Alzheimer’s disease: Lest you forget

(Second of Three Parts)

“Although Alzheimer’s disease is so common, it’s quite hard to make a diagnose.” – Dr. Willie T. Ong in his national column, “Mind Your Body.”

Alzheimer’s disease was first described by Dr. Lois Alzheimer in 1907 – and it was named after him. More than 100 years after, the disease continues to baffle medical science. Until now, the cause of Alzheimer’s disease remains a mystery.

“Alzheimer’s disease is one of the hottest areas of scientific research,” points out Dr. Simeon Marasigan, associate professor at the department of neurology and psychiatry of the University of Santo Tomas.

“In Alzheimer’s disease, parts of the brain degenerate, destroying nerve cells and reducing the responsiveness of the remaining ones to many of the chemical messengers that transmits signals in the brain (called neurotransmitters),” explains The Merck Manual of Medical Information.

Science has discovered that the gradual loss of brain function that characterizes Alzheimer’s is due to two proteins, beta-amyloid and tau. “These two are the possible culprits,” says Professor Edmund Chiu, a psychiatrist at St. George’s Hospital in Melbourne University.

Beta-amyloid protein accumulates in the brains of patients with Alzheimer’s disease, activating immune cells that try unsuccessfully to remove it. That triggers the release of poisons that ultimately kill nerve cells, leaving behind a trail of plaques and tangles – the remains of nerve cells and fibers, clogged up with beta-amyloid.

Many of the nerve cells that are destined to die show abnormal deposits of a protein called tau, which is assumed to be toxic to nerves. Tau formation is related to the severity of disease. “The more severe the disease, the more tau is found within the brain,” informs Dr. Adrian Tan, a neurologist who works at the Paragon Medical Centre and the Mount Elizabeth Medical Centre in Singapore.

Alzheimer’s has also been connected to a reduction of acetylcholine in the brain. Acetylcholine is a substance in the body that allows messages to travel from one nerve to another. For example, a person who decides to pick up a pen can act on the thought only when the hand receives the message from the brain. Studies have shown that Alzheimer’s patients have a severe drop, sometimes 90 percent, of acetylcholine.

Most medical scientists agree that the biggest risk for Alzheimer’s disease is age. Although it can occur at any age, even as young as 40 years, it is more common among the elderly. “Alzheimer’s occurs very rarely among those 40-50 years old, increases between 60 and 65 years, and is very common over 80 years,” says Dr. Marasigan.

Aside from increasing age, genes almost certainly play a role in the disease. Take the case of Ronald Reagan, whose mother and brother died from the disease. “Usually, Alzheimer’s is not transmitted from family member to family member, although there is a higher risk if two or more family members are affected,” explains Dr. Tan.

Diet may also play a part. Scientists from Rush-Presbyterian-St. Luke’s Medical Center in Chicago – who examined 815 people aged 65 and older over a four year period – found that the risk of developing Alzheimer’s was highest (2.3 times more likely) among those who consumed the highest levels of saturated fat. Conversely, people whose diet contained high levels of unsaturated fat were up to 80% less likely to develop Alzheimer’s disease.

Still another: “In a minority of cases, trauma may be a contributing factor,” says Dr. Marasigan. Studies conducted in the United States showed that about 15 percent of Alzheimer’s sufferers have a history of head injury.

Whatever the underlying cause or causes, Alzheimer’s disease is the result of the destruction of nerve cells in the brain. “These nerve cells cannot be replaced, so the person with Alzheimer’s disease gets progressively worse as more cells are destroyed,” points out Prof Chiu.

Alzheimer’s can run its course from insidious onset to death in just a few years, or play itself out over a period as long as 20 years. “Most people with Alzheimer’s live for seven to 10 years after diagnosis, spending five years under vigilant care,” says Dr. Socorro Martinez, head of the memory center of St. Luke’s Medical Center in Manila.

Despite the advance of medical science, no one still discovers drugs for the disease. “There are no medications that can cure Alzheimer’s disease,” Dr. Marc Evans M. Abat told the Philippine Daily Inquirer in an interview some years back. “The key here is to ‘slow down’ the deterioration.”

There are drugs that can do this. “The neurologist may prescribe drugs that may help reduce memory loss and other cognitive changes in the patient,” wrote Dr. Willie T. Ong in his Philippine Starcolumn, “Mind Your Body.” “The first line drugs are called cholinesterase inhibitors, such as Donepezil (brand name Aricept). These drugs work by increasing the neurotransmitters in the brain. Donepezil is given at the usual dose of 5 mg once a day for four to six weeks. However, this drug only works in half of the cases. If the patient doesn’t improve or has side effects like nausea, then the drug is stopped.”

The second drug usually prescribed is memantine. This medicine “acts by reducing abnormal activity in the brain, thereby, reducing memory loss and thinking problems,” according to the website It may also “improve the mental functions of a person with Alzheimer’s,” but again it won’t cure the disease.

“Aside from medicines,” wrote Dr. Ong, “the family plays a crucial role in the health and safety of the patient. First, you should create a safe environment by installing handrails in the bathroom and other strategic locations in the house. Make sure that doors are locked at night. Watch out for slippery surfaces and too much furniture in the house. Have the patient wear comfortable clothes and rubberized shoes or slippers.”

There are also some non-pharmacologic management which may help in reducing the frequency and duration of abnormal behavior and slow down cognitive deterioration. Dr. Abat enumerates the following: physical exercise, music therapy, cognitive therapy, multi-sensory modalities, massage, aromatherapy, use of props and visual aids to prevent wandering and unwanted movements, reducing/eliminating restraint use, and bright light therapy for those suffering from insomnia.

According to Dr. Ong, supplemental feeding (high calorie and high protein) may be needed “for patients with poor appetite.”

There is no single cause of death associated with Alzheimer’s. Many sufferers die from problems related to the decrease in brain function. When Alzheimer’s is the cause of death, patients often die because of the complications related to the disease like as pneumonia, urinary tract infection, and skin infection from pressure sores.

Do you think your loved ones or you yourself are experiencing some symptoms of Alzheimer’s disease? “Don’t delay; getting early diagnosis and going public with the disease is really, really important,” suggests Lorna Drew Ferrari, who co-wrote the book, Different Minds, with her husband who suffered from the disease. “There is nothing to be ashamed of.” (To be concluded)