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HomeBlogAlzheimer’s: new thinking on securing release from the disease known as the living death sentence

Alzheimer’s: new thinking on securing release from the disease known as the living death sentence

By: Medix Team
Alzheimer’s: new thinking on securing release from the disease known as the living death sentence

Many countries are falling short of the World Health Organisation’s (WHO) dementia targets. Why is it proving difficult to combat the disease that so many of us fear? But there are hopeful signs, as new Alzheimer’s drugs reach the approval stage and we all become more aware of simple steps we can take to reduce our risk levels.

There are few greater fears than slowing losing your mind, or watching someone you love lose theirs: that ebbing away of what makes us each unique, combined with the threat of physical pain as we, or they, lose the ability to stay out of harm’s way.

 

Dementia isn’t a normal part of the ageing process, but a disease. And in 2017, the WHO decided to tackle it head on. It set a number of targets for 2025 including doubling research funding and getting 75% of member states to develop a national plan.

 

However, its latest annual review shows that much of the world isn’t keeping up. Only 40 countries have a plan and the WHO is still predicting that dementia sufferers will rise from today’s 50 million to 152 million by 2050. The largest number live in Asia Pacific: China leads on 9.5 million.

 

Does this mean that we’ve made little progress since 1906 when the German doctor Alois Alzheimer performed an autopsy on a woman who’d died at the Frankfurt Irrenschloss (Castle of the Insane)? He noticed that her brain had accumulated a large number of abnormal protein clumps (amyloid-beta plaques) and tangled fibres (tau).

 

This led to the theory that Alzheimer’s, the most common form of dementia, is caused by a build up of plaques and tau. Communication between brain cells (neurons) breaks down, as do repair and renewal mechanisms. The brain starts to die.

 

However, not everyone agrees, since some people have lots of plaques but no Alzheimer’s. The debate burst into the open again this summer when the US Food and Drug Administration (FDA) approved the first new drug since 2003.

 

It’s called aducanumab (brand name Aduhelm) and it breaks up abnormal protein clumps using lab-created molecules called monoclonal antibodies, which mimic the immune system (any drugs ending in mab are based on the technique).

 

However, the FDA’s independent advisory committee universally voted against approval and three members resigned after it went ahead anyway. The FDA has now called for a federal investigation into its own approval process.

 

The advisory board decided that the trial hadn’t reached a high-enough clinical threshold (the FDA application was based on one data subset, which showed cognitive improvement among patients who’d been given the highest dose).

 

Nevertheless, the FDA decided to approve Biogen and Eisai’s drug under its Accelerated Approval Programme on the basis that it breaks up protein clumps. Approval was also conditional on a follow-up trial to confirm that it improves brain function as well.

 

Advocates say that the world desperately needs an Alzheimer’s drug, which can tackle the biological cause of the disease rather than just the symptoms. But others believe that too much funding has already been thrown at minimising amyloid-beta plaques to no avail.

 

There’s already been a knock-on effect. A second drug manufacturer, Eli Lilly, plans to accelerate an FDA application for its own Alzheimer’s drug, donanemab, before the end of 2021 (it also removes a type of amyloid-beta). Phase II trial participants recorded a 32% slower decline in certain brain functions compared to those on the placebo.

 

Biogen and Eisai also have a second prospective Alzheimer’s drug in the works called lecanemab. This removes clumps too and received FDA breakthrough status this summer, speeding up development.

 

There’s another new drug, developed in China, which received approval there in 2019. It’s called oligomannate and is currently undergoing a phase III clinical trial in the US.  It’s derived from marine brown algae and blocks a particular type of intestinal bacteria linked to brain inflammation.

 

Such a drug underscores Hippocrates’ famous saying that all diseases begin in the gut. Indeed, we have a kind of second brain living there, a network of brain-like neurons and transmitters, which communicate with the one in our heads through the vagus nerve (the human equivalent of an information superhighway).

 

Therefore what we eat has a big impact on how our brains function and that knowledge is helping to shift the focus of Alzheimer’s treatment away from just drug development to making lifestyle changes that might prevent the disease in the first place.

 

As such, in 2020 The Lancet expanded its dementia risk list from nine to 12. The medical journal’s Commission on Dementia concluded that while genetics play a role, 40% of dementia cases are preventable. Most aren’t diagnosed until old age, but the process starts much earlier and that’s why prevention is so important.

 

Here’s a checklist of how to reduce your risk based on The Lancet’s recommendations.

