By Dr Rahul M Rao
October 4, 2019
World Alzheimer’s Day is popularly called as the Alzheimer’s week. On account of this, a lot of awareness activities are carried out. Before I forget, I want to make sure I contribute towards creating awareness.
In 1906, Dr Alois Alzheimer, German Psychiatrist first described and demonstrated to the world about the signs and symptoms of Alzheimer’s Disease in his patient Auguste D.
Introduction:
Dementia is an umbrella term. Alzheimer’s dementia is the most common form of dementia. It is a neurodegenerative disease characterised by loss of neurons at various centres in the brain causing the brain to shrink. It is, of course, an age-related illness although rarely can be seen below the age of 65 years.
Why should we know about Alzheimer’s Dementia?
The prevalence of Alzheimer’s dementia is 5-6%. The population of India is about 137 crores. Approximately 8 crores of this population are composed of people above the age of 65 years. So it amounts to around 40 lac people who are suffering from Alzheimer’s Dementia. It is expected that by 2030 this number would rise to a whopping 70 lac people with this illness.
This means that it would take a toll on the caregivers, the financial aspects and the quality of life of the individual.
What are the causes of Alzheimer’s Dementia?
There is not 1 specific cause of Alzheimer’s Dementia. However, it is believed that a combination of genetics, environmental and lifestyle changes act in the causation of this illness. The most common risk factor is the age of the person. After the age of 65, the risk is about 5% and it doubles every 5 years to reach about 20-25% by the age of 80 years. It is also found to be more common in women, as women tend to have a longer life span and because oestrogen is known to have a protective role. Other risk factors include smoking, alcohol, diabetes and hypertension.
How do we differentiate between normal memory loss as part of ageing and that associated with Alzheimer’s?
A person with the usual memory loss tends to remember the part that was forgotten, after a period of about a few minutes to hours. He/she also has insight that he is losing memory. However, a patient with Alzheimer’s is not aware of his memory deficits and is totally unable to recollect the forgotten bits even after a certain period of time.
What are the signs and symptoms of Alzheimer’s disease?
A) The first and foremost sign of this illness is forgetfulness. Other symptoms that follow are deterioration of rationality and intellectual functions.
Patients have forgetfulness pertaining to normal day to day activities. They tend to search for their belongings like a pen, watch, mobile etc. Eventually, they also forget whether they had a meal and repetitively ask the family members to give them food. In later stages, they would also forget what date, month and time of the day it is in spite of telling them repeatedly.
B) Other symptoms include apraxia, i.e difficulty in performing activities that are previously known to the patient such as combing, buttoning the shirt, using a pen etc. which makes them dependent on others for such activities.
C) Another difficulty which is faced by them is termed as agnosia, defined as the inability to interpret sensations and hence the difficulty in recognising things. Prosopagnosia which is difficulty in recognising faces including that of oneself, resulting in misidentification of family and friends.
D) Along with these they also develop symptoms known as behavioural and psychotic symptoms which present as aggression, anger outburst, restlessness, visual and auditory hallucinations.
How do we diagnose a case of Alzheimer’s?
There are certain investigations that aid in the right diagnosis of Alzheimer’s, however much prominence should be given to history, given by the family members. Imaging of the brain with either a CT scan or an MRI is a must for confirming the diagnosis. The scan would show shrinkage of the parts or whole of the brain with atrophy of the gyri and hippocampus and widening of sulci with dilatation of ventricles. Some of the blood investigations such as blood sugars, serum electrolytes and lipid levels help in keeping a check on the risk factors. On microscopic examinations post mortem, we find clumped neurons called as Neurofibrillary tangles and Beta-Amyloid plaques.
How do we treat Alzheimer’s?
To this date, we do not have any medications that would reverse or cure the underlying changes. However, we do prescribe what is known as cognitive enhancers. Medications like Donepezil, Rivastigmine, Memantine and Galantamine are believed to only slow down the disease process but do not assure complete recovery and gain of memory. Also, these medications are effective when given early in the disease process. For behavioural and psychotic symptoms we prescribe antipsychotics such as Risperidone, Olanzapine and Quetiapine. Remember, it has to be under the psychiatrist’s supervision only.
How should the family members take care of an individual with Alzheimer’s?
First and foremost the role of a family member in identifying the initial symptoms and bringing it to the notice of a Psychiatrist is of utmost importance. The caretaker is ideally expected to be calm and cooperate with his family member and help him remember/find the lost items rather than accusing him or showing discontent. The family is also expected to maintain the familiarity of the patient’s environment by labelling and keeping his items of
daily use at one place, labelling the room, kitchen bathroom etc. such that the patient will not have any orientation difficulties.
Adequate stimulation in terms of physical, emotional and social aspects has shown some benefits. These can be achieved by taking the patient for regular walks, showing him old photo albums and involving him in social gatherings. Constantly having an identity card with the patient goes a long way, especially if at all the patient goes missing at any point of time.
Is Alzheimer’s preventable?
Alzheimer’s dementia is a progressive neurodegenerative illness. It has a deteriorating course and as mentioned earlier it is not possible to reverse it. Unlike Tuberculosis and polio which are infectious diseases, Alzheimer’s is not a disease that can be attempted to eradicate. At the same time, there is no evidence to suggest that this condition can be prevented. We can only take account of the risk factors and modify them. This condition is not curable but definitely
treatable.
Are there any centres to provide help and support for a person with Alzheimer’s?
Yes. There are a number of centres in the country, in cities like Bangalore, Mumbai, Delhi, Calicut which work towards the betterment of people with Alzheimer’s. Some of the centres include Alzheimer’s and Related Disorders Society of India, Helpage India, Dementia daycare and respite care. Few of these centres do offer daycare set up if a family member is interested.
Take-Home Message?
The take-home message is that although Alzheimer’s dementia sounds like an illness with poor prognostic factors the caregivers should not lose hopes and desert the patient. It is challenging to be around someone with failing memory, especially when they fail to recognise their own family members. But, what we need to think is that this particular person is your own mother, father, aunt or uncle and hence providing good quality of life is the least we could do.
For more information and guidance please contact:
Dr Rahul M Rao
Senior Resident
Dept. of Psychiatry
Srinivas Medical College
Mukka, Mangaluru
Email: drrahulraom@gmail.com
Mobile: 6361005358