World Alzheimer's Day 2018 September 21st

World Alzheimer's Day 2018 September 21st 

Alzheimer's Disease - Questions and Answers

Dr.M.A.Aleem  M.D.D.M (Neuro)

Emeritus Professor
The Tamilnadu Dr.M.G.R. Medical University

Past President
Tamilnadu Pondycherry Association of Neurologists

Former Vice-Principal 
KAPV Govt. Medical College and MGM Govt. Hospital.

Fromer HOD and Professor of Neurology Senior Neurology civil surgeon KAPVGMC and
MGM Govt. Hospital

Consultant Neurologist
ABC Hospital

Trichy 620018
Tamilnadu
India

drmaaleem@hotmail.com
Phone 9443159940

‘India has second most number of individuals suffering from dementia’

Dementia is a category of brain disease which can cause long-term memory loss and even gradual decrease in the ability to think. The most common type of dementia is Alzheimer’s disease. Even though this is a commonly seen disease mainly in elderly people.

Dementia is equated with memory loss and Alzheimer's disease is the most common form of dementia. It is a disorder that impairs the mental functioning. Commonly, people associate memory loss or dementia to Alzheimer’s disease but dementia has multiple subtypes. At times, it first presents behavioural problems like irritability, confused behaviour, problems with visual perceptions and difficulty in daily activities. Memory disturbances may appear last. To overcome this hurdle, a term has been coined called ‘Neuro-Cognitive Disorders for Dementia’.

The tendency to normalise the memory disturbances by the patient and family members and also lack of awareness of the other symptoms of dementia, leads to a delay in diagnosis of dementia. According to me, more than 25 per cent cases remain undiagnosed.

Globally, there is rise in the population of the elderly people with the generation of baby boomers having entered the age of 60 years. Old age is commonly associated with disorders such as high blood pressure and heart diseases. Along with this problem, it also leads to slowing of the brain functions. Memory lapse is the most common brain dysfunction that people notice and are aware of. However, the attribution of memory lapse to old age commonly masks the onset of a disease called dementia. Globally, India houses the second most number of individuals suffering from dementia with an estimated 4.1 million people suffering from it . This is expected to double by 2035. Maharashtra and Uttar Pradesh alone are expected to house more than 5,00,000 patients by 2026.

 Professional evaluation may detect a treatable condition. Early detection and diagnostics will be helpful to control dementia.

1. What is Alzheimer's disease?

Alzheimer's disease is a progressive and irreversible brain disorder that is characterized by a steady decline in cognitive, behavioral and physical abilities severe enough to interfere with everyday life and necessitate full time care. Symptoms vary from person to person, but all people with Alzheimer's disease have problems with memory loss, disorientation and thinking ability. Individuals with Alzheimer's disease may have trouble finding the right words to use, recognizing objects (such as a pencil), recognizing family and friends, and may become frustrated, irritable, and agitated. As the disease progresses, physical problems may include loss of strength and balance, and diminishing bladder and bowel control. As more and more of the brain is affected, areas that control basic life functions, like swallowing and breathing, become irreversibly damaged, resulting eventually in death.

2. What is dementia?

Dementia is a group of symptoms characterized by a decline in intellectual functioning severe enough to interfere with a person's normal daily activities and social relationships. Alzheimer's disease is the most common cause of dementia in older people. The second most common cause of dementia is multi-infarct dementia, which is caused by a series of strokes. Some of the other diseases that cause dementia are: Creutzfeldt-Jakob disease, normal pressure hydrocephalus, Pick's disease, Parkinson's disease, Lewy body disease, and Huntington's disease. Symptoms of dementia may also result from depression, drug interaction, metabolic disorders (such as thyroid problems), head injury, vision or hearing problems, tumors, and infection. It is important to identify the actual cause, as many of these conditions are reversible. Early diagnosis increhe chances of treating these conditions successfully.

3. What is senile dementia?

Senile dementia is an outdated term once used to refer to any form of dementia that occurred in older people.

4. What is Mild Cognitive Impairment?

Mild Cognitive Impairment (MCI) is a borderline condition between normal, age-related memory loss and early Alzheimer's disease. A person with MCI is characterized as having memory deficit beyond that expected for a person's age, yet without other clinical signs of dementia. Induals with MCI have a higher than normal chance of developing Alzheimer's disease.

