BY DALE BREDESEN, MD

In 2024, a team of Geneticists, neuroscientists, and supercomputing experts from Spain and the United States co-authored a study that sent shockwaves around the world.

They found that nearly seven million Americans and 150 million people globally are homozygous for ApoE4—meaning they carry two copies of the gene variant ApoE4, which significantly increases the risk of Alzheimer’s disease.

The scientists’ sobering conclusion was that virtually all individuals with this genetic profile are almost certain to develop Alzheimer’s—with symptoms typically appearing around the age of sixty-five.

APOE4 and the Hundred-Year Brain

So, is it really possible to achieve a hundred-year brainspan even with this genetic burden?

My patient, cognitive guide star Henry, would say yes.

Like seven million other Americans—and many more worldwide—Henry is homozygous for ApoE4.

Yet, at the time of this writing, he still enjoys excellent cognition and plans to maintain it for years to come. I should add: Henry is one hundred years old.

If he can reach a century with two copies of ApoE4 and preserve a youthful brain, I’m confident the rest of us can too.

But this leads to the question I hear often from patients: If this is really possible—or even probable—why doesn’t everyone know about it?

The answer, as you might guess, comes down to two words: Big Pharma.

The Leqembi Dilemma

Markku Kurkinen, PhD, a professor at the Center for Molecular Medicine and Genetics at Wayne State University, has drawn attention to this issue with his investigation of the FDA-approved Alzheimer’s drug Leqembi (lecanemab).

He observed that although Leqembi reduced amyloid—a key disease marker and long-standing treatment target—the overall results were far from encouraging.

Kurkinen pointed out that the drug did not slow cognitive decline in women, who face twice the Alzheimer’s risk of men.

Nor did it help those at the highest genetic risk—individuals homozygous for ApoE4—in whom the drug was associated with worse outcomes than placebo. Even in other groups, it failed to stop Alzheimer’s and at best modestly slowed its progression.

In 2024, Kurkinen wrote, “These findings make me wonder if the approval of lecanemab was the worst decision the FDA has made to date.” A close second, he quipped, was the agency’s earlier approval of Aduhelm (aducanumab) in 2021—a so-called “blockbuster” drug that launched at an audacious $56,000 per year.

A Smarter Future for Alzheimer’s Care

Here’s the troubling reality: companies behind Leqembi and Aduhelm promote a narrative that leaves patients Cognitive guide stars like Ruth, Shirley, Howard, and Les are not alone.

In 2024, there were approximately 750,000 centenarians worldwide—a number projected to quadruple over believing there’s no hope outside of these drugs.

But studies my colleagues and I have conducted show that’s simply not true.

Still, the mainstream consensus remains that perhaps there’s no harm in hoping for a miracle from a drug that seems to work in some people, sometimes, in some ways, albeit only to forestall the inevitable.

That “desperate times calls for desperate matters” mindset was echoed by the Alzheimer’s Association (whose largest single sponsor for many years happened to be the pharmaceutical company Eisai).

At the Association’s 2023 annual international conference in Amsterdam, attended by about eleven thousand doctors and scientists, a twenty-person panel of peers recommended a radical new way of diagnosing Alzheimer’s disease.

Regardless of whether someone is actually experiencing any symptoms of cognitive decline, the panel suggested that anyone who tests positive for elevated levels of amyloid would be diagnosed with “stage I” Alzheimer’s, thus making them medically eligible to be coerced into taking a prescription—Leqembi, Aduhelm, or the similar Kisunla (donanemab)—despite the fact that there was no evidence these drugs would reduce the risk of dementia among monosymptomatic people.

Following the Money

In the wake of the 2023 conference, Los Angeles Times investigative reporter Melody Petersen, a longtime pharmaceutical industry watchdog, began wondering who on the panel that was making this revolutionary recommendation.

She uncovered that at least seven members were employed by pharmaceutical or medical testing companies, while seven others had received payments from these companies for consulting or research. Four “outside advisors” were executives from Eisai or companies developing similar drugs.

Petersen was also interested in understanding why the panel’s proposal included the National Institute on Aging in its title.

Did the panel have the backing of the US government’s leading center for research on Alzheimer’s disease and other dementias? After she asked, the institute quickly took its name off the panel’s proposal.

To be clear: I am not antidrug. I am pro whatever achieves the best outcomes.

I believe the future of Alzheimer’s care will involve a combination of personalized, precision-medicine protocols and targeted pharmaceuticals.

But to limit treatment options to a single, minimally effective drug with a long list of side effects—while dismissing safe, evidence-based dietary and lifestyle measures—is a decision rooted in income, not outcome.

____________________________________________

Well Being Journal adapted the above excerpt from The Ageless Brain by Dale Bredesen, MD. Copyright © 2025 by Dale Bredesen and reprinted with permission from Flatiron Books.