Let’s Change the Odds: Interdisciplinary Analysis of Alzheimer’s Disease

“What a nice surprise!” my grandma exclaimed as I walked into the dining room. She was sitting across from her new friend enjoying a hot dog and fries. This was the first time I had seen my grandmother in six months. She had moved into an assisted living facility and the staff explained to my father, her primary caretaker, that it would be easier for her to transition if she didn’t have too many visitors. Knowing my grandmother’s condition, I did not want to wait any longer to visit her so my mother and I stopped by for lunch. I felt a sense of relief as soon as we entered the room because I knew that she still remembered who I was.

My father had visited the assisted living facility earlier that day to remind my grandmother that we were coming for lunch but it was clear that she had forgotten. He has been taking care of my grandmother for about three years and helped her transition into the facility she is in now. It has been difficult to watch my father’s life become consumed by caring for his mother but I know that I would do the same for him. He has shown more love and patience than I could have ever imagined.

My mother and I sat down next to her and decided to order lunch while she finished hers. She introduced her friend and then introduced us to her friend’s dog as well. The dog is a Chihuahua named T-Rex. My grandmother has simply fallen in love with the little guy. This, however, was very comical to my mother and I because she has never been an animal person in the past. She excused herself from the table at least four times to play with him.

IMG_1449

My grandmother and T-Rex

We chatted briefly about her “new” home that she claimed she had only been living in for around five days now. Although she didn’t understand that she had been there for six months she had only positive things to say about where she was living. This was the most comforting part of the whole visit; we knew she was happy where she is. We engaged in pleasant conversation about what was going on with different family members including my brother and I. She didn’t remember that I was in college but she was truly excited about my future. When it was time to leave my grandmother and her new friend walked us outside. We said our goodbyes and went on our way. My father stopped by about fifteen minutes later to bring my grandmother something and she was still outside with her friend. She did not remember that my mother and I had been there for lunch. As you may have already guessed, my grandmother has Alzheimer’s Disease.

WHAT EXACTLY IS ALZHEIMER’S DISEASE (AD)

Most people understand that Alzheimer’s Disease (AD) typically impacts the older population and alters their memory but there can be a lot of grey area when it comes to understanding exactly what the disease is. According to the National Institute of Aging (2017), Alzheimer’s Disease is the most common form of dementia which causes “an irreversible, progressive brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks.” AD is named after Dr. Alois Alzheimer who was the first person to discover abnormal clumps and tangled bundles of fibers in the brain tissue of a woman who passed away due to mental illness. The abnormal clumps are now referred to as amyloid plaques and the tangled bundles of fibers are referred to as neurofibrillary or tau tangles. The third main contributor to AD is the decrease in nerve cells (neurons) in the brain that allow for communication between different parts of the body.

The prevalence of AD in the United States is enormous and there is currently no cure. According to the Alzheimer’s Association (2017), “an estimated 5.5 million Americans of all ages have Alzheimer’s disease.” This prevalence translates to “one in 10 people age 65 and older have Alzhemier’s dementia”. These numbers are astonishing and growing. AD is also listed as “the sixth-leading cause of death in the United States”. The immense influence that this disease has on our world has motivated research to establish preventative measures and hopefully, one day, the cure.

NUTRITION

The first element of preventative research that I chose to investigate is the connection between nutrition and AD. So much of what I have learned about the human body is impacted by what we eat. The link between diet and brain health has been highlighted for years now. The trouble with nutrition is that everyone makes different choices and has access to different sources. When it comes to nutrition there is no ‘one size fits all’. People choose certain dietary restrictions/habits, have access to certain foods, can only afford certain foods, and sometimes suffer from different medical conditions (mental, physical, or emotional). It is my goal to acknowledge all of these differences and outline how nutrition is associated with AD.

