World Alzheimer’s Day, 21.09.2014-Dementia: can we reduce the risk?

World Alzheimer’s Day, September 21st


Dementia can we reduce the risk? Pro. Dr.M.A.Aleem M.D.D.M(Neuro) , Professor of Neurology, KAPV Government Medical College & MGM Government Hospital Trichy – 620017.Tamilnadu India. Cell: 94431-59940

Dementia is a syndrome – usually of chronic or progressive nature – in which there is deterioration in cognitive function (i.e. the ability to process thought) beyond what might be expected from normal ageing. It affects memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgment. Consciousness is not affected. By deterioration in emotional control, social behavior, or motivation.

Although dementia mainly affects older people, it is not a normal part of ageing.

World wide, 35.6 million people have dementia and there are 7.7 million new cases every year

Alzheimer’s disease is the most common cause of dementia and may contribute to 60 – 70% of cases.

World Alzheimer’s Day, September 21st of each year, is a day on which Alzheimer‘s organizations around the world concentrate their efforts on raising awareness about Alzheimer‘s and dementia. Alzheimer’s disease is the most common form of dementia, a group of disorders that impairs mental functioning.

Alzheimer’s disease is often called a family disease, because the chronic stress of watching a loved one slowly decline affects everyone.

Alzheimer’s is not a normal part of aging.

Alzheimer’s disease is an irreversible degeneration of the brain that causes disruptions in memory, cognition, personality, and other functions that eventually lead to death from complete brain failure.

Alzheimer’s is growing epidemic.

Alzheimer’s is on the rise throughout the world.

Worldwide, nearly 44 million people are believed to be living with Alzheimer’s disease or other dementias. By 2050, rates could exceed 135 million.

Every four seconds, a new case of dementia occurs somewhere in the world.


The overall economic impact is staggering.

If dementia care were a country’s economy, it would be the world’s 18th largest, ranking between Turkey and Indonesia. If it were a company, it would be the world’s largest by annual revenue, exceeding Walmart (US$414 billion) and Exxon Mobil (US$311 billion).

People who have Alzheimer’s disease need others to care for them, and many of those providing care are not paid for their time and services.

Caring for a person with Alzheimer’s or another dementia is often extremely difficult, and many family and other unpaid caregivers experience high levels of emotional stress and depression as a result.

Caring for someone with Alzheimer’s disease has been found to have a negative impact on the health, employment, income and financial security of many caregivers.

Alzheimer’s is the only leading cause of death that is still on the rise.

Alzheimer’s disease is the sixth – leading cause of death across all ages .For those 65 and older, it is the fifth – leading cause of death.

Between 2000 and 2008, deaths attributed to Alzheimer’s disease increased 66%, while those attributed to the number one cause of death – heart disease – decreased 13%. This increase reflects changes in patterns of reporting deaths on death certificates over time as well as an increase in the actual number of deaths attributable to Alzheimer’s. Alzheimer’s disease is the only major cause of death that significantly increased from 2009 to 2010, while other major causes of death declined.

What is Alzheimer’s disease?

Alzheimer’s disease is a progressive disease in which healthy brain tissue degenerates, resulting in problems with memory, behavior, and other mental abilities. It is the most common cause of dementia (the loss of memory and other intellectual abilities serious enough to interfere with daily life)

What are the symptoms?

The symptoms of Alzheimer’s disease are more serious than the mild memory changes that typically accompany aging. Symptoms may start gradually but eventually become severe enough to interfere with activities of daily living. They include:
Increasingly worse memory loss, especially forgetting recently learned information

Difficulty performing familiar tasks, such as cooking or making a phone call

Difficulty in finding the right words.

Problems with abstract thinking, such as trouble balancing a checkbook

Poor judgment, such as dressing inappropriately for the weather or overspending money

Misplacing things or putting them in unusual places, like putting car keys in the freezer

Disorientation, such as getting lost in familiar surroundings

Loss of initiative

Changes in mood, behavior, and personality.

Although the course of Alzheimer’s disease is individual and highly variable, most people with the condition will survive about eight to ten years after being diagnosed.

Stages of dementia

Dementia affects each person in a different way, depending upon the impact of the disease and the person’s personality before becoming ill. The signs and symptoms linked to dementia can be understood in three stages.

Early stage: the early stage of dementia is often overlooked, because the onset is gradual. Common symptoms include:

Forgetfulness

Losing track of the time

Becoming lost in familiar places.

Middle stage: as dementia progresses to the middle stage, the signs and symptoms become clearer and more restricting. These include.

Becoming forgetful of recent events and people’s names

Becoming lost at home

Having increasing difficulty with communication

Needing help with personal care

Experiencing behavior changes, including wandering and repeated questioning.

