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Alzheimer’s Disease: How much does it Impact Your Brain Anatomy? 1

Alzheimer’s Disease: How much does it Impact Your Brain Anatomy?

Meghan West

Longwood University

December 1st, 2015


Abstract:

This research paper will explore Alzheimer’s disease and its effects on various

brain anatomy. The purpose of this paper is to provide readers with a better

understanding of this disease as well as to provide information relevant to those who

may suffer from the disease or know someone who suffers from the disease. This paper

is part of research towards an enhancement for my anatomy class that I was interested

in as my grandparents both suffer from this disease. The hopes were to not only inform

others of the results, but also to use this personally in my life currently and in the future

with my career as a Speech-language pathologist.


With over five million Americans already diagnosed and the number continuously

climbing daily, Alzheimer’s disease is the sixth leading cause of death and the most

expensive condition in the United States. (Martone & Piotrowski, 2015) Alzheimer’s

disease is the most common form of dementia and is progressive beginning with mild

memory loss and ending in severe memory loss and the need to be cared for. (Martone

& Piotrowski, 2015) While the cause of Alzheimer’s disease is unknown, there are a few

indicators that not only affect brain anatomy, but hinder the cognitive functions of the

person leading them to seek therapy treatment from speech-language pathologists.

Alzheimer’s disease is a “progressive disease resulting in the loss of higher

cognitive function,” and its current cause is unknown. (Burns, Howard & Pettit, 1995) It

is the most common form of dementia and its stages range from mild to severe with a

wide variety, depending on the person. This disease affects many areas of the brain

from the cells and nerves to the nervous system and psychic-emotional system.

(Peterson, 2002) It is proven to be a degenerative disorder that attacks the brain and

leads to personality changes as well as the impairment of judgement. This disease

affects each person differently, but the end result remains the same. The disease can

be severe enough with the loss of intellectual and social abilities that it can begin to

interfere with daily functioning. (Peterson, 2002) By no means is it a simple disorder or

one that can be easily identified and treated, yet it leads to constant research and

confusions in the eyes of professionals.

Alzheimer’s was discovered in 1906 by researcher Alois Alzheimer and a major

finding from his research indicated that the disease disrupts the way the brain works

and “intellectual functioning progressively declines.”(Khachaturian & Radebaugh, 1996)


Throughout various research completed on Alzheimer’s disease, researchers

have discovered that “neuritic plaques and neurofibrillary tangles,” are most prevalent in

those with the disease. (Chakrabarti, 2015) Both plaques and tangles play a role in the

destruction of neurons which in a “Domino effect” leads to no communication between

neurons and the overall shrinkage of the brain’s size and mass. It also causes a

reduction in the chemical needed for cognitive function and helps explain why these

patients have so many issues with communication and memory. The chemical is known

as acetylcholine and is also needed in order to process memories and learning.

(Petersen, 2002) These are both areas vital to everyday life and without them the

number of difficulties seen by those with the disease greatly increase.

Another key cause of Alzheimer’s researchers have not ruled out are amyloid

plaques. Amyloid plaques are abnormal aggregations of tissue that consists mainly of

beta-amyloid, which is found between nerve cells that are living. (Petersen, 2002) While

they are not seen as readily as the plaques and tangles, they may help to explain why

communication is loss between nerve cells since its location is in between nerve cells.

Alzheimer’s primarily effects anatomy of the brain in that the main symptom of

the disease is memory loss and every part of the brain is involved in the maintaining

and storing of memories. The brain controls a majority of the activities we as humans

complete from organizing ideas and memories to producing emotions. When the

disease enters into the picture one experiences effects in language, judgement,

understanding, and the ability to focus. (Peterson, 2002)

The two areas of the brain that are affected the most are the cerebral cortex and

the hippocampus. The cerebral cortex houses “higher functions of the mind,” from


thought to sensation and motion. (Martone & Piotrowski, 2015) The hippocampus

functions to “learn and process various forms of information as long-term memory,” and

if damaged can produce global amnesia. (Martone & Piotrowski, 2015) Along with these

two structures, there is also a breakdown in the brain that causes brain cells to lose

communication with one another

The main effect that Alzheimer’s has on the anatomy of the brain is that the

“brain shrinks affecting nearly all functions.” (Petersen, 2002) This means that the

cortex becomes smaller as brain cells are killed thus leading to issues with planning,

memories, and thinking. Not only does the brain shrink in terms of appearance, but also

in terms of mass as neurons are killed and communication ceases to exist. This leads to

difficulty in completing everyday tasks to the point that something that used to be easy

to complete such as tying one’s shoe is now almost impossible as they are either too

weak to complete the task or simply cannot remember how to carry it out.

