Alzheimer’s disease can be challenging for both the person experiencing it and their family support network. This progressive brain condition is a form of dementia and it causes patients to display a number of tell-tale symptoms. But recent scientific research may have pinpointed an everyday behavior that could be an early indicator of the affliction.
But what is it like to experience the condition? Well, Rick Phelps – who was diagnosed with early onset Alzheimer’s in 2010 – gave Aging Care a poignant personal perspective. He said to think of giving someone a dose of midazolam – a drug used to induce sleep for minor surgeries. The medication doesn’t last long, but it does affect the ability to make short-term memories and means the person will have no recollection of events after being dosed.
Phelps wrote, “Imagine giving this drug to someone. Then, have them awaken in a building they have never been in before that is full of furniture and items they do not recognize. Give them five minutes alone in this unfamiliar place, and then – one by one – have complete strangers enter the room and talk to the person as if they have known each other their whole lives.”
“Have these strangers talk to the person as if one of them is their daughter, their spouse and their pastor,” Phelps went on. “Have these strangers express concern for the person’s loss and assurances that everything is going to be alright. The entire time, this person will be wondering what in the world is going on. Then, have all the strangers exit the room. Leave the person entirely alone to ponder what just transpired.”
“This simple scenario does not even begin to show what [someone with dementia] goes through,” Phelps concluded. “How do I know? I am a patient, not someone who talks about dementia as if they have it. I live with this disease day in and day out. ‘When will it get better?’ It won’t. The only time peace will come for patients is when we pass away.”
According to the World Health Organization, “Dementia is a syndrome – usually of a chronic or progressive nature – in which there is deterioration in cognitive function… beyond what might be expected from normal aging. It affects memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgment. Consciousness is not affected.”
“The impairment in cognitive function is commonly accompanied – and occasionally preceded – by deterioration in emotional control, social behavior, or motivation,” the WHO goes on. “Dementia is one of the major causes of disability and dependency among older people worldwide. It can be overwhelming not only for the people who have it, but also for their carers and families.”
“There is often a lack of awareness and understanding of dementia – resulting in stigmatization and barriers to diagnosis and care,” the WHO continues. “The impact of dementia on carers, family and society at large can be physical, psychological, social, and economic. Dementia affects each person in a different way, depending on the impact of the [condition] and the person’s personality before falling ill.”
The progress of dementia is broken down into three key phases in which signs and symptoms will present themselves: early, middle, and late stage. The WHO adds, “… The early stage of dementia is often overlooked because the onset is gradual. Common symptoms include forgetfulness, losing track of time and becoming lost in familiar places.”
“As dementia progresses to the middle stage, the signs and symptoms become clearer and more restricting,” continues the WHO. “These include becoming forgetful of recent events and people’s names, becoming lost at home and having increasing difficulty with communication.” Meanwhile, other symptoms include “needing help with personal care [and] experiencing behavior changes – including wandering and repeated questioning.”
“… The late stage of dementia is one of near total dependence and inactivity,” the organization writes. “Memory disturbances are serious, and the physical signs and symptoms become more obvious. Symptoms include becoming unaware of the time and place, having difficulty recognizing family and friends, having an increasing need for assisted self-care, and having difficulty walking.” Sadly, behavioral changes may also escalate to aggression.
There are a number of different varieties of dementia. According to the WHO, “Alzheimer’s disease is the most common form and may contribute to 60 to 70 percent of cases. Other major forms include vascular dementia, dementia with Lewy bodies… and a group of diseases that contribute to frontotemporal dementia…”
The National Institute on Aging (NIA) states, “Estimates vary, but experts suggest that more than 5.5 million Americans – most of them age 65 or older – may have dementia caused by Alzheimer’s. [The condition] is currently ranked as the sixth leading cause of death in the United States. But recent estimates indicate that the disorder may rank third – just behind heart disease and cancer – as a cause of death for older people.”
