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Alzheimer’s Disease
By
Christina Charles
Doris Fansler
Kellie Wallen
WRA 110, Sec. 4
Michigan State University
November 19, 2008
Word Count: 3312
Alzheimer’s Disease
Almost all adults experience mild memory loss. It is a normal, expected part of
aging. When memory and other brain functions decline rapidly, it may be a sign of
Alzheimer’s disease. Those close to an affected individual understand just how
devastating this disease can be. It is upsetting and difficult to watch someone you love
be influenced by this disease. It starts with minor memory lapses, but quickly
progresses, and the individual often forgets familiar faces, cannot remember how to
perform daily tasks, and becomes very disoriented to times and locations.
Imagine going to visit a loved one and finding out they do not remember who
you are. All three of us college students researching this topic have had a firsthand
experience with this. Both Doris’ and Christina’s grandfathers currently suffer from the
disease. Kellie’s great aunt is also affected by Alzheimer’s. Her experience closely
relates to many common situations and emotions felt by those touched by the disease.
As Kellie describes her experience:
I was always very close with my great aunt, visiting her often, chit chatting with
her about our lives. She was known for making the best molasses cookies. However,
as she began to age, she started to show signs of severe memory loss. She would
often ask the same question over and over, or not remember how I was related to her or
why I was there. Several times, when making her famous cookies, she would forget
important ingredients such as sugar, and then not understand why the cookies did not
turn out. Eventually, the memory loss became so significant that she was moved into
an assisted living home. This confused her even more, and to this day, she still asks
me how she got there and when she is going back home.
What really intrigues me about this situation is that my great aunt, who suffers
from Alzheimer’s, is an identical twin. Yet her twin, my grandmother, does not show any
signs of memory loss. This sparks my curiosity as to what factors cause one person to
develop Alzheimer’s over another person. I analyzed the living situations of my
grandmother and great aunt. My grandmother is still happily married, living in a condo
with my grandfather. My great aunt was widowed when she was middle aged, and has
been living alone ever since. This seems to suggest that living alone may have
contributed to her development of Alzheimer’s. Perhaps the limited social activity led to
inactive brain cells which were destroyed by dementia. While one direct cause for
Alzheimer’s has not been found, research shows that lifestyle factors play a role in the
development of the disease.
Alzheimer’s is a highly complex disease of the brain. The direct cause is
unknown, but there are several factors such as genetics, age, and environment that
may influence the development of the disease. While there are currently no known
cures, research and experiments have led to the development of several different types
of treatments for the disease. Available treatments include therapies and medicines
which work to relieve symptoms but do not stop the progression of the disease.
Scientists are experimenting and researching with the hopes of creating new
medications and vaccines.
Alzheimer’s disease (AD) is named after the German doctor, Dr. Alois Alzheimer.
In 1906, one of his patients died of an unusual mental illness. After performing a post-
mortem autopsy, he discovered abnormal plaques and tangles in this patient’s brain.
Alzheimer’s is a disease caused by plaques and tangles in the brain leading to severe
memory loss and later death (Soliz 13).
The brain has billions of nerve cells which work together and have specialized
roles including thinking, learning, memory, smelling, and hearing. Although plaques and
tangles are normal aspects of the brain, a huge abundance of these, as in someone
with Alzheimer’s, is not (Basics 10). These plaques are “deposits of a protein fragment
called beta-amyloid that build up in the spaces between nerve cells” and tangles are
“twisted fibers of another protein called tau that build up inside cells” (11). Scientists
know that plaques and tangles disrupt nerve and cell communications in the brain but
are not exactly sure how this affects the disease.
In a person affected with Alzheimer’s, certain brain cells become inactive and
lose their ability to perform specific tasks. This leads to cell death and degeneration of
the brain. Brain shrinkage and holes in the brain occur. This is shown in Fig.1, which
compares a healthy brain to an Alzheimer’s brain.
