Rebecca Halliburton

Mrs. Lynne Maxwell

Honors English IV
9/23/16
Review of Literature
As projections indicate that 10 million baby boomers will get Alzheimers, the need for
a treatment to slow the progression of this debilitating disease grows (Alzheimers Association,
2011). It is agreed upon by experts and caregivers alike that more federal funding needs to be
invested in research to treat those currently afflicted. An issue of equal importance, however, is
the matter of prevention of Alzheimers. Scientists are becoming more convinced that prevention
is key, as the biological changes of Alzheimers disease begin years before diagnosis. Some
people tend to assume Alzheimers is a disease of the elderly, a result of normal aging, and thus,
do little to prevent this disease before diagnosis. Citizens need to know the basic facts of
Alzheimers and what they can do to reduce their risk.
The prevalence of the debilitating disease of Alzheimers is beginning to rise and will
grow exponentially as the Baby Boomer generation ages. The Alzheimers Associations Boomer
Report details the issues that Alzheimers disease has already created and offers a financial
investment by the federal government for research as a solution. The Alzheimers Association is
the largest nonprofit organization for Alzheimers. It is informed and largely staffed by scientists
and medical professionals. The report outlines the sharp increase in Alzheimers cases that can be
expected as the baby boomer generation ages: an impending wave. The Alzheimers
Association projects that an estimated 10 million baby boomers will get Alzheimers and die

with it, if no intervention is made. It also states that as baby boomers reach 85, they will have a 1
in 2 chance of having Alzheimers disease, and the report continues to assert that in 2050, there
will be an estimated 13.5 million Alzheimers cases. The report highlights how debilitating the
disease is for those affected. It reports that on average, patients survive long as 20 years with the
debilitating progression of this disease. As death rates for other major ailments decrease, the
death rate for Alzheimers increases, as the report says, because the federal government has not
invested enough financially in Alzheimers research. Next, the report addresses the immense
stress of caregivers, (many are unpaid and untrained to deal with this stress). The report asserts
that there is a great human cost to Alzheimers to caregivers and sufferers alike. The report
concludes that Alzheimers is costly for America because $172 billion was spent caring for
people with Alzheimers and other dementias, costs are projected to be over $1 trillion in 2050,
and One in six Medicare dollars is spent on caring for Alzheimers disease (Alzheimers
Association, 2011, p. 10). The Alzheimers Association believes that an investment now in
research funding for Alzheimers could prevent cost later. Its reported that an individual with
Alzheimers will result in a 3 times greater cost for Medicare, and 9 times greater for Medicaid.
The report asserts that a disproportionate amount is spent on Alzheimers research considering
the diseases prevalence and cost; for every $100 the government spends on Alzheimers
research, it spends more than $25,000 for care for people with Alzheimers and other dementias
(Alzheimers Association, 2011, p. 13). The report concludes that given the scientific advantages
society currently has, with investment from the federal government, valuable treatments for
Alzheimers can be found.
While a cure has not yet been developed, certain relationships have been drawn for risk
factors for Alzheimers, and scientists believe lowering risk is a proactive way to try to prevent

Alzheimers. Leisure-time Physical Activity at Midlife and the Risk of Dementia and Alzheimer's
Disease is a longitudinal study conducted to test the relationship between physical activity and
dementia risk (Rovio et al., 2006). The scientists had various connections to aging research
centers or medical hospitals, and they studied a preventative approach for Alzheimers which
seemed to be fairly effective. 1449 individuals aged 65-79 years old from a past cohort study
were surveyed and evaluated again after an average of 21 years. 76 had Alzheimers disease.
Individuals that reported in midlife that they participated 2 or more times a week in leisure-time
physical activity that caused breathlessness and sweating had 50% lower odds of dementia and
60% lower odds of Alzheimers diseasethe protective effect of physical exercise was even
more pronounced in carriers of the APOE e4 gene (Rovio 2005). Based on the survey, the team
concluded that leisure-time activity at least twice a week during midlife, (usually before
symptoms and diagnosis), could help delay the onset of Alzheimers, even among those
genetically at risk.
Another study about the relationship between physical activity and Alzheimers
conducted by Michael Beckett, Christopher Ardern, and Michael Rotondi, (who were all
associated with York Universitys School of Kinesiology and Health Science), analyzed nine
longitudinal studies about the relationship between physical activity and Alzheimers. The
Ontario Brain Institute provided financial support for the publication of this study. The
participants in the studies that were analyzed were aged over 65 years. After statistical analysis,
the researchers found that individuals who were more physically active had a lower risk of
developing Alzheimers disease, and that these results were significant in six out of the nine
studies. With those results, the study concluded: an emphasis on health interventions to
encourage older adults to incorporate physical activity in their lives may be a viable and safe way

