Alzheimer’s

Alzheimer’s patient

Last Updated February 20th, 2019

Overview

Old age is associated with many disorders. One such disorder where the memory and brain function is affected is Alzheimer’s. Alzheimer’s is the most common form of dementia that affects one’s thinking, memory, and behavior. Initially, the disorder had mild symptoms but progressively worsens. As stated in Alzheimer’s Association, one in every nine adults over the age 65 is diagnosed with Alzheimer’s disease. It also states 61% of those who suffer from Alzheimer’s are expected to die by the age of 70 as opposed to the 30% who are not diagnosed with Alzheimer’s.

 

Definition of Alzheimer’s

Alzheimer’s diseaseAlzheimer’s disease is a neurodegenerative disorder that progressively destroys one’s memory, language, and ability to think and carry out daily activities.

Typically, the first sign of Alzheimer’s occurs at the age of 65, but Alzheimer’s can also occur as early as in one’s 40s and 50s. When affected by this disease, proteins build up in the brain to form plaques and tangles.

This leads to the death of nerve cells which disrupts the behavior of brain functionality.

 

What causes Alzheimer’s?

The primary cause of Alzheimer’s of the death of brain cells. Though research does not conclusively prove the cause of Alzheimer’s, early-onset Alzheimer’s is said to be genetic while late-onset Alzheimer’s is caused by a combination of factors. These factors are environmental, based on genetics and lifestyle choices. Along with imbalance in the chemical called acetylcholine, plaques and tangles also cause Alzheimer’s.

  • Plaques: The formation of the protein beta-amyloid in the brain causes the death of brain cells and thus, disrupting cell-to-cell interactions.
  • Tangles: Brains cells interact with each other through the structure and functioning of the protein tau. These interactions are necessary for transport of nutrients and other essential materials. Those diagnosed with Alzheimer’s are observed to have irregular twists in their brain cells which affect them in the internal support system. The scientific term for these tangles is neurofibrillary tangles.

 

Symptoms of Alzheimer’s

Alzheimer’s patientAlzheimer’s disease is a progressive disease. Early symptoms are often left unnoticed and undiagnosed, but with time the symptoms are more evident.

  • Memory loss to an extent where daily activities are disturbed
  • Emotional problems
  • Judgment is impaired
  • Difficulty carrying out simple and familiar tasks
  • Forgetfulness – Especially when one doesn’t remember directions or loses track of the date
  • Wandering aimlessly
  • Difficulty communicating
  • Difficulty recognizing near and dear ones
  • Insomnia / Increased sleeping
  • Constantly seeking isolation

Once symptoms are observed, it is important to get a thorough diagnosis immediately. The earlier the treatment is started, the lesser will be the deterioration of the quality of life.

 

Types of Alzheimer’s

Though those diagnosed with Alzheimer’s will generally have the same symptoms and long-term effects, doctors have categorized Alzheimer’s into three types.

  • Early-onset Alzheimer’s – Those diagnosed with Alzheimer’s at the age of 40-50.
  • Late-onset Alzheimer’s – The most commonly observed form of Alzheimer’s which is diagnosed in people at the age of 65 and above.
  • Familial Alzheimer’s Disease (FAD) – This form is linked to genetics. WebMD states that those diagnosed with Alzheimer’s have members of at least 2 generations being diagnosed with the disease. The FAD is extremely rare and only 1% of those diagnosed with Alzheimer’s have a FAD.

 

Long-term effects of Alzheimer’s

Alzheimer’s take a heavy toll on the brain and the body and though research is ongoing, no cure has been found to shun the aftermath of Alzheimer’s. Progressive deterioration of memory is the chief long-term effect of Alzheimer’s which leads to death. Healthline states that the average life expectancy of those suffering from Alzheimer’s is 10 years. It is not conclusively proven if treatment can help prolong the life of those diagnosed with Alzheimer’s. However, when diagnosed at an early stage, the quality of life doesn’t drastically deteriorate.

 

Vulnerable Groups

There are a lot of reasons that aggravate the risk of developing Alzheimer’s. People who are diagnosed with or those facing the following problems are also at a risk of developing Alzheimer’s.

  • Down’s syndrome
  • Old age
  • Cardiovascular diseases
  • Gender – Mayo Clinic states that women are more likely to be diagnosed with Alzheimer’s because they live longer.
  • Head injuries
  • Family members being diagnosed with Alzheimer’s.

