In 1906 Dr. Alois Alzheimer (1864-1915) a German psychiatrist and neuropathologist described the first case of the form of dementia during a lecture at the German Psychiatrists conference in Tubingen, which is a traditional university town in central Baden-Württemberg, Germany. He was describing one of his patients, whose symptoms were memory loss, language problems and unpredictable behavior. After her death, Dr. Alzheimer noticed changes in her brain tissue, abnormal clumps and tangled bundles of fibers. Since then, this disease is one of the most common dementia in the aging population, bearing Alzheimer’s name.
Alzheimer disease is a neurodegenerative disorder which shows progressive dementia and it is the fourth most common cause of death. There are clear pathological hallmarks of the disease, mainly in the form of plaques and tangles. Plaques are abnormal clusters and fragments of protein, which build up between nerve cells. Dying nerve cells contain tangles, which are made up of another protein. These plaques and tangles might be the reason for cell death and tissue loss in the Alzheimer’s brain.
Our brain has three major parts: the cerebrum, the cerebellum and the brain stem. The cerebrum is the major content of our skull. Its main function is in the areas of remembering, problem solving, thinking, feeling and controlling our movement. The cerebellum located at the back of our head, under the cerebrum and it controls our coordination and balance. The brain stem is located beneath the cerebrum in front of the cerebellum. It connects the brain to the spinal cord and controls functions which are automatic, such as breathing, digestion, heart rate and blood pressure.
The brain is nourished by networks of blood vessels comprised of arteries, veins and capillaries. The arteries carry blood to fuel our brain with each heartbeat.
The unique outer layer of our brain is called the cortex, which is quite clearly mapped according to specific functions. Among the major functions we can notice our sight, sound and smell, thoughts, problem solving, memory storing and retrieving and controlling certain movements.
Our brain is divided into two hemispheres; the left half controls the right body’s side and the right half controls the left side. The speech-language area is on the left side in most people. The brain contains over 100 billion neurons or nerve cells, which branches and generates connections at more than 100 trillion connection points. Brain signals are traveling via the network of neurons involving our memories, thoughts, and feelings. Nerve cells are connected to one another at synapses. A burst of chemicals called neurotransmitters are released at the synapses when triggered by the appropriate electric charge and so the ‘message’ is carried to other cells.
Alzheimer’s disease is responsible for the destructions of those neurons and to the disruption of the activity of the neurotransmitters. We also know that Alzheimer’s disease leads to nerve cell death and tissue loss throughout the brain. Over time, the brain shrinks dramatically, affecting nearly all its functions. Shrinkage is especially severe in the hippocampus, which is an area of the cortex that plays a major role in formation of new memories.
Early symptoms are in the area of learning and memory, thinking and planning, which may interfere with work or social life. At this stage people may get confused and have problems expressing themselves, organizing and handling money.
As Alzheimer’s progresses, individuals may experience changes in personality and behavior and have trouble recognizing friends and family members. People with Alzheimer may live an average of eight years. In certain cases it maybe more depends on other health conditions and other factors like genetics.
What causes Alzheimer?
It is assumed that the cause is a complex sequence of events comprising of genetic, environmental and lifestyle factors. We do not understand the exact cause or the contributions of those factors and it varies from case to case.
What diagnostic tools are available?
Until today, there are no effective therapies to cure, to halt or to slow down the progression of Alzheimer disease. At the same time there are many diagnostic tools to identify the disease, such as non-invasive imaging techniques to assess the aspects of neuro-anatomy, chemistry, physiology, and pathology of the disease and its evolutionary status.
One of the popular examinations is using Magnetic Resonance Imaging (MRI), mainly because it enables the visualization of the brain structures in three dimensions. Computed Tomography (CT) is another visualization tool used for the diagnosis and evaluation of dementia, especially for cases at early stages. The Positron Emission Tomography (PET) scan shows brain activity in real-time associated with functions such as: reading, hearing, thinking and saying words. High activity areas are marked with red and they decrease in colors as activity level decreased. PET scan is also used to detect alterations in regional brain metabolism. This metabolic over activity is reflected as “red-hot-spots” on PET images, enabling doctors to confirm the status of suspected tumor area and assess whether they have spread. Recently, new devices combining multi-modalities are being developed such as MRI/PET. This is a hybrid imaging technology that utilizes MRI soft tissue morphological capabilities with PET functional imaging, which is effective for tumor detection.
What parts of the brain are affected?
Alzheimer eventually affects most parts of the brain. However, each person is affected differently as the disease progresses. The main brain regions affected by Alzheimer are the frontal, temporal and the parietal lobes.
The frontal lobe is located at the front of the brain and controls a range of functions such as intelligence, making decisions, solving problems and other mental and social functions.
