COMMENTARY:

The Big "A"--As in Alzheimer's

Memory, however, that disappears, never to return again, is another story. According to the experts, “forgetting is not normal”; forgetting transiently, however, is a forgivable happenstance and not an indicator of impending doom.

Alzheimer’s disease is a slow, deliberate eating away of neurons in the brain. It is as if massive portions of the brain have been wiped away. In actuality, that is what happens. Huge chunks of the brain are decimated, never to be repaired or returned. Once they’re damaged, once they’re gone, they’re gone forever. It’s why memories, particularly recent memories, are non-existent in an individual with Alzheimer’s.

Alzheimer’s disease, normally associated with the more senior of our population, can actually begin as early as sixty and in rare cases even earlier. Those moments of inappropriate language, or an awkward interjection once thought kind of cute, much like that of a precocious two-year-old, become a source of great embarrassment to family members of an individual with Alzheimer’s.

Individuals with Alzheimer’s can often display bad behavior. Sometimes it’s saying or shouting expletives in inopportune situations or in front of company; sometimes it’s being aggressive or belligerent; sometimes it’s hearing songs or voices that aren’t present or seeing people that aren’t there. Alzheimer’s runs the gamut of discomforting experiences.

For children of parents with Alzheimer’s the gloom hangs as if a cloud of black doom. The knowledge that their parent may one day not recognize them is difficult to fathom, but it happens in many cases, but thankfully not all. Some individuals with Alzheimer’s can actually forget how to eat, or remember that they need food for substance. Their bladders betray them and so goes their dignity.

It is estimated that 5 million people in the United States have Alzheimer’s; 30 million worldwide. One physician I spoke with said matter-of-factly that “the longer we live the greater the likelihood we will get Alzheimer’s." Scientists know that the risk of Alzheimer's nearly doubles every 5 years, so by the age of 95 nearly one-half of everyone lucky enough to reach the ripe old age of 95 will have Alzheimer's disease. So what is one to do?

There are many old-wives tales; we’ve all heard them: keep your mind alive, learn a new language, do crossword puzzles. But the truth is the professionals don’t know the answers. In fact, they can’t even definitively diagnose Alzheimer’s until after death and upon an autopsy. Short of that, it’s pretty much conjecture and guesswork. Educated guesswork, but guesswork nonetheless. Most clinical charts will state that the patient has "dementia probably secondary to Alzheimer’s," but that’s the extent of the physician putting his or her reputation on the line.

Consulting the myriad of books on Alzheimer’s and talking with the medical experts doesn’t allay the confusion. Sadly, they don’t even seem to agree with one another. The New England Journal of Medicine in February 14, 2002 wrote that there is a suspected correlation between the intake of Folic Acid, Vitamins B-6 and B-12 and reducing the risk of Alzheimer’s. The American Academy of Neurology reportage seems to verify some old wives' tales: stimulating activities such as board games, playing a musical instrument, exercising and gardening are all components in warding off Alzheimer’s. But, then again, not every expert agrees.

Most of us remember the warnings that touted aluminum as the culprit that causes of Alzheimer’s. Nowadays, that notion is fairly confidently debunked. But, then again, there is still a contingency that refuses to disavow this assumption. However, more often today the new nemeses are copper and zinc. Harvard Medical School neuroscientist Ashley Bush, also a devotee of the aluminum theory, recently uncovered links between copper, zinc, and Alzheimer's disease. He conducted a promising small clinical trial that indicated that a drug that binds metals, clioquinol, actually slows the progression of Alzheimer's.

The FDA, U.S. Public Health Service and the World Health Organization continue to support the use of amalgam for dental treatments, stating “there is no evidence to show any connection between mercury-based fillings and Alzheimer's or other neurological diseases." However, not all clinicians are in agreement. Some laboratory studies indicate mercury affects nerve cells and some of the biochemical processes involved in Alzheimer's disease. Again, a conundrum.

There are studies that propose that “People who were less active were more than three times more likely to have Alzheimer’s disease as compared to those who were more active.” There are other studies that suggest a prior head injury could play a role in getting Alzheimer’s later in life.

Scientists from Erasmus Medical Center in the Netherlands recorded the dietary habits of 5,395 men and women aged 55 and over who ate lots of vegetables, took Vitamins E and C, and showed no signs of dementia. They concluded in their six-year study that those who consumed higher amounts of beta-carotene, vitamin C, vitamin E and vegetables remained free of Alzheimer’s. (No mention, you’ll note, of the aforementioned inclusion of vitamins B6, B12 and Folic Acid.)

The University of Minnesota’s Department of Neurology, in a study in 2002, indicated that loss of memory was reversed in mice after administering a monoclonal antibody, BAM10. In their report, they wrote, “Our results indicate that a substantial portion of memory loss in mice {in the study} is not permanent.”

One doesn’t have to be a scientist to know that (1) this is a stunning report, and (2) that it disagrees with much of what the medical profession is articulating to the families of individuals with suspected Alzheimer’s disease.

The newest and most promising study, reported on January 19, 2006, comes from Case Western Reserve University's Alzheimer's Disease Center in Cleveland. This study, if validated by further studies, may change all that once was thought about the origins of Alzheimer’s disease.

Danilo Tagle, program director of neurogenetics at the U.S. National Institute of Neurological Disorders and Stroke, says of the results of that study, "It really is going against the central grain of what we know, and it actually may lead to something more promising." In short, its findings indicate that prior to the amyloidal plaquing of the brain and subsequent cell deterioration that has been well documented, the mice showed evidence of cell cycling six months before any amyloid plaques showed up. Additionally, the study indicated that these neurons had extra chromosomes, which is another sign that the cells had begun to divide. Furthermore, the activity was seen in the cortex and regions of the brain, which are most implicated in Alzheimer's.

In the meantime, the battle and the fight rage on. Questions outnumber the answers. In the meantime, families suffer. It appears questionable if the Alzheimer victim suffers. Experts say that the brain of an Alzheimer’s patient keeps them in a state of unawareness. Perhaps this is so in the later stages, but not in more moderate stages.

Unless the Alzheimer’s patient is in the last stages of the debilitating disease, there are many moments of lucidity. In those moments, however brief they may be, most individuals feel regretful and apologetic for their lack of memory or their personality fluctuations. One doctor I spoke with said it doesn’t matter what one says to an Alzheimer’s patient because they won’t remember it later. My personal exposure differs. I’ve found that many will latch on to the one word of negativity and remember it and repeat it often.

It is true that families must find a new, more tolerant, less confrontational manner of talking to one’s parent with Alzheimer’s. Many individuals with Alzheimer’s may have a tendency to be paranoid, confused, agitated, angry, volatile, combative, and more, which makes coping that much more difficult.

The biggest fear for the children of parent’s with Alzheimer’s, or suspected Alzheimer’s, is: am I destined to get Alzheimer’s? Without a doubt, this question is at the crux of our fear. For the most part, one form of Alzheimer’s is more likely to be familial, the other, not so. Adding more fear to this is a recent study of twins which offers new credence to the concept of hereditary aspects. In a study of 1200 sets of twins, 392 were later diagnosed with Alzheimer’s.

One physician gave a pragmatic view, saying, “It's tremendously important that people actually, while they still have a capacity to understand what's going on, sort out what's going to happen to them, and that is an inevitable progression in dementing diseases; at some point or other you will lose your understanding of reality and your legal capacity to sign a will, sign a check, to make decisions about your quality of life or whether you should have an operation. Somebody else will have to do that for you.”

Clearly, Alzheimer’s is a disease many of us will have to reckon with.