to slow the rising rates of Alzheimers disease (Beckett et al. 2015). This suggests a proactive
prevention plan for Alzheimers as simple as routine physical exercise could have a great impact
on risk reduction.
Another practice that is believed to temporarily stave off dementia is the buildup of
cognitive reserve (CR). Cognitive reserve is thought to be a useful component for those likely to
get dementia as it is commonly found that those who had more experience, education, and
accumulated knowledge were less likely to develop dementia, and with less severity. Some
researchers believe cognitive reserve can even be contributed to in older adult populations to
preserve or improve normal cognitive function. It is believed if cognitive reserves are built up in
older adults that do not yet have dementia, they will have a lower risk for dementia or
Alzheimers or they will experience a less severe progression. In 2013, Seinfeld et. al conducted
a study to determine if learning music and practicing it on a piano was a more advantageous
leisure-time activity than others (i.e. working out, swimming, taking computer lessons, etc.).
Over four months, an experimental group of individuals aged 60-84 years without dementia
received a piano training program from a professional musician. The control group chose other
leisure time activities instead of the piano training program. At the beginning of the study,
participants were given a series of psychological evaluations concerning executive function,
mood, and motor function. Every week, one hour and a half group piano lesson with the
instructor would take place, with participants being assigned homework practice to do between
lessons. Participants were instructed to practice 45 minutes per day for five days per week while
not in a group lesson. As the program continued, the difficulty level increased. At the end of the
program, the standardized psychological evaluations were performed. The researchers found that
the participants in the experimental music learning group had greater improvements in areas of

attention and executive function mood, subjective well-being visuomotor tracking,

processing speed, and motor function (Seinfeld et. al 2013). The study concluded with: Based
on our results, we suggest that learning to play piano in older ages might contribute to promote
CR and improve or maintain cognitive function in later stages of life (Seinfeld et. al 2013).
These results support the idea that addition to CR even in later life through musical learning
improves cognition and may have protective qualities against dementia and Alzheimers.
The overall initiation of Alzheimers disease is unknown, although there are many
theories to explain its beginning. What is known, however, is the biological changes associated
with the disease. Alzheimer's Disease- Symptoms, Causes, & Pathophysiology is a video
produced by the organization, Osmosis, which aims to create media to assist in the education of
healthcare students. The scriptwriter of this piece, Tanner Marshall, earned a MS in biomedical
engineering at the University of Wisconsin-Madison. The video visually represents and describes
the mechanisms and basic facts of Alzheimers Disease. Marshall begins with Alzheimers
disease is the most common cause of dementia. Dementia consists of symptoms like poor
memory and cognitive impairment; Alzheimers causes dementia through neurodegeneration, the
damage and killing of neurons. Marshall outlines the two major damaging biological
mechanisms of Alzheimers: beta-amyloid plaques and tau tangles. He outlines how betaamyloid plaques occur. Amyloid precursor protein (APP) is a transmembrane protein, (a protein
that spans the entire membrane of neurons). As proteins are used and wear down, enzymes are
used to cut and break them down; this process is no different for APP. Normally, -secretase and
-secretase are used to cut APP, but in Alzheimers, -secretase is used instead of -secretase,
and APP is cut in the wrong spot, resulting in insoluble remains called beta-amyloid. Betaamyloid can accumulate outside of the neurons and form beta-amyloid plaques. Theses plaques

