Quick Guide

• Blood Pressure < 120/80
• LDL < 100 and ideally < 70
• HBA1C < 5.6% and ideally < 5.4%

• Sleep at the same time every night
• Sleep 7-9 hours each night
• Treat sleep apnea if you have or suspect it

• Protect your head from injury
• Minimize illness frequency, particularly Covid-19 as it is so contagious and impactful
• Get vaccinated for covid, flu, and shingles
• Limit activities that cause brain injury (e.g., hard boxing sparring) if you can
• Limit time spent in areas with high air pollution, such as next to a freeway or busy intersection. Use an air filter if you can't

• Get at least 150 minutes of moderate-intensity exercise per week
• Include both aerobic and strength training exercises
• Try to walk or engage in other physical activity shortly after eating

• Lots of leafy vegetables, berries, seafood, nuts, and olive oil
• Little sugar, fried foods, and saturated fat from animals

• Protect your hearing from loud noises
• Get regular hearing and vision checkups
• Use aids if needed
• Get cataract surgery if needed

• Quit smoking or reduce tobacco use
• Limit alcohol intake to moderate levels
• Be aware of long-term anticholinergic medication use. Research suggests that cumulative use of anticholinergic drugs is associated with higher dementia risk later in life. Ask your doctor or pharmacist to review your medications for anticholinergic burden, especially if you take them regularly.

• Engage in activities that challenge your brain, such as learning new skills
• Maintain social connections and participate in group activities

More Information

• Website: https://apoe4plan.com/
• Android: https://play.google.com/store/apps/details?id=com.suarasolutions.apoe4plan

Clinical Evidence

• LDL levels in midlife are modestly associated with dementia rates in later life and should be kept low. (Source)
• People with genes for low cholesterol have lower dementia rates. (Source)
• LDL below 70 is correlated with a >25% lower rate of dementia and Alzheimer's when compared with LDL above 130. (Source)
• Higher LDL levels lower longevity due to increased Alzheimer's rates. (Source)
• APOE4 carriers have higher cholesterol levels; statins are more effective for Alzheimer's mitigation in this population. (Source)
• Statin use while young is associated with lower dementia and Alzheimer's rates when old; the longer the usage, the greater the reduction. (Source)
• General statin use is associated with lower dementia and Alzheimer's rates. (Source)
• Ezetimibe use is associated with significantly lower dementia and Alzheimer's rates. (Source)
• Diabetes in midlife is positively associated with higher dementia risk in later life. (Source 1, Source 2)
• The earlier you develop diabetes, the higher your risk for dementia later in life. (Source)
• Diabetes is associated with increased dementia risk, and the effect is larger for APOE4 carriers. (Source)
• APOE4 carriers have poorer blood sugar control, which leads to more brain lesions. (Source)

• COVID significantly increases the rates of moderate and severe cognitive impairment in older adults. (Source)
• COVID causes neuroinflammation; APOE4 carriers get more neuroinflammation from COVID than non-carriers. (Source)
• Long COVID patients have Alzheimer's-like changes to their brains. (Source)
• APOE4 carriers are more likely to develop cognitive impairment from COVID than non-carriers. (Source)
• COVID infection is associated with increased risk of dementia. (Source)
• Patients with MCI are vastly more likely to progress to severe impairment after getting COVID vs. those who didn't. (Source)
• COVID infection leads to generation of more amyloid plaques. (Source)
• COVID causes brain damage equivalent to years of aging. (Source)

• Resistance exercise improves memory retention and slows loss of brain volume in people with MCI. (Source 1, Source 2)
• A moderate amount of daily walking delayed dementia onset by years. (Source)
• Exercise during midlife significantly lowered dementia risk in late life. (Source)
• Alzheimer's markers in the brain are reduced with exercise; more exercise yields more reduction. (Source)
• Exercise lowers dementia risk in everyone; it is more effective for APOE4 carriers, and the benefit scales with amount and intensity. (Source 1, Source 2)
• Long-term exercise improves waste clearance in the brain. (Source)
• Dementia risk reduction scales directly with the amount of exercise performed. (Source)
• Exercise increases brain-derived neurotrophic factor (BDNF), which protects neurons and encourages growth. (Source)
• Walking for 10-15 minutes immediately after eating reduces blood glucose spikes more effectively than walking later. (Source 1, Source 2)

