Are you sometimes forgetful? Do you ever wonder if it’s because your life is too busy or you’re getting older or perhaps the early signs of Alzheimer’s?If you have bouts where you can’t remember where you put your keys or some other item, or if the name of that person you know doesn’t readily fall off your tongue, don’t put yourself in tizzy thinking you have early stage Alzheimer’s.Neuropsychiatrist Paul Rosenberg, a specialist in the disease at Johns Hopkins School of Medicine in Baltimore, said Alzheimer’s looks quite different from simple forgetfulness, even in its early stages.The associate director of the Memory and Alzheimer’s Treatment Center at Johns Hopkins Bayview Medical Center spoke with Body and Soul, in anticipation of World Alzheimer’s Day tomorrow.He explained that forgetfulness in Alzheimer’s patients includes an inability to remember the sequence of things and to switch from one mental task to another.“It’s very customary as we get older to being slower to remember things like names and the word we want to use, we’re slower at retrieving information,” said Dr Rosenberg. “But what you don’t forget are things that are important.“You don’t forget to take your medication, you don’t forget the sequence of events, how to do things or how to use reminders to help you.”So forgetting where you put your keys is one thing, if you can’t remember how to use your keys that is a sign of Alzheimer’s.And it’s this aspect of the condition that makes it debilitating. As the disease progresses the person loses more and more of what is called ‘executive functioning’.This is the ability to do normal day-to-day activities like getting, dressed, paying bills, plan projects, set goals and objectives, prioritise and even exercise self-discipline.Not being able to function in this way, the Alzheimer’s patient effectively loses their independence.What is physiologically going on in the brain to cause Alzheimer’s? According to Dr Rosenberg, it’s a build-up of proteins.Deposits of the protein beta-amyloid cause plaque to form between nerve cells in the brain. Deposits of the protein tau build up inside nerve cells causing tangles.It is normal to have some plaque and tangles in the brain as we age, but research has shown that Alzheimer’s patients have significantly more of these deposits.Studies are ongoing in this area but many scientists believe that the plaque and tangles block the ability of brain nerve cells to communicate between each other.This breakdown in communication makes it difficult for them to survive and so eventually they die.When this damage spreads into the hippocampus area of the brain that part of the brain where memories are formed the patient’s memory diminishes.As nerve cell death occurs, the brain physically shrinks.Is there anything we can do to slow the spread of this cell death? According to Dr Rosenberg, not yet.“That is the Holy Grail,” he said. “Industry and academia are working hard on developing disease modifying treatments.”In the meantime it looks like getting regular exercise will help prevent onset of Alzheimer’s, he said.Other lifestyle modifications including having a variety of leisure activities both physical and cognitive a good diet and a healthy heart are also believed to help prevent the disease.“It appears that having a healthy heart in midlife decreases your chance of getting Alzheimer’s in late life,” said Dr Rosenberg. “By far the biggest risk factor for getting the disease is ageing.“There are rare genetic forms that you can get in your 30s and 40s, but they are pretty rare.”Alzheimer’s is the most common type of dementia in the US, and most likely also in Bermuda.According to Dr Rosenberg the disease affects about five percent of those in their 70s, 15 percent of those in their 80s and about half of those in their 90s.