Other anatomical parts of the brain effected by this disease are neurons, nerves,

and both nervous systems. Neurons are smaller nerve cells that help carry messages

through the brain and are a large part of communication in the brain. (Peterson, 2002)

In the brain alone there are more than 100 billion neurons moving around and the ones

that we have currently are around for our entire life. (Petersen, 2002) Alzheimer’s

affects these neurons by destroying them resulting in fewer overall and since they stay

the same most of our lives, they most likely will not regenerate.

Nerves are a step larger than neurons and are “the pathway for electrochemical

nerve impulses,” that send impulses of sensation to the brain. (Khachaturian &

Radebaugh, 1996) Again Alzheimer’s affects this anatomical structure by affecting and


limiting the communication between cells that is transferred through the nerves and

sends signals to the brain. Lastly, the nervous system is affected as a whole in that it is

the larger part of the system that sends impulses between various parts of the body and

when damaged cannot only affect the brain, but can prevent signals from making it to its

designated body part and thus the action that one wants to do will not occur.

The most common risk factors of the disease are age and family history. Age

tends to be the reason that the plaques and tangles occur, but family history plays a

large role in that the genes are passed down through reproduction. Alzheimer’s tends to

be seen in those age 65 and older, but there are rare cases when it can occur as early

as age 30 or 40. It is fair to assume that Alzheimer’s is diagnosed in all elderly people,

yet this is not completely accurate. While it is most likely to occur, it does not mean that

everyone as they reach their 60s and 70s will be diagnosed with the disease. Some

may develop symptoms and may choose to not be diagnosed or simply tell themselves

that they do not have the disease.

Alzheimer’s disease is not officially diagnosed until one dies as the only way to

truly figure out if someone has it is through an autopsy. How do so many people find out

they have Alzheimer’s then? Doctors pick up on certain key indicators such as

personality changes, memory loss, and inability to remember simple daily tasks,

therefore they diagnose the patient with the disease. While most of the time the person

really does have the disease, there is so much uncertainty about the disease that

doctors could be diagnosing and trying to treat patients who may not even have the

disease at all.


Along with initial diagnosis, there are also various forms of dementia that one can

have, some more prominent than others. Not only is it difficult for physicians to diagnose

dementia, but it is also difficult to pinpoint which form of dementia a person may have.

Alzheimer’s disease is one form of dementia and makes up about half of the total

number of dementia cases. There are three groups of dementia that are known to

physicians and those will be briefly mentioned. These groups are primary differentiated

dementia, secondary dementia, and primary undifferentiated dementia. Of these three

groups, Alzheimer’s disease falls under the primary undifferentiated dementia along

with another form of dementia know as Pick’s disease. Primary undifferentiated

dementia is defined as “affecting the brain and producing dementia through direct

effects on brain tissue.” (Heston & White, 1991) This also proves that the anatomy of

the brain is greatly affected and in a way the brain begins to “shut down.”

On the other end of the spectrum is the severity of the disease. Alzheimer’s

disease has three different severity levels. These levels are mild, moderate, and severe

which are similar terms used with almost any disease diagnosis. The mild and moderate

stages are grouped together with the major affects being memory, thinking, and

planning. (Martone & Piotrowski, 2015) This stage can last anywhere from two to ten

years, but again each person is different and their progression may change in a matter

of days or weeks. Speech and understanding speech can be affected during this stage

as one may not be able to remember certain words or their own language may be

impaired by tangles in that area of the brain.

The last severity level is that of severe. This stage is when most of the cerebral

cortex is damaged due to plaques or tangles and the brain shrinks dramatically due to


widespread cell death. (Martone & Piotrowski, 2015) At this point communication does

not exist, family members are not normally recognized, and the patient is unable to care

for themselves. Most likely a caregiver is needed or the person has to be put in a

nursing home in order to receive the best care possible. Oftentimes the person is

bedridden and needs assistance in bathing, dressing, and eating to name a few. This

stage tends to last one to five years, but again varies depending on the person and

what treatment, if any they are going through. The end of this stage is normally death,

but the cause of death is not determined as solely due to Alzheimer’s.

