What is Alzheimer's disease?

Alzheimer’s disease is a type of dementia that most commonly affects adults 65 or older.

Dementia is one of the most devastating diseases of the 21st century. Not only is it tough living with dementia, it’s also incredibly hard for loved ones who need to take care of the individual, be it their parents, partner, or someone else. 

Alzheimer's disease affects the brain, causing changes in a person's memory, thinking, and behavior. One of the key features of Alzheimer's disease is the presence of abnormal protein deposits in the brain called amyloid plaques and neurofibrillary tangles in the brain made of tau proteins. These protein deposits can damage and kill nerve cells, stop neurons functioning properly, and lead to the cognitive and behavioral symptoms of Alzheimer's disease.

Many people believe that your risk of Alzheimer’s disease is set in stone; a concoction of genetics and old age that we just have to wait to catch up with us. One genetic risk factor is a gene called APOE4. This increases your risk of Alzheimer's disease when you inherit it from one parent, and even more when you inherit it from both parents. 

However, the genetic risk factors of developing Alzheimer’s don’t make up the full picture. Instead of just genetics and old age, the development of dementia is driven by the same mechanisms as other chronic conditions, namely inflammation, dyslipidemia, oxidative stress, insulin resistance and an unhealthy gut microbiome ⁶.

The 2020 report of the Lancet Commission, a highly respected publication, found that 40% of dementia cases could be prevented or delayed by addressing 12 lifestyle-related factors; tobacco smoking, physical inactivity, depression, hypertension, obesity, diabetes, hearing loss and social isolation, excessive alcohol consumption, air pollution and traumatic brain injury ⁷. Based on their research, the scientists state ‘It is never too early and never too late in the life course for dementia prevention.’

Symptoms 

Some of the main symptoms of Alzheimer’s disease include: 

• Memory loss, particularly short-term memory— those with Alzheimer's disease often experience significant memory loss and have trouble remembering recent events or even familiar faces.
• Confusion and disorientation— as the disease progresses, individuals may become easily confused and disoriented about the time and place, even in familiar surroundings
• Challenges in planning and problem solving 
• Difficulty with judgment and decision making
• Loss of independence— difficulty completing daily tasks, such as bathing and eating, as well as wandering and getting lost lead to a loss of independence  
• Difficulty communicating— trouble with speaking and words, making it hard to join or follow a conversation, and difficult to express themselves or understand others.
• Depression and anxiety— Living with Alzheimer's disease can be incredibly difficult and cause individuals to withdraw from things they use to enjoy, it can be very lonely and cause feelings of depression and anxiety
• Changes in personality— this can be very difficult for their loved ones  
• Misplacing things and losing the ability to retrace their steps— someone with AD may put objects in unusual places, struggle to find them again, and accuse others of stealing 

Diagnosis

To diagnose Alzhiemer’s disease, a healthcare provider will typically need to understand the individual's symptoms, get a perspective on the symptoms from a close friend or family member, and conduct a thorough medical evaluation, including a physical exam and review of the individual's medical history. Additionally, the provider may recommend a variety of tests to assess cognitive function and rule out other potential causes of memory loss and cognitive decline. These tests may include:

1. Neurological exam— This exam assesses muscle strength, reflexes, coordination, balance and other aspects of neurological function.
2. Mental status and neuropsychological  testing— This type of testing involves a series of questions and tasks designed to assess cognitive function, including memory, attention, and problem-solving abilities.
3. Brain imaging— Including MRI scans, CT scans, Amyloid PET imaging, and Tau PET imaging, can help to rule out other conditions and identify structural changes in the brain associated with Alzheimer's disease.
4. Laboratory tests— Blood and other lab tests can help to rule out other potential causes of cognitive decline, such as thyroid problems or vitamin deficiencies.

Ultimately, a diagnosis of Alzheimer's disease is made based on a combination of clinical evaluation, testing, and the presence of specific symptoms and cognitive changes.

Treatment

Pharmaceuticals have notoriously failed to produce effective results for treating or managing AD. On the other hand, lifestyle interventions have shown to be safe, cheap, and effective in managing the risk and progression of dementia and cognitive decline. 

Making sure we follow a healthy diet, along with physical activity, restorative sleep, and stress management, are the key features in preventing or slowing the progression of Alzheimer's disease and improving symptoms of cognitive decline once they have started.

Plant based diets address the key drivers of dementia. They are rich in vitamins and minerals that act as antioxidants to put out fires caused by inflammation in our brain. For brain health, lots of leafy green vegetables and berries, alongside the reduction of saturated fat intake from animal products, are crucial for protection against damage. 

These are just a few of the changes that may give individuals and their loved ones the best chance of living a long, dementia-free life. If we can learn and implement what it takes to protect our brain, perhaps families can stay together a little longer. 

Useful links

36-step protocol for preventing, managing, and even reversing AD: The End of Alzheimer’s: The First Programme to Prevent and Reverse the Cognitive Decline of Dementia : Bredesen, Dr Dale 

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References 

1. Alzheimer’s Disease Facts and Figures. Alzheimer’s Disease and Dementia https://www.alz.org/alzheimers-dementia/facts-figures (2022).

2. Morris, M. C. et al. MIND diet associated with reduced incidence of Alzheimer’s disease. Alzheimers Dement. 11, 1007–1014 (2015).

3. Tsai, J.-H. et al. Taiwanese Vegetarians Are Associated with Lower Dementia Risk: A Prospective Cohort Study. Nutrients 14, 588 (2022).

4. Ngandu, T. et al. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. The Lancet 385, 2255–2263 (2015).

5. Elwood, P. et al. Healthy Lifestyles Reduce the Incidence of Chronic Diseases and Dementia: Evidence from the Caerphilly Cohort Study. PLoS ONE 8, e81877 (2013).

6. Edwards III, G. A., Gamez, N., Escobedo Jr., G., Calderon, O. & Moreno-Gonzalez, I. Modifiable Risk Factors for Alzheimer’s Disease. Front. Aging Neurosci. 11, 146 (2019).

7. Livingston, G. et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet 396, 413–446 (2020).