According to the United Kingdom’s National Health Service (NHS) website, “People with Alzheimer’s… can live for several years after they start to develop symptoms. But this can vary considerably from person to person. Alzheimer’s… is a life-limiting illness, although many people diagnosed with the condition will die from another cause.”
“As Alzheimer’s… is a progressive neurological condition, it can cause problems with swallowing,” the NHS adds. “This can lead to aspiration – food being inhaled into the lungs – which can cause frequent chest infections. It’s also common for people with Alzheimer’s… to eventually have difficulty eating and have a reduced appetite.”
The condition is named after the man who discovered it – Dr. Alois Alzheimer. In 1906 he examined the brain tissue of a female patient called Auguste Deter at an asylum in Frankfurt, Germany. She’d died from a strange mental illness and had exhibited memory loss, problems with language and unpredictable behavior.
Alzheimer discovered abnormal clumps and tangled fiber bundles in Deter’s brain. These days, the clumps are called amyloid plaques and the fibers are known as neurofibrillary – or tau – tangles. And to this day, they are still considered by experts to be some of the primary identifiers of Alzheimer’s disease.
What is the science of Alzheimer’s, though, and precisely how does it affect the brain? The NIA writes, “It seems likely that changes in the brain may begin a decade or more before memory and other cognitive problems appear. During this pre-clinical stage of Alzheimer’s… people seem to be symptom-free, but toxic changes are taking place in the brain.”
“Abnormal deposits of proteins form amyloid plaques and tau tangles throughout the brain,” the NIA goes on. “Once-healthy neurons stop functioning, lose connections with other neurons, and die.” It adds, “The damage initially appears to take place in the hippocampus and the entorhinal cortex – parts of the brain essential in forming memories.”
The NIA continues, “As more neurons die, additional parts of the brain are affected and begin to shrink. By the final stage of Alzheimer’s, damage is widespread, and brain tissue has shrunk significantly.” According to Oregon Health & Science University, a late-stage Alzheimer’s brain loses a portion of its mass – weighing around 10 percent less than a healthy one.
However, scientists are still not clear exactly what causes the condition. The NIA writes, “In people with early onset Alzheimer’s, a genetic mutation may be the cause. Late-onset Alzheimer’s arises from a complex series of brain changes that occur over decades. The causes probably include a combination of genetic, environmental and lifestyle factors.”
“Scientists are conducting studies to learn more about plaques, tangles, and other biological features of [Alzheimer’s],” the NIA continues. “Advances in brain imaging techniques allow researchers to see the development and spread abnormal amyloid and tau proteins in the living brain, as well as changes in brain structure and function.” Furthermore, studies are also being conducted on changes in body fluids and the brain.
Research is being conducted into normal brain aging in an effort to explore the unknown question of why Alzheimer’s primarily strikes older people. The organization adds that the age-related changes being studied include “[shrinking] of certain parts of the brain, inflammation, vascular damage, production of unstable molecules called free radicals and mitochondrial dysfunction.”
Additionally, medical science hasn’t been able to pinpoint an exact gene that causes late-onset Alzheimer’s. But the NIA adds that scientists believe having one version of an apolipoprotein E gene called APOE ε4 does increase the chances of developing the condition. Though it adds that possession of this gene does not necessarily mean that someone will go on to have Alzheimer’s.
“Early onset Alzheimer’s disease occurs between a person’s 30s and mid-60s and represents less than 10 percent of all people with Alzheimer’s,” the NIA continues. “Most people with Down syndrome develop Alzheimer’s. This may be because people with Down syndrome have an extra copy of chromosome 21, which contains the gene that generates harmful amyloid.”
The treatment of Alzheimer’s, meanwhile, is multi-faceted. The NIA writes, “Current approaches focus on helping people maintain mental function, manage behavioral symptoms and slow down certain problems – such as memory loss. Researchers hope to develop therapies targeting specific genetic, molecular, and cellular mechanisms so that the underlying cause of the disease can be stopped or prevented.”
In the meantime, there are medications that can be prescribed to Alzheimer’s patients in the U.S. to help preserve cognitive function and manage behavior. Examples include donepezil for mild Alzheimer’s symptoms and memantine for more severe cases. These drugs apparently regulate a person’s neurotransmitters, which are the chemicals that send messages between neurons.
