A 2021 Guide to Alzheimer’s and Dementia

Alzheimer’s and dementia

Alzheimer’s disease and dementia are two conditions that affect a person’s memory and ability to function in daily life. Although the conditions have some shared symptoms, each can affect the brain in different ways. Let’s examine the different dementia types, how alcohol abuse affects each, and risk factors.

Defining Dementia

Dementia is the umbrella term for a loss of cognitive function.¹ According to an article in the journal Alcohol and Alcoholism, an estimated 44 million people in the world live with dementia. This number is expected to triple by the year 2050.⁶

This includes changes in the way a person thinks, feels, and reasons in the world. This loss of function can range from mild symptoms, such as occasional forgetfulness, to severe and life-impairing behavioral changes.¹

Defining Alzheimer’s

Alzheimer’s disease is a form of dementia. According to the National Institutes of Health, it is the most common dementia form. Of those with dementia, an estimated 50 to 75 percent of the cases are Alzheimer’s disease-related.³

An estimated 5.5 million Americans suffer from Alzheimer’s disease, and medical experts rank it as the sixth-leading cause of death in the United States. However, among individuals age 60 and older, Alzheimer’s disease is the third-leading cause of death.¹

Types of Dementia

While Alzheimer’s is the most common dementia form, there are other types. These include vascular dementia, Lewy body dementia, and frontotemporal disorders.

Vascular Dementia

Vascular dementia is the second-most common dementia type, accounting for an estimated 20 percent of dementia cases, according to the National Institute for Health and Care Excellence.³ This condition occurs when a person experiences reduced blood flow to their brain.

This is often the result of a previous stroke or mini-strokes known as transient ischemic attacks that can affect blood supply to the brain and result in the death of brain cell tissue. Taking steps to prevent conditions such as heart disease and stroke may also help to prevent vascular dementia.

Lewy body Dementia (LBD)

Lewy Body Dementia is a progressive brain disorder where abnormal deposits of a protein called alpha-synuclein (or Lewy bodies) build up in areas of the brain that regulate behavior, cognition, and movement.

Symptoms include:

• Problems with Thinking
• Memory
• Moving
• Sleep
• Changes in Behavior

Frontotemporal Dementia (FTD)

Frontotemporal dementia (FTD) caused by decline in the parts of the brain that control decision-making, behavior, emotion and language. People struggling with FTD typically see symptoms that fall under the following categories:

Behavior Changes

• Disregard for social conventions
• Impulsivity
• Loss of sympathy or empathy
• Repetitive or compulsive movements
• Dietary changes
• Poor insight, planning and assessment
• Issues with expressing themselves

Language Problems

• Difficulties with reading and writing

General Weakening of Muscles or Slowing of Movements

• Feeling like they are walking through water or harder to move
• Muscle spasms
• Slowing of some eye movements
• Changes in the reflexes and muscle stiffness or slowness

Mixed Dementia

A person can also have a type of dementia known as mixed dementia, where they have two or more dementia types. Although doctors can identify the likely underlying dementia cause based on a person’s symptoms, they may not be able to definitively diagnose Alzheimer’s disease or other dementia forms until a person dies and a doctor performs a biopsy on their brain to identify distinct patterns known as plaques and tangles in the brain.

Origins and Effects

Causes of Alzheimer’s and Dementia

Doctors and researchers are learning more about dementia and Alzheimer’s every day. They know that long before a person experiences the outward symptoms of Alzheimer’s disease, such as forgetfulness,  brain changes start to damage healthy nerve tissue.¹

Once this tissue dies, it cannot regenerate, which is why Alzheimer’s disease is a progressive condition. The damage typically starts in the hippocampus, which is the brain area responsible for memories. Over time, other areas of the brain become damaged, which leads to affected movement and other problems with thinking.

Long-term effects of Alzheimer’s and Dementia

Alzheimer’s and dementia are devastating diseases that take away a person’s memories, personality, and ability to function. Ultimately, the progressive damage associated with Alzheimer’s can lead to death.

This is because a person with advanced Alzheimer’s disease may have difficulty eating and swallowing. There is an increased risk for aspiration, when food or liquids go into the lungs instead of the stomach. As a result, a person is vulnerable to infections, such as pneumonia.

This can be lead to life-threatening infections that are difficult to treat and can often prove deadly to persons suffering from Alzheimer’s disease.

Connection to Alcohol

Doctors know that alcohol abuse can cause changes in the brain that lead to increased risks for dementia.¹ Doctors associate these increased risks with a person who drinks alcohol excessively over a long time period, according to the Alzheimer’s Society.²

Currently, doctors do not associate drinking alcohol in moderation (two drinks or less per day for men and one drink per day for women) with this risk. Therefore, doctors don’t usually recommend stopping drinking altogether as a way to prevent Alzheimer’s disease or dementia.

How Alcohol Damages the Brain

Alcohol can damage the brain in a variety of ways. Those who drink heavily typically have less white matter in their brains.² Because white matter is responsible for helping the brain transmit impulses and messages to other portions of the brain and body, a decrease in white matter can mean decreases in cognitive and physical functioning.