 

Genetics of Alzheimer’s

Genetics is one of the chief contributions to being diagnosed with early-onset Alzheimer’s. The chromosomes 21, 14 and 1 along with amyloid precursor protein (APP) gene, presenilin-1 (PS-1) gene, and presenilin-2 (PS-2) gene are linked to early-onset Alzheimer’s. Mutation of these chromosomes and genes cause excessive production of peptide A beta 42. This peptide causes plaques in the brain which is observed in patients suffering from Alzheimer’s.The exact gene contributing to late-onset Alzheimer’s is not determined, apolipoprotein E locus (APOE) is the gene that is often linked to the cause.

 

Diagnosis

Because the root cause of Alzheimer’s is not determined, there is no one test that can convincingly say a person has the disease. A thorough medical assessment is required to give the diagnosis. One has to undergo neuropsychological and physical tests that’ll help identify behavioral changes and memory loss. Tests like computerized tomography (CT) scan and magnetic resonance imaging (MRI) scan are conducted to observe possible brain damage caused by the disease.

 

Treatment and prevention

Alzheimer’s pillsTreatment 

  • Certain medications to produce a neurotransmitter called acetylcholine are prescribed to help reduce the symptoms of agitation and depression. The improvement in the symptoms is on a slight to a moderate level.
  • At times antidepressants and anti-anxiety medications are also prescribed to help treat the symptoms of Alzheimer’s.
  • Exercise helps in elevating the mood of the patient who has been diagnosed with Alzheimer’s. Going for a walk can help them get peaceful sleep.
  • Those who have been diagnosed with Alzheimer’s may forget to eat or drink water. This is why caregivers must make sure that they give them their meals, water, juices and other necessary nutrients to prevent dehydration and malnutrition.
  • Ensuring that the Alzheimer’s patient is comfortable and does not panic as much is important. This is why their caregivers must take certain steps to make sure that they do not find day-to-day activities as difficult. Measures such as – keeping things in the exact same place as they once were, making sure that there are sturdy handrails along the stairs and in the washrooms, reducing the number of mirrors in the house as the Alzheimer’s patient are helpful.

Prevention – There are no guaranteed preventive measures against Alzheimer’s. One can still reduce his/her chances of developing Alzheimer’s by following these healthy lifestyle and dietary habits:

  • Consume a diet rich in omega-3 fatty acids. These are found in tuna, salmon, and nuts.
  • Regular exercising is important in maintaining healthy cognitive abilities.
  • Healthy mental stimulations such as reading, learning a musical instrument, and solving puzzles especially if you are aging can be helpful.
  • Studies suggest that stress reduction and healthy levels of social engagement can also help in keeping Alzheimer’s at a bay.
  • Getting quality sleep is also a significant factor in ensuring that one doesn’t develop neurodegenerative diseases.

 


TL;DR?

Alzheimer's infographic

 

Facts

  • Alzheimer’s was first noticed in 1906 by a German doctor named Alois Alzheimer. He noticed this condition in a patient named Auguste D.
  • This condition is the most common form of dementia.

Facts

  • Alzheimer’s is most common in Western European countries. However, its prevalence is gradually increasing in sub-Saharan African regions too.
  • It is the 6th leading cause of death in the United States.

Facts

  • 1 in every 10 individuals above the age of 65 has been diagnosed with Alzheimer’s in the United States.
  • This condition is more common among women. Approximately 2/3rd of the patients of Alzheimer’s are women.

Related Conditions

Want to live a healthy lifestyle?

Subscribe to free FactDr newsletters.

REVAMP YOUR

If you're enjoying our website, we promise you'll absolutely love our new posts. Be the first one to get a copy!

Get factually correct, actionable tips delivered straight to your inbox once a week.

I want the latest scoop on :

We hate spam too. We will never share your email address with anyone. If you change your mind later, you can unsubscribe with just one click

By clicking Subscribe, I agree to the FactDr Terms & Conditions & Privacy Policy and understand that I may opt out of FactDr subscriptions at any time.

