In November 1906, Alois Alzheimer, a German psychiatrist, presented at a psychiatric conference in Tübingen the clinical characteristics of an unusual woman who developed paranoid ideas, impaired memory and progressive dementia. He showed that her brain at autopsy had previously undescribed abnormalities, which he termed neuritic plaques in the extracellular spaces and neurofibrillary tangles within the neurons. He postulated that these lead to neurodegeneration and cell death and cause dementia. His colleague Emile Kraepelin promptly called it “Alzheimer’s disease”. Even after a century, research has yet to point to a cure for this debilitating disease.
The identification of amyloid beta as the main component of plaques and of phosphorylated tau as a tangle in neurons led to a rush to discover its biology. Patients with Alzheimer’s disease present to neurologists with impaired memory, personality and behavior changes, and sometimes impairments in language and visuospatial skills. Neurologists rely on brain imaging to elucidate regional shrinkage and subdued glucose utilization in order to correlate clinical features.
Therapy of Alzheimer’s disease
Therapeutic attempts (using a variety of methods) to block extracellular accumulation of amyloid and intraneuronal phosphorylation of tau have failed in clinical trials. Today, after the onset of Alzheimer’s disease, therapy is essentially supportive. Prescribed drugs increase the deficient production of a neurotransmitter called acetylcholine in the brain and try to slow down neural degeneration. Some medications are prescribed to control patients’ behavioral abnormalities.
The current view is that multiple pathways lead to this catastrophic form of brain failure. It is accepted that both neural degeneration and regeneration occur daily, albeit in a delicate balance.
Causes of Alzheimer’s and lifestyle changes needed to prevent it
A sedentary lifestyle, untreated diabetes and high blood pressure, poor sleep hygiene in middle age, and sleep disorders such as sleep apnea can accelerate the development of Alzheimer’s disease in a genetically susceptible individual. Regular cardiovascular exercise, investing in good sleep hygiene, a balanced diet rich in vegetables and fruit, and an optimistic and enthusiastic attitude to life are investments in health that promote regeneration. Healthy social connectivity and pursuing new hobbies/passions and maintaining good oral hygiene are also neuroprotective.
The discovery of an exclusive sleep-driven elimination system in the brain called the “glymphatic system” has sparked an enthusiastic study of sleep as a novel biomarker of amyloid biology. The glymphatic system has been shown to secrete both amyloid and tau on a daily basis in normal individuals, and even a few nights of sleep deprivation can upset this balance unfavorably for the brain.
Therefore, sleep disorders such as sleep apnea (characterized by suboptimal sleep-related breathing) can act as a biological catalyst, accelerating the accumulation of amyloid and tau in the brain. Disciplined sleep hygiene and treating sleep disorders early can ward off the looming specter of Alzheimer’s disease later in life.
Also Read: Predicting Alzheimer’s Is Now Possible, Says Study
Many luminaries with glittering careers in the public sector have fallen prey to this occupational compulsion of sleep deprivation and subsequently developed Alzheimer’s disease. Names such as Ronald Reagan, Margaret Thatcher, Agatha Christie, Charles Bronson, Omar Sharif, Rita Hayworth and Sean Connery abound among those who fell victim to this devastating late-life degenerative disease. Obviously, some of the by-products of civilization, for example self-indulgence, lack of sleep discipline, fragmentation of the social fabric of integrated families, and loneliness in old age, are the unrecognized predators lurking in the shadows of brain biology, ready to claim their pound of the brain,” despite the supposed heroic deeds of modern medicine. You have to stop and look within.
Our lifestyles need to be reformed and time may be running out for those late in midlife.