Alzheimer’s Disease: Important Issue in our Aging Society

Alzheimer’s Disease: Important Issue in our Aging Society

Dementia is the most common disease in older adults more than any other age group (Miller, 2019).  Approximately forty percent of those over eighty years old are affected (Mosconi, Berti, Swerdlow, Pupi, Duara, & de Leon, 2010, p. 170).  With that being over five million older adults affected, this is a significant issue to the aging population (Grammas, 2011, p. 26).  In the year 2050, it is expected that approximately thirteen million older adults will be affected which increases the significance of this issue (Bateman et al., 2012, p. 795).  There are different types of dementia with Alzheimer’s disease accounting for approximately sixty to eighty percent of the cases (Miller, 2019).  It is a disease that affects the older adults’ cognitive abilities and causes changes in their personality, memory, and decision making (Miller, 2019).  Alzheimer’s disease has a gradual and insidious onset over five to ten years with symptoms going either unnoticed due to its slow progression or symptoms being attributed to normal factors of aging.  In between the brain’s neurons, there are abnormal deposits of a protein called beta-amyloid plaques which causes disconnections between neurons and cell death.  In time, this causes the degeneration of the brain cells and tissue called brain atrophy (Miller, 2019).  There has been debate on whether Alzheimer’s disease can be attributed to the aging process or a result of inheritance and genetics.  There are multiple research studies done on Alzheimer’s disease that explain the factors that can increase the risk of Alzheimer’s disease occurring, in which case, some are avoidable.  With time, the progression of this disease can cause demands on families as well as the person with the disease.

Inheritance and Genetics

Our genetics determine a lot about us; from our personality to our likelihood to develop certain diseases and possibly transmit them to future generations.  Those who have family members who have Alzheimer’s disease are at an increased risk of obtaining the disease later in life.  Certain mutations in the amyloid precursor protein genes, such as presenilin 1 and presenilin 2, are common mutations in the genes of families with the disease (Mosconi et al., 2010, p. 172).  Both genes are considered autosomal dominant in transmission with presenilin 1 being thirty to seventy percent of the early onset forms of Alzheimer’s disease.  The age of onset in this population of people carrying the disease is between the ages of forty and fifty years of age with rapid progression of symptoms. When compared to presenilin 2, these genes affect less than five percent of the cases of early onset forms of Alzheimer’s disease with the age of onset up to seventy years of age (Mosconi et al., 2010, p. 173).  It is also important to take note that women are more likely to have Alzheimer’s disease.  This is due to maternal transmission of the disease more likely to occur than paternal transmission (Mosconi et al., 2010, p. 178). Children of mothers with Alzheimer’s disease are also at risk for developing symptoms earlier in life such as brain hypometabolism which causes slower thought processes and changes in memory.  Although there may be a maternal link, there are other genes that can affect the diseases occurrence.  More studies will need to occur over a span of multiple generations in order to confirm if this disease is strictly genetically transmitted or just occurs from the aging process.  With this disease being so prevalent in the aging community, the elderly need to understand these risk factors (Mosconi et al., 2010, p. 187).

Cerebrovascular Changes in Aging

The normal aging process does not only cause physical changes but causes cerebrovascular changes.  It is thought that Alzheimer’s disease develops from amyloid-beta concentrations. Changes in those concentrations occurred approximately twenty-five years prior to the onset of symptoms associated with Alzheimer’s disease (Bateman et al., 2012, p. 801).  It is mentioned that the increase in amyloid-beta protein is a result of our genetics, but it is not until this protein increases, followed by the brain atrophy, that one can begin to see the cognitive changes.  This can take up to twenty-five years to even be noticeable depending on its progression (Bateman et al., 2012, p. 802).  These neurovascular changes can be attributed to aging due to the changes in the structure cerebral capillaries in older adults.  With changes in the neurovascular system through aging, such as the twisting and looping of neurons, this can contribute to the build-up of the amyloid-beta protein in between neurons (Grammas, 2011, p. 27).  Aging is unavoidable but there are numerous risk factors that may be associated with these cerebrovascular changes such as cardiovascular issues and chronic inflammation (Grammas, 2011, p. 26).  There is a correlation between those with Alzheimer’s disease or dementia and those with hypertension, hyperlipidemia, diabetes mellitus, and heart disease.  It is hypothesized that those who have vascular damage may also have cognitive decline later in life (Grammas, 2011, p. 27).  Another risk factor that increases the chance of having Alzheimer’s disease is having a family history of the disease.  Alzheimer’s disease can be decreased through remaining physically active, eating a proper diet, and participating in cognitive and social activities according to some researchers (Miller, 2019).

Family and Societal Demands

This disease not only impacts the person, family, and caregivers, but also affects society.  There is an increase in demand of families and caregivers due to the increase in amount of time providing care to the older adult.  This causes more stress in the home.  Some of those with disease may need constant monitoring if the changes have caused them to wonder or become aggressive due to their increased confusion.  The person with Alzheimer’s disease is also impacted due to the increase in confusion which may cause them to become angry or depressed (Miller, 2019).  Alzheimer’s disease affects society with a demand in Medicaid and Medicare by costing approximately $172 billion every year (Grammas, 2011, p. 26).  This is expected to increase to trillions of dollars by the year 2050 if a cure is not found (Bateman et al., 2012, p. 796).

Conclusion and Future Implications

Although genetics abnormalities cannot be reversed or avoided, there are known risk factors that can be understood and therefore treatment can be sought.  With knowing your family’s history of diseases, it is possible to seek early treatment before that disease progresses.  There is an extremely high occurrence and significance in Alzheimer’s disease in the elderly.  Early treatment can possibly delay the signs and symptoms of Alzheimer’s disease and increase the quality of life for that person.  Through numerous tests on the brain, researchers able to determine the significant changes in the physiology of the brain associated in a person with Alzheimer’s disease (Grammas, 2011, p. 2).  Researchers are unable to determine for sure whether the disease can be the result of aging or purely inheritance.  Regardless, it is important to know ones’ familial history when it comes to diseases in order to take measures to prevent or delay these life changing symptoms.  This is especially true in Alzheimer’s disease due to its insidious and slow progressive nature.  It is more important for those whose mother had the disease since it is considered (Mosconi et al., 2010, p. 178).  With the demands that the disease causes on families, more research studies need to be done in the hopes of forming some disease modifying therapies.

References

• Bateman, R., Xiong, C., Benzinger, T., Fagan, A., Goate, A., Fox, N., . . . Morris, J. (2012). Clinical and Biomarker Changes in Dominantly Inherited Alzheimer’s Disease. The New England Journal of Medicine, 367(9), 795-804. doi:10.1056/NEJMoal202753
• Grammas, P. (2011). Neurovascular dysfunction, inflammation and endothelial activation: Implications for the pathogenesis of Alzheimer’s disease. Journal of Neuroinflammation, 8(1), 26-33. doi:10.1186/1742-2094-8-26
• Miller, C. (2019). Nursing for wellness in older adults (8th ed.). Lippincott, Williams, & Wilkins: Philadelphia, PA.
• Mosconi, L., Berti, V., Swerdlow, R. H., Pupi, A., Duara, R., & Leon, M. D. (2010). Maternal transmission of Alzheimer’s disease: Prodromal metabolic phenotype and the search for genes. Human Genomics, 4(3), 170-193. doi:10.1186/1479-7364-4-3-170