Daniela Balducci: Progression by The Galleries at Moore

Progression A Relationship With A Disease

Progression

This book is dedicated to all those affected by Alzheimer’s Disease and their loved ones.

The function and survival of neurons depend on several key biological processes: Communication. Neurons are constantly in touch with neighboring brain cells. When a neuron receives signals from other neurons, it generates an electrical charge that travels down the length of its axon and releases neurotransmitter chemicals across a tiny gap, called a synapse. Like a key fitting into a lock, each neurotransmitter molecule then binds to specific receptor sites on a dendrite of a nearby neuron. This process triggers chemical or electrical signals that either stimulate or inhibit activity in the neuron receiving the signal. Communication often occurs across networks of brain cells. In fact, scientists estimate that in the brain’s communications network, one neuron may have as many as 7,000 synaptic connections with other neurons.

Metabolism the breaking down of chemicals and nutrients within a cell

Metabolism. Metabolism—the breaking down of chemicals and nutrients within a cell—is critical to healthy cell function and survival. To perform this function, cells require energy in the form of oxygen and glucose, which are supplied by blood circulating through the brain. The brain has one of the richest blood supplies of any organ and consumes up to 20 percent of the energy used by the human body— more than any other organ.

One afternoon I was in high school and I was supposed to be picked up by my grandmother at the end of the day and go back to their house. However, Nonny never came. My phone had died so I couldn’t call anyone to find out what happened. I was waiting andit survival of 45 neurons for what felt like hours The as itfunction turned out was about minutes. depend on several key biological processes: Anxiously waiting for someone to pick me up I went back into the Communication. are end school and called my grandparents house phone.Neurons On the other constantly in home touchfrom withwork was of the phone my Aunt who had just gotten neighboring brain cells. When shocked to hear that Nonny hadn’t gotten me yet because she left a neuron receives signals from other over two hours ago to get me. Nonny had said she was coming neurons, it generates an electrical early so she wouldn’t miss me and was going to read her book the to length while she waited. My auntcharge told methat shetravels was ondown her way get of its axon and releases neurotransmitter me. About 10 minutes later my aunt pulled up to the school. I was visibly chemicals a tiny gap, called upset and very confused. I wanted to first across make sure Nonny was ok a synapse. Like a key fitting and I also wanted to know what happened because never in myinto life lock, each neurotransmitter had she forgotten to pick mea up from anything. My aunt then binds totospecific explained to me that Nonnymolecule thought shethen was supposed go to the receptor sites on ofwaiting a middle school rather than the high school. So all thata dendrite time she was nearby neuron. This process triggers at the wrong place for me to come out of school and now she was chemical or electrical signals that waiting for me at home. either stimulate or inhibit activity in the neuron receiving the signal. Communication often occurs across networks of brain cells. In fact, scientists estimate that in the brain’s communications network, one neuron may have as many as 7,000 synaptic connections with other neurons.

Metabolism the breaking down of chemicals and nutrients within a cell

Repair, remodeling, and regeneration. Unlike many cells in the body, which are relatively short-lived, neurons have evolved to live a long time—more than 100 years in humans. As a result, neurons must constantly maintain and repair themselves. Neurons also continuously adjust, or “remodel,” their synaptic connections depending on how much stimulation they receive from other neurons. For example, they may strengthen or weaken synaptic connections, or even break down connections with one group of neurons and build new connections with a different group. Adult brains may even generate new neurons— a process called neurogenesis. Remodeling of synaptic connections and neurogenesis are important for learning, memory, and possibly brain repair.

Neurons are a major player in the central nervous system, but other cell types are also key to healthy brain function. In fact, glial cells are by far the most numerous cells in the brain, outnumbering neurons by about 10 to 1. These cells, which come in various forms—such as microglia, astrocytes, and oligodendrocytes—surround and support the function and health of neurons. For example, microglia protect neurons from physical and chemical damage and are responsible for clearing foreign substances and cellular debris from the brain. To carry out these functions, glial cells often collaborate with blood vessels in the brain. Together, glial and blood vessel cells regulate the delicate balance within the brain to ensure that it functions at its best.

OCCIPITAL LOBE The occipital lobe is the back part of the brain that is involved with vision.

TEMPORAL LOBE The sides of the brain, temporal lobes are involved in short-term memory, speech, musical rhythm and some degree of smell recognition.

PARIETAL LOBE The middle part of the brain, the parietal lobe, helps a person identify objects and understand spatial relationships (where one’s body is compared with objects around the person). It is also involved in interpreting pain and touch in the body. It houses Wernicke’s area, which helps the brain understand spoken language.

