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Alzheimer's Disease - Causes, Symptoms And Treatment

Alzheimer's disease is a common type of dementia, or decline in intellectual function. Once thought rare, Alzheimer's disease is now known to affect more than 4.1 million people in the United States . It afflicts 10 percent of Americans over sixty-five and as many as 50 percent of those over eighty-five. However, the disease does not affect only the elderly, but may strike when a person is in his or her forties.

This disorder was first identified in 1906 by a German neurologist named Alois Alzheimer. It is characterized by progressive mental deterioration to such a degree that it interferes with one's ability to function socially and at work. Memory and abstract thought processes are impaired. Alzheimer's disease is an irreversible, progressive disorder. Deterioration in critical areas of the brain may precede symptoms by as much as twenty to forty years. As Alzheimer's disease progresses, there is severe memory loss, particularly in short-term memory. The person may recall distant events but is unable to remember a just­viewed television show. At this stage, disorientation usually begins as well. Dysphasia (the inability to find the right word) may occur, and mood swings can be unpredictable and sudden. In the final stage, Alzheimer's disease creates severe confusion and disorientation, and possibly hallucinations or delusions. Some people become violent and angry, while others may be docile and passive. It is in this later stage that people with Alzheimer's disease may wander without purpose, experience incontinence, and neglect personal hygiene. Since the behavioral symptoms of Alzheimer's disease result from changes in the brain, the person neither intends nor can control this behavior.

Once considered a psychological phenomenon, Alzheimer's disease is now known to be a degenerative disorder that is characterized by a specific set of physiological changes in the brain. Nerve fibers surrounding the hippocampus, the brain's memory center, become tangled, and information is no longer carried properly to or from the brain. New memories cannot be formed, and memories formed earlier cannot be retrieved. Characteristic plaques accumulate in the brain as well. These plaques are composed largely of a protein-containing substance called beta­amyloid. Scientists believe that the plaques accumulate in and damage nerve cells.

Many people worry that their forgetfulness is a sign of Alzheimer's disease. Most of us forget where we have put our keys or other everyday objects at one time or another, but this is not an indication of Alzheimer's disease. A good example of the difference between forgetfulness and dementia is the following: If you do not remember where you put your glasses, that is forgetfulness. If you do not remember that you wear glasses, that may be a sign of dementia.

Other disorders can cause symptoms similar to those of Alzheimer's disease. Dementia may result from arteriosclerosis (hardening of the arteries) that slowly cuts off the supply of blood to the brain. The death of brain tissue from a series of minor strokes, or from pressure exerted by an accumulation of fluid in the brain, may cause dementia. The presence of small blood clots in vessels that supply the brain, a brain tumor, hypothyroidism, and advanced syphilis all can cause symptoms similar to those of Alzheimer's disease. In addition, the average person over the age of sixty-five is likely to be taking between eight and ten different prescription and over-the-counter drugs. Drugs reactions, coupled with a nutrient-poor diet, often adversely affect people not only physically, but mentally as well.

The precise cause or causes of Alzheimer's disease are unknown, but research reveals a number of interesting dues. Many of them point to nutritional deficiencies. For example, people with Alzheimer's tend to have low levels of vitamin B12 and zinc in their bodies. The B vitamins are important in cognitive functioning, and it is well known that the processed foods constituting so much of the modem diet have been stripped of these essential nutrients. The development of the neurofibrillary tangles and amyloid plaques in the brain that are characteristic of the disease have been associated with zinc deficiency. Malabsorption problems, which are common among elderly people, make them more prone than others to nutritional deficiencies. Alcohol and many medications further deplete crucial vitamins and minerals.

Levels of the antioxidant vitamins A and E and the carotenoids (including beta-carotene) also are low in people with Alzheimer's disease. These nutrients act as free radical scavengers; deficiencies may expose the brain cells to increased oxidative damage. In addition, deficiencies of boron, potassium, and selenium have been found in people with Alzheimer's disease.

Some research has drawn a connection between Alzheimer's disease and high concentrations of aluminum in the brain. Autopsies of people who have died of Alzheimer's disease reveal excessive amounts of aluminum in the hippocampus area and in the cerebral cortex, the external layer of gray matter responsible for higher brain functions such as abstract thinking, judgment, memory, and language. It may be that exposure to excessive amounts of aluminum, especially if combined with a lack of essential vitamins, minerals, and antioxidants predispose one to developing Alzheimer's disease. However, one recent study, published in Archives of Neurology in May 1998, showed no further correlation between the density of neurofibrillary tangles in the frontal and temporal lobes of the cortex and bulk aluminum concentration. This study further demonstrated that levels of aluminum are not elevated in the cerebrospinal fluid of patients with Alzheimer's disease.

