Dementia is characterized by a progressive, global deterioration in intellect including memory, learning, orientation, language, comprehension, and judgment due to disease of the brain. There is no cure for dementia. Treatment is only to delay or slow the progress of deterioration. AD was named after a scientist Dr. Alois Alzheimer. He reported a case of a woman with memory loss, language problems, and unpredictable behaviour and had changes in her brain tissue.
Every year on 21st September we celebrate World Alzheimer’s day to create awareness among the public, decreasing stigma, and urging policymakers to invest in providing care. AD is usually the disease of the elderly population and accounts for around 50-60% of all dementias. Prevalence increases with progressive age if it’s around 0.6% in people aged above 65years and increases to 20% in >85 years. Among 138 crores Indian population, 14 crore population are senior citizens and among them, around 50Lakh (5%) people are suffering from dementia. Among all dementia, Alzheimer’s dementia is the commonest type.
Dementia not only affects senior citizens but also their family members. There is a huge burden on the family and the community. As the disease progress dementia cases need assistance in their daily activities and will need a person dedicated 24/7 in providing care.
Signs and symptoms of dementia include- progressive declining memory loss, mood changes, including irritability and anxiety, difficulty processing new information and learning new things, loss of spontaneity and initiative, difficulty in identifying family members & friends, confusion about time and place, forgetting the way back home or difficulty finding the right path even at home, communication difficulties, decline inability to perform routine tasks, shorter attention span, difficulty with reading and writing and numbers, poor personal hygiene. Personality changes (e.g., aggression, significant mood swings), requires increasing assistance with daily tasks, psychotic symptoms, and are completely dependent on another person.
The exact cause of AD is not known. However, research and studies say neurons (brain cells) start to degenerate, lose connections with each other and eventually die. There is a build-up of abnormal proteins that form “amyloid plaques” and “tangles” around the brain cells. The e4 version of the APOE gene- provides instructions for making a protein called apolipoprotein E. This gene might be responsible for causing amyloid plaques and tangles.
Increasing age, family history, hypertension, diabetes, obesity, history of head injury, substance use and smoking, sedentary lifestyle, poor sleep habits, less formal education are the various risk factors for dementia.
It’s a diagnosis of exclusion- substances induced, nutritional, vascular, NPH/SOL/Tumours, subdural hematoma, infections, epilepsy, Cushing’s/Addison’s/hypothyroidism, chronic renal failure/ liver failure, and Wilsons’s disease needs to be excluded. Diagnosis is done by complete medical and psychiatric history and complete physical and neurological examination followed by routine blood and urine tests, CT scan &/or MRI scan, mental status examination to determine the level of mental deterioration, caregiver interview to determine the level of dependency.
There is no cure, treatment is only to slow the disease process (slowing the degeneration in brain cells) decreasing the caregiver’s burden, by giving care in the community and sharing them. Disease slowing agents available are cholinesterase inhibitors- galantamine, rivastigmine, donepezil, and memantine. Aducanumab is a recently FDA-approved drug that is a human antibody or immunotherapy, that targets the protein beta-amyloid and helps to reduce amyloid plaques, which are brain lesions associated with Alzheimer’s. Any medical or psychiatric comorbidities need to be treated.
There is various non-medical treatment available for dementia. These interventions can be learned by family members with few training sessions and can be administered at home.
1. Reminiscence therapy: Elicits recall past events, activities, and memories using tangible aids such as photographs, familiar items from the past, music, and movies
2. Validation therapy: Focused on validating the feelings of the person with dementia rather than focus on the confusion and loss. It is found to decrease stress, promote contentment and suppress behavioral disturbances.
3. Reality orientation: Aims to decrease confusion and behavioral symptoms in people with dementia by orienting the individual to time, place, and person.
4. Cognitive stimulation therapy: Typically delivered in a social setting in small groups involving cognitive-based tasks and activities, including word games and puzzles.
5. To care in the community: Nursing care by hiring nurses, long-term care homes, dementia homes, telemedicine for professional help, home visits by health care workers, and daycare centres.
Caregiver stress is inevitable, it can be dealt with by giving proper training and psychoeducation, stress management, decreasing the expectations and sharing the responsibilities, and by institutional care. Family members should be encouraged to socialize, forming self-help groups in the community, improving the treatment and care accessibility from the government side, providing economical support to caregivers and time outs and breaks as stress don’t burn them out. Caregiver’s guilt also needs to be addressed and providing professional help to them when needed by periodic assessment of the caregivers for depression and anxiety.
If you are looking for Neurology Hospital in Mangalore for Alzheimer’s Disease treatment then contact Manipal Hospital. They have the best Neurologist in Mangalore who are trained in Alzheimer’s Disease Treatment in Mangalore.
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