Alzheimer’s disease is a brain disorder named after the German physician Alois Alzheimer.
In November 1906, Dr. Alzheimer presented the case history of “Frau Auguste D”, a 51 year old woman, first seen by him in 1901. She had developed problems with memory, as well as other associated symptoms. Her symptoms progressed, she became bed ridden and she died in 1906. At autopsy, Dr. Alzheimer found that there was dramatic shrinkage of the brain, specially the cortex or the outer layer involved with memory, thinking, judgement and speech. Under the microscope, he saw widespread fatty deposits in small blood vessels, dead brain cells and abnormal deposits in and around the brain cells. This was reported in the medical literature in 1907, and in 1910, Dr Emil Kraepelin proposed that the disease be named after Alzheimer.
What is Alzheimer’s Disease?
Alzheimer’s disease, often referred to simply as Alzheimer’s, is the most common form of dementia.
Dementia is a general term for memory loss, and loss of other intellectual abilities, serious enough to interfere with daily life.
Alzheimer’s is a progressive and fatal brain disease which destroys brain cells, causing memory loss and problems with thinking and behaviour severe enough to affect work, recreational activities and social life. It gets worse over time. It is progressive and irreversible and it is eventually fatal.
There is no cure. But treatments for symptoms, combined with the right services and support, can make life better.
Alzheimer’s advances in stages, progressing from mild forgetfulness and cognitive impairment, to widespread loss of mental abilities. In advanced Alzheimer’s, there is dependency on others for every aspect of their care.
The time course of Alzheimer’s varies by individual, ranging from 5 to 20 years or more.
Dementia is the term used to describe the symptoms of a large group of illnesses which cause a progressive decline in a person’s mental functioning. It is a broad term, which describes a loss of memory, intellect, rationality, social skills and normal emotional reactions.
Dementia usually has an insidious onset, with symptoms developing gradually over a period of years. The rate of progression is largely unpredictable for each individual.
While the risk of dementia increases with age, dementia is not a natural part of aging.
In Australia, one in fifteen people aged 65+ have severe dementia. Among people aged 80 to 84 the rate is one in nine, and among those 85+ it is one in four. Dementia ranks as the fourth leading cause of death among the population aged 65 years and over.
Alzheimer’s, the most common form of dementia, accounts for 50-70% of all cases.
The second most common form is vascular dementia, sometimes called senile dementia, which may be preventable with appropriate diet and lifestyle.
In Australia, in 2008, there were nearly a quarter of a million people with dementia. Dementia is a major determining factor in precipitating entry to residential care.
Worldwide, in 2008, there were just on 30 million people with dementia, with the number expected to be more than 80 million by 2050.
(See Alzheimer’s Australia, www.alzheimers.org.au)
Signs and Symptoms of Alzheimer’s Disease
In the early stages of Alzheimer’s, the symptoms can be minimal and quite subtle. It generally begins with lapses in memory and difficulty in finding the right words for everyday objects.
Other symptoms and signs may include:
· persistent and frequent memory difficulties, especially for recent events
· vagueness in everyday conversations
· loss of enthusiasm for previously enjoyed activities
· taking longer to do tasks
· forgetting well known people or places
· inability to process questions and instructions
· deterioration of social skills
· emotional unpredictability.
Symptoms may vary and the disease progresses at a different pace according to the individual and the areas of the brain affected.
There is always deterioration over time. Alzheimer’s is a progressive, and currently irreversible, disease.
The Alzheimer’s Association (see www.alz.org/alzheimers_disease_10_signs) sets out the “10 Signs of Alzheimer’s”:
1) “Memory loss that disrupts life.
2) Challenges in learning or solving problems.
3) Difficulty completing familiar tasks at home, at work or at leisure.
4) Confusion with time or place.
5) Trouble understanding visual images and spatial relationships.
6) New problems with words in speaking or writing.
7) Misplacing things and losing the ability to retrace steps.
8) Decreased or poor judgment.
9) Withdrawal from work or social activities.
10) Changes in mood and personality.”
Diagnosis of Alzheimer’s Disease
There is currently no single test to identify Alzheimer’s disease. The clinical diagnosis should include a detailed medical history, with special attention to lifestyle and social activities. Input, from relatives and friends, is a necessary part of this.