Display this infographic on your website

 

Dos and Don'ts

Dos
  • Make sure that you are polite and not aggressive in any way, as they are already confused and may find it difficult to converse.
  • Introduce yourself every time you pay them a visit, as this will help them become more comfortable and open up.
  • Let them talk and finish what they have to say, this helps them express their thought and feelings.
Don'ts
  • Ask them if they remember something or not, this may tend to hurt their feelings and cause further confusion.
  • Take their negative remarks personally, the disease tends to make what they have to say sound rude, mean or angry when they did not intend on sounding that way.
  • Talk about them around other people as though they are not around, this may tend to cause confusion and hurt their feelings.

 

 

 

Related Conditions

Trending Topics

diverticulitis diet
Diverticulitis diet: The right way to eat if you suffer from the disease Are you suffering from diverticultis but clueless about your diet ? Read this complete plan for diverticulitis diet…
passion fruit juice
Passion fruit: How one exotic fruit can help you fight infections and cancer! Passion fruit: Why does this exotic fruit have such an enticing name? And how can it protect you…
Maltitol: Things you must know about this artificial sweetener Sugar alcohols are produced by fruits and vegetables. Maltitol is an artificially produced sugar alcohol and is used…
Top 6 remedies to treat a razor burn at home Symptoms of razor burn include bumps on the skin, redness, and irritation of the skin. Find easy and…
Chromium Picolinate: An essential mineral supplement for faster weight loss Did you know that about 1.6 million deaths were directly linked to diabetes globally? How is it linked…
The science behind daith piercing: Can it really cure migraine? Since the ear has several pressure points, it is believed that daith piercing activates the vagus nerve and…
The real reason why you shouldn’t be eating ramen noodles Instant ramen noodles might be your go-to snack for your hunger pangs. But with each spoonful you are…
maltodextrin sugar
Maltodextrin: What are the hidden health benefits of this food additive? Maltodextrin is one of the few food additives that has been relatively deemed safe. Many experts now have…
Vitamin K2: 8 reasons why you need this bone-building & cancer-fighting nutrient Vitamin K2 is claimed to be essential for your bone health, for reducing the risk of cancer, and…
BRAT Diet: What is the right way to follow this diarrhea-relieving diet? BRAT diet, a simple diet consisting of just bananas, rice, applesauce, and toast, can help you combat the…
rubella IgG test
Rubella IgG Test The rubella IgG test is a blood test that checks for the rubella virus IgG antibodies present in…
CLA: A breakthrough weight loss supplement with minimal side effects Tried every weight loss supplement in the market with no substantial gain? Why not try CLA supplements, derived…
diabetes symptoms in women
FBS Test – Fasting Blood Sugar FBS or fasting blood sugar test is a blood test that is used to determine the level of…
nature health benefits
Green Healing: The amazing health benefits of being in nature You have no idea what sitting in a closed room does to your body and mind.Can a stroll…
ASTtest-liver
AST- Aspartate Aminotransferase Test AST test is a blood test that is used to measure the level of a particular liver enzyme…
Stye : The best natural home remedies to ease the pain Styes developing inside the eyelid tend to be more painful whereas external styes are less painful and ooze…
ketoacidosis diabetes
HB1Ac Test HB1Ac test is an important blood test that is used to measure the levels of glycated hemoglobin in…
Colloidal silver benefits
Colloidal silver: An essential dietary supplement or yet another pharmaceutical hoax? Colloidal silver is hailed as an effective home remedy for infections. Many believe it can treat HIV and…
Piaget stages: Do they accurately describe the way the human brain develops?  A common assumption was that children are less competent thinkers as compared to adults, but this was refuted…
Juice Plus: Can you really replace actual fruits with pills?  Juice Plus supplements intend to fill nutritional gaps present in our daily diet. But how successful have they…
Lectin: The common link of proteins between peas and people Lectins are a type of protein that are found majorly in legumes. Most people are find it easy…
eating disorder anorexia
Eating Disorders: Lifestyle choice or a psychological condition? Is eating disorder just a harmless bad habit? Or does it represent grim psychological disorders? Do you want…
yoga health benefits
How to practice yoga for astounding health benefits Can a 5000-year-old system be the ultimate body healer? Did you know yoga can make you smarter and…
