Importance of Timely Prevention in Alzeheimer's Disease and Parkinson's Disease

Alzheimer’s disease is one of the most common neurodegenerative diseases in the United States with more than 3 million cases. Alzheimer’s falls under the category of dementia, a syndrome identified by deterioration in mental functions commonly seen in people older than 65 years of age. This neurological disease targets nerve cells, or neurons, in the brain. Neurons interact and transmit messages at synapses, where neurotransmitters carry information from one cell to another. This process is disrupted by Alzheimer’s, ultimately destroying the brain’s communication process. Parkinson’s disease, much like Alzheimer’s, is a neurodegenerative disease affecting the production of dopamine rather than being involved in the destruction of neurons. Organ systems such as the muscular system decline in functionality as the disease presents itself in the form of tremors and stiffness from overproduction of dopamine. Parkinson’s disease has a strong connection to Alzheimer’s and dementia due to its destructive nature within the human neurological system.

Both Alzheimer’s and Parkinson’s are not fatal, but the degeneration of bodily functions ultimately render the person helpless and debilitated. Risk factors for both conditions include age, genetics, family history, and other external factors such as head injuries and exposure to certain chemicals and toxins. Alzheimer’s disease has a wide spectrum of symptoms and signs, most of which involve the deterioration of cognitive function, “memory loss that disrupts daily life, difficulty completing familiar tasks at home, at work or at leisure, confusion with time or place,” and worsening of behavior and changes in personality (“10 Early Signs and Symptoms of Alzheimer's”). Alzheimer’s can be initially identified by a decrease in one’s ability to remember recent events, eventually leading up to such severity that those who suffer from Alzheimer’s forget how to tie their shoes or eat. Some may confuse an occasional error in memory or forgetting where a certain object was placed as early symptoms of Alzheimer’s, but this can be easily clarified by considering the frequency at which such a situation happens. Typical age-related changes include “making a bad decision once in a while, missing a monthly payment, forgetting which day it is and remembering it later, sometimes forgetting which word to use, [or] losing things from time to time” (“10 Early Signs and Symptoms of Alzheimer's”).

However, the beginning symptoms of Alzheimer’s are more consistent, including “poor judgment and decision-making, inability to manage a budget, losing track of the date or the season, difficulty having a conversation, [or] misplacing things and being unable to retrace steps to find them” (“10 Early Signs and Symptoms of Alzheimer's”). Symptoms of Parkinson’s disease are similar to the symptoms of Alzheimer’s disease in that they are responsible for the heavy weakening of a person’s motor functions. Someone suffering from Parkinson’s can experience “tremor[s]... loss of smell, trouble sleeping, trouble moving or walking, constipation… masked face, dizziness or fainting, [or] stooping or hunching over” (“10 Early Signs of Parkinson's Disease”). Facial masking, or having a masked face, is a lack of facial expression, often unintentionally conveying sadness, seriousness, or depression. This is one of the primary signs of losing motor control in the facial muscles and could worsen as the disease progresses. Losing motor control does not only affect the face but the hands, legs, and arms as well, causing an uncontrollable subtle to intense shaking known as tremors. Tremors occur while at rest often seen in the form of “pill-rolling”, a response in which the person suffering from Parkinson’s, “looks like [they are] holding a pill between thumb and forefinger and continuously rolling it around” (“10 Early Signs of Parkinson's Disease”).

As Parkinson’s develops, the chances of developing dementia or, more specifically, Alzheimer’s, increase. While there is treatment available to help with memory loss and behavioral issues, Alzheimer’s worsens over time and cannot be cured, gradually dismantling the brain’s ability to create reasonable thoughts and heavily impairing motor skills. Medications depend on the stage of Alzheimer’s in which the patient is in, ranging from mild to severe, and what specific symptom is being targeted. In order to treat memory loss in those with early to moderate Alzheimer’s, it is recommended to use cholinesterase inhibitors. Cholinesterase inhibitors are a group of drugs that hinder the breakdown of acetylcholine, “the main neurotransmitter found in the body [found] in both the peripheral nervous system and the central nervous system”, by preventing the enzyme cholinesterase to take action with any other chemicals in the human body (“List of Cholinesterase Inhibitors [Acetylcholinesterase Inhibitors]”). Once the cholinesterase is blocked, communication between neurons can be reestablished, ultimately restoring the ability to learn and to preserve memories. Cholinesterase inhibitors are the most commonly prescribed medications to treat Alzheimer’s disease. Those with moderate to severe Alzheimer’s require an additional medication, memantine (Namenda), and a combination of memantine and donepezil (Namzaric).