According to scientists, “as many as 4.5 million Americans suffer from AD” (Soliz
13) and “every 72 seconds someone in the
United States develops the disease”
(“Statistics”). Alzheimer’s is the most common
form of dementia. Individuals with this disease
become disoriented with their surroundings
and often forget certain names and places.
Figure 1, Brain Changes, (Janis 9).
Presently, there is no known cure for this disease. Scientists are not fully certain as to
what causes it. The only way to be certain if someone has Alzheimer’s is to perform an
autopsy after they die (Soliz 9).
Alzheimer’s is very common among older people. An increase in age leads to an
increase in chance of becoming diagnosed with this disease. Scientists have found “the
likelihood of developing Alzheimer’s approximately doubles every five years after age
65” (Basics 12). As a person gets older, several symptoms start to appear. It is very
unlikely symptoms will come up earlier. Statistics show “only 6 to 8 percent of people
who have Alzheimer’s develop symptoms before the age of sixty-five” (Soliz 9).
The first symptom to appear is memory loss. This memory loss can be quite
severe in that it affects a persons’ whole lifestyle. Memory loss is a normal part of
aging, but severe memory loss with serious confusion and disruption of brain
functioning is not. A person with Alzheimer’s may not remember whole events. Any
normal person would usually forget a part of an event, not a whole one. A normal
person may even remember this event later but an Alzheimer’s patient will usually never
remember (Basics 6).
Following memory loss, several other symptoms slowly emerge. Alzheimer’s
patients begin experiencing extreme confusion. They become unsure and lost in
familiar settings including their own home or neighborhood. They may regularly make
bad judgment calls such as turning the heat on full blast in the middle of the summer.
Also, they seem to continually misplace several possessions. Every so often, any
normal person loses a wallet or a pair of car keys, but an Alzheimer’s patient begins to
lose multiple belongings because they may put these items back in unusual places. For
instance, someone with Alzheimer’s may happen to store food in an oven as opposed to
a refrigerator or cabinet without even realizing (7).
Over time, Alzheimer’s patients have trouble taking care of themselves. They
may be unable to complete normal daily living tasks. Those with this disease become
incapable of following written or spoken instructions or lose the ability to take any sort of
note. Their language skills even change, as they forget correct speech or cannot recall
simple words (7).
In addition to struggling with memory, confusion, and simple living tasks, an
Alzheimer’s patient begins to encounter certain behavioral issues. Although everyone
can be moody, a person with this disease experiences severe emotional changes. For
no reason at all, they may get mad and angry. The next minute they could become
depressed or teary-eyed. This patient begins to undergo changes in personality. As
people age, they may often sit around more or not always want to go out. A person with
Alzheimer’s loses an initiative to socialize, participate in group activities, obtain a little
fresh air, regularly exercise, or journey anywhere including the grocery store or even
mall. They often sleep, watch TV, and lounge around a lot more (7).
A person with Alzheimer’s usually goes through a total of seven stages in which
these symptoms gradually appear. Stage One is the No Impairment Stage in which
there is no evidence of symptoms and no signs of memory loss. Stage Two, the Very
Mild Decline Stage, is when a person may find they are experiencing slight memory
loss. This includes things such as forgetting common words or usual locations. There
is no medical sign yet. Stage Three, the Mild Cognitive Decline Stage, is when family
members and friends begin to notice some of this forgetfulness. Doctors can somewhat
detect slight memory loss. The individual becomes forgetful of names, unsure of correct
wording, has issues performing simple tasks, loses certain items, and has difficulty
planning ahead (20).
Doctors are able to see definite problems with a patient in the Moderate
Cognitive Decline Stage, or Stage Four. For example, the patient is unable to
remember recent events or family background. They may become antisocial or
experience mood swings. Also, they have difficulty performing more complex tasks
such as “counting backward from 100 by 7s” (21).
