Understanding Alzheimer's Disease

Alzheimer’s is present in over 40 million individuals worldwide, with over 5 million being in the United States. Various organizations and institutions, such as the G8, have begun referring to Alzheimer’s as an epidemic, and one who experts fear could affect over 100 million people by the 2020’s. As of today, Alzheimer’s disease is the 6th leading cause of death in the United States and will only continue killing as the lifespan of U.S. citizens continues to rise. While many hopeful researchers are aiming to have a sound cure and or treatment for Alzheimer’s soon, the grim truth of the matter is that as of today millions are being plagued by this disease with no true curative treatments available.
While the statistics may paint a picture

of the grisly effects Alzheimer’s disease is having on the world, they still don’t provide an explanation of what Alzheimer’s truly is. Alzheimer’s disease is the leading cause of dementia, accounting for a large portion of dementia-related cases. Dementia is a type of cognitive disease, in which memory, and overall brain functionality is greatly diminished. While there are several dementia-related symptoms, the most common prodromes include; loss of memory, degradation of communicational skills, and an overall decrease in one’s ability to make rational decisions. Alzheimer’s disease is believed to strengthen in age, meaning that while mild at first, the disease begins to become much more devastating later in one’s life, resulting in an overall increase in both symptom occurrences and severity. Most cases of Alzheimer’s occur around the age of 65, with a rare amount of cases occurring in an individual’s 40’s. During the earlier stages of Alzheimer’s dementia, an individual can still function almost normally, with memory lapses occurring here and there. As the individual ages, however, an individual requires assistance in day-to-day living, have a hard time communicating with others, and overall display a lack of awareness towards their environment. In this stage, many individuals also begin to lose both long and short-term memories, eventually forgetting their own personal histories. Alzheimer’s disease may also affect a person’s behavior, leading to some individuals to display depression, paranoid, and irritability.
Another important component in understanding Alzheimer’s is knowing how health professionals diagnose the disease. After displaying various combinations of the aforementioned symptoms an individual will be tested for Alzheimer’s. A key step to diagnosing Alzheimer’s is a series of neurological exams designed to test a patient’s cognitive ability. These tests assess a patient’s ability to problem-solve, use language, as well as store and recall memories. After completing these steps, health providers may also interview individuals who are close to the patient to check for changes in their cognitive and emotional profile. Health providers will also run a series of laboratory tests with the intent of ruling out diseases with similar symptoms to Alzheimer’s. Lastly, health providers will use MRI’s (Magnetic resonance imaging), CT’s (Computerized tomography), and PET’s (Positron emission tomography) to search brains for neural degeneration consistent with Alzheimer’s disease. If an individual undergoes all these tests and displays sufficient evidence indicating that they have Alzheimer’s, their health providers will then work on finding a treatment plan to best serve the individual’s needs. While this process may seem overly complicated, it is currently the best method available to sufficiently diagnose someone with Alzheimer’s. Scientists are however working on improving Alzheimer’s detection methods that will search for key genetic markers and will be able to reliably indicate whether one has Alzheimer’s, thus bypassing the long series of steps actively being used today.
With Alzheimer’s plaguing the world, it is important for researchers to get a grasp from which the disease stems.

Though researchers have worked tirelessly to uncover the source of Alzheimer’s related dementia, its true cause is unknown. However, various studies have come to similar conclusions in understanding Alzheimer’s. Scientists have found that in Alzheimer’s afflicted individuals, there is a large build-up of proteins called amyloid and tau within brain cells. While these proteins are found in healthy individuals, it is the large amount in which scientist are worried. However, scientists do not yet know why these proteins occur in such large amounts. With this uncertainty also comes a clear connection, as more of these proteins form in brain cells, the more brain cells which lose their functionality and eventually die. What this results in is not only a decrease in overall brain activity but also a decrease in the brains actual

