Alzheimer's and Related Disorders Society of India - An Organisation to Improve the Quality of Life of the People with Dementia

Alois Alzheimer, Eminent German Neurologist and Psychiatrist described the symptoms of Aguste D as a disease in 1906, which was named after him. Great strides have been made in the early diagnosis and treatment of this mind crippling illness. In a totally bleak scenario, where nothing could have been done, four drugs are available now to manage some of the distressing symptoms and help the affected person lead a better life. It is estimated that there are nearly 22 million people suffering from this dreadful condition out which, over 3 million are estimated to be in India. By 2030 this number is expected to double.

Are we capable managing this large number of elderly people with dementia? With dwindling family support, care of these frail, confused elderly will fall on the community. This is going to be even more difficult in countries like India, where there is gross ignorance coupled with total lack of services for providing a reasonable quality life for the victims and their families in distress.

Alzheimer's Disease is the most common cause of dementia

Typically Alzheimer's Disease begins with lapses of memory, difficulty in finding the right words for everyday objects or swinging mood. Mild symptoms may be a natural effect of ageing, but in Alzheimer's Disease a pattern of problems emerges over six months or more. As it progresses the person may:

»	Routinely forget recent events, appointments, names and faces and have difficulty in understanding what is being said, become confused when handling money, driving a car or using a washing machine.

»	Undergo personality changes, appearing no longer to care about those around them, and becoming irritable or apathetic, suffer mood swings and burst into tears for no apparent reason, or become convinced that someone is trying to harm them

In advanced cases people may also:

»	Adopt unsettling behaviour, like getting up in the middle of the night, or wandering off from their home and becoming lost.

»	Lose their inhibitions and sense of suitable behaviour, undressing in public or making inappropriate sexual advances.

What are the Symptoms?

Alzheimer's is a physical disease which attacks brain cells (where we store memory), brain nerves and transmitters (which carry instructions around the brain). Production of a chemical messenger acetylcholine is disrupted, nerve ends are attacked and cells die. The brain shrinks as gaps develop in the temporal lobe and hippo campus important for receiving and storing new information. The ability to remember, speak, think and make decisions is disrupted. After death, tangles and plaques made from protein fragments, dying cells and nerve ends are discovered in the brain. This confirms the diagnosis.

What Causes Alzheimer's Disease?

The short answer is we don't know. It may be a combination of factors, some we are born with, some in our environment and some which happen to us. Things that cause Alzheimer's Disease more likely are called risk factors. They include:

Age

The greatest risk factor is increasing age

»	Below the age of 65 dementia affects one person in 1,000

»	Over the age of 65 it affects four to five in 100

»	By the age of 80 it affects one person in five

Although the risk continues to rise, a majority of 90 years old are still unaffected.

A Family Condition: Some people are born at risk because of the genes they inherit

Early onset: Alzheimer's Disease in younger people often progresses more rapidly. A number of rare genetic faults make the disease more likely at a young age.

Brain Damage: People who have had a severe head injury with loss of consciousness are at increased risk of dementia. This is also true of boxers who have become punch-drunk.

Down's syndrome: Because of their chromosomal defect, people with down's syndrome are more likely to develop Alzheimer's Disease. As more people with, Down's syndrome survive in to their 50's and 60s, more will develop the disease.

Other possible causes

»	A possible association has been discovered with the cold sore virus, herpes simplex, but the link is complicated and seems also to include genetic factors.

»	Some toxic chemicals put people at risk of Parkinson's Disease. This has led to a search for a chemical link to Alzheimer's.

»	There is no evidence of risk from aluminium saucepans or from drinking tea, which has traces of aluminium.

How is Alzheimer's Disease Diagnosed? It is important not to become over concerned at minor mental slips, but early and accurate diagnosis is important to clarify whether a treatable condition is causing symptoms, and to provide the best possible care

A health professional records the pattern of symptoms, and uses simple tests to see what someone remembers and if they can hold simple information in the memory. These can be repeated after a few months to measure change. Where dementia is suspected brain scans can show chemical activity and whether areas of the brain are shrinking. Diagnosis can be 80 to 90 per cent accurate in life but can only be confirmed after death.

Is treatment possible? There is no cure for Alzheimer's Disease but prospects for management have improved. New drugs are being developed which seek to slow down the rate of mental decline. These are promising in the early stages of the disease, although it is unclear for how long they can help and they are not yet widely available. In April 1997, donepezil (Aricept) became the first drug to be licensed for Alzheimer'' in Britain.

Affected people should live as normal a life for as long as they can. Memory aids and familiar routines are helpful. As the disease progresses, people need more support and may be need close supervision and eventually nursing care. In India Rivastigmine (Exelon) is being marketed by Novartis since 1999.