I'm a supplement junkie but curious to read into what Dr. Bredesen and others are saying... At this point I am honestly glad I know my status as it will help keep me motivated on a healthy lifestyle. Not knowing after my mother's diagnosis was simply not an option...

My current dilemma is whether or not to have my mother do 23andme. My brother has not done the test (it's not clear he will), and if she's 4/4 obviously that means he also carries a copy. I honestly want to know as much as possible as, at least in my mind, her diagnosis was at a relatively young age and has robbed her of many years...


Thanks,

-OD
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Re: New to board - 3/4

Post by circular »

Hi OkieDokie,

There may be some odd glitch about my situation yet to be discovered, but Promethease is no longer on my go-to list for reliable data when it comes to my own SNP results. Here's the thread where I point out some problems with it.

You have an alternative though. Are you aware that you can browse your raw data at 23andMe, at least for the SNPs they tested? Sign in, click the down arrow to the right of your name in the upper right corner, then select Browse Raw Data.

There are a lot of redundancies in our genomes—and the number of genes that they are finding affect AD risk seems to just keep growing and growing—so I try not to get too bent out of shape over a handful of results good or bad, because there is so much about my genome and its expression that I don't know, with some genes' effects canceling out others … if I understand it right.

Also, I find that for other SNPs with large known effects on cognition there is a lot less if any clear advice for managing their potential downsides than there is for ApoE4, so I've found it best for me not to give them too much thought, or it just produces anxiety, which is counterproductive to trying to prevent or delay AD. YMMV. It would be interesting to have a list of non-ApoE4 genes that are known to significantly raise risk for AD that also have some science to guide us on how to deal with them.

That said, the SNPs with known large effects, such as ApoE4, still get some of my attention. I also keep a chart of my and my parents' AD related SNPs looking for the standouts so I can watch where the research goes on those. I can't keep up with the GWAS though. (Darn, I just realized I worked up that chart using Promethease rather than 23andMe data, so I need to look up all the SNPs again.)
ApoE 3/4 > Thanks in advance for any responses made to my posts.
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Re: New to board - 3/4

Post by nerdymel23 »

OkieDokie wrote: I'm here to keep up with the latest information for both my mother and for prevention for both me and my brother. I'm a supplement junkie but curious to read into what Dr. Bredesen and others are saying... At this point I am honestly glad I know my status as it will help keep me motivated on a healthy lifestyle. Not knowing after my mother's diagnosis was simply not an option...

My current dilemma is whether or not to have my mother do 23andme. My brother has not done the test (it's not clear he will), and if she's 4/4 obviously that means he also carries a copy. I honestly want to know as much as possible as, at least in my mind, her diagnosis was at a relatively young age and has robbed her of many years...
Hi OkieDokie!

Thanks for sharing and welcome to the forum!

I'm glad you are invested in a healthy lifestyle because as you may have already noticed with the forum members, our genetics are not our destiny! I find it fun to optimize/biohack myself and by knowing my genetics, I feel like I'm giving myself an upgrade. I did find it exciting to know as much genetic details as could on myself and even my family members. As much as they would allow. ;) My parents had me take their raw data from 23andme and I ran it through Strategene. Very insightful for me to see who had what. My mom and I are both 3/4. I also started out with more supplements but have replaced some just through food.

You mentioned Dr. Bredesen, is that the protocol you are currently following for your information?

If you haven't already seen it, we do have the comprehensive Wiki page with lots of topics to explore. You can find more details on the Bredsen Protocol in there as well.

Enjoy exploring the forum and let us know if you need help finding more resources.

