In Alzheimer’s disease, the brain shrinks and shrinks. Why? Explains the neurologist

Alzheimer’s disease gradually but irreversibly takes away memory, thinking ability, and a normal life. People affected by it cease to be themselves completely, they develop strange, surprising and unacceptable behaviors. What Really Happens to People with Alzheimer’s, and Why? What signals appear first? What to do then? What does the uncontrolled development of this disease look like? All this was told by the neurologist Dr. Olga Milczarek from SCM Clinic in Krakow.

1. Alzheimer’s is an irreversible brain disease that gradually destroys memory, thinking abilities, and the ability to perform the simplest tasks. «It comes to the point that a person does not remember what he did before or what he did before. There is total confusion and helplessness »- says Dr. Milczarek
2. This disease is considered to be one of the most serious health crises of the 52st century. Already 30 million people are struggling with the disease, in XNUMX years there will be three times more
3. One of the first signals of changes taking place in the brain is the so-called being lost in the present. The sick forget what they ate for breakfast, they “run out of” some words, and they have less and less understanding of the places they know. If your loved ones indicate that this happens too often, do not take it lightly – consult your doctor
4. Why pathological changes in the brain occur at all and what can uncontrolled Alzheimer’s disease lead to, explains Olga Milczarek, MD, Ph.D.
5. Check your health. Just answer these questions
6. More important information can be found on the Onet homepage.

Monika Mikołajska / Medonet: People who have had or have cases of Alzheimer’s in their family talk about unusual behaviors of their relatives. Going out naked in the city, smudging food on the walls, walking on all fours, suddenly crying, constantly suspecting your spouse of cheating, pounding your fists on doors or windows – these are just examples. These people cease to be themselves completely, the family loses them piece by piece. What happens in the brain of a person with Alzheimer’s disease?

Olga Milczarek, MD, PhD, specialist in neurology: At the beginning, we need to clarify one very important point. The diagnosis of Alzheimer’s as a specific disease is based on a detailed histopathological examination. Colloquially, however, it is often said that a person has Alzheimer’s. Then the term is also understood as other dementia syndromes which we say are of the Alzheimer’s type. This term means that these disorders resemble Alzheimer’s, but we do not know what causes them, and there can be many factors. Examples include viral diseases that lead to brain damage, alcoholism, thyroid disease, and diabetes. What exactly will COVID-19 bring at the moment is also only a guess. It is worth remembering this distinction.

Back to the question. The situations you mentioned are symptoms of advanced brain aging. These processes usually become visible around the age of 65 (this is an arbitrary limit, but at this time in most people the aging processes begin to become visible). The aging process of the central nervous system, however, begins much earlier, basically after the age of 40. Then, however, they are microscopic changes, although in very detailed imaging studies they may already be visible. What is important – these changes are perfectly normal.

There is also a group of people in whom after the age of 65 there is a transition from Alzheimer’s dementia to actual Alzheimer’s disease. In the 65+ age group, about 5 percent experience it. people. Confirmation of this disease often takes place only in tests performed after the patient’s death.

In life, it will never be 100 percent. to be sure it’s Alzheimer’s?

It can be said that we are not able to 100 percent in life. confirm this disease. This certainty can be estimated at approx. 60 percent. based on the symptoms, i.e. the patient’s behavior, and the imaging test. The most reliable one is magnetic resonance imaging. Thanks to it, we will see which parts of the brain are atrophy, which are affected by degeneration (because Alzheimer’s is a neurodegenerative disease). In other words, we make a diagnosis in this situation somewhat indirectly. It can only be confirmed by microscopic post-mortem examinations, if, of course, someone needs them, because it is not done in a standard way.

The doctor says that everyone’s brain starts to age after the age of 40. The question is, what makes it pathological in some people and ultimately leads to Alzheimer’s disease.