can disrupt signaling between neurons, which can lead to cognitive impairment and death of
under stimulated neurons. The plaques could also cause inflammatory responses which could
also damage nearby neurons, and they could cause hemorrhage of blood vessels in the brain. The
second major biological change, tau tangles, are thought by scientists to be caused by the
accumulation of beta-amyloid plaques. Microtubules normally provide structure and help with
the movement of substances within cell, and tau is a stabilizing protein for microtubules. Kinase
is activated and causes tau to change its shape; it can no longer support the microtubules, and the
modified tau can clump together in the neuron forming neurofibrillary (tau) tangles. The
microtubules are nonfunctional, so the neuron cant signal properly. Accumulation of the tangles
within the neuron can cause apoptosis- a process of cell death. Marshall then connects these
small-scale changes to the larger issues; these changes on the cellular level lead to the death of
neurons and overall brain shrinkage.
Marshall then goes on to define the different types of Alzheimers; there is sporadic
Alzheimers, without an obvious cause, and familial Alzheimers, resulting from a dominant
gene that speeds Alzheimers progression. Sporadic Alzheimers is a late onset condition that is
thought to result from a combination of environmental and genetic risk factors. Some risk factors
include age, general health, and a gene (e^4 allele apolopprotein, APOEe^4). APOE helps break
down beta amyloid, but the e^4 allele is less effective, so individuals with this allele are more
likely to develop beta-amyloid plaques. In familial Alzheimers, presenilin 1 and presenilin 2
genes help form -secretase subunits, but they change where the -secretase would cut APP, and
this makes it easier for beta-amyloid plaques to form. Another form of familial Alzheimers
results from Trisomy 21 (Down Syndrome), where there is an extra chromosome 21. APP genes
are on chromosome 21, so this leads to increased expression of APP in individuals with Trisomy

21, which increases the risk of accumulating amyloid plaque as there is more APP to be mis-cut
and accumulate.
Marshall then discusses the progression of Alzheimers. Biological changes and damage
can occur without presenting symptoms, then an individual will begin to experience mild
memory issues, then they will become more limited in movement, then they will begin to lose
long-term memory and become increasingly confused and disoriented, then they will become
bedridden and die, (many due to infection). Marshall finishes with saying that there are no cures
for Alzheimers and that medications currently treat symptoms, but they do not stop the
progression.
As there are no cures for Alzheimers at this time, scientists are increasingly convinced
that a vital aspect of Alzheimers treatment is actually prevention. If the biological damage can
be prevented or delayed with activities like physical exercise and music learning that have been
shown to reduce risk of Alzheimers, it would be advisable for the public to know the risks and
what they can do for themselves to attempt to prevent Alzheimers.

References
Alzheimer's Association. (2011). Boomer Report. Chicago: Alzheimer's Association.
Alzheimer's Disease- Symptoms, Causes, & Pathophysiology (2016). [Motion
Picture]. Retrieved August 2016
Beckett, M., Ardern, C., & Rotondi, M. (2015, February 11). A Meta-Analysis of
Prospective Studies on the Role of Physical Activity and the Prevention of
Alzheimer's Disease in Older Adults. BMC Geriatrics. Retrieved September
2016
Rovio, S., Kareholt, I., Helkala, E., Viitanen, M., Winblad, B., Tuomilento, J., . . .
Kivipelto, M. (2005, November). Leisure-time Physical Activity at Midlife and
the Risk of Dementia and Alzheimer's Disease. The Lancet, 705-711.
Retrieved August 4, 2016, from
http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(05)701988/abstract
Seinfeld, S., Figueroa, H., Ortiz-Gil, J., & Sanchez-Vives, M. (2013, November 1).
Effects of Music Learning and Piano Practice on Cognitive Function, Mood and
Quality of Life in Older Adults. Frontiers in Psychology.
doi:10.3389/fpsyg.2013.00810