Causes, Treatment and Prevention of Alzheimer’s Disease

Researchers don’t yet fully understand the cause behind Alzheimer’s. There is no known definitive cause for Alzheimer Disease. There have numerous proposed causes such as high levels of aluminum in the brain, the loss of the neurotransmitter acetylcholine, and other proposed causes; but none have been verified through experimental investigation. At this point any so-called causes of Alzheimer’s disease remain speculative at best.

However, research suggests combination of both genetic and environmental factors contribute to Alzheimer’s. Over a dozen different genes may be factors in causing Alzheimer’s. Environmental factors are just as complex and various. Alzheimer’s may be caused by a large variety of environmental factors, such as education, type of employment, exercise, and diet. Hence, combination of several of them is likely to be involved in the development of the illness.

According to Dr. Daniel Amen, 50% of people aged 85 and above will have Alzheimer’s. From that age, the risk doubles every five years. One in eight are diagnosed at age 65 and it progresses to 1 in 2 at age 85! In addition, the 85+ age group is the fastest growing – making the need to be proactive quite evident.

You can prevent its onset by six years or more, with a brain-healthy lifestyle. If a family member has Alzheimer’s disease you may be at higher risk. You can’t change this, but you can delay the onset of Alzheimer’s disease and improve the health of your brain. Following are some risk factors and causes for Alzheimer’s disease.

Risk Factors of Alzheimer’s Disease

  • reduced synthesis of the neurotransmitter acetylcholine
  • generalized neuroinflammation
  • APP gene that develops fibrillar amyloid plaques
  • The onset of Alzheimer’s could be due to plaques and tangles in the brain.
  • The N-APP/DR6 pathway might be involved in self-destruction and neuronal withering.
  • Tau protein abnormalities may be responsible for initiating Alzheimer’s.
  • Another hypothesis states that the disease must be due to age-related myelin breakdown.
  • heredity
  • heart disease, open heart surgery, hypertension and high cholesterol
  • stroke/smoking
  • diabetes
  • chemotherapy/cancer
  • untreated ADD and depression
  • brain/head injury
  • exercising less than 2x per week
  • exposure to chemicals
  • lack of lifelong learning
  • too much alcohol (more than 2 glasses per week)
  • too much caffeine (more than 2 cups coffee per day)
  • Hormone Replacement Therapy

Massive Neuronal Loss

The brains of Alzheimer’s patients are characterized by a massive loss of neurons. Consequently, Alzheimer’s disease brains look smaller and shrived when compared to the brains of their age-matched normal peers. Of course, a loss of neurons means that the brain is unable to effectively function and the greater the neuronal loss will result in more cognitive problems. This loss of functioning tissue begins in the temporal and parietal regions of the brain (in typical Alzheimer’s disease) where functions such as the formations of new memories, visual-spatial skills, and language skills are known to occur. As the disease progresses other areas of the brain are affected as well, resulting in a global decline in functional abilities.

Senile Plaques

These are deposits of a substance called amyloid in the brain. These beta-amyloid deposits are clumps of insoluble fibrous protein material associated with the neuronal loss in Alzheimer’s disease and thought to also produce a neurotoxic effect. Basically, these plaques can be thought of as functionless scar tissue in the brain.

Neurofibrillary Tangles

The neurofilaments of a neuron can be thought of as the skeletal structure of the neuron. They also serve as the transport system for certain components within the cell. Thus, when these structures have become malformed the cells cannot function properly and send signals or messages to other cells. These tangles can often result in cell death.

Alzheimer’s and Chromosome 19

Out of more than a dozen genes suspected to be factors in Alzheimer’s, specific genes on chromosome 19 and on chromosome 21 have received considerable attention. The gene on chromosome 19, which codes for a protein called apolipoprotein E (ApoE), according to an article titled “Alzheimer’s Disease Genetics Fact Sheet” published by the National Institute of Aging. This protein functions to transport cholesterol in the body. This protein is found in three different forms, ApoE-2, ApoE-3, and ApoE-4. White Americans and Chinese who have two ApoE-4 genes are more than twice as likely to develop Alzheimer’s. In these demographics having one ApoE-4 gene carries less risk than having two. However, in African and Hispanic Americans, the form of ApoE seems to make no difference.

