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Expert Speak

Alzheimer’s disease

By Dr Deepak Arjundas

Alzheimer’s disease in India

Research on Alzheimer’s disease in India is still in the initial stages. Medication is expensive. Among the family members care for Alzheimer’s patients, with the best of intentions, is low priority. Professional support systems are non-existent. Against this background general physicians and neurologists try their best to makes things better for AD patients. Dr Deepak Arjundas, a noted neurologist, explains how.

Who is at risk of Alzheimer’s disease?

Usually people over sixty are at risk of Alzheimer’s disease (AD). We also see a few cases of early onset AD, where people in the forties or fifties are affected.

Have any epidemiological studies been conducted in India? Does AD affect both rural and urban populations? Are there any links between diet, racial characteristics, or lifestyle patterns and the disease?

We have very little data to rely on. Some epidemiological studies have been conducted, but these have been confined to small pockets of the population. These seem to suggest that the incidence in India is not very different from that in the West.

Researchers still have not been able to discover any causative factors for AD. From our experience we see that it affects both rich and poor, urban and rural populations and highly intelligent people as well as persons with average intelligence. I know of a senior ophthalmologist who pioneered corneal transplant in India who has dementia now. It is really tragic.

Are people aware of the disease? How do you explain to them?

There is very little awareness. By the time patients come to me, the disease has already entered the middle stage.

When we hint at the possibility of Alzheimer’s disease, the family member or friend who escorts the person, usually breaks down. So we try to prepare them. By the time they take all the diagnostic tests a few weeks lapse. This helps people to come to terms with the situation a little by little.

Do we have medicines to treat Alzheimer’s disease?

As of now there is no cure. But there is medication that will help delay the progress of the disease for some time. It helps to push suffering a little further away.

Drugs are expensive. There is no cure as of now. How are persons expected to cope with this?

It is difficult. Right now dementia is like a death sentence.

We advise those who can afford it to buy medicines. To others, when possible, we give away some samples free. When both are not possible we advise caregivers how to reduce the suffering of Alzheimer’s patients by taking proper care.

“Just keep the person with AD happy and accept them as they are.” is my advice the families.

Do people die of Alzheimer’s disease?

Not directly. But they are often victims of neglect and their failing intellectual powers. For instance, we get AD patients with serious burns and patients who have been injured by pressure cooker blasts. Accidents happen owing to their declining mental alertness.

We do not have day care centres or assisted living communes as in the West. Are there any aids or gadgets that make life a little better for AD persons?

Different type of urine bags and diapers are a great help for those who have lost bladder and bowel control. We advise water beds for those who are bedridden.

What about people in the lower income groups?

In fact they are more accepting of the situation. “ Oh he is very forgetful you know, and does silly things,’ they say and support him as well as they can. They tie a dhothi with a firm clasp or belt (otherwise some of them might undress in public without realising it), give him a meal and a bare bed (no mattress as he is likely to wet it). When it gets too much for them they abandon him at a bus stop or a place far way from home.

As I travel in the city I observe many Alzheimer’s patients among the poor people who live or wander on the streets. In a country where there is so much poverty and getting one square meal a day is a problem for millions, care of ailing elderly people gets very little attention.

Is the scene likely to change? Does research give us hope of a cure?

I think research in the field of genetics and gene therapy will give us some hope of better treatment possibilities.

Is there any treatment available in alternative systems of medicine?

One company is working on a herbal preparation that is of some help in the early stages of the disease.

Dr Deepak Arjundas is an MD in General Medicine and DM in Neurology and is a consultant with two leading Chennai hospitals namely Apollo Hospitals and Vijaya Hospital.

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