Losing the mind to Alzheimer's

Alzheimer’s is fascinating and intriguing and it’s concerning. At any point in time, many of us are starting to get up there in age. I’m certainly one of them.

It’s of great interest because we see it in action. People can, if we can use the vernacular, “lose their minds” and it’s very sad. It’s pretty scary to realize that we are all aging also. We think about it. Especially when we see someone in that state we really think about it. We just have to wonder, “Am I going to lose my mind some day? Is that going to be me?”

Probably 20 years ago we had never heard the term Alzheimer’s. We called it senile dementia or this or that. As we improved imaging technology, mainly CT and MRI we began to see more specific symptoms related to structural changes in the brain. That’s when Alzheimer’s started becoming more of a thing. Today, Alzheimer’s represents 70% of all dementia. So it’s basically what we used to call senile dementia. It seems to be increasing and getting worse.

Let’s define what it looks like and what it is. It’s a loss or decline of memory or other cognitive skills. That can include speech, hearing and understanding speech or reading the written language. It can be failure to recognize or identify object in terms of being able to feel them. You put a cell phone in an Alzheimer sufferer’s hand and they can’t tell you that’s a cell phone. You put a familiar letter opener in their hands and they can’t tell that’s a letter opener or scissors or something like that. Or it can be motor skills that you lose, the ability to walk and function. Or it can even be abstract thought and judgment and the ability to carry out a task.

Those are all different things, from being able to identify something in your hand to being able to carry out a complex, abstract task. That’s because different areas of the brain can be more affected than others, or sooner. It’s all according to what area of the brain is affected, that’s what would show up first, if you would. Eventually the whole brain is involved. It is a whole brain disease. It’s just that it is going to show up some place first. That’s why it appears one of those places before it does the others. It will eventually encompass them all.

The economic impact is almost incomprehensible. Just the loss of income to the nation from the care-givers, someone who has to stay home and take care of this person because they are a danger to themselves and their family, is a staggering $100 billion a year. That doesn’t include people who are hospitalized or in nursing care facilities.

What happens in Alzheimer’s? The truth is, we’re still learning a lot about it. We know a few things and there’s a whole lot we don’t know yet. There are about 100 billion nerve cells in your brain. Each one of those nerves may have millions if not up to a billion other little touch points where it touches on other nerves. If we can borrow a phrase from Saddam Hussein, it’s the mother of all networks. It’s the ultimate network, your brain. It’s just incredible. Each cell will connect millions and millions and millions of times to other nerve cells and axons (the shaft of the nerve, going from one to the other). So this is an extremely complex, intricate, inter-related piece of matter that we’ve got between our ears.

Those little connections are called synapses. We know for a fact that these synapses become damaged and start to disappear as Alzheimer’s progresses. As they disappear, the nerve axons begin to die and then the nerve cells themselves begin to die. These nerves have different signal patterns than healthy nerves. You begin to lose the interconnectedness of all the different synapses: the reason why Alzheimer victims begin to forget things. Then there’s a whole lot of dead debris laying around the brain, if you would, from all these dying cells.

We notice that there’s a substance that we call amyloid there, or specifically beta-amyloid which is a little tiny protein fragment. There’s a huge debate about whether this is the cause or the result. Is it an over production of beta-amyloid? Okay, let’s figure out how to stop the production, or help the body clean it up. We know that the beta-amyloid does jam the synapses, the little connections we were talking about. Ultimately those little pieces of beta-amyloid build up into plaque which we can physically see on MRI.

Another hallmark on the cellular level of Alzheimer’s is there are tangles inside the cells, tangles of proteins inside the nerve cells themselves. They have given those a name: “tau twist”. The other thing we know is there’s a huge amount of inflammation and oxidative damage due to highly reactive oxygen species in the brain. Those are called oxidizers. You neutralize those with anti-oxidants. But there’s a problem because a lot of anti-oxidants don’t cross the blood/brain barrier very well. So your normal, routine anti-oxidants might not be quite as effective. There are a few that do cross the blood/brain barrier. It seems the medical community would do well to best pay attention to those.

Next time I post I’ll talk more about who is more at risk for Alzheimer’s, and what treatments exist for this terrible disease. Stay tuned.