Whether Alzheimer’s disease quietly creeps into its victims’ lives or makes a grand, unwelcome entrance, it inevitably becomes a runaway train that erases the past and disrupts the future. Ultimately, it impedes everything the brain controls, starting with short-term memory and ending with the basic functions required to live. There is no known way to prevent or slow it, and a cure has not been found—yet.
By Keely Stockett
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The disease’s reach is broad and growing. According to the Alzheimer’s Association, more than 5 million Americans are currently living with Alzheimer’s; that number could triple by 2050. Victims of the disease aren’t the only ones affected. As it progresses, patients require near-constant care and assistance. Right now, there are more than 15 million caregivers of people with Alzheimer’s and other dementia. In 2012 alone, they provided more than 17.5 billion hours of unpaid care, valued at more than $216 billion.
As the sixth-leading cause of death in the nation, it could be considered an epidemic—and it’s an expensive one. This year, it will cost the U.S. $203 billion, which is on track to rise to $1.2 trillion by 2050.
Alzheimer’s doesn’t care about careers, health insurance, or plans for the future. Its toll is steep—physically, financially, and emotionally. But as the scope of the disease grows, so too does the urgency to stop it. In recent years, the medical community has gained a much clearer picture of what actually happens to an Alzheimer’s brain. As a result, our understanding of the disease’s progression has grown exponentially—and we’re getting closer to fighting back.
The brain has three main parts: the cerebrum, the cerebellum, and the brain stem. The cerebrum, which fills most of the skull, controls memory, thinking, feeling and movement. Located in the back of the head, the cerebellum is responsible for coordination and balance. The brain stem sits beneath the cerebrum and in front of the cerebellum, controlling automatic functions like breathing and digestion.
The outer layer of the cerebrum—the brain’s wrinkly surface area—is called the cortex. Different cortex regions are linked to specific functions, such as interpreting internal and external sensations, generating thoughts, forming and storing memories, and controlling voluntary movement.
How does a three-pound, jelly-like organ manage all of that? There’s a lot of action happening in there, and it’s all on the cellular level. According to the Alzheimer’s Association, the average adult brain contains about 100 billion nerve cells, or neurons, and branches that connect at more than 100 trillion points. Signals travel through this “neuron forest” as tiny electrical charges, forming the basis of memories, thoughts, and feelings. As we lead our lives, our experiences create patterns in signal type and strength. Those unique patterns make us who we are, dictating how our brains code what we think and feel.
Why Alzheimer’s begins in an otherwise healthy brain is a question that remains unanswered. But we do know how it proceeds. For people with the disease, the neuron forest becomes a battleground as nerve cells are killed and tissue is lost. As the brain shrinks, normal functions are disturbed and the cortex withers, particularly in the area that controls new memory formation.
Plaques, abnormal clusters of protein fragments, begin to build up between nerve cells. Twisted strands of proteins called tangles form, severely disrupting the brain’s cell transport system. Normally organized in parallel strands, the “tracks” of the transport system disintegrate in areas containing tangles. As a result, important nutrients can’t travel to the brain. As they spread throughout the cortex, plaques and tangles are thought to be the leading cause of cell death and tissue loss associated with
Alzheimer’s.
The microscopic war waged within a diseased brain may not be apparent to the naked eye, but the fallout is visible. Signs and symptoms typically follow a pattern, and while the progression can’t be stopped or slowed, patients may take comfort in knowing what to expect so they can prepare for the future and maximize their quality of life.
Alzheimer’s disease is typically observed in stages. Medical experts and organizations have developed frameworks to track its progression. Depending on the source, stages within the various guidelines range in terms of number and name, but each provides a general idea of what occurs during the disease’s early, middle, and late phases.
According to the Mayo Clinic, there are five stages associated with Alzheimer’s. Preclinical Alzheimer’s disease, the first stage, can last for years and quite possibly decades. Symptoms are not yet apparent in people with preclinical Alzheimer’s, but the brain is already under attack. Thanks to new imaging technology, deposits of a substance called amyloid beta, believed to be associated with the disease, can now be identified in the brain before any mental or physical signs emerge. The ability to track these early changes has given researchers a better understanding of the disease’s infant years, and it could be essential to the development of future treatments.
Mild cognitive impairment (MCI) due to Alzheimer’s is the second stage of the disease. People with MCI experience small changes in their ability to remember and think. MCI also can interfere with decision-making abilities. Although noticeable, these changes typically aren’t substantial enough to elicit concern or disrupt work and relationships.