Damage to this area causes decrease in quality of life and generates severe problems for patients to take care of themselves.
The temporal lobe is located at both temples and ears and they are responsible for the long and the short term memories. Episodic memory helps us to remember events such as where we parked our car or where are our house keys. Remembering such events requires the storing and retrieving processes located at our temporal lobe. The Ability to learn is located in these regions, so damage to these areas may lead to memory loss. This loss causes the inability to register new information and retrieve it later when needed.
Speech ability is located behind the temporal lobe at the parietal lobe. This region is also responsible for the visual system and enables visual analysis and stimuli. Damage to this area may cause abnormal speech and visual problems.
Alzheimer first affects the hippocampus which is located in the medial temporal lobe of the brain. It is the area of the brain in which new memories are formed. It then moves to other areas affecting different functions such as reasoning or emotions. The cerebellum and the brain stem are the last areas of the brain to be affected. This is when we lose control of basic functions such as breathing, heart-rate and blood pressure. This is Alzheimer’s final stage leading to death.
What medications are available to treat Alzheimer?
There are four FDA approved medications to treat Alzheimer. Donepezil, rivastigmine and galantamine are used to treat mild to moderate Alzheimer and moderate to severe Alzheimer is treated by memantine and also donepezil. These drugs are regulating neurotransmitters. They may assist in memory improvement, speaking and help with certain behavioral problems. The problem with these drugs is that their efficacy is limited to certain group of patients and for a limited period.
What do we know about the statistics of Alzheimer’s disease?
- More than 5 million Americans have Alzheimer.
- The number of Alzheimer’s cases doubles every five years after age 65 and the risk is about 50 percent after age 85. About 10 percent of all Alzheimer cases are at age around 30.
- More women than men develop Alzheimer’s disease.
- Alzheimer’s disease is the sixth-leading cause of death in the United States.
- Payments for care are estimated to be $200 billion in the United States in 2012. It is estimated that the total cost of Alzheimer’s is $604 billion worldwide.
- High glucose levels can double our lifetime risk for developing Alzheimer’s.
- Stroke and Alzheimer’s share many risk factors and the likelihood of dementia is doubled after a stroke.
What are the risk factors?
There are uncontrollable risk factors such as genetics and aging and risk factors that we may control such as our life habits.
The known and established risk factors for Alzheimer’s disease are genetics and aging; both uncontrollable. Alzheimer in our close family in most cases will increase our risk probability for Alzheimer’s disease. However, even in those cases we still may not get the disease. So currently we don’t have solutions, but it is assumed that adopting healthy brain life habits might delay or even prevent the appearance of Alzheimer’s disease in certain cases.
What can we do to reduce the risk?
Healthy brain life habits are not only keeping fit from the neck down, but in addition to perform certain daily exercises. Recent emerging evidence suggests there are certain steps we can take to help keep our brain healthier as we age. Some of these steps might also reduce our risk of Alzheimer’s disease or other dementias.
- Maintaining good blood flow – Physical exercise is essential for maintaining good blood flow to the brain. This is critical also for the generation of new brain cells. It also can significantly reduce the risk of heart attack, stroke and diabetes. According to the Alzheimer’s Research & Prevention Foundation, this step may reduce the risk by 50 percent.
- Low cholesterol diet – Low fat, low cholesterol diet with dark vegetables and fruits, which contain antioxidants, may help protect brain cells. We know that high cholesterol may contribute to stroke and brain cell damage.
- Reducing stress – Social activity not only makes physical and mental activity more enjoyable, it can reduce stress levels, which helps maintain healthy connections among brain cells. Studies show that the more connected we are, the better are our memory and cognition.
- Sleeping well – Nightly sleep deprivation may slow our thinking and affecting our mood. We may be at greater risk of developing symptoms of Alzheimer’s disease. Sleep apnea has long been recognized as a cause of decreased daytime alertness, but recent studies suggest it may also increase the risk of dementia.
- Stop smoking – Smoking will increase the risk factor and may reduce the age of Alzheimer’s onset by seven years. Smoking has an extremely harmful effect on the heart, lungs and vascular system, including the blood vessels in the brain. There is a significant improvement in blood circulation when smoking habits are abandoned.
- Stop drinking alcohol – Brain changes from alcohol abuse can only be reversed in their early stages. Drinking above recommended levels of alcohol significantly increases the risk of developing dementias such as Alzheimer’s, vascular and other alcohol-related dementias.