Memantine is commonly prescribed to treat memory, attention span, judgment, improve cognitive function, and can also have such effects boosted if taken with cholinesterase inhibitors. Treating behavioral issues involves both non-drug and drug related approaches, with non-drug approaches consisting of acceptance of the person’s changed behavior, keeping a relaxed environment, maintaining a healthy daily routine. Treatments for Parkinson’s consist of both non-drug and drug related approaches. Medications can be administered to lessen the severity of tremors and impaired movement-- “over time, however, the benefits of drugs frequently diminish or become less consistent” (“Parkinson's Disease”). Common medications prescribed by physicians, such as carbidopa-levodopa, dopamine agonists, and various types of inhibitors, contribute to the production of dopamine, the neurotransmitter that, “helps regulate movement, attention, learning, and emotional responses” (“Dopamine”). Levodopa is considered to be one of the most effective medications to treat Parkinson’s and functions by passing through the brain and converting into dopamine with a possible side effect of dyskinesia, or involuntary movement. The downside of levodopa is the body’s ability to increase its tolerance against it from prolonged usage, eventually rendering the medication useless.

Physical therapy and aerobic exercise are greatly encouraged to strengthen balance and motor functions; oftentimes, surgical alternatives such as deep brain stimulation, or DBS, are recommended to help stabilize dyskinesia or other unstable responses from taking levodopa. DBS is designed to help those with a more advanced form of Parkinson’s by “send[ing] electrical pulses to [the] brain and [reducing] Parkinson's disease symptoms”, but may come with risks including hemorrhaging, increased chances of a stroke, and infections (“Parkinson's Disease”). Aside from medical remedies, maintaining a healthy lifestyle and exercising will be a tremendous aid, much like non-drug related treatments for Alzheimer’s disease. Alzheimer’s and Parkinson’s can both be treated with alternative medicine-- that is, alternatives inclining to more natural substances. Herbal remedies have grown in popularity but effectiveness is unknown. Coenzyme Q10, also referred to as ubiquinone, is a naturally occurring antioxidant in the body that, “protects cells from damage and plays an important part in the metabolism” (“CoQ10 (Coenzyme Q10): Health Benefits, Dosage, & Side Effects”).

A synthetic version of Coenzyme Q10, named idebenone, and CoQ10 itself have been developed to be used to slow the progression of Alzheimer’s and Parkinson’s and are thought to slightly lower blood pressure, treat multiple heart conditions, muscle pains, and various other problems. Due to possible uncertain effects, is important to take precautionary steps before choosing alternative medicines and consult a physician prior to taking any supplements. Alzheimer’s consists of three general stages-- mild, moderate, severe-- and seven more specific stages. Stage one is “No Impairment” or “No Cognitive Decline”, meaning that there is no detectable trace of Alzheimer’s disease in the brain. Stage two and stage three, identified as “Very Mild Cognitive Decline” and “Mild Cognitive Decline” respectively, begin to show an increase in forgetfulness and struggle in everyday communication. Early-stage dementia begins to make an appearance at stage four, “Moderate Cognitive Decline,” in which the person’s forgetfulness worsens, concentration deteriorates, and the ability to express thoughts declines. Stage five, “Moderately Severe Cognitive Decline,” marks the start of mid-stage dementia and continues through stage six, “Severe Cognitive Decline”. In mid-stage dementia, daily activities such as going through the process of a morning routine, dressing, and cooking are immensely difficult. These struggles reach their peak severity in stage seven, “Very Severe Cognitive Decline,” as late-stage dementia settles within the brain. At this point, “most people will have lost their ability to speak or communicate. They often require assistance with most of their activities, including toileting, eating, dressing, bathing, and other daily activities, around the clock” (“The 7 Stages of Alzheimer's Disease: What to Expect from Preclinical Alzheimer's Disease to End-Stage Alzheimer's”). Those who suffer from Alzheimer’s disease typically live, “on average, four to eight years after diagnosis” (“Alzheimer's Disease Outlook / Prognosis”).