In its third stage, mild dementia due to Alzheimer’s, the disease makes itself known. Memory and thinking problems become apparent to the suffering individuals, as well as their family, friends, and doctors. During this phase, people with Alzheimer’s have trouble retaining newly learned information, problem-solving, completing complex tasks, and making sound judgments. Personality changes like irritability or withdrawal are common. The process of organizing and expressing thoughts becomes challenging, and people frequently get lost in familiar places or misplace things.
The next stage of the disease, moderate dementia, is associated with deepening confusion and forgetfulness. Assistance with daily activities becomes increasingly necessary—such as choosing clothes or using the bathroom—and personality changes continue to emerge. Restlessness, agitation, and aggressive outbursts are common. Severe dementia, the latest stage of Alzheimer’s, is associated with a steep decline in health. Coherent communication is no longer possible, and constant assistance is required. Physical abilities begin to deteriorate: muscles become rigid, swallowing is impaired, and control of bladder and bowel functions is lost.
Recognizing the Signs
From gray hair to wrinkles, weight gain to swollen joints, the aging process certainly has its challenges. But the annoyance of sagging skin and sore muscles pales in comparison to the mayhem caused by Alzheimer’s. As they approach their senior years, many people harbor an intense fear of the disease, and that’s understandable. Saying good-bye to youth is hard enough; losing those memories—and the ability to create new ones—is difficult to bear.
However, it’s important to keep in mind that occasional memory lapses are expected during any phase of life, and they do tend to increase as the years pass. Knowing the true signs and symptoms of Alzheimer’s can hold fear at bay, giving you the ability to determine if there is any true cause for concern.
Alzheimer’s causes consistent, increasing, and unprecedented behavioral changes that affect your day-to-day life. Forgetting the name of an old colleague, for example, isn’t worrisome, but forgetting the name of your daughter is. Misplaced items, neglected finances, and challenges using everyday objects and machines signal a problem. Getting lost in familiar territory—on your way home from the grocery store, for example—is another telltale Alzheimer’s symptom, as is repeating yourself constantly or asking the same questions over and over again.
If these behaviors appear and persist for an extended period of time, it’s important to seek the opinion of a medical professional who can dig deeper to find out whether an underlying issue exists.
Healthy Living—With Your Brain in Mind
Currently, there are no known prevention strategies for Alzheimer’s. But there are ways to keep your brain healthy, which can either decrease your odds of developing the disease or delay its onset. Adults may reduce their risk by regularly participating in physical exercise. Keeping the brain active and engaged—through reading, puzzles or social interaction, for example—also could be beneficial; activities that stimulate the mind strengthen brain cells and possibly create new nerve cells. There is some evidence that healthy eating may also have a role to play. Reduced intake of red meat and dairy, combined with increased consumption of fruits and vegetables, fiber-rich foods, and fish, could provide some protection against brain deterioration.
While these guidelines can help keep your body healthy, no one is immune to brain disease. Unfortunately, as is true with many medical conditions, you can do everything “right” and still develop Alzheimer’s.
Treatment Options and Managing Symptoms
Although prevention and cures remain out of reach, treatment options have been developed. These approaches address the symptoms of Alzheimer’s, but are currently unable to slow its inevitable progression.
Today, there are four medications that have been approved by the U.S. Food and Drug Administration to treat Alzheimer’s. Three of these are used for patients with mild to moderate Alzheimer’s, and one is prescribed for patients in the moderate to severe stages. These drugs may help maintain some essential brain functions—thought, memory, speech—but they don’t impact the brain’s ongoing deterioration, they don’t work for everyone, and they may only be effective for a short time.
Some treatments, both drug and non-drug, focus on managing sleeplessness, agitation, depression, anger, and other behavioral symptoms. These medications and therapies can offer comfort and improve quality of life for sufferers of Alzheimer’s, while making it easier for family, friends and medical professionals to provide care.
Coping Now and Looking Ahead
Alzheimer’s is a complex disease that has gripped the lives of millions. As the number of people with Alzheimer’s continues to grow, medical and research institutions and organizations across the globe are increasingly committed to stopping the disease. In the meantime, resources are being funneled toward the development of new treatments that could potentially offset the Alzheimer’s or slow its attack.
If you or a loved one has been diagnosed with Alzheimer’s disease, your hands are not tied. Empower yourself by learning about the disease, understanding treatment options, and seeking professional advice or care. If you feel lost, start by taking advantage of the wide-ranging resources that are available online. Organizations like the National Institute for Aging (www.nia.nih.gov/alzheimers) and the Alzheimer’s Association (www.alz.org) offer extensive information and tools for patients, caregivers and healthcare providers.
Most importantly, don’t lose hope. As you prepare for whatever the future may bring, know that it still holds promise for a cure.
