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. 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. 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.
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.
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.

 44 Million People in the World Living with Dementia

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. 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

In severe cases, LBD can cause people to experience visual hallucinations or act out their
dreams.

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.

 Alzheimer’s Related Dementia75%75%

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

 Early-Onset Alzheimer’s Type10%10%

Genes
Doctors have identified a specific gene called apolipoprotein E (APOE) that can lead to late-
onset Alzheimer’s disease. 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. 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 the disease. 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. 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. 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.
 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.

However, there are many people who live extremely healthy lifestyles who doctors diagnose
with Alzheimer’s disease. It can be a disease that does not discriminate as to who it affects.

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:

 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 daily 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.
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