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How does Alzheimer’s lead to death? – Alzheimer’s Disease

Alzheimer’s disease is a condition in which the brain cells die gradually and progressively, leading to changes in behavior and memory loss.

It is the most common form of dementia, and it affects people over 60 years old. It is the sixth leading cause of death in the United States. Within this article, you will find answers to some of the most frequent questions like what makes Alzheimer’s a deadly disease, and many others. Before reaching that point, there will be brief explanations about the basic concepts of the disease.

By reading this article, you will obtain key insights about Alzheimer’s disease, its causes, who are likely to develop it, and many others. Please continue reading to get pearls on this specific topic by the hand of a Doctor. 

What is Alzheimer’s disease?

Alzheimer’s is a neurodegenerative disease in which nerve cells die gradually and progressively. It is the leading cause of dementia, accounting for at least two-thirds of dementia cases in people over 65 years old. It has an acute onset and a progressive impairment of the behavioral and cognitive functions of the patient. These impairments include memory loss, comprehension, language, attention, reasoning, and judgment. It primarily affects the hippocampus in the brain; the hippocampus is the part of the brain, which is in charge of the memory. This disease has various stages that reflect the symptoms and the progression of the disease. In later stages of the disease, it shrinks the brain’s size and causes Alzheimer’s patients to ultimately die. The stages of Alzheimer’s disease are the following.

Preclinical

In this stage, the damage begins near the hippocampus and eventually reaches it. The hippocampus is a structure essential for the formation of short-term and long-term memories. The memory loss is the first visible sign. The hippocampus begins to atrophy. However, these brain changes occur decades before any signs or symptoms appear. At this stage, the patients can make their normal living without noticing the disease.

Mild Cognitive Impairment

In the mild stage of Alzheimer’s disease, the condition begins to progress, and memory problems start to appear. The disease at this stage affects the brain regions that are in charge of memory, language, and reasoning, but the patient seems healthy. However, these individuals continue to work, socialize, and function independently. But these patients have more and more trouble making sense of the world around them as they take longer to complete routine daily tasks. This is the most common stage for the diagnosis of the disease. 

Moderate (Dementia)

In moderate Alzheimer’s disease, the brain’s damage has spread, and the brain continues to atrophy. It affects sensory processing and conscious thought, asides from the language, memory, and reasoning. All of these changes lead to Alzheimer’s dementia. People in this stage begin to have problems recognizing family and friends. They may be unable to learn new things or carry out simple daily tasks. People at this stage may have hallucinations, delusions, paranoia, and impulsive behavior due to extensive brain damage.  

Severe

In severe Alzheimer’s disease, the brain shrinks significantly due to atrophy. These patients cannot communicate as they have lost the ability and cannot recognize their family. It is a stage of terminal illness in which the patient depends totally on hospice care. Near the end, the Alzheimer’s patients may be in bed the whole time as their bodies slowly shut down.

What is the difference between Dementia and Alzheimer’s disease?

Although people believe dementia and Alzheimer’s are the same, they are not. Dementia is a general term for a cognitive (mental) decline, which is severe enough to interfere with daily life. On the other hand, Alzheimer’s is the most common cause of dementia in older adults. It is a specific disease, dementia is not. Knowing the difference between them is essential. It may help the family and the caregivers give them the necessary knowledge of the patient’s condition. 

Alzheimer’s is a degenerative disease in the brain that runs with complex brain changes leading to cell damage and atrophy of the brain. The brain tissue shrinks progressively due to this disease. This leads to symptoms that gradually get worse leading to dementia. Ultimately it leads to an impossibility to communicate, walking, comprehend, or reasoning. It is a disease with no chance of betterment, either of its progression or to cure it.

On the other hand, dementia is a general term that describes a group of symptoms related to a decline in memory, reasoning, and other skills. Although Alzheimer’s is the most common cause of dementia, there are many types of dementia and several reasons. Among the types of dementia, we can find the following:

  • Vascular dementia: It is the second most common cause after Alzheimer’s dementia. Cerebrovascular disease (Strokes) is a primary risk factor for developing this kind of dementia.
  • Lewy Body Dementia
  • Frontotemporal Dementia
  • Mixed Dementia
  • Creutzfeldt-Jakob Disease
  • Huntington’s Disease
  • Down Syndrome and Alzheimer’s disease
  • Parkinson’s disease dementia
  • Korsakoff Syndrome
  • Posterior Cortical Atrophy
  • Normal-pressure hydrocephalus

How does Alzheimer’s disease affect the brain?

