Memories Do Matter - Alzheimer's Disease Newsletter (November 2022)

M e m o r i e s D o M a t t e r

N o v e m b e r i

A L Z H E I M E R ' S A W A R E N E S S M O N T H

People may forget things like someone ’ s name People may forget things like someone ’ s name or a certain date… or a certain date… This is This is FINE FINE for a healthy brain. for a healthy brain.

However, forgetting where you live or where you However, forgetting where you live or where you came from, how to eat or how to dress, may be came from, how to eat or how to dress, may be an indication of a disease causing the an indication of a disease causing the deterioration of memory and other cognitive deterioration of memory and other cognitive ffunctions. unctions.

DDementia ementia

What Is What Is Dementia ? Dementia ?

It is a wide term that characterizes the inability to It is a wide term that characterizes the inability to remember major ideas, think properly, take remember major ideas, think properly, take decisions, or perform normal daily activities. It decisions, or perform normal daily activities. It encompasses four types of syndromes: Alzheimer’s encompasses four types of syndromes: Alzheimer’s Disease, Lewy Body Dementia, Vascular Dementia, Disease, Lewy Body Dementia, Vascular Dementia, and Fronto Temporal Dementia. and Fronto Temporal Dementia.

The most common type of dementia is Alzheimer’s The most common type of dementia is Alzheimer’s Disease. It is a neurodegenerative disease that Disease. It is a neurodegenerative disease that starts with a mild unrecognizable loss of memory starts with a mild unrecognizable loss of memory that may lead to more severe behavioral and that may lead to more severe behavioral and cognitive damage such as impairment of memory, cognitive damage such as impairment of memory, comprehension, attention, reasoning, and comprehension, attention, reasoning, and jjudgment. udgment.

What Are What Are the Causes the Causes of Alzheimer's of Alzheimer's Disease ? Disease ?

The main cause of Alzheimer’s Disease is still unknown and under investigation. However, current theories stipulate that aberrant protein build-up in and around brain cells may contribute to the disease. These proteins appear to be either amyloid, that form plaques around brain cells, or tau, that deposit in the form of tangles within brain cells.

Other theories suggest that insufficient amounts and/or improper functioning of the neurotransmitter Acetylcholine may contribute to Alzheimer's Disease.

WhatArethe RiskFactors WhatArethe RiskFactors

forAlzheimer's Disease ? forAlzheimer's Disease ?

AAge ge

The chance of getting Alzheimer's Disease increases every five years after the age of 65. However, age is not a specific indicator and any age is at risk of getting the disease. When it occurs before the age of 40, it is known as early-onset Alzheimer's Disease or youngonset Alzheimer's Disease.

Family History

OOther ther RRisk isk FFactors actors

Some inherited genes may increase the risk of Alzheimer's Disease. The risk is particularly high in a person with a first-degree relative suffering from Alzheimer’s Disease.

Other Risk Factors include Smoking, Obesity, Diabetes, Hypertension, High Cholesterol, and Head Injuries.

What Are the What Are the Signs & Symptoms Signs & Symptoms of Alzheimer's Disease ? of Alzheimer's Disease ?

Symptoms of Alzheimer’s Disease are divided into 3 main stages:

Early Symptoms

Middle Stage Symptoms

Late Symptoms

Unfortunately, Alzheimer’s Disease is often diagnosed in its third or late stage. At this stage, the lifespan of the patient is very short.

How Is Alzheimer's How Is Alzheimer's Disease Diagnosed ? Disease Diagnosed ?

There is no single test to screen or confirm Alzheimer’s Disease. The following steps are taken.

FFirst irst

Other conditions that can cause similar symptoms such as psychiatric disorders or heart diseases need to be ruled out.

TThen hen

A specialist must assess the patient’s symptoms, including memory and thinking, and how they developed.

FFinally inally

A brain scan, CT scan or MRI must be performed to show possible changes in the brain such as protein deposits as plaques or as tangles.

What Is the What Is the Prognosis of Prognosis of Alzheimer's Disease ? Alzheimer's Disease ?

Generally, Alzheimer’s disease has a slow rate of progression but this rate may differ from one patient to another.

