Alzheimer's disease – early diagnosis, prevention & drug treatment

Dr Irengbam Mohendra Singh *

Combination of two brain diagrams in one for comparison. In the left normal brain, in the right brain of a person with Alzheimer's disease
Pix - wikipedia/Garrondo

There is plenty of reason why one shouldn't like old age. Old age includes old people and ageism (prejudice). New research suggests that old age starts at 74, with middle age lasting 9 years longer. Old age refer to someone who is nearing or surpassing human life expectancy. Old age is a social construct, despite being biological. A lot of old people feel young at heart. As Gaucho Max once said, a man feels as young as the woman he feels. You can't say Donald Trump (70) is old, feeling his ex-model wife Melania (46). As old age is now unstoppable, the concept of old age is hopelessly 'out of date.'

It brings me a little bump of expected joy that life expectancy in Manipur is also increasing and with it a light dusting of irony that dementia over 65 is also increasing. The most common cause is Alzheimer's disease but people before this age can also develop. As in Manipur, it's twice as common among women than in men.

As a student, I can remember only one woman, mother of a friend of mind, suffering from dementia. I didn't know how old she was. This friend also later in his 50s had dementia after recovering from a stroke, and probably had mixed vascular and Alzheimer's dementia. Lately, I have seen a few women I grew up with in Imphal, with dementia and less with men.

Old age aside, still you reap what you sow. People who live a healthy lifestyle, especially from mid-life onwards, are less likely to develop Alzheimer's. It means having regular physical exercise, keeping a healthy weight, not smoking, eating a healthy balanced diet and drinking only in moderation.

There are 40,00 people under 65 with Alzheimer's in Britain. It affects about 5% of people under 65, while over 65, the risk of developing the disease is 7% at ages 65-69; roughly doubles every 5 years [Framingham studies, US] . Alzheimer's is a doctor's diagnosis, while we know dementia is a confusional state with severe mental impairment and inability to solve problems. The earliest sign is short term memory loss with difficulty remembering recent events ie subtle changes in the cognitive function (thought process).

September 21 2016 was World's Alzheimer's Day and hence this article. There were a lot of scientific articles about it. I am reproducing some of them. Though there is no medication to cure or halt the progression of the disease at the moment, scientists are confident that with serious research to find "biomarkers" (biomarkers – short for 'biological markers' ie protein-based, disease-specific substances or gene in the blood, body fluid or tissue, such as now available for breast cancer, bowel cancer etc) so that the disease can be treated early. They predict there will be drugs to treat Alzheimer's in its earlier stage in 10 years' time.

Scientists at Waterloo University in Canada, have discovered deposits of amyloids (a type of protein that causes brain degeneration with shrinking) in the retina of patients with Alzheimer's. The disease is inherited in some, meaning if your parent or parents had the diseases there is a chance that you might get the disease, but you might not.

I have written about Alzheimer's in the past. Latest figure (2010) showed about 48 million people worldwide, and 850,000 in the UK, out of which about 486,000 died from it. The disease itself does not cause death though it shortens one's life. Frailty and immobility often leads the person to suffer from pneumonia that kills them.

Until now, drugs to treat severe Alzheimer's is available only to stabilise the condition and improve some tasks like feeding, or reduce aggressiveness and restlessness. In 2011, drug treatment by memantine was recommended in the UK for moderate to severe disease where drugs such as donepezil cannot be used.

I am not scaremongering. There is evidence that show Alzheimer's is not an inevitable part of old age. In this month of September (2016), scientists at Harvard, US, published research, not on dementia but on the opposite spectrum. They studied an elite group of aged and retired people (60-70s) dubbed as "super agers", who could remember as well as people in their 20s. Critically, they found that those areas of brain associated with learning and memory showed no shrinkage. This could provide clues about how to prevent declines in memory.