 

Enhance your brainpower

 

View the brain as a muscle that we need to exercise and keep fit. As the English saying goes: “use it or lose it”.

 

A recent Hong Kong study found that elderly participants who read, or played games had a reduced risk of dementia over a five-year period.

 

Puzzles and crosswords are good. So are activities that stimulate neuron development and communication such as learning a new language, or taking up a musical instrument.

 

Nurture close relationships

 

The Lancet lists a lack of social relationships and depression as two major dementia risk factors. A Japanese study found that diverse but deep social relationships halve the risk.

 

It cited five factors: a happy marriage; close family ties; regular contact with good friends; participating in community activities and engaging in paid work.

 

Steer clear of smoking and air pollution

 

The two both have vascular and toxic effects. Reduced blood flow increases the risk of brain bleeds and strokes, which are linked to dementia.

 

Meanwhile toxins increase inflammation. This August, a US study measured the impact of air pollution in one area since the 1970’s. It found that an increase of one microgram per cubic metre of exposure to fine particulate pollution called PM2.5 raised someone’s dementia risk by 16%.

 

Prevent lifestyle diseases and avoid head injuries

 

Roughly three-quarters of dementia suffers have at least two chronic diseases according to the Lancet. It lists hypertension and diabetes as two risk factors in addition to obesity.

 

Over the age of 40, it says we should all aim to maintain a systolic blood pressure level of 130 mm Hg or less.

 

Take up exercise

 

Research shows that walking more than six miles (9.7km) per week can prevent brain shrinkage and memory loss.

 

When we’re exercising we also produce a hormone called irisin that’s been shown to improve Alzheimer’s disease in mice.

 

We also burn glucose, reducing blood sugar levels. Our brains’ glucose receptors can easily become overwhelmed, as they’re particularly sensitive to sugar.

 

Be mindful of your diet

 

UK-based functional medical practitioner, Ingrid Kitzing says there’s a “growing body of evidence, which shows that poor blood sugar control is a dementia risk factor.”

 

She adds that, “it’s important to eat in a blood sugar friendly way, including an appropriate amount of protein and moving away from refined white pasta and rice to unrefined brown varieties with a higher fibre content.”

 

Foods rich in omega-3, like oily fish, are also well known brain boosters: their fatty acids help to preserve cell membrane health.

 

Berries keep brains healthy too because they contain flavanoids, which protect cells from free radical damage. One particular type, anthocyanin, can cross the blood brain barrier, helping to create new neurons and aiding signalling between existing ones.

 

Studies also highlight the importance of B vitamins. They’re needed for energy production and lower levels of homocysteine, an amino acid created when proteins are digested. High levels are associated with increased production of amyloid-beta.

 

Moderate alcohol use

 

Heavy drinking has long been associated with adverse brain changes. The Lancet says dementia risk increases with more than 21 units of alcohol per week.

 

This August, one study showed that some genetic risk factors for alcohol misuse overlap with neurodegenerative diseases. Genetic testing could help people with a genetic pre-disposition to cut down on their intake. 

 

Get your hearing checked

 

Mild hearing loss doubles dementia risk, moderate loss triples it.

 

Scientists remain uncertain why, but it’s known that hearing loss shrinks parts of the brain associated with auditory responses. The Lancet advocates getting a hearing aid.

 

Sleep well and de-stress.

 

Many studies cite broken sleep as a risk factor although cause and effect remain unclear. Does lack of sleep cause the disease, or is it a symptom?

 

When we sleep our body carries out essential cellular repair work via autophagy. It includes clearing out abnormal proteins such as amyloid-beta.

 

Getting the recommended eight hours is tied to the production of a hormone called melatonin, which regulates our body clocks. Darkness helps to stimulate production: one reason why it’s good to sleep in a darkened room and avoid looking at electronic devices for a few hours before bed.

 

Regulating stress also reduces cortisol. Prolonged high levels block the brain’s ability to produce new neurons.

 

What might change if we take some, or all, of these preventative steps? One clue lies in the fact that while Alzheimer’s is rising across the globe, it’s not everywhere.

 

Last year, one report showed that some European countries and the US are recording declining rates on a per capita basis.  Scientists aren’t yet sure why but they think it’s due to a mix of government action (such as de-leading petrol) and greater health awareness.

 

So while we may continue to fear Alzheimer’s that doesn’t necessarily mean we need to succumb to it as well.



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