Dementia

Dementia is the general term for a progressive brain disorder that gradually destroys a person's ability to carry out daily activities. Alzheimer's disease (AD) is the most common form of dementia. AD is a multifactorial neurodegenerative disorder characterized by:[34-37]

• Accumulation of amyloid beta (Aβ) plaques and hyperphosphorylated tau

• Oxidative stress

• Mitochondrial defects

• Impaired glucose metabolism 

It is estimated 10% of people in their 60s, 20% in their 70s, and 30% in their 80s have AD in the U.S.[28] On average, Alzheimer's patients live from 7 to 10 years after a diagnosis, with some living up to 20 years. Death normally occurs usually within ten years, and usually from the failure of a body system or an infection.

Symptoms

Memory loss is the most common sign of cognitive impairment, but other brain processes can be affected, including communication skills (speech and writing), judgment and decision making, auditory scene analysis[23], olfactory function[24], and attention span. 

However, Dr. Bruce L. Miller's work at UCSF[53] has shown that creativity is an area of strength spared by the disease, and that for some persons with dementia their creative ability is even enhanced.

“Younger people can have memory problems, but in many cases it’s difficulty with visual and spatial perception,” said Brian Appleby, MD, who specializes in young-onset Alzheimer’s. “They have problems judging things in space — tripping over curbs, knocking things over or trouble with left-right orientation.” 

Pathology

The major underlying mechanism of Alzheimer's is the buildup of protein deposits in the brain. The recent research has shown that the tangled web in Alzheimer's protein deposits is more complex than once thought. In [25], Scientists from the National Institutes of Health have discovered that the protein tangles involve at least three different proteins rather than just one. Medical researchers still don't know what sparks the disease process, but it is now accepted that this protein buildup goes on for many years before patients develop symptoms[44]. 

New UC Riverside research points to cells’ slowing ability to clean themselves as the likely cause of unhealthy brain buildup (i.e., amyloid plaques and neurofibrillary tangles).[72]  Those with brain buildup but no dementia had normal tau while a different-handed form of tau was found in those who developed plaques or tangles as well as dementia.

As more of these proteins form in certain parts of the brain, healthy neurons stop functioning and eventually die. And as more neurons die, affected brain regions shrink, leading to memory loss and other functional problems that are signs of Alzheimer's. To find out more information about plaques, tangles and amyloid protein, check out some good links provided by the Alzheimers Association Web Page.

In the brains of people with Alzheimer's disease, acetylcholine neurons that project into the hippocampus and cortex die very slowly. In Your Brain on Food, Gary L. Wenk explains that:

• The loss of normal acetylcholine function in the cortex may be why patients with Alzheimer's disease have difficulty paying attention to their environment.

  • Acetylcholine's job is to instruct the neurons in your frontal cortex to pay attention to important information and be vigilant to impending danger.

• The loss of acetylcholine projections to the amygdala, part of the brain's limbic system, may underlie the emotional instability, such as irritability and paranoia, that is sometimes observed in these patients.

• The loss of acetylcholine projections to the hippocampus may underlie the profoundly debilitating memory loss that is the major hallmark of this disease.

It is interesting to find the similarities between patients with Down and Alzheimer's. Both patients have the same pathological brain findings and clinical signs. Both show similar brain amyloid disposition. Down Syndrome is due to a trisomy, an extra copy of chromosome 21. The gene for beta amyloid protein is located on chromosome 21 near the locus for earlier onset Alzheimer's disease. This explains why more and more Down syndrome patients, who have survived into middle age, also develop dementia that appears similar to the Alzheimer's type.

Genetics also shows a link between Type 2 diabetes and dementia. People with a mutation known as ApoE4, who are known to have a higher risk for Alzheimer's disease, also have an increased risk of diabetes. The relationship between diabetes and dementia diseases drew headlines in September when a large study conducted in Japan reported that people with diabetes are twice as likely to develop Alzheimer's disease[22].

Type 2 diabetes and dementia share several key biological processes. Diabetes appears to play a role in the buildup of amyloid plaque as found in the AD patients. Some researchers believe that poor blood sugar control can make it harder for the body to clear away amyloid. Others suspect that high levels of glucose create a kind of toxicity in the body related to oxidative stress, in which harmful free radical molecules build up and damage tissue[20].

