Alzheimer's

The most common form of dementia, Alzheimer's is a progressive neurodegenerative brain disorder. It was first described by German psychiatrist and neuropathologist Alois Alzheimer in 1906, and was named after him. Normal brain cell function is gradually destroyed, leading to irreversible declines in memory, cognition, and behavior. But what causes things to go awry remains unknown. It may be that Alzheimer's has several causes or that the interplay between genetic makeup and certain risk factors determines who's affected. (Wiki; Spencer; Park)
In 2006, there were 26.6 million sufferers worldwide. Alzheimer's is predicted to affect 1 in 85 people globally, and the number of Alzheimer's patients will grow to 13.4 million by 2050. More than five million Americans currently suffer from Alzheimer's disease. There is no cure. There isn't a definitive test for Alzheimer's. Current therapies can only delay, not stop the onset of memory loss, confusion, and cognitive decline. (Wiki; Spencer; Park)
Causes: It is thought that the disease is caused by a buildup of protein-based plaques in the brain. The disease begins when the brain starts to churn out amyloid, a long protein which is then cut by enzymes into fragments. These fragments become molecularly sticky and clump together, forming a plaque. Once the plaques form, tau protein that maintains the integrity of the neural highway break down, leaving the equivalent of potholes that interrupt the electrical signals traveling along the nerve. With this disruption, nerve cells start to wither and die, leaving behind their remains. The result is a brain full of dead and dying neurons. The shutdown of neural connections leads to a drop in cognitive function. (Park)

