What is Alzheimer's Dementia?

[slightly edited for readability-AZ]

Amyloid proteins in normal people lose their normal structure and functions and are broken down and eliminated as a routine physiology. Amyloids in some humans however, instead of being eliminated by the body, deposit themselves around cells. This results in as many as 50 human diseases and this includes their role in development of Alzheimer’s.

In Alzheimer’s disease, amyloids are not broken down properly and beta-amyloid plaques (clumps or tangles of these proteins) accumulate in the brain. They deposit between neurons and harden into plaque-like substances which eventually block the synapse of the neurons. Synapses are like the communication nodes of the neurons through which they transfer signals or info.

Another influential protein, Tau protein, stabilizes the microtubules of the brain’s neurons as they assist in transporting substances through synapses of the brain. Instead of communicating signals, they transport substances needed by the neurons. What happens in Alzheimer’s is the collapse of Tau protein in microtubules causing the neurons to become tangled and twisted. Neurons start to die. 

Successful Aging

Successful aging is having a good quality of life as we approach the twilight years. Let’s face it - we will all leave this world  but there is a difference between a person staring at the ceiling for years before he leaves  and another who lives independently, does whatever he wants, spends time with friends and family, goes wherever  without using a wheelchair and without fear of losing balance and losing his  mind; one who can deal with people in perfect speech and behavior; one who doesn’t need to go to the Doctor and hospital frequently. Don’t we all wish to leave this world after we reached the ripest age of a hundred and quickly exit without drama or someone changing our diaper? 

Based on the articles I read from APTA, we can achieve a good quality-aging outcome if we start getting ready for it at about mid-life, something like 50 years old onwards. Obviously, we cannot alter our genetic or inherited defects but there are a few areas we can do something about. The pandemic has proven that sometimes, we can be helpless. Injuries and accidents are events we cannot do anything about. But barring all communicable diseases and injuries, there are non-communicable conditions that can reduce the risks if we put them under control - diabetes, cardiovascular (heart abnormalities, blood pressure, cholesterol, arteriosclerosis or hardening of blood vessel walls etc.) and certain cancers. Some of these can occur as early as in our 50s so it is good to keep watch on them early on.

There are 3 specific areas we need to watch: Dementia, Disability and Frailty. 

Despite our gratitude for the wisdom, respect and freedom from tremendous responsibilities as we get old, we also fear cognitive changes. A study showed that by age 45, memory, reasoning and verbal fluency will start declining. Walking speed has been observed to start declining by age 30. Some limitations in daily activities have been reported among 11% of men and 10% of women between age 50 to 64 in 1 or 2 daily tasks. 

Things may even get worse because at middle-life age, you might be taking care of very sick parents, and which could reduce your ability to earn a living; becoming a caregiver of a loved one could also confine you to your home leading to your isolation and inability to pursue the regular rhythm of life. Again, this may lead to dementia, disability and frailty.

Dementia is always associated with Alzheimer’s although there is a growing agreement among health care providers that it is a combination of Alzheimer’s and Vascular Dementia (I have discussed these two in part 1 of this blog). The Lewy bodies and fronto-temporal bodies are less common, and we don’t have much literature about reducing the risk of these. 

Disability is a long-term restriction on the ability to perform an activity in a normal way. We all know what disability means. But for some, disability is often associated with difficulty or inability to walk which is limiting its scope. Disability can also cover problems using hands, hearing and vision losses, speech impairment. These can be made worse if for example, you are weak in legs and yet need to climb stairs to get into the house or the bus or the car, or your hands are arthritic or paralyzed so you’re unable to use spoon and fork or even pull toilet paper to wipe yourself, or comb your hair, button your shirt, brush teeth, change your clothes, shower, and put shoes on.  How about being deaf if you love music or movies? And being legally blind when you rely on books or TV or smart phone for leisure? These limitations can easily happen in strokes, diabetes, and some heart (MI, abnormal heart beats, easy fatigue) and respiratory (COPD, lung cancer) problems and would limit your endurance to do normal things. 

