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Alzheimer's: Pathology, Diagnosis and Risk reduction

We are coming upon Alzheimer's Awareness Month. SO, I wanted to take this opportunity to talk about the condition in hopes that we can all learn ways to reduce our chances of developing this devastating condition.

Alzheimers Disease

Alzheimer's disease has been classified as a progressive disorder. The cells in the brain begin to waste away and eventually die. The most common cause of dementia is this disease. This disease results in a continual decline in thinking, social skills and behavioral skills, causing a disruption in the ability of the individual to function independently. As of 2018, there were approximately 5.5 million individuals in the United States believed to have this disease. This figure is based on estimates from 2010. There are recent international and national surveys suggesting there are ways to decrease the risk of this disease.

One of the main concerns for aging individuals is the preservation of cognitive abilities. A lot of these individuals have stated this is the disease they fear the most. This disease is more feared than stroke or even cancer. The earliest signs an individual may have this disease include forgetting recent conversations, activities or events. As the disease continues to progress, the individual may develop a severe impairment of their memory. This can prevent them from performing simple, everyday tasks and routines. There are medications available that may help temporarily slow down the progression of this disease and improve the symptoms.

In some cases, these types of treatments may help individuals suffering from this disease maintain their independence and maximize their function for a limited period of time. There are different services and programs available to provide support for both the individual with this disease and their caregiver. There is currently no treatment available that will cure Alzheimer's disease. The process of the disease is not able to be altered. Once an individual is in the advanced stages of the disease, the severe loss of function can result in serious complications. This includes infection, malnutrition, dehydration or even death.

The Diagnosis

To diagnosis this disease, a neurologist or geriatrician review the individual's symptoms, medication and medical history and conducts tests. The physician will evaluate:

  • If cognitive skills or memory are impaired
  • How cognitive issues are impacting daily life
  • The cause of the symptoms
  • If there ate behavioral or personality changes and the degree

This disease results in degeneration or loss of cerebrum cells. This can show up in scans. Although these scans are unable to make a solid diagnosis, they can show abnormal changes in the cerebrum. Imaging scans are also helpful. This may include (MRI) magnetic resonance imaging, (CT) computerized tomography scan, (PET) positron emission tomography scan. This disease is difficult to diagnose until obvious symptoms have appeared. Recently, researchers have discovered a blood test that may be able to accurately detect this disease. One of the markers of the disease is the formation of toxic plaque in the cerebrum. Some of this is a tau protein buildup.

The molecules forming tau proteins have slightly different properties. The researchers conducted a study where the tau molecules appearing during the higher levels of the disease were identified. This was accomplished through both the cerebrospinal fluid and blood. Plasma from two different groups was used to test both methods. The scientists determined the most effective test and called it the NT1 assay. This test accurately detected the disease through specificity and sensitivity. Although blood samples were verified, larger trials with more participants are required to ascertain the effectiveness. Research is now being conducted to determine the changes in tau proteins as the disease progresses.

The Risk Factors

The number one risk factor for this disease is age. The older the individual, the more likely they are for this condition to develop. This does not mean Alzheimer's disease is inevitable as the individual ages. Approximately two of every 100 individuals between the ages of 65 and 69 will get this disease. The figure increases to nineteen out of every 100 people between the ages of 85 and 89. When the disease has a late-onset, the cause may be genetic. There is a clinically established link between this disease and the apolipoprotein E (ApoE gene). In most cases, the disease is caused by changes in the mind and the impact of the environment and lifestyle of the individual.

The only cause of this disease is not inherited genes. It is not possible for an individual to change their genetic profile. There is also no way currently known to prevent this disease. The risk can be decreased by making lifestyle changes. WHO recently released a report stating the risk of Alzheimer's, dementia and cognitive decline can be reduced. Although genetics can play a role in this disease, there are non-genetic risk factors that should be considered because they can contribute to the disease. The main risks for developing this condition include the age, medical history, genes and life choices of the individual.

The risk of developing this disease is higher for certain Asian and black ethnic minority groups. This is due to their higher risk of medical conditions such as diabetes and high blood pressure. According to the latest reports, a lot of cases of this disease can potentially be prevented through specific lifestyle changes including getting more exercise and quitting smoking. The findings of the reports suggest as opposed to proving that there are steps people can take to decrease their risk of developing this disease. There are currently in excess of 33 million people all over the world with this condition.

