The brain is made of nerve cells
known as neurons, these cells carry electrical impulses and between the neurons
there are gaps known as synapses, across which chemicals known as
neurotransmitters diffuse, to pass the impulse from one neuron to another,
enabling us to respond to both internal and external stimuli. In Alzheimer’s
disease, several changes occur within the brain, including the destruction of
the neuron and synapses resulting in the atrophy (severe reduction in size due
to wasting away) of certain regions of the brain. In the cells of a healthy
brain, a fibrous protein known as tau is produced, and is essential for
maintaining the size and shape of nerve cells and ensuring effective cell
communication. In those with Alzheimer’s an abnormal version of tau is
produced, which cannot carry out these functions and accumulates in, what are
known as, neurofibrillary tangles, disrupting the communication between cells and causing the disintegration of the microtubules that maintain cell structure, eventually leading to cell death. Additionally, in the brains of people who
have Alzheimer’s disease, neuritic plaques form. This is the accumulation of a
small protein known as beta amyloid, which is produced when APP (amyloid precursor
protein) is broken down. Beta amyloid is broken down healthy people, but not in
Alzheimer’s disease, therefore it forms plaques around the nerve cells which
are thought to be toxic to the cells, causing changes leading to cell death.
The changes in Alzheimer’s first occur in the hippocampus region of the brain
which is responsible for forming and storing memories. The changes then spread
to the cerebral cortex and the frontal (skilled movements and problem solving),
temporal (language and hearing) and parietal (sensory abilities such as pain
response) lobes. The region known as the basal nucleus of Meynert undergoes
degeneration in Alzheimer’s disease. This region is normally rich in neurons
using the neurotransmitter acetylcholine, which is thought to be important in
memory, however, this degeneration means that the brain produces less
acetylcholine.
Alzheimer’s disease is categorised
as either mild (usually involving: forgetfulness; mood swings; speech
impairment and withdrawing from social situations), moderate (often with
symptoms such as: disorientation and problems with spatial reasoning; problems
with eyesight; hallucinations; obsessive behaviour; insomnia; incontinence and frustration or depression resulting from
confusion and inability to carry out tasks) or severe (likely to display many
of the symptoms listed above in addition to: a complete loss of short and
long-term memory; hallucinations causing the person with Alzheimer’s to become
distressed, violent and suspicious of those around them; self-neglect;
difficulty moving or swallowing and a loss of appetite, due to forgetting when
they have begun these tasks). The symptoms of Alzheimer’s may also be seen in
individuals who are suffering from strokes, brain tumors, multiple sclerosis, thyroid
dysfunction, infectious diseases such as HIV and syphilis, substance abuse or
the side effects of some medications; it is important to first eliminate any
of these, more-treatable conditions as the cause of the symptoms. As a result, Alzheimer’s
diagnosis can take some time. The diagnosis of Alzheimer’s will usually involve
neurological examination, potentially followed by CT (using x-rays) or MRI
(using a magnetic field and radio waves) scans of the brain. Severe Alzheimer’s
can lead to compromised immunity and life threatening infections, so as the
disease develops, full-time care is needed to support the person with
Alzheimer’s disease. Most people with Alzheimer’s disease die with the illness
rather than from it, however, there is a significantly reduced the quality of
life for those with the disease.
There is no cure for Alzheimer’s disease, however there are a few drugs
which have been shown to alleviate some of the symptoms of the disease.
Donepezil, galantimine, rivastigmine and memantine are drugs that are currently
prescribed for Alzheimer’s treatment. The first three drugs are acetylcholinesterase
inhibitors and prevent the breakdown of the neurotransmitter acetylcholine, in
an attempt to maintain the levels of this chemical and communication between
nerve cells, however they can have the side effects of nausea, diarrhoea and
fatigue. Memantine blocks the chemical glutamate which is released in excessive
amounts in Alzheimer’s disease and can damage the brain cells. It is also
important to treat the psychiatric problems that may present alongside the
disease, and incorporate memory aiding activities into day-to-day life such as
labelling cupboards, making timetables and diaries and keeping useful addresses
and telephone numbers to hand.
The reasons for the brain
deterioration in Alzheimer’s are not entirely known, however there are several
factors which may increase the risk of developing the disease. Incidence of Alzheimer’s
disease is significantly correlated with increasing age, however, it is also
thought that lifestyle factors such as keeping mentally and physically active
can reduce the risk of Alzheimer’s whereas high blood pressure, high blood
cholesterol and smoking increase the risk. Severe head trauma, whiplash
injuries and repetitive head injuries such as from boxing can lead to an
increased risk of developing Alzheimer’s in later life. People with Down
Syndrome who live over the age of 50 are at an increased risk of developing
Alzheimer’s, they have an extra copy of Chromosome 21, so have extra copies of
the gene producing the protein RCAN1 therefore the protein is produced in
excess and can cause neuronal death. The overexpression of this gene can also
be caused by stroke, high blood pressure and high levels of beta amyloid.
The influence of inheritance on
developing late-onset Alzheimer’s is not very significant, however, recently
several genes have been identified as playing a role in the biochemical changes
that occur in Alzheimer’s. One particular gene involved in Alzheimer’s is the
gene apoE that codes for the protein apolipoprotein E, which carries fat
molecules in the brain and are thought to be involved in the breakdown of beta
amyloid. This gene has three different alleles (different versions of the same
gene), apoE2, apoE3 and apoE4. The
proteins coded for by the genes apoE2 and apoE3 are large protein molecules
that effectively transport fats and so can breakdown the plaques, but by apoE4,
the protein is a small molecule which is easily degraded so cannot carry out
these functions. In some populations, though not all, if a person has one or
more copy of the apoE4 allele, they have a greater chance of developing late
onset Alzheimer’s, those who are heterozygous (have 1 copy of the apoE4 allele and
1 copy of another allele) have a three times greater risk and homozygotes (who have
2 copies of the apoE4) have a ten times greater risk of developing the
condition.
Recent research has identified 11 new genes linked to Alzheimer’s. The
study comparing the genetic information of Alzheimer’s patients and healthy
volunteers (as controls) has shown that at least 20 genes are involved in
late-onset Alzheimer’s, as are significantly more common in those with the disease.
The findings are useful as they can provide further information on the biological
pathways involved in the disease, and although at the moment there are no
preventative drugs against Alzheimer’s disease, if they were developed, this
information could be used to screen and identify those at risk in the
population. The findings suggest that changes in the inflammatory response,
immune system and neuronal communication all affect the progression of the
disease.
Additionally, there has been research into a pill to combat degenerative brain diseases
and neuronal death due to the accumulation of protein. This particular study
looked at prion (a protein) diseases such as CJD however the biological causes of these
diseases are similar to those involved in Alzheimer’s. The study showed that
over the 5 week study, mice remained free of symptoms such as memory loss and
impaired reflexes, as well as living longer than untreated animals. Although
the same effects may not be true for Alzheimer’s in humans and drugs suitable
for human trials are unlikely to be developed for many years, this study offers
hope into the development of a cure for Alzheimer’s disease in the future.
http://www.nhs.uk/Conditions/Alzheimers-disease/Pages/Introduction.aspxhttp://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=100
http://www.theguardian.com/science/2013/oct/27/alzheimers-study-new-genes-implicated
http://www.theguardian.com/science/2013/oct/10/study-gives-hope-alzheimers-pill