FRONTAL LOBE The largest lobe of the brain, located in the front of the head, is involved in personality characteristics, decision-making and movement. Recognition of smell usually involves parts of the frontal lobe, and it contains Broca’s area, which is associated with speech ability.

Over time, a person with Alzheimer’s gradually loses his or her ability to live and function independently.

How Does Alzheimer’s Disease Affect the Brain? The brain typically shrinks to some degree in healthy aging but, surprisingly, does not lose neurons in large numbers. In Alzheimer’s disease, however, damage is widespread, as many neurons stop functioning, lose connections with other neurons, and die. Alzheimer’s disrupts processes vital to neurons and their networks, including communication, metabolism, and repair.

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Over time, a person with Alzheimer’s gradually loses his or her ability to live and function independently.

How Does Alzheimer’s was Brain? in the early afternoon when my aunt called my mom. On the Disease Affect Itthe

other side of the phone she sounded extremely frantic. Nonny was missing. She and my grandfather had gone out to the hardware The brain typically shrinks store, to he some asked her to wait in the car while he went inside to get degree in healthy aging but, surprisingly, something quickly. When he returned he was obviously surprised to does not lose neuronssee in large she wasnumbers. not in the car. He went back into the store, looked all In Alzheimer’s disease, however, over and could not find her. As soon as my mom heard about my damage is widespread,grandmother as many neurons going missing she got in the car and went to go help. stop functioning, loseIconnections stayed home with while they were looking for her. I had no idea what other neurons, and die. wasAlzheimer’s actually happening while they were out looking for her. For all disrupts processes vital to neurons andhave walked across the major road and gone I knew she could their networks, including communication, anywhere or even gotten hurt. She also did not have her purse with metabolism, and repair. her or any belongings. After about an hour they finally found her in the neighboring Chinese restaurant. She had sat down and ordered a cup of tea and was waiting for them to bring her food. My grandfather paid the bill and brought her home.

At first, Alzheimer’s disease typically destroys neurons and their connections in parts of the brain involved in memory, including the entorhinal cortex and hippocampus. It later affects areas in the cerebral cortex responsible for language, reasoning, and social behavior. Eventually, many other areas of the brain are damaged. Over time, a person with Alzheimer’s gradually loses his or her ability to live and function independently. Ultimately, the disease is fatal.

Ultimately, the disease is fatal.

What Are the Main Characteristics of the Brain with Alzheimer’s? Many molecular and cellular changes take place in the brain of a person with Alzheimer’s disease. These changes can be observed in brain tissue under the microscope after death. Investigations are underway to determine which changes may cause Alzheimer’s and which may be a result of the disease.

Amyloid Plaques The beta-amyloid protein involved in Alzheimer’s comes in several different molecular forms that collect between neurons. It is formed from the breakdown of a larger protein, called amyloid precursor protein. One form, beta-amyloid 42, is thought to be especially toxic. In the Alzheimer’s brain, abnormal levels of this naturally occurring protein clump together to form plaques that collect between neurons and disrupt cell function. Research is ongoing to better understand how, and at what stage of the disease, the various forms of beta-amyloid influence Alzheimer’s.

During the summer of 2018 something traumatic happened to me that would change me for the rest of my life. Events such as this were always something I would talk to Nonny about. I was due to go over to their house to check in on her and see how she was and sit and chat. When I got there she looked at me and said hello vand then went about watching her show on television. I went to sit with her on the couch and she had no words to really talk through a conversation with me anymore. We just sat next to each other snuggled up on the couch and watched HGTV for about two hours. I only wanted to talk to her about it and explain what had happened just the night before but unfortunately that was another portion of Nonny that was no longer able to be there for me in the same ways as before.

Ultimately, the disease is fatal.

10:45 11:00 11:45 12:30 1:15 1:30 2:30

Clock in- WRITE IT ON THE CALANDER Say hi to Poppy Set up breakfast: Cereal and 1/2 a banana Get pills ready Wake up Nonny- Talk to her about the day Remove covers and lift her out of bed Bring her into the bathroom Prep washcloth with soap and water Refresh with washcloth from waist up Dress her from the waist up while she is still sitting Lift her up and rotate towards the towel rack Refresh with wash cloth from waist down Dress from waist down GENTLY lower her into the wheelchair Brush teeth and hair Bring her out to the kitchen

Help her eat breakfast- Talk to her Ask her if she wants tea Make her tea(She likes mine the best) Let her thumb through the paper Talk to her about it or read her the paper

