Broken "Clock" in the Brain May Explain Alzheimer's, Other Brain Diseases

My dad developed full-blown dementia about the age of 80. I was living with him at the time. One of the most frustrating aspects of the disease for him, and for me, was his loss of his sense of time.

One Saturday morning my father, who still drove his car until the last three months of his life, pulled into carport angry. "Not one single person showed up for church today," he groused, "not even the preacher."

We weren't Seventh Day Adventists. We were both members of a church that met on Sunday. I gently pointed out to my father that the day was Saturday, not Sunday, and he told me in unequivocal terms I was wrong. I showed him the newspaper. He insisted it had been delivered the day before. A friend called. My father told his friend he was wrong about what day it was, too.

As my father's disease progressed, he also lost his ability to distinguish between night and day. He would doze off in his easy chair about 7 every evening, and then bound out of his chair 2 or 3 hours later, cooking breakfast. Dad would then want to stay up all night.

As the condition got even worse, my father would be sharp, his old self, in some early morning hours and around midnight every night, and totally out of it in the middle of the day, when relatives and doctors and caregivers would come in to see him. I would insist that he still had more than a few flashes of his former personality--and he did even on the day he died--but most people would only see an old man who drooled and coud not talk.

My father suffered a condition called Lewy body dementia. Another way of describing what was going on with him was that he suffered a "broken clock" in the brain. Many other conditions of mental deterioration are essentially caused by the inability of cells in the brain to keep time, doctors tell us.

Clocks and Cellular Cleanup Crews

Dr. Erik Musiek, an MD/PhD who teaches neurology at the Washington University School of Medicine in St. Louis, Missouri, says that the brain performs a tune-up every morning. During the hours leading up to noon, the brain produces enzymes that neutralize free radicals. In turn, this protects neurons from becoming coated with tangled proteins that short circuit electrical transmissions and eventually kill the cell.

Without an internal clock to tell the cells of the brain to do their clean-up work, free radicals of oxygen--which multiply especially fast in the presence of sugar--damage the linings of neurons and eventually cause tissue destruction. While there actually is small production of new neurons in the brain throughout life, the brain cannot repair itself fast enough, without this daily enzymatic process, to prevent significant destruction.

See Also: Alzheimer's Dementia: Signs, Symptoms and Treatment Options

Not Just Sleep, Sleep at the Right Time

Dr. Garret FitzGerald, a physician who chairs chairman of pharmacology at the University of Pennsylvania, directed Dr. Musiek's earlier research with mice bred to lack the gene that enables the internal clock of the brain. These mice were no more sleep-deprived than any other mice, but they tended to sleep equally at night and during the day. FitzGerald and Musiek discovered that when mice sleep turned out to be as important as how much they sleep.

Many Diseases Linked To The Brain Clock

When the specially bred mice did not get sleep at the proper time (which for a mouse is during the day, unlike humans who naturally sleep at night), they tended to develop diabetes, obesity, and high blood pressure. Similar effects have been demonstrated for sleep-deprived humans. 

And when mice did not get their sleep during their normal sleeping times, their brains accumulated free radicals to toxic levels. They developed conditions analogous to Alzheimer's in humans as their brains accumulated damage that was never repaired.

In humans, this kind of uncompensated damage to the brain causes a condition called sundowning, or late-day confusion. Sundowning isn't really a disease, but it is a symptom shared by Alzheimer's disease, Lewy body dementia, Parkinsonian dementia, and other conditions of greatly reduced mental competence caused by brain-based disease. While the connection between sundowning and the brain's internal circadian clock is theoretical, if you have to deal with this symptom in caring for someone you love, there are, fortunately, a number of things you can do.

• Encourage staying awake during the day and sleeping at night. You can do this by making sure the person who has the degenerative brain condition is exposed to strong light in the morning and lights are out at night. Blue light is the wavelength that activates the brain. Morning sunlight contains blue light, and sun lamps designed to treat this condition and seasonal affective disorder provide blue light, too. Without these wavelengths, it is hard for the brain to wake up. Conversely, any blue light at night has to be avoided. If you have a nightlight, make sure you put in a yellow bulb.
• Limit caffeine and sugar to the morning hours. It's relatively OK to be "hyper" in the morning, but the brain has to get its down time at night to be ready to make clean up enzymes in the morning.
• Serve dinner early, so the digestive process does not interfere with sleep.
• Minimize confusion in the middle of the afternoon. In a nursing home or extended care facility, it is important for workers to leave quietly, if they leave around 3 o'clock pm (1500), to avoid creating a cue to for the patient to leave, too. Escapes from full-time care facilities are especially likely in the middle of the afternoon.

And ask your doctor about adding melatonin to your loved one's treatment program. Melatonin is the hormone that induces sleep. It is made by the pineal gland of the brain when the eyes are not exposed to blue light. The retina is so sensitive to blue light that even when the eyes are shut blue light can be detected. This is why sound sleep requires exclusion of even tiny amounts of blue light in the bedroom.

See Also: Alternative Therapies For Alzheimer's Disease

Supplemental melatonin may replace the melatonin the brain is unable to make because of the patient's need for light for security and getting around. Because melatonin is also an antioxidant, supplemental melatonin, some scientists believe, can replace the enzymes not made by the brain during morning hours. It may delay the deterioration caused by brain disease. Melatonin supplements are generally safe and effective even in relatively large (up to 10 mg) doses, but some people will experience restless legs, headache, or stomach upset when first taking the supplement.