Alzheimer’s disease is a well-recognized condition of the elderly often affecting the quality of life of both the patient and family.
Let us start by understanding the word Dementia which means a decline in mental ability severe enough to interfere with daily life. Dementia is caused due to damage or degeneration of a part/parts of the brain (cerebral cortex – commonly called grey matter of the brain). Dementia is also called Major Neurocognitive Disorder. (Cognition means the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses)
At least 2 of the following brain functions should be impaired for the condition to qualify as dementia:
- Progressively decreasing Memory
- Difficulty in communication, language comprehension, and expression
- Decreased ability to focus, concentrate and pay attention
- Affected reasoning, judgment, and ability to execute multiple tasks simultaneously
- Visual (spatial) disorientation (inability to maintain body orientation and/or posture in relation to the surrounding environment (during rest or in motion)
Alzheimer’s disease (named after the doctor who discovered it), accounts for 60-80% of Dementia cases. Other causes include stroke, Parkinson’s, and rarer ones like brain infections, trauma to the brain, fluid in the brain, brain tumors, thyroid abnormalities, and other degenerative disorders.
It is a condition affecting roughly 5% of the population >65 years. An exact preventable or treatable cause or risk factor for Alzheimer’s disease is still being researched. It may run in families and may be a result of genetic mutations of certain proteins (beta-amyloid and tau proteins) which cause their abnormal processing. This leads to their progressive deposition in the brain in the form of plaques and tangles, thereby causing damage and disrupting the function of brain cells (neurons).
Some of these symptoms may appear in many aging people but not so frequently or repetitively, are not so typical, or progressively worsening. A serious decline of mental function is not part of normal aging therefore the term senility or senile dementia is not considered appropriate or relevant anymore.
Some skills like reading or listening to books, telling stories of the past and reminiscing, singing, enjoying music, dancing, drawing, or doing some crafts may typically remain intact longer in Alzheimer’s disease.
Signs of late and progressive disease include forgetting names of family members and everyday objects, not able to recognize familiar people, and not being able to perform basic tasks such as eating, dressing, bathing, self-care and self-safety. Therefore, these people will need constant care and supervision.
Lack of eating and self-care leads to increasing weakness, reduction in immunity, and risk of serious infections like pneumonia which can cause death. It is also difficult to manage other ailments in Alzheimer patients like those of the heart, kidney, liver, and lungs, which can lead to complications with a high risk of mortality. So though Alzheimer’s disease shortens life span, it is not the direct cause of death, and patients can live even up to 15-20 years post-diagnosis. This has a considerable bearing in planning for their care.
Usually, the diagnosis of Alzheimer’s is established on the basis of clinical signs, symptoms and evaluation. Neurologists may conduct some tests to assess the brain cognitive function. The commonly used one is the Mini-Mental State Exam (MMSE), while others may include the mini-cog test and other computerized tests. A brain scan (CT/MRI/PET) is done for ruling out other conditions of the brain like stroke, tumors, fluid, or trauma. Scans can also be done to assess the levels of the abnormal beta-amyloid protein plaques and twisted/tangled Tau proteins in the brain which can confirm the diagnosis of Alzheimer’s disease.
HEALTH SOLUTIONS FOR ALZHEIMER’S DISEASE
Proper care of the patient, is of utmost importance and the points below can be of immense help.
Enable mobile phones with location trackers and all the important emergency contact numbers. An identification bracelet should be worn.
Never leave cash or important papers lying around, and use auto-payment methods for important bills and payments. Medicines should be kept securely, and all dosages tracked.
Reduce furniture, rugs and general house clutter, install latches on all doors and secure locks on the main door, have handrails on stairs as well as in the bathroom, and minimize mirrors in the house. Clothes should be easy to wear, loose-fitting with comfortable flat footwear, while hairstyles kept as simple as possible.
Keep things of regular use like keys, phones, wallets, walking sticks, spectacles, books, remotes, toiletries etc always in the same place. Keep lots of familiar photographs around on the walls. A whiteboard with instructions (ticking task completions), along with calendars and clocks readily visible in the house can help.
Alzheimer’s patients tend to ignore their diet and nutrition. Including fruits and vegetables, protein powder/milkshakes, and lots of water and juices to maintain good nutrition and hydration, and avoid constipation is very important. A reduction in saturated fats, high sugar, and high salt foods are advisable. Caffeine should be avoided, and alcohol should be completely stopped. Alzheimer’s patients may need regular reminders to drink water, as well as supervision during meals.
Regular and daily exercise like using a stationary cycle, supervised walking, yoga/aerobic classes, and swimming are some of the good options. Exercise venues should be devoid of slippery floors/items and be well lit. A chair to sit whenever they want should always be nearby. Exercise timing can be slowly increased starting with just 10 minutes to 30-45 minutes daily. There should be no pressure or overexertion. Simple chair or bed exercises can also be tried as less strenuous options for some people.
Social and intellectual stimulation
Joining senior citizen’s social groups, attending discourses, concerts or theatre is good for them. If they are unable to read themselves, attending book reading sessions by others is recommended. Watching a favorite TV show or movie, listening to music, doing crafts, gardening, playing board games, and especially engaging in activities with children really improve the quality of life of these people.
Behavioral therapy and counselling
These involve talking sessions that help patients identify triggers, missing links, feelings, thoughts, and actions. It helps to improve clarity and manage the day to day challenges.
Currently, some drugs like Cholinesterase inhibitors (donepezil, galantamine and rivastigmine) and memantine which improve communication and regulate signal transmission between brain cells, can give relief to many patients, but may not help in all, or may have limited benefit in some due to side effects. Often additional medicines to treat mental health conditions like anxiety, depression or agitation may need to be added when such symptoms are also present.
Specific drugs for treating Alzheimer’s disease are still being researched actively. One such medicine called aducanumab, which targets and prevents the build-up of beta-amyloid plaques in the brain, has been submitted for priority review and approval in August 2020 and should be available in early 2021.
All medicines for Alzheimer’s or mental health conditions should be taken under the prescription, guidance and monitoring of the treating physician.
Meticulous health care
Alzheimer’s patients are not too adept at describing symptoms or taking care of their health. So regular health check-ups, diagnosis and management of other health conditions like high blood pressure, diabetes, heart problems, infections, arthritis or digestive disorders and constipation, become all the more important in them.
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