Why Should I Learn?
Learn why Alzheimer’s Disease has no cure, delay, or prevention and leads to AD Dementia. Though this may be true now, as human life expectancy continues to increase, so will AD candidates (possibly you). This will create an AD tsunami by 2050. Despite an AD tsunami and no cure by 2050, prevention may be possible for early detection candidates in Asymptomatic stage. With additional biological knowledge, delay could be possible during Prodromal AD and maybe even for the Mild Cognitive Impairment (MCI) stage.
- Figure 1 is segmented into a Presymptomatic and Synptomatic periods. Figure 1 assumes a 20 year Presymptomatic period with two stages, Asymptomatic and Prodromal AD. Theses are described below. The Symptomatic period has three stages, Mild Cognitive Impairment (MCI), Symptomatic AD, and Dementia. Dementia begins when the patient is no longer able to independently sustain Activities of Daily Living (ADL).
Where do you fit on Figure 1 five stages of AD leading to dementia? Are you a Presymptomatic AD Candidate?
What Should I Learn?
Be informed by gaining knowledge and awareness of Alzheimer’s Disease (AD). Determine if you are a risk candidate. Prevention may become an option. This is especially important for members of families with heredity AD indicators. Prepare yourself with knowledge and realism to manage a lifestyle in an environment where medical services are in decline, appointment wait times are on the increase. and care facilities become more expensive with fewer of them to meet the demand,
Take responsibility for yourself and/or those you love. Researchers indicate AD might be delayed through an active lifestyle. Develop midlife habits such as “Social activities, continued Learning, Exercise (physical and mental), and a healthy Diet (SLED). Bruce stresses not only physical exercise but also mental exercise to pursue knowledge that increases an understanding and acceptance of AD, along with caregiver skills and expectations to manage the disease.
PRESYMPTOMATIC ALZHEIMER’S DISEASE
Autopsies evidence reported AD starts many years before symptoms appear. This Presymptomatic period make today’s caregivers possible future candidates. Also, Presymptomatic AD changed the research focus to prevention along with a need to develop biological diagnostic tools for candidates who do not have cognitive symptoms. The Presymptomatic period has two early stages (Asymptomatic and Prodromal AD – Figure 1 above)
45 – 55 + YRS. ASYMPTOMATIC AD and PREVENTION
Asymptomatic is an assumed 10-year period during which amyloid aggregates accumulate to an unknown level where they triggers Tau fibrils and tangles. Candidates/future patients are unaware of this aggregate accumulation or the trigger level that occurs. Candidates (heredity, ApoE-4 allele, APP mutation) should become aware of their risks, monitor current research for approval of amyloid biological markers such as non-invasive blood tests, and learn about prevention possibilities – – – Review “Bruce’s Hypothesis – Prevent AD. https://alzheimersabcs.com/2019/01/04/510/
55 – 65 + YRS. PRODROMAL AD
Prodromal AD starts when neurons begin to die from fibrils and tangles triggered by the accumulation of aggregated amyloid. Unknowingly, neuron loss starts in the Transentorhinal and Entorhinal Cortex (EC). Then, an unknown mechanism causes neurodegeneration (some believe Tau hyperphosohorylation is involved). Neurodegeneration precedes via unknown pathways to other areas of the brain (Tauopathy). Now, the Brain’s Immune System becomes involved.
BRIAN’S IMMUNE SYSTEM’S COMPLICATIONS
Once fibrils and tangles start (assumed caused by Hyperphosphorylation), the brains immune system is involved. Unfortunately, researcher need more knowledge of both the immune system and Tau Protein. In addition, there are various forms of the Tau protein currently being investigated in basic research. This complicates finding an intervention target. Tau pathology (also not well understood) could be the key for stopping or delaying neurodegeneration before cognitive symptoms appear (MCI).
