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Alzheimer's disease - latest research

Alzheimer'sdiseaseisthemostcommonformofdementiaintheelderly.Itisaprogressiveand eventuallyfataldiseaseofthebrain.Itimpairshigherbrainfunctionssuchasmemory,thinking andpersonality.Currentresearchislookingatcauses,treatmentandpossiblepreventionof Alzheimer'sdisease. Alzheimersdiseaseismostcommonlysporadic,affectingonein25Australiansaged60yearsand over.However,raregeneticmutationscancauseaninheritedformofthedisease.

Ima ge des crip

Alzheimers disease causes changes in the brain

Braincellsorneuronestalktoeachotherthroughconnectionscalledsynapses.InAlzheimers disease,theseconnectionsarebrokenandultimatelydisappearinthepartsofthebrainwhere thinkingoccurs. ResearchhasfoundthatpeoplewithAlzheimersdiseasehavedamagedbraincells,calledtangles, anddepositsbetweenthecells,calledamyloidplaques.Theseplaquesaremostlymadeupofa proteincalledbetaamyloidorA-beta.Abuild-upofthisotherwisenormalproteinisthoughtto causethedamage. Thebetaamyloidproteincandamagebraincellsindifferentways,including: Convertingoxygenintohydrogenperoxideaformofbleachwhichthenoxidisesor corrodesbraincells Signallingtobraincellstoselfdestruct Interferingwiththenormaltransmissionofmessagesbetweenbraincells,particularlythe partsofthebrainwithmemoryandreasoning.

Researchersaretryingtoworkoutwhythisbuild-upofamyloidplaquesoccursinsomepeopleand notothers.Theyarealsotryingtofindwaystoreduceorabolishthetoxiceffectsofthisprotein.

Established risk factors for Alzheimers

ThecauseorcausesofAlzheimersdiseasearenotknown.However,someriskfactorshavebeen identified.Well-establishedriskfactorsforAlzheimersinclude: AgetheriskofdevelopingAlzheimersdoublesforeveryfiveyearsoverage65.For peopleaged7074years,thereisa1in30chance,comparedtoa1in3chancefor peopleaged90to94years. Genetic historyearly-onsetAlzheimersisaveryrareformofthediseasethatcanoccur inpeoplebetweentheagesof30and60.Inthe1980s,researchersfoundthatchangesin certaingenescauseearly-onsetAlzheimers.Apersonhasaoneintwochanceof developingearly-onsetAlzheimersifoneparenthasanyofthesegeneticmutations. Genetic conditionsmanypeoplewithDownsyndromeovertheageof40willdevelop Alzheimersdiseaseatarelativelyearlyage.Thisismostlikelyduetoanacceleratedbuild upofamyloidlinkedtothepresenceofanextracopyoftheamyloidprecursorprotein gene,the'parent'moleculeofbetaamyloid.

Possible risk factors

OtherriskfactorsforAlzheimershavebeensuggested,butnotallhavebeenproven.Some possibleriskfactorsinclude:

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Head injuryespeciallymoresevereheadinjuries Head sizepeoplewithasmallerheadmaybeatahigherriskofAlzheimersdisease Vascular risk factorsfactorsthataffectthevascular(bloodvessel)systemmayalso increasetheriskofAlzheimers;thesemayincludethingssuchassmoking,hypertension anddiabetes Diet adiethighinsaturatedfatsmayincreaserisk.

