Alzheimer’s Dis­ease: Great­est Threat to Healthy Ag­ing

BioSpectrum (Asia) - - Bio Content -

Ac­cord­ing to a re­port by Alzheimer’s Dis­ease In­ter­na­tional (ADI) ti­tled ‘De­men­tia in the Asia Pa­cific Re­gion’ the num­ber of peo­ple with de­men­tia in the re­gion will in­crease from 23 mil­lion in 2015 to al­most 71 mil­lion by 2050. It also notes that by the mid­dle of the cen­tury, more than half of the to­tal num­ber of peo­ple with de­men­tia world­wide will live in the Asia Pa­cific re­gion. De­men­tia care costs in the re­gion cur­rently stand at $185 bil­lion, with 70% of this amount oc­cur­ring in the ad­vanced economies. It fur­ther notes that these fig­ures are likely to in­crease as the num­bers of peo­ple with de­men­tia grow, bur­den­ing the health sys­tems of coun­tries in the re­gion, es­pe­cially those in low and mid­dle in­come nations.

The re­port rec­om­mends that coun­tries in the re­gion should: Pro­vide ed­u­ca­tion and aware­ness; Im­prove the qual­ity of life of peo­ple liv­ing with de­men­tia through pub­lic aware­ness and train­ing pro­grams; De­velop na­tional de­men­tia ac­tion plans and Pro­mote the devel­op­ment of health and community care sys­tems to deal with an in­creas­ing num­ber of peo­ple with the dis­ease.

Alzheimer’s Dis­ease (AD) is a chronic neu­rode­gen­er­a­tive dis­ease, and is the most com­mon form of de­men­tia that usu­ally starts mild and gets pro­gres­sively worse. Early symp­tom is short-term mem­ory loss (dif­fi­culty in re­mem­ber­ing re­cent events), with dis­ori­en­ta­tion, be­havioural is­sues, prob­lems with lan­guage, not un­der­stand­ing sim­ple in­struc­tions, and mood swings and other cog­ni­tive dif­fi­cul­ties in later stages. As the dis­ease pro­gresses, of­ten the person af­fected se­cludes him­self from fam­ily and so­ci­ety. The av­er­age life ex­pectancy af­ter be­ing di­ag­nosed in such cases is nor­mally three to nine years (with vari­a­tions in speed of pro­gres­sion of the dis­ease).

World Alzheimer’s month

21st Septem­ber, 2017 will mark the fifth global World Alzheimer’s Month, an in­ter­na­tional cam­paign to raise aware­ness and chal­lenge the stigma that sur­rounds de­men­tia. World Alzheimer’s Month was launched in 2012. The im­pact of World Alzheimer’s Month is grow­ing, and peo­ple are more aware of the dis­ease but the crit­i­cism and mis­in­for­ma­tion that sur­rounds de­men­tia still re­mains a global prob­lem that re­quires at­ten­tion world­wide.

Im­por­tant facts on Alzheimer’s dis­ease

Alzheimer’s dis­ease is the most com­mon type of de­men­tia.

There are an es­ti­mated 44 mil­lion peo­ple who have Alzheimer’s or a re­lated de­men­tia world­wide.

2 in 3 peo­ple with Alzheimer’s dis­ease are women. 1 in 3 se­niors dies with Alzheimer’s or other de­men­tia. Due to the phys­i­cal and emo­tional toll of care­giv­ing, Alzheimer’s and de­men­tia care­givers had $9.7 bil­lion in ad­di­tional health care costs of their own in 2014. The global cost of Alzheimer’s and de­men­tia is es­ti­mated to be $605 bil­lion, which is equiv­a­lent to 1% of the en­tire world’s gross do­mes­tic prod­uct. Alzheimer’s and other de­men­tias are the top cause for dis­abil­i­ties in later life.

Causes of Alzheimer’s dis­ease

The cause of Alzheimer’s dis­ease is poorly un­der­stood. It is a neu­rode­gen­er­a­tive dis­ease, in which the to­tal brain size shrinks and the nerve cells and con­nec­tions get fewer grad­u­ally. If post-mortem/au­topsy is done, the af­fected brain al­ways shows tiny in­clu­sions in the nerve tis­sue called plaques and tan­gles.

These plaques are a re­sult of build-up of a pro­tein called beta-amy­loid (or “amy­loid plaques”) and are

found be­tween the dy­ing cells in the brain. The tan­gles are formed within the brain neu­rons as a re­sult of dis­in­te­gra­tion of an­other pro­tein, called tau. Till date, there is no con­clu­sive study that fully un­der­stands the rea­son be­hind this dis­ease. Sev­eral dif­fer­ent fac­tors are be­lieved to be in­volved. Fac­tors that can act as a pre­cur­sor to de­vel­op­ing the con­di­tion in­clude ag­ing, a fam­ily his­tory of Alzheimer’s, and car­ry­ing cer­tain genes.

