I’m doing a whole series on dementia, and this is part 4. In part 3 I went through the many types of dementia, and we’re going to have separate episodes on the most common of these. This is the first of that series-within-a-series.
Alzheimer’s Disease (AD) — if you haven’t heard about it you have had your head in the sand, my friend. Because, like most forms of dementia, it is diagnosed later in life, and we have a huge number of baby boomers for whom it’s starting to get late. This has been a big topic for a long time, and will continue to be. It’s so huge, making up 60-80% of the population of dementia sufferers that for many, AD is synonymous with dementia, which is one of the false ideas we are trying to overcome in this series.
AD is a specific type of dementia and I’m going to get a little technical here. The degeneration of neurons and synapses in multiple areas of the brain is accompanied by amyloid plaques and neurofibrillary tangles. The plaques are dense, insoluble formations of smaller bits of the proteins whose normal function is to enable growth, survival, and repair of these brain cells.
Imagine that you could only get the water you need through the pipes that come in to your house from a well or local water system. You have a trusty plumber that keeps everything running smoothly, but he goes nuts and starts cutting up your pipes into small lengths and melting or welding them together and leaving them lying around your yard. Having no other way to get water, you would eventually die, thanks to this mad plumber.
In this analogy, the plumber represents the tau protein. It helps your brain cells get the stuff they need, particularly a protein called APP, or Amyloid Precursor Protein, represented by the water in my analogy. The pipes represent microtubules, part of the cell’s support structure that get cut up and and eventually form the telltale plaques.
Why get so technical. Because there’s a reason that these diseases are part of a group called dementia. They all have similar symptoms. If I just gave you the symptoms and more general information like the fact that it’s a disease in which brain cells degenerate, they would all be the same.
Diagnosis. The only way to know for sure that someone has AD is to examine his brain tissue under a microscope. Before death, that means a biopsy, which is an invasive procedure performed under general anesthesia. Other than this diagnoses of living persons are not definitive. It involves eliminating other possibilities and making assumptions.
There is a standard set of criteria used to diagnose Alzheimers:
Definite: autopsy or biopsy
Probable: established dementia and progressive cognitive impairments in 2 or more areas of cognition, onset between ages 40 and 90, and other causes of dementia are eliminated
Possible: dementia with atypical onset, presentation, or progressions, no known etiology or cause, no other dementia-causing diseases believed to be the origin
Unlikely: dementia with sudden onset, focal neurologic signs, or seizures or gait disturbance early in the course of the illness
A very disappointing guide for diagnosis if you ask me. It seems to mostly involve eliminating other possible causes.
I suppose a good reason for deciding to have the biopsy is the possibility of treatments. So what treatments are there? Well, the standard answer is that there is no cure, and that other than some drugs used with little success to treat the effects of the disease, palliative care is the norm.
However, there is at least one doctor who disagrees. He wrote a book called The End of Alzheimers. He says that the disease can be prevented and reversed. His program is called ReCode, which stands for Reversing Cognitive Decline. It’s a combination of things, including diet, supplementation, and much more. Actually it is very complex. Beyond the scope of this episode. I recommend reading the book though. It came out in 2017 and studies are ongoing. Some general practitioners are putting into practice. In short, as is the case for many treatments for AD, the jury is still out.
This is a huge topic in itself, and I recommend you check out the references in the show notes. And if you think I should do more on Alzheimer’s, or you have other comments, please contact me.
References:
Bredensen, Dale E. (2017). The End of Alzheimer’s: The first program to prevent and reverse cognitive decline. Avery.
Outsmart Dementia. (2020). The latest tools for controlling cognitive health — preventing dementia and Alzheimer’s disease. Morton Grove, IL: Publications International, Ltd.
https://www.prb.org/justhowmanybabyboomersarethere/#:~:text=There%20were%20actually%20a%20total,leaving%20some%2065.2%20million%20survivors
https://en.wikipedia.org/wiki/Alzheimer%27s_disease
https://mayfieldclinic.com/pe-brainbiopsy.htm#:~:text=A%20brain%20biopsy%20is%20a,)%20or%20cancerous%20(malignant).
https://link.springer.com/article/10.1007/s00401-010-0721-y
https://en.wikipedia.org/wiki/NINCDS-ADRDA_Alzheimer%27s_Criteria
https://journals.stfm.org/familymedicine/2018/june/br-jun18-scherger/