Dr. Avinash Chandra

Recently, some of you might have seen a picture of an old man going viral on social media. In the description it said that he was unable to tell his own name or family or home and that was because of memory problem! Well, it might sound horrific for those who have not faced this situation but for those who have elders who keeps forgetting person or doing things, this will sound real. Yes, we are talking about the disease Alzheimer, notoriously known for forgetfulness and unsocial behavior.

Disease and Its Causes
Alzheimer’s disease first described by, and later named after a German psychiatrist and pathologist Alois Alzheimer in 1906. It is a chronic disease that usually starts slowly and gradually worsening over the time usually seen in elderly people (over 55 years old). Medically, it is a neuro-degenerative disease (a disease in which nerve cells in brain starts to lose in function and structure).
The cause of Alzheimer disease is poorly understood. It is believed that the majority of Alzheimer’s patients have inherited from their parents (genetic cause).
Unfortunately, there have been many genes found to be involved causing this disease. Other causes are head injury, depression, poorly controlled hypertension, or other diseases like diabetes, etc. There are some chemicals and structural abnormality found in brain that has association with the disease process, they are called neuro-fibrillary tangles and plaques.
Symptoms
Alzheimer’s disease is not simply the disease of forgetfulness and not every forgetfulness is Alzheimer’s. Scientists have tried to categorise Alzheimer’s disease in mainly three categories: Early/mild, moderate, and late/severe.
The reason to categorise is to know and halt the disease as early as possible since, it is progressive and unstoppable till now. Symptoms can vary as per the category.
Early stage: In this stage the symptoms may show as episodes of forgetfulness (the victim himself/herself occasionally might be aware of it), attention deficits, forgetting names of family or friends, or some confusion in situations which are unfamiliar. Interestingly, these changes are frequently noticed only by close friends or relatives and the patient himself/herself might not be noticing the change in him or her. Subtle problems with executing fine decisions are lacking. However, the daily activities are not hampered.
Moderate stage: In this stage Alzheimer has gone into the middle stage resulting into the great difficulty in remembering recently learnt information or things. The confusion creeps into the behavior and it frequently shows up. The deepening confusion will interfere in performing daily activities in many circumstances. There may be problem with sleeping and most importantly patients with Alzheimer encounter trouble determining their locations. Even the recent memory is affected, the remote memory (older memories like birthplace, birth name) are usually intact. Patients may need assistance or supervision in performing cognitively demanding tasks which they were able to perform alone.
Severe stage: In this stage patient suffer from poor ability to think. They will have problems speaking or they will repeat same conversations several times. The social behavior degrades, and thy will be more abusive, anxious, or paranoid. Sundowning (increased confusion and restlessness in the evening) is frequently seen at this stage. This is the stage where they are more vulnerable to the physical abuse or mental torture by their own or the society.

Disease Management
The doctors apply several assessment scales, imaging (MRI, CT of brain), several lab tests to diagnose this disease or rule out other diseases that can mimic Alzheimer. Despite the medical advancement Alzheimer at large is untreatable.
There are very few medicines that offer relatively small symptomatic benefits, but they all remain palliative in nature. Current treatments are pharmaceutical, psycho-social, and rehabilitative and caregiving. In medication, most promising are Acetylcholinesterase inhibitor (Sorry for the medical jargon but there are no simple words for these types of medicine. So, it would be better to let the doctors understand).
Psycho-social treatment can be ad-junked to the medicine treatment. Psycho-social treatments include cognition, stimulation, emotions, or behavior-oriented approaches. The efficacy for this treatment is not well understood yet. Behavioral interventions attempt to identify and reduce the antecedents and consequences of problem behaviors.
This approach however has not shown great success in improving overall functioning, but it can help to reduce some specific behavioral problems like urinary leakage. Other popular behavioral therapy that is promising is the Music therapy.
It has shown effectiveness in reducing behavioral and psychological symptoms like depression, paranoid behavior. Emotion-oriented therapy includes psychotherapy and other type of behavioral therapy. Reminiscence therapy is one of the most popular emotion-oriented therapy that involves the discussion of past experiences individually or in group, with the help of showing photographs, household items or the other familiar items from the past.
The unsocial behaviors also called as challenging behavior (culturally abnormal behavior that may risk the physical safety of the person or others in serious jeopardy) are usually treated with Simulated presence therapy which is based on ‘the attachment theory’ it involves playing a recorded voice of the closest relatives of the person with Alzheimer’s disease. There is no evidence of the usefulness of these therapies.

Yoga/Exercises
There is no definitive evidence to support that any particular therapy is effective in preventing the Alzheimer. Global studies of measure to prevent or delay the onset of Alzheimer have often produced inconsistent results. However, Yoga or physical exercises have always been helpful in reducing the risk and keeping healthy.

Care-giving
As we now know that Alzheimer has not cure and it is progressive, the victim gradually become incapable of tending for their own needs. Care-giving is essentially the treatment and must be carefully managed over the course of the disease. The modifications to the surrounding and modification of the lifestyle might be needed to increase the patient safety and reduce the caretaker burden. If eating becomes problematic food will be needed to be prepared in smaller pieces or even purred.
Above all, careful management can prevent the undesired effect to the patient or the caretaker. The compassion for the victim should always win even during the final stage of the disease.

(Dr. Chandra, MD Neurologist, works at Annapurna Neuro Hospital. E-mail: mczu2005@yahoo.com)