Alzheimer’s and Chromosome 21

Another gene, which scientists believe may cause risk of Alzheimer’s is found on chromosome 21. This gene codes for an amyloid precursor protein (APP), according to the National Institute of Aging. Mutations of this gene may produce a form of APP turned into Ab, which accumulates in the brain. Genetic factors of Alzheimer’s are varied and numerous and will require more research for scientists to fully understand. Scientists are now currently employing a method called genome-wide association study in order to understand genetic factors. This method involves rapidly scanning complete sets of DNA, or genomes of many individuals to find genetic variations correlate to particular diseases.

Environmental Causes of Alzheimer’s

Along with genetic factors, environmental factors also play a role in many cases of Alzheimer’s. People with higher education and those that work with people in complex interactions during employment have lower risks of Alzheimer’s. Good nutrition, eating fish, and exercise also helps to lower risk. One environmental factor that has received a lot of attention is aluminum. Brain autopsies have found higher levels of aluminum in brains from people who had contracted Alzheimer’s. Researcher Masahiro Kawahara says that unnecessary exposure to aluminum should be avoided if possible.

Individual Circumstances and Alzheimer’s

Whether the causes of Alzheimer’s are genetic or environmental seems to depend on individual circumstances. Various genetic and environmental factors seem to be at play. Certain genes seem to affect some ethnic groups while not other ethnic groups. Whether cultural differences in diet and lifestyle may be a factor or not remains to be studied. Further research will be needed to more fully understand the genetic and environmental causes of Alzheimer’s.

Heart Disease, Blood Pressure, and Diabetes

Studies suggest elements of heart disease like high levels of blood cholesterol and homocysteine, an amino acid which in large amounts can make neurons stop working and die, may contribute to the development of AD. High blood pressure can damage blood vessels in the brain and reduce the brain’s oxygen supply and may increase the risk of AD by disrupting nerve cell circuits that are thought to be important to decision-making, memory, and verbal skills.

The evidence is mounting that type 2 diabetes and AD share several characteristics, and that abnormal glucose and insulin regulation takes a toll on brain health by encouraging inflammation and the inefficient use of oxygen in the body.

Depression

Studies of individuals with a history of major depression show they were more than twice as likely to develop Alzheimer’s disease as those without past depression. Researchers hypothesize that depression may increase AD risk by overstressing the brain’s complex memory, feedback and reaction system or by exposing it to excessive amounts of the hormone glucocorticoid, causing brain cell damage and perhaps susceptibility to Alzheimer’s.

First Warning Signs of Alzheimer’s

In people with Alzheimer’s disease, changes in the brain may begin 10 to 20 years before any visible signs or symptoms appear. Some regions of the brain may begin to shrink, resulting in memory loss, the first visible sign of Alzheimer’s disease. It is very important that family members and loved ones are aware of, and look for early signs of this disease.

Sometimes these signs can mimic symptoms of normal memory loss can be difficult to recognize, since most people experience some form of forgetfulness from time to time.

According to the Alzheimer’s Association, forgetfulness should not be a cause for concern, unless it interferes with a person’s ability to function in everyday life. Alzheimer’s disease signs and symptoms include an inability to recognize family and friends, and getting lost in familiar places.

What seems like an innocent suggestion or question to the outsider may be disturbing to the person who has Alzheimer’s. For example, asking the elderly person how his oldest son is doing may trigger anxiety. Why? The elder may not remember what is happening with his son, or he may not remember that he even has a son.

Cognitive ability in the Alzheimer’s patient is drastically impaired in the latter stages of the disease. Events and details are lost completely until the elderly person can no longer remember how to do the most basic self-care. An elderly person affected by memory loss, Alzheimer’s disease, or some other form of dementia lives in the present time. More than likely, he will not be able to recall the funny incident that happened last Christmas. He may not remember the names of his grandchildren or even some of his children. He may not remember any part of the argument he had with his spouse or caregiver one day earlier.

