What are the genetic risk factors of AD?
How do hyper-phosphorylated tau proteins contribute to Alzheimer's?
Why can't she remember the death of her husband?
Why can't dad differentiate between a brush and a fork?
or recognize his children?
How is he unable to read, write or draw anymore?

Find attached a detailed summary of the science behind the symptoms of Alzheimer's Disease. AD: Neuropathology and symptoms

.The prevalence of dementia worldwide is increasing. The impact on women will be greater than for men. Women make up a larger proportion of the older population: 62% of people aged over 80 are women.

• More women live with dementia than men. Women are more at risk of developing dementia and the symptoms they live with are more severe.
• Women provide a substantial proportion of informal care to people with dementia, with around two thirds of primary caregivers overall being women. The effects of being a caregiver, on health and well being as well as the financial impact is therefore likely to be greater for women.
• The formal care workforce is predominantly female, particularly in dementia care, providing the majority of health and social care in the community as well as in hospitals and care homes.

Information sourced from Women & Dementia: A Global Research review

With 900,000 Australians expected to be living with dementia by 2050, what  types of questions will children be asking as they come to know someone living with dementia?

Published by the Mental Health Foundation, UK; "The Milk’s in the Oven" is a beautifully collated and informative booklet about dementia for children and young adults.

Do brain cells die as we age?
In a healthy brain, brain cells change shape over time, however there is limited actual cell (neuronal) death. Up to 10% is considered a normal part of ageing. Symptomatic dementia occurs when there is a 40% or more loss of neuronal connections in the brain.

What happens when our brain cells (neurons) change shape?
As we age, our neurons undergo structural changes that leads to less efficient connectivity and information processing. Consequently, gradual cognitive changes result as part of normal ageing, like struggling to multitask and hear and understand speech in background noise.
In Alzheimer's disease, brain cells (neurons) change shape in a different way to healthy ageing and by a different process that eventually leads to neuronal atrophy (cell death).

The impact of age on cognition, Murman. D (2015)

Dementia is an important predictor of nursing home admissions. Due to progressive dementia symptoms, over time it becomes difficult for persons with dementia to communicate their wishes and participate in decisions concerning their everyday lives. Their well-being, sense of dignity, integrity and personhood are at risk (Grondahl et al, 2017).

Creating people’s life stories is particularly important in dementia care as it enables us to see the person beyond the dementia. The process of making a life story enables the voice of persons with dementia to be heard. However, enabling persons with dementia to tell their own life story can be a challenge due to factors such as memory loss, dexterity and visual loss, and impaired ability to communicate. Joint authorship is referred to as a way of supporting the ability of persons with dementia to contribute to their own story.
After a life story process, persons with dementia often report feeling more positive. Life story work helps aged care staff to see the person with dementia as more than a patient as it enhances their understanding of the person for whom they are caring for (past jobs, likes, dislikes and interests.) Family members can be included in the process and provide personal family photographs, and often appreciate that life story work can make their loved ones feel more visible, present and heard.

Alzheimers disease is marked by changes in memory, language and behaviour, however there's an increasing awareness of changes in mobility and its' correlation to cognitive decline. Having worked in dementia units of aged care facilities, I've seen the gradual changes in people's walking abilities. What starts off as a change in gait and stride, can over time lead to missteps, imbalance and falls, increased falls and then the reliance on tub chairs and wheel chairs for mobility.
Part of the story of what helps us to maintain balance involves the vestibular system of the inner ear. This is made up of three semicircular canals, a saccule and utricule, all of which are attached to the cochlea. These three structures, all have tiny hairs (stereocilia) that play a big part in motion detection. These layers of micro hairs within the three structures are arranged in bundles and poke out into an internal gelatinous liquid (endolymph). When this liquid moves, in either of the three structures in response to head and/or body movement, the tiny hair cells bend and send nerve signals to our brain to tell us how to auto correct to find balance.

