Alzheimer’s - Not Just Another Disease

“Of all the things I’ve lost, I miss my mind the most”[1].

Mark Twain’s words aptly echo the innate fear many of us harbour. Dementia, the progres- sive and usually severe loss of brain function, has over 100 different causes; Alzheimer’s Disease alone accounts for 50-70% of all cases. It is a disease with far reaching impacts, and one that might be closer to our own social circles than we would like to believe. 

Alzheimer’s is a neurological disease generally diag- nosed in people over 65 years old. Although the causes of Alzheimer’s are not clear, scientists believe that it results from protein tangles in the brain: neurofibrillary tangles and amyloid plaques, collections of protein fibres in the brain that are characteristic of Alzheimer’s. Some also believe that Alzheimer’s is the result of a deficiency in acetylcholine, a chemical messenger in the brain. The dementia seen in Alzheimer’s develops when the affected areas of the brain include those involved with learning, memory, decision- making, and language. [2] Patients typically have - problems with their short-term memory, become disoriented in time and place, may develop problems with finding words when communicating, become unable to solve problems or make decisions and judgements, and find it increasingly difficult to learn new information and do new things. As the condition progresses, they need help to perform even the most basic tasks of everyday living, including washing, dressing and eating. Alzheimer’s often persists for many years until death but is not usually the actual cause of death. [3] 

Alzheimer’s is a disease affecting the elderly; although other risk factors, both environmental and genetic, are still the focus of intense research. Nevertheless, the fact that age- ing increases the risk means that ageing can cause problems not just to the individuals, but to their family members and society as well, both in terms of the manpower needed as well as the costs incurred. 

What further exacerbates the impact of Alzheimer’s on society is the huge proportion of people who will be affected. Dementia is one of the world’s fastest growing diseases, compounded by the fact that life expectancies have increased and populations are growing older, or ‘greying’. In developed countries, more than 20% of the population is currently aged 60 years or older, and this figure is expected to be over 30% by 2050 [4], which will increase demand on healthcare systems. Worldwide, an estimated 24 million people live with some form of dementia. Without a major medical breakthrough, by 2040 as many as 84 million will have age-related memory loss, 15% of the population will develop Alzheimer’s disease by the age of 65, and 35% by the age of 85. [5,6] 

In view of this, efforts are being made in scientific re- search, carried out and funded by a range of different public and private sector organisations such as - Élan Corporation, a biotechnology company with an interest in neuroscience [7],The Alzheimer’s Research Trust, the largest charitable trust funding Alzheimer’s research in the UK [8], The Alzheimer’s Society, a membership organization in England, Wales and Northern Ireland that supports research programmes and provides grants for “cause, cure and care” [9], and the Al- zheimer’s Association in the USA, which provides more than $21 million in funding for research grants every year [10]. The efforts of these groups have undeniably yielded results, particularly in the area of treatment targeting amyloid plaques for degradation. In January 2009, research published by Yuji Goto et al. has shown that adding an amyloid-specific dye to the plaques and then hitting them with a laser beam can, under the right conditions, inhibit the growth of the plaques and even degrade them[11]. Another possible treat- ment is ‘beta-amyloid immunotherapy’, in which antibodies made in response to an injected protein may then clear the amyloid plaques from the brain [12]. With the hypothesis that Alzheimer’s can result from a lack of acetylcholine (ACh), drugs that can increase the availability of ACh are also being used as treatments with promising results. 

Research into the genetics of Alzheimer’s shows that genes such as amyloid precursor protein, tau, and a variant of the PCDH11X gene on the X chromosome [13] are all correlated with familial forms of Alzheimer’s. Traditional preventive mechanisms, including mental exercise and minimising alcohol intake have also been suggested. [14] Indeed, the increasing prevalence of Alzheimer’s Dis- ease is a trend that requires family care and places demands on healthcare systems and the economy. Despite the ad- vancements in research, the fact remains that Alzheimer’s is still an incurable condition; the impacts on society and the increasing prevalence mean that public awareness is needed for one’s better understanding of how to deal with this disease, whether it afflicts themselves or their relatives. This understanding is necessary for people to be able to seek the right help and the right support. 

 In addition, better organisation of human and fi- nancial resources in healthcare could include more em- phasis on geriatric care, increasing the number of trained personnel, and even establishing more institutions for the elderly whose families are unable to support them.  

Jia Shee Hee is a 3rd Year Pathology student from Fitzwilliam College.