- Melissa
Last edited by nerdymel23 on Fri Jul 02, 2021 7:12 pm, edited 1 time in total.
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Re: New to board - 3/4

Post by OkieDokie »

Thanks to both of you! I have had some issues with Promethease in the past, and often refer back to the raw data I've exported. I had not played much with the 23andme raw data browser but will give it a shot. For what it's worth, 23andme refers to my single APOE4 status as "slightly increased" risk of Alzheimer's. I think that description is debatable, but either way loading the 23andme results into Promethease definitely gave me an unneeded scare there yesterday. The fact that I was able to find articles suggesting synergies and then more recent articles suggesting that polymorphisms in the iron-related alleles may infer some level of protection (regardless of APOE status) was pretty surprising and made it clear that you can get lost in reading these various papers, all to no real benefit.

I am not currently following any protocol, really, but I'm curious to learn more. Fitness has always played some sort of role in my life - I've always tried to do some running and weight lifting. However, when I hit 40 I really dedicated myself and, as I'm sure many others have found, once you find your path with exercise suddenly you do start caring more about what you put in your body. I did read Lifespan, by David Sinclair, and found that I was already doing a number of things he recommends - I suspect many of these likely overlap with things that benefit APOE4 carriers such as exercise, getting good sleep, etc. I've purchased "The End of Alzheimer's" but have not yet started it, though it's next on my list!

I do get routine blood work done at least once a year, but it seems like there are a lot more tests to consider - I didn't even know about LDL-p before reading this board. To date in life I've only had standard lipid panels and comprehensive metabolic panels, but no others that I can recall. If anyone has any recommendations it would certainly be helpful! Given my C282Y HFE status I was considering a test for TIBC, Ferritin, and Transferrin just to make sure everything there is in normal range...
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Re: New to board - 3/4

Post by JD2020 »

OkieDokie wrote:All,
However, all of that changed in the last 6 months or so when my mother (70) was diagnosed with Alzheimer's...
Your mom is young. You and I might have time to orient to the protocol as we attempt prevention, but she does not. If you read the books and read the threads here, you will find specific suggestions that you can implement, like meditation, brainHQ. But most of this protocol is not some separate small activity, where you can check off a box. It is a comprehensive program. It involves a lot of testing in order to find out what is causing the disease. The disease is not just about being 3/4 or 4/4. We find out what is wrong, and start working on that. It is about finding out our specific vulnerabilities and then figuring out how to balance those out.

I live a healthy lifestyle and was really surprised at the doctor's instructions. My exercise wasn't good enough. I had to add HIIT. How could my gut health be so mediocre? I eat a lot of veggies. It turns out that not eating some raw veggies every day is not ok. I tested high in mold, which set off a search for the mold exposure. Found it, remediated, at the cost of $2k, and that was for a small, contained exposure. This thing is a full time job, and I have dialed back certain work commitments so that I can do it, as imperfectly as I do. Which brings me to the part I don't do - the keto thing. I tried for a year, and by the end of the year, I was only doing it for 2 days a week and then eating more than is comfortable for the other days, trying to maintain weight. Forget it, I am tired of obsessing about food! But if I develop cognitive issues, then I am all in 100% and will just become so skinny that I will disappear into a glass of water.

My point: it is not enough to just have a generally healthy lifestyle. There is a lot of work to be done, and if you want to help your mom, the starting point is getting her with a doc trained in this protocol. She is young, perhaps she is not too frail, and perhaps she can change the trajectory of this disease.
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Re: New to board - 3/4

Post by NF52 »

OkieDokie wrote:...

My current dilemma is whether or not to have my mother do 23andme. My brother has not done the test (it's not clear he will), and if she's 4/4 obviously that means he also carries a copy. I honestly want to know as much as possible as, at least in my mind, her diagnosis was at a relatively young age and has robbed her of many years..
-OD
A warm welcome and virtual hug, OkieDokie, from someone who is only a year younger than your mom, and who does have ApoE 4/4 and also has three healthy adult kids who are each ApoE 3/4. You've gotten some great advice already, so I'm only going to comment on your last question (and maybe a few tiny suggestions for testing!).

