Alzheimer's disease - Health &

Wellbeing
by ABC Health & Wellbeing
Alzheimer's disease is a form of dementia that is more common in older people. A
person with dementia can experience memory loss, confusion, and personality and
behaviour change.

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Alzheimer's disease is a form of dementia – a term used to describe a progressive
decline in mental functioning. A person with dementia can experience memory loss,
confusion, loss of skills in planning, reasoning, language and communication, and
personality and behaviour change.

In Australia, about 80 per cent of people with dementia have Alzheimer's disease,
either in pure form or combined with another kind of degeneration such as cerebro-
vascular disease (poor circulation to the brain). Other kinds of dementia include
Lewy body disease, vascular dementia (sometimes caused by mini-strokes), Pick's
disease and alcohol-related dementia.
Alzheimer's disease is named after a German doctor, Alois Alzheimer, who was the
first to describe the characteristic changes in the brain, in 1906.
He conducted an autopsy on a woman who had died of a strange illness and found
unusual changes in her brain – abnormal 'plaques' (clumps) of amyloid (a pale waxy
protein), and 'tangles' of tau (another protein) – in the cortex of her brain, especially

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 in areas known to be important in memory and concentration. Alzheimer postulated
that these degenerative changes had caused her dementia.

It was later shown that people with Alzheimer's also have lower-than-normal levels of
some neurotransmitters, especially acetylcholine, in the cortex of their brains.
Neurotransmitters are chemicals that help transmit messages from one nerve cell to
another.
These changes don't happen in the general population, so we know that they aren't
part of the normal ageing process. However, we don't know for certain whether the
brain changes are the primary cause of Alzheimer's or whether there is some other,
unknown, underlying cause.

Alzheimer's disease is more common among older people. It usually begins after
age 60, and gets more frequent with advancing age. In Australia, one in four people
over 85 will have dementia, usually of the Alzheimer's type.

It can appear to run in families, but is only strictly inherited in a small number of
cases – less than five per cent. These people have a type of Alzheimer's disease
called 'familial' Alzheimer's, which can be traced to particular genes, and they tend to
contract the disease earlier in life – between 30 and 60 years. Persons in each
generation of these rare families have a one in two chance of developing the
disease.

However, most people develop Alzheimer's disease later in life and do not have a
family history of dementia. The risk to their children or siblings is double that of the
general population, but these relatives should note that before the age of 80 it is still
relatively unlikely that they will develop Alzheimer's.
For most people, genes are only one part of the risk equation – in other words, if you
have an immediate family member who has Alzheimer's you are more susceptible,
but your chances of developing the disease are also affected by other factors. It's
thought that diet, physical and mental activity, environment, and cardiovascular
disease may also play a role in Alzheimer's, for example. The old theory that cooking
in aluminium pots was the culprit, however, has fallen by the wayside.

Symptoms
Alzheimers's disease begins slowly and insidiously. The first sign is often mild
forgetfulness – the person has trouble remembering recent events, activities, or the
names of familiar people or things.

Of course, elderly people are inclined to be forgetful occasionally, as are people who
are depressed or malnourished. But in someone with Alzheimer's the memory loss

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 becomes increasingly troublesome.

They forget things like the names of family members, common words, where they
live, and what activities they experienced earlier in the day.

As the disease progresses, they get more and more confused. They may lose the
ability to manage their own finances or take their medications. Cooking or writing a
letter, once second nature, becomes a major task. They may do meaningless things
(often things that are socially embarrassing to friends and family).

In conversation they tend to repeat themselves. They may become anxious or

aggressive, or wander away from home. Finally they lose the ability to dress
themselves, bathe or toilet themselves, and finally to talk, to eat, and to perform
bodily functions. In the end stages of the illness, people with Alzheimer's need 24-
hour care.

How quickly these changes happen can vary from person to person. The average
life expectancy for someone with Alzheimer's disease is generally given as eight to
10 years from the time they are diagnosed. Some studies suggest it may be shorter,
especially if people with the most severe cases (who tend to die sooner) are
included in the study (often they are not).

On the other hand, some people will live with Alzheimer's for longer than 20 years.

Diagnosis
At the moment, Alzheimer's disease can only be definitively diagnosed by examining
the brain of the patient. But this can only be done at autopsy, so it isn't much use in
diagnosing the condition in the living. New brain imaging techniques now allow
doctors to see the amyloid plaques in a living brain, but this is not yet available for
routine clinical use in Australia.