However, it varies from person to person, as some people live up to 20 years or more after the initial diagnosis. Parkinson’s symptoms are rated on a scale from one to five using the Hoehn and Yahr scale, one being mild and five being severe, advanced stages. This condition, on the other hand, provides a longer life expectancy and “usually worsens over an average of 15 years” (“Parkinson’s Disease Prognosis”). Stage one of Parkinson’s disease shows rather mild symptoms such as tremors and involuntary movements that are not severe enough to impact daily activities. Stage two shows significant worsening of movement, now including rigidity, or stiffness of the limbs. While partaking in daily activities is still possible, they may require more time to complete. Stage three, “considered mid-stage, loss of balance and slowness of movements are hallmarks. Falls are more common” (“Stages of Parkinson’s”). Stages four and five require help from another person as stiffness in the legs and arms have increased to the point where walking or even standing is impossible. At its worst point, stage five will trigger hallucinations and delusions, much like Alzheimer’s. Aside from the Hoehn and Yahr Scale, the Unified Parkinson’s Disease Rating Scale (UPDRS) is used as a “more comprehensive tool… to account for non-motor symptoms, including mental functioning, mood and social interaction.” (“Stages of Parkinson’s”).

Compared to the simple five stages that the Hoehn and Yahr Scale presents, the UPDRS has many more specific activities to rate instead of rating a general progression of Parkinson’s. It is divided into six categories, with each category correlating to different aspects of the person’s life: Mentation, Behavior and Mood, Activities of Daily Living, Motor Examination, Complications of Therapy, Modified Hoehn and Yahr Staging, and Schwab and England Activities of Daily Living Scale. These six categories consist of multiple subcategories in which the person is rated on. For example, Mentation, Behavior and Mood contains a subcategory named “Intellectual Impairment” with a rating scale from zero to four, zero being none and four being severe. The specificity of the UPDRS is able to provide a more accurate diagnosis of Parkinson’s and may possibly be used to detect Parkinson’s at its early stages so that proper medical arrangements can be made. While hearing about such serious conditions may be worrisome, there are ways to reduce the risk of neurodegenerative illnesses before they materialize, mostly based on lifestyle changes.

There are multiple methods for prevention that apply to both Alzheimer’s and Parkinson’s: regular exercise, eating healthy and incorporating omega-3 fatty acids into one’s diet, getting enough sleep, and meticulous stress management. The listed methods will also help to prevent other illnesses unrelated to neurodegeneration that may affect the circulatory system, respiratory system, endocrine system, and much more. Mental stimulation is vital for someone at risk of Alzheimer’s, as “those who continue learning new things and challenging their brains throughout life are less likely to develop Alzheimer’s disease and dementia” (“Preventing Alzheimer’s Disease”). Activities like playing memory and strategy games, learning something new like a foreign language or painting, and socializing all keep the brain active and help maintain strong connections between neurons in the brain. Exercise, specifically aerobic exercises, are especially recommended for those with Parkinson’s since Parkinson’s primarily focuses on the deterioration of movement and motor skills. Alzheimer’s disease and Parkinson’s disease are both conditions that raise multiple questions still left unanswered to this day, despite such technological advancements in the medical field. The time it takes to reach the deterioration of all brain functions differs. and such uncertainty may be difficult for the family of the person diagnosed with the condition to cope with. However, support groups and 24/7 helplines have been designed specifically to help families adjust to a new lifestyle with a neurodegenerative illness affecting a loved one. The most important action to take is to watch one’s own health, regularly check in with a physician, and educate oneself on what to expect if either Alzheimer’s or Parkinson’s were to show up in a loved one’s life.