You don't mention what stage of Alzheimer's disease your mom was diagnosed as having, so it might be helpful if you can, to see if she was given information about that. Assuming that she is in the early (mild) stages, I encourage you to think about her as still having many years to live a life with meaning and joy. I have worked with people with early-stage (mild) AD on several projects and aside from needing modifications for tech (don't we all at age 70!) and memory cues, they were wonderful speakers and contributors to groups. That's not true of everyone at this stage, in part because like a traumatic brain injury, AD affects people differently depending. But I encourage you to view your mother as a "person with a progressive disease .." (as you might if you knew she had Parkinson's, which can also cause dementia) rather than as "having dementia".

In thinking that way, it may help to view the decision about 23&me testing as her decision, based on how she would use the information. Would she want to know that being 4/4 means her other son might come to know of his risk? [My three siblings may not have a single copy of ApoE 4 if both of my deceased parents were ApoE 3/4. At least one sister has decided she doesn't want to know her status, even though she biohacks herself carefully.]

I would also encourage you to read Atul Gawande's Being Mortal. My 37 year old daughter read it after two of her friends had dads diagnosed with AD at age 68, and one was encouraged by his doctor to take his whole family on that trip to his native country that they had put off for decades. The dr. emphasized that he would likely have slow decline and should put his values and preferences first.

I'd also encourage you to talk with your mom about seeing an elder care attorney with you or another trusted relative or friend to be sure that her values and preferences for health care proxy and durable power of attorney and even who gets great Uncle Ezra's chifforobe are known and put in writing. It's amazing how doing that can be a time of shared fond memories and not a sad task.

Last quick suggestion. Remember that your mom experienced an almost complete loss of estrogen in mid-life, which we know is correlated with marked changes in brain metabolism. You don't have that risk. What you should focus on is keeping up the great work you're doing, maybe check your B-12 and Vitamin D levels, and at 45, start getting colonoscopies (think about your family history and look at the new recommendations on that) and a coronary calcium scan of your arteries (again, think family history and keeping your brain happy!)

Hugs from another mom--I bet I'd love knowing your mom.

NF52
4/4 and still an optimist!
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Re: New to board - 3/4

Post by OkieDokie »

Thanks for the kind words, NF52. Unfortunately, the last 6 months have been difficult for us. We had noticed my mom repeating questions a couple of years ago but whether it was just plain ignorance ("oh, she's just getting older") or perhaps some level of denial, but around last Christmas there was a real step change in her short-term memory. My father took her to a neurologist around that time and she had been undergoing all sorts of tests, but when my brother and I - who live in different states - came to visit a few months ago my father (who was 80 and sharp as a tack) suddenly and coincidentally fell ill as we flew to see them from something seemingly random and out of the blue. Without his presence in their home her progression became extremely evident. My dad was the most active person I've ever met and generally did most of planning, communicating, taking care of finances, basically everything - and unfortunately he passed away 2 months ago from his illness, about 4 days after her official diagnosis. I could probably write a book about everything that transpired during those few months as the timing, coincidences, just everything was pretty unbelievable and still is.

We've moved my mom closer to me in TX. Her neurologist in her home state had identified some stenosis in her carotid arteries (50%+ in one side) and noticed a small, recent stroke on her last MRI, but his opinion is that it is Alzheimer's. There's a lot more to the story, but we are switching her to local doctors and will see what their opinions are. We weren't told an official stage but I would assume middle stages as her short-term memory is highly impacted at this point. We do have everything set up from a legal standpoint which has helped immensely during all of this.

That's a lot of backstory, I know, but the dilemma on the 23andme testing is that it feels a bit more selfish on my part. My mom would be fine with it (she's very agreeable and generally very happy) but I do not think I would be able to really explain the significance of the results to her. I think I'm going to go ahead with it, though.

At this point mom is on what I would assume is the typical medications (including donepezil). Over the past several weeks I have also started giving her choline (based on some recent articles) as well as melatonin as she was having trouble sleeping. This is all still very new to us, and a lot of focus was on dad during his stay in the hospital, but now we are just trying to catch up and learn what we can.