Symptoms of Alzheimer’s

Alzheimer’s disease is a long gradual process. Symptoms of Alzheimer’s Disease tend to start gradually and become more severe over time. Progression to severe stages might take two to twenty years or longer. Although Alzheimer’s mainly affects people over the age of 65, this most common form of dementia may have an early onset in those as young as 30. Although everyone may experience moments in which they forget things, Alzheimer’s has patterns of abnormal changes affecting

  • Memory
  • Thoughts
  • Language
  • Behavior

A person who does not have dementia might misplace his or her keys while someone with Alzheimer’s may be holding the keys but cannot remember what they are called and may be unsure of what to do with the keys or why they are holding them.

Someone without Alzheimer’s might miss an appointment or forget a name while someone with Alzheimer’s may forget how to get to the doctor’s office or have no recollection of ever meeting the person. Alzheimer causes a person to eventually lose the ability to interact with others and perform daily tasks.

Alzheimer’s disease is the leading cause of dementia. This condition causes brain tissue to degenerate, which results in the loss of memory and other mental skills, such as thinking and reasoning. The risk of developing Alzheimer’s increases as a person gets older. Some of the numerous symptoms of Alzheimer’s disease that may be observed in the early stages include:

  • frequent disruptive memory changes
  • short-term memory loss- failing to remember recently learned information, forgetting important dates, asking the same questions repeatedly, depending on others to handle tasks they used to do themselves.
  • Disorientation
  • problems with abstract thinking
  • problems in relation to planning and managing
  • abnormal level of difficulty completing familiar tasks such as driving, managing finances, brushing teeth, getting dressed, or playing a familiar game
  • confusion with time or place Inability to remember the time or place – a person with Alzheimer’s may be somewhere but have no idea how they arrived at the location or where they are.
  • mixed up words in speech or writing-Difficulty with speech may appear as the person struggles to find the right word, forgets what he is trying to say, or frequently repeats herself.
  • withdrawal from social activities-  Social isolation tends to result as the person avoids activities and social gatherings he or she once enjoyed.
  • mood fluctuations
  • language troubles
  • changes in sleeping routine
  • loss of problem-solving ability
  • loss of the ability to retrace steps
  • degradation of judgment skills
  • Problems with vision, such as discriminating colors, contrasts, or depths. They may also have difficulty reading and might mistake a mirror image as another person.
  • Losing items, placing items in odd places, and being unable to retrace his or her steps in order to find those items.
  • Disinhibition.
  • Hallucinations and delusions.
  • Physical and verbally aggressive behavior.

Other Alzheimer’s Symptoms

Memory loss is not the only indication of Alzheimer’s. Alzheimer’s symptoms can cause a person to become paranoid, defensive, or agitated. It can also cause poor judgment. This is why it is not uncommon for a person who has Alzheimer’s to fall for scams. He no longer has the ability make sound decisions with his money and is susceptible to trusting the wrong people.

A person who has Alzheimer’s disease may also have a hard time performing familiar tasks, such as balancing a checkbook, cooking, or remembering and following the rules of a favorite game. The inability to concentrate makes it extremely difficult for people who have Alzheimer’s to take care of themselves. As a result, it can take them an unusually long time to do simple tasks.

Alzheimer’s disease also causes confusion with time. As a result, a person may have a hard time keeping track of the date. He may not know what day it is, the month, or the year. Furthermore, he may not be able to tell the difference between the past and present. Often, he will confuse the experiences that he had in dreams with actual events.

Stages of Alzheimer’s Disease

Another way to classify the symptoms of the Alzheimer is to group them according to the stages of the Alzheimer. Depending on what reference you read, you may find from 4 stages all the way up to 8 stages. All stages are correct, but I chose to stick with the 3 stages, so as to not load you with information.

STAGE ONE: 2-4 years leading up to the diagnosis

  • Recent short-term memory loss
  • Losing personal items
  • Confusion with time and/or place
  • Difficulty handling money
  • Poor judgment

STAGE TWO: 2-10 years after diagnosis (generally the longest stage)

  • Memory loss increases
  • Difficulty reading and/or writing
  • Difficulty speaking and/or expressing thoughts
  • Hallucinations and/or delusions
  • Repeat statements

STAGE THREE: Approximately 1-3 years (known as the terminal stage)

  • Difficulty eating/swallowing
  • Bowel/Bladder problems
  • Cannot recognize family and friends
  • Cannot communicate with words

Who is Most Affected by Alzheimer’s?