There is such a factor. Alzheimer’s disease is related to the accumulation of a protein of some kind – amyloid, outside the brain cells. In healthy people, this compound is broken down, but not in alzheimer’s anymore due to the aging processes taking place in the brain. So amyloid collects in specific regions of the brain to take the place of nerve cells (neurons). This area becomes granular, aquatic, spongy, it becomes less active and eventually disappears. The place where this compound is deposited determines the symptoms that will appear in a given patient.

In general, it can be said that amyloid is found in regions responsible for controlling behavior, arousal and emotions (including the hippocampus and the frontal cortex). Hence, in addition to memory disorders, there are also disinhibition and behavior inconsistent with social norms, which you mentioned at the beginning of the conversation – sudden crying, uncontrolled outbursts of anger or aggression, etc. Patients try to replace higher brain functions with other – more basic – drives. Hence, this characteristic childhood. The patient may, for example, urinate in forbidden places or not control this process at all.

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So to put it bluntly, in Alzheimer’s disease the brain simply shrinks, disappears …

This is what is happening. Degeneration causes the disappearance of certain structures. As a result, the brain gets smaller and smaller.

Are there any warning signs that the brain is starting to change, leading to dementia or Alzheimer’s over time?

By the time they are 60-65 years of age, something usually happens in these patients. At first, the signals are very uncharacteristic – patients slowly change, become a bit bizarre, anxiety disorders, depressive states begin. There may be symptoms suggesting mild cognitive impairment.

Families of such people visit the doctor most often when they observe memory deficits, most often the fresh one. For example, the sick forget what they had for breakfast, some words “run out” of their heads. These are the first signs of changes taking place in the brain.

It is worth remembering that these changes begin to occur even 10 years before any symptoms. However, these are elusive processes that take place at the microscopic level. Nor can they be predicted or prevented.

Most of us forget about something. How can you tell if this is not just absent-mindedness, but a harbinger of disease? Where is this border?

The limit is when our forgetfulness is noticed by others. We are aware of the usual absent-mindedness. We are aware that we sometimes did not remember something, that something fell out of our head. If, however, relatives signal that it happens too often, that we do not remember what happened on the current day or that we have less and less orientation in places known to us – this is the alarm moment., a signal that there is a so-called lost in the present (the key word for dementia) and an attempt must be made to heal the disorder. Usually, it is the case that families bring patients to the doctor, because the patients themselves do not see the problem yet.

Is “lost in the present” the only early sign of Alzheimer’s disorders?

Mental disorders are also a common early symptom. It is known that people develop depression at a certain age. However, if during the previous life a person has not been anxious or there have been few of these episodes and they suddenly appear, then such a situation requires consultation with a neurologist. Likewise, the sudden appearance of all sorts of quirks never before seen in a patient. A doctor can use a simple test to determine whether we are actually dealing with disorders, and if so, assess their level.

The next step is to verify this diagnosis and its basis by a neuropsychologist, as well as imaging diagnostics (the source of the problem may be an organic disease, e.g. complications after a heart attack). It is also recommended to consult an internist – it is worth checking for electrolyte disorders, deficiency or systemic diseases, it is good to check the functioning of the thyroid gland and liver.

All this will allow us to assess whether we are dealing with an isolated dementia syndrome, e.g. of the Alzheimer’s type, or not. Because it may turn out that the disorders result from, for example, vitamin deficiency or thyroid disorders, which can be treated causally. Submission to an examination is therefore absolutely not a sentence. And if it does turn out to be dementia, detecting the problem early will keep it under control.

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What about the uncontrolled progression of Alzheimer’s disease?

After “being lost in the present”, anxiety or depression, problems begin in communicating with others and expressing their needs, including physical needs. Over time, the symptoms worsen, leading to complete disability. Finally, the disease affects the memory of older events – a person begins to forget when he was born or when he has children. It gets to the point where he doesn’t remember what he did before or what he did before. There is total confusion and helplessness.

When the whole brain is affected by the disease (degeneration), it is necessary to take into account the neurological symptoms or their severity. Examples include epilepsy or stiffness. It can be said that in such a state the functions of the brain are kept to a minimum degree, higher activities are out of the question. They are gone.