Brains of people with Alzheimer's disease have been found to contain higher than normal concentrations of the toxic metal mercury. For most people, the release of mercury from dental amalgams is the primary means of mercury exposure, and a direct correlation has been demonstrated between the amount of inorganic mercury in the brain and the number of amalgam surfaces in the mouth. Mercury from dental amalgam passes into body tissues, and it accumulates in the body over time. Mercury exposure, especially from dental amalgams, cannot be excluded as a major contributor to Alzheimer's disease.

Causes of Alzheimer's disease

Many people who develop Alzheimer's disease have a family history of the disorder, suggesting that heredity may be involved. By age ninety, the risk is at least 50 percent for those with a first-degree relative (father, mother, brother, sister) who has (or had) Alzheimer's disease. The equivalent rate is about 50 percent for identical twins. As with other brain disorders, such as schizophrenia and manic-depressive disorder, the hereditary pattern is complicated. At least four gene variations are linked to Alzheimer's disease. All of them reduce the clearance, or increase the production, of beta-amyloid. A variation of a gene involved in the synthesis of beta-amyloid, located on chromosome 21, is associated with a rare type of Alzheimer's disease that typically begins between the ages of forty and fifty. Interestingly, people with Down syndrome, who carry an extra copy of chromosome 21, are prone to develop very early Alzheimer's disease, beginning in their thirties and forties.

Yet another possible culprit in the death of brain cells is the immune system. Many illnesses result from immune system malfunction causing it to attack the body's own tissues. Powerful immune system proteins called complement proteins have been found around the plaques and tangles in the brains of people who have died of Alzheimer's disease. In animals, brain injury is known to result in an alteration in the genetic "instructions" for two kinds of complement proteins. Some experts theorize that complement proteins normally help clear away dead cells, but in Alzheimer's disease, they begin to attack healthy cells as well. Cell degeneration results in accumulations of amyloid. Many researchers believe that beta-amyloid is a key player in this memory-destroying disease. This substance is "not unique to the brain, but is produced in virtually every cell in the body as a result of the degeneration of tissue. Amyloid itself is not highly toxic, but it might possibly trigger dementia if a critical mass accumulates in the brain. Further evidence reveals that the presence of amyloid may trigger the release of a cascade of complement proteins; perhaps sparking a vicious cycle of inflammation and further plaque deposits. However, an immune system attack on brain cells may be a result, or may be merely one element, of Alzheimer's disease, rather than the cause. Other potential risk factors being studied are head injury, very high blood pressure, and low education levels.

Although all of these findings offer hope that Alzheimer's disease may one day be fully understood, and thereby prevented, science does not yet know what can be done to arrest the mental deterioration. Even diagnosis of the disease is not a precise science. There are tests that can suggest a diagnosis of Alzheimer's and that can dismiss other problems as the cause of symptoms, but there currently is no single laboratory procedure or biochemical marker that can definitively confirm the disorder in a living person. Physicians can, however, make a probable diagnosis by performing a comprehensive evaluation including a complete health history and physical examination, a mental status assessment, neurological tests, blood tests, urinalysis, an electrocardiogram (EKG), and x-rays. Additional tests may be conducted, such as a computerized tomography (CT) scan, electroencephalography (EEG, a recording of brain-wave patterns), and formal psychiatric assessment. These tests are necessary to rule out other possible causes of dementia symptoms, such as pernicious anemia, hypothyroidism, or tumors. Documenting symptoms over time, in a diary-like fashion, helps doctors to understand each individual case. Unfortunately, the diagnosis of Alzheimer's disease is often made long after the person has lost the ability to communicate and comprehend information. As more is learned about the contribution of genetic and other factors to Alzheimer's disease, the possibility of delaying the progression of disease may become more real.

Ten Warning Signs and Symptoms of Alzheimer's Disease

Everyone experiences forgetfulness or the momentary inability to pull up the proper word from time to time and, especially as we get older, we may worry that such episodes are a sign of Alzheimer's disease. The symptoms of Alzheimer's disease are distinctly different from those of everyday forgetfulness. The Alzheimer's Association gives the following ten warning signs of Alzheimer's disease.

