Written by SMH Copywriter Phil Lederer
More than 5 million Americans are currently living with Alzheimer’s disease, according to the Alzheimer’s Association, and that number is projected to rise to as many as 14 million by 2050.
The disease is the sixth leading cause of death in the U.S. — killing more than breast cancer and prostate cancer combined — and deaths due to Alzheimer’s have increased by 146% since the year 2000.
“It’s a significant problem for individuals, for their families and for all of us as citizens,” says Sarasota Memorial neurologist Alan Grindal, MD, who specializes in geriatric medicine and particularly Alzheimer’s disease. “In 2050, there’s only going to be two types of people in the world: those with Alzheimer’s and the ones taking care of them.”
Rogue Proteins – Plaques & Tangles
Traditionally, Alzheimer’s disease was diagnosed based on the presence of two harmful abnormalities, both caused by naturally occurring proteins that had gone off-script and weren’t being properly disposed of by the body. These are called amyloid plaque and neurofibrillary tangle.
Amyloid plaques are the gradual buildup and accumulation of protein fragments between neurons; these form when Alzheimer’s disrupts the brain’s normal disposal process for the proteins, eventually impacting cognitive function. Neurofibrillary tangles are the buildup of tau protein within healthy neurons. In a healthy brain, this protein binds with neurons’ internal structures, which in turn help disperse nutrients and molecules throughout the neuron. As Alzheimer’s sets in, however, the tau protein instead binds with other tau proteins, forming long protein threads within the neuron; these threads become protein tangles and interfere with the neuron’s ability to function.
Together, amyloid plaques and neurofibrillary tangles disrupt both internal and external neuron function, affecting how systems in the brain operate and contributing in large part to what physicians today understand as Alzheimer’s disease.
A Closer Look at 'Amyloid Plaque'
The first abnormality to present itself, and the one most familiar to the general public, is the oft-referenced "amyloid plaque" present in the brains of patients with Alzheimer’s. But what is this plaque?
Amyloid plaque is a gradual buildup and accumulation of protein fragments, called beta-amyloid, that forms between neurons, eventually impacting brain function.
The parent protein, amyloid precursor protein, can be found in large concentrations in the synapses of neurons; its primary function is not yet certain, but researchers theorize that it plays an important role in synapse formation, neural plasticity and more. As this amyloid serves its regular purpose in a healthy brain, it is broken down and disposed of. Alzheimer’s disrupts this process.
“The issue is that it is not properly broken down,” explains Dr. Grindal, and the patient is left with protein fragments that cannot be properly disposed of, so they accumulate in the brain instead.
Some of these protein fragments, such as beta-amyloid 42, can be particularly toxic. As time passes and more fragments accumulate, these beta-amyloid fragments develop into a “diffuse fibrous material,” says Dr. Grindal, “that blocks the synapse — the connection between nerve cells — and blocks the transmissions from one cell to another.”
Treatment & Research
Many physicians, including Dr. Grindal, believe that the amyloid plaque precedes the tau tangles, and so many physicians maintain that removing this plaque buildup may be the key to intervention for those with Alzheimer’s. But so far, removing the plaque has not proven successful.
“By the time symptoms develop, the disease is already well-established,” says Dr. Grindal. “In a sense, the brain cells are already irreversibly damaged and the likelihood of recovery lower. It doesn’t do much good to put out the fire if the house has already burned down.”
Dr. Grindal believes that research should instead be focused on how to prevent the plaque from ever forming in the first place. For that, he needs to study younger patients, he says.
“We know that the amyloid process may be going on for 15 to 20 years before people ever develop symptoms,” he says. “The real target may well be people in their 40s.” If amyloid buildup can be detected early, maybe it can be disrupted before they harden into a stubborn plaque.”
Using a PET scan, doctors and researchers have long been able to locate, identify and study the amount of amyloid plaque in a patient’s brain. However, widespread identification of potential research participants, patients who are high risk or have early buildup, is not currently possible because the discovery process is very expensive and it’s not covered by Medicaid.
Preventing the Plaque that Causes Alzheimer’s
While doctors do not yet have an effective treatment for removing amyloid plaque or curing Alzheimer’s disease, there are preventative measures that studies say can help prevent amyloid buildup from ever occurring.
Exercise – People who physically exercise have a significantly decreased incidence of Alzheimer’s, according to Dr. Grindal.
Diet – Avoid smoking and overdrinking, and try to generally eat healthy. Dr. Grindal points out that numerous studies have shown the Mediterranean Diet to have possible preventative effects when it comes to Alzheimer’s.
Keep your mind active – Engage in challenging, but not frustrating activities, says Dr. Grindal. Crossword puzzles are commonly adopted, but you can also try learning a musical instrument or another language, or enroll in a course and keep your studies going as a lifelong learner.
Social Interaction – The engaging complexities of interpersonal communication and behavior stimulate the mind while keeping spirits up, ideally. Those who isolate themselves are at “much higher risk” of developing Alzheimer’s than others, Dr. Grindal says.
Sleep – A good, healthy sleep routine is thought to be a promising preventative method. Untreated sleep disorders, particularly sleep apnea, can lead to a much higher risk of developing Alzheimer’s.
As a Sarasota Memorial copywriter and wordsmith, local journalist Philip Lederer crafts a variety of external communications for the healthcare system. He earned his Master’s degree in Public Administration and Political Philosophy from Morehead State University, Ky.