Alzheimer’s 101

Business Standard - - ECONOMY - RIMA KHANNA Con­sul­tant, De­part­ment of Neu­rol­ogy, For­tis Hos­pi­tal Shal­i­mar Bagh

De­men­tia is a broad cat­e­gory of dis­eases in­volv­ing the brain that leads to for­get­ful­ness and re­duc­tion in the abil­ity to think and rea­son. Glob­ally, about 46 mil­lion peo­ple suf­fer from de­men­tia. Out of them, Alzheimer’s dis­ease (AD) con­sti­tutes about 50 to 70 per cent of all the cases.

AD is named af­ter Ger­man psy­chi­a­trist Alois Alzheimer, who no­ticed changes in the brain tis­sue of a woman who died of unusual symp­toms of for­get­ful­ness and be­havioural ab­nor­mal­i­ties. This is a neu­rode­gen­er­a­tive dis­ease and is pro­gres­sive af­ter its on­set. It usu­ally af­fects el­derly in­di­vid­u­als af­ter the age of 65 years with a ma­jor­ity of in­di­vid­u­als over 85 years old. It is char­ac­terised by pro­gres­sive mem­ory loss that se­verely af­fects their ac­tiv­i­ties of daily liv­ing.

Early symp­toms in­clude Mem­ory im­pair­ment, more so for re­cent events Re­peat­edly mis­plac­ing phone, money ,im­por­tant things, etc Con­fu­sion with the names of rel­a­tives Fre­quently get­ting lost in fa­mil­iar sur­round­ings Dif­fi­culty in cal­cu­la­tions Dif­fi­culty in find­ing the right words

Not able to man­age fi­nances Frag­mented sleep and in­som­nia Changes in ol­fac­tory func­tions Im­pair­ment in judg­ment Re­peat­ing things

The early signs may per­sist for many years be­fore the pa­tient comes for consultation. This is a in­sid­i­ously pro­gres­sive dis­ease but the rate of pro­gres­sion varies from per­son to per­son. The symp­toms that ap­pear in later stages in­clude Be­havioural ab­nor­mal­i­ties, in­clud­ing ag­gres­sion ,ag­i­ta­tion ,ir­ri­tabil­ity and con­fu­sion Re­quir­ing con­sid­er­able as­sis­tance in daily chores, like dress­ing and eat­ing With­draw­ing one­self from so­cial ac­tiv­i­ties Un­able to con­trol bowel and blad­der move­ment Un­able to com­mu­ni­cate Seizures


Presently, there is no def­i­nite in­ves­ti­ga­tion modal­ity avail­able for di­ag­nos­ing Alzheimer’s, but with ac­cu­rate and com­plete med­i­cal history, it can be di­ag­nosed by neu­rol­o­gist with up to 90 per cent ac­cu­racy. The pro­gres­sion of the dis­ease can be quan­ti­fied by var­i­ous de­men­tia scales avail­able like Mini Men­tal State Ex­am­i­na­tion, Mon­treal Cog­ni­tive As­sess­ment and Clin­i­cal De­men­tia rat­ing scale.

Brain imag­ing, prefer­ably MRI, is re­quired for eval­u­a­tion of Alzheimer’s and also for rul­ing out other struc­tural causes of de­men­tia. In AD, there is sig­nif­i­cant cor­ti­cal at­ro­phy of me­dial tem­po­ral lobe, which is its char­ac­ter­is­tic find­ing. The func­tional neu­roimag­ing meth­ods like FDG-PET, SPECT may be help­ful in de­lin­eat­ing the dis­ease.

While no cure or dis­ease mod­i­fy­ing drugs are cur­rently avail­able, symp­to­matic treat­ment is given to the pa­tients. Main­tain­ing a healthy life­style, which in­cludes an in­crease in phys­i­cal ac­tiv­ity and be­ing on a balanced diet may de­lay the pro­gres­sion of the dis­ease. Steps are also taken to mod­ify vas­cu­lar risk fac­tors in pa­tients and con­trol hy­per­ten­sion and di­a­betes.They are also given cog­ni­tive train­ing.

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