Chronic alcohol consumption also leads to nutritional deficiencies, specifically those of thiamine or vitamin B1.

Doctors associate the lack of this vitamin with increased risk for a condition known as Korsakoff’s Syndrome, which affects a person’s short-term memory.

Binge Drinking and Alzheimer’s

While researchers have conducted studies regarding alcohol use and dementia, the results have been controversial and conflicting. Some studies find that alcohol has neuroprotective benefits when consumed in moderation while others have linked it with causing neurocognitive conditions, including dementia.

A study published in a 2018 edition of the Journal of Neuroinflammation found the presence of alcohol in the body may slow or stop the clearance of a protein known as amyloid beta in the brain in the study conducted on rats.⁵ This protein is associated with potentially contributing to Alzheimer’s disease.

The researchers gave laboratory rats alcohol and studied how their genes were expressed, particularly for those known to “eat” or engulf amyloid beta — essentially, how well the rats could “trash” these wastes products with alcohol present in their systems. Specifically, when the researchers exposed the rats to alcohol levels that would be equivalent to a person binge-drinking, the ability to clear amyloid beta decreased by 15 percent within one hour.

The researchers concluded that excess alcohol intake could have the potential to contribute to conditions such as Alzheimer’s disease.

Increased Risk of Alzheimer’s Disease

A literature review regarding alcoholism, beta-amyloid deposits, and inflammation in Alzheimer’s disease was published in the journal Alcohol and Alcoholism.⁶

In one of the studies the reviewers examined, alcohol misuse and abuse increased the likelihood a person would have Alzheimer’s disease by three- to four-fold. This was especially true for those who were ages 65 to 79 years of age. They also found that people who had a family history of early-onset Alzheimer’s disease, heavy smoking, and heavy drinking were diagnosed on average 10 years earlier than those who did not.

The researchers also noted that alcohol abuse was known to contribute to a number of problems that could lead to Alzheimer’s disease and dementia. Examples of these include heart disease, stroke, diabetes, hypertension, and hyperlipidemia (elevated blood cholesterol).

Those who drink to excess are also at increased risks for traumatic brain injury from falls and motor vehicle accidents, which can in turn increase their risk for experiencing dementia and Alzheimer’s disease.

Alcohol Withdrawal and the Brain

Another finding from the literature review was how alcohol affects the body and brain. For example, doctors know that alcohol intoxication and alcohol withdrawal can cause inflammation in the immune system and lead to the development of pre-cursors to plaques in the brain.

Alcohol withdrawals for those who chronically abuse alcohol have also been shown to cause inflammation and activation of inflammatory cells in the brain. Researchers have detected higher than average amounts of microglia, which is an immune system cell in the brain that “consumes” inflammatory compounds.

Risk factors for Dementia

Unfortunately, doctors don’t know what exactly causes a person to experience Alzheimer’s disease or dementia. They do know those who have early-onset Alzheimer’s tend to have a family history of Alzheimer’s disease and dementia.¹

Early-onset Alzheimer’s occurs when a person younger than age 65 starts to have symptoms of Alzheimer’s disease. Less than 10 percent of all people with Alzheimer’s have the early-onset type, according to the National Institutes of Health.

Genes

Doctors have identified a specific gene called apolipoprotein E (APOE) that can lead to late-onset Alzheimer’s disease.¹ Doctors know that a variation of this gene called APOE-E4 can increase a person’s risk for early disease onset. However, not all people with this genetic variation have early-onset Alzheimer’s.

Currently, an organization called the Dominantly Inherited Alzheimer Network (DIAN) is conducting studies where those that have genes associated with early-onset Alzheimer’s disease receive either antibodies or a placebo to beta-amyloid plaques, which are the types of injuries to the brain that form in Alzheimer’s disease.

The researchers are monitoring these patients to determine if the antibodies could help to potentially prevent early-onset Alzheimer’s disease from occurring.⁴ Researchers with the Anti-Amyloid Treatment in Asymptomatic Alzheimer’s trial are conducting similar research on older persons who are considered at high-risk for the disease.

Down Syndrome

Researchers also know that nearly all persons with Down syndrome, a defect of chromosome 21, develop Alzheimer’s disease.¹ The current working theory regarding this risk factor is that chromosome 21 contains genetic instructions to create harmful amyloid plaques in the brain that lead to Alzheimer’s disease.

Head Trauma

A history of head trauma may also increase a person’s risk for Alzheimer’s disease.⁴ According to the Alzheimer’s association, a history of head injury — especially when a person lost consciousness due to the head injury — can make a person more likely to experience Alzheimer’s disease.

While a person cannot always prevent head trauma, there are some steps they can take, such as always wearing a seatbelt when in the car, wearing proper protective equipment (such as a helmet or headgear) when playing sports, and taking steps to prevent falls at home.

