Ronald Reagan, the 40th president of the United States, suffered from Alzheimer's disease and died at the age of 93, 14 years after leaving office.
Ronald Reagan, the 40th president of the United States, suffered from Alzheimer's disease and died at the age of 93, 14 years after leaving office.

The Alzheimer's Puzzle



Despite ongoing discoveries regarding some of the mechanisms of Alzheimer's disease, effective treatments remain as elusive as the true nature of the disease. First described in the early 20th century by Alois Alzheimer, a German clinician, the illness tends to affect people aged 65 and over. The risk of developing the disease roughly doubles every five years after age 65. While everyone from paupers to presidents - most notably the former US president Ronald Reagan - is at risk, the degree to which people can cope with the condition varies. For example, latest research shows that a victim's level of education may play an important role.

A study published in the Archives of Neurology said that well-educated Alzheimer's victims performed better in problem solving and memory tests than less-educated patients. Among people who did not have the condition, or who had few of the brain plaques - accumulations of a protein fragment - that develop in sufferers, the test performance was not influenced by educational level. The research, which was led by Catherine Roe of Washington University School of Medicine in St Louis, Missouri, did not produce surprising results, according to Sir John Grimley Evans, professor emeritus of clinical geratology at Green College at the University of Oxford. Previous studies, he says, have made similar findings.

One suggestion, according to Sir John, is that better educated or more intelligent people can more easily "cover up" their condition and compensate for its effects. "Most people think it's reasonable that if your brain starts to go, you find ways round it if you've had a good education and can find a number of ways of dealing with problems," he says. Population studies appear to support this explanation. For example, in the United States, Sir John says disabilities in old age related to dementia are becoming less common even though the population is ageing.

"In the case of the black population, this has been correlated with the improvement in their education," he says. Another hypothesis to explain the better performance of educated Alzheimer's patients is that people with lower education levels have spent their careers in more hazardous jobs. "They have been exposed to other things that damage their brain. They may smoke more, drink more and may have been exposed to industrial chemicals," he says.

"These things have got to be thought of, but most people think the idea that the brain can compensate longer [in more educated people] is the most likely explanation." If education can help compensate for Alzheimer's, Sir John says it means people should stay mentally active to stave off the condition. Indeed, patients with Alzheimer's are encouraged to keep their minds exercised by, for example, setting themselves tests.

However, Sir John says by the time someone is diagnosed, their ability to learn new things is impaired. "These ways round your difficulties have got to be there before you have the difficulties," he says. Just as individuals vary in the extent to which they can compensate for the brain damage caused by Alzheimer's, so the speed at which deterioration occurs shows "enormous variation". The time between a patient first presenting with symptoms and being unable to look after themselves varies, as "a very crude measure", from two to 10 years in Sir John's experience.

"I've known patients who've deteriorated and become static and then deteriorated again," he says. The huge variation could stem from the possibility that more than one disease is affecting the patient. Since diagnoses are nearly always made on the basis of symptoms, rather than brain biopsies - once in vogue but generally not performed now - it is possible several conditions are being lumped together.

Doctors certainly believe that early-onset Alzheimer's, which affects people prior to their 50s, represents a distinct form of the disease. It is usually more aggressive and is thought to have a genetic component since it is heritable. Unfortunately, Sir John says research into possible environmental factors behind Alzheimer's has not yet yielded significant results. "My own field was looking at the epidemiology and causes in diet and lifestyle, but we came up with nothing very definite," he says.

Laboratory studies have attempted to discern the biochemistry of the condition and there are several lines of inquiry. One looks at the neurotransmitter acetylcholine, which is depleted in brains affected by Alzheimer's. Doctors have prescribed sufferers with acetylcholinesterase inhibitors, which are drugs that interfere with the enzymes that break down acetylcholine, a major neurotransmitter in the brain. "There has been a big row over whether they could be prescribed on the NHS [Britain's state funded National Health Service]," says Sir John.

"About a third of people show some benefit. Sometimes it's a slowing up, sometimes it's a small improvement. They don't make enormous difference but they sometimes do buy a little more time. "My view is that they're worth a try. I used to run a memory clinic and I saw some promising results in some people." Scientists have also focused on amyloid beta, a protein fragment that makes up the brain plaques of people with Alzheimer's.

