Research Essay: Lily Morgan

Abe’s Garden Memory Support Program

The Effects of Environmental Factors on Predisposition and Progression of Alzheimer’s and Dementia

Dementia is an umbrella term for the cognitive and functional decline in seniors as a result of the deterioration of neurons (Killin, et al.). When these neurons and their connections stop working properly, damage occurs in certain parts of the brain, resulting in memory loss. Some diseases, such as Parkinson’s disease, Huntington’s disease, and Chronic Traumatic Encephalopathy, have dementia as a symptom There are several types of dementia, including vascular dementia, Lewy body dementia, and frontotemporal dementia. The most common type, however, is Alzheimer’s disease. Between 60 to 70% of people with dementia have Alzheimer’s. Alzheimer’s not only damages neurons, but shrinks the brain as well. Alzheimer’s usually begins with a victim forgetting recent events or conversations, but progresses with time to cause severe memory impairment and inability to do everyday tasks (Killin, et al.). The worsening of the symptoms is due to how the disease progresses physiologically. In the early stages, the neurons are destroyed in the entorhinal cortex and hippocampus, which are regions of the brain primarily responsible for memory. As the disease progresses, damage spreads to the cerebral cortex, which is responsible for social reasoning and behavior In the final stages, the brain rapidly shrinks, or atrophies, causing severe degeneration of basic human function (“Alzheimer’s Disease”). Alzheimer’s is worsened by the accumulation of two proteins, beta-amyloid and tau proteins. Beta-amyloid proteins collect between neurons and form plaques, causing neuron degeneration. While beta-amyloid collects around the neurons, the tau protein collects inside the neurons. In a healthy brain, the tau protein binds to microtubules, structures that guide molecules from the cell body to the neurotransmitter sites, and stabilizes them. In a brain with Alzheimer’s, these tau proteins detach from the microtubules and attach to each other, creating a protein chain that tangles within the neuron. These neurofibrillary tangles block neurotransmitters, harming cell communication and leading to cell death When the beta-amyloid protein levels reach a certain point, the amount of tau protein tangles skyrocket (“What happens to the Brain in Alzheimer's Disease?”). Besides a genetic predisposition for Alzheimer’s and dementia, certain environmental factors, such as air quality, behavior, high contact sports, and nutrition, affect the predisposition for said conditions; factors such as cognitive complexity, physical activity, and socialization affect the speed of progression for Alzheimer’s and dementia, as seen at Abe’s Garden Memory Care Center. Poor air quality and pollution increase the risk and predisposition for Alzheimer’s. In the last decade, pollution and air quality have become a major concern for people all over the world. Pollution is a known cause of global warming and damage to the environment, but recent studies show that pollution is harming human health as well. Air pollution consists of gasses, chemical compounds, trace metals, and minuscule particles known as particulate matter. Specifically, researchers study fine particulate matter (PM 2.5) because of the high amount of magnetite, a form of iron, that can be studied due to its magnetic properties. PM 2.5 can be released through burning fossil fuels and can enter the brain via the bloodstream or breathing it in through the nose. A 2016 study proved that magnetite is present inside the brain plaques caused by beta-amyloid protein formation. The formation of the plaques indicates the progression of Alzheimer’s inside the brain. People with Alzheimer’s have high levels of these plaques, proving a connection between air pollutants, such as magnetite, and Alzheimer’s. Another 2016 study proved a connection between pollution and dementia through car exhaust and proximity to major roads. Out of 6.6 million people, the study found that people living within 50 meter proximity to a major road were 7% more likely to develop dementia than people living over 300 meters away from major roads. The particulate matter level, which is used to measure levels of pollution, was 10 times higher within the 50 meter proximity than the 300 meter proximity (“Air Pollution and Dementia”). Even young children’s brains exhibit differences resulting from exposure to pollution. A 2014 study of children from urban areas showed that about half of the children had both amyloid plaques and neurofibrillary tangles in their brains, which are both a cause of Alzheimer’s The children in rural areas had no plaques or tangles in their brains (Calderón-Garcidueñas, et al.). Overall, there is a correlation between high levels of pollution and levels of amyloid plaques in the brain, a hallmark of Alzheimer’s. Behavioral habits, such as diet, exercise, drinking, and smoking, all have an impact on the predisposition for Alzheimer’s and dementia. When these behaviors become negative, like having a bad diet, not exercising, and smoking excessively, they create a domino effect regarding human health. A bad diet and no exercise lead to obesity, high blood pressure, and high cholesterol, and these lead to poor cardiovascular health. Smoking also leads to poor cardiovascular health. For years research has shown a strong correlation between poor cardiovascular health and vascular dementia, which is caused by interrupted blood flow supply to the brain and damaged blood vessels, but more recent studies are proving a connection between cardiovascular health and Alzheimer’s. High blood pressure and high cholesterol are the leading causes of heart disease, and any kind of heart disease causes reduced cerebral blood flow (CBF). Reduced CBF worsens the vascular homeostasis in the brain, which worsens the cognitive problems associated with the buildup of plaques and tangles. Small vessel disease caused by poor cardiovascular health disturbs CBF, worsening the accumulation of amyloid plaques and tangles. Atherosclerosis, or lesions in the arteries as a result of high cholesterol, serves as a connection between coronary artery disease and dementia. Studies prove that the rate of dementia is higher in those with coronary artery disease and that coronary artery disease is associated with major cognitive impairment seen with dementia. Also, the progression of atherosclerosis is directly related to the dementia patients’ performance on cognitive testing. The worse the atherosclerosis, the worse the cognitive assessment score was. Heart disease is a significant risk factor for dementia, which leads back to basic habitual behaviors like diet, exercise, and smoking These behaviors, therefore, are indirect risk factors for Alzheimer’s and dementia (B Ng et al.).

