Alzheimer's disease

Prof JC Sanasam *

Combination of two brain diagrams in one for comparison. In the left normal brain, in the right brain of a person with Alzheimer's disease
Pix - wikipedia/Garrondo

Alzheimer's disease (AD) is the most common form of dementia, defined as disorder of irreversible deterioration of intellectual faculties with accompanying emotional disturbance and forgetfulness to the extent of loss of memory, and abnormal behavioral and physical changes resulting from organic brain damage.

It was Alois Alzheimer, a German psychiatrist and neuropathologist who, in 1906, described the disease, hence the name of the disease. It is more or less like the disorder known as Peng Choiba, in Manipuri term, which is loosely taken for a physiological disorder in old age. When it becomes severe, it manifests the typical picture of Alzheimer's disease.

The ancient Greek and Roman philosophers and physicians too associated old age with increasing dementia. In the previous decades before the 20th century such a disorder in an individual before 45 years of age was known as pre-senile dementia and that in an elderly individual as senile dementia.

In the 20th century the diagnosis of Alzheimer's disease was reserved for individuals between the ages of 45 and 65; but as the 21st century draws in many authors have concluded that there is hardly any difference, pre-senile or senile dementia, in the clinical and pathological evidences. Eventually, the term Alzheimer's disease was formally adopted in medical nomenclature to describe all forms of dementia in individuals of all ages with a characteristic common symptom pattern, disease course, and neuropathology.

In 2006, the number of sufferers was estimated at 26.6 million worldwide. Alzheimer's is today predicted to affect 1 in 85 globally by 2050. It is roughly estimated that there are 2 or 3 patients of Alzheimer's disease in every neighbourhood or village in Manipur.

Difficulty in remembering recent events is the commonest early symptom, which often is mistakenly presumed as 'age-related' concerns, or manifestations of stress. Specific evaluation of behaviour and thinking abilities followed by a brain scan is the world standard to confirm the diagnosis. Advanced symptoms like confusion, irritability, aggression, mood swings, trouble with language, and long term memory loss eventually gradually set in, and the sufferer declines and withdraws from family and society.

At late stages bodily functions are lost, ultimately leading to death. It can progress undiagnosed for years before becoming fully apparent. Life expectancy following diagnosis, on average, is 7 years approximately. Less than 3 percent may live more than 14 years after the diagnosis.

Active research and investigations have been going on; as of 2012, more than 1000 clinical trials have been or are being conducted to test various pharmacological molecules and compounds with no conclusive reliable recommendation.

The cause and progression of Alzheimer's disease are not well understood. Research has this much revealed that the disease is associated with presence of plaques and tangles in the brain. In about 1 to 5 percent genetic differences have been identified as the possible cause. No medication so far can stop or reverse the progression of the disease.

Current medicines only help in allaying the symptoms only, that too temporarily. Mental stimulation, exercise, and a balanced diet have been suggested as ways to delay cognitive symptoms. Alzheimer's disease is known for its great burden on caregivers, the spouse or a close relative; almost at the same range as that of the vegetative life of a brain stroke patient or advanced cancer patient.

The pressure can be wide-ranging, involving social, psychological, physical, and economic elements of the caregiver's life. In developed countries Alzheimer's disease has proved to be one of the most costly diseases to the society. Ronald Reagan, President of the USA and Charlton Heston were both renowned Hollywood stars and close friends at that. Both suffered from AD and had very pitiable vegetative lives in their last days.

Experts have divided the course of the disease into 4 stages:

Pre-dementia:

The earliest and most noticeable deficit is forgetfulness and memory loss, which shows up as difficulty in remembering recently learned facts and inability to acquire new information. Executive functions like attentiveness, planning, flexibility, and abstract thinking may be subtly problematic. There may be impairment in memory of meanings, and concept relationships. Apathy may be visible and it usually remains throughout the disease span. A degree of depression, irritability and reduced awareness of memory is also manifested.

Early stage:

By this stage difficulties with language, perception (agnosia), executive functions, or execution of movements (apraxia) are more prominent than just the problem of impaired memory. Memories of old events (episodic memory), facts learned (semantic memory), and implicit memory (like knowing how to handle a comb) still remain intact.

Vocabulary may shrink and word fluency will decrease leading to poor oral as well as written language. The individual will deteriorate, becoming sluggish in performing day to day activities. Inability to recall vocabulary, incorrect word substitution (paraphasia), further loss of the skill of reading and writing may come one after another.

Physically risk of falling increases. Failure to recognise close relatives and impairment of long term memory may become very problematic. Behavioural and neuropsychiatric changes in the form of aimless wandering, irritability, leading to crying, outbursts of unpremeditated aggression, or confrontation to the caregiver may occur. Urinary incontinence (no control whether it is on the bed or with cloths on) can develop.

Advanced stage:

By this stage the person is completely dependent upon caregivers. Language is reduced to simple phrases or even single words, eventually leading to complete loss of speech. But the person still may be able to understand and return emotions. Extreme apathy, exhaustion leading to becoming bedridden, inability to perform the simplest task, dependency on somebody for feeding and toileting, and ultimately the last day comes with or without complications like bed-sores, diarrhoeas, pneumonias or infection somewhere.

The research findings on the cause of this disorder are too technical for general reading; so it is deleted from this small report.

Management:

It does not need to repeat again that no medication has proved to be curative; but it is given as supportive treatment. Stem cell transplantation is said to be of some promising perspective future therapy. As preventive measures as well as for slowing down the deteriorating progression a Mediterranean diet, which include fruits and vegetables, bread, wheat and other cereals, olive oil, fish, and red wine is recommended.

Reading, playing board games, completing crossword puzzles, playing musical instruments, or regular social interaction are strongly recommended. Learning a second language even later in life seems to delay getting Alzheimer's disease.

For Manipuri oldies it will be a double benefit to try to learn Meetei Mayek.

Another well studied and minutely observed fact is that music is good to prevent and arrest Alzheimer's disease. Jubilation to those who love music.