Risk factors for Alzheimer's: (Spencer)
1. Age: Age is the most significant established risk factor for Alzheimer's disease. One in 7 people over age 71 has some form of dementia, and 2.4 million of these have Alzheimer's, according to the latest National Institutes of Health data. The percentage of people with Alzheimer's rises from just 2.3 percent of those ages 71 to 79 to 18 percent of those ages 80 to 89, and 29.7 percent of those 90 or older. Some estimates say as many as half of all people over age 85 have Alzheimer's disease.The total number of people with the disease doubles with every five-year age jump after age 65.
2. Gender: Women live longer than men, on average, and Alzheimer's disease risk rises with age. Research indicates that a lack of estrogen after menopause may contribute to the fact that slightly more women are affected. Taking hormone-replacement therapy has not been shown to protect against Alzheimer's. Vascular dementia is more common in men than women, probably because more men develop contributing factors such as hypertension and vascular problems.
3. Family history: People with a family history of Alzheimer's are more likely to develop the disease. The risk is thought to rise with each relative who had it.
It's unknown, though, exactly how much of this association is due to genetic factors and how much is due to shared lifestyle factors. Most experts believe that some combination of the two is responsible. Even when an immediate family member has the disease, however, your increased risk is only slightly higher than if your family had no history of dementia.
Up to 80 percent of Alzheimer's risk may have a genetic component, according to a 2006 study of more than 12,000 Swedish twin sets -- a greater influence than was previously thought. But having a relative with the disease does not doom a person to a similar fate; even among identical twins, when one male twin had it, almost half of the time the other twin did not. Among female twins, the other twin developed Alzheimer's 60 percent of the time, a difference researchers attributed to the fact that women generally live longer than men.
One kind of genetic test identifies a person's risk of developing Alzheimer's disease but doesn't guarantee whether or not he'll develop the condition. Everyone inherits a form of the apolipoprotein (APOE) gene from each parent. Apolipoprotein helps carry cholesterol in the blood. Its three most common forms are APOE-e2, APOE-e3, and APOE-e4. Those who have two copies of APOE-e4 seem to be at the highest risk of getting Alzheimer's and of developing symptoms earlier in life. Having one copy of APOE-e4 also elevates the risk. Only about 15 percent of people carry the APOE-e4 form.
A second type of existing genetic test for Alzheimer's disease can predict with certainty who develops one rare form of the disease. This is early-onset familial Alzheimer's disease, which strikes between the ages of 30 and 65 and stretches through multiple generations. It accounts for less than 5 percent of all cases.
4.Smoking: Evidence is growing that smoking raises the risk of developing Alzheimer's disease by as much as 50 percent. In late 2007, Dutch researchers who tracked almost 7,000 people age 55 or older for 7 years reported that current smokers were more likely to develop dementia than people who had never smoked or had quit. Interestingly, the effect was more pronounced for people who did not have the APOE-e4 gene (the type known to be most vulnerable to the disease). Smoking didn't raise the already elevated risk of Alzheimer's in those who had the APOE-e4 gene. (Spencer)
5. Head injury: Prior head injury -- even years earlier -- is linked with a greater risk of developing Alzheimer's, though it's not clear why. That's not to say that any youthful bump will lead to Alzheimer's. The injury itself isn't thought to directly cause the disease, although it may hasten the process. But the more severe the trauma, the greater the risk of developing Alzheimer's, according to a large study of World War II veterans. The most concerning are thought to be falls with head injuries that occur later in life.
6. Education: People with lower education levels are more often affected by Alzheimer's disease. Researchers theorize that longer education helps the brain develop stronger, denser, more complex connections between brain cells, creating more cognitive reserve. This positions the brain to be better able to withstand the abnormal stresses associated with Alzheimer's disease and compensate for the changes that occur.
7. Diet and nutrition: Although there's no "Alzheimer's-prevention diet," a growing body of research indicates that nutrition influences brain health and may protect against or postpone cognitive decline. Specifically, your overall risk of Alzheimer's may be lower if you consume:
· B vitamins: People who are folate (B-9) deficient may run triple the risk of developing dementia, according to recent South Korean data. Previous research showed vitamin B-12 to be protective.
· Vitamin E: Those who consume the highest dietary amounts of this antioxidant have a lower incidence of Alzheimer's. Vitamin E supplements have not been shown to have the same protective effect.
· Vitamin C: Another antioxidant, vitamin C, seems to have a protective effect in certain people, though possibly only in dietary form. Antioxidants counter the effects of oxidative stress, which is linked to nerve cell damage and death. Over-the-counter vitamin C supplements did not reduce Alzheimer's risk in a recent study of 2,969 people 65 and older.
· A heart-healthy diet: People who consume a generally balanced diet that avoids too much fat and includes complex carbohydrates are less likely to develop conditions that are Alzheimer's risks, including obesity, diabetes, and cardiovascular disease.
8. Exercise: Regular exercise reduced the risk of dementia by as much as 40 percent in a 2006 study of nearly 2,000 people age 65 and older. This was the first study to factor in one's pre-existing physical condition. And those most frail at the start of the study showed the greatest protection against dementia if they exercised. The threshold that made a difference: physical activity for at least 15 minutes, three times a week. Exercise both lowers the risk of obesity and cardiovascular conditions linked to Alzheimer's and reduces the risk of developing dementia.
Previous research has shown that the variety of activity engaged in is more important than the intensity of a workout, when it comes to providing brain benefits. (Variety of workouts had no benefit, though, to those with the APOE-e4 gene variation most commonly associated with Alzheimer's.)
9.Mental stimulation: Just as physical activity exercises the body, "cognitive activity" exercises the brain. Numerous studies now support the "use it or lose it" idea that mental workouts lower the risk of dementia. For example, participants in the Religious Orders study who attended museums, worked puzzles, and read newspapers were 47 percent less likely to develop Alzheimer's after four years than those who did such activities less frequently.
Brain-stretching activities can't prevent Alzheimer's, but they help the brain better withstand the physical changes associated with it. What's key: The stimulation should be ongoing.
10.Social stimulation: Isolation is a risk factor for developing dementia, probably because there's less opportunity for mental stimulation. But a surprising 2007 study also found that people who were around others but felt lonely (emotional isolation) were also at higher risk for Alzheimer's. This sense of loneliness wasn't a result of the disease (as is often the case with depression) but a clear precursor.

