World Alzheimer’s Day:September 21-2012

Dementia-Living Together

Prof. Dr.M.A.Aleem.M.D.D.M.,(Neuro) HOD and professor of Neurology KAPV Government Medical college. MGM Government Hospital Trichy -620017.

Introduction:

Dementia is syndrome, usually of a chronic nature, caused by a variety of brain illnesses that affects memory, thinking, behaviour and ability to perform everyday activities. . Alzheimer,s disease(AD) is the most common cause of dementia and possibly contributes to up to 70% of cases. Alzheimer,s is a degenerative disease of the nervous system where the patient starts to lose their memory and in later cases even show behavioral disorders and forgets their own identity. Dementia is the major symptom of Alzheimer’s disease where the person loses the activity of the brain and the memory. The factors contributing to the disease are unknown; however 5 percent of the Alzheimer’s has been reported to have a hereditary origin. Though a number of researches are being done to find more on the disease and its cure, till now only symptomatic treatment are available for it and neither the reason behind the disease or its progression is clearly understood. The ignorance about the disease and its symptoms has wrecked a number of families and has turned their world upside down when they have to deal with a patient from their family. And the knowledge about what the disease actually is and how the patients should be taken care of can change the way of life of such caregivers and also patient who needs the most care and support in this difficult time. The ADI (Alzheimer’s Disease International) launched the International Alzheimer’s Day on 21^st September 1994 on their tenth annual conference. Since then International Alzheimer’s Day or the World Alzheimer’s Day is observed every year on the 21^st of September to spread the understanding of this degenerating disease of the central nervous system. The Alzheimer’s organization around the globe keeps their focus on the day by creating awareness about this progressive and irreversible disease which has million victm every part of the world every three minutes . . Alzheimer,s disease is increasing its number of patients every minute and so does it calls for the right education and guidance about it and its initial symptoms which we often never notice. Alzheimer’s disease is the major cause of dementia around the world and it is estimated that every year millions of lives are affected by it. Almost ten percent of adults above the age of 65 are affected by Alzheimer,s and it is believed that the incidence and the rate of disease will increase with age and time. There are also cases of early onset of the disease where people of 30 to 45 . Every year on the 21^st of September, Alzheimer associations across the globe unite to recognize World Alzheimer’s Day. Together, we are making small but important strides toward increasing awareness and combating the stigma. Alzheiimer Disease International, the ‘global voice on dementia’, has given the theme of “Dementia – Living Together” to this year’s World Alzheimer Day2012.

Magnitude of problem:

Every 4 seconds, a New Case of Dementia in the World

Dementia and Alzheimer’s a Global Health Priority

Every 71 seconds, someone develops Alzheimer’s disease. Today, it is estimated that about 30 million people worldwide suffer from Alzheimer’s disease. Alzheimer’s affects about 10 percent of people aged 65 and up, and the prevalence doubles roughly every 10 years after age 65. Half of the population ages 85 and up may have Alzheimer’s. Because the population of the india is aging, the number of people with Alzheimer’s will continue to rise unless something can be done to stem the disease.

By 2050, there is expected to be one new case of AD every 33 seconds, or nearly million new cases per year, and AD prevalence is projected tobe 11 million to 16 million. Dramatic increases in the number of “oldest –old (those age> 85 years) across all racial and ethnic groups are expected to contribute to the increased prevalence of AD. Worldwide nearly 35.6 milion people live with dementia. This number is expected to double by 2030 (65.7 million) and more than triple by 2050 (115.4). Dementia affects people in all countries, with more than half (58%) living in low –and middle-income countries. By 2050, this is likely to rise to more than 70%. WHO recognises the size and complexity of the dementia challenge and countries to viwe dementia as a critical public heaith priority.

Dementia represents not only a public health crisis but a social and fiscal nightmare as well Around the world a new case of dementia arises every four seconds. That’s a staggering growth rate, equivalent to 7.7.million new cases of dementia every year –the same size as the populations of Switzerland and isreal. Our current health systems simply cannot cope with the explosion of the dementia crisis as we all live longer ; this is as much an economic and fiscal disaster waiting to happen as it is a social and health challenge of the highest order. Alzheimer’s disease in particular-as a “ticking time bomb” given the rapid growth in aging populations worldwide. There would be 35 million people worldwide with dementia by 2010. That number is set to almost double every 20 years to 65.7 million in 2030 and 115.4 million in 2050.

