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A Deeper Look into Alzheimer’s Disease

  • 24 Oct 2023
  • 5 mins

Dementia is an umbrella term for conditions that involve the loss of memory, thinking skills, and other mental abilities severe enough to interfere with daily life. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s ability to function, to the more severe cases, where a person will need assistance from others to function and move around.

Alzheimer’s disease is the most common type of dementia worldwide, and it results in a progressive and irreversible loss of cognitive abilities (memory, language skills, judgment, and decision-making, among others) in sufferers of the disease. In its early stages, memory loss tends to be mild, but in the later stages of the disease, patients will eventually become dependent on their caregivers for basic activities such as feeding themselves and using the toilet. Individuals will also eventually lose the ability to carry on a conversation and respond to their environment.

History of Alzheimer’s Disease

The disease got its name from Dr. Alois Alzheimer. In 1901, Alzheimer oversaw the care of Auguste Deter, who was admitted into the Frankfurt Mental Hospital over an ‘unusual mental illness’. Deter was unable to answer to her name nor able to write it down, she gave the wrong answer when asked what she was eating and was unable to fully remember the objects she had looked at. Throughout her stay at the hospital, Deter’s behaviour would fluctuate between loud crying to others and acting politely and kindly to people around her. Eventually, she had to be kept in an isolated ward that was securely locked to protect herself. As time passed, Deter ended up losing all cognitive ability and succumbed to septicemia and pneumonia in 1906.

After conducting a biopsy of Deter’s brain, he found the cerebral cortex, the region of the brain that controls memory, language, judgment and thinking, much thinner than normal. Abnormal plaques were found in her neurons, and tangles could be seen in nerve fibers. Deter would later go on to become the first known case of Alzheimer’s disease.

Early Symptoms of Dementia

According to psychiatrist Dr. Tan Hong Yee, one of the most common early signs of Alzheimer’s Disease is difficulty remembering recently-learned information or recent events.

“This may include forgetting important dates or events, or asking for the same information repeatedly,” Dr. Tan adds. “They may keep things or money away, and have difficulties remembering where to find them.”

Early memory difficulties are often attributed to a risk of progression to dementia. Occasionally forgetting something, such as misplacing your keys or forgetting someone’s name, is normal. However, in dementia, this forgetfulness appears more frequently and severely. With normal forgetfulness, your daily activities typically aren’t significantly affected. For example, it is normal to forget an item on your shopping list, it is however not normal to forget how to get home from the grocery store.

Furthermore, dementia is often more than just forgetfulness.

It can affect other cognitive functions like problem-solving, where one might have difficulty completing familiar tasks; language, where one might have trouble continuing a conversation; and remembering the names of familiar objects. It can also affect one’s spatial awareness, causing those suffering from Alzheimer’s to have trouble with properly gauging distance and colour, and paying less attention to keeping themselves clean.

Dementia is also often accompanied by a noticeable change in mood and behaviour.

“A person with Alzheimer's may start to withdraw from hobbies, social activities, work projects, or sports,” Dr. Tan states. “There can also be associated behavioral and psychological symptoms of dementia, such as confusion, suspicion, depression, anxiety, or becoming easily upset, especially in unfamiliar situations.”

If you have concerns over memory problems, you are advised to seek medical advice. Your doctor will conduct a series of assessments including cognitive tests, medical history reviews and review tests to help determine whether the forgetfulness is related to normal ageing or indicative of a more serious condition like dementia.

Even though there is no cure for Alzheimer’s Disease, there are interventions and medications available that slow down the disease’s progression.

That is why early detection is important, it can help patients and their families retain independence and a good quality of life. Early detection can also give patients and their family sufficient time to make preparations for the future. For example, while patients still have the ability to make decisions on their own, they should consider setting up a Lasting Power of Attorney (LPA) through their doctor or psychiatrist.

Risk Factors for Alzheimer’s

The onset of Alzheimer’s disease is a complex interplay of age, genetics and lifestyle factors.

Age does not actually cause Alzheimer’s disease but it is a significant risk factor for the condition. The vast majority of Alzheimer’s cases have a late onset, typically after the age of 65 years. Age-related changes to the brain such as the shrinking of certain parts of the brain, vascular damage and the breakdown of energy production within cells could be reasons why age is an important risk factor for Alzheimer’s.

Having a family member with Alzheimer’s does not mean you will develop the condition for sure, but it does mean you are more likely to develop it than someone with no family history of the condition. The risk also increases if there is more than one family member with dementia.

Studies have also shown that people with hearing loss have an increased chance of developing dementia. This is as hearing loss can cause the brain to work harder, forcing the brain to strain itself to fill it the gaps for what the ears could not hear. This diversion in cognitive resources to make sense of what one is hearing can result in less cognitive reserves being available for memory and other thinking functions.

Aside from these factors, Dr. Tan states there are lifestyle factors that increases the risk of developing Alzheimer’s disease. This includes “excessive alcohol consumption, chronic sleep deprivation, a sedentary lifestyle, high blood pressure, high cholesterol levels and diabetes.”

Ways to prevent Alzheimer’s

As the cause of Alzheimer’s disease is still unknown, there is no definite way to prevent the condition but there are still ways you can lower your risk in developing Alzheimer’s. Going for regular health checks can help ensure that any cardiovascular risk factors (blood pressure, cholesterol, high blood sugar) are well-controlled. Here are some other steps you can take to reduce your risk of getting the disease:

Stop smoking

Smoking increases the risk of cardiovascular problems. In addition, toxins in cigarette smoke causes inflammation and stress to cells which have been linked to the development of Alzheimer’s disease. Studies have shown that smokers are at a significantly higher risk of developing dementia, with current smokers 40% more likely to develop Alzheimer’s disease. Alternatively, studies have also shown that quitting smoking can erase the higher risk for brain harm. Quitting at any time will be beneficial but the early you quit, the better.

Cut down on alcohol

Alcohol has a toxic effect on the body’s central nervous system which results in changes to one’s metabolism, heart functions and blood flow. People who drink heavily over a long period of time are also more likely to have reduced white matter in their brain. White matter is associated with the transmission of signals between different brain region. A decline in thinking-related abilities is a gradual process and will depend on how much alcohol one has consumed and for how long.

Exercise regularly

Regular physical activity has been shown to reduce your risk of cognitive decline, which includes dementia. Exercise helps to improve your memory by forming new synapses that mediate learning and memory, making it easier for you to absorb information and form long-term memories.

Frequent social interaction and lifelong learning

Maintaining an active lifestyle with frequent social interaction and lifelong learning has been shown to reduce the risk of Alzheimer’s disease1.

Building up your brain’s ability to cope with diseases and relieve stress by engaging lifelong learning may help to delay or prevent the onset of dementia as you age. It is best to find activities that challenge your brain, this could range from puzzles or crosswords, to other activities such as working on arts and crafts, reading books, learning a new language, or playing card games.

Social activities are also a good way to engage your brains, this involves activities that let you interact with people in person and online. Having conversations with people can help you exercise a wide range of mental skills such as active listening, finding the right words to express what you want to say, and recalling things that have happened and are relevant to the conversation.

A study conducted in Finland2 showed that lifestyle changes consisting of good dietary habits, exercises and social interactions resulted in reduced cognitive decline in people at risk of dementia. Similarly, in Singapore, studies have looked at activities such as exercise (Tai chi), choral singing, or art therapy3/4, and found that these activities reduced cognitive decline as well.

Contributed by

Dr. Tan Hong Yee
Mind Care Clinic
Farrer Park Hospital