Bring her to the couch and make sure she is comfortable Turn on HGTV Talk to her about the terrible design choices Start making her lunch Sandwhich with NO CRUST Get a can of soda- Split it Give her some fruit or raw veggies for crunch or sweetness Help her eat lunch Clock outWRITE IT ON THE CALANDER Bring her to the couch and make sure she is comfortable Wait for Aunt Karen or Anna before leaving Cry in the car on the way home

10:45 11:00 11:45 12:30 1:15 1:30 2:30

Help her eat breakfast- Talk to her Ask her if she wants tea Make her tea(She likes mine the best) Let her thumb through the paper Talk to her about it or read her the paper

Neurofibrillary Tangles Neurofibrillary tangles are abnormal accumulations of a protein called tau that collect inside neurons. Healthy neurons, in part, are supported internally by structures called microtubules, which help guide nutrients and molecules from the cell body to the axon and dendrites.

In healthy neurons, tau normally binds to and stabilizes microtubules. In Alzheimer’s disease, however, abnormal chemical changes cause tau to detach from microtubules and stick to other tau molecules, forming threads that eventually join to form tangles inside neurons. These tangles block the neuron’s transport system, which harms the synaptic communication between neurons.

Chronic Inflammation Research suggests that chronic inflammation may be caused by the buildup of glial cells normally meant to help keep the brain free of debris. One type of glial cell, microglia, engulfs and destroys waste and toxins in a healthy brain. In Alzheimer’s, microglia fail to clear away waste, debris, and protein collections, including beta-amyloid plaques. Researchers are trying to find out why microglia fail to perform this vital function in Alzheimer’s.

One focus of study is a gene called TREM2. Normally, TREM2 tells the microglia cells to clear beta-amyloid plaques from the brain and helps fight inflammation in the brain. In the brains of people where this gene does not function normally, plaques build up between neurons. Astrocytes—another type of glial cell—are signaled to help clear the buildup of plaques and other cellular debris left behind. These microglia and astrocytes collect around the neurons but fail to perform their debris-clearing function. In addition, they release chemicals that cause chronic inflammation and further damage the neurons they are meant to protect.

Vascular Contributions People with dementia seldom have only Alzheimer’s-related changes in their brains. Any number of vascular issues—problems that affect blood vessels, such as beta-amyloid deposits in brain arteries, atherosclerosis (hardening of the arteries), and ministrokes—may also be at play.

Sight Although Alzheimer’s disease has no physical effects on the eyes, it impacts the ability of the brain to translate images. This can cause confusion, disorientation and anxiety. It can also prevent the person from recognizing familiar people or places.

Taste As Alzheimer’s progresses the sensitivity of the taste buds can be dulled. This side effect may cause your family member to become less hungry. A loss in taste may also increase the probability of your family member placing hazardous items in their mouths. We recommend removing dangerous chemicals and objects from the home to avoid health hazards.

Touch

Once someone reaches a late stage of Alzheimer’s, their brain may not be able to interpret physical sensations. An individual with this side effect may not be able to distinguish between hot or cold or may not feel pain. Because this covers such a broad range of experiences and safety issues, we recommend removing dangerous possessions, objects, and materials from the house.

Smell An ordinary side effect of Alzheimer’s Disease is a loss of smell. In most cases, this issue is discovered before the diagnosis. Although the loss of the sense of smell does not indicate that one has Alzheimer’s disease, it is advised that one consult a physician to confirm the source of the problem.

Hearing While an individual’s hearing is not usually impacted by Alzheimer’s disease, the ability to process sounds can be impaired. For example, the doorbell could ring and be heard, but not understood. It becomes a random sound that would just cause confusion and anxiety.

Touch

Loss of Connections and Cell Death In Alzheimer’s disease, as neurons are injured and die throughout the brain, connections between networks of neurons may break down, and many brain regions begin to shrink. By the final stages of Alzheimer’s, this process—called brain atrophy— is widespread, causing significant loss of brain volume.

Walking into my grandparents house having just gotten over Covid-19 there is a frantic energy all around. My grandmother, who we believed to have Covid as well, was weezing. After having given her a shower my aunt and cousin noticed that she was coughing heavily and unable to breathe clearly. My mom called 9-1-1. While on the phone with them I sat with Nonny and my cousin holding Nonny’s hand for my own comfort. While I watched the ambulance pull up to the house I started to become overwhelmed with emotion. After kissing her for what would unknowingly be the last time as they loaded her into the ambulance, I did not move until she left the street and I could not hear the sirens anymore. Nonny died on January 16, 2021. Her cause of death we would later come to find was a complication of Alzheimer’s disease related to Covid-19.

This book was created for a thesis project at Moore College of Art and Design by Daniela Balducci. All medical content within this book has been sourced from online or text resources. Rights reserved ©2022