ALZHEIMER’S DISEASE
PART 1.
IS AGE RELATED MEMORY IMPAIRMENT AN EARLY PART OF THE DISEASE?
Recent controversial and premature approval of a new drug by the FDA for Alzheimer’s Disease (AD) has rekindled my interest in the subject. Since its precise description as a distinct disease by Alois Alzheimer in 1907, it is one of the most common causes of dementia in the elderly, with precise clinical pictures and histologic pathological brain findings. Despite a century long massive research effort, we still do not have a clear understanding about the disease, its prevention or cure. Yet, it is spreading like wildfire across the globe.
Today, 6 million people in the USA, and around 30 million people worldwide are suffering and slowly dying from Alzheimer’s Disease.
My interest in Alzheimer’s Disease comes from my in-laws, both of whom were afflicted with AD. They suffered terribly for years and died from it. The disease had profound impact on our family. The entire family suffered physically, mentally and financially alongside them, while providing years long of caregiving and physical, mental and financial support.
Alzheimer’s Disease robs, erases and destroys its victim’s memory, mind, personality and self-awareness, long before it destroys the whole body. Family members are tortured physically and psychologically, while trying to take care of them. How can anybody reconcile the idea that the loved ones are already dead, and slowly and unknowingly walking towards their grave?
As an experienced clinical practitioner first, I would like to answer the most often asked questions asked to me about AD, and then try to summarize current research findings and information about Alzheimer’s in two parts, as I see and understand them. Finally, I will raise some questions and opinions of my own, as well as share my objection for the premature approval of a new drug by the FDA.
These are the most commonly asked questions about Alzheimer’s Disease, to me:
1. How many types Alzheimer’s are there?
2. Is Alzheimer’s a hereditary disease?
3. Is it age related?
4. Are common memory impairments an early sign of Alzheimer’s Disease?
There are two main types of Alzheimer’ Disease: Early-Onset and Late-Onset.
To me, Alzheimer’s is not a classic hereditary disease. Heredity only comes into play, in form of increased tendency, for only early – onset disease. This early type runs in families; and starts manifesting itself at younger age (before 50). It is a rare form of Alzheimer’s disease; it only presents 5% of all Alzheimer’s cases. Genome wide studies on AD patients have shown that mutations in three genes present in early-onset AD. But not all patients with these genetic mutations get the disease. Some other important, but nonspecific internal and external environmental factors, such as being female, old age, an increase in small-particle air pollution, smoking, a change in dietary habits, changes in gut bacterial microbiome population, physical and intellectual inactivity, metabolic illnesses and social isolation, all together, could play important roles in the development of Alzheimer’s.
Late – Onset Alzheimer’s Disease is more common and has no genetic component. Therefore, my answer to my wife’s frequently asked question, “since both of my parents died of Alzheimer’s, am I going to get Alzheimer’s?” My answer to her was, “no you are not, because late-onset AD is not a genetic disorder.”
Age related memory impairment is normal and has nothing to do with Alzheimer’s. Having said that, sometimes severe cerebral arteriosclerosis with silent strokes and TIAs could destroy significant amount of memory cells in the brain so that clinically, it would look like Alzheimer’s. This is called vascular dementia or mixed dementia. If Alzheimer’s features are strongly present in these patients, then a PET scan and spinal tap could be done to detect elevated levels of amyloid protein in the spinal fluid. But the presence of amyloid alone is not enough to diagnose Alzheimer’s, because some people with high level amyloid in spinal fluid don’t develop AD.
I shall discuss pertinent research findings and my own opinions about the AD and my objections the approval of a controversial new drug by the FDA in upcoming second part of this article.
