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Alzheimer’s Disease:

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Susan Schiller

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2

Every 70 seconds, someone develops Alzheimer’s disease. Alzheimer’s disease is an

irreversible, progressive brain disease that slowly destroys memory and thinking skills. Direct

and indirect costs of Alzheimer’s and other dementias to Medicare, Medicaid, and businesses

amount to more than $148 billion each year. By age sixty five, the probability of developing

Alzheimer’s doubles every five years. Many baby boomers reached sixty five in 2011. By 2000,

thirty five million people turned sixty five and by 2050, that number is expected to double. These

demographics prompt a sense of urgency to find answers on how to deal with a pending

epidemic that could exhaust financial and social resources within twenty years if we fail to

reduce the risk. Because of the difficulty in finding pathological evidence, the diagnosis for

Alzheimer’s can be made only when other etiologies for the dementia have been ruled out. 1

German doctor Alois Alzheimer first described the disease in 1906. Auguste D. became a

patient of the hospital five years before her death at age fifty-one with symptoms of loss of

memory; speech, comprehension, and also hallucinations and behavior problems. The autopsy

revealed a massive amount of sticky proteins lodged in spaces between the nerve cells now

called beta-amyloid plaques. He also discovered tangled bundles of protein threads within the

neurons themselves, called neurofibrillary tangles. These two findings are the defining features

of Alzheimer's disease, the most common form of dementia.

Studies over the next fifty years from the time it was discovered were slow since at the

time this was a rare occurrence, life expectancy was much lower (forty-seven or forty-eight.)

Today we know that beta amyloid is produced and cleared away very rapidly in our brains, in an

eight or nine hour period an young person’s brain will have produced and cleared away half of

their beta amyloid. These levels can rise and fall dramatically throughout the day, when neurons

communicate they are productive. Research may one day tell us what activities cause the rise and
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fall as well as provide better drug inhibitors. Unlike beta amyloid, neurons cannot be replaced; to

stay healthy they must continuously repair themselves. The brain has billions of neurons partly

made up of microtubules, each with a cell body containing a nucleus that controls most of the

cell’s activities. The axons & dendrites transmit across the synapse for the nucleus. Molecules

within the axons & dendrites are supported by tau protein, but when an abnormal phosphate

molecule attaches itself to the tau, it detaches causing collapse resulting in tau tangles. The beta

amyloid production and neuron communication, metabolism, and repair are impaired in

Alzheimer patients. Signs of the disease first appear in the entorhinal cortex, proceeding to the

hippocampus. These areas begin to shrink as nerve cells dissipate; changes can start ten to twenty

years before symptoms begin, memory loss is the first sign.

There are two kinds of AD; early onset, a rare form usually found in people age thirty to

sixty (although there was a case in which a twenty-two year old man was diagnosed) and late

onset, a more common type often found in people over sixty-five. The top ten signs include;

memory loss affecting job performance, difficulty performing familiar tasks, language problems,

time/place disorientation, poor/decreased judgment, trouble with abstract thought, misplacing

things, mood changes, personality changes, and loss of initiative. 2

For years the only way to know this was happening was by autopsy but early detection is

not only possible it is recommended so that treatment can delay severe stages and diagnosis has

ninety percent accuracy rate. Mild cognitive impairment (MCI) or being more forgetful on an

above average scale could be a precursor. Things that once were easy to remember become

difficult or significant changes in behavior such as forgetting a familiar route. Even then a

diagnosis may not happen since other indicators within physical, memory and cognitive testing

may show no need for concern. This disease is very progressive and the tests help doctors
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distinguish between memory loss from dementia and regular aging. MCI may later develop into

Alzheimer's. Different pathways are being explored: The relationship between inflammation and

beta amyloid plaque is also being explored. Another hypothesis is looking at possible links to

vascular disease. If a link can be established, it would lead to therapeutic and preventative

strategies that have already been researched extensively. Also homocysteine, an amino acid

linked to heart disease, shows up in elevated levels with AD patients. A link has also been found

in people with type two diabetes and insulin resistances. Both are more at risk of developing

MCI and AD. Vascular disease, diabetes and insulin resistance are all preventable with diet,

exercise, and other lifestyle changes. Researchers are studying genetic mutations to identify a

gene code.

Although genetics are still a barrier, a long term study revealed that a diet rich in fish

with the omega-3 fatty acid, DHA, consumed weekly cut the odds of dementia nearly in half.