Alzheimer’s disease induces multiple microscopic changes in the brain, and these changes lead to an alteration in brain function. Scientists believe that this disease begins after a combination of genetics, lifestyle, and environmental factors. Although the specific causes are still in study, reports show that there are proteins that do not normally work in this disease. This malfunction disrupts the work of brain cells. It produces toxic events for the cells, eventually leading to damage and breaking the connections leading to the cell’s death.

There are two protagonists in how Alzheimer’s disease affects the brain. Alzheimer’s disease characterizes itself for an accumulation of abnormal neuritic plaques and neurofibrillary tangles. These plaques have a conformation of Beta-Amyloid, a protein within the brain, which is why they receive the name of amyloid plaques. They exist at normal levels within the brain. Still, due to genetic factors and aging, the production of this protein grows becoming dangerous to the neurons. The deposition of beta-amyloid produces a toxic reaction and damage the communication between neurons. 

These plaques accumulate outside of the neurons and produce an alteration of the protein “Tau.” The protein tau is an essential part of the microtubules in the neurons. These microtubules act as the skeleton of the cells. The alteration of this protein destabilizes the microtubules causing them to entangle within the neuron. Both of these leads to a response of the immune system that attacks the erratic neurons asides from the toxicity. The immune response leads to neuronal death, which also leads to brain atrophy.

Who’s likely to get Alzheimer’s disease?

Alzheimer’s is a disease that commonly affects people over 65 years old, and as people grow older, the risk rises. It is important to remember that Alzheimer’s is not a normal part of aging. However, there are many risk factors asides from aging for developing the disease. These include the following:

  • Genetics and Family History: Having a first-degree relative, for example, a sibling or a parent with the diseases, increases the risk of developing the disease. Specific genetic mutations make people very likely to develop Alzheimer’s. The variation of the Apolipoprotein E gene (APOE) into APOE e4 increases the risk of Alzheimer’s disease. However, not everyone with this variation develops the disease.
  • Down syndrome: In this particular disease, there are three chromosomes instead of two in the 21st pair. Within the 21st pair, there is the gene that produces the beta-amyloid protein, which produces the amyloid plaques. Having three chromosomes means there are three copies of the gene-altering the production and increasing the risk for developing the disease. People with Down syndrome develop Alzheimer’s disease 10 to 20 years earlier than the general population.
  • Sex: Although there is no difference between males or females, the latter tend to develop Alzheimer’s disease because they tend to live longer.
  • Past head trauma.
  • Poor sleep patterns: People who suffer from difficulty falling asleep or staying asleep have a higher risk of developing the disease.
  • Lifestyle and heart health: Recent studies reveal that risk factors for heart disease may also increase the risk of Alzheimer’s. Factors like obesity, lack of exercise, smoking, high blood pressure, high levels of fats in the blood, and diabetes increase the risk of developing cardiovascular disease and Alzheimer’s. However, these are modifiable risk factors that can help to prevent Alzheimer’s.

What makes Alzheimer’s a deadly disease?

There is more to Alzheimer’s disease than just memory loss and cognitive impairment. Alzheimer’s is the sixth-leading cause of death in the United States, and there is no cure. When Alzheimer’s is onset, the progression may be slow, but it will not stop. Therefore it is the same progression of the diseases, which makes it deadly. Studies from 2000 to 2008 demonstrate that death rates from major diseases like stroke or lung cancer actually declined while Alzheimer’s death rate increased two-thirds during that period. 

After the memory loss and cognitive decline, Alzheimer’s may complicate. The physical affectations lead to an inability to communicate or report symptoms or another illness, as well as a failure to follow treatment. As the disease progress, the brain functions begin to alter due to shrinkage of the brain tissue and the loss of connections between neurons. The atrophy of the brain tissue is mainly due to an immune response that seeks to eliminate neurons with a malfunction within them. Therefore, in the later stages of the diseases, the brain changes begin to affect the body, preventing it from developing essential functions like swallowing, balance, and bowel and bladder control. These inabilities lead to further complications making the patient die from infections or accidents having Alzheimer’s as the underlying cause.