Late stage: the late stage of dementia is one of near total dependence and inactivity. Memory disturbances are serious and the physical signs and symptoms become more obvious. Symptoms include:

Becoming unaware of the time and place.

Having difficulty recognizing relatives and friends

Having an increasing need for assisted self – care

Having difficulty walking

Experiencing behavior changes that may escalate and include aggression.

Common forms of Dementia

There are many different forms, or causes, of dementia. Alzheimer’s disease is the most common form of dementia and may contribute to 60 – 70% of cases. Other major forms include vascular dementia, dementia with Lowy bodies (abnormal aggregates of protein that develop inside nerve cells), and a group of diseases that contribute to front temporal dementia (degeneration of the frontal lobe of the brain). The boundaries between different forms of dementia are indistinct and mixed forms often co – exist.

Rates of dementia

World wide, 35.6 million people have dementia, with just over half (58%) living in low – and middle – income countries. Every year, there are 7.7 million new cases.

The estimated proportion of the general population aged 60 and over with dementia at a given time is between 2 to per 100 people.

The total number of people with dementia is projected to almost double 20 years, to 65.7 million in 2030 and 115.4 million in 2050. Much of this increase is attributable to the rising numbers of people with dementia living in low – and middle – income countries

What are the causes?

The exact cause of Alzheimer’s disease isn’t yet clear. However, scientists know that the brains of people with the condition contain abnormal clumps and knots of brain cells, called plaques and tangles. These plaques and tangles are made up of proteins that may be involved in the neurone (nerve cell) death that occurs in Alzheimer’s disease. Researchers also believe that the inflammation observed in the brains of some people with disease may play a central role.

Who is likely to develop Alzheimer’s disease?
Alzheimer’s appears be influenced by a combination of genetic, environmental, and other factors. Some major factors that appear to increase the risk of Alzheimer’s disease include:

Age: Alzheimer’s disease is most common in people older than age 65.

Family history: Having a parent or sibling with the disease slightly increases risk.
Genetic mutations: Three genetic mutations are known to cause early – onset Alzheimer’s, while a form of the APOE gene increases risk of late – onset disease.

Gender: Women are more likely than men to develop Alzheimer’s disease.

Other conditions: The same factors that raise the risk of heart disease, such as high blood pressure, high cholesterol, and diabetes, also increase Alzheimer’s risk.

Education: Research shows a link between lower education levels and higher risk of Alzheimer’s disease.

Head injure: Some studies show a link between traumatic head injuries and Alzheimer’s risk.

How is Alzheimer’s disease diagnosed?

Alzheimer’s disease is typically diagnosed after doctor’s rule out other conditions. There is no specific test used to diagnose or confirm the diagnosis of Alzheimer’s disease. General test than can help doctors determine whether a patient has Alzheimer’s disease include:

Physical exam

Blood tests

Mental and memory tests

Brain scans

What is the conventional treatment?

Although there is no cure for Alzheimer’s disease at this time, medications can help treat symptoms of the condition. Conventional doctors may recommend one of five prescription drugs currently approved to treat Alzheimer’s, depending on the severity of the illness. These medications are:

(galantamine)

(rivastigmine)

(donepezil)

(tacrine)

(memantine)

These drugs affect brain chemicals and may help improve symptoms of Alzheimer’s and allow patients to perform daily activities longer than they otherwise would be able to numerous new treatment s are being investigated in various stages of clinical trials.

Much can be, however, offered to support and improve the lives of people with dementia and their caregivers and families. The principal goals for dementia care are:

Early diagnosis

Optimizing physical health, cognition, activity and well – being

Identifying and treating accompanying physical illness

Detecting and treating behavioral and psychological symptoms
Providing information and long – term support to caregivers.

Risk factors and prevention

Research identifying modifiable risk factors of dementia is scarce. Prevention focuses on targets suggested by available evidence, which include countering risk factors for vascular disease, such as diabetes, midlife hypertension, midlife obesity, smoking and physical inactivity.

What therapies dose Doctor Will recommend for preventing and slowing the progression of Alzheimer’s disease?

Dietary changes: A2002 study published in the New England Journal of Medicine indicated that people who have high blood levels of toxic amino acid known as homocysteine have twice the usual risk of developing Alzheimer’s disease. Homocysteine levels tend to be higher in people whose diets are high in animal protein; conversely, fruits and leafy green vegetables provide folic acid and other B vitamins to help the body reduce homocysteine levels. It’s difficult to establish cause and effect but reducing animal protein and eating more plant foods is a good idea for general health, and may help to prevent or alleviate symptoms of Alzheimer’s.

An anti – inflammatory diet is generally protective against a wide range of diseases, and Alzheimer’s disease is believed to have an inflammatory component.