Early-onset Alzheimer’s is a rare form of dementia that strikes people younger than age 65. Aging is the number one risk factor and both men and women are equally at risk for the disease; however, women make up more of the Alzheimer’s population because they are likely to live longer than men. There is a stroke or head trauma connection to the disease. When a person fall and hit his head and go unconscious for over an hour from a head injury, he has twice the risk of developing Alzheimer’s, even though after the bleeding stops and the swelling goes down.

Diagnostic Techniques

Brain MRI and CT Scans

Brain scans are computerized pictures of the brain that help identify Alzheimer’s disease-related abnormalities. They can be taken using different medical equipment and techniques. Usually, doctors prescribe MRI or CT scans.

MRI stands for magnetic resonance imaging. A brain MRI scan is obtained through the use of a large magnet. The procedure is safe, painless and takes about one hour. The person lies inside a machine similar to a small tunnel, and pictures of the brain are taken from different angles.

This diagnostic tool can help spot Alzheimer’s disease in the early stages. In fact, a study published in the journal Neurology suggests that MRI scans have the potential to detect the illness many years before it manifests when the person shows no signs of cognitive and memory loss.

CT stands for computerized tomography. A brain CT scan is obtained using X-rays. Like for MRI scans, the patient lies inside a tunnel-shaped machine where pictures of the brains are taken from various angles. The whole procedure is painless and takes about half an hour. However, since CT uses X-rays, it is not as safe as MRI. For this reason, the number of scans is usually kept to a minimum, so as to limit exposure to radiation.

Cognitive Assessment

Some cognitive tests consist of questions aimed at establishing whether the person can remember well-known events and facts. For example, they may be asked to name the current president, the currency used in their country or the four seasons. They may also be presented with a list and asked to recall and repeat as many items as possible after a few minutes. Other cognitive tests involve tasks that help assess the person’s language, reasoning, counting, and problem-solving skills, as well as their attention span and mood.

The most commonly used cognitive test is the Mini Mental State Exam (MMSE). Another frequently used is the Clock-Drawing test. Other tests that are easier and quicker to administer are under study, including the TYM (Test Your Memory) test, recently developed by researchers of the Department of Neurology of Addenbrooke’s Hospital, Cambridge, UK. The TYM test takes only five minutes to complete and, according to findings published in the British Medical Journal, can detect dementia of the Alzheimer’s type in 93 percent of cases, versus 52 percent identified with the MMSE test.

Laboratory Tests

These include blood, urine and, in some cases, tissues and fluids tests. Some of these help rule out other diseases associated with memory loss and confusion. Others can help determine the presence of genes that are considered risk factors for dementia of the Alzheimer’s type. There is also a new test, which allows detecting Alzheimer’s disease by measuring blood levels of certain proteins called biomarkers. Not all these tests are routinely prescribed.

Your First Doctor Visit as an Alzheimer’s Patient

After the diagnosis, the doctor will help you, or the person in your care, make important decisions and deal with problems as they arise. It is therefore important to make the most of your appointments with him or her, especially the first time you visit as an Alzheimer’s patient.

Ask questions. The more you know the better you will cope with the diagnosis. You may want to know about:

  • Your tests results–what do they show exactly?
  • How far into dementia you are.
  • Drugs you’ll need to take–their benefits and possible side effects.
  • Alternative treatment options.
  • Strategies that can help you cope with memory loss.
  • How dementia will progress–which skills are you going to lose? Which ones are you going to retain?
  • Helpful resources–booklets, leaflets and so on.
  • Organizations and groups you can approach for support and advice.

To help your doctor develop a care plan that best suits your specific situation and needs, it is also important that he or she knows about

  • medications, supplements or herbal remedies you are taking;
  • changes in health, weight or behavior you have recently noticed; and
  • anything that may concern you, no matter how small.

Follow the doctor’s instructions carefully. Take a little notebook with you and write these down, or ask a relative or friend to do this for you.

