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Alzheimer's Disease  Diabetes Link

What is Alzheimer's Disease?

Causes

The main culprit found to develop Alzheimer's is the deposition of certain proteins in and around brain cells. 

There are two main proteins that are causing such deposits including:

• amyloid
• tau protein 

Amyloid is a natural protein found in the brain cells (neurons). When beta-amyloid proteins clump together, they tend to form some types of hard plaques locating between the brain cells (neurons). In this way, they do not carry the normal function, ending up in abnormal neurological functioning with Alzheimer's symptoms. 

The tau proteins are also natural part of nerve cells. Its function is to regulate the transportation of nutrient and other types of substances from one side of the nerve cells to the other. In patients with Alzheimer, the tau proteins are also falling abnormal and tend to form neurofibrillary tangles. 

Altogether, the characteristic histopathological, molecular and biochemical abnormalities of AD include cell loss, many neurofibrillary tangles, dystrophic neurites, amyloid precursor protein, beta amyloid deposits, increased activation of prodeath genes, impaired energy metabolism, mitochondrial dysfunction, chronic oxidative stress, DNA damage. 

Risk factors

There is no exact triggering factor for developing Alzheimer. However, there are some others that can increase the risk for Alzheimer's onset as following: 

• Age
• Gender
• Family history
• Head trauma/injuries
• Down Syndrome
• Cardiovascular disease
• Alcohol
• Smoking
• Obesity
• Sedentary life
• Diabetes
• High blood pressure
• High cholesterol
• Untreated depression
• Living alone
• Hearing loss

Symptoms

There is one characteristic for the symptoms of Alzheimer's disease: they tend to set gradually over time. That's why they go undiagnosed or misdiagnosed and confused with other pathologies. Sometimes, there are some other illness such as infections, delirium or stroke that can make the symptoms get worse enough to serve as a ringing bell signaling Alzheimer onset. 

There are three main stages for the disease:

1. Early stage
2. Middle-stage 
3. Later stage.    

The memory problems are the most noted one that tends to get worse in time. Meanwhile, moods/behavior changes, hallucinations, difficulty to speak or perform daily tasks tend to worsen from early stage to middle-age and later stage.

Type 3 Diabetes

Here we go, type 3 diabetes is something new that we need to explain it more. Yes, this other type of diabetes, the number 3 is related to how the nerve cells use sugar. 

1. Insulin resistance - Diabetes is characterized by insulin resistance. So, there is too much of blood sugar and insulin at the same time. Sugar is not getting used properly by the brain cells because insulin is not working properly. This leads to atherosclerotic (fatty) plaques on the blood vessels. 

On the other hand, the non-used insulin remains inside the bloodstream, and can alter the functioning of many substances in the brain cells.  

2. Damages of blood vessels - It is a well known fact that persistent high blood sugar levels can cause chronic inflammation and high oxidative stress to blood vessels. This can lead to Alzheimer onset. 

On the other hand, the presence of persistent inflammation can make it hard for the brain cells to utilize insulin, increasing the chances for insulin resistance and AD. 

3. Altered Nerve transmission: As we described above, there are deposits of proteins in the neurons, that make it difficult for them to function properly because they clump together, sticking in between the neurons. Thus, it makes it difficult for neuron communication and signal transmissions. 

4. Tangled Tau Proteins - The nutrients are helped by tau protein to move in one direction from one part of the nerve cells to the other. In diabetics, these tau proteins are more tangled as compared to non-diabetics. The more tangled the tau protein the higher the chances for nerve cells to die. Unfortunately, the nerve cells cannot get repaired over time. The one lost is lost forever increasing the risk for more severe symptoms of AD and dementia. 

Treatment

There are 2 main lines for treatment in AD: 

1. Medications

2. Cognitive and Rehabilitation Therapies

We should emphasize that

 There is NO specific treatment for AD

1. Medications

The main aim of these medications are to ease the symptoms. They include: 

• Acetylcholinesterase (AChE) inhibitors such as Rivastigmine, galantamine and donepezil are prescribed for early to mid stage AD. 
• Memantine blocks the effects of glutamate which is being excessively produced by the brain of moderately and severely AD patients. 

There is another type of medications which are used to treat challenging behavior such as depression, mood changes, etc. 

Neurologist or psychiatrist will decide the best treatment strategy. That's why it is important to get regular follow  ups with the specialist. 

2. Cognitive and Rehabilitation Therapies

The aim is to help AD patients to live well with dementia. They include: 

• Cognitive stimulation therapy
• Cognitive Rehabiliation
• Reminiscence and life story work

Prevention

Prevention is better than curing.

As mentioned above, there is no specific risk factor for AD. However, studies have concluded that lifestyle changes can reduce the risk of developing AD. 

Most important, taking good control of your blood sugar levels, giving up to alcohol and smoking, taking part in physical activities organized in fresh air, can also help reduce the chance for AD. 

Treating chronic illnesses adequately such as cardiovascular diseases, diabetes, hearing loss, depression can also reduce that chance. 

We do encourage elderly to keep socialized and mentally active. Running daily activities that keeps your brain and body busy will also help. 

Written by                                                                                Edited by

Dr.Albana Greca, MD                                                        Dr.Ruden Cakoni, MD