In India Scientists had earlier said that by 2020,around 10 million indians above the age of 65 would suffer from dementia. By 2040, the number would incerase to around 22 million. Going by the new estimaties, the report said the percentage increase of the number of peopel with dementia in the next 20 years will stand at 107% in south Aisa, 134% in latin America and 125% in north America and Middle East. A few, like india ,have national strategies developed by civil society organisations, and we hope this report will prompt their governments to adapt these into official national plans . since we know the prevalence of the disease will explode in this century as we all live longer-the risk of dementia is 1 in 8 for those over 65 and a shocking 1 in 2.5 for those over 85-its impact will become greater as the decades go by .

The report recommended that the WHO declare dementia a health priority,and that countries including india develop a plan for dealing with the greater numbers of dementia patients. The study had earliar made an interesting finting. When compared to China and Latin America, indian relatives were much less likely to acknowledge that the elders in their households were suffering from memory loss.

Alzheimer’s disease clinical stages.

The Leading Theory :

Alzheimer’s disease process beings when deposits of betaamyloid protein collect out side neurons (brain cells), gradually destroing synapses (the connection that enable neurons to receive and communicate information). The next step in the process occurs when neurofibrillary tangles made of tau protein accumlate inside neurons, interfering with normal cell function and eventually killing them. As neurons die and synapses wither, brain tissue shrings in key areas that support memory, language, and other thinking abilities in Alzhimer’s dementia.

The Unnoticed Fact:

About 30% of older people have amyloid deposits that might suggest Alzheimer’s later, others are spared.

It is possible to predict, on an individual basis, which people with early Alzheimer’s pathology will go on to develop the sevear memory and thinking problems that characterize the disease?

By better delineating the three stages of Alzheimer’s disease progression, researchers hope one day to find a way to intervene in the diseaes process in the people most at risk.

Stage 1:preclinical:

In this stage the patiens are mostly asymptomatic but pathological changes are properly already underway in the brain.

The section of the new guidelines that discusses the preclinical stage of Alzheimer’s does not provide diagnostic advice since there is nothing to diagnose but instead describes how researchers might use five biomarkers to estimate the changes of whether someone mihgt be at the preclinical stage. of Alzheimer’s, but also to learn what facter might predict a transition to mild cognitive impairment.

Stage 2: Mild Cognitive Impairment:

Mild cognitive impairment is an intermediate state between the normal forgetfulness that and thinking deficits that occur in Alzheimer’s. within five year, about half the people with mild cognitive impairment develop dementia most often Alzheimer’s As many as one quarter of those with mild cognitive impairment regain normal cognitive functioning in time. The rest remain stable. The new guidelines not only outline criteria whether someone has mild cognitive impairment, but also describe how biomarker tests might be used to predict whether they are likely to progress to Alzheimer’s.The foundation of diagnosis is a through evaluation to rule out other medical problems that might cause problems in thinking, such as heart disease, stroke, depression, or head trama. There are no standart neuropsychological test to diagnose mild cognitive imparment, so clinicians adapt those developed for other purposes. Because other thinking areas may deteriorate in parallel with or even before memory, the guidelines also recommend testing a varity of cognitive function. The following pattern of findings may suggest mild cognitive impairment: 1)Change In Cognition: A deterioration in thinking ability noticed either by the person affected, a loved one, or a clinician. 2)Impairment of one or more abilities: Including memory, attention, language, and ability to plan Ability To Function Independently: Some clinicians may suggest biomarker testing in a person with mild cognitive impairment if the results could guide treatment or help with life planning. Although some people in this position might not want to know what the future holds, others do-to allow time for making medical and financial plans or enabling participation in research studies. Stage 3:Dementia Due To Alzheimr’s Disease:

