Alzheimer’s Disease – When you forget that you can remember!

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Spread awareness of this disease on World Alzheimer’s day – September 21

Alzheimer’s … It is a barren disease, as empty and lifeless as a desert. It is a thief of hearts and souls and memories” – Nicholas Sparks

Rose sat in a corner, staring blankly into space. She has, for the fifth time, asked her husband what he had for breakfast and Frank calmly replied ‘Toast’. Rose was having moderate Alzheimer’s disease.

Alzheimer’s disease is a brain disorder, where the brain slowly loses its nerve cells and their connections. First described in 1901 by a German psychiatrist Alois Alzheimer, it is a type of dementia (a common term for memory loss), which is irreversible. It severely affects memory and thinking skills to such an extent that the patients need help for performing even their day-to-day activities.

Detecting Alzheimer’s

People older than 65 years are more prone to get the disease but there is also early onset in some patients between 40-50 years of age. Rose first started getting her symptoms when she was 67 years old. Initially, she had trouble remembering new information, like how to use the smart phone her husband gifted her. She used to fumble for words during conversations (language difficulty) and lose track of what date or day it is frequently (time/ place orientation issues). She could not park the car properly (visuospatial issues) and even forgot how to cook her own favourite lasagne recipe (challenges in planning/ organising).

At first her husband Frank brushed aside these issues thinking that they are common problems of old age. However, he became anxious as these problems became progressively worse over time. He immediately consulted their GP, who referred them to a general adult psychiatrist and a neurologist. She then underwent a series of brain scans including CT and MRI scans. It helped to rule out other conditions such as stroke, tumour or a build-up of fluid inside the brain, which could have similar symptoms to Alzheimer’s. They found out that her hippocampus (the part important for storing memories) and surrounding brain tissue have shrunk, thus confirming she had Alzheimer’s disease.

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          Marked cortical atrophy in Alzheimer’s Disease Credit: docjana.com, Wikipedia 

What actually happens in the brain

The onset of the disease is not an overnight process. The process of damage to the brain appears to start at least a decade before, in patients at high risk of getting the disease. Although the exact mechanism is not known, researchers have proposed few hypotheses that may lead to the disease. The generally accepted hypothesis is associated with two proteins found in the brain called amyloid beta and tau.

Normal brains (left) vs Alzheimer’s patient’s brain (right) Credit: Wikimedia Commons
                  Normal brains (left) vs Alzheimer’s patient’s brain (right) Credit: Wikimedia Commons

Amyloid beta in its normal form, is involved in essential activities including regulating cholesterol transport and protecting against oxidative stress. However, due to unknown reason(s), they start to fold improperly and forms amyloid plaques. These then deposit on the nerve cells and becomes highly toxic to them, thus leading to neuronal death.

The other theory involves the tau proteins, which stabilizes the microtubules (the scaffold that hold the cells) of the nerve cells. In Alzheimer’s patients’ brains, the tau protein starts to add excessive phosphates groups (known as hyperphosphorylation). They then clump together and forms tangles that disintegrate the nerve cells’ scaffolds (microtubules) and destroy them.

Both of these processes usually begin in the hippocampus region (that is associated with memory) and gradually spreads to other regions. Thus, the early symptoms begin with memory loss and other brain disabilities develop later. The formation of amyloid plaques and tangles happen in all our brains as we age. However, in Alzheimer’s patients there are high levels of abnormal deposits of the amyloid protein and tangles throughout their brain, thus shrinking the brain as the disease advances.

What causes the Alzheimer’s disease

Several reasons from sleep deprivation and stress, to genetics have been blamed for the onset of the disease but what triggers the Alzheimer’s disease is still not known.

Scientists have found a strong association of amyloid beta protein production with sleep patterns. When a person is more sleep-deprived, there is accumulation of amyloid beta protein, thus increasing the chances of getting Alzheimer’s.

In about 1-5% of the patients, changes in the genes have been associated with early onset of the disease. People with Down syndrome are at a higher risk of getting Alzheimer’s as they have an extra copy of chromosome 21, where the gene of the precursor to amyloid protein is present.

People with high cholesterol, high blood pressure, diabetes and those who smoke are at a higher risk getting the Alzheimer’s disease. Despite all these associations, what really causes the disease remains a mystery.

Alzheimer’s disease progression

There are four stages of Alzheimer’s disease – Preclinical, early, moderate and severe.

Preclinical stage has symptoms that are very similar to symptoms of old age or stress, such as forgetting or misplacing things and short-term memory loss.

Early stage symptoms include getting lost, confusion, difficulty in involving in conversation, handling money, taking longer to complete normal daily tasks and changes in personality and behaviour that becomes noticeable to others.

As the disease progresses, major areas of the brain controlling language, reasoning and sensory processing are affected. In the moderate Alzheimer’s disease, memory loss and confusion becomes worse and they face trouble learning new information and in performing day-to-day activities such as getting dressed. Patients may find it hard remembering the names of family and friends. Hallucinations, delusions and paranoia also occur during this stage.

In the advanced stage, the body slowly shuts down and doesn’t respond to changes in environment. The patients become completely dependent on their caregivers as they cannot even feed themselves and cease to communicate. Eventually, they become immobile and bed ridden most of the time.

People with Alzheimer’s usually live about 6-8 years from the time of diagnosis (early-mid stage) and fewer than 3% live beyond 14 years. Patients die of pneumonia, dehydration and other old age related problems sooner, due to their inability to respond to the changes in environment, immobility and dependence on caregivers.

Can Alzheimer’s be prevented?

Intellectual stimulations to the brain, such as playing chess or board games, reading, solving puzzles or even regular engagement in social activities seems to deter the onset of the disease.

Interestingly, there are some evidences that people who eat foods low in saturated fats and simple carbohydrates have lower risk of Alzheimer’s. Specifically, western diet that is rich in saturated fats and simple carbohydrates was associated with cognitive impairment while Mediterranean diet has shown to improve outcomes in those with the disease.

However, in spite of these associations, there is no conclusive evidence suggesting a complete prevention to the Alzheimer’s disease.

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Benefits of early diagnosis        

Although there is no cure for Alzheimer’s yet, early detection of Rose’s condition helped Frank understand her situation and give her emotional and physical support, which is important for the patients as they progress through the disease. Most of the medications help by slowing down the processes that damages the brain and thus, is most effective during the early stages of the disease.

Early detection also enabled Frank and Rose to reach out to their local Alzheimer’s support groups, which helped them to manage the disease by giving psychological interventions such as behaviour-, emotion-, cognition- or stimulation-oriented approaches. This helped Rose to have a better quality of life as a patient and Frank in giving adequate and appropriate care to Rose as a primary care giver.

Image courtersy: Pixabay
Image courtersy: Pixabay