Alzheimer's Disease: Progressively Forgetting

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Alzheimer's Disease Progressively Forgetting

• By- Dr Amitabha Ghosh

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• We all forget where we kept that box of
  firecrackers, or the bill that needs to be paid.
  But there is a more serious loss of memory that
  progressively begins to disrupt one's normal
  day-to-day functions. Alzheimer's disease is the
  commonest form of dementia, a disease of old age,
  and becomes increasingly frequent with every
  passing decade after 60 years.
• Over the age of 80, more than 20 of people have
  mild dementia. Currently, over 3 million people
  suffer from dementia in India alone. In about 20
  years time, the numbers are expected to double,
  thanks to a greater life-span and to better
  identification of patients in large areas of our
  country.

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The impact

• Many elderly couples live alone these days. They
  are frail and particularly vulnerable. Their
  children may not live close by and could even be
  in a different country altogether, finding it
  difficult even to come down for Diwali. What
  would be the impact of Alzheimer's disease in
  such a couple?
• Imagine the pain of seeing your partner slowly
  forget everything that was once special and
  precious to you. Forgetting all likes and
  dislikes, friends and relatives, or how to be
  happy or sad. And one day, even forgetting who
  you are! Imagine your helplessness on being left
  alone, caring for the one you care for most, but
  not knowing how to care. And then there is the
  grocery, the banks, the pension, the medical
  bills, all that for you to sort out. You are old
  and frail yourself but there is no time for all
  that. Medicines help a bit, but for you there are
  no balms of comfort. Such is the impact of
  Alzheimer's disease. It affects two people - the
  patient, but enormously more, the caregiver.

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• Alzheimer's is not an obscure illness but an
  ailment affecting real people in real families
  like yours and mine. I want you to learn to
  recognise the signs of Alzheimer's disease, but
  at the same time be reassured that all
  forgetfulness is not dementia.

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Facts about forgetting

• We all forget things, all the more as we age. A
  certain degree of forgetfulness is normal for
  every age group, especially in the elderly. That
  is not dementia. Some people are naturally bad
  with names, telephone numbers or addresses, as
  the case may be. That is 'normal' for them and is
  not dementia either. Ask their families and you
  will find that they have always been like that.
• The worry is, when the memory loss exceeds what
  is normal for the person's age, education or
  nature. In such situations, a decline in dayto-
  day function may also be noticed. Appointments
  may be forgotten and memos may need to be kept.
  Shopping lists may be difficult to remember.
  Things may be misplaced and lost a bit too
  frequently. There may be difficulty remembering
  names and even recognising people not seen for a
  few years. Objects that have not been used
  recently may also be forgotten.

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• Wrong names may be used. Some may start losing
  their way, initially in unfamiliar and later in
  familiar places. They may have great difficulty
  in locating their seats in a train or in flight,
  for example.
• And gradually, even forget the way to their own
  home. Conversation may be affected in many. Some
  cannot stop speaking while others sit quietly by
  themselves with almost nothing to say. Some speak
  with stutters and trip over words. Finding the
  right words may be difficult for many of them.
  Reading and handwriting may be affected
  pronunciation and spelling errors may be
  prominent. Signing a cheque could become a
  harrowing experience. Dressing, cooking, handling
  a remote control, a mobile phone or a push-button
  telephone may become difficult.

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• While any or all of these symptoms may be seen in
  Alzheimer's disease, loss of memory is typically
  the most prominent. Very often it is this loss of
  memory that draws the attention of the caregivers
  and other close relatives. At other times, a
  worried patient himself rings the doctor first.

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The memory test

• There are tests we can do to screen for
  Alzheimer's disease. Some of these are simple
  questionnaires that take around 10 minutes to
  finish. More detailed memory tests can be done
  later. Screening tests are easy to administer,
  require minimum training for the tester and can
  be performed at almost all settings like
  screening camps for Alzheimer's disease, general
  outpatient clinics and special clinics
  exclusively set up for memory disorders.
• Besides picking out those with Alzheimer's
  disease or other forms of dementia, memory tests
  help us separate those who do not have dementia
  from those who have very mild memory impairments
  (mild cognitive impairment or MCI). This last
  group is particularly important. Most people with
  MCI will be forgetful - but only some will
  develop Alzheimer's disease. Others may have mild
  but significant forgetfulness for several years,
  while a few may even improve and be back to
  normal. Identifying patients with MCI and trying
  to treat them early is an area of major interest
  in Alzheimer's disease research today.

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New horizon in treatment

• Until now, much of the treatment of Alzheimer's
  disease has been symptomatic and not really
  geared to treat the root cause. This is now
  changing. Current international research is
  looking to find molecules that can act against
  the very proteins that cause Alzheimer's disease.
  Many such drugs are now in the pipeline and could
  be expected to hit the shelves over the next few
  years. These drugs seem to work best on patients
  with early and mild Alzheimer's disease. A
  heightened awareness and an early diagnosis of
  the disease are therefore essential.

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Lowering the risks

• Can you reduce your risk of having Alzheimer's
  disease? Researchers have been finding links
  between the occurrence of Alzheimer's disease and
  diseases of the small blood vessels of the brain.
  
• MRI scans of the brain can sometimes pick up
  patchy, mini-stroke like areas in the brains of
  patients with Alzheimer's disease. This has led
  to the suggestion that good food, lots of green
  vegetables and an otherwise healthy lifestyle
  could reduce the chances of having Alzheimer's
  disease much as it reduces the risks of brain
  strokes and heart attacks. Turmeric, frequently
  used in Indian food, is also believed to be one
  of the protectors against Alzheimer's disease.

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Caregivers' care

• Looking after the caregivers and their needs is
  as much a part of Alzheimer's disease care as is
  looking after the patient. In this regard our
  social service systems leave a lot to be desired.
  The Alzheimer's disease and Related Disorders
  Society of India (ARDSI), in its own way, is
  trying its best to fill this vacuum. One day,
  drop in at one of their offices, share a thought,
  and show them that you care. Don't wait a whole
  year till the next World Alzheimer's Day 2016
  September 21st. Who knows how long you will
  remember the 'forgotten ones'?

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• Dr Amitabha Ghosh is Senior Consultant
  Neurologist and Honorary Consultant-in-charge,
  Memory Clinic, Alzheimer's disease and Related
  Disorders Society of India at Apollo Gleneagles
  Hospitals, Kolkata