Alzheimer’s and your brain

Posted on 4 August 2016

Dr Jaco Cilliers, a neurologist at Mediclinic Bloemfontein, helps us understand how Alzheimer’s works by explaining exactly what happens to your brain during the disease.

What is Alzheimer’s disease (AD)?
Simply put, AD happens to a number of people, usually during old age, and is characterised by mental deterioration. Normal cognitive functioning, like language and complex learned behaviours, becomes impaired and worsens as the brain degenerates over a period of time.

That’s because nerve cells in certain areas of the brain die, certain abnormal proteins accumulate, and the brain shrinks (atrophies) as gaps develop in the areas responsible for storing and retrieving new information. The easiest way to visualise the process is if you think of the brain as a grape – with AD, it becomes more like a raisin.

What are the early symptoms of Alzheimer’s disease?
Patients come in with complaints of forgetting things – for example, linguistically they experience words ‘going missing’. Over time, the ‘forgetting’ becomes more prominent as cognitive functioning degenerates. Now it’s not just words they’re forgetting; learned verbal exchanges like ‘Hello, how are you?’ or ‘Fine, thank you’ remain and can be run through without fault. But if you continue to chat, the content of their speech becomes more empty as the disease progresses.

Many patients also develop apraxia, where learned complex behaviour – like using the TV remote, dialling on a cellphone or using the microwave – goes missing. Once the disease has progressed even further, the patient’s perception that there’s something wrong with them goes missing as well.

AD usually occurs from the age of 65 or later, but in some cases earlier. Studies have shown that by the age of 85, 30 to 40% of patients have the pathology of AD in their brains. If a patient is younger than 55 and experiencing ‘forgetting’, it’s usually due to something else rather than AD – brought on by conditions like depression, stroke, drugs, extreme stress and so on. In such a patient I’d automatically try to exclude these first in trying to reach a proper diagnosis.

Is there any further research happening in the area of AD prevention?
There are more than 600 ongoing studies on Alzheimer’s across the world, but no concrete results for anything curative or preventative – yet. There are promising studies being conducted where researchers are hoping to discover Alzheimer’s biomarkers in a patient’s blood or spinal fluid as a kind of early warning sign, but they are still ongoing.

What we have discovered is that we can’t physically change what’s happening in the brain. Alzheimer’s symptoms can be alleviated somewhat with drugs that improve the symptoms slightly and help to improve memory and retain some cognitive functioning. Treatment also depends on what else is wrong: for example, some AD patients are also paranoid, aggressive or – at the other end of the spectrum – apathetic, and treatment needs to address those issues as well.