“Think of your brain as the finely tuned engine of your car. If you give your car low quality fuel, the engine may break down before its time” (Isaacson & Ochner, 2016). The increasing amount of poor dietary decisions in the United States is a prime example of this ‘low quality fuel’. Processed foods high in fats and sugar are big contributors to the obesity epidemic. As a result, excess body fat contributes to many different health issues such as heart disease, some forms of cancer, diabetes, and poor brain health. Isaacson & Ochner (2016) highlight the impact of obesity on brain health; “research shows that those who have a higher BMI and waist-to-hip ratio tend to see both lower total brain volume and greater shrinkage of the hippocampus (the brain’s memory center)”. This association between excess body fat and poor memory can often be traced back to the consumer’s dietary habits.

Isaacson & Ochner (2016) also outlined the work of scientists who studied aging Okinawan people. This research supported the idea that excess body fat can influence memory later in life. The research not only supported this idea, but also uncovered a possible preventative dietary treatment for AD. Okinawan people have one of the highest life expectancies on Earth. Caloric restriction has been identified as one of the main reasons why. “On average, Okinawans consumed between 1,800 and 1,900 calories each day, and typically had BMIs between 18 and 22. By way of contrast, the average American eats between 1,800 and 2,600 calories and has a BMI of 26.5.” It is not only the food we eat but how much. The overconsumption of calories in the United States has become the norm. Whereas, in Okinawa the people tend to follow the mindset “eat until 80% full”.

Following the discussion of caloric restriction, it is important to acknowledge that malnutrition has been identified as an additional risk factor for AD (Hu, Yu, Tan, Wang, Sun, & Tan, 2013). Caloric restriction is different from malnutrition in the sense that those practicing caloric restriction are still exposed to the necessary nutrients they need to maintain a healthy body. According to Hu et al. (2013), “the mean prevalence of malnutrition in AD patients living at home is 5%”. Results have shown that chronic malnutrition can lead to cognitive decline (Ogawa, 2014). Common indicators associated with malnutrition are “loss of appetite, poor food intake, pain and acute gastrointestinal symptoms” (Ogawa, 2014). Weight loss associated with malnutrition can also lead to an accelerated decline for those with AD. Alzheimer’s patients who experience weight loss can increase their chances of infection, ulcers, and falls.

Another nutritional risk factor outlined by Venturini et al. (2014) is the dysfunction of the blood-brain barrier caused by saturated fats and cholesterol. Most of the drugs produced to treat AD currently address cell-to-cell communication instead of cerebrovascular function. Research suggests four different ways in which cholesterol may impact AD. (1) Cholesterol impacts the age of onset, (2) stimulates an amyloid-precursur-protein, (3) higher plasma cholesterol levels in midlife are associated with AD, and (4) drugs used to lower cholesterol reduce the chances of having AD. Dietary fats contribute to the increase in presence of cholesterol which does not pass through the blood-brain-barrier (Venturini et al., 2014). All of these associations between cholesterol levels and AD give reason to maintain healthy levels and avoid foods high in saturated fats.

The consumption of saturated fats should be limited but the consumption of others fats may act as a preventative measure for AD. According to Morris (2012), “persons in the highest quintile of n-6 polyunsaturated fat intake had a 70% lower risk of AD compared with persons in the first quintile”. Omega-3 fatty acids are a common type of polyunsaturated fat present in fish. Therefore, the consumption of fish may have preventative properties for AD. Docosahexaenoic acid (DHA), is the most abundant omega-3 polyunsaturated fatty acid in neuronal membranes. DHA has been identified as an important dietary component for brain function in adults. Since fish is the main source of DHA, scientists have analyzed the relationship between fish consumption and AD. Research shows that people who consumed one fish meal or more a week had a 60% lower risk of developing AD.

Barnard et al. (2014) lists replacing meat and dairy with vegetables, legumes, fruits and whole grains as one of the dietary guidelines for prevention of AD. These food sources provide the micronutrients essential for brain function. They are also low in saturated and trans fat. “In both the Chicago Health and Aging Project and the Nurses’ Health Study cohorts, high vegetable intakes were associated with reduced cognitive decline” (Barnard et al., 2014). Another guideline listed is the intake of Vitamin E from foods. Some of the best sources of Vitamin E include seeds, whole grains, nuts, and leafy green vegetables.

