I Have a Genetic Risk for Alzheimer’s. I Made These 5 Lifestyle Changes to Preserve My Brain Health - TODAY.com

What the report says

TODAY reported on Elena Castellanos, a 57-year-old school enrollment director and mother of three in Miami, who pursued genetic testing after her father’s Alzheimer’s disease and death in 2020. In 2024, she learned she carries two copies of APOE e4, a gene variant associated with elevated Alzheimer’s risk. Castellanos told TODAY the result was frightening because there is no cure, but she has since focused on steps aimed at protecting long-term brain health.

The report cites Dr. Kellyann Niotis, a preventive neurologist at the Institute for Neurodegenerative Diseases who is treating Castellanos, explaining that APOE is involved in cholesterol transport and that the e4 variant is the strongest known genetic risk factor for Alzheimer’s. TODAY reported that about a quarter of people have one APOE e4 copy, while roughly 2% to 3% have two. Niotis said two copies can raise risk substantially, but do not make dementia inevitable.

According to TODAY, Castellanos met with Niotis in March 2025 and is participating in research in the emerging field of preventive neurology. Her monitoring includes lab work, cognitive testing and annual brain imaging, though some tests may be costly and not fully covered by insurance. Niotis also pointed to modifiable dementia risk factors such as exercise, smoking, alcohol use, air pollution and social isolation.

Castellanos’ lifestyle changes include following a Mediterranean-style diet, prioritizing heart health and cholesterol management, adding varied exercise such as resistance training and rowing, improving sleep routines while addressing sleep apnea, and cutting out alcohol. The story frames her experience as an example of how people with known risk factors may work with clinicians on prevention-oriented habits, while emphasizing that genetics alone do not determine an outcome.