With Alzheimer's Disease, balance is impaired, not by actual deterioration or damage to the vestibular system but by the inability to access neuronal information.
Neuronal information is inaccessable as neurofibrillary tangles and plaques in the brain of people with Alzheimer's, serve as a barrier to slowing down and eventually blocking the information needed to make readjustments to posture to find balance in movement and gait. But that's just one part of a bigger picture.

Once Iris learned how to forge cheques, there was no turning back.
Her new skill set became part of her learned memory.
She would never forget the sight of her first set from Tiffany’s.
It was forever etched into her visual cortex.

Memory is the ability to use the past in service of the present. It is the sum total of what we remember; experiences, facts, skills and habits. It is the record of a life lived. Experiences that are emotional or prolonged are what our brains deem worthy of saving to long term memory, however our memories are not fixed entities, but rather they are transformed over time, changing as we revisit them and by our current point of view.
Long-term memories are stored throughout the brain as groups of neurons that are primed to fire together in the same pattern that created the original experience, and each component of a memory is stored in the brain area that initiated it (e.g. groups of neurons in the visual cortex store a sight).

Remembering requires many parts of the brain to work together.
The brains inner layer (hippocampus and parahippocampal regions) work with the brains outer layer (cerebral cortex) to organise, store and retrieve memories. The repeated firing of neural circuits back and forth between the inner brain and the outer brain allows an experience to be recalled and consolidated from short term to long term memories. The simultaneous firing of all these groups constructs the memory in its entirety.

The most commonly associated symptom of Alzheimer’s is memory loss. Alzheimer's does not affect all memory capacities equally.

The first to go is short term memory
- the ability to hold information in an active, readily-available state for a short period of time.
Next affected is episodic memory
-memories of autobiographical events.
Then semantic memory
-memories of the meanings of words & facts about the world. Lastly,
Procedural memory
-how to perform tasks and skills.

Beauty is in the eye of the beholder!
In this study, MRI imaging was used to determine whether the activity of distinct cerebral areas of the human brain correlate with the experience of beauty and ugliness. People viewed different styles of paintings (abstract, landscape, portrait and still life) as their brains were scanned for neural activity.
The results showed that:
1 – brain activity for both beautiful and ugly, is in the same cortical areas.
2 – different types of art lit up different parts of the brain.

Inspired by a recent panel discussion I attended, Art & Neuroplasticity: are they linked?
One of the speakers sited this article by Shlegel et al.

"How does the brain mediate visual artistic creativity?
We investigated three aspects of cognition vital to many visual artists: creative cognition, perception, and perception-to-action. We found that the art students became more creative via the reorganization of prefrontal white matter ... Moreover, the art students improved in their ability to sketch human figures from observation, and multivariate patterns of cortical and cerebellar activity evoked by this drawing task became increasingly separable between art and non-art students.
Our findings suggest that the emergence of visual artistic skills is supported by plasticity in neuralpathways that enable creative cognition and mediate perceptuomotor integration."

Resident looking at a 1970's Trifle Recipe Card

For the month of February, I have run a "Back to the 50's" program with my residents.
We've looked at 1950's headlines and remembered Elvis, Marilyn, The Space Race and The Queen's Coronation.
We've looked at Laurie Richards photo's from the 1950's and reminisced about laundry day, supermarket shopping, black & white television and the pace of life.
We've coloured in Blues, Soul and Rock and Roll colouring sheets as we've listened to Nina Simone and danced a little to Little Richard.
We finished up the month with famous weddings from the 1950's and remembered wedding days, wedding traditions and even wedding songs. One of the ladies shared a little rendition of 'Always.' It was the icing on the cake!

Days may not be fair Always,
That's when I'll be there Always.
Not for just an hour,
Not for just a day,
Not for just a year,
But Always.

Always, by Ella Fitzgerald

My 1950's reminiscing resources can be found HERE. Enjoy!