11d • General discussion
5 Blood Tests That Predict Alzheimer's Risk (Not Brain Scans)
The 5 lab tests I order for every patient worried about Alzheimer's.
Not the tests you'd expect.
Most doctors order specialty referral or brain imaging first.
I start with these blood tests.
Cheaper. Faster. Actionable.
Test 1: Hemoglobin A1c
Measures: 3-month average blood sugar
Why it matters: Every 1% increase in A1c increases dementia risk by 20-40%. Even in people without diabetes.
Target: Under 5.7% (ideally 5.0-5.5%)
What I do if elevated: Diet modification, exercise, metformin if prediabetic. See results in 90 days.
Test 2: ApoB (Apolipoprotein B)
Measures: Number of atherogenic particles in your blood
Why it matters: Better predictor of cardiovascular disease than LDL. Cardiovascular disease doubles dementia risk.
Target: Under 80 mg/dL (some experts say under 60 mg/dL)
What I do if elevated: Statins, ezetimibe, supplements, lifestyle modification depending on level.
Test 3: High-sensitivity CRP (hs-CRP)
Measures: Systemic inflammation
Why it matters: Chronic inflammation drives neurodegeneration.
Target: Under 1.0 mg/L (ideally under 0.5 mg/L)
What I do if elevated: Look for source. Treat sleep apnea. Optimize diet. Address metabolic dysfunction.
Test 4: Homocysteine
Measures: Amino acid that damages blood vessels when elevated
Why it matters: Elevated homocysteine independently increases dementia risk. Often easily correctable.
Target: Under 10 μmol/L (ideally under 8 μmol/L)
What I do if elevated: B vitamins (B6, B12, folate). Recheck in 3 months.
Test 5: APOE Genotype
Measures: Genetic risk for Alzheimer's
Why it matters: APOE4 carriers have 3-12x increased Alzheimer's risk. Changes prevention strategy.
Target: This is information, not a target
What I do if positive: More aggressive prevention. Earlier screening. Closer monitoring.
The tests I don't routinely order:
Specialized imaging (e.g. amyloid PET): $5,000+. Not covered by insurance. Doesn't change management in asymptomatic people.
Brain MRI: Useful for diagnosis. Less useful for prediction in healthy people.
Lumbar puncture: Too invasive for screening.
Total cost for my panel: $200-400 out of pocket if insurance doesn't cover.
Here's what this panel tells you:
Your metabolic health (A1c)
Your cardiovascular risk (ApoB)
Your inflammation status (hs-CRP)
Your vascular health (homocysteine)
Your genetic risk (APOE)
With this information, you can build a personalized prevention plan.
If your A1c is 6.0%, you know metabolic optimization is priority #1.
If your ApoB is 120 mg/dL, cardiovascular risk reduction becomes critical.
If you're APOE4 positive with high hs-CRP, aggressive anti-inflammatory strategies matter more.
You don't need $100,000 in testing to prevent dementia.
You need $300 in the right tests. And a plan based on what they show.
⁉️ Have you had any of these tests?
👉 Follow Reza Hosseini Ghomi, MD, MSE
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5 Blood Tests That Predict Alzheimer's Risk (Not Brain Scans)
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