Participants who ate the most fish (three times per week or 180 milligrams) had the lowest

incident of dementia over age seventy-five. DHA (docosahexaenoic acid) is found in the brain,

and may raise HDL levels or good cholesterol and lower harmful fats called triglycerides. It also

slows the buildup of plaque that can slow blood flow in the vessels. DHA builds the strength of

neurons and synapses responsible for memory, language, and thinking. Oily fish, such as salmon,

tuna, mackerel, and herring are rich in DHA.3

Another growing body of evidence is a link between vitamin D and cognitive function.

Metabolic pathways for vitamin D have been found in the hippocampus and cerebellum, areas of

the brain used in planning, processing, and forming new memories leading to the idea that

vitamin D may be involved in cognitive functions. A study involving more than 1,000 people

receiving home care, researchers looked at the connection of vitamin D blood concentrations and
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neuropsychological tests. Elders needing home care have a higher risk of a lack of vitamin D

because of limited exposure to the sun and other issues. People ages sixty-five to ninety-nine

years, were grouped as deficient, insufficient, or sufficient in vitamin D. Only thirty-five percent

had enough vitamin D. The same people who had better cognitive performance on the tests.

Some B vitamins nourish the brain as well. B12 is essential for brain and nerve cell

function, B6 is essential to nerve tissue, and folate (another B vitamin) is vital to cell and tissue

growth. Studies on mice fed a diet without these vitamins found that the mice had lower

cognitive functioning. Researchers hypothesized that the deficiency triggered a malfunction of

the brain’s blood vessel circulation and increased levels and the mice showed similar

characteristics as those of older adults at risk for Alzheimer’s. Volunteers with depression whose

B12 ratios were significantly less were more than three times more likely to show cognitive

decline, showing an association between lower blood folate and depression which is already

known to influence brain function.

While various foods reduce the risk of different forms of dementia, other research shows

the risk of developing some cognitive problems is inherited. People who carry the E4 version

(allele) of the apolypoprotein gene variant (about 20 percent) are known to have a greater chance

of developing Alzheimer’s disease compared to all other causes of dementia. In an eight-year

study, those with the apolypoprotein E4 allele did not have a major oily-fish eating benefit found

with other study participants.

Degenerative brain diseases are brought on by a combination of factors that include both

inherited factors and lifestyle choices. One dramatic example of this is Alzheimer’s disease in

Africa. African Americans with the apolypoprotein E4 allele gene have the expected risk of

developing late onset after the age of sixty but Africans living below the Sahara with the same
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gene have a reduced risk of developing the disease. The major difference between the two

groups: those living in the sub-Saharan region get plenty of exercise and eat low fat diets. The

first clear link between vitamin D deficiency and development of cognitive problems, a key trait

of dementia, was exposed by a University of Exeter research team. An antioxidant-rich diet with

walnuts improved memory and learning in mice with Alzheimer's. Physical activity, green tea

and vitamin D were found to aid in cognitive ability for older adults in three long-term, large-

scale studies. Also, a nasal spray restoring normal insulin function in the brain may provide

benefits. A type of jellyfish found in Oahu, Hawaii called Aequorea victoria contains a protein

that is a potential therapeutic for Alzheimer's disease.4

In conclusion, prevention and treatment methods, especially early diagnosis make it

possible to delay symptoms and progression through a series of family education, drug therapy,

antioxidants and also lifestyle changes for an improved quality of life as well as less medical

costs. Current FDA approved drugs include Donepezil-Aricept; Rivastigmine-Exelon,

Galantamine-Razadyne, and Memantine-Namenda. The prognosis is hopeful as advanced

research, prevention methods and case studies continue.5

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Notes

1. National Institute for Alzheimer’s Disease, National Institutes of Health, Department of

xxxx Health and Human Service. (Ed.). (2009). Progress Report on Alzheimer’s Disease.

Xxxx Washington DC: NIH 09-7378.

2. Hoffman, John, Froemke, Susan, & Golant, Susan. (2009). The Alzheimer’s Project.

XxxxNew York: Public Affairs.

3. Bliss, Rosalie. (2010). Food discoveries for brain fitness. Chicago USDA Agricultural

xxxx Research, 07, 18-20

4. Alton, H. (2010, July 17). Doctors, scientists adopt new approach to Alzheimer’s care.

Xxxx Honolulu Star, Retrieved from

xxxxhttp://www.staradvertiser.com/news/hawaiinews/20100717_doctors_scientists_ado

xxxx pt_new_approach_to_alzheimers_care.html

5. CBS News. (2009, July 9). Alzheimer's early signs revealed by brain scans, memory

xxxx tests. Retrieved from http://www.cbc.ca/health/story/2009/07/14/alzheimer-early-

xxx diagnosis.html