What Is Alzheimer’s Disease
Alzheimers disease is the most common form of dementia, affecting up to 70% of all people with dementia. It was first recorded in 1907 by Dr Alois Alzheimer. Dr Alzheimer reported the case of Auguste Deter, a middle-aged woman with dementia and specific changes in her brain. For the next 60 years Alzheimers disease was considered a rare condition that affected people under the age of 65. It was not until the 1970s that Dr Robert Katzman declared that “senile dementia” and Alzheimers disease were the same condition and that neither were a normal part of aging.
Alzheimers disease can be either sporadic or familial.
Sporadic Alzheimer’s disease can affect adults at any age, but usually occurs after age 65 and is the most common form of Alzheimer’s disease.
Familial Alzheimers disease is a very rare genetic condition, caused by a mutation in one of several genes. The presence of mutated genes means that the person will eventually develop Alzheimer’s disease, usually in their 40’s or 50’s.
The Healthy Human Brain
Behind the ears and temples are the temporal lobes of the brain. These regions process speech and working memory, and also higher emotions such as empathy, morality and regret. Beneath the forebrain are the more primitive brain regions such as the limbic system. The limbic system is a structure that is common to all mammals and processes our desires and many emotions. Also in the limbic system is the hippocampus a region that is vital for forming new memories.
Common Forms Of Dementia
There are many different forms of dementia. Alzheimer’s disease is the most common form and may contribute to 6070% of cases. Other major forms include vascular dementia, dementia with Lewy bodies , and a group of diseases that contribute to frontotemporal dementia . The boundaries between different forms of dementia are indistinct and mixed forms often co-exist.
How Is Alzheimer’s Disease Diagnosed
There is currently no single test to identify Alzheimer’s disease. The diagnosis is made only after careful clinical consultation.
The clinical diagnosis might include:
- A detailed medical history
- Lumbar puncture for cerebral spinal fluid tests
- Medical imaging
These tests will help to eliminate other conditions with similar symptoms such as nutritional deficiencies or depression. After eliminating other causes, a clinical diagnosis of Alzheimer’s disease can be made with about 80% to 90% accuracy if the symptoms and signs are appropriate. The diagnosis can only be confirmed after death by examination of the brain tissue.
It is important to have an early and accurate diagnosis to determine whether a treatable condition other than Alzheimer’s disease, is causing the symptoms. If Alzheimer’s disease is diagnosed, medical treatment and other assistance can be discussed.
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Support For Family And Friends
Currently, many people living with Alzheimers disease are cared for at home by family members. Caregiving can have positive aspects for the caregiver as well as the person being cared for. It may bring personal fulfillment to the caregiver, such as satisfaction from helping a family member or friend, and lead to the development of new skills and improved family relationships.
Although most people willingly provide care to their loved ones and friends, caring for a person with Alzheimers disease at home can be a difficult task and may become overwhelming at times. Each day brings new challenges as the caregiver copes with changing levels of ability and new patterns of behavior. As the disease gets worse, people living with Alzheimers disease often need more intensive care.
What Does Apoe Have To Do With Alzheimers And Dementia
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The APOE is a gene that creates a protein called apolipoprotein E . This protein binds to fat to create lipoproteins , which help carry cholesterol around the bloodstream and are mainly responsible for carrying fats to and from the brain and central nervous system.
As you know, good fats play a vital role in brain function. Basically, we all have a fatty brain.
So, why all the fuss about APOE4? Large studies show that of the three major forms of the APOE gene, two are associated with a greater risk of certain diseases and conditions.
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Risk Factors For Dementia
Researchers have identified several risk factors that affect the likelihood of developing one or more kinds of dementia. Some of these factors are modifiable, while others are not.
Age. The risk of Alzheimer’s disease, vascular dementia, and several other dementias goes up significantly with advancing age.
Genetics/family history. Researchers have discovered a number of genes that increase the risk of developing Alzheimer’s disease. Although people with a family history of Alzheimer’s disease are generally considered to be at a heightened risk of developing the disease themselves, many people who have relatives with Alzheimer’s disease never develop the disease, and many without a family history of the disease do get it.
In most cases, it is impossible to predict a specific person’s risk of the disorder based on family history alone. Some families with Creutzfeldt-Jakob disease, Gerstmann-Sträussler-Scheinker syndrome, or fatal familial insomnia have mutations in the prion protein gene, although these disorders can also occur in people without the gene mutation. Individuals with these mutations are at significantly higher risk of developing these forms of dementia.
Abnormal genes are also clearly implicated as risk factors in Huntington’s disease, FTDP-17, and several other kinds of dementia.
Many people with Down’s syndrome show neurological and behavioral signs of Alzheimer’s disease by the time they reach middle age.
A Whole New Hypothesis
When science converges from multiple independent laboratories like this, it is very compelling, says Casey Lynch of Cortexyme, a pharmaceutical firm in San Francisco.
Now researchers from Cortexyme and several universities have reported finding the two toxic enzymes that P. gingivalis uses to feed on human tissue in 99 and 96 per cent of 54 human Alzheimers brain samples taken from the hippocampus a brain area important for memory . These protein-degrading enzymes are called gingipains, and they were found in higher levels in brain tissue that also had more tau fragments and thus more cognitive decline.
