Update on Alzheimer’s disease
By Michèle Sirois, animator at Ère Libre, MAtv and collaborator at the University Institute of Geriatrics of Montreal.
Although scientists are working harder than ever, they have yet to find a drug to cure Alzheimer’s disease. But there is still hope! We now have a better understanding of the mechanisms of this neurocognitive disorder—but what if prevention turned out to be our ultimate weapon?
As we age, brain health becomes a major source of concern—and for good reason. More than 50 million people worldwide suffer from some kind of dementia, including Alzheimer’s disease, it’s most common form. If scientists are unable to discover all of the disease’s mechanisms and no treatments are found, that disturbing statistic is likely to double every 20 years.
Seeking a ray of hope, many people attended a talk by Dr. Fadi Massoud* on January 30, during which he gave an update on Alzheimer’s disease. Invited as part of the Université de Montréal’s series of lectures and workshops (Les belles soirées) and by Centre AvantÂge, Dr. Massoud struck a tone that was both caring and realistic.
What is the difference between dementia and Alzheimer’s disease?
Dementia is a catch-all term that is divided into various categories, as are certain other diseases (e.g. pneumonia includes bacterial pneumonia, viral pneumonia and fungal pneumonia). In the same way, dementia includes Alzheimer’s disease, vascular dementia, dementia with Lewy bodies (DLB), mixed dementia and frontal dementia.
The term dementia is actually outdated. It has a pejorative connotation that is all too often linked to insanity. Several years ago, the scientific and medical communities began using the term neurocognitive disorders.
If we wish to learn how to treat or even prevent Alzheimer’s, we need a better understanding of how the disease develops. In this regard, science has made significant progress in the past three decades.
We now know that as beta-amyloid protein accumulates in the brain and tau protein is modified, inflammation increases, leading to a neurotransmitter deficit. Neurotransmitters convey messages between neurons. In the event of a shortage, communication between neurons is interrupted, ultimately leading to serious brain damage.
Scientists also know that the symptoms of Alzheimer’s (e.g. memory loss, impaired judgment, language problems) develop several years after onset. Thanks among other things to the “plasticity” of our brain and our “cognitive reserve”, Alzheimer’s can go unnoticed for as long as 15 or even 20 years.
- What is brain plasticity?
Brain plasticity (also known as neuroplasticity) is the brain’s capacity to modify how networks of neurons are organized based on lived experience. If a region of the brain becomes ineffective due to the onset of Alzheimer’s, plasticity (or flexibility) means that other neuronal pathways can be created. That way, communication between the neurons is maintained.
- What is cognitive reserve?
The harder the brain worked during a person’s lifetime, the greater his or her cognitive reserve. This is extremely useful during the normal aging process or in Alzheimer’s cases.
Discovering a “miracle drug” ?
One obstacle to the discovery of a “miracle drug” is the fact that diagnoses are made once the disease is at a very advanced stage. As always, it is more difficult to treat a health problem if there is a delay in care.
Buoyed by these discoveries, hundreds of researchers are working hard to find a drug that might cure Alzheimer’s. The disease itself is studied based on various hypotheses. For example, while some researchers are attempting to dissolve proteins that “clump” in the brain, others are seeking to stop these proteins from developing in the first place.
So far, no molecules, diets or vaccines have been developed that will cure Alzheimer’s, although some options being explored appear promising. Even though various drugs have reached Phase 3 (clinical trials) and received extensive media coverage, no new medications have been approved or authorized since 2003.
At the present time, individuals with neurocognitive disorders only have access to two types of drugs, both of which are aimed at slowing the evolution of symptoms over time.
Nevertheless, the research being conducted is moving the science forward. As we explore, we are learning more and more about the risk factors that predispose individuals to Alzheimer’s, as well as about factors that may protect against the disease.
Caring for Alzheimer’s patients and their loved ones is an area of focus for many researchers and healthcare professionals. As we await the arrival of a “miracle drug”, teams are coming up with creative and humane approaches geared towards patients and caregivers alike.
We now know which factors put us at risk for developing Alzheimer’s. The good news is that the impact of a large number of them can be modified.
Dr. Massoud noted that 35% of risk factors can be avoided. Some researchers even believe that up to 50% of Alzheimer’s cases can be prevented!
Non-modifiable risk factors
- Age (the older we are, the greater the risk we will develop a neurocognitive disorder).
- Our family history (the total number of cases in our family).
- Being a woman (science has not yet found an explanation, but women do have a higher risk of developing Alzheimer’s disease—and it’s not because they usually live longer than men).
Modifiable risk factors
- Sedentary lifestyles
- High blood pressure
- Type 2 diabetes
- Social isolation
- Hearing problems
What if it turned out that prevention was our best weapon?
Once again, Dr. Massoud noted that we have various available strategies to protect against Alzheimer’s. So let’s take action where we can, that is, in the area of prevention!
- Exercise regularly. According to Dr. Massoud, the most important thing is not how intensely or how long we exercise, but rather how regularly we do so. He recommends walking for at least 15 minutes EVERY day.
- Stay curious and keep on learning. For example, a new language or a new musical instrument.
- Engage in stimulating recreational activities. Unfortunately, watching TV does not count as “stimulating”!
- Cultivate your social networks. Share your news, keep in touch and ask for help if you need it.
- Make sure your hearing is OK. Hearing-related problems tend to increase isolation.
- Avoid sleeping pills, certain analgesics/antidepressants and decongestants.
- Don’t smoke.
- Drink little or no alcohol. The recommendations issued by the Canadian Coalition for Seniors’ Mental Health are stricter than Educ’Alcool’s.
- For women: 0 to 1 drink per day. No more than 5 glasses per week.
- For men: 0 to 2 drinks per day. No more than 7 drinks per week.
In conclusion, Dr. Massoud noted that our brains age, just as our other organs do. It is normal to notice a few changes after age 60, including:
- Slower reaction time.
- Reduced working memory, e.g. losing our place while reading. Working memory means our capacity to temporarily retain information that we need to accomplish a task.
- Difficulty doing two things at once.
* Dr. Fadi Massoud is a geriatrician at the Institut universitaire de gériatrie de Montréal (IUGM) and at Hôpital Charles-Lemoyne. He is also a professor at the Université de Montréal and the Université de Sherbrooke.