nutritional yeast bread
Nutritional Yeast : How can a fungi culture be good for your body? Nutritional yeast: How a simple culture of fungi can transform your skin, digestion, immunity , and much more.…
Milk Thistle skin
Milk Thistle: Find possible cures for fatal diseases in these purple blooms Milk thistle is well-known for treating liver conditions. However, did you know that it comes with a plethora…
How do neutrophils protect you from fatal bacterial attacks? During an infection, certain enzymes alert the mature neutrophils.  Neutrophils then travel through the bloodstream to the affected…
anti-thyroglobulin antibody
Anti-Thyroglobulin Antibody test Anti-thyrogloubin antibody test measures the level of antibodies that attack the thyroid gland cells and are hence indicative…
magnesium test
Magnesium Test The magnesium test is a blood test that is generally prsecribed when an individual starts showing signs of…
occupational hazards types
Occupational Hazards: How to vouch for your health at your workplace Occupational hazards affect millions worldwide. Chemical spills, faulty wires, deadly pathogen, and work-stress can happen anytime. Follow these…
TBHQ: A carcinogen lingering in your child’s favorite snacks TBHQ - Why you should shun the practice of eating instant noodles or microwave popcorn to get rid…
Chlorella: Therapeutic powers of the billion-year-old algae now within your reach Chlorella - A billion year old nutrient-rich algae that can potentially ward off cancers and high cholesterol; the…
Tamarind: The top health benefits of this staple Asian ingredient Did you know this sweet and sour pulpy fruit does more than just add a tangy flavor to…
How accurate is the hair follicle drug test? Hair follicle drug test is one of the best ways to identify drug use in professional circles. But…
Poop chart: Top things you didn’t you your poop could reveal about you Bristol poop chart was designed during the 1990s in order to help doctors identify various types of poops…
bilirubin-test-result
Bilirubin Test Bilirubin is a substance produced in the body as a result of red blood cell breakdown. A bilirubin…
Jicama: A fiber-rich tuber for your weight loss goals Pronouced as HEE-kah-ma, Jicama is the "new kid on the block" that has taken the world by the…
low fodmap plan
Troubled with IBS? Here’s a complete roadmap to the low FODMAP diet Leaky & inflammatory gut troubling you? No medicine bringing you relief from the pain? Why not try the…
Silicon Dioxide: How can a component of sand be essential to your wellbeing? Silicon is one of the most abundant elements in the nature. Find out how silicon dioxide can prove…
What is the right way to take a pregnancy test? A pregnancy test is undertaken to determine if you have conceived. A home pregnancy test is the most…
Eustachian Tube : Functions and top home remedies to prevent its infection Pressure equalization, mucus drainage and protecting the middle ear from bacteria and viruses are the three important functions…
Quinine: How gin and tonic came to be known as a potent health elixir The discovery of quinine-containing tree bark is sometimes considered the most serendipitous medical discovery of the 17th century.
lifestyle diseases
The Big 5 lifestyle diseases: How your everyday living might be killing you You'd be shocked to know how unhealthy and potentially fatal your everyday routine could be. Has the modern…
Salt dangers
Sodium chloride: The wonders and dangers of the simple table salt Sodium chloride is a salt containing sodium and chlorine ions at a 1:1 ratio. It is edible and…
liver detox facts
7 liver detox facts and why ignoring these could kill you! Are you taking care of this organ that handles over 500 different vital functions in your body? Your…
ashwagandha brain
Ashwagandha: The best-kept secret of Ayurveda now revealed! Ashwagandha literally means "smell of horse". Don't get bogged down by that one tiny detail because this ayurveduic…
green poop causes
Green poop : What are the reasons and how can you correct it Ever sneak a peek down the toilet only to shockingly find green poop? Why does our poop turn…
waterchestnut
Water Chestnuts: The tastiest ways to include this healthy tuber in your diet Water chestnut is not a nut after all. It is a tuber (much like the potatoes) growing close…
Oxalates: How healthy greens can sometimes be bad news for your kidneys Oxalates are compounds present in a majority of healthy foods. However, at times an overconsumption of these could…
Urologist: When should you visit one and why? A urologist can treat not only genitourinary problems of both men and women but also can treat various…
reflexology massage
Top reasons why you should go for a reflexology massage today Reflexology involves the application of pressure to your feet and hands to encourage self-healing. Could this be beneficial…
IGE test
