Genetic Factors (Clare, 2003)

While most people associate Alzheimer's with aging, about 3% of 65-year-olds and over 30% of 85-year-
olds will experience AD. Familial cases appear earlier, often before 65, and run in families like a
dominant from one parent making them almost certain in a child. Mutations in three genes, APP, PSEN1,
and PSEN2, are the usual culprits here.

 Familial AD: Certain genes, like APP and PSEN, are "faulty wires" passed down from parents to
children, increasing the risk of early-onset, family-clustered Alzheimer's.

 Sporadic AD: There's no clear family link, but many smaller things, like the APOE4 gene can increase the
risk.

 Having a form of the apolipoprotein E (APOE) gene increases your risk APOE gene influences how
efficiently your body handles fats. APOE ε4, increases your risk of developing Alzheimer’s and is also
associated with an earlier age of disease onset

 Having a Biological parent or sibling with Alzheimer’s disease, Increases your risk of developing the
condition by 10% to 30%. People with two or more siblings with late start of Alzheimer’s disease are
three times more likely to develop the condition than the general population..

BIOLOGICAL FACTORS

Age

Age is the single most significant factor. The likelihood of developing Alzheimer's disease doubles every
5 years after you reach 65. But it's not just older people who are at risk of developing Alzheimer's disease.
Around 1 in 20 people with the condition are under 65. This is called early- or young-onset Alzheimer's
disease and it can affect people from around the age of 40.

Alzheimer's isn't just a brain issue - its roots can lie deeper in your overall health

Conditions like high blood pressure and heart attacks, along with blood flow issues in the brain
(cerebrovascular disease) damage blood vessels and restrict oxygen flow, starving your brain's memory
centers.

Chronic inflammation – (The state of swelling caused by the congestion of blood vessels) - From past
injuries, infections, or even bone fractures in older people can leave behind scars and debris, making it
harder for your brain to function smoothly.

The presence of "inflammatory indicators" in your blood, such as interleukin 6, is a sign of trouble since it
is released by your body and acts as an ongoing alert in your brain. Your cognitive ability can be
weakened by this ongoing stress, which also raises your risk of developing Alzheimer's and other
dementias.
An abnormal build-up of proteins in your brain causes Alzheimer’s disease. The build-up of these
proteins amyloid protein and tau protein causes brain cells to die.

The slow and ongoing death of the nerve cells results in the symptoms of Alzheimer’s disease. Nerve cell
death starts in one area of your brain (usually in the area of your brain that controls memory the
hippocampus) and then spreads to other areas.

Lifestyle Factors

Conditions associated with cardiovascular disease can increase the risk of Alzheimer's disease.

Smoking – Weakens the brain cells and can contribute to the build-up of proteins linked to Alzheimer's.

Diabetes - This condition disrupts how your body uses blood sugar, affecting energy levels and
potentially damaging brain cells.

High blood pressure - Uncontrolled high blood damages the delicate pipes (blood vessels) that supply
your brain. This weakens these pathways and reduces blood flow, leading to cognitive decline.

High cholesterol - High levels lead to the build-up of fatty plaques that narrow and harden your
arteries. This, again, restricts blood flow and oxygen delivery to the brain.

Psychological Factors -

Loneliness and Social Isolation: Your brain needs social interaction. Loneliness and isolation are like
leaving your brain under activated, weakening its connections and potentially increasing the risk of low
cognitive functioning.

Sleep Disruption: Poor sleep, like insomnia, disrupts this process and can contribute to problems with
thinking and memory.

Negative Thinking- Feeling helpless and hopeless can lead to decreased engagement in activities that
keep your brain sharp, potentially accelerating cognitive decline.

Traumatic Brain Injury - Physical damage: Bruising, bleeding, and tearing of brain tissue can directly
impair cognitive function and memory.

Depression:

Depression, often characterized by feelings of sadness, hopelessness, and loss of interest.

Disrupted neurotransmitters: Depression disrupts the delicate balance of brain chemicals like serotonin
and dopamine, crucial for mood regulation and cognitive function.

