Brain Disease

The most serious brain diseases are stroke , which kills nearly 130,000 Americans and 6,99,000 Indians each year, and Alzheimer’s disease, which kills nearly 85,000 in America, I have no data of killing reports of this in India. Most strokes can be thought of as “brain attacks” like heart attacks, but the rupturing plaques in your arteries cut off blood flow to parts of brain rather than to parts of the heart. Alzheimer’s is more like a mind attack.

Alzheimer’s disease is one the most physically and emotionally burdensome disease, for both sufferers and caregivers. Unlike stroke, which can kill instantly and without any warning, Alzheimer’s involves a slower, more subtle decline over months or years. Instead of cholesterol- filled plaques in your arteries, plaques made of a substance called amyloid develop in the brain tissue itself, associated with loss of memory and, eventually, loss of life.

Stroke

In about 90 percent of strokes, blood flow to part of the brain gets cut off, depriving it of oxygen and killing off the part fed by the clogged artery. That’s called ischemic stroke (from the Latin ischaemia, meaning “stopping blood”). A small minority of strokes are hemorrhagic strokes, which are caused by bleeding into the brain when a blood vessels bursts. The damage wrought by a stroke depends depends on which area of the brain was deprived of oxygen (or where bleeding occurred) and for how long the deprivation lasted. People who experience a brief stroke might only need to contend with arm or leg weakness, while those who suffer a major stroke can develop paralysis, lose the ability to speak, or, as is too often the case, die.

Sometimes the blood clot lasts only a moment, not long enough to notice but still long enough to kill off a tiny portion of your brain. These so called silent strokes can multiply and slowly reduce cognitive function until full blown dementia develops. The goal is to reduce the risk of both massive strokes that can kill you instantly and the ministrokes that kill you over the course of years. Just as with heart disease, a healthy diet can reduce stroke risk by reducing cholesterol and blood pressure while improving blood flow and antioxidant capacity.

Alzheimer’s Disease

In all my medical year, this is the disease, I fear the most, even more than cancer. It wasn’t just because of the psychological toll to come for the patient but because of the emotional toll that would be placed on loved ones. The Alzheimer’s Foundation estimates that fifteen million friends and family members supply more than fifteen millions friends and family members supply more than fifteen billions unpaid hours annually caring for loved ones who may not even recognize them.

Despite the billions of dollars spent on research, there is still neither a cure nor an effective treatment for the disease, which invariably progresses to death. In short, Alzheimer’s is reaching a state of crisis- emotionally, economically, and even scientifically. Over the past two decades, more than seventy- three thousand research articles have been published on the disease. That’s about a hundred papers a day. Yet very little clinical progress has been has been made in treating or even understanding it. And a total cure is likely impossible, given that lost cognitive function in Alzheimer’s patients may never be regained due to fatally damaged neuronal networks. Dead nerve cells cannot be bought back to life. Even if drug companies can figure out how to halt the disease ‘s progression, for many patients, the damage has already been done, and the individual’s personality may be forever lost.

History of Alzheimer

In 1901, a woman named Auguste was taken to an insane asylum in Frankfurt, Germany, by her husband. She was described as delusional, forgetful, disoriented woman who “could not carry out her homemaking duties” She was seen by Dr. Alzheimer and was to become the subject of the case that made Alzheimer a household name.

On autopsy, Alzheimer’s described the plaques and tangles in her brain that would go on to characterize the disease. But lost in the excitement of discovering a new disease, a clue may have been overlooked. He wrote “Die größeren Hirngefäße sind arteriosklerotisch verändert,” which translates to “The larger cerebral vessels show arteriosclerotic changes”. He was describing the hardening of arteries inside his patient’s brain.

Is Alzheimer a vascular disease?

We generally think of atherosclerosis as a condition of the heart, but it’s been described as “an omnipresent pathology that involves virtually the entire human organism. You have blood vessels in every one of your organs, including your brain. The concept vessels in every one of your organs, including your brain. The concept of “cardiogenic dementia”, first proposed in the 1970s, suggested that because the aging brain is sensitive to a lack of oxygen, lack of of adequate blood flow may lead to cognitive decline. Today, we have a substantial body of evidence strongly associating atherosclerotic arteries with Alzheimer’s disease.

Autopsies have shown repeatedly that Alzheimer’s patients tend to have significantly more atherosclerotic plaque build up and narrowing of the arteries within the brain. Normal resting cerebral blood flow- the amount of blood circulating to the brain- is typically about a quart per minutes. Starting in adulting, people appear to naturally lose about half aa percent of blood flow per year. By age sixty- five, this circulating capacity could be down down by as much as 20 percent. While such a drop alone may not be sufficient to impair brain function, it can put you close to the edge. The clogging of the arteries inside, and leading to, the brain with cholesterol- filled plaque can drastically reduce the amount of blood- and therefore oxygen- your brain receives. Supporting this theory, autopsies have demonstrated that Alzheimer’s patients had particularly significant arterial blockage in the arteries leading to the memory centers of their brains. In light of such findings, some experts have even suggested that Alzheimer’s be reclassified as a vascular disorder.

There are limitations to how much we can glean from autopsy studies, however. For example, perhaps a person’s dementia led to his or her poor diet rather than vice versa. To further assess the role of clogged brain arteries in the development of Alzheimer’s researchers followed about four hundred people who were just starting to lose their mental faculties, which is called mild cognitive impairment. Special brain artery scans were employed to evaluate the amount of arterial blockage in each patient’s brain. The researchers found that the cognition and daily functioning of those with the least narrowing of the arteries in their heads remained stable over the course of the four- year study. Meanwhile, subjects with ,more arterial blockage lost significant brain function, and those with the worst cases of plaque build up declined rapidly, doubling their likelihood of progressing to full- blown Alzheimer’s. The researchers concluded: “An inefficient blood supply to the brain has grave consequences on brain function”.

A study of three hundred Alzheimer’s patients found that treating vascular risk factors, such as high cholesterol and blood pressure may even slow the progression is the key. Cholesterol doesn’t just help generate atherosclerotic plaques that riddle the brain tissue of Alzheimer’s victim. Cholesterol is a vital component of your cells, which is why your body makes all that you need. Consuming excess cholesterol, and especially trans and saturated fats, can raise your blood cholesterol, and especially trans and saturated fats, can raise your blood cholesterol level. Too much cholesterol in your blood is not only considered the primary risk factor for heart disease but is also unanimously recognized as a risk factor for Alzheimer’s disease.

Autopsies have revealed that Alzheimer’s brains have significantly more cholesterol buildup than normal brains. We used to think that the pool of cholesterol in the brain was separate from the cholesterol circulating in the blood, but there is growing evidence to the cholesterol circulating in the blood, but there is growing evidence to the contrary. Excess cholesterol in the blood, can lead to excess cholesterol in the brain, which may then help trigger the clumping of amyloid seen in Alzheimer’s brains. Under an electron microscope, we can see the clustering of amyloid fibers on and around tiny crystals of cholesterol. And indeed, advanced brain imaging techniques, such as PET scans, have shown a direct correlation between the amount of LDL (“bad”) cholesterol in the blood and amyloid build up in the brain. Drug companies have hoped to capitalize on this connection to sell cholesterol- lowering statin drugs to prevent Alzheimer’s, but statins themselves can cause cognitive impairment, include short- and long- term memory loss. For people unwilling to change their diets, the benefits of statins outweigh the risks, but it’s better to lower your cholesterol levels naturally by eating healthier to help preserve your heart, brain, and mind.

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