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What is Dementia?

There are many forms of dementia, the most common form being Alzheimer’s dementia which accounts for over 50% of all dementias. Dementia affects cognitive function (memory, learning, reasoning, judgement, attention, language), emotions, behaviours and then physical abilities in the later stages. The Alzheimer’s Association has a list of early symptoms and some very good information about dementia. Background information about Alzheimer’s disease can also be found here.

Dr Bredesen’s research has focused on the factors which influence the production of amyloid beta in the brain, which is described below in ‘What causes Alzheimer’s dementia’. Other research has looked at inflammation in the brain (which is called neuroinflammation) and the factors that influence its progression and resolution. Specifically, of great relevance in any neuroinflammatory condition including dementia is the research into how the immune cells in the brain (the microglia) are activated, how they can destroy neurons and how they can be switched into an anti-inflammatory mode to resolve inflammation. As it turns out, there is a large overlap in the treatments which improve dementia and reduce neuroinflammation.

Dr Datis Kharrazian, a US functional medicine doctor and researcher, has developed a treatment program for neuroinflammation, much of which is outlined in his book Why isn’t my brain working?’. More information and patient education are available at drknews.com

Both Dr Bredesen and Dr Kharrazian have developed training programs for health care professionals to implement their treatment programs, and they provide ongoing support and the latest research findings to their practitioners. I am grateful to have had the opportunity to complete these training programs and am excited to be able to provide Dr Bredesen’s treatment programs incorporating relevant neuroinflammation treatments.

Stages of Dementia

The sooner in the disease process you start treatment the better the result will be. It takes decades for dementia to develop, starting as early as your 30s or 40s. Your individual risks for developing dementia can be identified before the disease progresses. As there are other causes for memory problems aside from dementia, an assessment in the early stages may identify other possible causes and lead to appropriate treatments which resolve the memory problems.

The broad stages dementia progresses through are outlined below. Individual symptoms and the rate of progression vary. Each person’s experience will be unique. Improvements obtained from effective implementation of the program can be expected to be maintained with continuation of the interventions found to be beneficial for the individual. This program isn’t a cure. It’s not a case of doing the treatments and wah-lah… you are fixed. Some level of ongoing treatment will be needed to prevent a return of symptoms or progression into later stages of dementia.

Subjective Cognitive Impairment

This is the earliest stage of possible dementia. You start to notice memory/cognitive problems, but you can still function as normal in your life. At this stage you know there is a problem, but nothing shows up on testing. Nearly everyone treated in the earliest stages of dementia should have a complete recovery.

Mild Cognitive Impairment

Memory/cognitive problems worsen, and testing will start to show that there is an issue, but you can still function fairly normally in your life. If treated successfully 50-75% should have a complete recovery. You may need some help from family to implement some aspects of the program.

Early stage Alzheimer’s dementia

Increased memory/cognitive problems which are impacting daily life, eg trouble keeping track of appointments or multi-tasking. This stage typically lasts for 2 to 4 years. Most of those treated (more than 50%) will stop progression of dementia and should be able to achieve reversal to some extent. Results vary depending on adherence to the protocol and the correct identification and treatment of enough relevant factors driving the disease in the individual. You will need help from family/friends to implement some aspects of the program.

Middle stage Alzheimer’s dementia

There is significant short-term memory loss and long-term memory begins to decline, and recognition of family/friends is declining. Daily activities are broadly affected, with a loss of interest in activities. The stage can last 2 to 10 years. Treatment may stop progression and some reversal may be achieved in 50% of people adhering to the program. Treatment may prevent or delay the need for nursing home care. Better results are obtained at the beginning of this stage than in the later years of this stage. You will need a good support network from family/friends to implement the program.

Late stage Alzheimer’s dementia

In need of full-time care, no short-term memory and only fragments of long-term memory, unable to recognise family. The program would be difficult to implement at this stage.

What causes Alzheimer’s dementia?

You may have heard that amyloid plaque and tau tangles are the causes of dementia, but this may be an outdated theory. A newer theory, the ‘Antimicrobial Protection Hypothesis’, identifies amyloid plaque as a protective mechanism, it’s a sign that there is something else going on that is causing the brain to conserve its resources by ‘pruning back’ the functional structures in the brain.

You can think of it like a business that has to cut back on staff when the economy is in a slump and sales are down – trimming back to preserve the essential core. In dementia the areas of the brain that process new memories are the first things to be cut back, which preserves the older memories, eg you don’t remember you went to the shop yesterday, but you remember your holiday 5 years ago. As the disease progresses you remember less and less of the recent stuff but retain the old stuff, but that too eventually is lost along with how to perform normal daily activities like driving, managing the house/money, getting dressed etc.

The presence of amyloid plaque by itself doesn’t always mean you have dementia. People with no memory problems or no symptoms of dementia have died with large deposits of amyloid in their brain, and some people with dementia have had relatively low amounts of amyloid. So it can’t be just the presence amyloid that causes dementia.

The research is indicating that there are dozens of factors that work together to cause dementia. This is why medications developed for Alzheimer’s haven’t been able to cure it. The medications target 1, 2 or maybe 3 of the factors but don’t do anything to address some of the other 50+ factors that may be involved for the individual.

Research has discovered that there is a protein which sticks out of neurons, called Amyloid Precursor Protein (APP). Depending on which molecules bind to APP it will either be broken into 2 or 4 smaller proteins (peptides). If APP is broken into 2 (by binding with a molecule called netrin-1) then it has a protective effect on the neurons in the brain and decreases amyloid beta levels. If, however, no netrin-1 binds with APP or amyloid beta binds with it, then APP will be broken into 4 peptides, one of which is also amyloid beta. This causes amyloid beta levels to increase and netrin-1 concentrations decrease, leading to more and more amyloid beta. Amyloid beta then leads to increased death of neurons.

Amyloid beta is a signal to the brain that there are not enough resources available to maintain and form synapses (the space between neurons which enables communication between neurons) therefore it’s necessary to downsize connections and prune back neurons. The first neurons to go are those associated with short term memories. The beauty of this that if you can decrease that signal (decrease new amyloid beta formation) then you can tell the brain it’s time to upscale production again and form new synapses.

There are over 50 factors that influence if APP is broken into 2 or 4 peptides. You don’t have to address all of them, just enough of them to tip the balance into increasing netrin-1 levels and decreasing amyloid beta formation. Those 50+ factors fall into 6 main categories which mainly relate to other disease states and lifestyle factors, so if we can identify the key areas of your health that might be contributing to amyloid beta formation and treat them effectively, you should be able to tip the balance back into your favour and stop downsizing your brain! The 6 main types of dementia and their possible causes are:

*BDNF is brain derived neurotrophic factor (neuro = nerves, trophic = stimulating growth), which strengthens synapses and is increased by exercise and adequate sex hormone levels and supported by nutrients such as vitamin D and folate.

Research is ongoing and new treatment possibilities will undoubtedly arise. The research process means that any new options will take 10+ years to be studied and implemented in order to assess their effectiveness. Perhaps some future treatments will be easier to implement than this program but until such options are shown to be effective, we know this program does work for the majority of people. It is the best treatment option at the moment. You will improve your overall health and your brain health. To do nothing is to accept the inevitable decline that is dementia as we’ve known it - until now!

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