Title: Alzheimer’s disease and the social consequences of an aging population 10 June 2018 Learning question: what is dementia and how does it affect the elderly? Homework: You have your class test next week – study!

Learning Objectives Candidates should be able to: (b) describe the symptoms and possible causes of Alzheimer’s disease; (c) consider the issues involved in the care of patients with dementia (HSW6b, 7c);

Key words Alzheimer’s disease Multifactorial Beta-amyloid protein Tau proten

Symptoms and possible causes of Alzheimer's disease Alzheimer’s disease is a degenerative disease of the NS – can effect any part of the brain e.g. temporal and frontal lobes of the brain Initially, destroys brain cells, but no obvious symptoms. Over time, may grow more serious and include memory lapses. Progression is always towards worsening of symptoms and increasing dependence on caregivers. End result is death due to inability of brain to maintain body/disease/injury Rate of progression variable

Symptoms and possible causes of Alzheimer's disease Causes of Alzheimer's disease probably multifactorial Age is the most important risk factor. Number of people with disease doubles every 5 years after 65 Family history a risk factor Research has shown that factors that increase risk of heart disease also increase risk of Alzheimer’s Smoking, drinking, high BP and cholesterol Severe head or whiplash injuries appear to increase risk also Boxing is a concern

Symptoms and possible causes of Alzheimer's disease Down’s syndrome 15% of Alzheimer's patients also have family history of this condition Beta-amyloid protein Gene responsible for the production of this protein found in Alzheimer's sufferers and adults with Down’s syndrome Protein produces a tangled mass of fibres in the brain Genes Hereditary risk Genes only found in few hundred families. Known as familial Alzheimer’s disease

Symptoms and possible causes of Alzheimer's disease Environmental factors Ingesting aluminium salts – circumstantial evidence linking this with Alzheimer’s disease Mental activity Studies suggest remaining mentally active throughout life, especially in old age, reduces risk of Alzheimer’s disease Evidence currently inconclusive

Pathology Alzheimer’s patients brains contain neurofibrillary tangles and plaques. These neurofibrillary tangles are composed of Tau protein

Pathology Tangles are accumulations of twisted protein fragments that clog up the inside of neurones Plaques encroach from the outside – they have a core of beta-amyloid which is infiltrated by clusters of degenerating axons and dendrites. The axons and dendrites are slowly engulfed

Pathology Research suggests that Alzheimer's disease is caused by inflammatory process associated with aging, and not by amyloid plaque deposits. Claims that disease is caused by the formation of toxic proteins within brain nerve cells These proteins are derivatives of beta amyloid (beta-amyloid derived diffusible ligands , ADDLs) Beta-amyloids fibrils kill a wide range of neurones, whereas ADDLs affect only those implicated in Alzheimer’s disease

Pathology ADDLs are suggested to be organophosphorus molecules This type of molecule is known to attach to special Tau proteins involved in assembling microtubules found in axons, causing them to tangle.

Social responsibility?

Genetics https://www.alzheimers.org.uk/factsheet/405