SYMPTOMATIC ALZHEIMER’S DISEASE
Symptoms begin with a minor memory issue and are classified as Mild Cognitive Impairment (MCI). As the disease progress into this symptomatic stage, patients continue to have a fairly normal lifestyle. When a patient can no longer independently perform Activities of Daily Living (ADL), the AD Dementia stage is reached. With knowledge, a surprisingly normal lifestyle can be managed for many symptomatic years. Bruce provides a detailed desription of these years in his book (see below)
65M- 70 + YRS MILD COGNITIVE IMPAIRMENT (MCI) DELAY
Patients in this stage should become aware of their risks and recognized that neuron loss in the Entorhinal Cortex (EC) has been ongoing for possibly 10 years. The EC is like a computer server for the Brain’s memory control. It passes information from the five sense to the hippocampus for short term memory. Then the hippocampus receives instructions which memory is transferred to long term storage in the Neo-Cortex. Autopsy evidence identified significant damage to the EC at the very mildest stage of AD (evidence – Library –> Ref. 1 & 2 https://alzheimersabcs.com/?p=2132). Also, review evidence-based details in Bruce’s Book.
65 + YRS SYMPTOMATIC ALZHEIMER’S DISEASE
Unfortunately, realism is that even if an intervention was available to halt the disease process during the symptomatic stage, aging neurodegeneration would lead a patient to Dementia. Recommendation is to slow the decline process through SOCIAL interaction, continue to LEARN, EXERCISE, and DIET (SLED). The “L” part can be following on this website along with Bruce’s Book
70 + YRS AD DEMENTIA (QUALITY CARE)
Dementia is the resulting syndrome of Alzheimer’s Disease progression. It transforms an unprepared helper into a caregiver for a senior patient in an environment where decisions are complicated by economics, family, and patient physical health issues. This last stage becomes the image of mental health issues that beg for quality care. A senior population would benefit from creative governmental support such as (H.R. 647 Palliative Care and Hospice Education and Training Act (PCHETA) . https://alzheimersabcs.com/2019/12/23/h-r-647-palliative-care-and-hospice-education-and-training-act-pcheta/ being processed in congress
What Can be Learned
This is a personal choice, as the opportunities are vast, varied, and encompasses all facets of society. AD’s complexity creates stakeholders not only throughout the health industry but other participants with different goals. Such stakeholders might be legal, institutional care, home health aides, medical professional, academia, advocates, etc.. Your personal learning and mental exercise can begin by answering the following stakeholders’ issues:
1. What is realistic help to be provided by caregivers?
2. What is realistic help to be provided for patients?
- 3. What are realistic chances that pharmaceuticals will get a meaningful intervention approved during this decade?
- 4. Will research discover an intervention to meet “meaningful cognitive benefits” required by the FDA for market approval?
- 5. What is the chance that the National Alzheimer’s Project ACT (NAPA) number one goal, “to treat and prevent Alzheimer’s Disease and Related Dementia by 2025”, will be met?
- 6. What are chances that politicians will address future Mental Care needs for the increasing caregiver/patient population?
- 7. What are realistic expectations for symptomatic patients proceeding to AD Dementia?
- 8. Are professional football’s financial rewards worth the probable risk of Mental Health problems, Alzheimer’s Disease, and Dementia?
- 9. What geriatric medical preparations are needed for the coming AD-Dementia tsunami?
- 10. What are realistic expectations for Alzheimer’s Disease Presymptomatic candidate?
- 11. What insurance expectations should Presymtomatic candidates have?
- !2. What does AD Prevention and Delay mean?
- 13. Does caregiving need academia studies and research or simply quality patient support?
- Bruce’s Book (Pictured here) provides four narrative chapters of his ongoing 19 years of experience caring for his wife’s AD and Dementia (and dealing with non-verbal adverse events). There are four chapters for AD learning, as well as a mental exercise and challenge of Alzheimer’s Disease and Dementia complexities. Finally, Appendix D contains a case study of the Alzheimer’s Vaccine (AN-1792) failed trial.