Seems like I've been forgetting the blog. Well, Alzheimer's disease this week. Concise sources this time.
Alzheimer’s is a serious disease affecting 44 million people in the world. Though not from birth, it is typically considered worse than other lifelong diseases. It strikes late in life, but takes its toll: the disease is a progressive destruction of brain cells responsible for memory and important mental functions.
In the beginning the disease may seem to be a small matter, leading to people forgetting childhood memories, but can quickly escalate into forgetting loved ones or having massive personality shifts.
Asides from the memory loss aspect, Alzheimer's is also the most common cause of dementia. Dementia is an extension of what Alzheimer’s does: it’s a collective group of brain disorders causing loss of intelligence and a sheer drop in social skills.
The fact that only 1 in 4 cases are diagnosed makes the disease worse. What does this disease do?
It creates a plethora of problems for those affected, such as increasingly worse memory lapses leading to misplacing items, forgetting conversations, repeating statements, and forgetting family members.
Alzheimer’s can cause difficulty in concentrating and thinking, especially with math. Though it's not like math is ever without difficulty for the common folk. Multitasking becomes difficult and finance, bills, and checkbook managing becomes hard. The cause of these last few disabilities may be due to the decrease in mathematical skills by the disease.
Responses to ‘normal’ problems becomes a problem, and planning becomes an issue as well. As the disease progresses, people may begin to forget basic tasks such as dressing and bathing. FOr now, let’s forget that once those two things were unessential.
The disease can also lead to changes in emotions, leading to depression, apathy, mood swings, often changes in sleeping habits, and delusions. Alzheimer’s works backwards from modern memories in its path of destruction, and so abilities gained early in life are protected until the later ends of disease progression.
In its last stages, it can lead to additional unrelated health problems such as aspiration (inhaling food or liquid into lungs), pneumonia, fractures, malnutrition or dehydration, and issues in balance and bower control.
Alzheimer’s patients require extensive care as well, and an estimated $605 billion are spent yearly for Alzheimer’s patients, equivalent to 1% of the world GDP.
Currently, scientists believe that Alzheimer’s is a combination of three factors: genetic, lifestyle, and environmental. This is most of the time, applying to the majority (95%) of people, as there are some purely genetic causes.
The effect of the disease is clear, it damages connections in the brain that are responsible for memory. Memory works by creating bonds in your brain. When your brain receives constant messages the information is stored through a process called long-term potentiation (LTP). The strength of the memory created is determined through the amount of times the neuron recording the memory is bombarded with the same neurotransmitter signal.
A memory will be stronger the more signals you have to remember it. Alzheimer’s damages the connections created through the brain remembering stuff. The brain will eventually have much less connections and healthy brain cells.
Ooh, should have done memory before this. Well, that’s next!
As disease progression reaches a peak, more brain cells die, and leads to significant brain shrinkage. Doctors examining Alzheimer’s brain tissue under a microscope, they see two abnormalities characteristic of Alzheimer’s: plaques and tangles.
Run! Or just go to a doctor. Your teeth and hair have begun to invade your brain!
No, plaques are proteins, not bacteria. They are, according to the Mayo Clinic, ‘clumps of a protein called beta-amyloid (that) may damage and destroy brain cells in several ways, including interfering with cell-to-cell communication.’ This could be a cause of memory weakening.
Also, tangles aren’t like hair tangles in a literal sense, except they are. A protein called tau is necessary for internal support and a transport system to carry nutrients through long extensions in the brain. Tangles occur when the threads of tau twist into abnormal tangles in brain cells, leading to the failure of the transport system. This is a major factor in the death of brain cells.
Are there trends in Alzheimer’s diagnosis? Surprisingly, yes!
There are some risk factors, including but not limited to age, genetics, lineage, gender, lifestyle, location, and social engagement.
Age is the greatest risk factor for Alzheimer’s. Though not part of the normal ageing cycle, your risk increases significantly over 65. The rate of dementia basically doubles every decade after 60.
Genetics can lead to early onset Alzheimer’s as early as 30, but genetic studies show that your risk for Alzheimer’s is considerably higher if your first degree relatives have the disease. There are rare mutations in three genes that almost guarantee Alzheimer’s, though this accounts for less that 5% of diagnosed people.
The gene mutation leading to the highest risk for Alzheimer’s is apolipoprotein e4 (APoE4). If a patient has this mutation, his child has a 50/50 chance for receiving it and thus having a high risk of ALzheimer’s.
People with Down Syndrome have a high chance of developing the disease. In their case, the symptoms appear earlier: up to 20 years earlier than the general population.
Women have a slightly higher chance of developing Alzheimer’s partly due to life expectancy.
Those with mild cognitive impairment have memory problems as expected for age, but not classified as dementia. However, people with MCI do have a higher chance of being diagnosed with dementia later on.
Also, people with past head trauma have a higher risk of Alzheimer’s. Lack of exercise, obesity, high blood pressure and cholesterol and smoking can all increase your chance of developing Alzheimer’s.
Location seemes to have a difference in concentration: the disease is most common in Western Europe, and is least prevalent in Sub-Saharan Africa.
The major question is, “is there a cure, my knowledged doctors?” Well, they are working on it.
Here enters Antioquia, the largest concentration of people carrying the Apolipoprotein e4 mutation in the world.
A family here, headed by mother Cecilia and seven children and many grandchildren lost their patriarch, Alonso to Alzheimer’s. He carries the APoE4 switch, and has been diagnosed with Alzheimer’s. His family acts as his caregiver.
When he first began to show signs of memory loss, the doctor suggested exercise and vitamins, but his condition didn’t get better.
He knew what was going on, and asked about why his memory was dying. His family has a high chance of Alzheimer’s, and wish to know what causes it.
The Banner Alzheimer’s Institute wanted to try removing amyloids from the brain to prevent Alzheimer’s, but they couldn’t tell for certain if someone had the disease or not. This was a crucial piece of information because they believed that if you administered the medicine too late, when Alzheimer’s had already begun, it would have no effect.
They went to Ken Kosik, a man who had been studying the family in Antioquia for fifteen years. They wanted to try their medicine and prevent the disease.
They started a double-blind study: 300 people in total; 200 with Alzheimer’s guaranteed and 100 without. Half the people with the mutation will receive medicine and the other half harmless placebo. This method was meant to ensure that nobody participating in the study would know their condition of the disease.
The participants would check in every two weeks for five years, in order to see if the people with the medicine will have less amyloid buildup than those with the placebo.
This is an ongoing study, and is expected to run till 2021. This is just the start, though, as if this doesn’t work it means something else will have to be targeted in the body.
There are two drugs that are made to manage the symptoms of Alzheimer’s, if not prevent: cholinesterase inhibitors, and memantine (namenda).
Cholinesterase inhibitors work by boosting levels of a neurotransmitter that is depleted in Alzheimer’s, in order to increase cell-to-cell communication. This improvement is modest, but can also treat agitation and depression.
Memantine slows the progression of moderate to severe Alzheimer’s in another brain cell communication network.
The two are often paired together to slow the progression of Alzheimer’s, but it isn’t a cure, and the progression is inevitable.
Currently, 1 in 3 seniors die with Alzheimer’s, and this disease is on an unstoppable rampage. Perhaps the future generation will solve the problem. But for now, the disease is here to stay, and knowledge of it will help those afflicted.
CBS documentary series 60 Minutes episode The Alzheimer’s Laboratory (Nov. 27 2016)
