Dr. Shyam P Lohani

ALZHEIMER’S disease is a neurodegenerative ailment that usually starts gradually and progressively worsens. It is estimated that more than 55 million people live with dementia throughout the world, and 10 million new cases develop every year. Alzheimer's disease is the most common cause of dementia and contributes up to 60-70 per cent of all cases of dementia (WHO, 2021).

The cases of Alzheimer’s disease are continuously increasing as the composition of elderly population increases. Owing to better understanding of healthy living and better public health facilities for the management of common ailments, people are enjoying longer life than just a few decades earlier. Although increasing age is the most important known risk factor for the disease to ensue, much about the Alzheimer’s disease is yet to be known but it is devastating in a life of a patient.

Progressive disorder

Alzheimer’s disease is a progressive disorder of a brain that gradually damages memory and thinking skills and, ultimately destroys the capacity to carry out even the basic daily tasks. Usually it appears at the age of mid 60s in late onset type whereas early onset type begins between 30s and 60s, though rare. Alzheimer’s disease is a condition that affects the brain functioning. The symptoms are mild at the beginning and become more severe over the period of time. It becomes harder for people to remember recent events, to reason, and to recognise people they know as the symptoms deteriorate. Eventually, a person with Alzheimer’s disease may need full-time care and assistance.

Memory loss is a key feature and often one of the first signs of Alzheimer’s disease. A progressive decline in other aspects of thinking, such as coining the right words, impaired reasoning or judgment, and visual and/or spatial impairments may also signal the very early stages of Alzheimer’s disease. The symptoms appear gradually, over months or years and progressively deteriorate. The primary sign of Alzheimer’s disease is a memory loss which makes a person unable to process a new information and retaining information leading to repeating questions, losing objects, forgetting about events or schedules, and wandering or getting lost.

Cognitive deficits are other symptoms where a person may experience difficulty with reasoning, complex tasks, and judgment. The consequences are reduction in understanding of safety and risks, difficulty with money or paying bills, difficulty making decisions and difficulty completing complex tasks that have several stages. The subsequent development of problem with recognition makes a person less able to recognise faces or objects or less able to use basic tools not related to eyesight.

Spatial awareness becomes less efficient such as difficulty with the balance, or spill things more often, or they may have difficulty orienting clothing to their body when getting dressed. Problems with speaking, reading, or writing leads to difficulties with thinking of common words, or make speech, spelling, or writing errors. A person may experience changes in personality and behaviour that include easily becoming upset, angry, or worried more often than before, a loss of interest in activities once enjoyable, a loss of empathy and compulsive, obsessive, or socially inappropriate behaviour.

Alzheimer’s disease can range from mild to severe. The stages of deterioration ranges from a mild impairment at the beginning, then to moderate impairment over time, and eventually severe cognitive decline. Mild Alzheimer’s disease develops memory problems and cognitive difficulties including taking longer than usual to perform daily tasks, difficulty handling money, wandering and getting lost and personality and behaviour changes, such as becoming upset or angry more easily, hiding things, and wandering.

The portions of the brain responsible for language, senses, reasoning, and consciousness are damaged in moderate Alzheimer’s disease and can show symptoms such as increasing memory loss and confusion, difficulty recognizing friends or family, and an inability to learn new things.

The difficulty performing tasks with several stages, such as getting dressed, difficulties coping with new situations, impulsive behaviour, hallucinations, delusions, or paranoia are additional symptoms. Plaques and tangles are formed throughout the brain, causing the brain tissue to shrink substantially in severe cases. An inability to communicate, dependency on others for care, being unable to leave bed all or most of the time are symptoms in this stage.

The unavoidable risk factors for Alzheimer’s disease are aging, and a familial history of the disease. Severe or repeated traumatic brain injuries and exposure to environmental contaminants, such as toxic metals, pesticides, and industrial chemicals are thought to be other risk factors.

Guidelines

The cure for Alzheimer’s disease is not available yet. It seems most unlikely to recover from the death of brain cells. Therefore, the emotional and behavioural changes linked to Alzheimer’s disease can be challenging yet difficult to manage. People with the condition may increasingly experience irritability, anxiety, depression, restlessness, sleep problems, and other difficulties.

The most effective management of Alzheimer’s is to treat underlying causes of changes in a patient. It is important to find the triggers for those behaviours and avoiding or changing those triggers can help people deal with the changes.

The change in the environments, new caregivers, or being asked to bathe or change clothes can trigger the symptoms. It is often possible to change the environment to resolve obstacles and boost the quality of life, security, and peace of mind.

Studies have shown that the modifiable factors that may help prevent Alzheimer’s include regular moderate level of exercise, consuming healthy diets, maintaining a healthy heart, managing the risk of non-communicable diseases such as cardiovascular disease, diabetes, obesity, and high blood pressure, and keeping the brain active throughout life. It is important, therefore, for our country to develop policies and guidelines for specialised care homes and long-term strategic plans for the training the healthcare professionals needed.

(Prof. Lohani is the founder and academic director at Nobel College. lohanis@gmail.com)