The Struggle With Alzheimer's Disease

In the heart of every Tar Heel, there lies a deep respect for Coach Dean Smith. After thirty-six seasons and 879 career wins, the game he once loved has become a blur. Smith was the men’s basketball coach at The University of North Carolina at Chapel Hill from 1961 to 1997. He led the Tar Heels to 11 Final Fours and 23 straight NCAA tournament appearances. But these accomplishments are becoming increasingly difficult for Coach Smith to remember due to his struggle with Alzheimer’s disease. A remarkably intelligent man has become a shell of the man he once was. The Alzheimer’s Association has predicted
“Moment” that if a cure is not found, 7.7 million people will have the disease by 2030 and as high as 16 million by 2050. Alzheimer's disease

is a growing threat; however, there is hope as far as prevention due to the large strides research has made in further understanding the causes of the deterioration of the brain.
The term Alzheimer’s Disease came about in 1906 when a German physician, Dr.

Alois Alzheimer, presented a case history of a woman who suffered from a rare brain disorder. The autopsy of her brain identified plaques and tangles. These plaques and tangles work together to break down the brain’s structure. Today, the disease can be characterized by these plaques and tangles. Plaques arise when another protein in the fatty membrane surrounding nerve cells gets sliced up by a particular enzyme. This results in the formation of Beta-Amyloid Proteins, which are sticky and have a tendency to clump together. This clumping is what creates what we know as plaques. These clumps block signaling and communication between cells and also triggers immune reactions that cause the destruction of disabled nerve cells. In Alzheimer’s Disease, neurofibrillary tangles are built from a protein known as tau. The brains nerve cells contain a network of tube-like structures that act as a highway for food molecules among other things. Usually, the tau protein ensures that these tubes are straight, allowing molecules to pass through freely. However in Alzheimer’s Disease, the protein collapses into twisted strands or tangles making the tubes disintegrate, obstructing nutrients from reaching the nerve cell and leading to cell death. The destructive pairing of plaques and tangles starts in a region of the brain called the hippocampus. Alzheimer’s disease is a progressive and degenerative disorder that attacks the brain's neurons resulting in loss of things such as memory, thinking and language skills, and behavioral changes. Dementia is a general term for a decline in mental ability. Alzheimer's is the most common type of dementia. Dementia is not a specific disease. It is a broad term that describes a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person's ability to perform everyday activities. Alzheimer's disease accounts for

approximately 80 percent of dementia cases. Scientists believe that Alzheimer's disease results from a combination of genetic, lifestyle and environmental factors that affect the brain over time. Alzheimer’s disease is very complex and it is highly unlikely that any one change will be found to delay, prevent, or cure it. More than one gene mutation can cause Alzheimer’s disease, and scientists believe that genes on multiple chromosomes are involved. Knowing this, current approaches in treatment and research focus on several different aspects.
As nonfiction writer, Ihla Nation, aptly describes, “Alzheimer’s Disease is an octopus. It’s tentacles stretch out through the ether, strangling the lives of those within it’s reach. The aftermath… leaves survivors weaving the frayed threads of their lives into lessons colored in grief, anger, fear, sadness, and human frailty.” The human brain weighs only about three pounds, but it is the most complex and powerful organ in the human body. Scientists believe that brain changes may start ten to twenty years before any signs or symptoms of the disease appear. The brain controls everything from breathing, memory, thought processing, and movement. The disease has been broken into seven stages. However, the symptoms vary. The stages provide a general idea of how abilities change during the course of the disease. The cognitive decline continues throughout the seven stages ultimately leading to the inability to respond to their environment, loss of control of movement, and eventually death.
Today, there is still no cure for Alzheimer's. Those that are touched by the disease progressively suffer from memory loss and lose their ability to function. Researchers are still trying to fully understand how it’s brain plaques and tangles lead to memory loss and other cognitive, behavioral and psychiatric symptoms -- and how to reverse those changes to prevent or
“Digital” stop the disease. However, there are treatments available today that can help patients manage the symptoms of Alzheimer's disease, allowing them to function at a higher level for a longer period of time. Alzheimer's therapy involves a number of different treatments that address each of these problems. Because symptoms change over time, doctors need to adjust their Alzheimer's patients' therapies as new problems emerge. Currently, there are two types of US Food and Drug Administration approved medications to treat Alzheimer’s. The two types of medications are cholinesterase inhibitors and memantine. All of the prescription medications currently approved to treat Alzheimer’s symptoms in early stages are from a class of drugs called cholinesterase inhibitors. Cholinesterase inhibitors are prescribed to treat symptoms related to thought processes. These prevent the breakdown of acetylcholine, a chemical messenger important for learning and memory. This supports communication among nerve cells by keeping acetylcholine levels high. There are three commonly prescribed cholinesterase inhibitors; Donepezil, Rivastigmine, and Galantime. Donepezil was FDA approved to treat all stages of Alzheimer’s Disease in 1996. Galantamine is in a class of medications called acetylcholinesterase inhibitors. It works by increasing the amount of a certain natural substance in the brain that is needed for memory and thought. Lastly, Rivastigmine improves mental function by increasing the amount of a certain natural substance in the brain. The second type of medication approved to treat Alzheimer’s is Memantine. Memantine is prescribed to improve memory, attention, reason, language and the ability to perform simple tasks. Memantine is used to regulate glutamate activity within the brain. Glutamate is a chemical messenger that is involved in learning and memory. Many researchers consider the benefits of memantine similar to those of cholinesterase inhibitors. Ultimately, the path to effective new treatments is through clinical trials.
Although hope may seem bleak due to the lack of treatment available, there are many methods of prevention that can be used to lower ones chances of developing the disease. While gene factors are out of our control, there are many lifestyle factors that can be regulated to lower your chances of developing the disease. It is not certain if diet, exercise or healthy lifestyle choices can prevent cognitive symptoms; however, these healthy choices promote good overall health and may play a role in maintaing cognitive health. Regular exercise may also help prevent cognitive decline because it has been known to have benefits regarding vascular health. Social engagement is also very important. Social engagement and intellectual stimulation may make life more satisfying and help preserve mental function. The most important thing to remember is that there is a large and experienced Alzheimer's community out there that includes support groups that offer help, support, and advice.
It is evident that Alzheimer’s Disease is becoming increasingly prevalent and a cure will need to be found or huge losses will be sustained. Luckily, there is hope as far as prevention due to the large strides research has made in further understanding the causes of the deterioration of the brain. Currently, there are several promising drugs in development and testing; however, as stated earlier new developments in how to treat Alzheimer’s will not be possible without testing through clinical trials and more government funding. For now, certain factors that contribute to the formation of the disease can only be speculated. The death of a individuals brain does not mean the death of that person entirely. Those that are touched by the disease can still grasp some sense of distorted reality. They remember the person that they once were and others still have a sense of those precious memories. As for Dean Smith, he was remembered as what some call the greatest teacher of basketball that the world has ever seen. Dean Smith’s memory lives on.