Alzheimer’s, Ethics and Immortality

Alzheimer’s, Ethics and Immortality
Kazimir Uzwyshyn-Jones, St Georges School
Abstract
With a rapidly ageing human population Alzheimer’s and other similar diseases will become ever more common. Although the impact of Alzheimer’s on society is growing substantially, the disease is still poorly understood. Our society generally considers Alzheimer’s as a disease of the old with huge care costs but puts comparably little resources into prevention and cure. I argue that Alzheimer’s disease is a fundamental limitation to our society and indeed the future of humanity.
Introduction
Alzheimer’s is unlike most other common and important diseases. Firstly, there are no accepted risk factors, so there is relatively little anyone can do to prevent or slow it. Alzheimer’s and Dementia holds a decisive grip upon many families’ world-wide. It is often extremely difficult to watch a parent or grandparent deteriorate so much that they cannot recognise the people they love the most. Here Alzheimer’s and Dementia lie in a league of their own.

What is Alzheimer’s and Dementia?
Leading theories suggest that Alzheimer’s is caused by the buildup of misfolded beta-amyloid plaques between brain cells and later neurofibrillary tangles formed by hyperphosphorylated Tau proteins inside brain neurons. Essentially, both the plaques and tangles are caused by faulty proteins which break up, stick together and become toxic. These collections then prevent intercellular functions and communication which kill brain cells and nerve connections that lead to loss of mental function. ^[1]
Alzheimer’s does not directly cause death, sufferers most commonly die from pneumonia by being unable to consume food properly and getting food inside their lungs. Dementia on the other hand is the umbrella term of the symptoms Alzheimer’s and similar diseases such as Huntington\’s or Parkinson’s. This most commonly includes memory loss, loss of mental acuity and behavioural changes to name a few. Healthcreeds notes that dementia itself doesn\’t kill, but other underlying issues and complications from dementia can.

What is being done so far?
What must be considered when approaching Alzheimer’s is the sheer complexity in regard to finding a cure and its gargantuan social and economic impacts. In the US it is 6^th most common cause of death. Costing $259 billion per year in care, expected to reach $1.1 trillion by 2050, yet only $480 million is spent per year on research^[1]. In comparison, cancer’s yearly care costs are around $87.8 million compared to $6036 million on research^[2]. Thus per year Alzheimer care cost is almost triple that of cancer yet almost 13 times less money is put into research.
What could possibly be the cause of such a huge discrepancy? Surprisingly, there is no truly substantially effective treatment to slow, stop or even prevent the disease. Arguably, strong correlation between factors such as lifestyle, other diseases and gender has been formed yet the link to its causation is mostly undetermined. Symptoms of dementia in senile old men and women have been documented throughout time so what sets Alzheimer\’s apart?
Looking very simply into the mechanism of the disease one can see that the most common pathway for Alzheimer’s is faulty, malformed proteins leading to the formation of toxic clots killing brain cells. Over the years these cumulative deposits of proteins slowly engulf the healthy neurons in our brain. It is easy to conclude that if we die of nothing else this natural process of neuronal changes will eventually lead to our demise.^[1] Expressed in this way such mechanisms could simply be a consequence of ageing.

Statistically, the most important risk factor is age, by 85 there is nearly a 1 in 2 chance you will have Alzheimer’s. Through an ever ageing population, Alzheimer’s and Dementia are becoming ever more prevalent and at an unprecedented rate, with an increase of deaths by Alzheimer’s of 89% from 2000 to 2014^(1].

One thing that is particularly interesting to note is that in developed countries the accepted age for someone to be classed as elderly is 65 years. Similarly, common statistics with regard to Alzheimer’s are often quoted such as past 65 the likelihood of illness doubles every 5 years or the rarer early onset Alzheimer’s is loosely defined to occur before 65^[1] and even as late as 1977 diagnosis of Alzheimer’s was reserved for those aged over 65^[3].
Returning to statistics of money spent on research, the ethical question begs to be asked, what is a human life worth – is it circumstantial? Alzheimer’s patients rarely hold much societal value, yet cost vast sums of money and huge time lost. Last year in the US alone an estimated 18.2 billion hours of unpaid care was provided^[1]. Would society rather spend money helping a child recently diagnosed with Leukaemia, their life ahead of them, over a forgetful, aggressive pensioner? Although not stated, one could infer from money spent on research alone, just how society and research clinics value a human life.
Furthermore, Alzheimer’s influence doesn’t just affect those with the disease but has serious implications for their caregivers. Over 44% of the US population (between 45-55) feels the effect of the sandwich generation; both caring for their children and parents. Yet unlike heart disease or most other common diseases, Alzheimer’s patients require constant supervision. This places a crippling monetary and productivity strain on the midlife population, often correlated with spiralling depression rates. Likewise, unless there is financial aid for care homes, societal pressure nearly rests entirely upon these generations, thus repeating the ethical conundrum in terms of to which generation should priority be given .


Even recent breakthrough developments in gene sequencing and editing techniques, have yet to play any significant role, with only about 1-5% of cases having a genetic factor (Autosomal Dominant AD- APP/PS-1/PS-2). Diagnostic techniques such genetic screening can be used to see if the patient possesses the APOE-Ɛ4 allele on chromosome 19^[1]. This has been shown to increase the likelihood threefold nevertheless this is still yet to result in a cause. Similarly, the Alzheimer’s Association suggests that results are neither robust nor in fact completely ethical due to its impact regarding changes of health insurance since the only sure way for diagnosis is after an autopsy has been completed.
The Future of Alzheimer’s
But what would curing Alzheimer’s actually look like? If we do cure and not just slow Alzheimer’s, would we be able to stop these mutations, halt the degradation of proteins and ensure their subsequent removal, could this be one step in our journey to biological immortality? It could be revolutionary on so many different levels. Such ideas have been put forward as so-called SENS (Strategies for Engineered Negligible Senescence) programs. This suggests that out of the seven core issues on biological immortality, two would be directly linked to Alzheimer’s (LysoSENS and AmyloSENS).
No doubt space travel will become more than just a fantasy although for the moment even the closest stars will take many decades to reach and diseases such as Alzheimer’s could be a crucial limiting factor.
There is the argument that the cost of Alzheimer care is just part of living a fulfilled life. It is a disease understood by families everywhere and a force that has always shaped our society. There is hope that we may soon come to better understand the risk factors involved in Alzheimer’s. We may never find a cure, but one thing that is certain is Alzheimer’s will play a crucial role in the future of humanity.
References
^[1]Key numbers, details and figures 1 and 3 are taken from the Alzheimer’s Association and/or Alzheimer’s Society https://www.alz.org and https://www.alzheimers.org.uk/
^[2]Comparison Figures for Cancer from American Cancer Society
www.cancer.org
^[3]Further Alzheimer’s Statistics- Brody, E.M 1977 US National Committee on Vital and Heath Statistics,1978
^[4]Statistics taken from University of Michigan Depression Centre
www.depressiontoolkit.org
^[5]Research on Biological Immortality
http://www.sens.org/
^[6]Figure 2 is taken from http://www.nottingham.ac.uk/biochemcourses/NTM3/Tess_Alzheimers/plaques.html
Biography
Kazimir Uzwyshyn-Jones, 17, St Georges School, UK
Kazimir is currently studying in Biology, Chemistry, and Maths at St Georges School near London. He was inspired to write this after a work experience at the Centre for Misfolding Diseases in Cambridge and has greatly enjoyed researching the article and looking deeper into the crucial societal impact of Alzheimer’s. Outside of school he is a keen swimmer and plays the saxophone. After sixth form he wants to study the Natural Sciences at University.