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Alzheimer's Disease:
One of the Most Costly Diseases
in Health Care

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed on page 24 in the July 7, 2010 issue of
The Mississauga News under the feature: Health & Beauty, Medicine Matters.
Portrait of Dr. Peter W. Kujtan, supplied 2005
Dr. Peter W. Kujtan

One sad statistic that recurrently haunts us is the current certainty that almost half of the people who make it to age 85 will develop some form of cognitive disability affecting the brain. Alzheimer's Disease is perhaps the best known of these afflictions.

The brain is an organ which function defines who we are. It utilizes enormous amounts of energy to function, but its weight shrinks only about 10 percent from our twenties to death. In my younger days, high school health lectures taught us that we would lose 10,000 brain cells with every drink of alcohol. That does not quite seem to be the case anymore! We now think that in fact you may gain a few brain cells with time. What brain cells we have need to be properly nourished and looked after or their long axons and complex connections would shrink.

Alzheimer's Disease is only one form of dementia. It is a progression of brain cell degeneration that profoundly affects the memory, the ability to think, as well as communication skills. Early signs may include misplacing things, forgetting new concepts, fumbling for words, or suddenly not knowing where you are.

Sadly, those affected tend to transform from being productive societal members and go on to require a great deal of care and supervision. This condition is not limited to individuals, but affects the lives of entire families. It is turning into one of the most costly diseases within the health care system.

Two types of abnormalities are frequently found in the brain. The first type consists of the neurofibrillary tangles of a protein called tau found inside neuronal cells. The other abnormality is the build-up of plaques made of beta-amyloid which clog the space around neurons. Each neuron has thousands of synaptic connections with neighboring cells. When these kinds of cellular debris accumulate, those connections are lost and the neuron goes on to die.

These abnormalities may not be the cause, but serve more as a marker that an unhealthy process is going on. Currently, the diagnosis is made by noting the deterioration in a patient's memory.

At present, there are no adequate techniques to spot these plaques early. They are almost invisible to an MRI (Magnetic Resonance Imaging) in early stages. Medications do exist that attempt to promote the continued functioning of damaged neurons, but the effects are minimal.

Research on the Horizon

There is research on the horizon aimed at preventing the formation of tau protein, which holds a lot more promise. We now recognize a newer entity called MI or mild impairment, in which there are minor changes in function in personality but less debilitating. There are other types of dementia and mental impairments, which seem to be growing in numbers and have similar root causes.

Alzheimer's Disease was only characterized about 100 years ago. This raises several questions. Perhaps it was not fully recognized before then, people were not living long enough to see it, or changes in lifestyle, nutrition and environment could have triggered genetic problems.

There are at least two identified gene mutations associated with the disease. More recently, it has been suggested that strokes may be related to Alzheimer's Disease. Some people suffer large multiple strokes that leave areas of the brain damaged. They go on to develop some similarity in their deficits. In those cases, we refer to them as suffering from Multi Infarct Dementia.

At the other end of the spectrum, some scientists believe that almost undetectable mini-strokes cause minor damage and trigger local inflammation. This may go on to start a cascade of events that result in production of those abnormal protein levels. Insulin sensitivity seems to be a factor too, and diabetics are at a higher risk for developing Alzheimer's Disease.

Large studies have demonstrated that perhaps we can do something to help prevent this disease. The current thinking around the world is changing and suggests that poor circulation to the brain in various forms is the culprit. Obesity, smoking and alcoholism have all been linked to Alzheimer's Disease. It also turns out that you can exercise the brain. Regular physical exercise is just as important as mental exercise such as reading, continuing learning and socializing.

Low fat diets devoid of toxins and rich in natural antioxidants seem to have a protective role as well. You need to keep blood flowing to the brain just as it does to the heart. Keeping other diseases such as diabetes, elevated lipids and hypertension in check will help accomplish this task.

Unfortunately, our primary care system is not configured to provide the in-depth care that Alzheimer families require. It is a disease that frustrates front-line doctors because the resources to detect, manage and help families to cope with it are severely lacking. Visit Alzheimer Society of Canada for more information.

Related resources:

Alzheimer's disease from Wikipedia, the free encyclopedia.
Alzheimer's Disease Fact Sheet from U.S. National Institutes of Health (NIH)
Alzheimer's disease (AD) from MedlinePlus. Alzheimer's Disease is the most common form of dementia among older people. Dementia is a brain disorder that seriously affects a person's ability to carry out daily activities.
Test Your Memory for Alzheimer's and Dementia (5 Best Tests). These five memory tests for Alzheimer's and dementia are designed to detect early signs of cognitive impairment, memory loss, or or problem with judegment or thinking.
Alzheimer's Disease from MedicineNet. Causes, Symptoms, Diagnosis, and Treatment.
Alzheimer's Disease from MayoClinic. Overview, Definition, Symptoms, Causes, Risk factors, Tests and diagnosis, Complications, Treatments and drugs, Prevention, Coping and support.
Alzheimer's Disease Information Page from National Institute of Neurological Disorders and Stroke (NINDS). What is Alzheimer's Disease? Is there any treatment? What is the prognosis? What research is being done?
Alzheimer's Disease Videos from NIH Senior Health.
Multi-infarct dementia from Wikipedia, the free encyclopedia.
How to Recognize Demenita in a Loved One - and Why It's So Important to Speak Up by Amanda MacMillan, Real Simple, Time Inc. Lifestyle Network.
NINDS Multi-Infarct Dementia Information Page from National Institute of Neurological Disorders and Stroke (NINDS).

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