There is a lack of treatments to modify this disease and a growing awareness that it can take numerous years or even a decade for the development of the symptoms. This has led to an increased interest in finding effective strategies to prevent this condition. The findings of the studies have been published in a British medical journal called The Lancet Neurology. The authors of the study identified several different lifestyle factors by examining medical literature that may increase the risk of developing Alzheimers disease. These factors include:

  • Quitting smoking
  • Controlling diabetes
  • Mental stimulation
  • Managing depression
  • Increasing physical activity
  • Controlling blood pressure
  • Managing obesity

The estimate of the authors is when all of the above risk factors are properly managed, up to three million cases of this disease all over the world can be prevented. The authors were unable to determine if the development of the disease is promoted by any of these lifestyle choices. Currently, the main risk factors for this disease are genetics and advanced age. There are a lot of population studies suggesting lifestyle factors may have an important role in this disease.

Diabetes

Several studies have determined individuals with diabetes have a higher risk of developing this disease or another form of dementia. In excess of ten percent of older individuals living in the United States have diabetes. Managing the condition correctly is extremely important. There are also steps the individual can take to help prevent getting diabetes. The two factors contributing the most to diabetes are excess weight and not enough exercise.

Obesity

According to numerous studies, individuals carrying too much excess weight when they reach middle age have a higher risk of developing this disease. As the individual continues to age, the risk is higher when the bodyweight is too low. One of the biggest issues in the United States is obesity.

High Blood Pressure

Numerous studies have suggested there is a link between the heart and the health of the brain. A link has been established between hypertension during middle age and an increased risk for this disease in addition to other types of dementia as the individual ages. Individuals who have received treatment for high blood pressure have been shown to have a lower risk for cognitive issues in the future.

Stress Management: Recent studies have also suggested both hypertension and stress increase the risk for Alzheimer's disease and vascular dementia. One of the best ways for an individual to protect themselves from cognitive decline is to keep stress and hypertension under control. Some of the recommendations include:

  • Trying either deep breathing exercises, meditation or yoga
  • Spending time in a quiet place such as a peaceful waterfront, park or garden
  • Listening to relaxing and soothing music

The Sedentary Lifestyle

There is an established link between physical inactivity and a higher risk for the development of this disease. This risk may be lowered by remaining active. This includes ballroom dancing, jogging and walking. An improvement in cognitive skills has been found in older, sedentary individuals once they start a consistent exercise routine.

Depression

Individuals with a medical history of depression have double the risk of developing this disease in comparison to people not suffering from depression. Cognitive function for certain individuals may be improved when they receive medical treatment for their depression. Individuals with depression are generally socially withdrawn. The risk for this disease has been shown to decrease for seniors with social connections.

Smoking

Recent studies have shown the risk of this disease increases if the individual smokes. Other reports have shown quitting smoking decreases the risk of developing either Alzheimer's disease or dementia.

The Lower Education Level

Individuals with a lower level of education do not receive enough mental stimulation. There is evidence showing individuals without formal education have a higher risk of developing this disease. The risk can be decreased with mental stimulation such as learning how to play a musical instrument, learning a different language or working a crossword puzzle. The theory is the connections of the cerebrum may be enhanced through mental stimulation. This means if the disease destroys any of these cells, they are enough remaining to delay the symptoms of the disease. The biggest risk for dementia and Alzheimer's disease is age. There is evidence showing this risk can be decreased by remaining active, exercising the mind and consuming a healthy diet.

Physical Activity

One of the best ways to decrease the risk of this disease is consistent physical activity. This is also beneficial for mental wellbeing, weight, circulation and the heart. It is important for each individual to find the exercise that works best for their needs. The best option is beginning with just a little bit of activity. This can be increased gradually. Even ten minutes of activity is good for the body. It is important not to remain seated for too long. According to research, individuals that remain physically active have a decreased risk for thinking and memory issues. Remaining active additionally lowers the risk for other medical issues.

Two of the proven risk factors of this disease are type 2 diabetes and high blood pressure. This means remaining active not only promotes a healthy body but it also enhances cerebrum health. This does not mean the individual needs to run in a marathon or work out at a gym. The best way to create healthy habits is by participating in an activity the individual enjoys. There are good activities involving participation with other people such as cycling, dancing or walking. Remaining active in a group is a great way to provide encouragement for others. The activity can even be made into a social occasion.