Symp­toms of Alzheimer’s dis­ease

The first symp­toms of Alzheimer’s vary from person to person. Mem­ory prob­lems are typ­i­cally one of the first signs of cog­ni­tive im­pair­ment re­lated to Alzheimer’s dis­ease. Symp­toms can be di­ag­nosed at any stage of Alzheimer’s and care and man­age­ment can be dic­tated af­ter mon­i­tor­ing the pro­gres­sion through the stages of the dis­ease. For an ini­tial di­ag­no­sis of Alzheimer’s dis­ease, the med­i­cal prac­ti­tioner must first be sat­is­fied that there is de­men­tia. It in­volves cog­ni­tive or be­havioural symp­toms that show a de­cline from pre­vi­ous lev­els of func­tion­ing and per­form­ing and in­ter­fere with abil­ity to func­tion at work or at usual ac­tiv­i­ties.

The cog­ni­tive de­cline is in at least two of the five symp­tom ar­eas listed be­low:

Wors­ened abil­ity to take in and re­mem­ber new in­for­ma­tion

Im­pair­ments to rea­son­ing, com­plex task­ing and ex­er­cis­ing judg­ment

Im­paired vi­su­ospa­tial abil­i­ties

Im­paired speak­ing, read­ing and writ­ing

Changes in per­son­al­ity and be­hav­iour

6. A grad­ual on­set “over months to years” rather than hours or days (the case with some other prob­lems) Alzheimer’s dis­ease pro­gresses in sev­eral stages: pre­clin­i­cal, mild, (some­times called early-stage), mod­er­ate, and se­vere (some­times called late-stage).

Stages of Alzheimer’s dis­ease

Alzheimer’s dis­ease un­folds in var­i­ous stages. The stages are of­ten blurry and the symp­toms can vary -- but they can be a guide and help ef­fec­tive care of the suf­ferer. Stage 1: Pre­clin­i­cal Be­hav­iour

This is a very early phase and you might not no­tice any­thing amiss in your loved one’s be­hav­iour or rea­son­ing. A PET scan is needed to re­veal whether the person is suf­fer­ing from Alzheimer’s. Symp­toms be­come more prom­i­nent as the friend/rel­a­tive moves into next 3 stages.

Stage 2: Mild de­cline

At the start of this phase, there are still not many be­havioural dif­fer­ences, how­ever, for­get­ting a word or mis­plac­ing ob­jects could have be­gun.

As the stage pro­gresses, the person might start hav­ing dif­fi­culty per­form­ing in­de­pen­dent tasks, and hin­der one’s think­ing and rea­son­ing, such as:

For­gets some­thing he just read

Asks the same ques­tion over and over

Has more and more trou­ble mak­ing plans or or­ga­niz­ing

Can’t re­mem­ber names when meet­ing new peo­ple Stage 3: Mod­er­ate De­cline

Dur­ing this pe­riod, the prob­lems in think­ing and rea­son­ing that you no­ticed in stage 2 get more ob­vi­ous, and new se­ri­ous is­sues ap­pear. This in­cludes for­get­ting his per­sonal de­tails, trou­ble put­ting right date and amount on the cheque, for­get­ting the month or sea­son or even trou­ble cook­ing or or­der­ing meals. Be­ing delu­sional and for­get­ting re­la­tions is also com­mon dur­ing this stage.

Stage 4: Se­vere De­cline

Many ba­sic abil­i­ties in a person with Alzheimer’s, such as eat­ing, walk­ing, and sit­ting up, are hin­dered at this pro­gres­sive stage. You can still be in­volved by feed­ing the person with soft, easy-to-swal­low food, help­ing him use a spoon, and mak­ing sure he drinks. This is im­por­tant, as many peo­ple at this stage can no longer tell when they’re thirsty.

Treat­ment and prevention of AD

Till date, there is no known cure for Alzheimer’s dis­ease as the death of brain cells in de­men­tia can­not be halted or re­versed. How­ever, many ther­a­peu­tic in­ter­ven­tions are avail­able which can help im­prove qual­ity of life for peo­ple suf­fer­ing with this dis­ease.

Some im­por­tant el­e­ments of de­men­tia care (as men­tioned by Alzheimer’s As­so­ci­a­tion) in­clude:

Ef­fec­tive man­age­ment of any con­di­tions oc­cur­ring along­side the Alzheimer’s

Ac­tiv­i­ties and/or pro­grams of adult day care

Sup­port groups and ser­vices.

Sup­port

As with other types of de­men­tia and neu­rode­gen­er­a­tive dis­ease, sup­port given by health­care work­ers, fam­ily and friends to the person suf­fer­ing from Alzheimer’s Dis­ease can be very ther­a­peu­tic. It is an im­por­tant as­pect as the needs of the person in­crease with de­clin­ing in­de­pen­dence. There are sup­port groups for both the suf­ferer as well as for their care­givers. You can find one in your own lo­cal­ity/re­gion. These groups not only give a bet­ter in­sight about the dis­ease but also, pro­vide an op­por­tu­nity for re­spite while meet­ing other peo­ple in sim­i­lar sit­u­a­tions. Some groups meet monthly, oth­ers weekly, and they are free and open to any­one.

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