Ask the Doctor: Genetics & AD Risk; Insomnia & Depression; Fibromyalgia & Exercise

Q: Two of my close relatives have died of Alzheimer’s disease. Am I at higher risk for the condition because I have family members who had it?

A: The majority of cases of Alzheimer’s disease (AD) appear to be the result of a complex interaction between genetic influences and other risk factors. It is true, however, that individuals with a family history of AD may have a somewhat higher risk for developing the disorder, especially if the relative(s) with AD is a first-degree relative such as a parent or sibling. In a study published online April 17 in the journal PLoS ONE, researchers conducted brain scans and analysed spinal fluid for genetic biomarkers associated with AD in a group of more than 250 healthy adults ages 55 to 89. The researchers found that, in brain scans of participants with no signs of thinking or memory difficulties, those with a family history of AD showed twice the rate of silent brain changes as those without a family history of the disease. Moreover, these changes were occurring along pathways associated with AD. It’s important to remember that having a slightly higher risk for AD doesn’t mean that an individual will necessarily develop the disease. Addressing other risk factors by pursuing a healthy lifestyle with plenty of physical and mental activity, a nourishing, low-calorie diet, and adequate sleep and relaxation, as well as managing medical conditions such as high blood pressure and diabetes that can adversely affect the brain, are concrete steps individuals can take to significantly reduce the likelihood of developing AD.

Q: My 67-year-old brother has been battling insomnia for more than a year now, and I’m concerned that he’s becoming depressed about his inability to sleep, and even suicidal. Is there something that can be done to help him?

A: In depressed individuals, chronic insomnia is associated with double the risk of suicide, according to research published in the February 2013 Journal of Clinical Sleep Medicine. The study found that depressed participants with insomnia were more likely than those without insomnia to experience negative and dysfunctional thoughts about sleep, feel that they could no longer control their sleep, and lose hope that they will ever be able to achieve normal sleep. The suicide/insomnia connection adds to the potential risks of sleeplessness experienced by many older individuals, in whom insomnia is also known to increase the risk for memory difficulties, low mood, problems with attention, habituation to sleep medications, falls, and other problems. I would advise that your brother contact his medical care provider for a thorough examination to rule out medical conditions that might be causing his sleeplessness, and for help in finding an effective treatment for his sleep problems.

Q: I have fibromyalgia, and deal with constant fatigue, depression, and considerable pain in my joints. I have heard that exercise may help reduce my symptoms. Won’t exercise make my joint pain worse?

A: Research suggests that regular, long-term exercise—building up gradually from short, 10-minute sessions to about four days per week of 30-minute sessions of moderate exercise that achieves 60 percent of maximum heart rate—may help reduce fibromyalgia symptoms without pain. A study of 170 people with fibromyalgia found that participants who worked up to that level of exercise and sustained it for about nine months reported reduced physical impairment and greater well-being. According to a report on the study published online in the Feb. 11, 2013 issue of Arthritis Care and Research, participants reported that engaging in any increase in physical activity—even if it was not sustained—resulted in positive effects on symptoms and no increase in pain. Recommended exercise forms for people with fibromyalgia include walking, swimming, water aerobics, and biking.

—Editor-in-Chief Maurizo Fava, MD

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