What is Alzheimer’s Disease?

All of us forget things at times. Sometimes we forget where we put our keys. On a busy day we might forget to keep an appointment. We may not be able to recall the name of an acquaintance we bump into after many years.

In a person with Alzheimer’s Disease simple forgetfulness becomes more and more noticeable, interfering with a person’s daily activities. Normal activities such as dressing, hygiene or going to a marketplace become difficult. Progressively, the person becomes dependent on others to carry out the simplest tasks.

Alzheimer’s Disease (AD) attacks the parts of the brain that control thought, memory and language. This dementing illness is often noticeable after the age of 60.Certain chemical reactions occurring in the brain cause the shrinking of the brain cells. This eventually leads to the cluttering of the entangled cells. The brain goes on shrinking and so does the memory.

The onset of the disease is gradual and the person’s decline is usually slow.

History

Alzheimer’s Disease is named after Dr.Alois Alzheimer who in 1906 described changes in the brain tissue of a woman who had died of what was thought to be an unusual mental illness. These changes are now recognized as the characteristic abnormal brain changes of Alzheimer’s Disease.

The Stages of the Disease

Three stages have been identified in the progress of the disease. The rate of progress, however, varies from person to person. It is difficult to predict how long each stage will last and how rapidly the disease will progress.

The Early Stage

The early stage is often incorrectly labelled by relatives and friends as “Old Age” and overlooked as a normal part of the process of ageing. Because the onset of the disease is gradual it is difficult to identify the exact time it begins. The person may:

• Show difficulties with language.
• Experience significant memory loss - especially short term.
• Be disoriented in time.
• Become lost in familiar places.
• Display difficulty in making decisions.
• Lack initiative and motivation.
• Show signs of depression and aggression.
• Show a loss of interest in hobbies and activities.

The Middle Stage

As the disease progresses the problems become more evident and restricting. The person with AD has difficulty with day to day living and:

• May become very forgetful, especially of recent events and people’s names.
• Can no longer manage to live alone without problems.
• Is unable to cook, clean or shop.
• May become extremely dependent.
• Needs assistance with personal hygiene routines such as toilet, washing and dressing.
• Has increased difficulty with speech.
• Exhibits wandering and other behavioural abnormalities.
• Becomes lost at home and in the Community.
• May experience hallucinations.

The Late Stage

This stage is one of total dependence and inactivity.Memory disturbances are very serious and the physical side of the disease becomes more obvious.

The person may:

• Have difficulty eating.
• Not recognise relatives, friends and familiar objects.
• Have difficulty understanding and interpreting events.
• Be unable to find the way around in the home.
• Have difficulty in walking.
• Have bladder and bowel incontinence.
• Display inappropriate behaviour in public.
• Be confined to a wheel chair or bed.

Clues about the Cause

Scientists are not sure about the cause. Age and family history have been identified as possible risk factors. Researchers have been able to rule out certain conditions common to other diseases as factors that do not cause AD.

Alzheimer’s Disease is not caused by:

• Hardening of the arteries.
• Under use or overuse of the brain.
• Sexually transmitted diseases.
• Infection.
• Old age. It is not part of the ageing process.
• Exposure to aluminium or other metals.

Warning Signs or symptoms

The following symptoms are a checklist for you. If you have some of these do not ignore it as a sign of the ageing process but check with your doctor. You can notice both cognitive and behavioural problems.

Memory Loss : This gets to be distinctly different from the absentmindedness most people have. When you start forgetting familiar details like names of the members of your family or of friends or your home phone number.

Problems with familiar tasks : You may find yourself unable to tie your shoe laces, something you have done almost every morning of your life. Or may find yourself trying to write with a knife instead of pen.

Personality and Mood Changes : You can undergo a drastic personality change. A quiet and courteous person can turn an impatient and aggressive one. Rapid, unexplained mood changes are also part of the AD pattern.

Language problems : You might find it difficult to find the right word even in simple conversation. You may find difficulty in expressing your ideas.

Abstract Thinking impairment : Simple calculations become confusing.

Disorientation : Forgetting the day of the week or the date is not uncommon but getting lost in your own neighbourhood or mistaking morning for evening is.