Research into treatments

ResearchintoAlzheimersisfocusedonfourpossibletreatments,whichare: Increase the efficiency of the damaged nerve cellsthedrugscurrentlyusedare donepezilhydrochloride(Aricept)andmemantinehydrochloride(Namenda,Ebixa).They bolstertheefficiencyofthenervecellsmostaffectedbyAlzheimersdisease.However,the effectsareshortlivedanddontcurethedisease. Prevent production of beta amyloid proteinsresearchersaresearchingformolecules thatinhibitprocessingoftheparentmoleculeofthebetaamyloidprotein,toreducethe productionoftheproteins. Protect nerve cells from the damaging effects of hydrogen peroxidestudiesusing vitaminEhaveshownsmallbutsignificantimprovementsinfunctioninonegroupof Alzheimersdiseasesufferers.Researchersaretestingarangeofantioxidantstoseeifthey helpprotectnervecells.Otherresearchisaimedatpreventinginteractionswiththemetals copper,zincandiron,whichareneededfornormalbrainfunction,butcanalsocausethe betaamyloidtobecometoxic. Inhibit the build-up of beta amyloid proteinsresearchersbelievethatbetaamyloid proteinsmaybecometoxicastheybuildup.Iftheaccumulatedproteinscouldbebroken down,theymaybelessharmful.

Research into risk factors and prevention

Manyareasarebeingresearchedaspossibleriskfactors,whichmayhelpidentifywaystodelayor preventtheonsetofAlzheimersdisease.Areasofresearchinclude: Cholesterol Highbloodpressure Diabetes Genderandhormones Brainactivity Physicalactivity Antioxidantsandnutrition.

Cholesterol
Someresearchhassuggestedaconnectionbetweenhighbloodcholesterollevelsandahigherrisk ofAlzheimers.Thiscausedresearcherstoaskwhetherdrugsthatlowerbloodcholesterolmight alsolowertheriskofAlzheimers.Themostcommondrugsusedtolowerbloodcholesterolare calledstatins.However,clinicalstudieshavenotshownreducedriskofAlzheimer'sinlong-term usersofstatins. Otherresearchhasfoundthatahighleveloftheaminoacidhomocysteineisassociatedwithan increasedriskofdevelopingAlzheimers.Highlevelsofhomocysteineareknowntoincreasethe riskofheartdisease.

High blood pressure

Theremaybealinkbetweenhighbloodpressure,otherstrokeriskfactorsandAlzheimers disease. Highbloodpressureandotherstrokeriskfactorsage,diabetesandcardiovascular diseasecandamagebloodvesselsinthebrainandreducethebrainsoxygensupply.The resulting'oxidativestress'mayacceleratethebuild-upofbetaamyloid.

Diabetes

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StudiesshowthatdiabetesisassociatedwithseveraltypesofdementiaincludingAlzheimersand vasculardementia(atypeofdementiaassociatedwithstrokes).Alzheimersandtype2diabetes shareseveralcharacteristics,includingdepositsofadamagingamyloidproteininthebrainfor Alzheimersandinthepancreasfortype2diabetes.Scientistsarelearningmoreaboutthe possiblerelationshipsbetweenthesetwodiseases.

Gender and hormones

ItisknownthatwomenhaveahigherriskthanmenofdevelopingAlzheimersdisease,even allowingforthelongeraveragelifespanofwomen.Researchersareexaminingtheeffectofvarious hormonesonthebrain,includingoestrogen. Somestudieshavesuggestedthatwomenwhotakeoestrogen-basedhormonereplacement therapy(HRT)havealowerriskofdevelopingAlzheimersdisease,whileonerecentstudy suggestedahigherriskwhereoestrogenlevelsarelowinthebrain,notjustintheblood.However, anotherstudyhasshownthattheriskofdementiadoesnotreducewithoestrogen-onlyHRT,and increasesslightlywithcombinationoestrogenandprogesteronetherapy.

Brain activity
Keepingthebrainactiveisassociatedwithreducedriskofage-relatedAlzheimers,butitisnotyet clearwhythisisthecase.Researchislookinginto: Mentallystimulatingactivitiesandhowtheymightprotectthebrain.Itisthoughtthat theseactivitiesmighthelpthebrainbecomemoreadaptableandflexibleinsomeareasof mentalfunctionsothatitcancompensatefordeclinesinotherareas. Reducedinvolvementinintellectualstimulation,whichcouldreflectveryearlyeffectsofthe disease. Otherlifestyleissues.Peoplewhoregularlyengageinmentallystimulatingactivitiesmight haveotherlifestylefeaturesthatmayprotectthemagainstAlzheimers.