size.
Alzheimer’s disease, especially in terms of Alzheimer’s related dementia, also displays a clear genetic connection. “Genome-wide association studies have been used to identify more than 20 genetic loci associated with the risk of Alzheimer's disease” (Scheltens, 2016). This also supports findings done by various other researchers that conclude that individuals have a heightened chance to receive this disease if they have family members who also have it (Genin, 2011). One key genetic marker for Alzheimer’s is the protein APOE4, better known as “Apolipoprotein E.” A study performed in 2011 found that individuals who are homozygous for the APOE4 protein show over a 50% chance for possessing the disease, while individuals who are heterozygous for the protein stand at a much lower range of around 20-30%. These claims are also supported further by animal-based studies that state “mice that express APOE4 show disinhibition of a cyclophilin A signaling mechanism in the pericytes of the brain blood vessels, resulting in degeneration of these vessels, leakage of the blood-brain barrier, and neurodegeneration independent of Aβ” (Scheltens, 2016). In other words, mice that displayed a genetic favorability towards APOE4, also displayed an overall decrease in cognitive functionality, mainly due to the interaction between APOE4 and Peptidylprolyl isomerase A. Because of this interaction, not only is the overall blood flow to the brain decreased, but there is also a leakage of the blood-brain barrier, commonly known as “Leaky Brain.” Leaky brain is a malady in which high levels of inflammation, specifically in regions of the brain, may contribute towards brain degradation. Blood-brain barrier has been linked to a number of diseases including but not limited to: Alzheimer’s, Parkinson’s, dementia, Multiple sclerosis, ALS, seizures, ME/CFS, Autism, as well as a variety of mood swings attributed to these diseases such as depression and anxiety.
Alzheimer's as a disease negatively impacts many lives, and as mentioned above is being looked at very seriously by many medical organizations and groups. As with such, there have been many resources poured into researching treatments, cures, and curative treatments. Though scientists have worked tirelessly, there is no cure for Alzheimer’s disease, but there are several treatments available to ease Alzheimer’s related symptoms. Currently, the primary treatment for Alzheimer’s is very holistic and should include “supportive care from family and other caregivers” (Scheltens, 2016). Maintaining an active life is also important when confronting Alzheimer’s, the national institute of aging states “Getting exercise helps people with Alzheimer’s feel better and helps keep their muscles, joints, and heart in good shape.” There are also various medications used to help ease the symptoms displayed by Alzheimer’s afflicted patients. The most common medications prescribed in Alzheimer’s related cases include Donepezil, galantamine, memantine, rivastigmine, memantine, and donepezil. These medications are often prescribed in different stages of Alzheimer’s however, they all aim to help improve cognitive ability, as well as delaying symptom related effects. Doctors also prescribe a plethora of other medications, such as antidepressants, antipsychotics, and zolpidem, to not only help ease behavior changes but also help with daily activities such as sleep-related activity.
While the current treatments of Alzheimer’s work suitably in addressing symptoms, the community of Alzheimer’s based researchers are hard at work to find superior treatment methods.

With advancements in technology, scientists are becoming much more aware of the molecular and genetic basis in which Alzheimer’s disease occurs. Scientists hope to construct “Drugs targeting the amyloidogenic pathway to modify the course of the (Alzheimer’s) disease” (Masters, 1998). Beta-amyloids are a type of protein, that when clumped together, form plaques. When these plaques create groups, normally between nerve cells, they are suspected of causing neural degeneracy. Scientists are actively investigating possible treatments with the purpose of: “blocking the activity of beta-secretase enzyme; preventing the beta-amyloid fragments from clumping into plaques, and even using antibodies against beta-amyloid to clear it from the brain.” There have already been several studies performed with the intention of using antibodies to decrease plaque buildup, and with various accounts displaying both successful and promising results. Clinical studies in 2014 found “monoclonal antibody selective for aggregated forms of Aβ (ie, soluble oligomers and insoluble fibrils), in patients with early Alzheimer's disease (ie, mild cognitive impairment and mild dementia) was associated with a dose-dependent decrease in amyloid uptake and a slower decline in cognition and global functioning” (Scheltens, 2016).

With a decrease of brain inflammations, scientists hope that this treatment will help slow neural degeneration and greatly assist with other neurological diseases such as dementia.
In conclusion, Alzheimer’s is a serious disease that is plaguing the world. While there is no cure for the disease, there are a variety of medicines available to address Alzheimer’s related symptoms, as well as an assortment of treatments that are currently being tested in the lab. Leading experts in the Alzheimer’s field hope to make serious developments over the next decade, with a primary focus on being able to both, better understand the disease, as well as being able to better treat it. By the time the next generation reaches the age in which Alzheimer’s is prominent, scientists expect there to be an array of new treatments available to both better diagnose Alzheimer’s, as well as treat it.