INTRODUCTION
It was described first in 1907 by germen psychologist Alois Alzheimer. He performed a histopathology study of the brain of his patient Auguste D suffering from Dementia, he saw two types of legion in the brain- sterile plaque and neurofibrillary tangle. By discovering this he reached the conclusion of a distinct disease of the cerebral cortex. A 100 years later, thanks to current technological advancement, doctors have made a great leap in the understanding of our brain through MRI scan and other advanced technologies.
Many people when they get old, they can see changes in their memory and thinking abilities. At first they might ignore this due to aging. It might be aging, but it’s also people that these are the earlier signs of Alzheimer’s disease. Alzheimer’s disease or AD is the most common form of dementia and accounts to 60-80% of all cases of dementia.
DEMENTIA AND ALZHEMIER DISEASE
Before we understand what AD is, let’s understand what Dementia is. When dealing with dementia, the doctor has to find the underlying cause, while AD is the most common, it’s not the only one. Dementia is an umbrella term which describes a sort of memory loss and symptoms related to memory loss (Short term and long term). Some of the memory loss can be related to vitamin deficiency, medication you’re taking, depression, chronic brain infection, thyroid gland problem, etc. There are 30 different forms of dementia. It can be lewy body disease, frontal temporal dementia, vascular dementia, reversible dementia (10% of all cases).
Let me give a different example on how to differentiate Dementia and AD. Let’s see shortness of breath and asthma. Shortness of breath is not a particular disease; it can have many different causes as rapid heart beating, pneumonia, anxiety, heart failure, etc. So, asthma is just one disease because of shortness of breath.
CAUSES
What happens inside our brain?
We know our brain is composed of millions of neurons which are all interconnected with each other through synapses that enable the transmission of signals from one neuron to another.
SENILE PLAQUE: In Alzheimer’s disease, 10-15 years before the first symptoms start to show, two main legion forms in the brain: Senile plaque and neurofibrillary tangle. Amyloid beta which is formed in our brain is normally washed out by our body’s immune system. But in terms of Alzheimer’s disease, this doesn’t happen and amyloid beta is no longer regulated and this creates an imbalance of amyloid beta in our brain. These protein form indissolvable fibre create senile plaque.
NEUROFIBILLARY TANGLE: The signal in the neuron is passed from the head to the synapse via tail through microtubules. These microtubules are stabilised by normal tau protein. In Alzheimer’s disease tau protein becomes defective and detaches from microtubules, thus the microtubules dissociate themselves making the skeleton of neuron unstable. Thus the connection between the neuron are lost and these neuron start to degenerate. The tails of the neurons gets tangled and swirl around the head of the neuron. This abnormal accumulation of tau protein in the neuron creates a tangled shape structure known as neurofibrillary tangle. This eventually causes the death of the neuron.
Neurofibrillary tangle and senile plaque do not follow the same pathway in our brain. Neurofibrillary tangle first form in the hippocampus region which is essential for memory and learning. They then start to spread throughout the brain.
Senile plaque initially develops in the frontal cortex, then the hippocampus and then slowly spread throughout the brain. But their progression doesn’t correspond to the progression of the disease.
One gene which is identified which might cause AD is e4 Apo lipoprotein E (APOE E4 ). As the number of APOE E4 protein gene increases, the chances of getting the disease are high (from each parent). This increases the risk of developing the amyloid beta (A-Beta) protein which is one of the proteins causing nerve damage in our brain.
FACT: In America, it is believed that one person develops AD every 66 seconds.
SYMPTOMS
In earlier day, 1950’s and 1960’s, it was more or less termed as a psychological disease where people seemed to have lost their mind and go crazy and they were actually institutionalized.
In early stages of AD, people may start to face everyday task becoming more and more difficult. It may also include increased loss of memory, finding right words to convey things, becoming confused about time and space. Having trouble doing calculation like managing money, experiencing changes in mood, personality, misplacing things or unable to find things.
It is actually a neurological disease which affects the neurons in our brains which are responsible for everyday tasks that we do- right from listening, speaking, breathing, eating, walking, etc. Thus we can see it’s more of a neurological disorder than a psychological disorder.
If the nerve cells at the back of your brain get damaged, it might lead to vision blur, difficulty in climbing and balancing. If side of your brain becomes damaged then communication and language skills gets difficult. Unfortunately, once the nerve cells start getting damaged, we cannot recover them to their fullest potential.
Hippocampus in our brain controls our ability of navigation and memory. AD mostly first affects the hippocampus. So getting lost and loss in memory are the very early signs of Alzheimer’s disease.
Age Related: By age 65, 5% of people will have something related to dementia, by age 75, 10% of all people will have dementia, by age 85 almost 40-45% of people will be having some kind of dementia. The risk factor includes genetics, if one of your parents had AD, then the chances of you getting AD is 3 fold.
DIAGNOSIS
Early Diagnose AD in early stages:
Some are in the form of written test and interviews.
You can take a brain imagery study like PET-CT scan where we can study the presence of A-Beta plaques in our brain.
Also, a procedure to get our spinal fluid to test the abnormality levels of A-beta and tau protein.
TREATMENT
Unfortunately, there is no treatment for Alzheimer’s disease. There are drugs and medications to lower the spread of protein but there isn’t any clinically proven drug to stop the inhibition. One of the ways researcher's are finding way for treatment is through:
Clinical trials where doctors and researchers can do experimental treatments to study about the disease more.
Brain imagery has been a promising area to understand how it spreads throughout the brain in order to control it.
Looking at the blood samples is also helping in treatments for where aging is becoming a factor.
Epidemiological study shows, the more education you have, the lesser the chances of you getting affected by AD. Physically active people and people with good diet control have 40-50% less chances of getting affected by AD. Remaining cognitively engaged and cognitively active reduces the risk.
Explore more about ALZHEIMER’S DISEASE through these books:
The Clinical Management of Early Alzheimer's Disease: A Handbook
Alzheimer'S Disease: How My Mother And I Went Through The Disease: Caregivers Book
The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer Disease and Other Dementias
Please Explain Alzheimer's Disease to Me: A Children's Story and Parent Handbook About Dementia
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