So the good news is that all of us, especially if you are older than 65, have dementia. Yes, that is the good news. Because although we all have some of the biological mess in our brain, we deal with this on a daily basis and overcome these plaques and tangles through brain plasticity.

As with cancer, which we all have, our body deals with it effectively. It is only when our body stops dealing with these complications that these diseases then become a major health hazard. Most of the time however, we deal with these complications because our body is always changing. That is our natural state.

There are 37.2 trillion cells in the human body. All vibrating with activity and they are always changing. Our body is in reality only about 11 years old. It keeps replacing parts on a daily basis.

Jonas Frisen from Karolinska Institute in Stockholm have been studying how quickly our organs are replaced. He reports the following turnover of organs:  intestines (2-3 days), taste buds (10 days), skin and lungs (2-4 weeks), liver is replaced (5 months), nails (6-10 months), red blood cells  (4 months),  hair (3-6 years), bones (10 years) and heart – most of it (20 years). So how come I do not look 11 years old?

In the process of replication some mistakes are made and some damage cannot be corrected. There are also some cells that cannot be replaced. Cells like the inner lens cells of the eye, or some of the valves and muscle cells of the heart and also cartilage. If we have the disease in our brain can we heal ourselves?

We are not sure what causes dementia. The antiquated idea that it is caused by plaques (amyloid beta) has not been proven. Like a “brain mess”. To date most of the treatments tested in human clinical trials are drugs that remove amyloid and they have not resulted in any positive outcomes. Although the drugs were successful in removing the plaques from the brains of patients with dementia their dementia grew.

The focus on “brain mess” now has been directed at the tangles (tau-protein), although again we are finding that there are different types of these errant proteins that have different ways of infecting the brain. And we are not sure that they are the sole cause of the disease. It is telling that between one in five people – and as high as two out of three people – who have the “disease” in their brain do not show dementia.

We are also still struggling to diagnose Alzheimer’s disease correctly. We confuse Alzheimer’s disease with Creutzfeldt-Jakob disease, Lewy Body dementia and Vascular dementia. There is also confusion with anxiety, low education, cultural variability and – the main cause of misdiagnoses – depression. Our diagnostic tools are too crude to differentiate these other related problems with our thinking. Primarily because we are measuring how strong the problems are rather than the type of problems people experience.

More telling is that the “brain mess” is less likely to cause Alzheimer’s disease as we age. What this means is that there are other problems with the brain as we age. Half of older people with dementia do not have enough brain mess to explain their dementia.

Strangely enough, half without dementia have enough brain mess to be diagnosed with Alzheimer’s disease but they do not have it. The sad part about research in Alzheimer’s disease is that around one in 10 residents in nursing homes and assisted living facilities have a type of disease that can be reversed. It is caused by water pressure accumulating inside the brain.

They are likely misdiagnosed with Alzheimer’s disease when it can be cured. We are too quick to label someone with dementia. Especially in older age. It is not that these diseases do not exist, but that there are so many of them and not all are Alzheimer’s disease. We are too quick to label someone and then labelling has repercussions.

The husband and wife team of professors Alex and Catherine Haslam with the University of Queensland in Australia looked at how stereotypes play a significant role in diagnosis of dementia. What is referred to as stereotype-threat-related, by reading a short sentence or two about how older adults suffer from dementia when they have memory problems, physicians are more likely to then diagnose someone with dementia.

In one study, seven out of 10 physicians were more likely to diagnose an older adult who has memory issues as having dementia rather than when there is no stereotyping (only one in seven). Unfortunately, in response, when older adults are faced with negative stereotypes about their age and their thinking, their memory gets worse. We perform worse when we are stressed and we tend to conform to how people expect us to behave. And in some cases this will stop us from improving.

This is not to say that Alzheimer’s disease is made up. It is a real disease, but we still do not know what it is. There are likely to be many different types of Alzheimer’s diseases, and we need to become better at differentiating them before we try and cure them. Otherwise we label every problem with thinking as dementia and influence older adults’ behaviour in doing so.

Mario Garrett is the author of Politics of Anguish: How Alzheimer’s disease became the malady of the 21st century. He will be delivering a talk on ‘Methodological critique of Alzheimer’s disease: Bad science good politics’ at the University of Malta on February 9 from 5.30pm to 7.30pm.

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