IgE test – Immunoglobulin E IgE or immunoglobulin E test is a test that measures the level of IgE in the blood and…
Helicobacter pylori IGA
Helicobacter Pylori – IgA Test The H.pylori IgA test is a blood test used to identify the level of IgA antigen in the…
dance health benefits
5 unbelievable effects of dance on your overall health! You enjoy dancing, but did you know what else it does to your body? Dancing is not only…
kefir bottle
Kefir: Top reasons why this probiotic drink should be consumed by you Yet another remarkable fermented food, kefir is a much healthier version of yogurt. These chewy white grains can…
Jackfruit: Slice your way into higher immunity, better digestion, & more… Native to the South East Asia, the jackfruit is a fruit brimming with thousands of health benefits. Discover…
Pescatarian Diet 101: What are the inherent health advantages of this diet? People opt to become a pescatarian in order to enrich their bodies with the essential health benefits that…
Hydroquinone: Is it the best topical treatment for hyperpigmentation? Darkening of the skin due to high melanin levels is called hyperpigmentation.  Hydroquinone interferes with melanin production thus treating…
Bubble Tea: Bubbling with nutrition or a hidden sugar mine? The tapioca pearls present in the tea looks like bubbles and hence the name bubble tea became popular.…
hidden benefits walking
9 benefits of walking we bet you didn’t know! Did you know walking can be the miracle pill for eternal youth? Everyone knows walking is good for…
sleep deprivation
Don’t let your sleep deficit grow into memory loss or heart attack Why is sleep important for us? How could sleep deprivation harm you? We bet you didn't know about…
Cordyceps: How the Caterpillar fungus works as a proven cancer-shield Strange as it may sound, but cordyceps or "caterpillar fungus", a fungus variety native to the Himalayas may…
How chlorophyll is more than just a green pigment meant for photosynthesis Cholorphyll - you must know the usual function of this chemical in plants. But did you know that…
Astaxanthin: Why experts believe it could be 550x more potent than vitamin E! What is astaxanthin and why is this new supplement on the block touted as the most powerful antioxidant…
Mood swings
The real reasons for your mood swings and how to overcome them Are you prone to heated moods frequently? Do you also feel bouts of depressive feeling creeping up on…
Balneotherapy jacuzzi
5 things you didn’t know about balneotherapy and how you can do it at home Sauna baths have been popular since a long time. But how much more beneficial can balneotherapy be as…
Chest X-Ray A chest x-ray is a diagnostic test that uses x-rays to visualize the structures inside your chest. It…
Max thalassemia profile
Max thalassemia Profile Max Thalassemia is the most severe form of Thalassemia where a person’s body is unable to produce the…
Pumpkin Seeds: Why pumpkins are more than just for pies! Pumpkins have been long associated with Halloween carvings and delicious pies. But did you know that pumpkin seeds…
vital organ diseases
Common diseases that could cripple your vital organs Brain, heart, kidney, lungs, and liver - these vital organs are indeed vital for your survival. However, these…
chia seeds weight loss
Chia seeds: How to consume this staple Aztec food to get a leaner body Chia seeds: What is the actual reason for its sudden popularity? Why are celebrities swearing by its amazing…
Garlic health benefits cloves
Garlic: Nature’s white pill as an effective home remedy What are the secrets hidden in these tiny white pills? Find out the immense health benefits of using…
Anhedonia: Does the chronic inability to feel joy affect you too? How often do you feel dragged down by an invisible force? Do you feel an inexplicable emotional numbness…
Experts reveal the safest ways to perform an enema at home The idea of pushing some up your rectal area might make you queasy but an enema could actually…
Lauric Acid: 8 health benefits you can derive from coconuts Appropriate use of saturated fats containing lauric acid can provide you numerous health benefits. This is the main…
Is bronchitis contagious? And how to prevent this infection? It is acute bronchitis that is contagious which means you can contract it from another person or you…
Coffee Enema: Turn your favorite morning beverage into a powerful colon cleanser The wonders of coffee are not just limited to waking you up every morning. You can now use…
liver cleanse detox
14 go-to foods that are best for a complete natural liver detox Liver cleanse can be achieved by just choosing or avoiding certain types of food. Liver itself is a detoxifying…
Ear pain model
Easy and safe tips for ear wax removal you can do at home Cerumen impaction generally occurs when an external object like cotton swabs are used to remove the ear wax.…
CBC blood test
