Dementia Caused by Brain Degeneration Known as Alzheimer's

Alzheimer's disease, the most common cause of dementia, is a significant health concern that affects millions of people worldwide. The disease is responsible for more deaths than breast cancer and prostate cancer combined, making it the sixth leading cause of death in the United States.

At its core, Alzheimer's is characterised by the abnormal buildup of two proteins in the brain: beta-amyloid plaques and tau tangles. These proteins disrupt cell communication and nutrient transport, eventually leading to the death of brain cells.

Research has shown that Alzheimer's has typically been silently progressing for 15-20 years before a diagnosis comes. However, a 2020 study in the journal "Brain" has shed light on early detection signs of Alzheimer's, which appear years before clinical symptoms. Led by researchers from the University of Bonn and the German Center for Neurodegenerative Diseases (DZNE), the study found that subtle changes in language patterns, including a decrease in vocabulary richness and increased repetition, can be detected up to nine years before clinical diagnosis.

Alzheimer's affects people differently, and its progression can be divided into five stages. In Stage 2, cognitive changes become obvious to others, including short-term memory impairment, disorientation, impaired judgment, communication difficulties, and executive function decline. During Stage 3, memory fluctuations become more dramatic, with individuals often forgetting significant life events while adamantly denying memory problems. This stage is also characterised by disorientation to time, language deterioration, recognition problems, increasing paranoia, and emotional volatility.

As the disease progresses, non-cognitive symptoms often cause the greatest distress for both patients and caregivers. Approaches to manage these symptoms include antidepressants, mood stabilizers, and antipsychotics, used cautiously. In Stage 4, physical appearance often begins to reflect the internal neurological decline. Symptoms include profound memory impairment, language reduction, perceptual distortions, delusions, sleep disturbances, physical decline, and increased vulnerability to infections. In Stage 5, the person loses nearly all verbal abilities and becomes completely dependent on caregivers. Physical decline accelerates with loss of mobility, swallowing difficulties, loss of bowel and bladder control, reflexive behaviors, and increased vulnerability to infections.

Women account for nearly two-thirds of Americans with Alzheimer's disease, and research suggests biological factors may play a role in this disparity. The APOE-ε4 gene is the most significant genetic risk factor for typical late-onset Alzheimer's, with those having two copies facing a 12-15 times greater risk.

While no cure exists for Alzheimer's disease, treatments can temporarily improve symptoms and potentially slow progression. Four medications have longstanding FDA approval for treating cognitive symptoms: cholinesterase inhibitors (Donepezil, Galantamine, Rivastigmine) and NMDA receptor antagonist (Memantine). Additionally, evidence increasingly supports the value of non-drug interventions, such as cognitive stimulation, physical exercise, environmental modifications, music therapy, caregiver education, and stress management.

Growing evidence suggests several approaches may reduce the risk or delay the onset of Alzheimer's, including physical activity, Mediterranean-DASH diet, cognitive engagement, social connection, quality sleep, stress management, vascular risk control, and maintaining a healthy brain through mental exercises and social interaction. Health conditions such as high blood pressure, diabetes, obesity, high cholesterol, traumatic brain injury, sleep disorders, hearing loss, and depression significantly increase the risk of Alzheimer's.

Understanding these early signs of Alzheimer's becomes urgent, as early detection creates advantages such as treatment effectiveness, clinical trial eligibility, financial and legal planning, lifestyle modifications, symptom management, and giving people with Alzheimer's a voice in their future care. Recently, treatments targeting the underlying disease process have emerged, such as monoclonal antibodies (Aducanumab, Lecanemab) and tau-targeting therapies, which are in clinical trials.

In conclusion, Alzheimer's disease is a complex and devastating condition that affects many lives. Early detection, understanding, and appropriate care are crucial in managing this disease. As research continues, we hope for better treatments and, ultimately, a cure for Alzheimer's.