What is Alzheimer’s Disease (AD):
Alzheimer’s disease is an incurable, progressive degenerative disease of the brain. It is the most common form of dementia. Dementia is a broad term for the deterioration of brain function which results in loss of memory, reduced language skills and behavioral and emotional problems.
While the disease can occur in people in their 30s and 40s, it is most prevalent among older individuals: about one in 10 persons 65 years of age and older and almost half of those 85 years of age and older develop AD.
Alzheimer’s disease is progressive, meaning that symptoms worsen over time. How fast the disease progresses, and what pattern symptoms might follow, is variable by individual.
How does a brain Function?
When the brain is functioning normally, it exchanges signals from other parts of the body, and other parts of the brain, across the gaps (synapses) between nerve cells. These signals – in the form of countless electrical impulses – are essential for brain activity such as language and problem solving. They are also involved in controlling motor functions, such as instructing muscles when and how to work.
Alzheimer’s disease is the result of the destruction of nerve cells (neurons) in the brain. These nerve cells cannot be replaced, so a person with Alzheimer’s disease gets progressively worse as more cells are destroyed.
Scientific research indicates that Alzheimer’s occurs when nerve cells in several key areas of the brain are damaged or destroyed. These changes disrupt the normal flow of information between the body and the brain resulting in a steady decline in mental function.
- Reduction in acetylcholine– Nerve signals travel across the synapses with the help of chemicals known as “neurotransmitters”, including one called acetylcholine. Doctors believe that nerve cell destruction causes a reduction in acetylcholine, leading to impaired transmission of nerve signals.
- Formation of knots & clumps: The mental destruction is most likely caused by the formation of the neurofibrillary tangles (knots) and senile plaques (clumps) that are commonly found in the diseased brain during an after-death biopsy. These plaques and knots only form in the areas of the brain that control memory and the retention of learned information.
- Heredity– Although it is evident that genetics does play a role in susceptibility, someone with questionable genetics should not consider AD an inevitable event. People whose parents or brothers and sisters develop the disease appear to be at greater risk of developing it themselves
- Toxic Exposure: One of the main toxic elements associated with Alzheimer’s Disease is aluminum. Brain cells get tangled and die off; a study has shown that aluminum is a cofactor in the formation of these neurofibrillary tangles. Many of the elderly have digestive difficulties and use antacids. While antacids may seem to help with their digestive condition, antacids are loaded with unhealthy “aluminum.” Aluminum exposure also comes from deodorants; pots, pans, and silverware; food wrapped with aluminum foil; and non-dairy creamer, baking powder, and many brands of table salt. Minimal exposure to these items is crucial in keeping aluminum levels low. The most alarming aluminum-containing substance is drinking water!
- Nutritional Factor: Deficiency of vitamin E has can cause damage to brain cells. Bathing brain cells in vitamin E protects them from a toxic protein found in amyloid plaques. Just as soaking a peeled apple in lemon juice prevents oxidation from turning it brown, antioxidants such as vitamin E protect brain cells by neutralizing free radicals.
- Free Radical Damage: Chemically unstable molecules known as free radicals are produced simultaneously when the body burns oxygen to produce energy. Free radicals cause damage to brain cells by taking electrons from the body’s healthy molecules to balance themselves. A large amount of free radicals leads to even more free radicals, and this excessive free radical formation damages cells and tissues.
- Head injury is a risk factor.
Stage 1: No impairment
Stage 2: Very mild decline
Stage 3: Mild decline
Stage 4: Moderate decline (mild or early stage AD)
Stage 5: Moderately severe decline (moderate or mid-stage AD)
Stage 6: Severe decline (moderately severe or mid-stage AD)
Stage 7: Very severe decline (severe or late stage AD)
At first, the only symptom may be mild forgetfulness. People with AD may have trouble remembering recent events, activities, or the names of familiar people or things. Simple math problems may become hard to solve. Such difficulties may be a bother, but usually they are not serious enough to cause alarm.
Symptoms/warning signs of AD may include the following:
- Memory loss or unexplained confusion affecting job or home skills
- Difficulty in performing familiar tasks and chores
- Forgetting words or substituting inappropriate words
- Disorientation to time and place (e.g., getting lost in familiar surroundings)
- Poor or decreased judgment (e.g., wearing a winter coat on a hot summer day)
- Problems with abstract thinking (e.g., difficulty balancing a checkbook)
- Misplacing things in inappropriate places (e.g., putting the iron in the freezer)
- Changes in mood or behavior (e.g., rapid mood swings for no apparent reason or cursing)
- Drastic changes in personality (e.g., suspiciousness)
- Lack of interest and involvement in usual activities
If several of these symptoms/warning signs are present, the person should be evaluated by a physician. Frequently, the early symptoms of AD, which include forgetfulness and loss of concentration, are mistakenly dismissed as normal signs of aging.