There should be a thorough physical and neurological examination, as well as testing for intellectual function with specialist input when indicated.
Psychiatric assessment and neuropsychological testing may be required when the diagnosis is in doubt.
Appropriate tests to eliminate other conditions with similar symptoms, such as nutritional deficiencies, may be required. Depression should be considered as a possible diagnosis, and excluded.
It is important to have an early and accurate diagnosis, to determine whether a treatable condition other than Alzheimer’s is causing the symptoms.
What Causes Alzheimer’s Disease?
Scientists have made significant progress in understanding the possible causes of Alzheimer’s disease, but many questions remain unanswered. It is most likely that there is a complex interaction between many factors, both inherited and environmental, in poorly understood ways, to cause this disease.
A variety of suspected causes are being investigated, including factors in the environment, biochemical disturbances and immune processes.
A number of brain changes have been identified that are associated with Alzheimer’s. These include characteristic plaques and tangles around and inside nerve cells that were first described by Dr. Alzheimer. Plaques build up between nerve cells, and contain deposits of a protein called beta-amyloid. Tangles, which form inside dying cells, are twisted fibres of another protein called tau.
Though most people develop some plaques and tangles as they age, those with Alzheimer’s tend to develop far more. The plaques and tangles tend to form in a predictable pattern, beginning in areas important in learning and memory and then spreading to other regions. It is believed that these plaques and tangles in some way block communication among nerve cells and disrupt activities that cells need to survive. This leads to the eventual death of the brain cells and prevents the recall of information.
Risk Factors for Alzheimer’s Disease
There are two proven risk factors for Alzheimer’s disease:
The disease usually strikes after the age of 65, and risk increases with increasing age. It is of interest that the original case described by Dr. Alzheimer was in a relatively young person (aged 51 years). Strictly, Alzheimer’s disease is dementia occurring in younger people. However today, Alzheimer’s is used as a diagnosis, independent of age.
· Family history
Having a family member with Alzheimer’s increases one’s risk, particularly if the relative has the early-onset form of the disease (beginning before age 65). However, more than half the people with the far more common late-onset form have no family history.
Prevention of Alzheimer’s Disease
Two published studies are relevant to the prevention of Alzheimer’s disease. The first looks at the benefit of mentally challenging activities and the second demonstrates the benefit of a correct diet.
· The first study was published in the Journal of the American Medical Association (JAMA) in February 2002.
The study involved 800 Catholic nuns, priests and brothers, 65 years and older, who are taking part in the ongoing US-based Religious Orders Study.
It was found that those who participated most often in mentally challenging activities had a 47% lower risk of Alzheimer’s disease. Those who participated at a moderate level had a 28% lower risk compared to those who rarely participated.
Seven activities were looked at including watching television, listening to the radio, reading newspapers, magazines and books, playing games such as cards, checkers or doing crosswords or other puzzles, and going to museums.
During the five year study, 111 people developed Alzheimer’s disease.
The findings would appear to support the concept of “use-it-or-lose-it”.
· The second study was published in the Journal of Alzheimer’s Disease in August 2009.
The researchers investigated the relationship between fruit and vegetable intake, plasma antioxidant micronutrient status and cognitive performance in 195 healthy subjects aged 45 to 102 years. Their results indicated higher cognitive performance in individuals with a high daily intake of fruits and vegetables.
Subjects with a high daily intake (about 400 grams) of fruits and vegetables had higher antioxidant levels, lower indicators of free radical-induced damage against lipids as well as better cognitive performance compared to healthy subjects of any age consuming low amounts (less than 100 grams per day) of fruits and vegetables.
These findings were independent of age, gender, body mass index, level of education, lipid profile and albumin levels, all factors able to influence cognitive and antioxidant status.
Modification of nutritional habits aimed at increasing the intake of fruits and vegetables, therefore, should be encouraged to lower the prevalence of cognitive impairment.
Thus, participating in ordinary tasks such as reading, listening to the radio, playing games such as cards on a daily basis may delay the onset of Alzheimer’s. The more mentally challenging the activity, the better. Couple this with a diet high in fruit and vegetables, and the benefit in preventing, or at least delaying the onset of, Alzheimer’s disease will be even greater.