1. Recent memory loss that affects job performance. Everyone forgets things and then recalls them later. People with Alzheimer's disease forget often, never recall, and repeatedly ask the same question, forgetting the earlier answer.
2. Difficulty performing familiar tasks. For example, a person with Alzheimer's disease might prepare a meal, forget to eat or serve it, and even forget that he or she made it.
3. Problems with language. A person with Alzheimer's disease may forget simple words or use inappropriate words, making speech incomprehensible.
4. Disorientation as to time and place. A person with Alzheimer's disease may get lost on his or her own street and forget how he or she got there or how to get home.
5. Poor or weaker judgment. For example, anyone might get distracted and fail to watch a child. A person with Alzheimer's disease, however, might entirely forget the ere: under his or her care and leave the house.
6. Problems with abstract thinking. Anybody can have trouble balancing a checkbook; a person with Alzheimer's disease might completely forget what numbers are and what needs to be done with them.
7. Misplacing things. A person with Alzheimer's disease may put things in inappropriate places-an iron in the freezer or a wristwatch in the sugar bowl, for example­and not be able to retrieve them.
8. Changes in mood or behavior. Everyone has occasional. mood swings, but people with Alzheimer's disease can have rapid mood swings-from calm, to tears, to anger­within a few minutes.
9. Personality changes. A person with Alzheimer's disease may experience drastic and inappropriate personality changes, becoming uncharacteristically irritable, suspicious. or fearful.
10. Loss of initiative. People with Alzheimer's disease may become passive and reluctant to get involved in activities.

If you notice several of these symptoms in yourself or a loved one, consult a doctor for a complete examination and evaluation.

Treatment for Alzheimer's disease

• Butcher's broom promotes healthy circulation.
• Ginkgo biloba extract, taken in liquid or capsule form, act as an antioxidant and increases blood flow to the brain.
• Include plenty of fiber in your diet. Try oat bran or rice bran.
• Valerian root improves sleep patterns when taken at bedtime.
• Kava kava and St. John's wort help calm people who anger easily.
• The Chinese herb qianceng ta (Huperzia serata) increases memory retention. This is the same herb that is the source of huperzine A, and it is also known as club moss. Pure and standardized extracts of this herb have been shown to increase clearheadedness, language ability, and memory in a significant percentage of subjects with Alzheimer's disease. It is a potent blocker of acetylcholinesterase, an enzyme that regulates the activity of acetylcholine, which is an important chemical of the brain that maintains healthy learning and memory functions.

Considerations and prevention tips

• Do not drink tap water, as it may contain aluminum. Consume steam-distilled water only and drink at least eight glasses a day.
• Using your brain, remaining busy, writing, reading and learning new things are important overall factors in staying sharp and preventing mental disorders.
• Recent studies show that the progression of Alzheimer's disease can be slowed or even reversed by reducing free radical accumulation through the use of antioxidants. Tests conducted in Switzerland over a twenty-two-year period produced evidence of significantly higher memory scores associated with antioxidant therapy.
• The signs of alcohol abuse and the symptoms of Alzheimer's can be very similar. For example, actress Rita Hayworth, who had Alzheimer's disease, was at first thought to be an alcoholic.
• The herbs balm and sage are being researched for possible beneficial effects on brain chemistry. Balm appears to simulate the neurological receptors that bind acetylcholine. Sage contains compounds that are cholinesterase inhibitors.
• Experts are now considering ways to attack the disease at its earliest stages through the use of anti inflammatory drugs. One approach is to block the theorized inflammatory response to plaques. In fact, inflammation has been under suspicion as a cause of Alzheimer's disease, partly because nonsteroidal, anti inflammatory drugs (NSAIDs) like aspirin, indomethacin (Indocin), naproxen (Naprosyn), and ibuprofen (Motrin) seem to slow the progress of the disease.
• Scientists at the University of Kentucky found that levels of glutamine synthetase, an enzyme that controls the production of ammonia and glutamate, were higher in a group of people with Alzheimer's disease than in a healthy control group. Glutamate is vital to the brain in small amounts, but it can be poisonous in high concentrations. Abnormally high levels of glutamate have recently been associated with amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig's disease) and glaucoma as well.
• Experts say that it is in an individual's best interest to be told as soon as there is reason to suspect a diagnosis of Alzheimer's disease. Early warning cannot prevent the disease, but it gives people time to settle their affairs and make informed judgments about future care and other matters.