Alzheimer's disease

Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills, and eventually the ability to carry out the simplest tasks. In most people with Alzheimer’s, symptoms first appear in their mid-60s.  It's the seventh leading cause of death in the world.

However the symptoms of Alzheimer’s must not be confused with the age related changes.  Below is a table showing the difference between the two.

• Age - Most people who have the disease are 65 years or older.  About one third of all the people age 85 years and older may have alzheimer’s disease.
• Family history - if an immediate family member has the disease then you are more likely to develop it in the later stage.
• Genetics - certain genes have been linked to alzheimer’s. Apolipoprotein E (APOE) is a gene that’s been linked to the onset of Alzheimer’s symptoms in seniors.Blood tests can determine if you have this gene, which increases your risk of developing Alzheimer’s.
• Head Injury - there is a link between head injury and the future risk of dementia.
• Heart-head connection:  The brain is nourished by one of the body’s richest networks of blood vessels, and the heart is responsible for pumping blood through these blood vessels to the brain.
• The risk of developing Alzheimer’s appears to be increased by many conditions that damage the heart and blood vessels. These include heart disease, diabetes, stroke, high blood pressure and high cholesterol.
• Amyloid Beta (Abeta 42) - Amyloid beta are the protein plaques that are generated in response to microbial invasion in the brain. 
  Somehow, bacteria, viruses or other pathogens may be crossing the blood-brain barrier and get into the brain. The brain may be responding by using beta-amyloid to trap and kill them.

But if these plaques aren’t cleared away fast enough, they may then lead to inflammation and tangles of another protein, called tau, causing neurons to die and the progression towards Alzheimer’s disease.

To diagnose Alzheimer's disease in patients, doctor can use either one or multiple tools as listed below:

• By taking medical history - Doctor may ask about:

1. your symptoms
2. your family medical history
3. other current or past health conditions
4. current or past medications
5. your diet, alcohol intake, or other lifestyle habits

• Physical exam - Your doctor will perform a physical exam, and is likely to check your overall neurological health by testing your:

1. Reflexes
2. Muscle tone and strength
3. Ability to get up from a chair and walk across the room
4. Sense of sight and hearing
5. Coordination
6. Balance

• Lab tests - Blood tests may help your doctor rule out other potential causes of memory loss and confusion, such as thyroid disorders or vitamin deficiencies.
• Mental status tests - the doctor may conduct a brief mental status tests that evaluates memory, ability to solve simple problems and other thinking skills.
• Neurological tests/brain imaging tests - These tests create a picture of the brain and help to diagnose alzheimer’s.  The tests include -

1. Magnetic resonance imaging (MRI). MRIs can help pick up key markers, such as inflammation, bleeding, and structural issues.
2. Computed tomography (CT) scan. CT scans take X-ray images which can help your doctor look for abnormal characteristics in your brain.
3. Positron emission tomography (PET) scan. PET scan images can help your doctor detect plaque buildup. Plaque is a protein substance related to Alzheimer’s symptoms.

1. Medications^2,3: Current Alzheimer's medications can help for a time with memory symptoms and other cognitive changes. Two types of drugs are currently used to treat cognitive symptoms: Cholinesterase inhibitors and Memantine.
2. MIND diet: Mind stands for Mediterranean-Dash Intervention for Neurodegenerative Delay.  It is a combination of Mediterranean and Dash diet.  Research has shown that people who followed this diet cut down their risk of Alzheimer’s by 54%.

Managing with Alzheimer’s - self help list⁴

• Keep a notebook to record any important appointments, emergency phone numbers, house address and directions.
• Put reminder notes (e.g. for taking medications) in the places that you go to very often like fridge, cupboards or reminder on phones
• Keep yourself busy with gardening/cleaning/reading/solving crosswords/learning a new language and so on.
• Eat healthy and maintain a healthy weight.  Go for periodic walks, socialise, meditate with deep breathing exercises.
• Keep the pictures of known people labelled with their names.
• Ask for help if you need one!
• Ask someone to go with you if you go out, keep an ID card with you always
• Take your time to do things, do not rush or panic.

Tips to the caregiver

• Establish a routine to make each day less agitating and confusing.
• Organise the cupboards to make the patient easier to find things
• Expect things to take longer, allow for short breaks in between for the person with alzheimer’s.
• Give choices to the person with alzheimer’s, fewer options are better. E.g. choice between going for a drive or a movie
• Involve him/her in day to day simple activities
• Provide clear and short instructions to complete a task.
• Over a period of time, a person with alzheimer’s may become more dependent, keeping a tab on the symptoms, medications and doctor’s appointment can help to manage.
• Patience and flexibility — along with good self-care and the support of friends and family — can help to deal with the challenges and frustrations ahead.

Making proper lifestyle choices can help to prevent Alzheimer's disease.  Apart from them, keeping your diabetes, blood pressure, cholesterol under control with proper medications and lifestyle management can help in protecting the brain cells from further damage.

MIND diet and its principles:

Nutritional Supplements:  Since the causes of Alzheimer’s disease is multifactorial.  The treatment is also a multi-target approach using a combination of micro-nutrients and drugs that could have beneficial effects on cognitive function.  Although there is no confirmed research that supports the use of the supplements, anti-oxidants like Vitamin E, C, glutathion, CoEnz-Q10 have been known to prevent the damage to the brain by reducing the effects of free radicals.

Ayurveda promotes a healthy lifestyle with good food, physical exercise, brain boosting exercises and certain treatments and herbs for brain health.

1. Nasyam - nasya or the nasal medication is one of the treatments of Panchkarma which delivers the medicine to the brain thereby acting on the whole body. It is believed in Ayurveda that the nose is the pathway to our brain. Therefore conducting Nasya improves intelligence and memory.
2. Shirodhara, shiropicchu & Shirobasti - are the oil treatment of the scalp that relaxes and renews the mind and body.
3. Use of simple medicines like kapikacchu & Ashwagandha
4. Use of oil massage
5. Food & lifestyle changes to prevent degeneration of nerve cells
6. Eat daily 5 soaked almonds, walnut - the good fats help to keep the brain cells healthy
7. Mental exercise like solving puzzles, sudoku or brain challenges
8. Daily walk , pranayama , mudras
9. Physical, mental & emotional well being
10. Avoid too much salt & sugar intake.

References

1. https://www.nia.nih.gov/health/alzheimers-disease-fact-sheet
2. https://www.alz.org/alzheimers-dementia/what-is-alzheimers
3. https://www.cdc.gov/aging/aginginfo/alzheimers.htmhttps://
4. https://www.j-alz.com/
5. https://www.newscientist.com/article/2090221-alzheimers-may-be-caused-by-brains-sticky-defence-against-bugs/
6. www.tandfonline.com/doi/abs/10.1586/ern.11.56