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Uncovering the Early Silent Stages of Alzheimer’s Disease

In 1985, a Swiss pathologist noted Alzheimer’s disease-like changes—plaques and tangles—in the brains of about three-quarters of a small group of men and women in their 50s and 60s who had died from other causes. Most brains from people under age 30, however, did not have these features. But these studies just involved a few dozen people.

As I discuss in my video, Alzheimer’s May Start Decades Before Diagnosis, based thousands of autopsies, we have seen what appear to be the first silent stages of Alzheimer’s starting as early as our 20s in about 10% of the population and increasing to about 50% by age 50. “Just as the first malignant cells in cancer…fail to produce any clinically detectable symptoms but represent a larger and potentially life-threatening disease process, the presence of… [these tangles in the brain] may constitute a true threat.”

The high prevalence of the first stage of the disease and its extraordinarily long duration—most people don’t get diagnosed until their 70s—had not been fully appreciated until now. We now understand that neurodegenerative brain changes begin by middle age, and so does cognitive decline; we start losing brain function in our 40s. 

Before people are diagnosed with Alzheimer’s, they are diagnosed with mild cognitive impairment, or MCI. That’s when cognitive decline becomes clinically apparent. A few years later, Alzheimer’s may be diagnosed, which then eventually results in death. We never knew what was happening before mild cognitive impairment was diagnosed… until now. There appears to be a slow decline in brain function and the buildup of plaques and tangles in the brain for decades before Alzheimer’s is diagnosed. 

This finding potentially has profound implications for the prevention of dementia: We have to start early before marked brain loss has occurred. The good news is that brain disease is not inevitable, even after age 100. The oldest woman in the world, aged 115, retained the brainpower of those practically half her age. Had she had not died from stomach cancer, she could have kept on thriving.

It turns out, there’s no such thing as dying of old age. In 42,000 consecutive autopsies, centenarians––those living past 100––succumbed to diseases in 100% of the cases examined, though most were perceived to have been healthy just prior to death, even by their physicians. In actuality, not one died of “old age.” Until recently, advanced age has been considered to be a disease itself, but people don’t die as a consequence of old age as commonly assumed, but from diseases and, most commonly, heart attacks.

One of the most intriguing findings from the 115-year-old woman mentioned above was that her body showed no significant atherosclerosis and the arteries in her brain were clear as well. That may have been one of the secrets to her mental clarity. There is emerging consensus that “what is good for our hearts is also good for our heads,” which I cover in my video, Alzheimer’s and Atherosclerosis of the Brain.

I have an extended video series on this dreaded disease. Learn more about Alzheimer’s in the following videos:

See more on cognitive decline in general in these videos:

More information on healthy aging can be found in

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:


Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.

35 responses to “Uncovering the Early Silent Stages of Alzheimer’s Disease

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  1. For more than 40 years the preferred medical terminology has been the non-possessive term “Alzheimer disease.” This is also true for other eponymous disorders, such as Parkinson disease, Hodgkin lymphoma, Down syndrome, Huntington disease, etc.

    In 1975, the NIH convened a conference to standardize the nomenclature of morphological defects. They recommended eliminating the possessive form: “The possessive use of an eponym should be discontinued, since the author neither had nor owned the condition.” Although both the possessive and non-possessive forms are used in the general population and medical literature, the non-possessive form is preferred terminology.

    [A planning meeting was held on 20 March 1974, resulting in a letter to The Lancet.”Classification and nomenclature of malformation (Discussion)”. The Lancet 303 (7861): 798. 1974. doi:10.1016/S0140-6736(74)92858-X. PMID 4132724.The conference was held 10–11 February 1975, and reported to The Lancet shortly afterward.”Classification and nomenclature of morphological defects (Discussion)”. The Lancet 305 (7905): 513. 1975. doi:10.1016/S0140-6736(75)92847-0.]

    Also, all three standard medical dictionaries reference the non-possessive form.

    1. Don’t care whatcha call it as long as you don’t call it Lonie’s disease. ‘-)

      I’ve been actively working to keep my body and mind in a state that isn’t conducive to being in a state of Alzheimer.

      Some of my methods are drinking beet root juice, eating 100% cacao (in powder or baker’s chocolate form as cocoa or poured squares.

      Another that I have only learned about recently is the supplement Naringin or as a food, grapefruit.

