What is Alzheimer’s Disease?

According to the Alzheimer’s Association, “Dementia is a general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life.” Alzheimer’s dementia (AD) is the most common form of dementia affecting memory and other cognitive abilities. Alz.org, reports 60-80% of dementia cases are AD. Additionally, 5.8 million Americans ages 65 and older are diagnosed with AD, and the numbers are expected to double by 2050. AD patients suffer a slow, mental decline and experience a progressive loss of memory beginning with losing recent events and concluding with losing the ability to perform basic human needs. AD is a tragic disease that forces family members and caretakers to suffer as their loved ones slowly lose their memory, independence, and ultimately, their entire identity. 

Diagnosis 

AD is largely a diagnosis of exclusion. CT and MRI scans eliminate the possibility that symptoms could be caused by a tumor, hemorrhage, or embolic stroke. However, scans that demonstrate the loss of brain mass and visibly smaller regions of the brain may indicate AD. The disease deteriorates the brain, injuring and killing 75% of neurons and weakens connections between neurologic networks. Specifically, AD causes the hippocampus, the region of the brain responsible for creating new memories, to shrivel. Dr. Alois Alzheimer coined the term AD after he discovered unusual clumps and tangled fibers during the examination of a patient who had died from an unknown mental illness. These clumps, now known as amyloid plaques, and fibers, neurofibrillary tangles, are significant signs that lead to the diagnosis of AD.

Causes

The causes of AD are not yet fully understood by scientists. The etiology of AD is likely multifactorial, arising from genetic, environmental, and lifestyle factors. For people with early-onset Alzheimer’s, a genetic mutation is probably involved, while a person with late-onset Alzheimer’s likely underwent a series of complex brain changes over a long period of time. 

Currently, scientists are examining amyloid plaques and neurofibrillary fibers in an effort to better understand the development of AD. With advancements in brain imaging technology, the exploration of the development and spread of various proteins in the brain are drastically easier to study. Additionally, professionals have been inspecting the changes in the body, from the brain to bodily fluids, that occur preliminarily to the demonstration of AD symptoms.

While it can occur at any age, AD mainly is seen in adults over 60. The cause for this age distribution is poorly understood. Some age-related changes include inflammation, vascular deterioration, mitochondrial dysfunction, and brain atrophy and are active areas of scientific research and investigation. 

Although there is not a single genetic malformation that has prose to be the source of AD, scientists have discovered that having the ε4 form of the apolipoprotein E (APOE) gene increases the risk for AD at an earlier age. Furthermore, the various regions in a genome (a complete set of DNA), exhibit relationships with AD. For example, people with Down Syndrome are more likely to develop the disease because they carry an additional copy of chromosome 21, which contains a gene that creates a dangerous amyloid. 

Environmentally, on the other hand, healthy aging is associated with having a balanced diet, social interaction, and exercising regularly. Scientists are continuing to study the brain and other possible factors to discover further information about Alzheimer’s.

Stages

There are three main stages of Alzheimer’s disease: Early-stage AD, Moderate stage AD, and Late-stage AD. Typically, patients may be unaware that they have Early-stage AD. Symptoms consist of non-specific forgetfulness that may not be seen outside of normal. Patients will most likely still be independent, but struggle with remembering names, making plans, managing money, and staying organized. The patient and their loved ones may notice the increased forgetfulness, but not place any significance into it. 

The moderate stage is the most prolonged. All the symptoms from the mild stage are increased and they will progress into trouble reading, writing, remembering things about themselves or familiar people, and they may start to exhibit personality changes. At this stage, the person starts to require assistance for routine tasks and may be unusually anxious or upset, as they notice their cognitive decline. 

The late stage of AD results in the deterioration of many physical abilities: walking, sitting and eating. Patients will also struggle to recall words or phrases. Their sentences will be hard to understand and they will struggle to hold a conversation. Patients in this later stage demonstrate a decrease in their immune systems and become prone to infections.

Treatment

AD has few treatment options and no cure. Treatment options include therapies and medications that help control the symptoms of AD, but nothing currently works to reverse its progression. The medicines typically prescribed to patients work by regulating neurotransmitters, the chemicals that transport messages in the brain, however, there are several limitations. Ultimately, these medications and therapies work for few patients, and while may help to ease symptoms, they do not cure the disease. Scientists are continuing work to develop better treatment and preventative options to preserve independence and comfort. 

Family & Caregiver Support

Caring for a person with AD is demanding, and it is draining for the patient and caregiver emotionally, physically, and financially. Most commonly, people are forced to watch their parents mentally deteriorate and have to care for them like they were an infant. 

My grandmother, for example, passed away due to the complications of AD six months ago but started exhibiting symptoms over ten years prior. It began by misplacing things and forgetting how to drive to routine places, and as she progressed to the moderate stages, her personality changed drastically. Before AD she was patient and outgoing, but the disease caused her to frustrate easily and slowly become introverted. As her decline continued, she was unable to take care of herself, presenting my mother with two options: 1. find 24-hour care for her mother at her apartment or our house, or 2. place her in a nursing home. According to my mom, this is one of the hardest decisions she has ever had to make. Ultimately, the best option was to place her in a memory care facility for her own safety. As my grandmother battled the late stages of Alzheimer’s dementia, she lost her identity, forgetting everyone including herself. She would cry when she could not communicate. She would get confused easily. She would fight over meaningless things. In July, she passed away after falling and breaking her hip wandering the halls late at night. Through this experience, my mother was torn between her responsibilities as a wife and mother and caring for her own mother. This disease placed a strain on everyone and everything in my mother’s life and caused the horrible guilt from wondering if death was the only solution.

 My grandmother is just one victim of the horrible effects of AD. The Hochman’s are another family victimized by the disease. Kamryn Hochman, a freshman at Johns Creek High School, spoke about her grandmother’s experience with AD. 

“It’s so tragic to see my grandma go through something so awful. She’s the most selfless and deserving person and it’s heartbreaking watching her slowly become less of herself,” Hochman said, “It’s almost as if I don’t know who she is anymore. The worst part is there’s nothing we can do to make it better.”

AD is the third leading cause of death for older adults, following cancer and heart disease, and a patient lives an average of only four to eight years after diagnosis. It is a tragic disease that turns the smartest, kindest and gentlest of people and makes them angry, depressed and sometimes abusive.

Conclusion

Alzheimer’s dementia affects millions of people all over the world, and unlike heart disease and cancer, its death rates are increasing. If AD is not cured soon, it is estimated that someone in the United States will develop Alzheimer’s dementia every 33 seconds. Because of this, scientists are working tirelessly to learn more about the disease and how to treat it. Alz.org explains,

 “The path to effective new treatments for dementia is through increased research funding and increased participation in clinical studies. Right now, volunteers are urgently needed to participate in clinical studies and trials about Alzheimer’s and other dementias.”

To learn more about Alzheimer’s visit:  

• Alzheimer’s Association
• Alzheimer’s Disease Public Health Curriculum
• Alzheimer’s.gov
• Us Against Alzheimer’s