Diagnosis

Although absolute diagnosis of Alzheimer's disease (AD) can only be made after death, clinicians who do this all the time are quite accurate in making a clinical diagnosis. In general, the more advanced the dementia is, the easier it is to know with certainty that your loved one has AD. Unlike cancer or other diseases that can be diagnosed with great accuracy under a microscope, there is no one single, definitive test for AD.

Some conditions can even masquerade as an AD , which are actually treatable and even curable. These include:

• Depression

• Alcohol

• Brain tumors

• Heart, thyroid, or metabolic conditions

• Head injuries

• Infections, and vision or hearing difficulties.

• Drug reactions

There are also other types of dementia, including:

• Mild cognitive impairment (MCI)

• Vascular dementia

• Mixed dementia

• Dementia with Lewy bodies

• Parkinson's disease

• Frontotemporal dementia (Pick's disease, a rare frontotemporal neurodegenerative disease)

• Creutzfeldt-Jakob disease

• Normal pressure hydrocephalus

• Huntington's disease

• Wernicke-Korsakoff syndrome

There is no one single, simple test for AD. But, four types of tests are commonly performed:

• Medical history and physical examination

  • Clinics can get feedback from family members or others who can corroborate or elaborate on information from the patient

  • Clinics can review a year's medical records to get an understanding of how the person's medical conditions may be contributing to the symptoms

• Laboratory blood and urine tests

• Neuropsychological (memory and thinking) tests

  • Clinics always do cognitive testing to check memory, visual function, orientation and more.

  • Neuropsychologists have access to normative data and can compare a person's performance to what someone else their age and education might do.

• Brain imaging tests (including CT scans, MRIs, PET scans, SPECT scans)

  • It can help to detect a tumor or other structural changes.

However, there are new methods developed for detecting Alzheimer's disease. For example, one method tests the spine fluid[26]. Another detects deposits of tau protein on mucous nasal membranes, even before dementia commences[27].

10 Best questions to identify the warning signs of AD [1]

• Does the person have a memory loss problem?

  • Even young people have occasional memory lapses. Look for a worsening pattern of forgetting, especially of recently learned information.

• Does the person have difficulty performing familiar tasks?

  • Suddenly you or your loved one can't do routine tasks, such as reading the car's fuel gauge, figuring out which coins to give the store clerk, or preparing a favorite recipe.

• Does the person have language problem?

  • We all grope for words occasionally, but someone with AD has greater and more frequent difficulty when describing commonplace objects such as a table, toaster, or toothbrush.

• Is the person often disoriented about the current time and place?

  • Ask the person for today's date and to tell you the current time on his watch or the hallway clock. Another sign is a person getting lost in his or her own neighborhood.

• Does the person show poor or decreased judgment?

  • Examples include making poor financial decisions, wearing sandals in the snow, or wanting to go shopping at two in the morning.

• Does the person have problems with abstract thinking or reasoning?

  • Forgetting how to use numbers, do simple arithmetic, describe objects' appearances, discuss concepts, or solve problems may signal AD.

• Is the person frequently misplacing things?

  • Beyond the occasional forgotten car keys, a person with AD may put the phone in the refrigerator, the cereal box in the dishwasher, and the dirty dishes in the car.

• Do you notice changes in the person's mood or behavior?

  • People with AD may demonstrate rapid mood swings and different behaviors ranging from sunny calmness to sudden anger to tears for no obvious reason.

• Are there changes in his or her personality?

  • Even the sweetest-tempered person with AD can become agitated, paranoid, irritable, fearful, or highly dependent for no obvious reason.

• Does the person exhibit a loss of initiative?

  • AD can cause passivity, depression, and reluctance to do much of anything.

Risk Factors

Read this companion article—Risk Factors of Alzheimer's Disease 

References

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40. Coconut Oil Touted as Alzheimer's Remedy (video)

41. Eating Berries Might Help Preserve Your Memory

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53. Alzheimer's stops where creativity begins

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57. The progress of Alzheimer's revealed by artist's self portraits (see diagram)

58. Is Alzheimer’s Type 3 Diabetes?

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59. Dr. Gary Small on "The Alzheimer's Prevention Program"

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73. Drama in real life: Moving Mom to memory care (touching story)