Physical activity
Researchinanimalsandhumanshasshownthatbothphysicalandmentalfunctionimprovewith aerobicfitness.Forexample,someresearchhasfoundthatwalkingwasparticularlybeneficial.In onestudy,awalkinggroupbecamemorephysicallyfitthanthosewhowereassignedtoa stretchingandtoninggroup.Thewalkersalsoshowedgreaterimprovementsontestsofplanning, schedulinganddecisionmaking.

Antioxidants and nutrition

ResearchiscontinuingintotheroleofnutritionandnutritionalsupplementsinAlzheimersdisease. Areasofresearchinclude: Antioxidantsthese mayprotectbraincellsagainstthedamagingeffectsofhydrogen peroxideasbetaamyloidproteinsbreakdown.VitaminEhasshownsomepromise,but veryhighdosesofvitaminE(above1,000unitsperday)canactuallyincreasetheriskof havingastroke.Theherbalsupplementgingkobilobaisalsobeinginvestigatedforits antioxidantproperties,butthereisnoevidencethatitwillcureorpreventAlzheimers. Fats in foodahighintakeofsaturatedfatsincreasestheriskofdiabetes,hypertension andothervascularconditions,whicharethoughttobeassociatedwithAlzheimers. ResearchisinvestigatinghowdietinteractswithAlzheimers. B-group vitaminspeoplewithlowlevelsoffolicacid(folate)orvitaminB12appearto beathigherriskofAlzheimersdisease.Adeficiencyineithervitaminmayallowan increaseinthelevelsofanaminoacidcalledhomocysteine,whichisknowntobearisk factorforheartdisease. Sagetheherbreputedlyboostsmemory.Ithasbeenshownthatsageactsasa cholinesteraseinhibitor,thesamebehaviourshownbythreedrugslicensedforAlzheimers disease. Aluminiumthereisnoevidencethataluminiuminthedietorenvironmentincreasesthe riskofAlzheimers,butresearchiscontinuing.

Vitaminsandherbalsupplementscanhavepowerfulsideeffectsandinteractwithother medication.Discusstakinganysupplementswithyourdoctorfirst.

Steps that may help prevent dementia and Alzheimers disease

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Itisnotpossibletocuredementia.Thereisnoprovenwaytopreventdementia,including Alzheimersdisease.However,researchhasshownthatsomemeasuresmayreducetheriskby eitherdelayingorpreventingtheonsetofdementia. Manyofthesestepshaveprovenhealthbenefitsforotherconditions,eveniftheydonotultimately protectagainstAlzheimersdisease.Suggestionsinclude: Avoidheadinjuryalwayswearaseatbeltanduseprotectiveheadwearforsports. Monitorandlowercholesterolandhomocysteinelevels. Monitorandcontrolhighbloodpressure. Controldiabetesandmaintainahealthyweight. Limitsaturatedfatsinyourdiet. Enjoyadiethighinantioxidantsfromfruitsandvegetables. MaintainadequatedietaryvitaminEandconsidersupplements(notmorethan400mga day)ontheadviceofyourdoctor. MaintainadequateB12andfolicacidintakeandconsidersupplementsontheadviceof yourdoctor. Enjoyamoderatealcoholintakeifyoudrinkalcohol. Maintainsocialandintellectualactivities. Exerciseregularly. Dontsmoke.

Where to get help

Yourdoctor NationalDementiaHelplineTel.1800100500 TheMentalHealthResearchInstituteofVictoriaTel.(03)93881633 Yourlocalcommunityhealthservice Yourlocalcouncil AgedCareAssessmentServices(contactviaDHS)Tel.(03)96060000

Things to remember

ThecauseofAlzheimersdiseaseisnotknownandthereisnocure. ResearchhasidentifiedmanyriskfactorsforAlzheimersdisease. ActivitiesthatmaypreventordelayAlzheimersdiseasewillalsobenefityouroverall health.

This page has been produced in consultation with, and approved by:

MentalHealthResearchInstitute
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Alzheimer'sdisease-latestresearch

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