Although there is currently no straightforward way to reach a diagnosis of dementia of the Alzheimer’s type, doctors can use a variety of tests–brain scans, cognitive assessment, and laboratory tests–to detect or rule out the illness. Making the most of the first doctor appointment after the diagnosis will help you better cope with the disease, right from the start.

Treatment and Prevention

Healthy diet and living style, yearly screening, and medication are some of the techniques that researchers suggest to prevent the onset of Alzheimer. Yearly screening from age 65 on can be helpful in detecting changes in functioning.

Sometimes a patient is asked to remember three words, draw a clock, etc. in screening. Seeing a medical professional can get a patient on the way to defining and addressing the problems along with researching the reasons via a proper diagnosis. Medical professionals can address concerns about safety, finances, therapy, treatment, medications, and caregivers. Besides screening, the treatments listed below act as a preventive measure rather than a cure, since researchers are still in the process of formulating an effective treatment against Alzheimer’s disease:

  • Cholinesterase inhibitors have shown some effect in relation to the degenerative disease.
  • Partial glutamate antagonists have also shown to be of use against Alzheimer’s.
  • Cognitive rehabilitation also yields positive results up to a certain extent.
  • Psychosocial intervention has also been proved to be helpful in this regard.
  • Vitamin E is useful for people suffering from Alzheimer’s.
  • Musical therapies help with the memory processing of the brain.
  • Art therapies are also known to have a positive effect on memory processing.
  • Diet rich in fish, healthy oils and nuts also helps delay Alzheimer’s.
  • Brain scans and smell identification tests can detect future Alzheimer’s even before symptoms appear.

Cholinesterase Inhibitors

An early hypothesis for the cause of Alzheimer’s disease is known as the “Cholinergic Hypothesis” that was based on early studies indicating that there is a reduction of the neurotransmitter acetylcholine in the brains of Alzheimer’s disease patients. (Neurotransmitters are chemicals secreted by neurons that allow the neurons to communicate and send messages to one another). Acetylcholine has been implicated as a neurotransmitter that is important in memory. Once neurotransmitters have been released and have performed their function they are either reabsorbed into the neuron or chemically broken down.

Cholinesterase is a by-product of the breakdown process of acetylcholine and cholinesterase inhibitors reduce the rate at which acetylcholine is broken down, hopefully increasing the concentration of acetylcholine in the brain and resulting in less neuronal death. The most commonly used cholinesterase inhibitors approved for Alzheimer’s disease symptoms are Aricept, Razadyne, and Exelon (and the Exelon Patch).

Most of these medications are hypothesized to be effective in the earlier stages of Alzheimer’s disease, but Aricept has some evidence for effectiveness at later stages. These drugs are not hypothesized to cure Alzheimer’s disease but only to slow its progression; however, some studies have indicated that they offer no real effects. Of course, these drugs and all drugs mentioned in this article can have side effects.

NMDA Receptor Antagonists

Of course, there are other neurotransmitters in the brain and one important neurotransmitter is called glutamate. Glutamate is an excitatory neurotransmitter, which basically means that it causes or stimulates neurons to fire. When glutamate neurons become overly stimulated for a prolonged period they can die through a process that is known as excitotoxicity. The NMDA neuron receptor is a form of glutamate receptor and this class of drugs binds to these receptors, therefore, inhibiting the further firing of the glutamate neurons and thus preventing the excitotoxicity process. The most common drug used in this class for the treatment of Alzheimer’s disease is Memantine, which has a host of brand names such as Namenda, Akatinol, Axura, Memox, and Ebixa/Abixa. This class of drugs is often used for the later stages of Alzheimer’s disease and is often combined with Aricept.

Behavioral Problems in AD

These problems can range from apathy or depression to aggression to hallucinations and delusions and are commonly treated with psychotropic medications such as antipsychotics or antidepressants and behavioral methods such as structuring the environment. Often treatment for behavioral issues will consist of a combination of both medication and psychosocial interventions.