At the early stage, patients still retain normal daily-life functioning, although they might start noticing increased incidence of forgetfulness. In the moderate stage, patients find it harder to handle daily-life activities independently and begin to display peculiar and stubborn behavior, quick irritation and difficulty remembering certain words. This stage can stretch over several years before progressing to the severe stage, in which patients become unresponsive to their environment, start losing proper muscle movement control and start displaying changes in personality.

What Is the What Is the Prognosis of Prognosis of Alzheimer's Disease ? Alzheimer's Disease ?

The average survival of patients with Alzheimer's Disease has been observed to range between 4 and 8 years post the diagnosis. However, these numbers can vary, and some patients may live for more than 20 years after diagnosis.

The status of the disease at diagnosis significantly impacts prognosis. Comorbid, untreated vascular risk factors, such as hypertension, is a predictor of poor prognosis and fast disease progression. Also, death by pneumonia in these patients is common because of their impaired ability to swallow due to muscle dysfunction, which increases the risk of infection and aspiration pneumonia. Patients also commonly die from other infections, dehydration, malnutrition and falls.

Can Alzheimer's Disease Can Alzheimer's Disease Be Prevented ? Be Prevented ?

The exact cause for Alzheimer's Disease remains unknown, but there are ways to stall its development.

A study conducted by the Centers for Disease Control and Prevention (CDC) found that high blood pressure, physical inactivity, obesity, diabetes, depression, smoking, hearing loss, and binge drinking are all risk factors for Alzheimer's Disease. The CDC thus recommends the following to prevent disease development:

Engaging in physical activity to maintain a healthy weight Managing and controlling blood pressure and blood glucose levels

The United Kingdom National Health Service (NHS) adds maintaining a healthy social and mental status to these recommendations. It suggests volunteering, exploring new hobbies and learning new languages as some of the ways to preserve good social and mental health, thus contributing to the prevention of Alzheimer's Disease development.

Early Detection of Early Detection of Alzheimer's Disease Alzheimer's Disease

Detecting Alzheimer’s disease before the appearance of symptoms is crucial for more effective treatment, especially in the absence of a cure. Early treatment gives patients more years with a healthy memory and more time for them and their families to learn about the disease and what to expect.

1. Dyes in Brain Scans

In brain scans, tracer molecules usually facilitate the procedure via a radioactive dye called Amyvid (florbetapir). This dye has allowed researchers to identify specific brain regions where amyloid plaques accumulate. This practice also helps distinguish Alzheimer’s Disease from other causes of memory loss. Unfortunately, insurance plans still don’t cover this diagnosis technique, rendering it inaccessible to most people.

2. Neurofilaments in the Spinal Cord

Another way to identify Alzheimer’s Disease is performing a lumbar puncture to test the cerebrospinal fluid in which the brain releases its products. It costs around $1,000 to $3,500. This screening technique reveals two hallmarks of Alzheimer’s Disease:

1.

Beta amyloid plaques, which are fragments of misfolded proteins, and Tau proteins, which also aggregate and accumulate in the brain.

2. This technique is highly effective since it allows early detection of disease precursors which can circulate in the body for up to 20 years before any symptoms appear.

Katrina Moore, a student at the Alzheimer’s Society, combined neuroscience and digital technology to create an IOS application called "Ignite". This app aims to diagnose early frontotemporal dementia in its users during the pre symptomatic phase. It consists of innovative games that require reasoning. Users with a genetic predisposition to FTD perform poorly. Hence, this app gives insight into whether a potential patient exhibits signs of dementia through its riddles. This method appears beneficial since it is more accessible to the public.

3. Katrina Moore’s Smartphone App to Detect the Signs of Frontotemporal Dementia (FTD)

What Is the What Is the NNon-Pharmacological on-Pharmacological Treatment of Alzheimer’s Disease ? Treatment of Alzheimer’s Disease ?

Nutritional Support Nutritional Support

Is a crucial component of comprehensive therapy and can improve the effectiveness of treatment: foods like fish products, walnuts, and omega-3 fatty acids rich food can slow down the development of cognitive deficits. Apples, spinach, extra virgin olive oil, red wine and grape juice, salmon, curcumin rich curries, cinnamon, coffee, and hot chocolate all boost brain activity.