      Also, sleeping on the side rather than on the stomach or back. That allows our brain to clear (I think via astrocytes, but not sure) tau from our brain through spinal fluid.

      I’ll try to track down the links to the above later as I’m a little pressed for time ATM.

        1. P.S. Just want to add a note of caution for people who might notice various cookbooks with ‘ The End of Alzheimer’s’ somewhere in the title, and which might even be sold alongside Bredesen’s book at amazon or other sites. From what I can see/have read, these cookbooks are NOT authored or co authored by Bredesen, but are poorly written quickly published books taking advantage of Bredesen’s title. (i don’t understand how this is legal, but it is happening)

          The books contain recipes including foods that are in contradiction to Bredesen’s principles for healthy eating, and one even has a pic of grilled something or other on the front cover – bar b que sauce and got to love charred bits of those AGEs !! Anyway.. be forewarned! Read the paper, and check out Dr Greger’s videos linked above.

          1. Lonie, you’d be agog at just how much imitative writing is legal.
            A funny man of yore once publicized his latest novel, titled “Twenty Thousand Leagues Under the Sea; or, David Copperfield”.

        2. Susan, that looks like a good find. I’ve just skimmed it for now and realized that many of the supplements mentioned were things I’m already taking so that’s good news.

          I’ve been taking ashwagandha for a while now but recently read something that triggered me to order a big bag of it so as to increase my intake. Ah good, I found the link:

          I’ll read the whole piece later as I’m still working outside getting ready for a cold snap. Thanks for pointing me to this info.

          1. @Lonie says:
            DECEMBER 19TH, 2017 AT 4:50 PM

            The link you provided for the metformin research on aging was covered in a documentary called in a series called ‘Breakthrough’ on NatGeo channel. Google it and you’ll find the one on Aging but they’re all worth watching.

        3. Forgot to mention… in the piece they refer to withaferin A as being a mimetic for both metformin and rapamycin. Withaferin A is AKA ashwagandha.

      1. Wouldn’t it be better to eat the beetroot instead of juicing it? You throw away a lot of the good stuff when you juice and the juice will be high in sugar. You can also buy powdered beetroot – I put a spoonful in my mug of coffee/cacao (although I have now cut right back on coffee because of Dr G’s information about coffee and glaucoma.

        1. Tom, I’m not a juicer so the company I buy my beet root juice from is probably utilizing the pulp.

          I’ve also bought the powdered form for mixing and didn’t use it for a period of time… when I went back to it, it had apparently soaked up moisture from the air and hardened.

          I’ve also bought what probably amounts to the dried and ground-up pulp. It seems to stay as purchased, in my cabinet in a jar. I use it to add to soups and such.

          I’m going to add water to the hardened powder and see if I can rehabilitate it for use. I did that with some Lo Han Sweetener (Monk Fruit) recently and it worked out well.

  2. The End of Alzheimer’s is a new book out – focussing on stopping or reversing symptoms with diet, lifestyle, hormones, and supplements. The tangles were interpreted to be signs of the body trying to repair itself, and not the cause of the problems. After testing of blood, hormones, nutrients, sleep quality, stress levels etc. A personalized program is designed to address deficiencies with good results when the protocol is followed. The brain doctor was influenced to try this approach by his wife who is a functional medicine type.

  3. Do the plaques and tangles associated with Alzheimer’s disease actually cause people to die? And, even if people don’t die from old age, and they have the healthiest lifestyle possible, isn’t it true that death is eventually inevitable? My mom had Alzheimers, but no heart disease, cancer, diabetes, etc. She eventually stopped eating, eventually died from pneumonia. I would call it dying from old age.

  4. Babies can even die from pneumonia, I almost died from it in my 20’s when my immune system and resources were compromised. Death is usually blamed on a single cause, but there is always contributing factors.. The elderly with their poor general health and diet, depression, lack of stimulation and exercise, declining immune function, etc, may be more susceptible, but it’s not a malady exclusive to old age..
    Atherosclerosis, the origin of high blood pressure, heart disease, stroke, Alzheimer’s, etc. depending on the individual’s genetics and proclivity, is at the root of most death and suffering in our culture of dietary excess. Of course we will all die of something, but the goal is to do our best to take good care of ourselves. Like Dr Kim Williams said…”I don’t mind dying, I just don’t want it to be my fault.” All around me people my age (65) are losing limbs, eyesight, and mental functions, having strokes and heart attacks, going on dialysis, having joint replacements and other surgeries, taking slews of drugs that only mitigate symptoms, but still suffering from the barrage of diet and lifestyle related issues they CAN do something about…but won’t. Sad and frustrating when the evidence is so clear but they won’t or don’t want to change.