Mutations in a gene that codes for a precursor protein to amyloid beta are thought to cause early-onset Alzheimer's. Other evidence pointing to the involvement of amyloid beta in Alzheimer's comes from looking at people with Down's syndrome. Such individuals have three copies - instead of the normal two - of chromosome 21, which contains the gene that appears to regulate plaque development in the brain. Duplicate copies of chromosome 21 appear to make those with Down's syndrome more susceptible to Alzheimer's, as most individuals with Down's syndrome develop the brain disease by the time they are 40.

Vitamin supplements have also been experimented with to inhibit plaque formation, although Sir John says "the jury is still out" on their effectiveness. "The necessary trials have not yet been done. People hope there's something in it, but as we don't know what causes the problems, we're probably not doing the right experiments," he says. @Email:dbardsley@thenational.ae

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THE SPECS

      

 

Engine: 1.5-litre

 

Transmission: 6-speed automatic

 

Power: 110 horsepower 

 

Torque: 147Nm 

 

Price: From Dh59,700 

 

On sale: now  

 
Tips for taking the metro

- set out well ahead of time

- make sure you have at least Dh15 on you Nol card, as there could be big queues for top-up machines

- enter the right cabin. The train may be too busy to move between carriages once you're on

- don't carry too much luggage and tuck it under a seat to make room for fellow passengers

Other workplace saving schemes
  • The UAE government announced a retirement savings plan for private and free zone sector employees in 2023.
  • Dubai’s savings retirement scheme for foreign employees working in the emirate’s government and public sector came into effect in 2022.
  • National Bonds unveiled a Golden Pension Scheme in 2022 to help private-sector foreign employees with their financial planning.
  • In April 2021, Hayah Insurance unveiled a workplace savings plan to help UAE employees save for their retirement.
  • Lunate, an Abu Dhabi-based investment manager, has launched a fund that will allow UAE private companies to offer employees investment returns on end-of-service benefits.
The Sand Castle

Director: Matty Brown

Stars: Nadine Labaki, Ziad Bakri, Zain Al Rafeea, Riman Al Rafeea

Rating: 2.5/5

The specs
Engine: 77.4kW all-wheel-drive dual motor
Power: 320bhp
Torque: 605Nm
Transmission: Single-speed automatic
Price: From Dh219,000
On sale: Now
Top Hundred overseas picks

London Spirit: Kieron Pollard, Riley Meredith 

Welsh Fire: Adam Zampa, David Miller, Naseem Shah 

Manchester Originals: Andre Russell, Wanindu Hasaranga, Sean Abbott

Northern Superchargers: Dwayne Bravo, Wahab Riaz

Oval Invincibles: Sunil Narine, Rilee Rossouw

Trent Rockets: Colin Munro

Birmingham Phoenix: Matthew Wade, Kane Richardson

Southern Brave: Quinton de Kock

What She Ate: Six Remarkable Women & the Food That Tells Their Stories
Laura Shapiro
Fourth Estate

How to protect yourself when air quality drops

Install an air filter in your home.

Close your windows and turn on the AC.

Shower or bath after being outside.

Wear a face mask.

Stay indoors when conditions are particularly poor.

If driving, turn your engine off when stationary.

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If you go
Where to stay: Courtyard by Marriott Titusville Kennedy Space Centre has unparalleled views of the Indian River. Alligators can be spotted from hotel room balconies, as can several rocket launch sites. The hotel also boasts cool space-themed decor.

When to go: Florida is best experienced during the winter months, from November to May, before the humidity kicks in.

How to get there: Emirates currently flies from Dubai to Orlando five times a week.
The story in numbers

18

This is how many recognised sects Lebanon is home to, along with about four million citizens

450,000

More than this many Palestinian refugees are registered with UNRWA in Lebanon, with about 45 per cent of them living in the country’s 12 refugee camps

1.5 million

There are just under 1 million Syrian refugees registered with the UN, although the government puts the figure upwards of 1.5m

73

The percentage of stateless people in Lebanon, who are not of Palestinian origin, born to a Lebanese mother, according to a 2012-2013 study by human rights organisation Frontiers Ruwad Association

18,000

The number of marriages recorded between Lebanese women and foreigners between the years 1995 and 2008, according to a 2009 study backed by the UN Development Programme

77,400

The number of people believed to be affected by the current nationality law, according to the 2009 UN study

4,926

This is how many Lebanese-Palestinian households there were in Lebanon in 2016, according to a census by the Lebanese-Palestinian dialogue committee

Paatal Lok season two

Directors: Avinash Arun, Prosit Roy 

Stars: Jaideep Ahlawat, Ishwak Singh, Lc Sekhose, Merenla Imsong

Rating: 4.5/5