Alzheimer’s disease often begins decades before memory loss becomes noticeable, and researchers increasingly understand that the choices people make in midlife may shape cognitive health later in life.
That growing understanding comes at a critical time. Approximately 7.4 million Americans age 65 and older are living with Alzheimer’s disease, a number expected to nearly double over the next 25 years. Across The University of Texas at San Antonio (UT San Antonio) and UT Health San Antonio, its academic health center and health system, researchers and clinicians are bringing together expertise in the sciences, engineering and technology, biomedical research, population health and patient care to better understand what protects brain health across a lifetime and translate discovery into better prevention, diagnosis and care.
“In South Texas, we face some of the highest rates of Alzheimer’s and dementia in the nation, yet we also stand at the forefront of discovery and progress,” said Francisco Cigarroa, MD, Senior Executive President for Health Affairs and Health System. “We strive to transform groundbreaking research into prevention, scientific understanding into compassionate care, and knowledge into hope for the patients and families we serve.”
UT San Antonio brings together expertise across brain science, aging, neurodegenerative disease and patient care to advance understanding of the brain and translate discovery into better prevention, earlier diagnosis and more effective treatments. The Brain Health Consortium advances cross-disciplinary research into how the brain functions and why disease develops, while the Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases and the Sam and Ann Barshop Institute for Longevity and Aging Studies contribute leading research in dementia, neurodegeneration, aging and longevity.
The Center for Brain Health, working in close collaboration with the Department of Neurology at the Long School of Medicine, connects this research strength with comprehensive neurological care. Together, these programs create powerful connections between scientists and clinicians, accelerating discoveries that can improve brain health throughout life.
A 30-year window for prevention
Understanding dementia risk requires looking well beyond an individual’s age, according to Claudia Suemoto, MD, PhD, MSc, a physician-scientist and professor at the Kate Marmion School of Public Health and the Biggs Institute.
“People need to think about their life course as a whole,” she said.
Suemoto studies modifiable dementia risk factors, conditions or behaviors that individuals may be able to change. These include high blood pressure, diabetes, high cholesterol, physical inactivity, depression, social isolation and limited cognitive stimulation.
Her research uses a life-course approach, examining how experiences from youth through advanced age combine with a person’s genetic background to impact cognitive health. While healthy changes can be beneficial at any age, Suemoto considers ages 35 to 65 a particularly important window for prevention.
Cardiovascular conditions that go uncontrolled during those years can contribute to changes in the brain that may affect dementia risk 10 to 30 years later, she said.
Research at UT San Antonio is helping explain why midlife health matters. A study of 402 San Antonio residents found that physical activity and controlling blood sugar in midlife were associated with slower cognitive decline later in life. Physical activity was particularly beneficial among one of the study’s two population groups, while lower fasting glucose was significant in the other, suggesting that individual health factors may not affect every population in precisely the same way.
“By improving cardiovascular health through lifestyle changes, we have the potential to help people maintain their cognitive health and reduce the impact of Alzheimer’s disease and other dementias on individuals, families and communities,” said Claudia Satizabal, PhD, an associate professor in the Department of Population Health Sciences and the Biggs Institute.
Looking outside of familiar explanations
UT San Antonio researchers are looking beyond traditional explanations for Alzheimer’s disease to identify earlier biological signals, new pathways to disease and the factors that may protect cognitive health. While cardiovascular health and lifestyle remain important, scientists are tracing clues that range from proteins and lipids to sleep patterns to better understand how Alzheimer’s disease develops and might be detected earlier.
In one recent study, researchers found that regularly sleeping 8.5 to 9 hours or more per night was associated with higher levels of p-tau181, an Alzheimer’s-related protein detectable in the blood. The increase was sharpest beyond 10 hours.
Unusually long sleep could be a behavioral marker of underlying changes and a reason to discuss sleep quality and overall health with a physician. The study does not indicate that long sleep causes Alzheimer’s disease.
Researchers also are expanding the search beyond the amyloid and tau proteins that have long dominated Alzheimer’s research. A study published in Nature Communications found that the loss of sulfatide, a type of fat found in myelin — the protective coating around nerve fibers — may do more than provide an early sign of Alzheimer’s disease. It may also help drive harmful inflammation in the brain, suggesting that disruptions in brain fats could play a central role in disease development.
“This tells us lipid disruption is not just a side effect. It is a central driver of disease,” said Xianlin Han, PhD, professor of medicine in the Joe R. and Teresa Lozano Long School of Medicine.
Together, these discoveries are advancing researchers’ understanding of dementia risk, revealing earlier biological signals and opening new possibilities for treatment.
Suemoto is approaching the question from yet another direction by studying “superagers,” people in their 80s whose memory functions like that of someone 20 to 30 years younger. Some remain cognitively healthy despite having brain changes associated with dementia, while others reach advanced ages with little or no apparent brain pathology.
By comparing their genetic profiles and lifetime experiences, Suemoto hopes to uncover what protects cognitive health well into old age.
“I want to look for the factors that make someone resilient or even resistant to dementia,” she said.
Together, these discoveries are reshaping scientists’ understanding of Alzheimer’s disease to help people reach older age with their cognitive health, independence and quality of life intact. For those wondering when to begin addressing the dementia risk factors within their control, Suemoto’s message is both urgent and hopeful: “The best time to start is at 35, and the second-best time to start is now.”
Learn more about how UT San Antonio is advancing the future of health. Visit ambition.utsa.edu.
Five ways to invest in your brain health
Research cannot yet suggest how a person can avoid dementia, but evidence indicates that addressing multiple modifiable risks may help support cognitive health.
- Move more. Physical activity supports cardiovascular health and can help control blood pressure, cholesterol, blood sugar and weight. Start with an achievable increase in movement and build from there.
- Know your health numbers. Work with a healthcare professional to monitor blood pressure, cholesterol and blood glucose. Treating cardiovascular and metabolic conditions in midlife may also protect the brain over time.
- Choose more whole foods. Emphasize vegetables, fruits, beans, whole grains, nuts and other minimally processed foods. Suemoto’s prior research associated greater consumption of ultra-processed foods with faster cognitive decline, although scientists continue to study the biological mechanisms involved.
- Keep your mind and relationships active. Continuing education, mentally stimulating activities, complex tasks and meaningful social connections can help build cognitive reserve and reduce isolation.
- Pay attention to meaningful changes. Persistent changes in sleep, memory, judgment, personality, language, balance or movement deserve a conversation with a healthcare professional. Dementia does not always begin with forgetfulness, and recognizing changes early can help families pursue appropriate evaluation and care.