____ Alzheimer’s Disease and Other Dementias: Symptoms, Stages, and Communication Strategies Expanded
COMMUNICATION OF NEURONS
ALZHEIMER’S DISEASE AND OTHER DEMENTIAS: CAUSE AND EFFECT
CAUSE AND EFFECT: AGE Scientists are researching age-related brain changes such as chronic inflammation, atrophy, production of free radicals, vascular damage, and changes to cell activity to further com- prehend their potential to impact symptoms of AD (Askarova et al., 2020). These changes are a byproduct of aging that can be positively influenced by lifestyle, nutrition, exercise, and social connections. Depression, memory loss, and lethargy are often attributed to aging. Aging does present normal physical and mental changes, but it is important to visit a physician to set benchmarks and note any changes that may be indicative of an age-related illness. There may be times when confusion or memory loss will pres- ent, but it may be situational. Experiencing loss or transition is a part of life that may present confusion or memory loss, as can a UTI or taking medication improperly. CAUSE AND EFFECT: GENDER Women develop AD at greater rates than men (Viña & Lloret, 2010); however, more research must be done to understand the pathogenic mechanism responsible for this reality. At this time research shows that estrogen may be helpful in protecting cells that have some amyloid plaque. Women with the APOE gene are known to experience a higher incidence of brain atrophy, as well as mild cognitive impair- ment, compared to men. The National Institutes of Health is now requiring all federally funded brain research to include gender information in both preclinical and clinical studies to distinguish and explore potential differences. CAUSE AND EFFECT: CHRONIC INFLAMMATION A potential cause of chronic inflammation in the brain may be failing glial cells that are unable to clear brain debris, which causes an increase in plaques and tangle. One type of glial cell, the microglia, is directly responsible for brain cleanup, including clearing amyloid plaques. In AD patients the microglia appear to not perform this function. There is a genetic component being researched, gene TREM2 (Kulkarni et al., 2021), which is correlated to the clearing function of the microglia cells in the brain. In AD patients the following occurs, resulting in chronic inflammation that can lead to impaired brain function. • Microglia fail to clear debris in the brain, including amyloid plaque. • The gene TREM2 does not function normally and therefore does not tell the microglia to clean the brain, plaque buildup results. • Astrocytes, a type of glial cell, also fail to clear up brain debris.
Adapted from Lourenco et al. (2019)
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This happens throughout the expansive brain neuron network, comprising the communications system of almost 7,000 poten- tial synaptic connections between neurons. Neurons evolve over time to support the needs of a function- ing brain. Their process includes perpetual maintenance and repair as they adjust the synaptic connections needed for message conduction and stimulation received from other neurons. This process happens throughout life for the brain to effectively function, since neurons can break down connec- tions and build new connections throughout the life span. Neurogenesis, the process of generating and developing new neurons, continues through adulthood, allowing the brain to remodel synaptic connections and perform functions such as learning, memory, and brain repair. Other cells, glial cells, are also necessary for healthy brain function. Glial cells work with blood vessels to protect and clear debris from the brain and to regulate brain balance. These cell types exceed the number of neurons in the brain almost 10 to 1. There are three types of glial cells.
• Microglia • Astrocytes • Oligodendrocytes
The brain is dependent on the fine-tuning and efficiency of neurons, cells, and the bloodstream. As a person ages, the brain decreases in size; however, there is very limited loss of neurons. For the person with AD or other type of dementia, neurons stop working and interneuron communication is disrupted, causing the neurons to be dysfunctional and ultimately die. Over time this lack of brain function impairs parts of the brain, including the cerebral cortex, which is responsible for behavior, emotional regulation, memory, critical thinking, and reasoning. As the brain becomes more impaired, the stages of AD become more evident.
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