Dr S K Gupta
21st September is the “WORLD ALZHEIMER’S DAY” This is the most common and important dementia with increasing incidence and have an immense societal impact.
Dementia may be defined as a diffuse deterioration in the mental capacities, resulting from brain dysfunction; usually secondary to organic disease of the brain. It manifests itself primarily in thought, memory and intelligence and secondarily affects feeling and conduct which can be of sufficient severity to interfere with social and or occupational functioning.
Incidence of dementia in developing countries accounts for more than 50% of the global elderly population. By the year 2020 approximately 70% of the World’s elderly population will be in the developing countries and India accounting for more than 15% of them.
The prevalence of dementia in the population aged 65 years or more varies from 1.36 – 3.5% and incidence is about 4.7/1000 persons years. With the elderly population of nearly 71 million, it follows that even by conservative estimates there are between 0.97 to 2.5 million people with dementia in India and 0.33 million are added to this every year.
Alzheimer’s disease is the most common cause of dementia in Western countries. In India it accounts for a sizeable percentage of all cases of dementia in old age. Alzheimer’s disease is more common in females and sometimes it may be seen in more than one member of a family.
The Brain Atrophies with age and which is inevitable, but these changes are mild and may not manifest, clinically. By contrast severe degrees of diffuse cerebral atrophy that evolve over a few years and invariably associated with dementia and the underlying pathologic changes in these cases most often prove to be those of Alzheimer’s disease.
The number of risk factors are associated with Alzheimer’s disease like:-
Head Injury
Parental age
Depression and
Smoking
The Patient with Alzheimer’s disease presents with memory disturbance – forget fullness is the major symptom. Small day to day happenings are not remembered and which may be ignored. Appointments are forgotten and possession are misplaced. Question are repeated again and again. Remote memory is preserved and recent is lost. Patient usually forgets what breakfast he has taken, speech also gets affected – patients forgets to recall words, ultimately speech becomes difficult.
Faults in balancing the checkbook, mistakes in figuring the price of items and is unable to carry out simplest calculations. In some patients visospatial orientation becomes defective. The car cannot be parked. Cannot put on clothes properly and way to home is lost.
Late in the course of illness, the patients forgets how to use common objects and tools.
Depression with insomnia and anorexia also occurs in 5-8% if cases. Delusions and psychotic behaviour increase with progression of Alzheimer disease and present 30% of the patients.
Agitation may coexist in upto 20%. Hallucinations occur with similar frequency which may be visual or auditory.
Disability or impairment of judgment and reasoning occurs. Vocabulary becomes restricted and conversation rambling and repetitions, misuse of proper names and inability to formulate phrases or sentences occurs. There may be destruction of speech function as a whole so that speech becomes increasingly meaningless and ends in a jargon.
Lastly patient has difficulty in walking and unsteadiness in gait and ultimately patient losses the ability to stand or walk, being forced to lie inert in bed and having to be fed and bathed and legs curl into a fixed posture of flexion and may pass urine in the clothes.
The symptomstic course of this tragic illness usually extends our a period of five years or more.
Diagnosis of the disease is made by clinical findings, CT Scan and MRI Scanning.
The patients are helped by early detection of the disease, exercise, good diet, vitamins and other neuroprotective drugs. Considering the severity of the illness and burden to the society let us come forward to be more aware about the disease and help the elderly population, who are at great risk of this serious illness by making the disease more understandable to common man in the society.
The theme of Alzheimer’s day is “No time to lose”. The key message is that no one has any time to loose, as the number of people with dementia around the world is set to double over the next 25 years. The estimated number of people with dementia and their careers to join the programmes to focus the attention of the Government and Non-Government sector on this neglected area of public health. The message is targetted to people with Dementia, their family, members of Alzheimer’s Society, Govt. officials, Parliamentarian, Medical Professionals and Media. This would also help to destigmatise or demystify this condition.
(The author is a neurologist)
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