One particularly promising spice is turmeric; one of its components, curcumin is strongly anti – inflammatory. Elderly villagers in India have one of the world’s lowest rates of Alzheimer’s; the reason may be the turmeric that they consume in their daily curries.

Exericise: Research indicates that regular physical exercise can lower the risk of developing Alzheimer’s by up to 50 percent. A Japanese study found that among 265 people with both normal mental function and mild cognitive impairment due to Alzheimer’s after one year of moderate exercise intervention, 70 percent of participants showed significant improvement in memory function. And the more the participants exercised, the greater the improvement. Aim for at least 30 minutes of aerobic activity such as walking, cycling or swimming on most days of the week.
Mind/Body: People who participate in mentally stimulating activities such as reading and playing cards are at lower risk for developing Alzheimer’s disease. Other research shows that the more years of formal education you have the less likely you are to develop the condition. The theory is that challenging intellectual activity builds up rich neural connections that function as insurance against later brain – tissue losses, just as well – developed muscles maintain their integrity longer during periods of inactivity than atrophied muscles.

Traditional Chinese Medicine (TCM): In Chinese medicine, Alzheimer’s disease is not yet recognized as a separate disease entity. Instead, it falls under the broader category of senile dementia. Practitioners of TCM often recommend herbal preparations for senile dementia; more research is needed to determine effectiveness.

Supplements: Some studies suggest that vitamins C and E, either in foods or supplements are protective against Alzheimer’s. In a January, 2004 study published in the Archives of Neurology researchers reported that older people who took daily supplements containing at least 400 IU of vitamin E and 500 mg of vitamin C were 64 percent less likely to develop the condition.

In May of 2008, the journal Neurology published a study from Boston University School of Medicine showing that people who took ibuprofen for more than five years had a 44 percent lower than normal risk of developing Alzheimer’s and that other NSAIDs reduced the risk by 25 percent. This study included more than 49,000 U.S. veterans aged 55 and older who developed Alzheimer’s and nearly 200,000. Who didn’t. Ibuprofen is the active ingredient in Advil, Motrin and other pain medications. While this suggests that NSAIDs have a protective effect, it is not clear which ones work best or that people should start taking any of them to ward of Alzheimer’s . First of all, taking NSAIDs long – term isn’t risk – free. These drugs can cause serious gastrointestinal problems including stomach ulcers and bleeding, and even fatal GI bleeds, and it is not known yet know if the benefits out weight these risks. More research is needed to look at that and to determine which NSAIDs are most effective. If one (or all) of the drugs prove to work as well as studies so far indicate, the next step will be to determine when to take them – and for how long – for maximum protection.
Ginkgo (Ginkgo biloba), a traditional herbal preparation made from the leaves of the ginkgo tree can increases blood flow to the brain. Some clinical evidence suggests that ginkgo can be useful in slowing the progression of early Alzheimer’s disease and age – related dementia. If you want to try ginkgo for memory enhancement, take 40mg of a standardized extract with a ratio of 24% ginkgo flavones glycosides and 6% terpene lactones three times a day with meals. Give it a two – month trial.

Also: Avoid smoking; smokers have twice the risk of developing Alzheimer’s as nonsmokers.

Protect yourself from head trauma, which has also been linked to increased Alzheimer’s risk, perhaps due to low – grade inflammation as the brain attempts to heal itself. Wear a helmet when on a motorcycle, bicycle, skates or skis, and high – traction footwear when surfaces are icy.

Maintain a normal weight; a study in Neurology online in March, 2008, revealed a potential link between excessive belly fat among people in their 40s and the onset of Alzheimer’s about 35 years later. Of the 6,583 people studied, those in the highest20 percent in terms of belly size were three times more likely to develop dementia than were those in lowest 20 percent.

Social and economic impacts
Dementia has significant social and economic implications in terms of direct medical costs, direct social costs and the costs of informal care. In 2010, the total global societal costs of dementia was estimated to be US$ 604 billion. This corresponds to 1.0% of the worldwide gross domestic product (GDP), or 0.6% if only direct costs are considered. The total cost as a proportion of GDP varied from 0.24% in low – income countries to 1.24% in high – income countries.

Impact on families and caregivers

Dementia is over whelming for the families of affected people and for their caregivers. Physical, emotional and economic pressures can cause great stress to families and caregivers, and support is required from the health, social, financial and legal systems.
Human rights

People with dementia are frequently denied the basic rights and freedoms available to other. In many countries, physical and chemical restraints are used extensively in care facilities for elderly people and in acute – care settings, even when regulations are in place to uphold the rights of people to freedom and choice.

An appropriated and supportive legislative environment based on internationally accepted human rights standards is required to ensure the highest quality of service provision to people with dementia and their caregivers.