Other Factors

Doctors theorize the development of Alzheimer’s disease is likely a combination of factors, including genetic history, lifestyle, and environmental.¹ However, they have yet to pinpoint exactly what would cause the condition to occur.

Reducing the Risk of Dementia

Unfortunately, doctors haven’t yet detected ways to definitively prevent a person from getting Alzheimer’s disease. They know that people who tend to live healthier lifestyles may be able to reduce their risk somewhat and maintain healthier brain functioning as they age.¹ Examples of steps a person could follow to accomplish this include:

• Eating a healthy diet filled with fruits, vegetables, and whole grains. While doctors haven’t proven any one diet is more effective in potentially preventing Alzheimer’s disease, many advocate for a Mediterranean diet.This diet type is one that many people who live in Mediterranean regions, such as Greece, consume. Examples of foods a person on the diet eats include olive oil, fish, whole grains, vegetables, and fruits.
• Engaging in regular physical activity, such as walking, running, or riding a bicycle. Not only does physical exercise help a person maintain a healthy weight, it also improves blood flow and oxygen levels in the brain. This is a way to “nourish” the brain.Also, a person who exercises regularly is more likely to experience a reduction in inflammatory compounds in the brain, which may have a protective effect against Alzheimer’s disease.⁶

• Maintaining a healthy weight.
• Reducing alcohol consumption if a person drinks alcohol excessively on a continual basis.
• Engaging in mentally stimulating activities, such as reading, finishing a crossword or Sudoku puzzle, or playing chess. These activities can help to keep a person “mentally fit” in addition to efforts to keep physically fit.
• Refraining from smoking, which increases a person’s risk for frailty later in life. Smoking can also increase the risks for certain medical conditions that can contribute to dementia, including increased risks for heart attack and stroke.
• Maintaining strong social connections whenever possible. This includes visiting with friends and family. Keeping these strong bonds can help to reduce the risks for cognitive decline, helping others live well.

Finding support

Caring for a loved one with Alzheimer’s disease or dementia can be difficult on many levels. First, a person with these diseases can experience severe behavioral problems that can be difficult for a loved one to see as well as manage on a daily basis.

Alzheimer’s disease can dramatically change a person’s personality. It can be devastating to see a loved one change from their previous levels of functioning to not recognizing a spouse’s or child’s face. These changes take time and development of coping skills to adjust to so that a person can establish a “new” normal.

Often, a person takes on a role as a caregiver and is required to develop a variety of skills, such as helping a person get up out of bed and with bathing and toileting.

Examples of changes in behaviors include:¹

• Agitation
• Aggression
• Anxiety
• Difficulty sleeping at appropriate times, such as sleeping all day and staying awake all night
• Restlessness

Giving Care during the Stages of Alzheimer’s

In addition, a person with Alzheimer’s disease or dementia often has multiple medications to take on a daily basis and may require physical care, such as help going to the restroom and bathing.

Many Alzheimer’s experts refer to Alzheimer’s as a disease that occurs in three stages, which are early-, middle-, and late-stage.

During the earlier stages of Alzheimer’s, a loved one may have good and bad days in terms of memory, but their symptoms are usually only most noticeable to those closest to them.

In the late stages of Alzheimer’s, a person often needs almost around-the-clock care, and many caregivers find they need medical support or care at a memory facility or hospital.

Each stage has unique needs to help a loved one life as high-quality a life as possible while also ensuring caregivers can maintain work and family responsibilities.

Finding Support

Fortunately, there are resources available that can help a caregiver receive emotional support and respite care whenever possible. Examples of some places to start include a loved one’s doctor, who may recommend known support groups in the area at local hospitals, senior centers, or even doctor’s offices.

Larger organizations, including the Alzheimer’s Association, often have local chapters who have events, including speakers, fundraising walks, and support groups for those who have a loved one living with Alzheimer’s.

Organizations also offer online resources, including support groups and chat rooms if a person’s job or caregiving responsibilities don’t enable them to be attend a physical meeting.

The Alzheimer’s Association specifically offers free modules and educational information on a variety of Alzheimer’s topics as well as Alzheimer’s caregiving issues and concerns.

Researchers are finding out new information on Alzheimer’s every day. From its causes to treatment and preventive methods, there are many focuses involved in this research that will one day ideally lead to an eradication of the disease.

While there is currently no cure for the disease, there are medications that can help to slow its progression. Until that time, seeking support in its many forms and engaging in healthy behaviors whenever possible is vital to helping a person live well.

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Resources

1. https://www.nia.nih.gov/health/alzheimers-disease-fact-sheet
2. https://www.alzheimers.org.uk/about-dementia/risk-factors-and-prevention/alcohol
3. https://www.nice.org.uk/guidance/ng16/chapter/What-is-this-guideline-about
4. https://www.alz.org/alzheimers-dementia/research_progress/prevention
5. https://www.sciencedaily.com/releases/2018/06/180604125018.htm
6. https://academic.oup.com/alcalc/article/52/2/151/2631407