How far can this process go. Because we know Alzheimer’s disease in itself is not fatal.

The very progressive degeneration of the brain is fatal. This leads to a situation in which the patient is no longer able to move, has lost the ability to walk and eat independently. It can only lie … At some point it comes to the point that a trivial cause, such as an infection or the severity of the underlying disease, eventually leads to death. So death does not come from Alzheimer’s itself, but from these additional factors. It is a feature of all neurodegenerative processes.

When we think “Alzheimer’s disease”, it is in fact primarily the elderly that come to mind. It is known, however, that the problem can also affect people at a young age.

Yes, we are talking about juvenile or early-stage Alzheimer’s disease. It can appear even around the age of 40. Genes play a decisive role here, hence it is often said about inheriting this disease. More specifically, the process of breaking down amyloid, which I talked about earlier, is genetically disrupted.

Fortunately, this type of Alzheimer’s is rare. It’s about 10 percent. all patients with dementia in Alzheimer’s disease. That is, among the mentioned by me 5 percent. patients with alzheimer’s, 10 percent are people with an early form of this disease.

Is such a “youthful” genetically determined Alzheimer different from the disorders that affect seniors?

In people with genetically determined Alzheimer’s disease, symptoms are often more spectacular and more violent. All the symptoms mentioned above appear not over a period of years, but even over a period of one year. Psychological symptoms come to the fore – depression, contact disorders, quirks. Patients with this form of the disease become completely disabled much faster and do not need to be looked after by others. Some families are prepared for this because, firstly, they know that they have a genetic predisposition to Alzheimer’s disease, and secondly – they have had the disease before.

Let’s go back to the topic of brain aging, because it concerns all of us. What is this process about? And what does its pace depend on?

From the neurological point of view, we reach the maturity of the central nervous system at the age of about 20 years. Then the brain reaches its maximum capacity, it is an efficient machine. Then the degenerative processes begin, which, as I mentioned, may be visible after the age of 40.

In the aging process of the brain, various compounds are deposited in cells, including cholesterol and closing small blood vessels in the brain, leading to hypoxia in small structures in the CNS. We do not feel these changes every day, although they are and are progressing.

Unfortunately, we contribute to the pace of these processes ourselves – the worse our quality of life is, the faster our brain will age. This happens the more we drink, smoke and consume fatty foods. But also, the less we move, work, read and learn. I often tell my patients to learn every day, because that’s how we train the brain, and it’s just priceless.

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What if someone says directly that he doesn’t want to?

Then I ask what he likes to do. If your cooking is good, I advise you to use the cookbook. For example, the mere conversion into measures of a given product is an exercise for the brain that extends its efficiency. The same happens, for example, when we visit a place, go to an exhibition or to the cinema.

Of course, we also have to consider the genetic aspect. In people with a family history of dementia, degenerative processes may occur more quickly. Nevertheless, we can all slow down while maintaining proper hygiene of life.

We have already talked about medical tests that diagnose disorders in the brain. Is there a good home method that will show us – indicatively of course – in what condition we are? For example, the clock test is known.

This test is also part of the study. The patient is then asked to draw a clock indicating a specific time, e.g. 10.45. However, this method will detect us only disorders related to specific functions, and more precisely, possible visual-spatial problems. It will not show how the brain works as a whole, nor will it rule out possible organic diseases, such as stroke.

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So I consider this type of test in itself to be pointless. For a visit to the doctor – a necessity. For starters, it might be your primary care physician who we’ll talk to about your general symptoms. This is much better than looking for the reasons for what is happening to us.

Throughout our conversation, the age of 65+ passes as the limit, beyond which old age and dementia processes progress faster. But that doesn’t mean people of this age should lie down and wait for the worst.

Of course not. This age should by no means be a barrier of any kind. As I said, this is a contractual limit. In medicine, we have to determine them because it makes it easier to find a diagnosis. In everyday life, however, we should not relate to them. On the contrary, we should move them around, enjoy life as long as possible and feel young. We, Poles, still have to learn this.

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