Severe stress: The chronic stress associated with depression can trigger inflammation and oxidative
damage in the brain, similar to the effects of TBI.
Midlife Hypertension - The brain is still developing and vulnerable during midlife. Consistent damage
from high blood pressure during this critical period can leave lasting scars, increasing the risk of cognitive
decline later in life.

Certain medications can temporarily slow the worsening of dementia symptoms.

Medications and other interventions can also help with behavioral symptoms.

Beginning treatment as early as possible for Alzheimer’s could help maintain daily
functioning for a while.

As AD affects everyone differently, treatment is highly individualized. Healthcare

providers work with people with Alzheimer’s and their caregivers to determine the best
treatment plan.

The U.S. Food and Drug Administration (FDA) has approved two types of drugs to treat
the symptoms of Alzheimer’s disease:

 Cholinesterase inhibitors.
 NMDA antagonists.

The FDA has given accelerated approval for aducanumab (Aduhelm™), the first
disease modifying therapy for Alzheimer’s disease. The medication helps to reduce
amyloid deposits in your brain.

Aducanumab is a new medication, and researchers studied its effects in people living
with early Alzheimer’s disease. Because of this, it may only help people in the early
stage.

Cholinesterase inhibitors

The following cholinesterase inhibitors can help treat the symptoms of mild to moderate
Alzheimer’s disease:

 Donepezil (Aricept®). This is also FDA-approved to treat moderate to severe AD.

 Rivastigmine (Exelon®).
 Galantamine (Razadyne®).

These drugs work by blocking the action of acetylcholinesterase, the enzyme

responsible for destroying acetylcholine. Acetylcholine is one of the chemicals that help
nerve cells communicate. Researchers believe that reduced levels of acetylcholine
cause some of the symptoms of Alzheimer’s disease.

These drugs can improve some memory problems and reduce some behavioral
symptoms of Alzheimer’s disease.
These medications don’t cure Alzheimer’s disease or stop the progression of the
disease.

NMDA antagonists

Memantine (Namenda®) is FDA-approved for treating moderate to severe Alzheimer’s

disease. It helps keep certain brain cells healthier.

Studies have shown that people with Alzheimer’s who take memantine perform better in
common activities of daily living such as eating, walking, toileting, bathing and dressing.

Managing behavior changes

If your loved one has been diagnosed with Alzheimer’s disease, you can take steps to
keep them comfortable in their environment and help manage behavior changes. You
can:

 Maintain a familiar environment for them. Don’t change the layout or organization of their
living space.
 Monitor their comfort.
 Provide comfort objects, such as a favorite stuffed animal or blanket.
 Try to redirect their attention if they’re under stress.
 Try to avoid confrontation.

Certain medications may help in some people, including:

 Antidepressants: These drugs can treat anxiety, restlessness, aggression and

depression.
 Anti-anxiety drugs: These medications can treat agitation.
 Anticonvulsant drugs: These medications can sometimes treat aggression.
 Antipsychotics (neuroleptics): These drugs can treat paranoia, hallucinations and
agitation.

These medications can cause unpleasant or potentially dangerous side effects (like
dizziness, which could lead to falls), so healthcare providers typically only prescribe
them for short periods when behavioral problems are severe. Or only after your loved
one has tried safer non-drug therapies first.

Clare, L. (2003). Managing threats to self: awareness in early stage Alzheimer’s disease. Social

Science & Medicine, 57(6), 1017–1029. https://doi.org/10.1016/s0277-9536(02)00476-8

Giannouli, V., & Tsolaki, M. (2022). What Biological Factors, Social Determinants, and
Psychological and Behavioral Symptoms of Patients with Mild Alzheimer's Disease
Correlate with Caregiver Estimations of Financial Capacity? Bringing Biases Against Older
Women Into Focus. Journal of Alzheimer's disease reports, 6(1), 503–507.
https://doi.org/10.3233/ADR-220037