Encouraging

Is essential in the management of dementia patients and must take into consideration their health and ability in such a way that they cannot be forced to accomplish tasks that they are no longer capable of. This approach is recommended in the mild to moderate stages of the disease.

OOrientation

rientation Is mainly used in the early stages of Alzheimer's Disease when the patient has short-term losses of memory Suitable approaches include color coding rooms or using pictograms.

The Milieu Therapy The Milieu Therapy

What Is the What Is the NNon-Pharmacological on-Pharmacological Treatment of Alzheimer’s Disease ? Treatment of Alzheimer’s Disease ?

Caring for a patient with dementia is challenging since Alzheimer's Disease cannot be cured and as it progresses, it leads to complete loss of memory. Below are some non pharmacological approaches that may positively impact patients' behaviors, actions and emotions, while preserving the highest quality of life.

Cognitive Training Cognitive Training

Is mainly used in patients with Alzheimer's Disease who want to train their cognitive skills by themselves. It slows the development of the disease and improves the quality of life and sometimes even serves as a daily activity for fun.

The Snoezelen Therapy The Snoezelen Therapy

Is a multifunctional method that is performed in a pleasant and adapted environment. The stimulating environment helps to reduce aggression and improve mood, encourages nice and pleasant memories and stimulates and activate old habits.

The Validation Therapy The Validation Therapy

Is one of the first specific non pharmacological approaches in the management of dementia patients. It is used in moderate to late stage Alzheimer's Disease and has an emotional impact on patients It is a way of demonstrating respect to the patient's feelings, decrease patient aggressiveness when in contact with the therapist and support not only his physical condition, but also his psychological state.

The Doll Therapy The Doll Therapy

Is used for patients with dementia, mental retardation, physical disability and various other psychiatric disorders. Dolls are made with a natural material, which is also anti allergic, and are used to positively stimulates the patient's senses.

Ervin Bohm;s Psychobiographic Model Ervin Bohm;s Psychobiographic Model

Is an internationally recognized nursing model and currently the most widely used in German speaking countries. It supports the ability of patients to take care of themselves, especially older and more confused patients, in an attempt to retain or restore this ability for the longest duration possible

Pharmacological Treatment Pharmacological Treatment of Alzheimer's Disease of Alzheimer's Disease

Acetylcholinesterase inhibitors (AChEIs) or Memantine is the mainstay of treatment in patients with Alzheimer's Disease. They are used to delay symptoms of cognitive and functional decline. Nonetheless, patients should be monitored for efficacy, side effects and possible treatment discontinuation.

Acetylcholinesterase Inhibitors (AChEIs) Acetylcholinesterase Inhibitors (AChEIs)

AChEIs are drugs that reduce the breakdown of acetylcholine, thereby reducing the apparent deficiency of cholinergic neurotransmitters. They are indicated for the treatment of mild-to-moderate Alzheimer's Disease and include Donepezil and Galantamine. They are present in different dosage forms:

Oral tablets & oral dissolvable tablets

People who are unresponsive to selective AChEIs may benefit from switching to a dual AChE butyrylcholinesterase inhibitor (BuChEI) such as Rivastigmine. Choices are based on the ease of use, cost, dosage form and clinician and patient preference.

Patches

Aduhelm (Aducanumab)

New

FDA Approved on June 7, 2021

Aduhelm has been shown to slow the decline in cognitive skills and functional ability in patients with Mild Cognitive Impairment or in the early stages of Alzheimer’s Disease. It is reported to work by clearing harmful amyloid beta that build up in the brain, which is thought to result in Alzheimer’s Disease. Aduhelm is given every 4 weeks as an IV infusion over one hour.

Natural Therapies Natural Therapies for Alzheimer's for Alzheimer's

DDisease isease

Recent reports indicate that mitochondrial dysfunction plays an important role in neurodegeneration as it leads to oxidative stress, calcium imbalance, apoptosis, and decreased energy levels. For this reason, research is directed towards finding natural antioxidants to regulate mitochondrial functions and protect the neurons in order to treat Alzheimer’s Disease.