As indicated earlier, one can not 100 percent accurately diagnose a person with

Alzheimer’s unless an autopsy is conducted. Once the person dies the autopsy will

prove which form of dementia they had if they had any at all. Alzheimer’s is not the

primary cause of death as many may think. It is only a secondary cause that is

accompanied by a primary cause such as pneumonia or aspiration to name a few.

Aspiration is a formal term for choking and as the disease progresses the likelihood of

this happening increases as one is unable to fully chew their food or goes to sleep with

some still stuck in their cheek.

Symptoms of Alzheimer’s disease vary from person to person and oftentimes

physicians misdiagnosed another illness for Alzheimer’s or Alzheimer’s for another

disorder. The symptoms of Alzheimer’s are very similar to mental and physical disorders

which explains why physicians tend to misdiagnose it. Physicians use a series of tests

and evaluate present symptoms in order to make the best diagnosis, but again this is

not a 100 percent diagnosis.


Some of the symptoms of Alzheimer’s disease include agitation, wandering,

emotional outbursts and the inability to remember tasks and events. The first stage

tends to be where a family member notices that their loved one is having difficulty with

remember where they put items or where events are occurring. The second stage

becomes slightly worse as they often have issues getting their point across to others

and tends to have hallucinations on people and things around them. They may blame

you for something that you did not do because in their mind they saw something

different or they do not remember the small things you have done to help them. The

third and last stage of the disease is that their ability to reason completely stops and

they are dependent on family members in order to be cared for.

Other symptoms of Alzheimer’s include depression, hallucinations, delusions,

and accusations or disbelief of reality. Oftentimes we do not realize that depression is

an indicator of dementia, rather other events occur that make one believe it is simply

this rather than looking at the larger picture of what it may turn into. Delusions and

hallucinations tend to be group together and can be anything from infidelity of a spouse,

to infestation of parasites, and believing that family members are imposters. This may

sound extreme, but coming from someone who has family members with Alzheimer’s

this has been the most common symptom.

Once someone is affected by Alzheimer’s disease it is harder for them to make

new memories. They often tend to reflect on long-term memories from their childhood or

large events such as an anniversary, death, or wedding. They may get upset over a

memory of a loved one who has past and tend to tell stories that happened years ago.

Short-term memory is almost nonexistent and often they repeat the same story or


memory over and over again because they cannot remember already telling you the

story. In their mind they think that they are telling a new story and most of the time

instead of correcting them, it is better to just listen to the story again in order to avoid

them becoming upset or feeling disadvantaged.

Alzheimer’s is not a disease to be taken lightly and even though there is not a

cure, the available treatments can slow down or alter the affects the disease has on

your loved one. A few of the current treatments involve helping those with the disease

maintain mental function and managing emotional outbursts. These treatments are

designed to “enhance communication between nerve cells,” which will prevent the

formation of plaques and tangles that are the main causes of the disease.

(Khachaturian & Radebaugh, 1996)

Researchers are still continuing to develop new forms of treatment, but in recent

years there has been very little luck. The goal is to find a cure for the disease, but at this

time there is no medication or treatments that will completely cure or make the disease

go away. Alzheimer’s is fatal and the time frame of how long someone has to live is too

unpredictable. One person may live ten years after they were diagnosed while others

may only live a few months depending on if they chose to undergo treatment or other

actions they take in order to slow down the progression of the disease.

From personal experience the toll that Alzheimer’s takes on a loved one is hard

to see and even harder knowing that there is not a cure for the disease. Family

members try to do everything possible to make the disease not exist, but at the end of

the day the progression only gets worst and it is just another day with the disease.


The inability to speak and understand speech is where Speech-language

pathologists (SLPs) come is as being able to talk is vital in today’s communication. Not

only is communication between neurons affected, but communication as a whole is

affected when the cognitive processes that help form speech are impaired due to the

breakdown of anatomical structures. Another factor that SLP’s tend to treat in

Alzheimer’s is cognitive function. Cognition is very important in that it aids in judgement,

ability to form abstract thoughts, and emotional responses. As one can see when this is

diminished or lost completely, several areas are affected and the ability to speak or

make coherent thoughts is out of their grasp.