Assessment of someone with possible dementia requires a thorough medical history

and physical examination as well as a number of investigations. Blood, urine, and
cerebrospinal fluid may be tested, and brain scans will usually be done. Scans will
usually show some atrophy, or shrinking, of the brain – although some degree of
brain atrophy is normal with ageing.

The diagnosis of Alzheimer's disease is made by excluding other possible causes

(such as thyroid or vitamin deficiency, or even depression), and clinically
demonstrating the typical pattern of deterioration of Alzheimer's (insidious onset and
gradual progression), on tests of memory and other mental tasks and on CT or MRI
scans of the brain.

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 It's important for a doctor to do these tests, because some of the conditions that
mimic Alzheimer's – such as thyroid problems, drug reactions, depression, brain
tumours and strokes – can be treated.

It's also important that an Alzheimer's diagnosis is made as early as possible.

Current drugs work best for mild to moderate Alzheimer's – they can help delay the
progression of the symptoms and preserve memory function, but they are less
effective once the disease is further advanced and more of the brain has been
damaged.

Treatment
There is no definitive treatment for Alzheimer's disease at present, but some drugs
improve the symptoms or stall their progression.
They include donepezil (Aricept), rivastigmine (Exelon), and galantamine (Reminyl).
They are available in Australia and are on the Pharmaceutical Benefits Schedule.

These drugs act by boosting the levels of the neurotransmitter acetylcholine in the
brain (they belong to a group of drugs known as cholinesterase inhibitors). They
improve Alzheimer's symptoms or slow the decline in function for a limited period,
but they have no effect on the progress of the underlying disease. And their effect is
variable – they work on some people but not on others.

Anti-anxiety and antidepressant drugs are sometimes used to help manage the
anxiety and depression that commonly affects people with dementia.
Other treatments that have been suggested for Alzheimer's include:

non-steroidal anti-inflammatory drugs

oestrogen

vitamin E

omega 3 fatty acids

statins (drugs used to lower cholesterol)

ginkgo biloba.

However, clinical trials have failed to show that any of these are effective in treating
or preventing Alzheimer's disease. Ongoing research is looking for new drugs that
will stop the plaques and tangles and the brain damage of Alzheimer's disease.
While researchers have hope for the future, the current reality is that existing drugs,
for most people, give limited, if any, benefit. So the main focus in treatment is on

Alzheimer's disease - Health & Wellbeing 4

 supporting the person with the condition to remain independent for as long as
possible.

This includes providing emotional support, counselling, and education programs –

not just for the patient but also for their family, as the condition can be very stressful
for close family members. Carers are often elderly and may have health problems
themselves. There are also legal issues, such as power of attorney, to be addressed.
Home nursing, respite care, meals on wheels, and other community support
programs will help. In the final stages of the disease, however, the patient will need
full-time nursing care. Studies suggest that about two-thirds of the beds in Australian
nursing homes are occupied by people with dementia.
Support organisations such as Alzheimer's Australia offer invaluable help for people
with any type of dementia and their families through support groups, telephone and
face-to-face counselling, training courses, help sheets, videos and other information.

Prevention
Though it can't be cured, there's increasing evidence that Alzheimer's disease you
can reduce your risk of developing the condition.

People who keep mentally active – read, do crosswords, play board games, go to
the theatre and so on – also have a lower risk of Alzheimer's. So do people who
have good social networks. Alzheimer's has also been linked to education levels –
the more education the person has, the lower the risk seems to be. Just why this is
isn't known – though it may be that mental stimulation helps keep neural networks in
the brain from deteriorating.
Alzheimer's also appears to be less likely in people who eat a diet that is rich in
antioxidants, that is, with plenty of fruit and vegetables. People who eat the so-called
'Mediterranean diet' for example – containing plenty of fruit and vegetables, bread
and pasta, fish, olive oil and a little red wine, but low in dairy products and red meat
– have a lower risk of Alzheimer's disease. So do people who exercise regularly.
These activities tend to lower the risk of arteriosclerosis – disease of the arteries –
and hence may in some way help protect from Alzheimer's.
People with high blood pressure, high cholesterol or diabetes that is not well
managed have an increased risk of Alzheimer's. So for prevention, these conditions
need to be detected and treated effectively. What's good for the heart is good for the
brain.
This article was reviewed by Dr Maree Farrow, a neuroscientist and research fellow
with Alzheimer's Australia.

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