Stage Five, or the Moderately Severe Cognitive Decline Stage, consists of more
severe memory and thinking issues in which a person begins needing help with daily
tasks. They usually do not need help eating or going to the bathroom yet, but often
need reminders of what day it is, or what types of clothes to wear in each season. They
are still able to remember major important facts about family and friends but can
sometimes be unsure of where they are (21).
When this person eventually needs a lot of help performing daily tasks they have
entered Stage Six, or the Severe Cognitive Decline Stage. Memory loss has increased
and they undergo major personality changes. Several patients often become lost, are
unable to hold their bladder, need help with simple tasks, begin to forget names, or are,
at times, unsure of their surroundings.
The last and final stage, Stage Seven, or the Very Severe Cognitive Decline
Stage, is when this person loses control of several daily tasks such as eating or using
the restroom. They have difficulty swallowing a lot of the time and their “reflexes
become abnormal” (22).
In addition to being informed about the various seven stages of Alzheimer’s, it is
important to understand the possible causes. There are many factors that are known to
be possible causes of Alzheimer’s. A person cannot control how old they are and “age
is the greatest risk factor that is known for the disease Alzheimer’s” (Risk Factors, sect
2). Typically, older people are more affected by Alzheimer’s disease than younger
people; in fact, “most of the people with Alzheimer’s disease [are] at the age of 65 or
older” (sect 2).
Genetics is what makes each person different from each other. Scientists have
been looking for genes that could play a role in Alzheimer’s disease and “so far they
have identified one Alzheimer’s risk gene called apolipoprotein E-e4 (APOE-e4)” (sect
2). This gene has been determined to increase someone’s chances of developing
Alzheimer’s, but it does not guarantee a person will have it. There are some genes that
scientists believe to be a possible cause for Alzheimer’s disease; however, “these cases
happen in only a few hundred families and the genes are rare” (sect 2). These cases
have been caused by a “complex combination of genetic and nongenetic influences”
(sect 2).
Family background has a major effect on someone who is developing
Alzheimer’s disease, in fact, “if someone’s family background has had a family member
whether it be a parent, brother or sister with Alzheimer’s disease that person is two to
three times more likely to develop Alzheimer‘s” (sect 2). Understanding family
background may help to better protect a person from developing Alzheimer‘s disease. A
person should be worried if “there is more than one person in their family that has had
Alzheimer’s disease” (sect 2). A person may want to see a doctor if they are worried
about contracting this disease. However, people cannot control these factors of their
lives. Luckily there are discoveries being made that may decrease someone’s chance
of getting Alzheimer‘s.
Leading a healthy lifestyle is a major component in decreasing someone’s
chances of getting Alzheimer‘s. In ways of making their life healthy they can start by
staying injury free. Staying injury free means protecting their head because “there is a
strong link to Alzheimer’s Disease between serious head injuries” (3). By trying to avoid
head injuries they can go about “buckling [ones] seat belt, wearing a helmet when they
participate in sports and fall proofing their home” (sect 3).
Also, by leading a healthy lifestyle a person can reduce their chances of
developing Alzheimer’s Disease by having a heart to head connection, and maintaining
a healthy heart which means “eating a healthy diet, staying socially active, avoiding
tobacco and alcohol consumption and exercising both the mind and the heart“(sect 3).
Exercising both the mind and heart are a good way to keep a person healthy. Also, to
build knowledge, one should exercise the brain, through activities such as brain teasers
or trying to learn new information. Performing these exercises often may prolong
individuals from developing Alzheimer’s because “some of the strongest evidence links
the brain health to heart health” (sect 3). In many cases the risk of developing
Alzheimer’s disease is “increased when there has been damage to the heart and the
blood vessels” (sect 3).
However, there is no cure for Alzheimer’s disease and there are many risk
factors are uncontrollable, and then there are those factors, such as leading a healthy
lifestyle, which a person can control in order to decrease their risk for developing the
disease. This may aid in prolonging an individual from developing Alzheimer‘s, until a
cure for this disease is found.