Once Alzheimer’s has progreassed to the point where memoey, thinking, and behavior are so impaired that a person is no longer able to function independently, the diagnosis is dementia.Diagnosis of Alzheimer’s dementia relies primarily on clinical signs and symptoms, along with tests to rule out other types of dementia or neurological illnesses.The changes in thinking and confirmed by a knowledgeable obsever, such as a spouse or close friend.Further testing may be necessary to confirm The nature and extent of cognitive impairment. The new criteria emphasize that memory impairment althought the most common initial symptom may not be the only one. After stroke, delirium, and other possible causes of dementia are ruled out, a diagnosis of Alzheimer’s is probable when cognitive or behavioral impairment develops gradualls, increased over time, and involves at least two of the following cognitive domans. Memory: This is the most common problem area and typically involves episodic memory(difficulty learning or remembering new information). In day-to-day life this might cause someone to misplace personal belongings, repeat the same question or conversation, forget things or get lost while walking or driving in familiar areas. Executive Function : This type of thinking indiudes planning, reasoning, judgment, and problem solving. Impairmend of executive function might manifest as difficulty with finances, failure to appreciate safety risks, or inapility to organize meals. Visuospatial albility: This refer to the ability to interpret visual information and see how objects fit into surroundings. Impairments in visuospatial ability may manifest in many different ways, such as trouble recognizing familiar people, or the inability to find objects such as eating utensils (even when in plain view). Language: Impairments in this domain might show up as hesitation in speaking, problems coming up with the right word, or spelling errors. Behaviour and personality: Uncharacteristic changes in behavior and personality include agitation, apathy, mood swings, obsessive or compulsive behavior, or socially unacceptable behavior. Conclusion:

Awareness about this degenerative and irreversible disorder is very important to understand and care for the patients affected with Alzheimer’s. The World Alzheimer’s Day focuses on getting more people know about the disease and why and how the patients could be managed though the disease itself cannot be cured or controlled as per the developement now. The first people who should be educated on the symptoms and management of the disease are those who have someone suffering from it.

In most of the cases the early Alzheimer’s symptoms are mistaken for age related forgetfulness and the disease is diagnosed only after it advanceds to higher stage making it equally difficult for the patient and for the caregivers. Being patient and knowing the symptoms and the extent to which the disease can proress will help in taking care of the patient and bearing with the pain of seeing their loved ones deteriorate into a living log.

The International Alzheimer’s day tells the people that they are not alone in their misery and someone next to them are facing the same or similar trauma, the talk show and the articles on the disease helps in educating the world t o know more about the disease. The day also promotes the donation into the fund for Alzheimer’s research which may someday provide a breakthrough for the treatment and new findings into key to unlock the disease.

Only eight countries worldwide currently have national programmes in place to address dementia. A new report Dementia: a public health priority, published by the World Health Organization (WHO) and Alzheimer’s Disease International, recommends that programmes focus on improving early diagnosis; raising public awareness about the disease and reducing stigma; and providing better care and more support to caregivers

Improving early diagnosis:

Lack of diagnosis is a major problem. Even in high-income countries, only one fifth to one half of cases of dementia are routinely recognized. When a diagnosis is made, it often comes at a relatively late stage of the disease.“We need to increase our capacity to detect dementia early and to provide the necessary health and social care.“Health-care workers are often not adequately trained to recognize dementia.”

There is a general lack of information and understanding about dementia. This fuels stigma, which in turn contributes to the social isolation of both the person with dementia and their caregivers, and can lead to delays in seeking diagnosis, health assistance and social support.

“Public awarness about dementia, its symptoms, the importance of getting a diagnosis, and the help available for those with the condition is very limited. It is now vital to tackle the poor levels of public awareness and understanding, and to drastically reduce the stigma associated with dementia.”

Strengthening care is also a key. In every region of the world, most caregiving is provided by informal caregivers – spouses, adult children, other family members and friends. The report notes that people who care for a person with dementia are themselves particularly prone to mental disorders, such as depression and anxiety, and are often in poor physical health themselves. Many caregivers also suffer economically as they may be forced to stop working, cut back on work, or take a less demanding job to care for a family member with dementia.

‘Alzheimer’s, among all non-communicable diseases, demends our urgent and serious focus.Alzheimer’s will surely become the fiscal nightmore of the 21 st centery, quite apart from the personal, family and community devastation it causes in its wake. By working togather to address these commen risk facter’s the global health community can make great inroads into the burten of disese caused by Alzheimer’s disese and these other NCDs(Non-communicable diseases), that together cause 3 in 5 of all deaths. Dementia is not a normal part of aging. 35.6 million people were estimated to be living with demendia in 2010. There are 7.7 milion new cases of demendia each year, implaying that there is a new case of demendia somewhere in the world every four seconds. The accelerating rates of dementia are cause for immediate action, especially in low- and middle- income countries where resources are few. People live for many years after the onset of symptoms of dementia. With apporiate support, many can and should be enabled to continue to engage and contribute within society and have a good quality of life.Dementia is overwhelming for the caregivers and adequate support is required for them from the health, social, financial and legal systems.