The aforementioned medications aid in the reduction of symptoms and can help with select behavioral issues associated with Alzheimer’s. But they don’t work for everyone and might only help for a short time period. They also don’t change the processes of the underlying condition at all; they simply help manage symptoms.
Naturally, medical communities all over the world are analyzing ways of preventing and delaying Alzheimer’s. For its part, the NIA is apparently supporting clinical trials in which several potential interventions are being tested and built-upon. It is also working on non-drug treatments like cognitive training, diet and physical exercise.
The NIA adds, “Under study are drug therapies aimed at a variety of targets. [These include] the beta-amyloid protein, cerebrovascular function, loss of synapses, and specific neurotransmitters, as well as nondrug interventions, such as physical activity, diet, cognitive training, and combinations of these approaches.” According to the Bright Focus Foundation, the effects of light therapy and acupuncture are even being studied.
However, it was in September 2019 that a potentially revolutionary study in the field of dementia analysis was published. It was conducted by scientists at Newcastle University in England and was published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association. The results found that it is possible to identify the specific type of dementia a patient has by analyzing their walking patterns.
A researcher at the Faculty of Medical Sciences at Newcastle University called Dr. Riona McArdle led this particular study. She wrote in the report, “The way we walk can reflect changes in thinking and memory that highlight problems in our brain – such as dementia. Correctly identifying what type of dementia someone has is important for clinicians and researchers, as it allows patients to be given the most appropriate treatment for their needs as soon as possible.”
“The results from this study are exciting as they suggest that walking could be a useful tool to add to the diagnostic toolbox for dementia,” McArdle continued. “It is a key development as a more accurate diagnosis means that we know that people are getting the right treatment, care and management for the dementia they have.” But how was the study conducted?
For reference, the researchers gathered together 110 test subjects. Twenty-nine were adults who had exhibited no cognitive decline whatsoever, 36 were Alzheimer’s patients and 45 of them had Lewy body dementia. They all took part in a walking test at the Gait Lab of the Clinical Ageing Research Unit in Newcastle upon Tyne, England.
The subjects’ exact footsteps were recorded as they walked along a mat with thousands of tiny sensors hidden inside. Travelling along this walkway at normal speed gave the researchers an insight into each of their personal walking patterns. And the difference between the walk of someone with Lewy body dementia and one with Alzheimer’s was striking.
The researchers found that the Alzheimer’s patients rarely altered their walking pattern. But those with Lewy body dementia often changed the length of their steps and also the amount of time it took them to take one. Overall, it amounted to their walking pattern being much more irregular, and this uneven pattern may lead to an increased risk of a fall.
This asymmetric walking pattern also means the left and right steps of someone with Lewy body dementia look different. The experts scrutinized the variability of step length and asymmetrical nature of step time, and they were able to identify 60 percent of all dementia subcategories. Apparently, this kind of identification hasn’t actually been possible before.
The research also represents a vital first stage in the effort to solidify gait analysis – the study of body movement – as a clinical biomarker for the different subcategories of dementia. But more work will be needed to ascertain how gait analysis can improve the current methods used to diagnose dementia, as well as if it is feasible for use as a screening method. The goal, however, is for the tool to be used in the National Health Service (NHS) within five years.
Dr. James Pickett – who is head of research at the Alzheimer’s Society – was glowing in his praise of the study. According to Science Daily, he said in September 2019, “In this well-conducted study we can see for the first time that the way we walk may provide clues which could help us distinguish between Alzheimer’s disease and Lewy body dementia. This research – funded by the Alzheimer’s Society – is pioneering for dementia.”
Pickett continued, “We know that research will beat dementia, and provide invaluable support for the 850,000 people living with the condition in the U.K. today. It’s now vital that we continue to support promising research of this kind. We look forward to seeing larger, longer studies to validate this approach and shed light on the relationship between a person’s gait and dementia diagnosis.”