Along with cognitive function, SLP’s also help with several speech disorders that

appear during this time. The main ones that will be discussed in this section are aphasia

and apraxia. While these are the main two we cannot rule out that other speech

disorders will not arise during the onset and progression of the disease. Aphasia is the

“simplification of the richness of language,” meaning that the word choice and even the

ability to write are made harder. (Heston & White, 1991) Indicators show that the

damage is in the left half of the brain therefore the damage occurred on the right side as

the opposite side is affect from where the damage occurs. Even though it does affect

speech, reading, and writing, aphasia does not affect one’s intelligence and should not

be seen as a disability.

The second speech disorder that can occur due to Alzheimer’s is apraxia.

Apraxia is a motor speech disorder that affects the ability to produce sounds or words

even though there is no impairment to the structures that aid in this. (ASHA, 2015) This

goes off of the cognitive issues in that they cannot put the thoughts together to form


words and sentences that make sense. This disorder is most often seen in those with

dementia or Alzheimer’s, but not everyone who has the disease is likely to experience

this.

SLP’s help those with these disorders by either retraining the muscles in order to

say the words or start therapy focused on reading, writing, and speech as a whole.

Treatment plans are made for each client in order to be able to meet their needs and

help them improve. There is not one set treatment or therapy that can reverse or fix the

disorder, rather they are put in place to help improve what has been undone and altered

by the disease. Another option that can be used is memory training in order to protect

and improve cognitive functions. (Heston & White, 1991) This can be anything from

repeating phrases to memory games and its sole purpose is to help regain memory and

keep it in tact.

It is not unlikely that a SLP would treat someone with this disease as our job is to

improve one’s ability to speak and make communicating easier to understand and do as

a whole. While we cannot treat Alzheimer’s as a whole, we can improve their overall

communication and provide speech therapy that will move them in the correct direction.

Some research has indicated that there are certain daily activities that improve

memory and prevent Alzheimer’s from occurring. While this activities do aid in memory

and could be considered memory training, they do not rule out Alzheimer’s completely.

Anyone can be diagnosed with the disease no matter if they complete these activities

every day or none at all. These include crosswords, word searches, Sudoku, and even

singing that when completed a few minutes a day may be the difference between

suffering from dementia and preventing it.


Alzheimer’s is not a disease to be taken lightly as it affects various anatomical

structures of the brain that include memory, and cognitive function. As these structures

begin to deteriorate the effects of the disease take their toll on the body and treatment

can merely slow down, but not reverse the effects. While a cure is not available at the

present, hopefully over the next few years one will become available and the disease

will merely be one for the history books. Until then one can only utilize treatments and

seek therapy and care in order to prevent the disease from consuming them rapidly if

not all together. The “unknown disease” as you may like to call it is continuing to affect

those closest to us, yet being proactive and noticing the symptoms early can keep them

around longer than one may expect.


Reference Page:

Burns, A., Howard, R., and Pettit, William. (1995). Alzheimer’s Disease: A Medical

Companion. Blackwell Science Ltd. Massachusetts. Print.

Chakrabarti, S., Khemka, V.K., Banerjee, A., Chatterjee, G., Ganguly, A., & Biswas, A.

(2015). Metabolic Risk Factors of Sporadic Alzheimer’s Disease: Implications in

the Pathology, Pathogenesis and Treatment. Aging & Disease, 6(4), 282-299.

doi: 10. 14336/AD.2014.002

Fuller, D., Pimentel, J.T., Peregoy, B.M. (2012). Applied Anatomy & Physiology for

Speech-Language Pathology & Audiology. Lippincott Williams & Wilkins.

Baltimore. Print.

Heston, L.L., White, J.A., (1991). The Vanishing Mind: A Practical Guide to Alzheimer's

Disease and other dementias. New York: W: H. Freeman. Print.

Khachaturian, Z.S., & Radebaugh, T.S., (1996). Alzheimer’s disease: Cause(s),

Diagnosis, Treatment, and Care. Boca Raton. Print.

Martone, R.L., & Piotrowski, N.P. (2015). Alzheimer’s disease. Magill’s Medical Guide

(Online Edition)

Petersen, R. (2002). Mayo Clinic on Alzheimer’s Disease. Mayo Foundation for Medical

Education and Research. Minnesota. Print.

U.S. Department of Health and Human Services. (4 Oct, 2013). Centers for Disease

Control and Prevention: Dementia and Alzheimer’s Disease

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