Another risk factor for Alzheimer’s and dementia is high contact sports that lead to traumatic brain injuries (TBI). Approximately 2% of the United States’ population lives with disabilities resulting from TBIs, such as dementia TBIs can result from car accidents, falls, and high contact sports, like hockey and football. Individuals with TBIs are at a 50% increased risk for dementia, and an estimated 5-15% of dementia is attributed to TBIs (Shively, et al.). A World War II case study examined how the severity of a TBI affects the risk of dementia over the course of 50 years. The soldiers who suffered severe TBIs, which is considered to be a loss of consciousness or amnesia lasting over 24 hours, were four times more likely to develop dementia than the soldiers who did not suffer any level of TBI. The soldiers who had a moderate TBI, which is considered a loss of consciousness or amnesia between 30 minutes and 24 hours, were twice as likely to develop dementia later in life (Plassman, et al.). Research also shows that TBIs cause the accumulation of amyloid plaques and neurofibrillary tangles, which are known causes of dementia. In fact, amyloid plaques are found in 30% of all patients who died shortly after a TBI. In one study of professional athletes with a history of severe concussions and TBIs from sports who had developed dementia, neurofibrillary tangles were highly reported in autopsies (Shively, et al.). Although there are many studies proving the damage of severe TBIs, a recent University of Pennsylvania Medical School study showed that even a single fall causing a TBI results in a 1.25 times increased risk for dementia. When a person has two TBIs, the risk increases twofold (“Head Injury 25 Years Later – Penn Study Finds Increased Risk of Dementia”). Overall, TBIs cause an increased risk of dementia; many TBIs can be prevented through avoidance of high-contact sports.

Abe’s Garden serves the community as an independent living, assisted living, and memory care facility. I spent my time serving in the memory care facility so I could get a firsthand experience with memory related diseases and how they progress over time. Abe’s Garden created their facility with the intent to use scientifically proven ways to support and slow the progression of Alzheimer’s and dementia for the residents. Cognitive complexity, socialization, and exercise all affect the progression of cognitive decline in dementia and Alzheimer’s, as seen in my time volunteering at Abe’s Garden. Cognitive complexity is defined as the extent to which a person can perceive, analyze, and describe information and surroundings. Cognitive complexity is significantly higher in highly educated individuals who challenge their brains and often utilize the skills of the brain. Cognitive complexity can be used to study Alzheimer’s because a lack of use of cognitive complexity puts an individual at a higher risk for Alzheimer’s. Cognitive complexity can also be used to study the progression of Alzheimer’s and how it can slow the progression of the disease. Cognitively demanding activities, such as reading, writing, puzzles, art, playing an instrument, and speaking different languages can both lower the risk for Alzheimer’s and aid with slowing the progression. Moreover, cognitively complex activities stall the accumulation of amyloid plaques in the brain, a telltale sign of worsening Alzheimer’s. Once diagnosed with Alzheimer’s or dementia, cognitively complex activities can be used to slow the cognitive impairment (Bartolotti). Specifically in the early stages of dementia and Alzheimer’s, high-frequency participation in these intellectual activities can drastically slow down the cognitive decline associated with the diseases (Ruthirakuhan). Abe’s Garden uses the research behind this idea to support their residents. Abe’s Garden creates a schedule for the resident each day with both group activities and options to do alone. These activities include singing, drawing, drumming, reading, puzzles, flower arranging, games, and general community activities. These cognitively complex activities help the residents with their temperament, happiness, and sense of belonging and community (“Engagement and Person-Directed Care”). The socialization of the residents also aids with slowing cognitive impairment. Isolation from others has a large impact on a person’s mental health, and in turn, physical health. Older adults, especially those living in assisted living away from their family, may feel loneliness and isolation. In fact, the elderly with no social connections were 2.37 times more likely to experience cognitive decline compared to those with many social connections (The Power of Socialization”). People who experience Alzheimer’s or dementia can sense their own cognitive decline, which can lead to social withdrawal, anxiety, depression, irritability, and decreased self-confidence. By creating a good social environment, the patients may be able to gain self-confidence back and restore a more positive outlook on life. By improving social interactions, eating habits, like eating all three meals together, and exercise habits can be improved and benefit the patient’s overall wellbeing (Ruthirakuhan). The volunteer program at Abe’s Garden was created in hopes to support the social needs of the residents. Studies show that volunteer programs with Alzheimer’s and dementia patients improved their participation in other social activities. Especially if the patient does not have family to visit them often, these volunteers show them undivided attention and provide positive social interactions (Ruthirakuhan). Abe’s Garden also uses exercise as a proven method to slow the cognitive decline that comes with Alzheimer’s and dementia (“Engagement and Person-Directed Care”). Moderate exercise for the residents not only improves symptoms of cognitive decline, such as alertness, visual tracking, inhibition, and temperament, but physical health as well (Ingold). The architecture of the Abe’s Garden Memory Care Center supports and encourages an active lifestyle by connecting all three units with a large, circular garden. The residents not only complete group exercise activities, but often use the garden to move throughout the property (“Engagement and Person-Directed Care”). Abe’s Garden uses proven scientific research to support their residents in a social sense to slow the cognitive decline associated with Alzheimer’s and dementia.

Many factors besides genetics affect the predisposition for Alzheimer’s and dementia. Environmental factors can also be used to aid the patients after Alzheimer’s or dementia diagnosis. Abe’s Garden uses these factors to help the residents with their wellbeing and happiness in efforts to slow their cognitive decline associated with these diseases.

Works Cited

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