Researchers at Oxford University, England, launched "Prevent Trial" in August 2016, to identify measurable "biomarkers" in people aged 40-59 to detect the occurrence of Alzheimer's very early when a person has no obvious symptoms. Simon Lovestone, professor of Translational Neuroscience, says: "Previous studies have shown changes to the brain as early as 10-20 years before symptoms arise. If we can identify the biomarkers, we have the chance of developing drugs that treat the disease and thus prevent the damage to people's memory." He estimates by 2025, such treatments may be a reality.

Likewise, Craig Ritchie, professor of 'Psychiatry of the Ageing' at the University of Edinburgh says: "In the next 10 years we are going to get more and more evidence about things people can do to prevent Alzheimer's and other dementias. In the meantime, there are things we can do to help prevent it. The key to the solution is brain stimulation to prevent cognitive decline, such as social interaction like chatting, being socially interactive with friends and at work to stimulate your brain."

Present evidence suggest that taking up new hobbies and interests, such as doing crosswords that challenge you, are more beneficial. But if you have been doing crosswords all your life, learning to play the piano at 65 is going to have more benefit on your cognitive health than keeping doing things you have always done.

Carol Brayne, professor of 'Public health medicine' at Cambridge University, says: "Protecting your brain against dementia is all about 'building cognitive reserve', the connections between the brain network. As we age, the brain shrinks and these connections weaken. The bigger the cognitive reserve is, the longer you will hold onto your memory. Stimulating the brain with certain behaviours helps to maintain cognitive reserve."

Further, "someone with high cognitive reserve, would be someone with a mixture of high education, a complex lifetime occupation and high level of social engagement in old age. The more of these factors you have, the more protective you may be. If you do develop a bit of cognitive impairment, it will take longer for it to turn into dementia."

Occupational scientists at the 'Alzheimer's Disease Research Centre' in Wisconsin, US, graded jobs according to how much intellectual engagement they provide. They found those less associated with the development of Alzheimer's in later life, were those that worked in complex jobs involving other people. Doctors, lawyers, teachers and social workers were best protected, while those who enjoyed the least protection included shelf-stackers, machine operators and labourers.

Now, the results of the biggest study (the Ascend Trial in the UK), involving 15,000 volunteers taking low dose aspirin for seven years, to see if it prevents Alzheimer's are expected in 2018. Jane Armitage, professor of 'Clinical Trials' at Oxford University, who is leading the research, says the trouble with aspirin, even if it helps in low dosage, is its side effects, such as bleeding in the stomach and intestines or bleeding in the brain causing a stroke.

Some studies published in the Journal of Alzheimer's disease, found supplementation with fish oil, containing omega-3 helped slow the decline in cognitive function on those with Alzheimer's. My mother, 150 years ago, used to take Cod liver oil. May be coincidence, she didn't suffer from Alzheimer's. The Ascend Trial is also looking at it. Our body does not make omega-3s.

On the value of alcohol in preventing Alzheimer's, scientists at the University of Reading, UK, have recently found out that one to three glasses of red wine a week might help. French wines, such as pinot noir and pinot meuniere had the ability to increase spatial memory (memory responsible for recording information about your whereabouts, such as planning a route to a specific location), improve cognitive function, promote learning and memory retention. Memory has three parts: attention, retention and recall. It's the recall that is more impaired in old age like saying, ah! it's at the tip of my tongue.

Professor Ritchie confirms that while high levels of drinking are injurious to health, small amounts of red wine may help, provided you stick to the recommended limit of 14 units a week ie six pints of beer/lager or ten small glasses of wine.

There are mobile simulators with trained facilitators in the UK, to guide interested people to have a glimpse of what would be inside the mind of dementia sufferers. It's meant to make people understand the needs of people living with dementia. It's called Virtual Dementia Tour. The tour alters the senses of people with neurological disorders like Alzheimer's.

My considered feeling is that dementia, unknown in antiquity, has come out crashing in modernity because of Western technical innovations, which have increased human longevity. You have the fright of your life and is particularly upsetting when the sufferer is your loved one. Alzheimer's should be cared for with love and understanding, bucking up the societal stigma of uncoolness.