Scientists are constantly working to find new treatments for Alzheimer’s Disease.
There have been several recent experiments that led to exciting discoveries regarding
Alzheimer’s disease. These discoveries may aid in the development of a treatment or
vaccine for the disease. One influential experiment dealt with a specific type of protein
that collects on the brain. This protein, known as amyloid, forms a plaque on the brain,
causing Alzheimer’s disease. Scientists discovered that injecting mice with external
amyloid causes the mice to develop anti-amyloid antibodies, causing the brain plaque to
decrease. This led to a human trial to see if the same would happen in human
Alzheimer’s patients. Eighty Alzheimer’s patients were provided external amyloid. Six
years later, eight patients “showed evidence of a significant reduction in brain amyloid
plaques” (Holtzman par.4). While these results were promising, the patients did not
experience any delay in the progression of the disease. There are several possible
reasons for why this treatment was ineffective, one being that the treatment may have
started too late in the development of the disease. Amyloid build-up “seems to begin
some 10–15 years before the onset of any symptoms or signs of dementia due to the
disease” (par.6). In this study, amyloid immunization began “when subjects already
had mild to moderate dementia” (par.6). Despite these findings, amyloid protein
remains an influential factor in Alzheimer’s and scientists hope to design trials among
Alzheimer’s patients at earlier stages in the disease.
Many different types of research are being performed with the hope that it will
lead to an important discovery about Alzheimer’s disease. Simply finding a way to slow
the development of the disease would be beneficial. Delaying Alzheimer’s by as little as
one year would still “reduce the projected number of cases in 2050 by 9.2 million,
according to research published last year in Alzheimer’s & Dementia, the journal of the
Alzheimer’s Association” (Bregel and Sohn, par. 4). Scientists have begun to look at
common items such as yellow curry, vitamin E, and anti-inflammatory medications for
possible treatments. According to Dr. John Standridge , “in India, where yellow curry is
a large part of the folk medicine and the diet, persons between the ages of 70 and 79
have less than a quarter the Alzheimer’s cases of similar ages in the U.S. population”
(par. 11). Scientists are planning human trials to see if yellow curry may aid in delaying
the development of Alzheimer’s. Researchers studied both vitamin E and antiinflammatory medications hoping that they might aid in reducing the protein plaque that
causes the disease. However, human trials showed that these items had little impact.
Some research is focused on prevention of risk factors for the disease. There is
evidence that individuals with high cholesterol and blood pressure are at a higher risk
for dementia. This suggests that “interventions for heart disease and diabetes could
also lower the risk for Alzheimer’s” (par. 13). Due to the complexity of the disease,
doctors such as Dr. Morrison-Bogorad, head of the nation’s Alzheimer’s research
program, believe that “the Alzheimer’s solution likely will be a combination of lifestyle
interventions such as regular exercise and dietary changes, combined with a medical
treatment, not one “little white pill,” (par. 14).
There are currently two basic types of dementia treatments. Pharmacologic
treatments use drugs to relieve symptoms, while non-pharmacologic does not. Among
pharmacologic treatments, there are symptomatic therapies and disease-modifying
therapies. Symptomatic therapy works to temporary relieve symptoms, while diseasemodifying therapy works to delay the progression of the disease. According to
Constantine Lyketsos, author of “Developing New Treatments for Alzheimer's Disease:
the Who, What, When, and How of Biomarker-Guided Therapies,” there are currently
only symptomatic therapies for Alzheimer’s disease. These therapies consist of
medicines such as cholinesterase inhibitors, antidepressants, and antipsychotics. Each
of these therapies has a different purpose and work in different ways. Cholinesterase
inhibitors work by increasing certain brain chemicals which are low in Alzheimer’s
patients. Antidepressants have been shown to slow the progression of dementia and
improve the daily lives of Alzheimer’s patients. Antipsychotics are used to treat
common symptoms such as paranoia and anger in those affected by the disease.