• Adherence to the Mediterranean diet is associated with lower dementia risk; the effect is larger in APOE4 carriers and scales with adherence. (Source)
• Adherence to the MIND diet is associated with lower dementia risk. (Source 1, Source 2)
• High consumption of ultra-processed foods is associated with a higher dementia risk. (Source)
• Replacing a small % of ultra-processed foods with quality foods significantly reduced dementia risk. (Source)
• Consumption of saturated fats is associated with faster cognitive decline in APOE4 carriers. (Source)
• Blood levels of Omega-3 are negatively associated with dementia risk 10 years later. (Source)
• Omega-3 supplementation resulted in fewer brain lesions in APOE4 carriers over a 3-year period. (Source)
• High Omega-3 and key B vitamin levels slowed brain atrophy. (Source)
• Omega-3 intake and long-term supplement use are associated with reduced rates of dementia. (Source 1, Source 2)
• Omega-3 supplementation for APOE4 carriers might help if started pre-dementia. (Source)
• Higher intake of flavonols (berries/plants) is associated with a lower risk of developing Alzheimer's. (Source)
• Adherence to preventative diets like DASH or Ketoflex improved cognitive scores and lowered risk. (Source 1, Source 2)
• Higher folate intake is associated with reduced dementia risk. (Source)

• Sleep apnea is associated with developing dementia, but the risk goes away or is reduced with CPAP usage. (Source 1, Source 2)
• Poor sleep increases risk of Alzheimer's in everyone, particularly for APOE4 carriers. (Source)
• Poor sleep accelerates brain aging. (Source)
• A drop in deep sleep is associated with increased dementia risk. (Source)
• Getting under 6 hours of sleep/night in midlife significantly increases dementia rates in later life. (Source)

• Even slight hearing loss in midlife is associated with much higher dementia rates; the effect is larger for APOE4 carriers. (Source)
• Dementia risk increases with the severity of untreated hearing loss. (Source)
• Untreated hearing loss leads to higher dementia rates than treated hearing loss. (Source)
• Vision loss and untreated cataracts are associated with increased dementia risk; surgery lowers this risk. (Source 1, Source 2)
• The most social people developed Alzheimer's several years later than the least social ones. (Source)
• Social isolation predicts cognitive decline. (Source)
• Bilingualism and using digital devices for engagement are associated with better cognitive function. (Source 1, Source 2)

• A single head injury changes levels of biomarkers for dementia for years. (Source)
• Brain injuries in early life increase risk of cognitive issues later; risk increases with the number of injuries. (Source 1, Source 2)
• Flu and shingles vaccines are associated with significantly lower dementia rates. (Source 1, Source 2, Source 3, Source 4, Source 5)

• Stopping smoking early lowers risk; APOE4 carriers are harmed more by smoking and early-life smoke exposure. (Source 1, Source 2)
• Heavy alcohol consumption and alcohol use disorder are strong predictors of dementia risk. (Source 1, Source 2, Source 3)
• Cumulative use of anticholinergic drugs is associated with higher dementia risk; avoidance is advised. (Source 1, Source 2, Source 3)
• Gum disease severity and chronic oral diseases are predictive of dementia and Alzheimer's risk. (Source 1, Source 2, Source 3)
• Using a sauna several times a week is associated with reduced Alzheimer's rates. (Source)
• GLP-1 medications (like Semaglutide) show neuroprotective potential and lower dementia likelihood. (Source 1, Source 2)
• Air pollution exposure increases dementia risk, especially for APOE4 carriers; reducing exposure lowers risk. (Source 1, Source 2, Source 3, Source 4)