Symptoms: Short-term memory loss is one of the most noticeable signs of Alzheimer's disease. But the disease process usually begins before symptoms are noticed. To assess someone's risk of becoming one of the more than 5 million Americans with Alzheimer's, it's helpful to understand the risk factors that increase the odds of developing the condition. (Spencer).

Only a qualified physician can conclude with high certainty that a living person has Alzheimer's disease. But the following eight symptoms are strongly associated with the disease. If you detect these signs in someone, it would be wise to seek a medical evaluation.
Alzheimer's symptom #1: Memory lapses (Spencer)
1. Does the person ask repetitive questions or retell stories within minutes of the first mention?
2. Does she forget the names of recent acquaintances or younger family members, such as grandchildren?
3. Are memory lapses growing progressively worse (such as affecting information that was previously very well known)?
4. Are they happening more frequently (several times a day or within short periods of time)?
5. Is this forgetfulness unusual for the person (such as sudden memory lapses in someone who prided herself on never needing grocery lists or an address book)?

Having problems with memory is the first and foremost symptom noticed. It's a typical Alzheimer's symptom to forget things learned recently (such as the answer to a question, an intention to do something, or a new acquaintance) but to still be able to remember things from the remote past (such as events or people from childhood, sometimes with explicit detail). In time, even long-term memories will be affected. By then other Alzheimer's symptoms will have appeared.
Alzheimer's symptom #2: Confusion over words
1. Does the person have difficulty finding the "right" word when she's speaking?
2. Does she forget or substitute words for everyday things (such as "the cooking thingamajig" for pot or "hair fixer" for comb)?
3. Of course it's normal for anyone to occasionally "blank" on a word, especially words not often used. But it's considered a red flag for Alzheimer's if this happens with growing frequency and if the needed words are simple or commonplace ones.
This can be a very frustrating experience for the speaker. She may stall during a conversation, fixating on finding a particular word. She may replace the right word with another word. This substitute could be similar enough that you could guess at her meaning ("hair dryer" instead of "hairdresser"), especially early on in the disease process. Or it could be completely different ("bank" instead of "hairdresser") or nonsensical ("hairydoo").
Alzheimer's symptom #3: Marked changes in mood or personality
1. Is the person who's usually assertive more subdued (or vice versa)? Has the person who's reserved become less inhibited (or vice versa)?
2. Does s/he withdraw, even from family and friends, perhaps in response to problems with memory or communication?
3. Has she developed mood swings, anxiety, or frustration, especially in connection with embarrassing memory lapses or noticeable communication problems?
4. Has she developed uncharacteristic fears of new or unknown environments or situations, or developed a distrust of others, whether strangers or familiar people?
5. Do you see signs of depression (including changes in sleep, appetite, mood)?
Mood shifts are a difficult sign to link decisively to Alzheimer's disease because age and any medical condition may spark changes in someone's mood, personality, or behavior. In combination with other Alzheimer's symptoms, however, changes such as those described above may contribute to a suspicion of the disease.
A person with Alzheimer's may also become restless and/or aggressive, but usually in later stages of the disease.
Alzheimer's symptom #4: Trouble with abstract thinking
1. How well does the person handle relatively simple mathematical tasks, such as balancing a checkbook?
2. Is she having trouble paying bills or keeping finances in order, tasks she previously had no problem completing?
3. Does she have trouble following along with a discussion, understanding an explanation, or following instructions?
Abstract thinking becomes increasingly challenging for someone with Alzheimer's, especially if the topic is complex or if the reasoning is sequential or related to cause and effect.
Alzheimer's symptom #5: Difficulty completing familiar activities
1. Has the person begun to have trouble preparing meals?
2. Is she less engaged in a hobby that once absorbed her (bridge, painting, crossword puzzles)?
3. Does she stop in the middle of a project, such as baking or making a repair, and fail to complete it?
4. Has she stopped using a particular talent or skill that once gave her pleasure (sewing, singing, playing the piano)?
5. Activities with various different steps, however routine and familiar, can become difficult to complete for a person with Alzheimer's. Your parent might become distracted or lose track of where she is in the process, feeling confused. Or she might just lose interest altogether and leave a project unfinished.
Alzheimer's or some other form of dementia is especially suspect when the difficult or abandoned activity is something the person formerly delighted in and excelled at, or used to engage in frequently.
Alzheimer's symptom #6: Disorientation
1. Has the person begun to be disoriented in new or unfamiliar environments (such as a hospital or airport), 2. asking where she is, how she got there, or how to get back to a place she recognizes?
2. Has she become disoriented in an environment she knows well?
3. Does she wander off and get lost in public (or get lost when driving or after parking)?
4. Does she lose track of the time, day, month, or year? For example, after being reminded about a future doctor's appointment over the phone, she may start getting ready for the appointment right away. Or she may have trouble keeping appointments and remembering other events or commitments.
These examples of disorientation are all typical Alzheimer's symptoms, more so in later stages of the disease but sometimes early on as well.
Alzheimer's symptom #7: Misplacing items
1. Does the person "lose" items often?
2. Do they turn up in unusual places (such as finding a wallet in the freezer)?
Losing track of glasses, keys, and papers happens to most adults sometimes, whether due to age or just a busy lifestyle. However, it may be a symptom of Alzheimer's if this behavior escalates and if items are sometimes stored in inappropriate or unusual places, and your parent doesn't remember having put them there.
Alzheimer's symptom #8: Poor or impaired judgment
1. Has the person recently made questionable decisions about money management?
2. Has she made odd choices regarding self-care (such as dressing inappropriately for the weather or neglecting to bathe)?
3. Is it hard for her to plan ahead (such as figuring out what groceries are needed or where to spend a holiday)?
Difficulty with decision-making can be related to other possible symptoms of Alzheimer's, such as lapses in memory, personality changes, and trouble with abstract thinking. Inappropriate choices are an especially worrisome sign, as your parent may make unsound decisions about her safety, health, or finances.
Many of these Alzheimer's symptoms go unnoticed for a long time. That's because they're often subtle or well concealed by the person (or a spouse), who may be understandably freaked out by the changes she's noticing in her own behavior. Some patterns of behavior take time to make themselves obvious. (Spencer)

