Alzheimer’s disease (AD) is one of the most frightening diagnoses in our society today. Almost every patient coming to my office asks me the same question: Are my memory problems the signs of Alzheimer’s disease? And I immediately see the fear in the eyes of these patients and their accompanying relatives.
The statistics are definitely frightening. More than 5 million Americans suffer from Alzheimer’s disease. Half of the people with Alzheimer’s are never diagnosed and among those who do receive a diagnosis, half of them do not get any treatment.
Our knowledge about this disease and treatment options continue to grow exponentially, but we still do not have an “Ehrlich’s Magic Bullet” yet to cure this disease. As a scientific community, we are working hard to gather as much data possible in order to ultimately cure AD.
When first described by Doctor Alois Alzheimer about 100 years ago, there was practically no solid knowledge about the brain, people’s thoughts, feelings, and behaviors. At the time, all medical information was gathered by description of symptoms and by observed changes in the tissues, either with the naked eye or the microscope. Dr. Alzheimer described the critical findings which have since become the hallmarks of Alzheimer’s disease, specifically, the plaques and tangles in the cortex area of the brains’ of people who suffered from AD.
The present knowledge about the brain today is vast and impressive. Every day, thousands of doctors and researchers collect data about the brain, starting from the earliest stages of human development and going to the last stages on human life. This includes research in both the healthy brain as well as the brain as it is affected by different diseases. There is extensive, ongoing research related to understanding how the brain works in different situations, such as under stress, with hypoxia (lack of oxygen) and with various kinds of infection.
Today we know that Alzheimer’s disease is a whole brain and body disease and is not limited to the cortex. This means that it affects every part of the brain and every element of cognition, emotions, and behavior. There are techniques which allow doctors to take a look at the blood circulation, sugar intake, amyloid binding, and other factors in the brains of living people who experience memory loss.
Memory loss is the main complaint of people affected by this disease. The decline of network activities in the brain affects all types of memory, starting from forgetfulness and inattentiveness and going on to every aspect of a person’s life, including basic self-care activities.
Our knowledge of Alzheimer’s disease has grown to encompass not only the perspective of whole brain dysfunction but even further to seeing the disease as one of multiple body system disability. It turns out that almost every bodily system is affected by this disease. Among them are the blood circulation system and the skeletal and muscular systems; this involvement of other systems affects gait, coordination, hand movements, and many other aspects of daily living.
The number of factors which contribute to the development of this disease continues to grow. Well-known risk factors are advanced age, genetics, family history of the disease, and history of head trauma. In addition, recently identified factors include depression, high blood pressure, high cholesterol, diabetes, and cardiac problems, especially irregular pulse.
In the early stages, the emotional reactions most people experience are related to their inability to recall familiar facts and names, or the inability to find important documents in timely matter. Feelings of being overwhelmed, upset, depressed, irritable, embarrassed, and anxious are common. Changes in behavior may be manifested in unstable and slow gait, withdrawal from society, and the avoidance of social activities. While working with people affected by AD, I have observed that most of them develop their own compensatory strategies, their own personal tricks to cope with their memory deficit for as long as possible.
People suffering with AD also experience both “dark” and “clear” time intervals related to memory. During the dark intervals they are very forgetful for recent and remote events, not able to maintain conversations, and often cannot recall words or names. During clear episodes, they are fully alert, maintain conversation, and have better memory on recent and remote events. I believe that the most probable explanation of these phenomena is changes in brain blood flow. As soon as the brain gets less blood and oxygen, all networks in the brain start to work sluggishly. A second explanation is related to stress whether it comes from family relationships, changing roles in the family, medical or financial problems or other sources. Stress at any age has a negative impact on cognition, especially attention and working memory.
Another very important observation I have noted is related to the progression of this disease. It looks like the pattern of decline is not a simple, downgrade slope in memory loss over the time. Rather, there is a step-like memory decline. Every step has a different duration (weeks, months, even years). There are periods when people are relatively stable and relatives may start questioning the legitimacy of the Alzheimer’s diagnosis. Recent data related to these plateaus,when memory decline is postponed for some period of time in AD patients, confirm my hypothesis.
Doctors actively treating patients with Alzheimer’s disease accumulate a vast clinical experience, related to all aspects of the disease and its treatment. These issues are often described in modern psychiatry as cognitive decline, depression, anxiety, apathy, fears, psychosis, personality and behavior changes, and much more. Physicians in this field know that the memory losses assess a big toll on people’s perceptions, communication abilities, and physical capacities. Over the time, the brain forgets how to talk, to walk, to move, and even breathe at the end stage of disease.
Based on my experience with demented people for more than 16 years, the integrative treatment of Alzheimer’s disease (a combination of medications with non- pharmacological interventions) is the only viable model today. Until new diagnostic tools and new medications come in the future that can effectively address the multiple aspects of AD, an integrative approach is the best option. Among the non-pharmacological modalities, restoring brain blood, oxygen and nutrients flow and maintaining better brain blood supply are the core foundation (or “pillow”) to help disabled brains work better.