Aim to age successfully

THE world’s oldest prime minister turned 93 this week.

Global population statistics show the number of geriatrics (those over 60 years old) is growing in all parts of the world except Africa.

The percentage of the elderly in this country rose from 4.6% of the population in 1957 to 5.7% in 1990. The expected expansion is from the current 7% to 15% by 2030 when Malaysia will attain “ageing nation” status.

The growing number of the aged is a manifestation of better healthcare facilities and services provided by many, if not all, national governments and the private sector.

In Malaysia, we are seeing the return of the elders to helm national politics. Tun Dr Mahathir Mohamad is in his early 90s (prompting the joke that did the rounds during the recent Hari Raya celebration that the retirement age in Malaysia was to be raised to 95 years!) while a former “future” prime minister who is making a comeback as prime minister-in-waiting is a septuagenarian (those aged 70 to 79 years old).

The Council of Eminent Persons includes another nonagenarian (90 to 99 years old) and seems to be led by an octogenarian (80 to 89 years old). So too is one of the candidates of the recent Umno presidential election.

All these would indicate that while Malaysians are indeed ageing, some are ageing gracefully or, more fittingly, successfully.

A three-year study (2014-2017) sponsored by the Education Ministry with the catchy title TUA (Towards Useful Aging) involving three research universities and Universiti Teknologi Mara (UITM) classified ageing into three categories, namely Successful Aging (SA), Usual Aging (UA) and Mild Cognitive Impairment (MCI), a prelude to the more serious condition of progressive and relentless loss of memory or dementia).

It was found that the prevalence of SA, UA and MCI was 11%, 73% and 16% respectively. The rate of cognitive decline among the UA was two times faster than the SA.

At its conclusion, TUA proposed a neuroprotective model consisting of both prevention and community rehabilitation programmes to elevate those in the UA to the SA category. Early screening was encouraged, using an affordable and simple “cognitive decline risk calculator”.

Diseases normally linked to old age include Alzheimer’s disease (AD) and Parkinson’s disease. Another less talked about disorder is Huntington’s disease, but this is very much a genetically linked complication.

One of the major and perhaps most debilitating conditions of the brain relating to AD is dementia. Literally translated as “loss of the mind”, dementia is a general term for a group of disorders in which mental ability and cognitive function become impaired for at least six months.

An individual with dementia is unable to recall past events, recognise faces, speak coherently and care for oneself, and becomes oblivious of the surrounding. Symptoms deteriorate quickly over time and are irreversible.

AD and other neurodegenerative diseases are not only putting a huge toll on the patients but also caregivers. Great sacrifice of time and effort is a must for the next of kin of those living with dementia.

The TUA study reported that in Malaysia, the mean cost of dementia was RM12,806 for a two-week stay in hospital, including ward services, medications and intensive care unit charges.

Despite research being extensively conducted around the world, brain-related diseases remain recalcitrant, hence not easily treated. Thus, the time and cost of care for patients remain overwhelming.

Most of the people with AD are the aged. Less than 10% of AD cases are of the early-onset AD type that affects people in their 40s or 50s.

Since the first post-mortem investigation conducted by Dr Alois Alzheimer of Tübingen, Berlin at the turn of the last century, the pathology of the brain of an AD victim has been quite consistent:

> One, there appears to be a build-up of abnormal protein called beta-amyloid in the surrounding area of the neurons in the memory storage and processing areas of the brain.

> Two, inside the cells there is a collapse of proteins – known as tau, which are supposed to support the scaffold that keeps the neurons stable and intact – into heaps of cellular muddle and rubbish.

These two events appear to be the reasons why affected cells like the memory neurons fail to do what they normally do. Hence, memory slowly fades away along with other information, knowledge and even wisdom previously entrenched in the person’s brain and mind.

Despite the attractiveness of the theory of the two failed proteins, scientists are not sure if they are the cause or consequence of AD. In view of such uncertainties, efforts to come up with drugs to treat AD have been futile. For instance, this year alone several clinical trials of potential candidate drugs to alleviate AD have been terminated due to poor results.

Hence, AD remains incurable. Present medications are unable to prevent progression of the disease but they can provisionally slow down the worsening symptoms and somewhat improve quality of life of AD patients and, indirectly, their caregivers, too.

Worldwide, scientists are now putting a lot of effort into AD research to not only discover better ways of treating the disease and delaying its onset but also to understand how to prevent it from developing.

At the recently concluded International Brain Research Organization’s (IBRO) Associate Summer School in Cairo (June 19 to 22), much discussion was focused on brain disorders, some of which are linked to old age.

Although the greatest identified risk factor of AD is increasing age, development of the disease is not a normal part of the ageing process. Early detection would be a tremendous boost to deal with the possibility.

At the same Cairo-IBRO event, a team from the Brain Research Laboratory, Universiti Teknologi Mara and University Malaya Medical Centre (UMMC) reported the findings of potential early indicators of AD.

These indicators are referred to as biomarkers. Some of these are in the form of genes which have not been previously reported. It is now being accepted that genes which are indicators of a disease may not be similar across the world’s population.

As the UiTM-UMMC study involves local AD patients and healthy individuals, the discovered biomarkers may be useful for early detection of AD in the Malaysian population.

Another good thing about the UiTM study is that these biomarkers may be detected in the blood, which is highly practical.

Currently, biomarkers for AD are either identified in the fluid of the brain and spinal cord, or by using imaging technique. The former technique gives much discomfort to the person being tested, while the latter is normally too expensive or unavailable at most health screening facilities.

Early detection is vital as proper preventive measures against the disease can be put in place. The longstanding belief that a disease is a manifestation of both nature and nurture and that nothing can be done about it seems debatable now.

The new paradigm of thinking is that a person may be able to determine his or her own health status by working hard on the nurturing side. This involves living a healthy lifestyle and striving for a positive physical, mental and spiritual health.

Brain diseases pose a huge challenge to humanity. Rightly or wrongly, ageing has been blamed as one of the major contributors to some of these disorders.

However, let’s embrace the emerging concept of successful ageing, taking our cue from the recent call by the Royal Society of Public Health to ban “anti-ageing” from product adverts. The frequent use of the term paints the ageing process in a negative light.

Among Malaysians, Dr Mahathir is without doubt the epitome of successful ageing. Happy Birthday, Prime Minister!

ABU BAKAR ABDUL MAJEED Brain Research Laboratory Faculty of Pharmacy Universiti Teknologi Mara