The team also found genetic material from P. gingivalis in the cerebral cortex a region involved in conceptual thinking in all three Alzheimers brains they looked for it in.
This is the first report showing P. gingivalis DNA in human brains, and the associated gingipains co-localising with plaques, says Sim Singhrao at the University of Central Lancashire, UK, who wasnt involved in the study. Her team has previously found that P. gingivalisactively invades the brains of mice with gum infections.
The Porphyromonas gingivalis bacteria that can cause gum disease
A. Dowsett, Public Health England/Science Photo Library
When the team gave P. gingivalis gum disease to mice, it led to brain infection, amyloid production, tangles of tau protein and neural damage in the regions and nerves normally affected by Alzheimers. This suggests causation, says Lynch.
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Alzheimers Disease Vs Mild Cognitive Impairment
Early dementia, also known as mild cognitive impairment , involves problems with memory, language, or other cognitive functions. But unlike those with full-blown Alzheimers, people with MCI are still able to function in their daily lives without relying on others.
According to the Alzheimers Association, about 15 to 20 percent of people over the age of 65 experience mild cognitive impairment. Many people with MCI eventually develop Alzheimers disease or another type of dementia. However, others plateau at a relatively mild stage of decline and are able to live independently. Some people with mild cognitive impairment even return to normal.
Symptoms of MCI include:
- Frequently losing or misplacing things.
- Frequently forgetting conversations, appointments, or events.
- Difficulty remembering the names of new acquaintances.
- Difficulty following the flow of a conversation.
It is not yet fully understood why MCI progresses to Alzheimers disease in some, while remaining stable in others. The course is difficult to predict, but in general, the greater the degree of memory impairment, the greater the risk of developing Alzheimers down the line.
Where To Get Help
- Your local community health centre
- National Dementia Helpline Dementia Australia Tel. 1800 100 500
- Aged Care Assessment Services Tel. 1300 135 090
- My Aged Care Tel. 1800 200 422
- Cognitive Dementia and Memory Service clinics Tel. 1300 135 090
- Carers Victoria Tel. 1800 242 636
- Commonwealth Respite and Carelink Centres Tel. 1800 052 222
- Dementia Behaviour Management Advisory Service Tel. 1800 699 799 for 24-hour telephone advice for carers and care workers
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Granulovacuolar Degeneration And Neuropil Threads
Granulovacuolar degeneration occurs almost exclusively in the hippocampus. Neuropil threads are an array of dystrophic neurites diffusely distributed in the cortical neuropil, more or less independently of plaques and tangles. This lesion suggests neuropil alterations beyond those merely due to NFTs and SPs and indicates an even more widespread insult to the cortical circuitry than that visualized by studying only plaques and tangles.
Risk Factors And Prevention
Although age is the strongest known risk factor for dementia, it is not an inevitable consequence of ageing. Further, dementia does not exclusively affect older people young onset dementia accounts for up to 9% of cases. Studies show that people can reduce their risk of dementia by getting regular exercise, not smoking, avoiding harmful use of alcohol, controlling their weight, eating a healthy diet, and maintaining healthy blood pressure, cholesterol and blood sugar levels. Additional risk factors include depression, low educational attainment, social isolation, and cognitive inactivity.
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For Those With Apoe2 Certain Foodstuffs Could Be Beneficial Such As Natt Made From Fermented Soybeans
This contains an enzyme called nattokinase that is synthesized by the bacteria that ferment the soybeans. Nattokinase is a very powerful clot-buster helping to break up fibrin blood clots, which could offset some of the cardiovascular risks associated with the APOE2 gene.4 If finding and eating natt is highly unlikely for you, nattokinase is also available as a dietary supplement in your health food store.
Finally, APOE4 is the variant most associated with an increased risk of Alzheimers disease and other neurological conditions.1 It isnt, however, at all clear why this variant increases a persons risk of AD. Potentially, this variant might affect the development of neurites, part of the brains neural network.5
There is certain agreement within the scientific community that those with the APOE4 genotype may fare badly on a diet high in the processed fats and inflammatory seed oils that are so pervasive in our diets today. These may cause a dramatic increase in brain inflammation.
This genotype should strictly avoid these inflammatory foods and may do best on a diet higher in anti-inflammatory dark green and root vegetables, obtaining their animal protein from grass-fed animals. Grass-fed animals have a higher ratio of omega-3 fats.
How Does Alzheimers Develop
Research suggests that changes in the brain can occur up to ten years before a person starts to show symptoms of Alzheimers disease. The symptoms are usually mild at the beginning and gradually worsen over time. These may include:
- difficulty remembering recent events while having a good memory for past events
- poor concentration
- difficulty recognising people or objects
- poor organisation skills
- slow, muddled or repetitive speech
- withdrawal from family and friends
- problems with decision making, problem solving, planning and sequencing tasks
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What Causes Alzheimers
The causes of Alzheimers disease are not yet fully understood, but probably include a combination of:
- Age-related changes in the brain, like shrinking, inflammation, blood vessel damage, and breakdown of energy within cells, which may harm neurons and affect other brain cells.
