{"id":1289,"date":"2011-11-30T13:05:08","date_gmt":"2011-11-30T18:05:08","guid":{"rendered":"http:\/\/blog.beliefnet.com\/intentchopra\/?p=1289"},"modified":"2011-11-30T14:21:38","modified_gmt":"2011-11-30T19:21:38","slug":"alzheimer%e2%80%99s-disease-how-to-face-fear-with-knowledge-part-2","status":"publish","type":"post","link":"https:\/\/www.beliefnet.com\/columnists\/intentchopra\/2011\/11\/alzheimer%e2%80%99s-disease-how-to-face-fear-with-knowledge-part-2.html","title":{"rendered":"Alzheimer\u2019s Disease: How to Face Fear With Knowledge (Part 2)"},"content":{"rendered":"

By Deepak Chopra, MD, FACP and Rudolph Tanzi, Ph.D.,<\/strong><\/p>\n

The Joseph P and Rose F. Kennedy, Professor of Neurology, Harvard Medical School, Director of Genetics and Aging, Massachusetts General Hospital<\/strong><\/p>\n

In the first post we confronted the primary fact about Alzheimer\u2019s disease \u2013 fear and terror \u2013 which is a psychological reality, not a piece of scientific data. Our minds are the window to reality. Any form of mental illness is frightening to the patient because their grip on reality has become tenuous, if not delusional. The same disorder is frightening to onlookers because the fragile bond that links us \u2013 our agreement that A is real but B is not – is threatened and often broken beyond repair.<\/p>\n

<img src="http:\/\/blog.beliefnet.com\/intentchopra\/wp-includes\/js\/tinymce\/themes\/advanced\/img\/trans.gif" class="mceItemMedia mceItemFlash" width="508" height="430" data-mce-json="{'video':{},'params':{'flashvars':'totnum=15','wmode':'transparent','src':null},'object_html':'<!– ‘}” alt=”” \/> <!–<\/object><\/div>\n

Visualization is courtesy of TheVisualMD.com<\/a><\/p>\n

To lose someone you love to Alzheimer\u2019s feels worse than death to many families. Death is a decisive break, and afterwards the grieving process occupies its own domain.\u00a0 The territory is painful, to the point that many grieving survivors would rather follow their loved ones into the unknown after death. But Alzheimer\u2019s is a gray, ambiguous land where your loved one gradually fades away, with many false returns and defeated hopes.\u00a0 Death is considered a mercy compared to the tormented stranger who torments those who suffer through the disease with them.<\/p>\n

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We said in the first post that knowledge is our best weapon in fighting fear. At least we can stand on rational ground.\u00a0 And knowledge is advancing in the diagnosis and treatment of Alzheimer\u2019s.\u00a0 As painfully slow as progress may seem \u2013 like the disease itself, there have been defeated hopes along the way – let me summarize the current state of affairs.<\/p>\n

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In Alzheimer\u2019s disease, two abnormal buildups<\/a> accumulate in the brain. One type of buildup is a sticky substance called beta-amyloid. It deposits in senile plaques, on brain blood vessels, and as smaller clumps in the synapses where it can disrupt communication between nerve cells impairing learning and memory. The other type is the neurofibrillary (nerve cell) tangles. These buildups disrupt the trafficking of proteins and neurotransmitters in nerve cells leading nerve cell death and neurodegeneration. Together, these abnormal buildups lead to Alzheimer\u2019s type dementia and are targets of drug discovery aimed at treating and preventing<\/a> this devastating disease.<\/p>\n

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Testing for and diagnosing Alzheimer\u2019s involves psychological tests that assess cognition. Doctors can make a probable diagnosis of Alzheimer\u2019s, but the only time a definite diagnosis can be made is at autopsy, when the pathologist confirms the widespread presence of plaques and tangles throughout the brain.<\/p>\n

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More recently specific types of brain imaging, including those capable of visualizing senile plaques and other beta-amyloid deposits are being used to detect Alzheimer\u2019s changes in the brain. Biomarkers in the cerebrospinal fluid can also indicate the presence of plaques and tangles in the brain. The combination of brain imaging and biomarkers is dramatically enhancing our ability to diagnose Alzheimer\u2019s and even detect it before any cognitive symptoms appear.<\/p>\n

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\u00a0<\/em><\/p>\n

During the course of Alzheimer\u2019s disease, several key proteins are deposited in the brain, including proteins called amyloid beta protein and tau protein. Amyloid beta protein (in senile plaques, blood vessel beta-amyloid, and small clumps of beta-amyloid in synapses) accumulates in the areas of the brain responsible for learning and for creating, retaining, and extracting memories. The plaques occupy more and more space over time causing brain inflammation. The smaller clumps of amyloid beta protein known as oligomers interfere with normal communication between brain cells, disrupting the neural network of the brain.<\/p>\n

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Most of the scientists who study Alzheimer\u2019s believe that it\u2019s the excessive accumulation of amyloid beta protein that induces the protein called tau to form nerve cell tangles that eventually choke and kill nerve cells. Beta amyloid protein is certainly a part of Alzheimer\u2019s, but the presence of beta amyloid alone isn\u2019t sufficient to cause the disease. Beta amyloid must trigger tangle formation to create dementia. So far, the genes that have been shown to affect risk for Alzheimer\u2019s have in common that they increase the accumulation of beta-amyloid in the brain. More recently, the Cure Alzheimer\u2019s Fund Alzheimer\u2019s Genome Project<\/a> has identified dozens of new Alzheimer\u2019s disease gene candidates, many of which likewise influence beta-amyloid levels in the brain.<\/p>\n

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What tests are used for Alzheimer\u2019s?<\/em><\/p>\n

There is no single test for Alzheimer\u2019s. A physician examining someone who may have the disease will consider many factors and conduct a number of tests <\/a>\u00a0before making a diagnosis. The physician will probably ask questions about the person\u2019s medical history and conduct a physical exam. A neurological exam will probably be given as well. Some of these tests are done to rule out another medical disorder (for example, a vitamin deficiency) that may be causing Alzheimer-like symptoms.<\/p>\n

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Cognitive tests for Alzheimer\u2019s<\/em><\/p>\n

A commonly used mental status test is the mini-mental state examination (MMSE). The MMSE is a brief test that only takes about 10 minutes to complete. In it, the health care professional asks a series of questions designed to test a range of everyday mental skills. These include:<\/p>\n

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