Frailty is an impairment in daily living/functions due to a combination of many factors, especially psychological. An elderly woman who fell and broke a bone would be frozen and vehemently resist to get out of the chair or bed for fear of another fall. A woman who is severely abused would likely hide in a corner and wouldn’t move for fear of the abuser’s return. A man who has been mugged, beaten and terrorized would develop insomnia or in case of some veterans, PTSD. A mother facing eviction without any help coming can get into severe depression and would just like to sleep. These are just a few examples that can lead to frailty. Obviously medical conditions and other psyche conditions can lead to this as well. The moment you develop dementia, there is a possibility you’d be watched carefully by those who are responsible for your well-being. For your every attempt to get up or get close to the door, someone would block you. If you had a massive stroke, especially with aphasia (blank face, unable to talk, and God forbid, unable to swallow food because your throat muscles are paralyzed leading to choking and aspiration pneumonia) or if you are a diabetic with both legs amputated, these all lead to frailty. And this may not even include mental illness ranging from schizophrenia to bipolar and the worst kind, suicidal which complicate everything.  And then there are those with anorexia who are afraid of food.  I am just giving you some examples situations that result in frailty based on my previous experience as a clinician. Indeed, there are other conditions that can make a person frail.

There were many studies done on successful aging based on the articles I read in APTA. They pointed out a few lifestyles to increase success:

  1. Never having smoked.
  2. Exercising regularly.
  3. Eating fruits and vegetables daily.
  4. Drinking moderately.

From the EPIC-Norfolk study, they found that people who adhered to these 4 lifestyles lived an average of 14 years longer than those who did not.

Another study (Whitehall) discovered that the people who adopted these in their lifestyle are 3.3 times more likely to age successfully. These studies also discovered that the more educated people are, the better is their chance to age successfully and this is because of their good understanding of healthy lifestyle. 

In an English study, they found that socio-economic disadvantage or poverty is both a cause and a result of disability and disability increases the risk of frailty and dementia. Basically, and I guess this is a no-brainer, to succeed in getting old, one must be knowledgeable about a healthy lifestyle, isn’t disabled and have enough money to live comfortably. LOL. So, for the middle-agers, it is time to crank up that healthy lifestyle, good savings to rely on when old, and prevent any form of disability. You’d thank me when you reach 70. 

There are other lifestyles that can be adopted to improve mental capacity that may reduce or minimize the risk Dementia:

  1. Keep learning. As I said earlier, challenging the brain is like exercising the muscles to prevent weakness. To challenge the brain means forming a new network of brain cells that keep one sharp and less demented. There are a few things to indulge in for this: Reading, learning a new skill whether food preparation of computer coding or answering the most difficult mathematical puzzles or Sudoku or crossword puzzles or learning how to play bridge or other challenging card games, p[lay chess, and believe it or not, learning new dance steps. A lot of people do not realize how mentally challenging it is learning new dance steps - it requires mental sharpness to figure the next step at the right time and tempo and that my dear, is heavy mental lifting. I am poor at dancing.

The rest of the suggestions were taken from Google:

Use all your senses.

The more senses you use in learning something, the more of your brain that will be involved in retaining the memory. In one study, adults were shown a series of emotionally neutral images, each presented along with a smell. They were not asked to remember what they saw. Later, they were shown a set of images, this time without odors, and asked to indicate which they'd seen before. They had excellent recall for all odor-paired pictures, and especially for those associated with pleasant smells. Brain imaging indicated that the piriform cortex, the main odor-processing region of the brain, became active when people saw objects originally paired with odors, even though the smells were no longer present and the subjects hadn't tried to remember them. So challenge all your senses as you venture into the unfamiliar.

Believe in yourself.

Myths about aging can contribute to a failing memory. Middle-aged and older learners do worse on memory tasks when they're exposed to negative stereotypes about aging and memory, and better when the messages are positive about memory preservation into old age. People who believe that they are not in control of their memory function — joking about "senior moments" too often, perhaps — are less likely to work at maintaining or improving their memory skills and therefore are more likely to experience cognitive decline. If you believe you can improve and you translate that belief into practice, you have a better chance of keeping your mind sharp.

Prioritize your brain use.

If you don't need to use mental energy remembering where you laid your keys or the time of your granddaughter's birthday party, you'll be better able to concentrate on learning and remembering new and important things. Take advantage of smart phone reminders, calendars and planners, maps, shopping lists, file folders, and address books to keep routine information accessible. Designate a place at home for your glasses, purse, keys, and other items you use often.

Repeat what you want to know.

When you want to remember something, you've just heard, read, or thought about, repeat it out loud or write it down. That way, you reinforce the memory or connection. For example, if you've just been told someone's name, use it when you speak with him or her: "So, John, where did you meet Camille?"

Space it out.

Repetition is most potent as a learning tool when it's properly timed. It's best not to repeat something many times in a short period, as if you were cramming for an exam. Instead, re-study the essentials after increasingly longer periods of time — once an hour, then every few hours, then every day. Spacing out periods of study helps improve memory and is particularly valuable when you are trying to master complicated information, such as the details of a new work assignment.

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