(To be continued)

Sources:
Alice Park. "Alzheimer's Unlocked".Time (Oct 25, 2010),pp. 53-59.
Paula Spencer. http://www.caring.com/articles/alzheimers-symptom-misplacing-items#ixzz1IfZU2ILr.
http://www.caring.com/articles/education-and-diet-alzheimers-risk#ixzz1IfhdlnDX.
http://en.wikipedia.org/wiki/Alzheimer%27s
http://www.caring.com/alzheimers#ixzz1IqtT7T2i
http://www.caring.com/articles/late-stage-alzheimers-health-care#ixzz1Iqw4Od00
http://www.caring.com/end-stage-alzheimers#ixzz1IqvRd6Gc
By Maria M. Meyer, Mary S. Mittelman, Cynthia Epstein, and Paula Derr,
http://www.caring.com/articles/severe-alzheimers#ixzz1Iqv0CgUE
http://www.caring.com/articles/moderate-alzheimers#ixzz1IqudDonU
http://www.caring.com/articles/mild-alzheimers#ixzz1Iqu5g8oJ

For more information, please check:
Alzheimer's Disease Centers (ADCs)
Alzheimer's Disease Education and Referral (ADEAR) Center
Alzheimer's Association
UCSF Memory and Aging Center
Richard Taylor. Alzheimer's From the Inside Out
National Institute on Aging. nia.nih.gov/Alzheimer's
Alzheimer's Association. alz.org