It is right to say that Alzheimer’s is one of the most deadly diseases as it will not stop. But what makes Alzheimer’s really deadly is the outcome of the disease. As there is no cure, these patients can only use palliative care to improve their quality of life. However, it is the disease’s progression that increases the possibilities of dying from other causes as the patient cannot move or express any symptoms.

How does Alzheimer’s disease cause people to die?

After Alzheimer’s onset, there is nothing that physicians can do yet to prevent it from progressing. The disease’s progression leads to difficulties in completing necessary physiological acts like swallowing, which may lead to aspiration pneumonia. Aspiration pneumonia is the most common cause of death at the end stage of Alzheimer’s disease. Respiratory diseases represent a challenge for caregivers. They have to bear in mind that this is a possibility in the end-stage. They have to practice continuous aspirations to the patient as they cannot swallow. This can cause the saliva to accumulate and allowing bacteria to reproduce in this habitat leading to respiratory diseases.

Alzheimer’s patients end-stage due to the physical changes are also in bed the whole time as they cannot do simple physical tasks. This may lead as well to the formation of blood clots due to lack of movement, which may lead to a blockage. The blood clots can travel through arteries and veins reaching the heart, kidneys, or brain. This may lead to complications like coronary heart disease, strokes, or even death. 

The patient can also suffer from pressure ulcers or bedsores due to its state. While the patient being unable to move, this makes possible the appearance of these ulcers. This may lead to further complications like skin infections or sepsis, adding more possible causes of death to Alzheimer’s patients.

What are the signs of Alzheimer’s disease?

The signs of the disease may vary depending on the stage. However, the cardinal sign of the disease is memory loss. An early sign of this particular disease is usually having trouble remembering recent events or conversations as these patients cannot create new memories. The patient may be aware of having difficulty with remembering and organizing thoughts. But as the diseases progress, the family may notice how the symptoms get worse. These are the cardinal signs to be aware of:

Memory

The patients with Alzheimer’s disease have a substantial memory loss that is notable. It is a loss that persists and worsens. This may affect the ability to properly function at work or at home. People with Alzheimer’s may:

  • Repeat statements and questions over and over.
  • Get lost in familiar places.
  • Forget conversations or appointments constantly.
  • Have trouble finding words to identify objects or express thoughts.
  • Misplace possessions putting them in illogical locations.

Thinking and Reasoning

Alzheimer’s can cause difficulty concentrating and thinking, especially about abstract concepts like numbers. For these patients, multitasking can represent a struggle. Managing finances, balance checkbooks, and pay bills is something they cannot deal with as the disease progress. This represents a difficulty for daily life, making these patients dependent on their families for everyday tasks.

Judgments and Decisions

The ability to make daily judgments and decisions may decline as the disease get worse. People tend to make erratic decisions in their daily life, including social interactions, or wear clothes that are inappropriate for the moment. For example, a person with Alzheimer’s disease may decide to wear pajamas for a work meeting. 

Planning and performing familiar tasks

Activities that require sequential steps like planning and cooking a meal may become a struggle for the patient. These patients may eventually forget how to dress or take a bath if the disease worsens over time.

Changes in personality and behavior

The course of this disease leads to brain changes that will eventually affect the patient’s moods and actions. These are the most common changes:

  • Depression
  • Social Withdrawal
  • Mood swings
  • Apathy
  • Changes in sleep habits
  • Loss of inhibitions
  • Delusions
  • Irritability and aggressiveness

How is Alzheimer’s disease diagnosed?

To diagnose Alzheimer’s, doctors perform several tests to assess memory impairment and other thinking skills. They also look to judge functional abilities and identify behavior changes. However, with these tests, they seek to rule out other possible causes of impairment. To perform an assertive diagnosis, a specialist in the area should conduct a proper and full examination. This includes a full familiar history to check if any other family suffers from this disease and a thorough physical examination. If possible, a familiar should be in the interview as the patient may have severe cognitive impairment.