Scientists are now focusing on developing more disease modifying therapies, which
would have stronger impact and provide more benefits than existing symptomatic
therapies. These therapies would be used in patients who have just begun to
experience symptoms of Alzheimer’s in order to stop or delay the progression of the
disease. While it may take several more years to develop, a treatment for Alzheimer’s
is possible and likely.
The prevalence of Alzheimer’s disease in today’s society leads to heightened
curiosity and increased scientific research to find possible causes and cures. An
overabundance of plaques and tangles in the brain can lead to an interference of brain
cell and nerve communication, affecting their ability to perform certain functions. These
large amounts of plaques and tangles lead to memory loss, confusion, language issues,
personality changes, or disability to perform daily functions. Each of these symptoms
progressively becomes worse through the seven stages of Alzheimer’s. There are many
risk factors which contribute to the development of this disease. Some of these are
controllable through lifestyle choices, while others are not. Controllable factors include
cardiovascular health, avoiding head injuries, maintaining a healthy diet, avoiding
excessive tobacco and alcohol, performing mental exercises and staying active.
Factors which cannot be controlled include age, genetics and family background.
Although there is no known cure, there are treatments available that help
decrease the risk of developing the disease. While it is a long, complex process,
Alzheimer’s disease is very significant and continuing research on the disease is
important. Statistics show that “after age 85, the risk [for developing Alzheimer’s]
reaches nearly 50 percent” (Basics 12). Therefore, any advancement in cures or
treatments would have a strong impact on society. With continual research, the
development of treatments is very likely and possible within the next decade or so.
Treating this harmful disease would lead to comfort and hope for those affected and
their loved ones. Maybe, in the future, other young people like ourselves will not have
to experience the trauma of losing a loved one to Alzheimer’s. This could open up a
whole new world of possibilities by adding many more years of life to Alzheimer’s
patient.
Works Cited
Basics of Alzheimer's Disease. 2005. Alzheimer's Association. 21 Oct. 2008
<http://www.alz.org/national/documents/brochure_basicsofalz_low.pdf>.
Bregel, Emily and Pam Sohn. "Chattanooga: New Research Shows
Promise.” McClatchy - Tribune Business News 20 October 2008 ABI/INFORM
Dateline. ProQuest. MSU Main Library, East Lansing, Michigan. 21 Oct. 2008
<http://proquest.umi.com.proxy2.cl.msu.edu>.
Constantine G. Lyketsos, et al. "Developing new treatments for Alzheimer's disease: the
who, what, when, and how of biomarker-guided therapies. " International
Psychogeriatrics 20.5 (2008): 871-89. Health Module. ProQuest. Michigan State
Library, East Lansing, Michigan. 20 Oct.
2008 <http://www.proquest.com.proxy2.cl.msu.edu>.
Holtzman, David M. "Moving towards a vaccine.” Nature 454.7203 (2008): 418-420.
Research Library Core. ProQuest. MSU Main Library, East Lansing, Michigan.
20 Oct. 2008
<http://www.nature.com/nature/journal/v454/n7203/full/454418a.html>.
Janis, Stacy. "Brain Tour." Alzheimer Society. 2007. 12 Nov. 2008
<http://www.alzheimer.ca/english/alzheimer_brain_mini_site/09.htm>.
“Risk Factors”. www.alz.org. 28 July 2008. Alzheimer’s Association. Sections 1-3
5 Nov 2008. <http://www.alz.org/alzheimers_disease_causes_risk_factors.asp>.
Soliz, Adela. Alzheimer's Disease. San Diego: Greenhaven P, 2006.
“Statistics.” Long Island Alzheimer’s Foundation. 2007. 8 Nov. 2008.
<http://www.liaf.org/en/statistics.html?Itemid=33>.