PHYSICAL ACTIVITY

The second element of preventative research that I chose to investigate is the connection between physical activity and AD. People are sitting more, spending less time outside, driving instead of walking, and spending more time in front of screens. This increase in physical inactivity may cause poor health later in life. According to the World Health Organization, in order to maintain proper cardiorespiratory and muscular fitness, bone health, and to reduce the risk of non-communicable diseases and depression, adults ages 18-64 should perform at least 150 minutes of moderate-intensity aerobic activity per week. Although this guideline doesn’t mention AD, research suggests that engaging in this level of physical activity may play an important part in decreasing the risk of developing the disease. Ginnis et al. (2017), reviewed 33 studies involving the association between physical activity and AD. The authors came to the conclusion “that an active lifestyle seems to have a protective effect on brain functioning and may also slow the course of Alzheimer’s disease.”

Loprinzi (2015) compared the physical activity levels of those at risk for AD to those not at risk. The results indicated that those who weren’t at risk engaged in more physical activity than those who were at risk. He listed “changes in neurotrophins, oxidative damage, cerebral metabolism and circulation, and amyloid-beta levels” as associative properties for the protective role of physical activity against AD risk. Regular participation in more than 150 minutes of moderate-to-vigorous physical activity was highlighted as playing the most significant protective role. Promotion of physical activity at an early age could potentially decrease the risk of developing AD for future generations.

Alzheimer's Association.jpg

CC BY: Alzheimer’s Association

https://www.flickr.com/photos/greaterillinois/

            Many people use physical activity as a coping mechanism for stress. Stress has been identified as a major risk factor for AD. Torosa-Martinez and Clow (2012) investigated the ability of physical activity to reduce the risk for AD by interacting with the stress neuroendocrine system. They concluded that “voluntary regular physical activity decreases HPA axis response to psychological stress, promotes angiogenesis and neurogenesis within the hippocampus, improves cognitive function, reduces amyloid load, inflammatory markers, insulin resistance, and oxidative stress while increasing BDNF and serotonin function.” This conclusion includes a lot of complex terms from the research so I will break down certain aspects of it.

One of the early indicators of patients with AD is HPA axis dysfunction which causes elevated cortisol levels leading to the progression of the disease. Angiogenesis and neurogenesis within the hippocampus help prevent loss of volume and neurons in an area of the brain which processes and stores memories. The amyloid load refers to the presence of amyloid plaques in the brain which are one of the main causes of AD. Oxidative stress is a common factor in neurodegenerative disease which occurs when there’s an overproduction of aerobic metabolism products. BDNF (brain-derived neurotrophic factor) levels are decreased in AD patients which causes a decrease in brain plasticity and neurogenesis. This collection of positive results associated with physical activity suggests that it certainly could reduce risk factors for AD but further research needs to be done.

Phillips, Baktir, Das, Lin, & Salehi (2015) took a similar approach to researching how AD and physical activity are connected. They used different characteristics typically present in patients with AD and analyzed whether or not physical activity levels had any influence on them. The first characteristic, amyloid plaque plasma deposition, was reduced in those who reported higher levels of physical activity. Tau tangles, which cause atrophy and dysfunction of neurons, were also lessened due to physical activity. Synapses, the location of communication between neurons, may function better as result of regular physical activity. Hippocampal neurogenesis, which improves memory function, was shown to improve due to physical activity. Neurotrophin levels, proteins that help maintain neurons, can be normalized by physical activity. Evidence suggests that a decrease in systemic inflammation and positive immune health can be associated with physical activity. Many AD patients must be institutionalized due to sleep disturbance and physical activity levels are shown to positively influence circadian rhythms.

Lastly, people who already have AD have shown improvement in cognition from an increase in physical activity levels. This study encompassed a wide variety of variables that impact both those at risk and those whom already have AD. A lot of the results were derived from tests involving mice or rats. With that being said, there are many areas that require further investigation. The general trends point towards a positive association between physical activity levels and the risk of developing AD.

PATIENT CARE

The last element of AD that I wanted to cover involves patient care instead of preventative measures. There are millions of people already living with AD that need support now. The elderly population is bigger than ever and as previously stated one in 10 people over 65 will suffer from this disease. This is why I believe it’s important to discuss different approaches to caring for people with AD. After watching what my father has gone through with his mother it is clear how difficult it is cope with this type of neurodegeneration.

