Alzheimer’s disease: Raising awareness of risks and mitigating factors

Written by Alessandra Macedo Pinto*

21 September is recognised worldwide as Alzheimer’s Disease Awareness Day and, as such, this month all health authorities are focusing on raising awareness of this condition, which affects a large proportion of the world’s population and is increasing in direct proportion to rising life expectancy. This awareness is necessary so that society understands the importance of prevention, early diagnosis, care and support for the families and carers of people living with this disease.

Alzheimer’s disease (AD) has been studied for a long time, as it is the leading cause of dementia in older people. It develops slowly and gradually, making it very difficult to pinpoint its exact onset. It is believed that the brain changes characteristic of the disease occur up to years before the first signs of the disease appear. To date, no medication has been developed that is capable of reversing these changes, which are responsible for all the clinical and behavioural signs of AD.

As the disease progresses, the individual begins to display some typical characteristics of the condition, such as:

• 
  Memory impairment.
  The ability to form new memories is impaired and people tend to forget recent events. Retrospective memory – that is, memories of past events – is preserved until the very later stages of the disease.
• 
  Inability to plan and think logically
  are noticeable right from the onset of the illness.
• 
  Difficulties with activities
  such as shopping and making phone calls telephone companies, understanding costs and calculations – tasks that used to be carried out with ease.
• 
  Disorientation in time and space
  is a recurring symptom, which can mean that even a very familiar environment is no longer recognised. It is common for the individual to get lost in their own neighbourhood or even within the home. A loss of the ability to orientate oneself in time can lead a person, for example, to get up in the middle of the night and start preparing lunch.

In moderate stages of the disease, other symptoms may appear, such as significant personality changes and difficulties with language. Introverted and reserved people may become extroverted and behave inappropriately, whilst those who have always communicated well may have trouble understanding and expressing ideas.

One of the brain structures affected in the early stages of AD is the hippocampus. It is in the hippocampus that memories are formed, so when the connections between cells in this region are disrupted, the person becomes unable to form new memories. As the disease progresses, all structures and regions of the brain are affected and, in addition to memory, other skills and functions are lost, such as the ability to communicate, move around and swallow, resulting in the total loss of functional capacity and, consequently, death.

Although it is a progressive and irreversible disease, AD can be prevented or delayed. An article by University College London, published in July 2020 in the journal The Lancet, showed that 4 out of 10 cases of dementia could be prevented or delayed. This study identifies the main risk factors for dementia, including Alzheimer’s disease. These risk factors may be reversible; in other words, if they are modified, avoided or eliminated, they can prevent the development of the disease. Scientific evidence from various studies identifies 12 risk factors linked to the development of dementia, namely: low educational attainment, high blood pressure, diabetes, smoking, a sedentary lifestyle, obesity, depression, hearing loss, social isolation, alcohol consumption, head injury and air pollution.

Different ways of ageing can influence the development of diseases in old age and, amongst the less privileged sections of Brazilian society, may contribute to the worsening of these risk factors.

It is important to note that risk factors such as a low level of education do not, on their own, determine whether or not a person will develop AD. At any age, one can develop skills that foster new connections in the brain, such as learning to play a musical instrument, dancing, speaking a new language, doing crafts, painting, drawing, crocheting, etc. It is never too late to learn, in the broadest sense of the word; this is not to condemn those who have not had the opportunity for formal education.

It may sound like ‘common sense’, but recommendations to keep blood pressure and diabetes under control, and to avoid smoking, alcohol consumption, a sedentary lifestyle and obesity, are measures that will not only help prevent dementia but will also ensure that quality of life is maintained. Appropriate treatment of conditions such as Depression and hearing loss will encourage social interaction, which, in turn, stimulates cognitive development. And there is nothing better for oxygenating the brain than being in contact with nature and breathing fresh air.

It is also well known how important it is to prevent falls in older people, given the risk of fractures. Concussions and head injuries are often caused by falls and can trigger neuronal changes that lead to dementia.

It is important to emphasise that for each of these risk factors, there is a form of intervention, and studies show that certain activities, even when started in later life, can benefit the brain and help prevent dementia.

In light of what has been discussed in this article, it is important to emphasise that raising awareness of Alzheimer’s disease must always include measures to prevent the condition. Increased life expectancy is a This is an achievement not only in terms of medical progress, but also in terms of better living conditions and access to healthcare ; however, it is essential that these extra years of life are lived with independence, autonomy and a good quality of life. We hope that a biological marker will soon be discovered that can accurately diagnose Alzheimer’s disease, so that we may look forward to a better future.