Alzheimer’s Disease

1. Alzheimer’s Disease By Sarah Chorn

2. Why Alzheimer’s?

3. Topics to be Covered • History of Alzheimer’s • Alzheimer’s Basics • Dementia vs. Alzheimer's • How Alzheimer’s Spreads • Stages of the Disease • Risk Factors • Diagnosing • Common Medical Tests • Treating the Disease • The Framingham Heart Study • Alzheimer’s and the Mediterranean Diet • Vitamin E • Beta-Amyloid Testing • Overall Diet & health information • Ethical Dilemmas • Conclusions

4. Alzheimer’s: A History • Dr. Alois Alzheimer – November 1906 • Presented a case at a scientific meeting • Frau Auguste D. • 51-year-old woman with memory problems • Symptoms rapidly worsened and within years was bedridden. • Her symptoms lasted from 1901 to her death in 1906

5. The Autopsy • Dr. Alzheimer performed an autopsy on Augusta D • Discovered severe shrinkage of Augusta’s brain • Shrinkage in cortex • Cortex deals with memory, thinking, judgment and speech • Abnormal fatty deposits in brain cells and blood vessels • In 1907 Alzheimer published his findings • In 1910 a psychiatrist named disease after Dr. Alzheimer.

6. Alzheimer’s Basics • Alzheimer’s is a breakdown of the brain’s cells • Damage begins in one part of the brain and quickly spreads to others • If brain cells are like a factory, the damaged cells causes the factory to back up, stop doing their job and eventually die • Scientists are unsure of where the damage starts and why

7. Alzheimer’s vs. Dementia

8. How Alzheimer’s Spreads • Plaques and Tangles build in the brain at an abnormal rate • Plaques are beta-amyloidprotein deposits • Tangles are the tangled portions of protein strands • Scientists believe that plaques keep brain cells from communicating and surviving • The destruction of these cells causes the problems Alzheimer’s patients suffer from

9. 7 Stages of Alzheimer’s • Stage 1 – Normal functioning • Stage 2 – Very mild decline • Occasional lapse of memory, forgetting familiar words etc • Stage 3 – Mild cognitive define • Doctors may detect memory problems • Stage 4 – Mild or early onset Alzheimer’s • Difficulty in complex tasks, forgetting recent events, forgetting personal history • Stage 5 – Moderate to mid-stage Alzheimer’s • Unable to remember address, confused about where they are, day, time • Stage 6 – Moderate to severe mid-stage Alzheimer's • Stage 7 – Sever or late-stage Alzheimer’s • Lose the ability to control movement, respond to environment, carry on a conversation

10. Risk Factors Age Most Alzheimer’s disease patients are over 65 years old After the age of 80, risk for Alzheimer’s increases by 50% Genetics Those with a parent or sibling with Alzheimer's are three times more likely to get the disease Scientists have discovered a rare gene that almost guarantees an individual will get the disease Other risks Serious head injury Brain health may be related to heart health

11. Diagnosing • Patients may be referred by their primary care doctors to see neurologists, psychiatrists or psychologists. • There is no one test used to diagnose Alzheimer’s • Physicians are usually able to diagnose the condition with 90% accuracy. • It is important to evaluate overall health, mood and memory to diagnose the disease.

12. Common Medical Tests Physician Neurologist Reflexes Coordination Muscle tone & strength Eye movement Other tests to rule out other conditions like Parkinson’s, stroke, brain tumors, or fluid on the brain. • Evaluate diet and nutrition • Check blood pressure & temp • Blood and urine will be evaluated to rule out other medical conditions like vitamin deficiencies, diabetes etc.

13. Treating the Symptoms Two types of drugs Cholinesterase – Inhibit the breakdown of acetylcholine is important to memory and learning These drugs supportcommunication between nerve cells Memantine inhibits glutamate breakdown Glutamate is important in information processing. Behavioral Treatments Identify the symptom Understand the cause Changing the care giving environment to remove challenges or obstacles

14. The Framingham Heart Study • Published by the American Medical Assn. • A study of ~900 men and women with a median age of 76, without dementia, studied for 9 years. • Studied Docosahexaenoic acid (DHA), an abundant fatty acid in the brain, also common in fish • Discovered that DHA content decreases in patients with dementia. • Therefore, decreased DHA is a risk associated with dementia

15. The Framingham Study: Implications • Increased fish and DHA was found to be protective against increased risk of Alzheimer's. • 50% decreased risk of Alzheimer’s if fish was consumed 2x/week. • In the future, studies are planned to determine exactly how much dietary supplementation of DHA affects Alzheimer’s risk.

16. Alzheimer's and the Mediterranean Diet • Study done by Columbia University • Evaluated the effect of the Med. Diet & physical activity on Alzheimer’s disease • Discovered that individuals with a high adherence to the Med. Diet and high levels of physical activity had less risk of Alzheimer's.

17. Vitamin E • Federally funded study • Discovered that vitamin E supplementation delayed the loss of the ability to carry out daily activities • Believe that vitamin E may work because it is an antioxidant and thus, protects cells from certain kinds of wear and tear • The doses used in the study were high, thus, it is important to not use it to treat Alzheimer's unless a doctor prescribes it. Corn oil, nuts, olives, green, leafy vegetables, vegetable oils, wheat germ and supplementation.

18. Beta-Amyloid Testing • Beta-amyloid is a protein fragment that build up into plaques in the brain – considered a “hallmark” of the disease • Researchers have developed several ways to clear these proteins from the brain and prevent plaques from forming. • The first drug that focuses on doing this is currently being tested. Beta-amyloid plaques prevent brain cells from functioning properly – like “backing up a factory.”

19. Overall Health & Dietary Information Diet & the Brain Heart Health & Brain Health Strong evidence links heart health to brain health The brain is nourished by one of the body’s richest networks of blood vessels Thus, it is important for people to: Maintain a healthy weight Maintain healthy blood pressure Low cholesterol levels Have healthy blood sugar levels • Studies suggest that brain health can be maintained by: • Eating a low-fat diet • Eating lots of fruits and vegetables • Exercising regularly • Staying mentally and socially active

20. Ethical Dilemmas Currently nutrition and medical professionals are on the same page regarding how to treat symptoms of Alzheimer’s, and deal with risk factors. Dilemmas exist with certain issues: When to use a feeding tube When to tell an individual they may have the disease How to deal with the individuals suffering from the disease (nursing homes, caregivers, etc)

21. Conclusions • Alzheimer’s is a brain disease which is probably the result of plaques and tangles • Alzheimer’s is a breakdown of the cells of the brain causing memory loss and loss of control • The disease has 7 stages of progression • Age, genes, heart health and injury are risk factors • There is no specific test for diagnosing the disease • There are two FDA approved drugs that help delay the symptoms and spread of the disease

22. Conclusions Cont. • The Framingham Study concluded that DHA is an important nutrient involved in the risk and prevention of Alzheimer’s • Other studies have concluded that exercise, the Med. Diet and vitamin E are important with prevention. • Currently, drugs preventing plaques are being tested • Some ethical dilemmas include when to give patients feeding tubes, when they should be told they have the disease, if they can be cared for at home, or if they should live in care facilities

23. The end Any Questions?