Consuming Less Alcohol

Consuming too much alcohol increases the risk of developing this disease. The most any individual should consume is a maximum of fourteen units per week. Regular consumption of more than this amount on a regular basis can result in brain damage due to alcohol. Any individual consuming fourteen units per week should space them out over a minimum of three days. Certain research has established a link between consuming too much alcohol on a regular basis and a higher risk of this disease. Alcohol-related dementia has been linked to heavy drinking for long periods of time. This includes (WKS) Wernicke-Korsakoff Syndrome.

The cause of WKS is not enough thiamine or vitamin B1. Treating the individual early with this vitamin can result in a reversal of the symptoms. If the individual does not receive treatment, the condition can result in permanent memory loss. Any individual with concerns should speak with their physician. There are ways to decrease alcohol consumption. This includes:

  • Setting a limit and tracking the amount of alcohol consumed
  • Switching between soft drinks and alcoholic drinks
  • Trying alcohol-free or low alcohol drinks
  • Receiving motivation through specific events and dates such as making a New Year's resolution to cut down on alcohol consumption.

Aerobic Activities

Every week the individual should perform either:

  • Performing 75 minutes of aerobic activity including riding a bicycle up a hill, fast swimming or jogging.
  • Performing 150 minutes of aerobic activity including pushing a lawnmower, riding a bicycle or taking a brisk walk.

The individual should also include a variety of resistance activities requiring strength twice per week. This will effectively work the muscles. This includes:

  • Exercises such as sit-ups or push-ups
  • Digging in the garden
  • Both resistance and aerobic activities should be alternated such as circuit training, netball, running and football.

The Research

There is still a lot of research being performed regarding cognitive decline. Despite this, there are important actions everyone can take. The same healthy steps known to help lower the risk of diabetes, cardiovascular disease and cancer may decrease the risk of cognitive decline as well. This includes remaining active mentally, consuming a diet good for the heart, body and cerebrum and participating in physical activity on a regular basis. Some evidence has been revealed showing a lot of people benefit by remaining socially active with their family, friends and within their community.

The evidence showing living a healthy lifestyle positively impacting cerebrum is consistently increasing. A new educational program has been launched by the Alzheimer's Association. There are numerous chapters making this program available to the public. The program educates people regarding the positive impact of making healthier lifestyle choices. This is important for both the short and long term.

Eating Healthier

The risk of this disease as well as other medical conditions can be decreased by eating a balanced and healthy diet. This includes heart disease, obesity, type 2 diabetes and stroke. A balanced diet should include:

  • Consuming a minimum of five servings of fruits and vegetables per day.
  • The sugar intake should be limited. The individual should be careful regarding hidden salt.
  • The amount of saturated fat consumed should be decreased.
  • Eating protein a minimum of twice per week including meat, eggs, beans oily fish and pulses.
  • Every individual should drink six to eight glasses of liquids per day such as sugar-free drinks, low-fat milk and water.
  • Starchy foods such as pasta, potatoes and bread should be part of the diet.

Exercising the Mind

The risk of this disease can most likely be decreased by keeping the mind active. When an individual mentally challenges themselves on a regular basis, the ability of the cerebrum to cope with diseases is built up. This is often referred to as using the cerebrum or losing it. Individual should look for something they find challenging and do it on a regular basis. It is important to find something enjoyable to ensure the individual will continue. This includes:

  • Studying for a course or qualification just to have fun
  • Playing board games or cards
  • Doing quizzes, crossword puzzles or jigsaw puzzles
  • Writing non-fiction or fiction or reading a challenging book
  • Learning how to speak a new language

Communicating or talking to others may help decrease the risk of this disease. It is important to make the effort to stay in touch with individuals who are the most important such as family and friends. Some other good ways to remain socially active are to join a community group or club or to volunteer.

The Mediterranean Diet

Consuming a Mediterranean diet has been shown to slow down the progression of this disease. According to a recent study, even following this diet partially will provide benefits. This is very important for anyone experiencing difficulty sticking with a new diet. This diet includes whole grains, fresh fruits and vegetables, nuts, fish, olive oil, legumes, moderate amounts of dairy, eggs and poultry, consuming red meat sparingly and drinking red wine in moderate amounts.