5. How many people have Alzheimer's disease?

The Alzheimer's Association estimates that 40 million people age 65 and older have Alzheimer's disease in the world. India has 4.1 million oeople with dementia

6. What is the age of most people with Alzheimer's disease?

An estimated that
• One in ten people age 65 and older (10 percent) has Alzheimer’s disease.
• About one-third of people age 85 and older (32 percent) have Alzheimer’s disease.
• Of those with Alzheimer’s disease, the vast majority (81 percent) are age 75 or older. The percentage of people with Alzheimer’s increases with age: 3 percent of people age 65-74, 17 percent of people age 75-84, and 32 percent of people age  85 and older.

7. Does Alzheimer's disease occur in younger adults?

Yes - the disease can occur in people in their 30s, 40s, and 50s; however, most people diagnosed with Alzheimer's are older than age 65. 

8. What causes Alzheimer's disease?

Scientists do not yet fully understand what causes Alzheimer's disease, but it appears that Alzheimer's disease develops as a result of a complex series of pathological events that takes place over time inside the brain. Age is the most important known risk factor for Alzheimer's disease.

9. If a member of my family has Alzheimer's disease, am I at increased risk for developing it?

Two types of Alzheimer's disease exist: familial Alzheimer's disease (FAD), which is an early-onset form of the disease that appears to be inherited, and sporadic Alzheimer's disease, where no obvious inheritance pattern is seen. Approximately 5% of Alzheimer's disease is familial and approximately 95% is sporadic. In familial Alzheimer's disease, several members of the same generation in a family are often affected. Sporadic Alzheimer's disease develops as a result of a variety of factors, which scientists are still attempting to determine. Age is the most important known risk factor for sporadic Alzheimer's disease.

10. Do men or women have a higher risk of developing Alzheimer's disease?

Although Alzheimer's disease strikes both sexes, it is a disease that particularly affects women. More women than men die from the disease - most likely because women generally live longer than men.

11. What is the relationship between aluminum and the development of Alzheimer's disease?

One of the most publicized and controversial hypotheses in the area of Alzheimer's disease research concerns aluminum, which became a suspect in Alzheimer's disease when researchers found traces of this metal in the brains of people with Alzheimer's disease. Many studies since then have failed to provide consistent or conclusive evidence of a role for aluminum in Alzheimer's disease.

12. What are the symptoms of Alzheimer's disease?

Alzheimer's is a progressive disease; the symptoms grow worse over time. Yet, it is also a variable disease. Symptoms progress at different rates and in different patterns. The appearance and progression of symptoms will vary from one person to the next. The classic sign of early Alzheimer's disease is gradual loss of short-term memory. Other symptoms may include:

Anxiety, suspiciousness, and agitation;
Confusion;
Difficulties with activities of daily living, such as feeding and bathing;
Difficulty recognizing family and friends;
Forgetting how to use simple, ordinary things, such as a pencil;
Inability to recognize objects;
Loss of appetite; weight loss;
Loss of bladder and bowel control;
Problems finding or speaking the right word;
Loss of speech;
Repetitive speaking or action;
Sleep disturbances;
Total dependence on caregiver; and
Wandering and pacing.

13. How is Alzheimer's disease diagnosed?

There is no single clinical test that can be used to identify Alzheimer's disease. A comprehensive patient evaluation includes a complete health history, physical examination, neurological and mental status assessments, and other tests, including analysis of blood and urine, electrocardiogram, and an imaging exam, such as CT or MRI. While this type of evaluation may provide a diagnosis of possible or probable Alzheimer's disease with up to 90 percent accuracy, absolute confirmation requires examination of brain tissue at autopsy.

14. How important is a diagnosis of Alzheimer's disease?

Early and careful evaluation and diagnosis is important because many conditions can cause dementia-like symptoms, some of which are treatable or reversible. Potentially reversible conditions include depression, adverse drug reactions, metabolic changes, and nutritional deficiencies. The earlier an accurate diagnosis of Alzheimer's disease is made, the greater the gain in managing symptoms and allowing the person to take part in planning for their future.

15. How long do people with Alzheimer's disease live after developing the disease?

Every case is different, and progression of the disease varies from person to person. On average, from onset of symptoms, people with Alzheimer's disease can live from 8 years (the average) up to 20 years.  

16. How is Alzheimer's disease treated?

No treatment is yet available that can stop Alzheimer's disease. However, the drugs donepezil (Aricept), rivastigmine (Exelon), or galantamine (Reminyl) may help delay the progression of symptoms associated with Alzheimer's disease. Also, some medicines may help control behavioral symptoms, such as sleeplessness, agitation, wandering, anxiety, and depression. Treating these behavioral symptoms often makes people with Alzheimer's more comfortable and makes their care easier.