CBC (Hemogram 6-part diff) blood test CBC (Hemogram 6-part diff) blood test refers to the test that measures the number of RBCs, WBCs, etc…
hidden causes obesity
8 hidden causes of obesity you probably didn’t know! Did you know that around 2 billion people worldwide are either overweight or obese? Are you too a…
iron food shellfish
Iron-Rich Foods: Eat these foods to keep fatigue and anemia away! How to ensure a muscles as strong as iron? Eat iron rich foods ! Iron is one of…
Moringa drink
Moringa: This could be the most nutrient-dense food known to us! Moringa is a lush green tree brimming with over 90 essential nutrients required for a healthy mind and…
Exercises or diet? Find out the healthiest way to gain weight Tired of being called skinny all the time? Looking for healthy ways to beef up? Why not try…
Trisodium Phosphate: How a paint thinner made its way into your breakfast Ever thought how toxic chemicals find their way into our foods? How can they harm our body? And…
Love tea, hate tannins? Rooibos tea is just what you need The market is brimming with a multitude of herbal teas. But what makes rooibos tea (or red bush)…
How can Kegels help you overcome weak pelvic muscles & incontinence? Kegel exercises are pelvic floor strengthening exercises that can help you overcome incontinence issues that rise out of…
Appendix pain: Recent findings on this not-so vestigial organ The exact function of the appendix is still not clear. Some consider it as an organ that once…
Nipah Virus epidemic
Is shingles contagious? If yes, then how can you prevent this infection? What is shingles? How is different from chicken pox? Do adults get shingles? How contagious is it? Find…
How to scrub away stress and fatigue with an Epsom salt bath? Epsom salt is a popular home remedy for many skin ailments. Though there is a lack of scientific…
Hot cups for detox? Read all about the ancient technique of cupping Did you know inverted hot cups on your back can squeeze out and eject toxins from your body?…
Krill Oil: Does the solution to human illnesses really lie at the depths of the ocean? The word "krill" means “small fry of fish” in Norwegian. They are usually the primary food source of…
CT-scan-machine
CT – Computed Tomography Scan CT scan or computed tomography scan is an diagnostic imaging technique where cross-sectional images of body are obtained…
about mediterranean diet
Why you should be adopting a Mediterranean style of diet today Ever wondered why the Mediterranean diet is so healthy? One simple solution to lowering risk of several deadliest…
Panera bread steak arugula
Panera Bread: The truth behind this “healthy” restaurant chain What to order and what to avoid when dining at Panera Bread ? Know more about this popular…
Dragon Fruit – Blessing from Nature’s Basket The dragon fruit is packed with nutrients and yet low on calories and is the dream food that…
improve digestion weight loss
Power up your gut: 8 proven steps on how to improve your digestion Did you know you have a colony of bacteria in your gut that help you in digesting food?…
High Fiber Diet – Fire up your fiber intake for these health benefits! Regular bowels, healthy detox, higher immunity, and guaranteed weight loss - a high fiber diet can bring all…
bananas exercise
10 health reasons why you should go “bananas” over bananas! Bananas:The world's most popular fruit comes with a host of unbelievable health benefits. Find out how you can…
stevia side effects
Stevia: A healthy sugar substitute or yet another risky additive? Stevia is a plant native to South America.  It has been used as a natural sugar substitute and…
The right way to prepare Alfalfa sprouts at home Alfalfa or lusan ghas is not just a nutritious animal fodder. This flavonoid-rich herb has some amazing health…
Muscle relaxers: Think twice before popping prescription drugs for muscle pain The market is brimming with OTC muscle relaxers. But these come with a host side-effects. Find out the…
The Vegan Diet: The benevolent way of eating that wins hearts (and tummies) The vegan diet involves fauna-friendly outlook towards food. Could the diet that hopes to balance everything based on…
The complete fitness guide on how to perform Tabata This fitness routine is called Tabata workouts, which is named after Dr. Izumi Tabata who developed this intensive…
TRX: Why is this total resistance workout the best choice for your body? TRX or total resistance exercise is a form of exercise where suspension belts are used to produce that…
PiYo (Pilates + Yoga): Bringing you the best of both the worlds PiYo exercise routine was formulated for people who find it tedious and grueling exercise regimens such as extensive…
These are the top foods to increase your hemoglobin count It is important to add iron-rich foods into your diet in order to increase hemoglobin. Deficiency of hemoglobin could…