Are the most effective antioxidants due to the presence aromatic rings and phenolic groups. However, they do not penetrate the brain and have a low CNS bioavailability.

Is shown to reduce chronic inflammation and oxidative damage. Studies show that people who frequently administer curcumin in their daily diet have decreased the rate of Alzheimer’s disease by 4.4 times. However, its poor oral bioavailability, limited tissue distribution and chemical instability limit its use. For this reason, new formulations are being designed to improve brain penetration such as nanoparticle encapsulation which enhances its oral bioavailability by nine times.

ural Therapies for ural Therapies for heimer's Disease heimer's Disease

Extracted from clubmoss, it is a highly specific AChEI with good brain permeability. It has a positive impact on memory and cognitive function. For this reason, it was warranted long term clinical trials to assess safety and efficacy.

Gingko Biloba

AChEIs remain the mainstay of treatment.

Has antioxidant and antiinflammatory properties which regulate neurotransmitter function. However, a clinical trial showed that ginkgo biloba has no more than a placebo effect in the treatment of Alzheimer’s Disease. However, when combined with pharmacological therapy, it shows a potential increase in patients' life expectancy.

Is an antioxidant that is naturally produced in the body. It was found to improve cognitive functions, protect neurons from oxidation, and decrease apoptosis. Studies show positive neuroprotective and antioxidant effects in animal models, however, clinical trials studying CoQ10 supplements in humans have not given generalizable results yet.

However, natural therapies or vitamins may be added to increase the body’s response to treatment and to ensure a good quality of life.

The use of natural therapies in Alzheimer’s Disease is still limited.

OffLabelDrugs for Alzheimer'sDiseas OffLabelDrugs for Alzheimer'sDiseas

Off-label drugs are drugs that are used for purposes different than the

Alzheimer's Disease Alzheimer's Disease VVS S

Lewy Body Dementia Lewy Body Dementia

Dementia with Lewy Body (DLB) is a disease associated with changes in the brain leading to behavioral, mental, and movement challenges. Its definition strongly resembles that of Alzheimer’s Disease, making it important to know the differences between the two.

Both DLB and Alzheimer's Disease are classified under the big umbrella of “Dementia”, Alzheimer's Disease being the most common form of it. During the early stages of the two diseases, signs and symptoms can be quite similar. Alzheimer's Disease and DLB may even be occurring together, a condition known as a mixed case or Lewy Body variant of Alzheimer's Disease. In that case, manifestations of the two diseases overlap, making it hard on health care practitioners to propose a definite diagnosis.

This could lead to some people with Lewy Body dementia being wrongfully diagnosed with Alzheimer's Disease. Luckily, there are certain characteristics that can differentiate one type of dementia from another.

Alzheimer's Disease Alzheimer's Disease VVS S

Lewy Body Dementia Lewy Body Dementia

What is actually happening in the brain that leads to the manifestations of DLB? The pathophysiology of Alzheimer's Disease consists of a deposit of proteins of amyloid plaques and tau tangles. However, in DLB, proteins called “Lewy Bodies,” also known as alpha synuclein proteins, are deposited in the brain.

The two diseases differ one from another by their dementia characteristics as well as their behavioral, movement, and autonomic features. For instance, although both Alzheimer's Disease and DLB are associated with movement and balance problems, these are more apparent in the latter, especially in the early stages of the disease.

The same applies to hallucinations, REM sleep disorders, and problems identifying people, as well as extrapyramidal features and autonomic nervous system dysfunction. Anterograde memory loss on the other hand is more prominent in Alzheimer's Disease and occurs earlier than in DLB.

Unfortunately, both Alzheimer's Disease and DLB cannot be cured, and living with dementia or even taking care of someone with dementia is very hard. Luckily, many studies are getting closer to finding the long awaited cure.

DID YOU KNOW? DID YOU KNOW?

GGlobally lobally

1 IN 4 ONLY

people with Alzheimer's Disease get diagnosed.

~ 44 MILLION

people worldwide live with Alzheimer’s Disease or a related form of dementia.

n a l W o r d s

“PeoplewithAlzheimer’s deservetobeseen,sothat wecanfindacure”.

JulianneMoore

Rêve Khaddaj

This is the last page.