In the physical and neurological exam, the physician will be testing the following:

  • Reflexes
  • Muscle tone and strength
  • Sense of sight and hearing
  • Coordination
  • Balance
  • Ability to get up from a chair and walk across the room

The doctor will also perform routine lab tests. These tests may include blood tests and urine tests to rule out other potential causes of memory loss and confusion. Within these entities, the physician may rule out thyroid disorders or vitamin deficiencies.

Brain imaging

Alzheimer’s dementia is a result of the progressive degeneration of the brain cells. This degeneration may show up in a variety of ways in brain scans. However, these tests may not be enough to make a diagnosis. These scans’ usefulness may decrease as there is an overlap in which doctors consider a standard age-related change in the brain and abnormal changes. Brain imaging studies help rule out other causes of cognitive impairment, distinguish between types of degenerative diseases, and establish a baseline on the degree of degeneration. The imaging studies are the following:

  • Magnetic Resonance Imaging (MRI): It is a test that uses waves and magnetic fields to produce a full image of the brain. Although it can show brain shrinkage, the information does not add significant value to the diagnosis.
  • Computerized Tomography (CT): It is an exclusive X-ray technology that produces images in the brain’s slices. Doctors use this study to rule out strokes, tumors, or head injuries.
  • Positron Emission Tomography (PET): PET scans use low radioactive substances to reveal particular features in the brain. The most common material is Fluorodeoxyglucose (FDG). This shows areas in the brain in which nutrients metabolism is poor. This test can help distinguish between Alzheimer’s disease and other types of dementia. However, there are new types of PET scans that can detect amyloid proteins, but they use for now to research. 

Can Alzheimer’s disease be prevented?

Researchers are exploring the possibilities to reduce or prevent Alzheimer’s. Although they are not conclusive, there is proof that patients can reduce the risk of developing the disease. A small percentage of patients may have an early onset of the disease due to genetic mutations. People with these conditions are going to develop the disease.

On the other hand, some studies link the cardiovascular disease with Alzheimer’s disease. Risk factors that may produce cardiovascular disease produce as well Alzheimer’s. Around 80% of the patients that have Alzheimer’s disease also have cardiovascular diseases. Among these risk factors are the following:

That is why reducing the risk factor is so important. Regular physical exercise may be a beneficial strategy to lower the risk of Alzheimer’s and vascular dementia. By doing continuous exercise, the heart muscle strengthens and pumps more blood to the organs through the body. While the brain cells receive more blood, they also receive more oxygen, keeping them healthy. It is also important to include heart-healthy eating in daily life. This kind of eating includes limiting the intake of sugar and saturated fats. It also includes fruits, vegetables, whole grains, and sources of protein like fish.

Activities like maintaining strong social connections and keeping mentally active may help to reduce the risk. Activities like reading books, learning new skills or languages, or playing a musical instrument helps keep the mental activity. There is no specific connection, but it may be due to the social and mental stimulation that connections between cells remain a strength. 

Why has therapy development for dementia failed in the last two decades?

Alzheimer’s disease is a complex disease that, to this date, there is no full comprehension. Since 2003 there are no new drugs in the scheme of treatment of the disease. Over the last two decades, around 200 investigational programs have failed or have been abandoned due to its lack of response. Among the most probable causes of failure of disease-modifying treatments are the following:

  • Late initiation of therapy during Alzheimer’s disease development
  • Inappropriate drug dosages
  • Erroneous selection of treatment targets
  • Inadequate understanding of the complex pathophysiology of Alzheimer’s disease
  • Use of one treatment instead of a combination of treatments

However, efforts in finding a cure are still intact. Alzheimer’s Research UK is the leading dementia charity that dedicates itself to causes, diagnosis, prevention, treatment, and cure. This organization offers education to caregivers about dementia care and how to treat these patients. It also performs clinical trials on volunteers, whether they are healthy or have Alzheimer’s disease. With these clinical trials, the researchers look to fully understand the brain and how Alzheimer’s develops to find a cure.

You or someone you know is having symptoms or risk factors of Alzheimer’s disease?

This tool is an Alzheimer’s disease symptoms checker. It will help to determine the likelihood of someone having risk factors or symptoms of this condition. Importantly, it is free and would only take a few minutes.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.

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