BTW, I really like your "still an optimist"! I'm often accused of being an optimist about everything and look at my own APOE4 finding as more of a motivator than anything that will bring me down... Knowledge truly is power, and I'm glad I found this forum.

JD2020 - thanks for your comments as well. I need to learn more about these protocols (and the locally trained docs) to see what can possibly be done for her. She was always fairly active with brain games like Sudoku and such, but fitness and diet were certainly not a focus. Any major lifestyle changes will be difficult to implement for her but we literally have nothing to lose...
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Re: New to board - 3/4

Post by nerdymel23 »

OkieDokie wrote:Thanks for the kind words, NF52. Unfortunately, the last 6 months have been difficult for us. We had noticed my mom repeating questions a couple of years ago but whether it was just plain ignorance ("oh, she's just getting older") or perhaps some level of denial, but around last Christmas there was a real step change in her short-term memory. My father took her to a neurologist around that time and she had been undergoing all sorts of tests, but when my brother and I - who live in different states - came to visit a few months ago my father (who was 80 and sharp as a tack) suddenly and coincidentally fell ill as we flew to see them from something seemingly random and out of the blue. Without his presence in their home her progression became extremely evident. My dad was the most active person I've ever met and generally did most of planning, communicating, taking care of finances, basically everything - and unfortunately he passed away 2 months ago from his illness, about 4 days after her official diagnosis. I could probably write a book about everything that transpired during those few months as the timing, coincidences, just everything was pretty unbelievable and still is.

We've moved my mom closer to me in TX. Her neurologist in her home state had identified some stenosis in her carotid arteries (50%+ in one side) and noticed a small, recent stroke on her last MRI, but his opinion is that it is Alzheimer's. There's a lot more to the story, but we are switching her to local doctors and will see what their opinions are. We weren't told an official stage but I would assume middle stages as her short-term memory is highly impacted at this point. We do have everything set up from a legal standpoint which has helped immensely during all of this.
So sorry to hear about the loss of your father. That is extremely difficult for your entire family. I'm really glad you are getting another opinion on your mom's health with another health professional nearby and happy to know she is living close. That reading on her MRI requires more investigation. Lifestyle changes may be difficult to try, but if she is open, it's worth a try. Use that optimism to embrace those changes with joy.

Your post hits home with me so much. My dad has been declining since last year with something autoimmune and no answers. He is very sharp and handles all the planning and household things too. My mom a 3/4 doesn't want to to admit her repeating and forgetfulness, it's hard for me not to be concerned. She does some lifestyle changes. At least we worked to get her A1C and inflammation markers down.

As a side note, as you explore and respond in the forum, you can use the Quote Feature to make sure members get the alert that you responded to their post in case they have not subscribed to the thread.

I hope you get a chance to spend a relaxing weekend with the family for the holiday!
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Re: New to board - 3/4

Post by OkieDokie »

nerdymel23 wrote: So sorry to hear about the loss of your father. That is extremely difficult for your entire family. I'm really glad you are getting another opinion on your mom's health with another health professional nearby and happy to know she is living close. That reading on her MRI requires more investigation. Lifestyle changes may be difficult to try, but if she is open, it's worth a try. Use that optimism to embrace those changes with joy.

Your post hits home with me so much. My dad has been declining since last year with something autoimmune and no answers. He is very sharp and handles all the planning and household things too. My mom a 3/4 doesn't want to to admit her repeating and forgetfulness, it's hard for me not to be concerned. She does some lifestyle changes. At least we worked to get her A1C and inflammation markers down.

As a side note, as you explore and respond in the forum, you can use the Quote Feature to make sure members get the alert that you responded to their post in case they have not subscribed to the thread.

I hope you get a chance to spend a relaxing weekend with the family for the holiday!
Hi nerdymel23, thanks for the welcome - yes, it has been very difficult, especially with this double whammy of sorts. We were actually traveling to visit my folks about longer term planning (because of my mom) when my dad fell ill. My dad was 80, but honestly in such good health and spirits we never saw this coming. I've come to realize that, up until this point, we have just been very fortunate in life...