The DASH Diet

This diet was originally created to help stop hypertension, but it can also decrease the risk of developing Alzheimer's disease. This diet encourages the individual to eat a lot of low-fat dairy products, lean meats, beans, fruits, vegetables, whole grains and nuts. The DASH diet has been proven to dramatically decrease blood pressure for individuals with moderate hypertension. Hypertension results in damage to the blood vessels in the cerebrum in addition to increasing the risk factors for this disease.

The MIND Diet

This diet includes all of the foods best for the health of the cerebrum from both the Mediterranean diet and the DASH diet. The emphasis is placed on leafy green vegetables. Neurology recently reported a study supporting the MIND diet. The study showed seniors consuming portions of leafy green vegetables every day such as collard greens, kale and spinach exhibited a slower cognitive decline. The MIND diet includes eating berries, beans, fish, olive oil, nuts, whole grains and poultry. This diet even enables the individual to consume moderate servings of alcohol. Red wine is recommended.

The dietary guidelines are based on common sense. This includes eliminating heavy cream, butter and processed meats due to the heavy concentrations of saturated fats. Consuming a lot of sugar is dangerous because it can cause the individual to gain weight in addition to being inflammatory.

Getting Enough Sleep

There is a lot of evidence suggesting getting enough sleep may help prevent developing this disease. A link has been established between sleep and better amyloid clearance from the cerebrum. Between seven and eight hours of sleep every night is recommended. The quality of sleep and sleeplessness have been linked to altered marker levels of inflammation, tau, and beta-amyloid in the spinal fluid. All of this has been linked to this disease. The establishment of a bedtime routine can protect the cerebrum and decrease the risk of this disease. This includes:

  • Avoid excessive consumption of alcohol and overtaking sleeping pills
  • Do not exercise or eat during the last two to three hours before going to bed
  • Maintaining a regular sleep schedule

Taking Care of the Heart

According to the latest research, individuals with high cholesterol, diabetes, high blood pressure or who are obese have a much higher risk of developing this disease later in life. This is particularly true of individuals who have reached middle age. If any of these conditions are not properly treated, the result can be damage to the blood vessels in the cerebrum. This causes damage to the cells resulting in impaired cognitive functions. Although there is no guarantee this disease can be prevented by taking care of the heart, this is the best chance for delaying or avoiding this disease.

Studies have shown having high blood pressure treated will decrease the risk of developing this disease. Other studies have shown the risk for the development of dementia may also be decreased if the individual has either diabetes or high cholesterol treated.

The Recommended Regular Check-Ups

Having regular check-ups is recommended for the assessment of:

  • Blood Pressure: A long-term, effective treatment for high blood pressure can decrease the risk of this disease. Every adult should have their physician check their blood pressure on a regular basis. This is particularly important if the individual has reached middle age.
  • Cholesterol: Even if the cholesterol level is only mildly elevated, the risk of this disease is increased. This means it is important to take every possible step to ensure the cholesterol level remains within the healthy range.
  • Blood Sugar Levels: One of the indicators the individual has type 2 diabetes is high blood sugar levels. This increases the risk of Alzheimer's disease.
  • Body Weight: According to research, individuals who are obese when they reach the midlife point have a higher risk of developing this disease in comparison to those that are at a normal weight. To decrease this risk, healthy body weight should be maintained.
  • Smoking: This is one of the major risk factors for this disease. Any individual who smokes should do their best to quit. The smoke of others should also be avoided.
  • Regular check-ups with a physician are important for decreasing the risk of this disease. This is very important for middle-aged adults. The advice of the physician should be followed.

Head Injuries

An extremely severe head injury resulting in the loss of consciousness for a long period of time increases the risk of developing this disease. Head injuries can be avoided by wearing protective headgear when participating in high-risk activities such as cycling, wearing a seat belt when in a vehicle and being careful as a pedestrian. Certain research has suggested an individual receiving severe head trauma or injury has a higher risk of developing this condition. There is a specific type of dementia linked to damage caused by repetitive head trauma. This is called pugilistica.

This condition is estimated to affect approximately two of every ten professional retired boxers. When the boxing ring is not involved, the condition is referred to as (CTE) chronic traumatic encephalopathy. This is long-term damage to the cerebrum due to repetitive head injuries. Numerous governing bodies for a variety of contact sports are now conducting research regarding this condition. This has resulted in the introduction of new safety features during the last few years.

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