The Notebook

Los Angeles Magazine

http://www.lamag.com/wellbeing/forget/

            If this image doesn’t already pull on your heart strings it sure will after you’ve seen the movie. The Notebook (2004), is a love story based on the book written by Nicholas Sparks. It is a beautiful example of how far a dedicated caretaker will go for the person they love. Noah (left) visits Allie (right) every day and reads to her even though she doesn’t usually remember that he is the love of her life. Allie has Alzheimer’s Disease.

Caring for a family member with AD is not easy. To put things into perspective, “More than half of all dementia and Alzheimer’s caregivers report emotional stress as “high or very high,” almost 40 percent suffer from depression; and share that the physical and emotional costs of caregiving equate to $9.7 billion in health care costs of their own” (Alzheimer’s Disease International, 2015). One of the main reasons that family members have begun to take over caregiving is the shortage of facilities available for the growing number of patients. Many of these caregivers aren’t trained to handle certain situations or don’t fully understand the extent of the disease. Although they may have the best intentions, some methods of care are more effective than others.

Spencer (2017) investigated different caregiving techniques with a special focus on deception. One of the methods described is called Shared Reality. This is used in order to avoid causing stress and confusion to the patient. Many times AD patients don’t have a completely factual reality and it is more helpful for the caregiver to just play along with their reality. Validation Therapy is another technique listed that involves making the patient feel as if their emotions are okay instead of trying to argue them. It may seem strange to use the word deception when referring to caregiving, but when working with AD patients there can be a time and place for it. In order to enter the world of someone with dementia sometimes the caregiver must be able to put their factual reality aside. The study concluded that although deception challenges the social norm of telling the truth it can make things easier for both the patient and the caregiver.

Another interesting part of AD patient care is the dynamic between professional and family caregivers. Those who have been caring for their loved one can find it difficult to transfer some of their control to a professional whom they might not know very well. Carpentier and Grenier (2012) studied the relationships between families and professional systems in order to help improve the ways in which the two interact. The article focuses on four caregivers who created the best connections with formal care resources. In conclusion, the study explained that “the challenges related to linkage phenomena will not simply be solved by minor adjustments or establishing new programs. The medical system must also adapt, moving from model of standardized programs to an approach that incorporates the unforeseen, uncertain, and diverse viewpoints”. It will require training for practitioners and institutions in order to form trusting and supportive relationships with families. If professional systems can improve their ability to build relationships with caregivers, then the needs of AD patients can be met more successfully.

CONCLUSION

My exposure to AD certainly inspired my interest in preventative measures and patient care. I am lucky that my grandmother has a happy outlook and upbeat spirit, but I can’t help wish that she could still understand the world the way that she used to. I hope that one day soon we can find the cure but as research has suggested I believe there are ways in which we can take action early, in order to decrease the risk of developing AD in future generations. In this paper I outlined nutrition and physical activity as two preventative measures because those are two factors in life that we have a decent amount of control of. My question is what other important measures can we take to reduce the prevalence of this disease in our world? Sometimes it is hard to acknowledge that what we are doing in the present is going to influence what we experience in the future. After this involved investigation there is still a clear indication that AD has a strong genetic component along with other contributing factors.

The patient care that is occurring now also needs to constantly be evaluated. The astonishing number of AD patients in facilities and involved in home care need to receive the best treatment they can get. The caregiver techniques discussed can be controversial because they contradict what everyone learns about the importance of honesty. If the AD patient were you, how would you want to be treated? Would you rather be confused and frustrated or live in an altered reality? The most important part of this collection of information is the amount of lives that AD touches every year. If we can continue to work towards a cure and practice preventative behavior, then maybe future generations will see a world without AD.

