Alzheimer’s Disease

Each week, literally thousands of people are diagnosed with Alzheimer’s Disease. It’s the second most common cause of death in Australia after Heart Disease, and in the USA is the sixth most common cause of death.

By the year 2050, it is estimated that one million Australians could also be diagnosed with this debilitating condition if there is no sufficient breakthrough in research concerning its prevention or cause. The incidence of Alzheimer’s Disease is continuing to grow worldwide.

There are over 9.9 million new cases of dementia each year worldwide, implying one new case every 3.2 seconds.

Alzheimer’s Disease vs. Memory Loss

Even though statistics show that many people are being diagnosed with Alzheimer’s Disease, this does not mean that it is an expected step in the aging process, because it is not. There is a distinct difference between Alzheimer’s Disease and regular memory loss, such as there being damage and shrinkage of the neurons in the brain accompanying other symptoms.

The National Institute on Aging (NIA) classifies the difference between memory loss and Alzheimer’s Disease as follows:

Alzheimer’s Disease (AD) is a type of Dementia and the most common type at that, affecting nearly 70% of those diagnosed with dementia.

The NIA defines dementia as “the loss of cognitive functioning—thinking, remembering, and reasoning—and behavioral abilities to such an extent that it interferes with a person’s daily life and activities.”

Dementia can progress to a quite severe stage, whereby a person must depend entirely on other people for usual everyday activities. There are varying degrees of dementia as it is an umbrella term for cognitive decline and AD is just one of them. The different types of dementia are:

• Lewy body dementia
• Frontotemporal dementia
• Alzheimer’s disease
• Vascular dementia
• Alcohol-related dementia

What is Alzheimer’s Disease?

Alzheimer’s Disease is best described as a degenerative neurological disorder caused by damage to nerve cells resulting in changes to the brain and brain tissue.
The changes that occur in the brain due to AD likely start before symptoms do. Abnormal deposits of proteins form amyloid plaques, and nerve fibers become tangled throughout the brain. As a result, healthy neurons stop functioning and this causes the cells to die. Even at a preclinical stage, whereby symptoms may have not yet arisen, the damage seems to be evident in the hippocampus, which is the part of the brain responsible for storing memories. As the disease progresses, more neurons become damaged, and brain tissue will shrink significantly; the amyloid plaques are what distinguishes AD from other types of dementia.

There are other physiological changes associated with the development of neurodegenerative disorders like AD, such as increased biomarkers for oxidative stress and inflammation.

Literature supporting the role of mitochondrial dysfunction playing a causative role in AD also exists. Mitochondria have a wide range of functions, including ATP production, defending against free radicals and reversing oxidative damage, buffering calcium, synthesizing haem iron and they are also required for the differentiation of immune cells.

Lifestyle and dietary factors such as smoking, alcohol, stress, medications, chemical exposure and nutritional deficiencies can all play a role in the impairment of mitochondrial function.

Risk Factors for Alzheimer’s Disease

Aging is currently the most significant risk factor for AD as prevalence increases with age. According to the Alzheimer’s Association, the number of those diagnosed with Alzheimer’s Disease increases after the age of 65, with 1 in 3 people being diagnosed by the age of 85.

Particular lifestyle choices have also been identified as a risk factor for AD, such as heavy alcohol use, with research explaining the correlation between alcohol and AD as:

• Acetaldehyde, a neurotoxic metabolite of ethanol, has been shown to cause detrimental structural changes in the brain
• Heavy drinking is associated with thiamine and other nutrient deficiencies that are crucial for cognitive function and development
• Heavy drinking is associated with other risk factors for dementia such as tobacco smoking, high blood pressure, stroke, atrial fibrillation, heart failure, and depression

Heavy drinking is defined by The World Health Organisation as: “an adult over the age of 15 who has consumed a minimum of 60 grams or more of pure alcohol on at least one occasion in the past 30 days.”

Studies have also found a link between AD and vascular disorders such as heart disease, high blood pressure, and stroke, as well as metabolic conditions such as insulin resistance, diabetes, and obesity.

Traumatic brain and head injury have also been associated with an increased risk of AD.