Misplacing things : Everybody misplaces a book, paper or keys. But if you found that you have put your watch in the fridge or milk in the clothes cupboard and cannot even remember when you did it, you have got a problem

Judgement Problems : You might find that you are making the wrong decisions over simple tasks. Like watering plants on a rainy day or waiting for the postman knowing that it is Sunday.

Diagnosis

How is Alzheimer’s Diagnosed?

Though there isno single test to detect whether someone has Alzheimer’s disease, careful examination of the person’s physical and mental states can lead to a closer conclusion.

Caregiver or a close relative can provide insights about the person’s behaviour, identifying difficulties he has developed in performing routine tasks such as getting dressed, travelling alone, purchasing household items from the market, managing daily work or even in using household appliances like knife, spoon or iron.

A simple test known as Mini Mental State Examination is useful wherein the person is examined in two ways. First through various questions like, “What’s the date today? Which city we are in?” or through a test where he is asked to identify common items such as watch, key-chain, pen, etc. The second half of the examination is to ask the subject to follow a series of simple instructions.

Doctors will check the person’s medical history, make a physical examination, and ask for a CAT scan to be taken to rule out the possibility of other diseases.

A 100 percent confirmation of the presence of Alzheimer’s can be made only with a brain autopsy.

The importance of early diagnosis

It is depressing to have a doctor confirm an illness. And if it is Alzheimer’s there is reason to be really troubled. But this should not stop you from getting an early diagnosis, if you have detected the symptoms. You can get more out of life before things get worse.

There is ongoing research for treatment and there are medicines available that at least hope to relieve patients of some of the symptoms of the disease.

You can plan for the future (when making independent decisions is going to get difficult) and make arrangements. This will involve financial decisions as well as decisions on whether to participate in research, or arrange to donate brain tissue after death for research.

Should the patient be informed of the diagnosis?

Yes. Especially in the early and middle stages there is a definite benefit in informing the patient.

If a person knows about his/her Alzheimer’s disease and understands the process of its progression, he/she can plan to make most of the remaining years with initial stages of memory loss.

An AD patient can make arrangements for care that he might require. He can make financial decisions as well as decide to participate in research, or arrange to donate brain tissue after death for research. Informing the person about his disease could be a one-to-one talk, in front of family members or personally through doctor. This will depend on the personality of the patient.

Treatment

Currently there is no cure for Alzheimer’s disease. Three FDA approved drugs-donepezil [Aricept], tacrine [Cognex], and rivastigmine [Exelon]-may temporarily relieve some symptoms of the disease. Medication and non-pharmacological therapies are also available to reduce some of the behavioural symptoms associated with Alzheimer’s, such as depression, sleeplessness, and agitation.

Some Tips for Patients

If you are in the early stage of the disease, you can take some steps to cope with the disease as it progresses.

Future Plans

• Perform all the necessary legal and financial documentation while you are still in charge of your life.
• Discuss with your lawyers and close relatives as to how care should be arranged for you in the later stages of the disease. Identify a day care centre, if it is necessary.

Coping with the present

Short term memory is one of the first casualties of the disease.

Give yourself memory aids.

• Never leave home without your calling card or your name and address on slip of paper.
• Do not shift house unless it is absolutely necessary. There are two advantages in being in a familiar neighbourhood. The first is, it is easy for you to find your way about. The second is that even if you forget your way home or feel disoriented, you might find a neighbour or an acquaintance who can help you find your way back.
• Stick to the familiar colour and light patterns inside your house. If the bedroom walls and linen have been BLACK in the past few years stick to the same theme. Do not change the colour or the bathroom door, tiles or even that of the bucket. Do not change the access to the bathroom by rearranging furniture.
• Retain old favourites. If you have an armchair, cot or pillow that have been your favourite, retain it. They may not be in mint condition but familiarity helps independence and gives a sense of security.
• Establish a routine. Every morning try to wake up at a time convenient to you, with the help of an alarm, if required. Your morning ablutions, bath, breakfast etc must fall into a particular pattern. Later, if your caregivers adopt the same routine it will be easy for you to follow and also give you a sense of security.
• Wandering will be one of your problems. You are likely to become a listless individual. Join an exercise or yoga class that will help you relax and also pass time in a healthy way.