I'm sorry to hear about your father as well. I wish him and your family strength during all of this... While your mom may want to avoid the issue (for now), at least it sounds like you are on top of things and in a good position to do what you can for her and your father. My mom at times realizes there is an issue, but I do not believe she would be able to comprehend it long-term at this point. I will definitely pursue other opinions! Mom's first appointment here is in 3 days so I am happy I will be able to start going to them with her...
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Re: New to board - 3/4

Post by NF52 »

OkieDokie wrote:...We've moved my mom closer to me in TX. Her neurologist in her home state had identified some stenosis in her carotid arteries (50%+ in one side) and noticed a small, recent stroke on her last MRI, but his opinion is that it is Alzheimer's. There's a lot more to the story, but we are switching her to local doctors and will see what their opinions are. We weren't told an official stage but I would assume middle stages as her short-term memory is highly impacted at this point. We do have everything set up from a legal standpoint which has helped immensely during all of this.

That's a lot of backstory, I know, but the dilemma on the 23andme testing is that it feels a bit more selfish on my part. My mom would be fine with it (she's very agreeable and generally very happy) but I do not think I would be able to really explain the significance of the results to her. I think I'm going to go ahead with it, though.

At this point mom is on what I would assume is the typical medications (including donepezil). Over the past several weeks I have also started giving her choline (based on some recent articles) as well as melatonin as she was having trouble sleeping. This is all still very new to us, and a lot of focus was on dad during his stay in the hospital, but now we are just trying to catch up and learn what we can.
J...
Hi again, "J",

Your backstory isn't one word too long. Take it from someone who regularly has long posts--we value your willingness to share your story! I'm so sorry that you've had such deep losses and tough decisions recently. My dad died at age 67 of cardiac arrest, 8 months after quadruple bypass surgery and the same day his cardiac rehab nurse told him he was "perfect". Nothing prepares us for that unwanted loss of a great parent. I wish you comforting memories of him and eventual peace knowing that he is not suffering and would be incredibly proud of how you're helping your mother.

Not to play neurologist, but cardiovascular disease is a major contributing risk factor for people with ApoE4 (as my dad discovered too late.) Your mother's diagnosis of Alzheimer's may be the primary diagnosis, with typical clinical symptoms (seen in observation and testing) of memory and daily living skills impairments, rather than a "typical" post-stroke focal (isolated) difficulty with right or left-sided movements or speech. I've seen presentations and talked with researchers in the field who say that the majority of "Alzheimer's" cases in people over the age of 65 who have ApoE 4 include vascular disease also, with history of hypertension, strokes, carotid artery stenosis, coronary artery disease and white matter hyperintensities on an MRI. Studies of cognitively healthy people with ApoE4 show that many tend to have a more permeable blood-brain barrier starting at about age 60 and that pre-symptomatic vascular disease may need to be more carefully monitored and managed in this population.

Hope you don't mind my sharing excerpts from a two very recent studies--both of which may lead you to ask your mother's new doctor for a referral to a cardiologist in addition to a neurologist. You may not even need a cardiologist referral; I've been able to get referrals for both a coronary artery scan and an IMT ultrasound of my carotid arteries from my PCP, based on my 4/4 status and my dad's history. Medicare doesn't cover them, but the cost of each was about $ 150--and the info seems well worth it to me!

This is from April 17, 2021 in the Journal of the American Heart Association. [An explanation of "intimal-media. thickness" and why it's tested is here from Cedars-Sinai Hospital: https://www.cedars-sinai.org/programs/h ... -test.html]

Association of Carotid Intima‐Media Thickness and Other Carotid Ultrasound Features With Incident Dementia in the ARIC‐NCS [Bolded emphasis added by me.]
Abstract Background
Increased carotid intima‐media thickness, interadventitial diameter, presence of carotid plaque, and lower distensibility are predictors for cardiovascular disease. These indices likely relate to cerebrovascular disease, and thus may constitute a form of vascular contributions to dementia and Alzheimer disease–related dementia. Therefore, we assessed the relationship of carotid measurements and arterial stiffness with incident dementia in the ARIC (Atherosclerosis Risk in Communities) study.

