We all forget where we kept that box of firecrackers, or the bill that needs to be paid. But there is a more serious loss of memory that progressively begins to disrupt one's normal day-to-day functions. Alzheimer's disease is the commonest form of dementia, a disease of old age, and becomes increasingly frequent with every passing decade after 60 years.
Over the age of 80, more than 20% of people have mild dementia. Currently, over 3 million people suffer from dementia in India alone. In about 20 years time, the numbers are expected to double, thanks to a greater life-span and to better identification of patients in large areas of our country.
Many elderly couples live alone these days. They are frail and particularly vulnerable. Their children may not live close by and could even be in a different country altogether, finding it difficult even to come down for Diwali. What would be the impact of Alzheimer's disease in such a couple?
Imagine the pain of seeing your partner slowly forget everything that was once special and precious to you. Forgetting all likes and dislikes, friends and relatives, or how to be happy or sad. And one day, even forgetting who you are! Imagine your helplessness on being left alone, caring for the one you care for most, but not knowing how to care. And then there is the grocery, the banks, the pension, the medical bills, all that for you to sort out. You are old and frail yourself but there is no time for all that. Medicines help a bit, but for you there are no balms of comfort. Such is the impact of Alzheimer's disease. It affects two people - the patient, but enormously more, the caregiver.
Alzheimer's is not an obscure illness but an ailment affecting real people in real families like yours and mine. I want you to learn to recognise the signs of Alzheimer's disease, but at the same time be reassured that all forgetfulness is not dementia.
We all forget things, all the more as we age. A certain degree of forgetfulness is normal for every age group, especially in the elderly. That is not dementia. Some people are naturally bad with names, telephone numbers or addresses, as the case may be. That is 'normal' for them and is not dementia either. Ask their families and you will find that they have always been like that.
The worry is, when the memory loss exceeds what is normal for the person's age, education or nature. In such situations, a decline in dayto- day function may also be noticed. Appointments may be forgotten and memos may need to be kept. Shopping lists may be difficult to remember. Things may be misplaced and lost a bit too frequently. There may be difficulty remembering names and even recognising people not seen for a few years. Objects that have not been used recently may also be forgotten. Wrong names may be used. Some may start losing their way, initially in unfamiliar and later in familiar places. They may have great difficulty in locating their seats in a train or in flight, for example.
And gradually, even forget the way to their own home. Conversation may be affected in many. Some cannot stop speaking while others sit quietly by themselves with almost nothing to say. Some speak with stutters and trip over words. Finding the right words may be difficult for many of them. Reading and handwriting may be affected; pronunciation and spelling errors may be prominent. Signing a cheque could become a harrowing experience. Dressing, cooking, handling a remote control, a mobile phone or a push-button telephone may become difficult.
While any or all of these symptoms may be seen in Alzheimer's disease, loss of memory is typically the most prominent. Very often it is this loss of memory that draws the attention of the caregivers and other close relatives. At other times, a worried patient himself rings the doctor first.
There are tests we can do to screen for Alzheimer's disease. Some of these are simple questionnaires that take around 10 minutes to finish. More detailed memory tests can be done later. Screening tests are easy to administer, require minimum training for the tester and can be performed at almost all settings like screening camps for Alzheimer's disease, general outpatient clinics and special clinics exclusively set up for memory disorders.
Besides picking out those with Alzheimer's disease or other forms of dementia, memory tests help us separate those who do not have dementia from those who have very mild memory impairments (mild cognitive impairment or MCI). This last group is particularly important. Most people with MCI will be forgetful - but only some will develop Alzheimer's disease. Others may have mild but significant forgetfulness for several years, while a few may even improve and be back to normal. Identifying patients with MCI and trying to treat them early is an area of major interest in Alzheimer's disease research today.
Until now, much of the treatment of Alzheimer's disease has been symptomatic and not really geared to treat the root cause. This is now changing. Current international research is looking to find molecules that can act against the very proteins that cause Alzheimer's disease. Many such drugs are now in the pipeline and could be expected to hit the shelves over the next few years. These drugs seem to work best on patients with early and mild Alzheimer's disease. A heightened awareness and an early diagnosis of the disease are therefore essential.
Lowering the risks
Can you reduce your risk of having Alzheimer's disease? Researchers have been finding links between the occurrence of Alzheimer's disease and diseases of the small blood vessels of the brain. MRI scans of the brain can sometimes pick up patchy, mini-stroke like areas in the brains of patients with Alzheimer's disease. This has led to the suggestion that good food, lots of green vegetables and an otherwise healthy lifestyle could reduce the chances of having Alzheimer's disease much as it reduces the risks of brain strokes and heart attacks. Turmeric, frequently used in Indian food, is also believed to be one of the protectors against Alzheimer's disease.
Looking after the caregivers and their needs is as much a part of Alzheimer's disease care as is looking after the patient. In this regard our social service systems leave a lot to be desired. The Alzheimer's disease and Related Disorders Society of India (ARDSI), in its own way, is trying its best to fill this vacuum. One day, drop in at one of their offices, share a thought, and show them that you care. Who knows how long you will remember the 'forgotten ones'?