- Brain cells stimulation– “Use it or lose it” – Mentally stimulating activities such as crossword puzzles, reading, learning and interactive computer games may create new nerve cells and at the same time strengthen brain cells and the connections between them. It is believed that mentally active brain can better cope with the disease and may enable the delay of the dementia symptoms. Moreover, people who continue learning new things are less likely to develop Alzheimer’s disease and dementia. The best way to reduce the risk is to be involved in activities requiring interaction, communication and new learning skills.
Is there a Mind-Body connection?
We acknowledge a strong mind-body connection. Recent studies associate spirituality with better brain health. Meditating, praying and religious practice may immunize against the damaging effects of stress. Our immune system is built to protect us from many external threats; however it fails when emotion and stress are involved.
If we permit ‘bad energy’ to enter our brain, we are flooded by bad emotions that can affect our physical body. This is the negative power of belief.
The link of mind-spirit and body is obvious. We should realize that the power of belief can also work against us and may be a destructive force.Therefore, we should avoid negativism and seek positivism. Above all, we have to believe in ourselves.
Willpower is one of the significant human driving forces. We know that there is a power in our will, as in the saying: ‘Where there is a will, there is a way’.
This willpower helps us to overcome the many difficulties and obstacles in our life. It is one of the major components needed for success.
A healthy soul requires a healthy body, as the Latin has it: anima sanain corpore sano, and in Hebrew: “Nefesh bria beguf bari”.
We know that mind and body are connected. Our health is strongly dependent on how we deal emotionally and physically with various situations and conditions. Our immune system is affected when we suffer continuous stress. General illnesses can be largely stress-related. Stress is not always negative, however. Stress is a predictable, normal and sometimes desirable human response. Stress is activated in various circumstances, such as feelings of danger or urgency. In such cases stress protects us by alerting us to danger and keeping us focused.
When stress is continuous and unrelenting, this is the point at which it starts to be harmful. It can have a negative effect in both physical and psychological terms. There is a link between stress and life expectancy. Most researchers believe that stress is a major factor in reducing life expectancy.
The author, however, believes that a certain amount of stress in reaction to certain activities can have the opposite effect. Both ends of the spectrum, namely, no stress at all and extensive stress, are negative factors which influence our way and quality of life. Some stress in a multi-tasking environment, however, can have a positive effect on our life expectancy.
Being active in multi-disciplinary areas not only gives us positive emotions and satisfaction but could also extend our life expectancy.
This assumption is partly supported by the fact that diverse activities mean we activate different brain areas.
Research has shown that negative emotions such as anger and unhappiness have a significant impact on our nervous and immune systems and are probably the cause of certain diseases. On the other hand, positive emotions such as happiness and harmony are elements which have a positive influence on our health.
In neurobiology, the material functions of the mind could be a representation of certain mechanistic properties of the brain. The brain essentially shuts down the area which generates conscious thought during deep sleep and reactivates it on dreaming or waking.
The relationship of the brain with the mind is similar to that of computer hardware with software. This analogy of the mind as software is debated by scientists, who claim correctly that the human mind has powers beyond any artificial software.
Future proposed studies and methodologies
Accumulations of new databases (NDB) of Alzheimer patients are required. NDB should also contain genetic independent cases, above 50 years old, with their detailed history of activity or inactivity, during their last decade prior being diagnosed with Alzheimer’s disease. In addition, a correlation imaging database using MRI/PET should be created.
We should concentrate in detecting the specific location where Alzheimer’s disease may begin. This is probably a specific vulnerable area of the brain, from where the damage is spread to other areas of the brain.
We already know that Alzheimer first affects the hippocampus, which is the area where new memories are formed. We also know that the memory cells or circuit which is essential for generating and storing new memories is in the entorhinal cortex. The entorhinal cortex is an area of the brain located in the medial temporal lobe. It is functioning as a hub in a network for memory and navigation.
The entorhinal cortex is one of the first areas to be affected in Alzheimer’s disease. It would be interesting to follow the assumption that people with less or no physical activities especially after the age of 50, tend statistically to be more vulnerable to Alzheimer’s disease than those who are active physically and mentally. Accordingly, studies focusing in this area of the brain may lead to better understanding our brain system for enhancing memory.
Future gene research may lead to better understanding of the mechanisms of the disease, which hopefully will lead to the appropriate preventing treatment.
A promising research area is using stem cells for treating Alzheimer. There are many ways to approach this option. Among the various possibilities we may suggest to re-grow diseased parts, to heal rather than replace neurons or to use stem cells as drug delivery agents.
Adult stem cells have a positive effect on those who already have Alzheimer’s disease. In future they may even prevent the disease.
I believe that mentally stimulating activities in conjunction with enhancing our mind-body connections, could lead not only to improvement in our way of life, but also to significantly reduce the risk involved with Alzheimer’s disease.