 

References

Alzheimer’s Association (2017). 2017 Alzheimer’s disease facts and figures. Retrieved from http://www.alz.org/facts/

Alzheimer’s Disease International. (2015). World Alzheimer report 2015: The global impact of dementia. Retrieved from: http://www.alz.co.uk/research/WorldAlzheimerReport2015.pdf

Barnard, N. D., Bush, A. I., Ceccarelli, A., Cooper, J., de Jager, C. A., Erickson, K. I., Fraser, G., Kesler, S., Levin, S. M., Lucey, B., Morris, M. C., Squitti, R. (2014). Dietary and lifestyle guidelines for the prevention of Alzheimer’s disease. Neurobiology of Aging, 35 Suppl 2. doi: http://dx.doi.org/10.1016/j.neurobiolaging.2014.03.033

Carpentier, N., & Grenier, A. (2012). Successful linkage between formal and informal care systems: The mobilization of outside help by caregivers of persons with Alzheimer’s disease. Qualitative Health Research, 22(10), 1330-1344. doi:10.1177/1049732312451870

Formulation of evidence-based messages to promote the use of physical activity to prevent and manage Alzheimer’s disease. BMC Public Health, 171-17. doi:10.1186/s12889-017-4090-5

Hu, N., Yu, J., Tan, L., Wang, Y., Sun, L., & Tan, L. (2013). Nutrition and the risk of Alzheimer’s disease. Biomed Research International, 2013524820. doi:10.1155/2013/524820

Isaacson, R. S. & Ochner, C. N. (2016). The Alzheimer’s prevention & treatment diet: Using nutrition to combat the effects of Alzheimer’s disease. Garden City Park, NY: Square One Publishers, Inc.

Loprinzi, P. D. (2015). Need for Increased Promotion of Physical Activity Among Adults at Risk for Alzheimer’s Disease: A Brief Report. Journal of Physical Activity & Health, 12(12), 1601-1604. doi:10.1123/jpah.2014-0554

Ginis, K. A. M., Heisz, J., Spence, J. C., Clark, I. B., Antflick, J., Ardern, C. I., … Rotondi, M. A. (2017). Formulation of evidence-based messages to promote the use of physical activity to prevent and manage Alzheimer’s disease. BMC Public Health, 17, 209. http://doi.org/10.1186/s12889-017-4090-5

Morris, M. C. (2009). The role of nutrition in Alzheimer’s disease: Epidemiological evidence. European Journal of Neurology, 16 Suppl 11-7. doi:10.1111/j.1468-1331.2009.02735.x

National Institute on Aging (2017). About Alzheimer’s Disease: Alzheimer’s Basics. Retrieved from https://www.nia.nih.gov/alzheimers/topics/alzheimers-basics

Ogawa, S. (2014). Nutritional management of older adults with cognitive decline and dementia. Geriatrics & Gerontology International, 14 Suppl 217-22. doi:10.1111/ggi.12252

Phillips, C., Baktir, M. A., Das, D., Lin, B., & Salehi, A. (2015). The Link Between Physical Activity and Cognitive Dysfunction in Alzheimer Disease. Physical Therapy, 95(7), 1046-1060. doi:10.2522/ptj.20140212

Spencer, E. A. (2017). The Use of Deception in Interpersonal Communication with Alzheimer’s Disease Patients. Midwest Quarterly, 58(2), 176-194.

Tortosa-Martínez, J., & Clow, A. (2012). Does physical activity reduce risk for Alzheimer’s disease through interaction with the stress neuroendocrine system?. Stress: The International Journal On The Biology Of Stress, 15(3), 243-261. doi:10.3109/10253890.2011.629323

Venturini, L., Perna, S., Sardi, F., Faliva, M., Cavagna, P., Bernardinelli, L., & Rondanelli, M. (2014). Alzheimer’s Disease: From Genes to Nutrition. European Journal Of Inflammation (BIOLIFE, S.A.S.), 12(3), 405-414. doi:10.1177/1721727X1401200301

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2 thoughts on “Let’s Change the Odds: Interdisciplinary Analysis of Alzheimer’s Disease

  1. I think there may have been room here for more aspects in the research (the science of the disease itself is pretty quick as covered here, and I’d be interested also to know more about the history of research and understanding and care around the disease), but what you do cover is very clearly explained. And to have it all situated in the context of your grandmother’s story is very powerful. Your intro and conclusion are really the most resonant parts of this article, where you reveal your compassion, your intellectual curiosity, and your advocacy for the kinds of research and care models that will help diminish the negative effects of this disease.

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