Alzheimers Brain Changes Begin Years Before Symptoms
President Ronald Reagan’s son, Ron, has written a memoir about his father in honor of what would have been Mr. Reagan’s 100th birthday. In the book “My Father at 100”, Ron writes that he believes his father began showing symptoms of Alzheimer’s disease at least five years before his diagnosis in 1994. Not surprising, as the underlying pathology, including accumulation of amyloid beta plaques and brain injury and inflammation, occur as much as 10 years before cognitive tests can diagnose the disease.
Pathology Precedes Symptoms by as Much as 10 Years
Ron writes that he remembers how his father would “uncharacteristically (be at a loss) for words” and would sometimes look “lost and bewildered” as early as 1984, during the presidential debates with Democratic rival Walter Mondale. In 1986, President Reagan may have suspected his own condition when he became alarmed that he could not remember the names of familiar canyons north of Los Angeles as he was flying over them.
President Reagan left office in 1989, but son Ron believes that he would have left office prior to the end of his second term if he had been diagnosed sooner.
During normal aging, the brain undergoes changes such as the development of abnormal structures, restriction of blood flow, and an increase in free radical damage. All of these can account for a general decline in thinking abilities and memory capacity, sometimes referred to as “senior moments.”
But persons with Alzheimer’s disease have brain damage that is not part of the normal aging process. The two types of neuron damage include amyloid plaques and neurofibrillary tangles, also known as “tau protein tangles.” Amyloid-beta is a naturally occurring protein that builds to abnormal levels between the neurons in the brain of a patient with Alzheimer’s disease. These interfere with the neurons’ ability to communicate with one another. Tau protein is also a normally-occurring substance, but in the case of Alzheimer’s, tau protein strands are altered and become twisted, collapsing the neurons’ internal transport network.
Other changes in found in Alzheimer’s patients are the presence of brain inflammation and low levels of the neurotransmitter acetylcholine. Inflammation may further degrade brain function and acetylcholine is necessary for memory and other cognitive functions.
So, how can family members determine the difference between “senior moments” or memory changes that are cause for concern? Dr. Brendan Kelley, a University of Cincinnati neurologist and Endowed Chair in Alzheimer’s disease Research and Education says that “major increases in forgetfulness are not something that we should expect as part of normal aging.”
He says that it is time to be concerned for yourself or a loved one when memory lapses reach the point where they start to impair normal function in day-to-day life or when someone constantly repeats questions. “Those are the kinds of things you should bring to your doctor’s attention,” says Dr. Kelley.
As for President Reagan, Ron hopes the issue of his father’s health does not tarnish his legacy as the nation’s 40th President. “(This) serves as a reminder that when we elect presidents, we elect human beings with all their foibles and weaknesses, psychological and physiological,” he writes in the memoir.