    1. Amen to that Veg. I have siblings in their 70’s and 80’s and other loved ones who just won’t give up that 3-4 glasses of milk/day or the hamburger every day for lunch and live with crippling and life threatening diseases because of it. People have to WANT to be healthy in order to be able to help them with information.

    1. IMO, mainstream media like is way behind the curve most of the time. I think they play it safe and report what mainstream medicine puts out.

      But there is cutting edge research going on that suggests a much brighter future. Just one such approach is addressed in the link below:

      And while that one may be a while away and un-affordable for most, I’m reposting a link that Susan put up that shows by following a doable program, there can be a return to normalcy for some who are exhibiting the signs of Alzheimers:

  5. The US National Academies of Sciences issued a consensus report earlier this year on preventing cognitive decline and dementia. I haven’t finished it yet (I keep forgetting!) but it is free to download as a PDF

    It is also worth remembering that Alzheimer’s is not the only age-related dementia, Vascular dementia is the second most common dementia (after Alzheimer’s) and seems to be caused by eg the same unhealthy lifestyle choices that result in cardiovascular disease generally. So eating a WFPB diet low in saturated fat, maintaining low blood cholesterol levels, exercising, not being overweight and not smoking or drinking should provide considerable protection against this common dementia.

    I remember reading years ago that there are over 80 different types of dementia including dementias resulting from heavy metal poisoning. Accurate diagnosis can be very difficult and mixed Alzheimer’s/vascular dementia is apparently quite common. Alcoholic dementia may also be common in older people. The NHS and NIH have more information as do the various Alzheimer’s organisations eg

    1. Probably one of those people on the “good genes” diet.

      But I read that Jeanne Calmet, the Frenchwoman who lived to 122, ate dark chocolate and drank wine everyday, which probably helped her genetics… but her genetics probably explains how she lived so long and smoked most of her life. Or maybe she didn’t inhale.

  6. Have you read the recent report by Dr Christopher Exley of Keele University UK in The Journal of Trace Elements in Medicine and Biology concerning the high quantity of Aluminium in the brains of deceased children suffering from Autism.Perhaps that is one of the toxins affecting us all with the rise in the use of Aluminium pots and pans,chemtrails and its use in Vaccines as an inflammatory agent to stimulate the immune system.This metal is energetically very active but is not involved in any human enzyme system.Maybe the clue is there!

  7. I wish there were more research into the possibility that the (apparently) rising incidence Alzheimer’s may at least PARTIALLY be Creutzfeldt-Jakob disease (from mad cow beef prions) — this 2005 article says up to 13% of Alzheimer’s patients really have CJD:

    During life, there’s no definitive diagnostic test for Alzheimer’s beyond symptoms, as far as I know, and the similarity in symptoms seems striking. Reports of a similar prion spreading in wild deer in the U.S. make me wonder how many other food-species have those mind-destroying prions.

    This research into transmissibility of Alzheimer’s from growth hormone is also important:

  8. Maggie,

    there are indeed a number of new tests that will be coming to the market to determine Alzheimer’s disease.

    They range from chemical bonding of the blood plasma to specific set of proteins and minerals:

    See: and as two of the many chemistries being evaluated.

    As to the prions….good thing you’re not eating meat, eh ? As to the use of GH injections….. no question that better methods vs human harvesting were necessary. There are currently a number of other synthetic options that have no human contamination.

    Dr. Alan Kadish moderator for Dr. Greger

  9. Maybe I’m stupid or behind the times (or both) but I thought the catch-all or umbrella term for the disease state was ‘dementia’ of which Alzheimers was one. Although,of course, the net results are the same… all negative. Also,I thought a person could not be absolutely diagnosed with dementia until after they were dead and an autopsy was/ is performed. Again, I may be showing my stupidity. Having seen and known too many people destroyed by this affliction, all I can say from a personal level is it must be the worst or 2nd worst thing that can happen to us…. especially having a sense, in the early stages, of just how bad your mind & life are going to get.

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