Symptoms by Stage of Disease
There is currently no single test that accurately diagnoses Alzheimer’s disease, so doctors use a variety of assessments and laboratory measurements to make a diagnosis
Diagnosis of Alzheimer involves several types of evaluations and may take more than one day. Evaluations commonly performed include:
Medical history: an interview or questionnaire to identify past medical problems, difficulties in daily activities and prescription drug use, among other things. The doctor may wish to speak to a close family member to supplement information.
Physical examination: which should include evaluations of hearing and sight, as well as blood pressure and pulse readings.
Standard laboratory tests: might include blood and urine tests designed to help eliminate other possible conditions. These will measure things like blood count, thyroid and liver function, and levels of glucose and other blood-based indicators of illness. A depression screening should also be conducted. In some cases, a small sample of spinal fluid may be collected for testing.
Neuropsychological testing: Doctors use a variety of tools to assess memory, problem-solving, attention, vision-motor coordination and abstract thinking, such as performing simple calculations in your head. The goal is to better characterize the types of cognitive (Pertaining to cognition, the process of being aware, knowing, thinking, learning and judging.) symptoms present, which might provide clues to the underlying cause.
Brain-imaging scan: A “structural” brain scan such as CT or MRI is recommended to rule out brain tumors or blood clots in the brain as the reason for symptoms. Many scientists are trying to determine if other brain-imaging techniques might be able to identify telltale signs of early Alzheimer’s reliably enough to be used as diagnostic tools.
A diagnosis is said to be either possible (not all other causes can be ruled out) or probable (all other causes have been ruled out). A definitive diagnosis of Alzheimer’s is possible only by examining brain tissue after death.
It’s important for the person with Alzheimer’s to be under the continual supervision of a qualified medical doctor in order to stay in the best overall health possible. No treatment can stop AD. Attention must be paid to proper exercise, diet and to any new or long-standing health problems. Hearing and vision should also be evaluated regularly and treated appropriately if faltering. Ongoing consultation with a primary care physician may be supplemented with visits to specialists or other health professionals as necessary to address specific needs.
The goal of treatment is to help control the symptoms that affect memory and thinking.
The drugs tacrine (Cognex), donepezil (Aricept), rivastigmine (Exelon), or galantamine (Reminyl) may help prevent some symptoms from becoming worse for a limited time. Also, some medicines may help control behavioral symptoms of AD such as sleeplessness, agitation, wandering, anxiety, and depression. Treating these symptoms often makes patients more comfortable and makes their care easier for caregivers. The fifth approved medication, known as Namenda® (memantine), is an N-methyl D-aspartate (NMDA) antagonist. It is prescribed for the treatment of moderate to severe AD
However, even healthy older people experience changes in eating habits as they age: Food may not smell or taste the same; it may become more difficult to chew and digest food, and our cells may not be able to utilize the energy from food as efficiently. In early stages of the disease, people with Alzheimer’s may have difficulty preparing meals. They may forget they have food in the oven or cook something and forget to eat it. Step-by-step written or verbal instructions clearly delineating what to do to prepare and eat meals may be beneficial in such cases. Severe eating problems put the person with Alzheimer’s at risk for weight loss, dehydration and malnutrition.
A diet rich in foods containing vitamin E may help protect against Alzheimer Disease.
A low-fat, antioxidant-rich diet is associated with decreased risk of Alzheimer’s disease,
A Netherlands study published in JAMA reported a link between high dietary intake of vitamins E and C and protection against Alzheimer’s disease in certain people. Both vitamins have antioxidant properties that experts believe may help reduce damage to nerve cells caused by oxidative stress, which occurs throughout the body as a natural consequence of aging and may contribute to Alzheimer’s disease in ways that are not fully understood.
The first study, published in the American Journal of Clinical Nutrition, found that increased levels of homocysteine correlated both with deficiencies in vitamin B-12 and folic acid, another B vitamin, and with lower scores on cognitive tests. A second study reported at a major Alzheimer’s conference found elevated homocysteine and low levels of vitamin B-12 in African-Americans with Alzheimer’s disease.
Maintaining a reasonable level of exercise is important for many reasons, both for overall health and to address issues specific to Alzheimer’s. Exercise can improve mobility and help one maintain independence. In normal people, moderately strenuous exercise has been shown to improve cognitive functioning.
Light exercise and walking appear to reduce wandering, aggression and agitation. Incorporating exercise into daily routines and scheduled activities can also be beneficial in alleviating problem behaviors. The type of exercise should be individualized to the person’s abilities. Talk with your doctor about what is right.
These may include herbal remedies, acupuncture, and massage. It’s important to understand that complementary or alternative health approaches, including vitamins and herbal supplements, are not subject to the same kind of critical government review for safety and efficacy that new drugs are, so one must be cautious when considering such approaches. While there are a growing number of legitimate researchers investigating these approaches, there is also a great deal of misinformation in the public domain, and unsubstantiated claims are rampant. Ask your doctor to help you understand the benefits and risks of such approaches, and do not take herbal or vitamin supplements without first discussing it with your doctor, since many of these pills can interact negatively with prescription or nonprescription medications.