What are the early signs of Alzheimer’s?
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Most people associate dementia with short-term memory loss; someone with the condition can’t remember the prime minister’s name or where they left their car keys. But that inability to recall simple facts is not the only early sign of dementia, says Dr Selina Wray, Alzheimer’s Research UK senior research fellow and winner of the Alzheimer’s Research UK David Hague Early Career Investigator of the Year Award 2018.
“Memory loss is a common feature of early Alzheimer’s,” says Dr Wray, who is based at the UCL Institute of Neurology, “but there are several others which appear frequently, such as personality changes, apathy and withdrawal, aggression and a decline in spatial familiarity, which can make it difficult to navigate well-known routes.”
Quite often, she adds, dementia can be misdiagnosed, because symptoms such as withdrawal or apathy are not instantly recognised as related to dementia. Sometimes, it may be a partner or close relative who has noticed some behavioural changes and arranged an appointment.
What all these symptoms have in common is that they are caused by cell death – specifically neurons (or brain cells) located in the area of the brain which regulates or controls them.
“The brain is the most complex object in the universe,” says Dr Wray. “It’s highly organised too; each region has specific responsibility for different human processes, from movement to speech to our emotions.”
In a brain with Alzheimer’s, neurons get swamped by an abnormal build-up of proteins – specifically two proteins, called amyloid and tau – which cause cell death.
For many people this happens first in the cortex – that part of the brain which is associated with emotion and empathy, and the store of short-term memories and navigation. So when cells die in that region, they experience the corresponding symptoms of memory loss, mood swings and mental fogginess.
As the disease progresses, other areas of the brain become affected, reducing motor skills, eventually including those responsible for eating and moving. When Alzheimer’s – the most common cause of dementia – is very advanced, people need full-time medical care and assistance with eating and moving. Ultimately, this can lead them to an increased susceptibility to infection, weight loss, and complications, which is why dementia is now recognised as the leading cause of death in the UK.
At the moment, there is no way of stopping the progression of diseases like Alzheimer’s, let alone a cure. Drugs called cholinesterase inhibitors, such as Aricept, can relieve symptoms by boosting brain cell activity for up to 18 months but cannot slow or reverse damage.
Yet scientists believe that spotting symptoms early and a correspondingly swift diagnosis is crucial.
“I can explain the science,” says Dr Wray, “but when the conversation about dementia is led by those with the illness, as with other diseases, it helps to destigmatise dementia. This really reduces people’s fear of it.”
Early diagnosis also supports medical research, because scientists can try drug therapies at a time when people are in the early stages of the disease, when they’re more likely to be most effective.
“Dementia is not inevitable,” says Dr Wray, “and although there isn’t anything we know which reduces the risk 100 per cent, there is convincing evidence that a healthy diet, exercise and only drinking alcohol in moderation could be useful.
“There is also research which suggests that the proteins which are responsible for cell death may be cleared during the night as long as we are getting enough good-quality hours of sleep. It’s not proven yet, but it is exciting.” Telegraph.