It should be noted that the second study recommended fruits and vegetables as opposed to antioxidant supplements. Other studies have shown that while antioxidants from food have a beneficial effect on the brain, and can prevent or delay cognitive decline, supplements do not appear to offer the same benefits.
Another study, also published in JAMA in 2002, found that diets rich in vitamin E (antioxidant) may delay the onset of memory impairment in Alzheimer’s disease. This benefit only became apparent when the vitamin E was consumed in food and not as a supplement.
Fruits and vegetables are the basis of the dominantly alkali-forming diet which is recommended as the ideal diet for health and longevity. For details, see my September 2005 newsletter Acid/Alkali Balance- the Ideal Diet.
Regular exercise (three to five hours per week) between the ages of 20 to 60 is also protective against Alzheimer’s disease. According to one study, the odds of developing Alzheimer’s were nearly quadrupled in people who were less active during their leisure time compared to their peers in this age group. Regular exercise can significantly improve many aspects of physical and emotional life. For the elderly, simple activities such as walking and light weight training would likely provide benefits. For those who are younger, more strenuous exercise may give greater benefits.
It is also recommended that aluminium, for example as found in antiperspirants, cookware etc, should be avoided. It was thought that aluminium was an important factor in the development of Alzheimer’s. It is now considered to be much less relevant. However, when aluminium combines with fluoride (present in most water supplies), aluminiumfluoride complexes are formed and it seems that these compounds do have adverse effects on the nerve cells.
In addition to avoiding aluminium and fluoride, mercury should also be avoided since it is also a neurotoxin.
There is increasing evidence that radiation from mobile phones (cell phones) damages areas of the brain associated with learning, memory and may trigger Alzheimer’s disease.
Some authors also recommend against flu vaccinations because of a possible link to Alzheimer’s disease, since they often contain mercury.
Treatment of Alzheimer’s Disease
When a family is faced with having to cope with a family member diagnosed with Alzheimer’s disease, they are suddenly under enormous stress and are looking for answers to help them. What can and should be done?
First and foremost, the prevention strategies outlined above should be embraced and acted upon. With increasing age there is increased risk of developing Alzheimer’s. The preventive measures need to be undertaken to help prevent or delay the onset of the disease. Older people are aware of the possibility of developing this condition and often have a level of fear associated with this prospect. It is in this situation that active preventative steps can change their whole outlook.
Early diagnosis will provide the necessary motivation to change the diet, provide mental stimulation etc. Motivation is essential to consistently carry out the various preventive measures … measures that are now therapy.
Doctors resort to prescribing drugs because they feel that they have no other alternative, and know that they have to do something. And let’s face the reality that orthodox medical practitioners are essentially drug providers, aided by the push by the pharmaceutical companies to prescribe.
The main group of drugs prescribed for Alzheimer’s disease are called anticholinergic drugs. These raise the levels of acetylcholine, a chemical that influences the nerve signals in the brain. They appear to provide some mild degree of improvement in cognitive functioning for some people with mild to moderate Alzheimer’s. A trial of one of these drugs is worth considering, but if there is no worthwhile improvement after a reasonable time, there is no reason to continue them. They do have potential side effects.
Medication for the secondary symptoms, such as restlessness, depression and insomnia, has a place in the management of this condition.
Because Alzheimer’s disease cannot be cured and is progressive to death, general management of the patient is essential. The role of the main care-giver is often taken by the spouse or a close relative.
Alzheimer’s disease is known to place a great burden on care-givers, as often 24 hour supervision is required. The pressures can be wide-ranging, involving social, psychological, physical and economic stress in the care-giver’s life. Eventually, residential care in a special facility such as a nursing home becomes necessary. In developed countries, Alzheimer’s disease is one of the most costly diseases to society.
Community support should be available for the person with Alzheimer’s, but it is also essential for the family and especially the primary care-giver. This support can make a positive difference to managing dementia.
Support groups, such as Alzheimer’s Australia (National Dementia Helpline 1800 100 500), provide support, information and counselling for people affected by dementia, as well as their family and friends.
*Copyright 2010: The Huntly Centre.
Disclaimer: All material in the Huntlycentre website is provided for informational or educational purposes only. Consult a health professional regarding the applicability of any opinions or recommendations expressed herein, with respect to your symptoms or medical condition.
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