Raise HDL Cholesterol

High-density lipoprotein is known as good cholesterol. Studies indicate that HDL levels over 60mg/dl can reduce the risk of developing Alzheimer’s. And the best way to raise HDL and reduce LDL (the bad cholesterol) is through exercise and eating more fruits and fresh vegetables. More soluble fiber in the diet helps increase HDL levels.

Supplement with Vitamin C

The intake of vitamin C is woefully inadequate for most people. Vitamin C is a vital component of both body and brain health. The brain has 15 times more vitamin C than is found in the other organs of the body. It’s required for good memory and mental functioning. A supplement of one gram daily helps protect the brain from the onset of Alzheimer’s.

Reduce Homocysteine Levels

Homocysteine and C-reactive protein (CRP) are better markers of a future heart attack than cholesterol alone. Those who have high homocysteine levels have four to five times the risk of developing Alzheimer’s. Eight hundred mcg of folic acid, 150 mcg of vitamin B-12 and 75 milligrams of vitamin B-6 taken every day can help lower homocysteine levels.

Essential Herbs

Nature provides a number of herbs that can help improve blood flow to the brain and speed up the delivery of oxygen to help the absorption of glucose into the brain’s cells. The brain creates its own glucose and those who have low levels often suffer from Alzheimer’s. In some medical circles, Alzheimer’s is looked on as a type 3 form of diabetes. Ginkgo biloba and vinpocetine are two herbs that help to increase circulation. They have been shown to improve memory functioning in those at the early stages of Alzheimer’s. A good daily dose should be 100 mg of ginkgo biloba and 10mg of vinpocetine.

Lifestyle Changes To Reduce Alzheimer’s Risk

In addition to above-mentioned treatments, following lifestyle changes are also recommended by the researchers to reduce the risk of Alzheimer

  • Vigorous aerobic exercise a minimum of 2 times per week increases blood flow to the brain. Exercise that works on coordination, such as dancing, is most helpful.
  • Don’t have your hair dyed or nails done too frequently assure proper ventilation.
  • Always ensure proper ventilation when utilizing chemicals of any kind, including paint and cleaning fluids.
  • Do not drink alcohol in quantities of more than 2 glasses per week.
  • Get enough sleep — at least 6 hours per night — and lessen dependence on caffeine. Drink no more than 2 cups per day.
  • Socialize, do not isolate yourself.
  • Always be enrolled and engaged in learning something new. Fifteen minutes per day of a completely different activity than you usually do is more effective than learning something new in an activity you regularly engage in. For example, a cook learning a new recipe is not as effective as a cook learning to play the piano. If your brain is learning new things it makes new physical structures. If it is not learning, it deteriorates as you get older.

Foods for Healthy Brain

Following foods promote brain health:

  • lean protein, such as fish and poultry
  • complex carbohydrates with a low glycemic index (i.e. which don’t increase the blood sugar too much), such as green leafy vegetables
  • limit trans fat but eat foods containing Omega 3 fatty acids such as salmon, tuna, avocado and walnuts
  • drink lots of water and avoid dehydration
  • blueberries
  • broccoli
  • decaffeinated green tea
  • oatmeal
  • oranges
  • red bell peppers
  • spinach
  • turkey
  • fish oil supplements, or flax seed oil
  • daily multi-vitamin
  • eat from the rainbow eating foods of all colors provides the most antioxidants

It’s probably not a coincidence that protecting the brain is also good for all other organs. Improving the health of the brain and brain function will benefit people in all areas of life, not just by delaying the onset of Alzheimer’s. Clearly, it’s a win-win.

Keeping the Brain Active

Numerous studies have shown that being socially engaged and keeping the brain active, not only throughout one’s lifetime but by adding these elements in later life, improves memory and slows cognitive decline. The maintenance of relationships and participation in many social activities has been linked to decreased incidence of dementia, and challenging and novel mental activity is known to encourage regeneration of brain cells.

“The brain is a learning machine, and like all machines, it needs to be continually maintained,” says Michael Merzenich, a professor emeritus at the University of California at San Francisco. “If you stop exercising the brain — and this is what often happens during retirement — then you shouldn’t be surprised when it starts to die off.” A variety of brain health programs are springing up to teach people healthier brain habits. You can read more about Alzheimer’s here.