Updated: Jun 15
Lisa Genova wrote Still Alice.
During normal brain synapse function, neurotransmitters are applied to the synapse. In addition, a small amount of the peptide Amyloid Beta (AB) is applied.
Think of Amyloid Beta as a byproduct of normal brain neural synapse function, much the way Lactic Acid is a normal byproduct of muscle exercise and the release of energy via the ATP => ADP conversion process.
The AB should get cleared away by Microglia, the janitor cells of the neural function. If too much AB is produced, the AB may not be fully cleared and remain in the synapse.
Eventually, AB will bind to itself, creating Amyloid plaques (AP). The AP eventually will overwhelm the synapse, causing synaptic death. Once a significant number of synapses die, one becomes symptomatic to Alzheimer’s disease.
What can we do to reduce AB build up and AP formation?
Deep sleep - slow (delta) wave sleep is when spinal fluid is released into the brain, washing away excess AB, in effect assisting the microglia.
Diet - Eating a heart healthy / Mediterranean diet to maintain a strong body and maintain mental health.
Exercise - maintaining a strong body will assist your brain in maintaining mental health and slowing Alzheimer’s disease.
Promote neuroplasticity / cognitive reserve - this is a method of staying ahead of Alzheimer’s. Assuming we will all have some AP build up and related synaptic impairment, creating a reserve of healthy synapses will help the brain rewire around the plaqued synapses and help keep you symptom free. There was a famous Nun Study that demonstrated this.
Prevention is the key. Once the AP has formed and it starts a cascade of synapse failures, it is too late to reverse the synaptic impairment impact.
“Think of AP as a lit match, at the tipping point, the match sets fire to the forest. Once the forest is a blaze, it doesn’t do any good to blow out the match.”
- Lisa Genova
For a great primer on neuroscience, including the usage of neurotransmitters and how information is passed by different charged ions, see Appendix A, in the book Behave by Robert Sapolsky.
The Economist recently wrote the article America's approval of an Alzheimer's drug is premature. They make a good case. To Genova’s point, this drug feels a bit like focusing on blowing out the match after the forest fire has started. Instead, why not focus on the conditions that make the forest fire possible in the first place?
Thinking as an economist and following the incentives, focusing on educating people to get better sleep, diet, and exercise, will not pay as well as the promise of a dubious drug. However, this approach is consistent with how America’s medical system game rules have evolved from “Health Care” to “Sick Care.” Treating sick people is more profitable to the medical industry than teaching them not to be sick in the first place.