Making meaning of the “Fading memories”
What is Alzheimer ’s disease? What are the Causes? How to Identify? How to Prevent and Manage Alzheimer Disease? How to Break the Stigma?
The world is greying fast. World Health Organization (WHO) states that around 10% of the current world population is above 65 years. As per the global statistics, India is one of the rapidly aging countries with the Census report of 2011 showing that we have nearly 104 million older adults. With the growth of the country’s population, more individuals are reporting cognitive concerns on a mild to severe level, one of the major one being Alzheimer’s disease.
Ms Vasundharaa S Nair
PhD Scholar, Department of Psychiatric Social Work (PSW), NIMHANS, Bengaluru
Dr Debanjan Banerjee
Psychiatrist, Geriatric Services Unit, NIMHANS, Bengaluru
The world is greying fast. World Health Organization (WHO) states that around 10% of the current world population is above 65 years. As per the global statistics, India is one of the rapidly aging countries with the Census report of 2011 showing that we have nearly 104 million older adults. Their number is increasing due to multitude of factors like increased birth rates, decreased death rates, improved healthcare delivery enhancing the life expectancy, and better access and control of the diseases.
With the growth of the country’s population, we are also observing more individuals reporting cognitive concerns on a mild to severe level. One of the major one being Alzheimer’s disease. As the World Alzheimer’s Awareness Month (September) passed by, let’s try to understand the condition and break the stigma around it to lay the foundation of an age and dementia-friendly India and for the achievement of Sustainable Development Goal 3 – Good health & well-being.
What is Alzheimer’s Disease?
Dementia is a progressive disorder that causes brain cells to waste away or degenerate and die leading to certain changes in brain’s structure and function. It leads to deficits in memory and much beyond (thinking, behavior, social skills, judgement, comprehension, speech, direction sense, etc.). Dementia commonly affects people older than 65 years of age, however rarely in genetic conditions, younger people might also be affected.
Alzheimer’s Disease is the most common cause of dementia - accounting for 60-80 percent of dementia cases. It causes a gradual decline in the thinking, behavioral, and social skills with memory loss thereby affecting one’s ability to function independently. The early signs of the disease may be in terms of forgetting the recent events or conversations and difficultiesin carrying out day-to-day tasks. The Alzheimer’s and Related Disorders Society of India (ARDSI) reports that 5 of every 100 elderly in the country might be living with dementia.
How to Identify?
When the symptoms are mild, the person with Alzheimer’s disease may be aware that he/she/they are having difficulty with remembering and organizing their thoughts. Usually, a close family member or friend may notice the early change. With the gradual brain changes, they develop trouble with the following:
1. Memory loss: All of us have occasional memory lapses where it is normal to lose track of the name of an acquaintance or where one had put the keys or documents. But the memory loss occurring in Alzheimer’s disease persists and worsens with the difficulty in functioning at work or home. People with Alzheimer’s may:
- Repeat the statements and questions over and over
- Forget the conversations, important events, appointments or not remember them later (clue related recall might be present in early stages)
- Routinely misplace one’s possessions and may put them in illogical locations
- Get lost in familiar places
- Slowly forget the names of the family members and regularly used objects
- Searching or have trouble in finding the right words to identify objects, express one’s thoughts, or to take part in conversations.
2. Thinking and reasoning: Persons with Alzheimer’s find it:
- Difficult to concentrate and think, in specific about the abstract concepts like numbers.
- Multitasking becomes extremely difficult
- Difficulty in managing finances, paying bills on time, etc.
- Inability to recognize and deal with numbers.
3. Making judgments and decisions: People with Alzheimer’s Disease find it difficult to make reasonable decisions and judgments wherein the person is noticed to make:
- Poor or non-typical choices in social interactions.
- Wearing clothes which are inappropriate to the weather/situation
- Difficulty in responding effectively to everyday concerns like burnt food or an unexpected driving situation.
4. Planning and performing familiar tasks:Those affected with Alzheimer’s disease find it difficult to do the routine activities which require structured and sequential steps:
- Planning, cooking a meal, or playing a favorite game
- Forgetting to perform basic tasks such as dressing ad bathing
5. Changes in personality and behavior:The changes in the brain affect the mood and behavior in Persons with Alzheimer ’s disease where the problems may include:
- Depression
- Apathy (lack of interest, enthusiasm, and/or concern)
- Social withdrawal
- Constant change in Mood
- Difficulty in trusting others
- Irritability, anger, and aggressiveness
- Changes in sleeping habits - Reduced sleep or increased sleep
- Wandering behavior
- Loss of inhibitions
- Delusion – believing something strongly which is not true in the real world like someone has stolen something etc.
6. Preserved skills:Many significant skills that have been preserved for a fairly long period worsen with time. These include:
- Singing
- Reding or listening to books
- Telling stories and reminiscing
- Listening to music
- Dancing
- Drawing
- Doing crafts etc.
In summary, the signs and symptoms as memory loss, disruption of daily life, challenges in planning or solving problems, difficulty in completing familiar tasks, confusion with time or place, trouble understanding visual images and spatial relationships, trouble with new words in speaking or writing, misplacing or losing things, decreased or poor judgment, withdrawal from social or occupational events and changes in mood and personality, occur gradually with time.
- It is important to understand that all the above-mentioned symptoms do not occur together but might appear in a sequential fashion.
How to diagnose?
There is no single diagnostic test to determine and diagnose Alzheimer’s disease. It is a multidisciplinary set of physicians composed of neurologists, geriatric psychiatrists, social workers, and neuropsychologists who use a variety of approaches and assessments to help make a diagnosis. These include detailed medical history, mental status examinations, general and neurological tests,brain imaging(CT/MRI scan of brain), psychosocial assessments, and neuropsychological assessments.
Clinical assessment by a qualified physician is the best approach.
What Causes Alzheimer’s Disease?
Research so far states that it might be caused by a combination of genetic, lifestyle, and environmental factors that affect the brain over time. The exact causes are not fully understood, but at its core, the problems are with the brain proteins which fail to function normally resulting in disruption of the brain cells and unleashing a series of toxic events. Neurons get damaged, connections are lost, and results in death. Damage starts at the brain region controlling memory resulting in loss of neurons in other regions of the brain resulting in the late stage where the brain has shrunk significantly. Researchers have focused on the role of two proteins majorly:
- Plaques: Beta-amyloid is a leftover fragment of a larger protein. These fragments constitute a cluster which appears to have a toxic effect on neurons and disrupts the cell-to-cell communication. The cluster forms larger deposits which are called plagues.
- Tangles:Tau proteins play a significant role in neuron’s internal support and transportation of nutrients. When a person develops Alzheimer’s Disease, these tau proteins change shape and look like tangles that disrupt the transport system and are toxic to cells.