Methods and Results
A total of 12,459 ARIC participants with carotid arterial ultrasounds in 1990 to 1992 were followed through 2017 for dementia...Participants were aged 57±6 at baseline, 57% were women, and 23% were Black individuals... After multivariable adjustments, the highest quintile of carotid intima‐media thickness and interadventitial diameter in midlife was associated with increased risk of dementia (HR [95% CIs], 1.25 [1.08–1.45]; and 1.22 [1.04–1.43], respectively) compared with its respective lowest quintile. Presence of carotid plaque did not have a significant association with dementia ..
Conclusions
...Elevated cIMT represents not only increased intimal thickening but also medial hypertrophy, which is a result of long‐standing hypertension..[with] increases in cIMT beginning before overt hypertension...Regardless of whether the associations we observed between carotid markers and dementia are causal, cIMT and IAD were early markers of dementia risk, and our findings highlight the potential for optimal control of hypertension and other modifiable vascular risk factors in midlife to decrease dementia risk.
And this is from a pre-print abstract of the August 2021 Journal of Stroke and Cerebrovascular Disease about a multi-center study that found that only about 1/3 of patients with asymptomatic carotid artery disease were being prescribed the multiple medication regimen recommended by evidence-based guidelines:
Non-Adherence to Antihypertensive Guidelines in Patients with Asymptomatic Carotid Stenosis
Importance
Hypertension and carotid stenosis are both risk factors for stroke, but the presence of carotid stenosis might dampen enthusiasm for tight control of hypertension because of concerns for hypoperfusion.

Objective To determine the extent to which there are opportunities to potentially improve pharmacotherapy for hypertension in patients known to have asymptomatic high-grade carotid stenosis.

Setting The Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST-2) is a multicenter prospective randomized open blinded end-point clinical trial of intensive medical management ... for asymptomatic high-grade carotid stenosis. Of 1458 participants with complete data, 26% were on one, 31% on 2, and 43% on ≥3 antihypertensive medications at trial entry. Thirty-two percent of participants were prescribed thiazide; 74%, angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB); 38%, calcium channel blocker (CCB); 56%, a beta blocker; 11%, loop diuretic; and 27%, other. Of those prescribed a single antihypertensive medication, the proportion prescribed thiazide was 5%; ACEI or ARB, 55%, and CCB, 11%. The prevalence of guideline-adherent regimens was 34% (95% CI, 31-36%).

Participants: 1479 participants (38.6% female; mean age 69.8 years) from 132 clinical centers enrolled in the CREST-2 trial as of April 6, 2020 who were taking ≥1 antihypertensive drug at baseline.

Conclusions and relevance
In a diverse cohort with severe carotid disease and hypertension, non-adherence to hypertension guidelines was common. All preferred classes of antihypertensive drug were under-prescribed. ...
Final suggestion: The Primer: Biomarkers is an excellent resource on which blood tests and measurements to prioritize, written by a Board member of Apoe4.info who is herself ApOE 4/4 and a practicing physician. Many of the tests she recommends (B-12, Vitamin D, ferritin, HbAiC, fasting insulin, CRP (C-reactive protein, a measure of systemic inflammation), thyroid, etc. would probably be covered by your mother's Medicare or Medicare Advantage/Supplement program. If not, they are easily able to be ordered in Direct to Consumer Lab Testing Options with the lab work done at a local lab and results sent by email to you within a few days.

Your mother's happy demeanor and ability to move to be near you after the loss of her husband suggests the source for your own optimism. Apoe4 isn't the only thing our parents have gifted to us !
4/4 and still an optimist!
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