In healthy people, all sensations, movements, thoughts,
memories, and feelings are the result of signals or neurons, in the brain.
Neurons constantly communicate with each other through electrical charges that
travel down axons, causing the release of chemicals across tiny gaps to
neighboring neurons. Other cells in the brain, such as astrocytes and microglia,
clear away debris and help keep neurons healthy.
In a person with Alzheimer’s disease, the basic form of
dementia, toxic changes in the brain destroy this healthy balance. These
changes may occur years, even decades, before the first sign of dementia.
Researchers believe that this process involves two proteins called beta-amyloid
and Tau, Which somehow becomes toxic to the brain. It appears that abnormal tau
accumulates, eventually forming tangles inside neurons.
A beta-amyloid clumps into plaques, which slowly build up
between neurons. As the level of amyloid reaches a tipping point, there is a
rapid spread of tau throughout the brain. But tau and beta-amyloid may not be
the only factors involved in Alzheimer’s. Other changes that affect the brain
may also play a role over time.
The vascular system may fail to deliver sufficient blood and
nutrients to the brain. The brain may lack the glucose needed to power its
activity. Chronic inflammation set’s in as microglial cells fail to clear away
debris, and astrocytes react to distressed microglia. Eventually, neurons lose
their ability to communicate. As neurons die, the brain shrinks, beginning in
the hippocampus, a part of the brain important to learning and memory. People
may begin to experience memory loss, impaired decision-making, and language
problems.
As more neurons die throughout the brain, a person with Alzheimer’s
gradually loses the ability to think, remember, make decisions, and function
independently.
Achieving a deeper understanding of the molecular and
cellular mechanisms, and how they may interact, is vital to the development of
effective therapies. Much progress has been made in identifying various
underlying factors.
Advances in brain imaging allow us to see the course of
plaques and tangles in the living brain. Blood and fluid biomarkers are providing
insights into when the disease starts and how it progresses. More is also
known about the genetic underpinnings of the disease, and how they can affect
particular biological pathways.
These advances enable the development and testing of
promising new therapies, including drugs that reduce or clear the increase of
tau and amyloid proteins in the brain, Therapies targeting the vascular system,
glucose metabolism, and inflammation, and lifestyle interventions like exercise
or diet, and behavioral approaches like social engagement, that may enhance
brain health.
Research is moving quickly, ever closer to the day when we
can delay, or even prevent, the devastation of dementia.
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