- Changes or differences in genes, which may be passed down by a family member. Both types of Alzheimer’s the very rare early-onset type occurring between age 30 and mid-60s, and the most common late-onset type occurring after a persons mid-60s can be related to a persons genes in some way. Many people with Down syndrome, a genetic condition, will develop Alzheimers as they age and may begin to show symptoms in their 40s.
- Health, environmental, and lifestyle factors that may play a role, such as exposure to pollutants, heart disease, stroke, high blood pressure, diabetes, and obesity.
Watch this video to see how Alzheimers disease changes the brain.
Ps1 And Ps2 Mutations
Approximately 50-70% of early-onset autosomal-dominant AD cases appear to be associated with a locus mapped by genetic linkage to the long arm of chromosome 14 . Numerous missense mutations have been identified on a strong candidate gene, called PS1.
At the same time, another autosomal dominant locus responsible for early-onset AD was localized to chromosome 1. Two mutations were identified on the candidate gene, designated PS2. The physiological role of presenilins and the pathogenic effects of their mutations are not yet well understood.
Stages Of Alzheimers Disease
People with Alzheimers disease differ in the patterns of problems they experience and in the speed with which their abilities deteriorate. Their abilities may change from day to day, or even within the same day. What is certain is that the persons abilities will deteriorate sometimes rapidly over a few months, sometimes more slowly, over a number of years.Some of the features of Alzheimers disease are classified into three stages. It is important to remember that not all of these features will be present in every person, nor will every person go through every stage. But these stages are still a useful description of the progression of Alzheimers disease.At all stages of Alzheimers disease, treatments and support services are available. Use these to make sure of the best possible quality of life for everyone affected by Alzheimers disease.
What Are The Signs And Symptoms Of Alzheimers
Memory problems are often one of the first signs of Alzheimers. Symptoms vary from person to person, and may include problems with:
- Word-finding, or having more trouble coming up with words than other people the same age.
- Vision and spatial issues, like awareness of the space around them.
- Impaired reasoning or judgment, which can impact decisions.
Other symptoms may be changes in the persons behavior, including:
- Taking longer to complete normal daily tasks.
- Repeating questions.
- Trouble handling money and paying bills.
- Wandering and getting lost.
- Losing things or misplacing them in odd places.
- Mood and personality changes.
- Increased anxiety and/or aggression.
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What Is The Burden Of Alzheimers Disease In The United States
- Alzheimers disease is one of the top 10 leading causes of death in the United States.2
- The 6th leading cause of death among US adults.
- The 5th leading cause of death among adults aged 65 years or older.3
In 2020, an estimated 5.8 million Americans aged 65 years or older had Alzheimers disease.1 This number is projected to nearly triple to 14 million people by 2060.1
In 2010, the costs of treating Alzheimers disease were projected to fall between $159 and $215 billion.4 By 2040, these costs are projected to jump to between $379 and more than $500 billion annually.4
Death rates for Alzheimers disease are increasing, unlike heart disease and cancer death rates that are on the decline.5 Dementia, including Alzheimers disease, has been shown to be under-reported in death certificates and therefore the proportion of older people who die from Alzheimers may be considerably higher.6
Emotion And Behavior Treatments
The emotional and behavioral changes linked with Alzheimers disease can be challenging to manage. People may increasingly experience irritability, anxiety, depression, restlessness, sleep problems, and other difficulties.
Treating the underlying causes of these changes can be helpful. Some may be side effects of medications, discomfort from other medical conditions, or problems with hearing or vision.
Identifying what triggered these behaviors and avoiding or changing these things can help people deal with the changes. Triggers may include changing environments, new caregivers, or being asked to bathe or change clothes.
It is often possible to change the environment to resolve obstacles and boost the persons comfort, security, and peace of mind.
The Alzheimers Association offer a list of helpful coping tips for caregivers.
In some cases, a doctor may recommend medications for these symptoms, such as:
- antidepressants, for low mood
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Thinning Of The Cortex
Advances in MRI technology have provided the ability to see the brain structure in great detail in an easy, non-invasive manner in vivo. Bartzokis et al., has noted that there is a decrease in volume between adulthood and old age, whereas volume was found to increase from age 19â40, and decline after this age. Studies using have identified areas such as the and superior parietal gyri as being especially vulnerable to age-related losses in grey matter of older adults. Sowell et al., reported that the first 6 decades of an individual’s life were correlated with the most rapid decreases in grey matter density, and this occurred over dorsal, frontal, and on both interhemispheric and lateral brain surfaces. It is also worth noting that areas such as the , and surrounding the appear exempt from this decrease in grey matter density over time. Age effects on grey matter density in the posterior temporal cortex appear more predominantly in the left versus right hemisphere, and were confined to posterior language cortices. Certain language functions such as word retrieval and production were found to be located to more anterior language cortices, and deteriorate as a function of age. Sowell et al., also reported that these anterior language cortices were found to mature and decline earlier than the more posterior language cortices. It has also been found that the width of not only increases with age, but also with cognitive decline in the elderly.