Other factors such as lack of exercise and nutritional deficiencies have also been shown to impact the development of brain plaques and tangles present in AD. Nutritionally, preliminary research has demonstrated a Mediterranean diet to be most effective at reducing the risk of AD. It is the high intake of fruit, vegetables, legumes, different plant fibers, polyphenols and essential fatty acids that make the Mediterranean diet most ideal for brain health.

Signs and Symptoms

The most common symptoms of AD include:

• Gradual memory loss
• Reduced ability to perform routine tasks
• Impaired understanding of time and space
• Issues with physical coordination
• Learning difficulties
• Communication impairments
• Agitation
• Depression
• Anxiety or paranoia
• Hallucinations
• Changes in sleeping and eating patterns
• Changes in personality, behavior, and mood

How is Alzheimer’s Disease Diagnosed?

A diagnosis is made after a thorough clinical consultation, as there is currently no laboratory test to singularly diagnose AD. While there are still specific tests used, such as blood and urine samples and medical imaging (e.g., an MRI), which may assist in the diagnosis of Alzheimer’s, they cannot be used as diagnostic tools alone.

A clinical diagnosis of Alzheimer’s disease could include:

• A detailed health history to consider all potential contributing factors
• A thorough physical and neurological examination
• A test of intellectual function such as questions regarding memory, language, problem-solving and counting
• Asking family members about the patients change in behavior and ability to carry out daily activities
• Psychiatric assessment
• Standard blood and urine tests to detect any other possible causes of symptoms or correlating factors
• Lumbar puncture for cerebrospinal fluid tests
• Medical imaging such as an MRI, CAT or PET scan
• Alzheimer’s Disease can only correctly be 100% confirmed after death, by examining brain tissue in an autopsy.

Treatment

There is currently no cure for Alzheimer’s disease; treatment is complex and involves considering many factors, such as causative factors and health history. Current medical approaches focus on prescribing medication to help manage symptoms, such as depression, restlessness, or inability to sleep.

For a more extensive outline of treatment options for Alzheimer’s Disease, see the Mindd Treatment Profile for “Alzheimer’s Disease”.

A holistic understanding of Alzheimer’s disease is vital to consider a treatment plan. Having a sound knowledge of the role of mitochondria in AD is also essential in order to examine the nutrients and factors involved in the protection and function of the brain.

Naturopathic and Integrative Medicine Treatment Aims for Alzheimer’s are:

• Supporting the production of neurotransmitters via providing precursors and cofactors to enhance neurocognition
• Protecting neurons from further damage by reducing oxidative stress and inflammation to reduce the accumulation of amyloid plaques and improve mitochondrial function
• Supporting neuronal energy by providing sufficient cofactors for ATP production
• Reducing elevated homocysteine via increasing its metabolism and breakdown to minimize any impact on neurons

Essential nutrients and co-factors for brain health and mitochondrial function include B vitamins, magnesium, omega-3 fatty acids, CoQ10, alpha-lipoic acid and more. Exercise also plays a vital role in keeping our mitochondria healthy.

For more detailed information on an Integrative Medicine treatment of Alzheimer’s disease, please see the article ‘Holistic treatment and understanding of Alzheimer’s disease.’

 For a more extensive outline of treatment options for Alzheimer’s Disease, see the Mindd Treatment Profile for “Alzheimer’s Disease”.

Written by Lana Micallef, Clinical Nutritionist (BHSc NutMed) 

References

1. http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0~2016~Main%20Features~Australia’s%20leading%20causes%20of%20death,%202016~3
2. https://alzheimers.com.au/about-alzheimers/what-is-alzheimers/
3. https://www.nia.nih.gov/health/alzheimers-disease-fact-sheet
4. https://www.dementia.org.au/information/about-dementia/types-of-dementia
5. https://www.frontiersin.org/articles/10.3389/fnagi.2016.00256/full
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4840676/
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235787/
8. Salomon, L. N. (2014). International Approaches to Alzheimers Disease and Dementia. New York: Nova Science Publishers, Inc.
9. https://www.alz.org/alzheimers-dementia/what-is-alzheimers/risk-factors
10. https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30022-7/fulltext
11. http://apps.who.int/gho/data/node.wrapper.imr?x-id=459
12. https://aanddjournal.net/article/S1552-5260(15)02037-3/fulltext
13. https://www.sciencedirect.com/science/article/pii/S0925443909002427
14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5741875/