A couple days back I was watching a news program and here was a galaxy of senior citizens having a party! It was organized by a non-Governmental organization, whose members were adorned in yellow T shirts. I said to myself that I must have a look again at Alzheimer’s disease commonly referred to as senile dementia.
Alzheimer’s disease is the commonest form dementia or senility depending on how economical you want to be with words. It has no cure and once diagnosed it tends to worsen and eventually leading to death sometimes from other causes like PNEUMONIA or accidents. The biggest challenge of Alzheimer’s is not even the disease itself but the economic burden it can place on a nation and care givers. Burnouts have been reported among loved ones who took care of those challenged by the disease.
Generally, the disease can be described in four stages. The first stage is commonly associated with memory loss of recent events and inability to learn and acquire new information. Sometimes this may waved off as old age or stress in certain climes. This may go on for as long as six to eight years before the symptoms of full blown dementia manifests.
As the disease progresses to the second stage, there is increased disturbance of learning process and memory loss. It becomes very obvious to close relations and care givers. In some, there could be speech difficulties with limiting vocabulary and slowing down of speech. The most prominent feature at this stage is severe compromise in carrying out previously learned functions such as sowing or even preparing ingredients for soup and movements. At this stage he/she may have to be assisted by care givers. At this stage there is still the ability to do things occasionally without being assisted like writing by the educated ones.
By the third stage, there is a very obvious deterioration in cognitive ability and the person can no longer be independent even with the performance of the simplest act of daily living. The educated among them can no longer read and write. Recall of words is almost impossible. Memory loss is so bad that they can no longer recognize close relatives. Long time memory, the ability to tell an event of the past that was previously intact is lost! By this time some behavioral changes set in. These could include occasional emotional and aggressive out bursts, wandering aimlessly, irritability and loss of control of some natural phenomenon like urination or passing out faeces. They are very accident prone.
By the fourth stage, the ability to speak is almost completely lost. The person affected may still be aggressive but by and large he/she is extremely tired and apathetic. Most of the time, he/she is oblivious of the environment, completely dependent on care givers and bed ridden. This ultimately is the end stage with death coming from things like infection from bed sore, pneumonia and other challenges but Alzheimer disease itself. At the stage the challenge to the care giver could be enormous.
The cause of Alzheimer has been attributed to inheritance of genes that produce a complex of substances that form plaques in the brain. One of the best known risk factor is genes that produce a substance known as APOLIPOPROTEIN which increase the risk of early onset Alzheimer. Well we also know that some environmental factors can also trigger this phenomenon. For example in our country (Nigeria) we are lucky that the level of APOLIPOPROTEIN does not correlate with the incidence and prevalence of Alzheimer’s disease. A little to cheer about, you may say.
There are so many hypothesis and theories regarding the cause of Alzheimer that is beyond the scope and space of this column.
Diagnosis of Alzheimer is simple and based on history and clinical observations of neurological (nerve and mental states) and neuropsychological i.e. deterioration of the mindset and emotional states as the disease progresses. With the advent of high tech medical imaging, things like computed tomography (CT) scan, magnetic resonance imaging (MRI), positron emission tomography (PET) have become very handy. But ultimately the definitive diagnosis is to examined the shrunken brain and demonstrate the senile plaques under the microscope when the patient is dead anyway! Of what use you might ask.
The treatment of Alzheimer’s could be frustrating. No medication has been shown to delay or halt the progression of the disease. The most popular drug used is ANTICHOLINESTERASE INHIBITORS. This enzyme ACETYLCHOLINESTERASE helps to breakdown acetylcholine which is a neurotransmitter and by inhibiting it the rate of loss of acetylcholine is reduced leading to its build up and boosting the electrical conductivity in the brain. That’s how far it goes. Other products have been tried and researches are ongoing. One day there will be a break through. On the other hand there are No known measures to prevent the onset and progression of the disease.
This brings us to the important item in this piece which is the care of care givers. In spite of our economic difficulties, we are beginning to have a bludgeoning of a population of senior citizens of 65years old and above. These means that a reasonable pool of house helps, young members of the family, non-governmental organizations, community health extension workers and a lot of other stake holders would soon have their hands full.
Apart from Alzheimer’s, challenges from stroke, diabetic complications even severe arthritis are potentially things that are likely to keep our children out school in other to look after their guardian and grandpa. We are lucky that the extended family system is still there but you must accept the reality that the economic situation of today has put that under serious strain. Thus as our senior citizens age gracefully there is a need to be proactive in the management of Alzheimer’s because I can see the bell tolling.
While discussing with a colleague on my posting for this week he showed me a piece where it was stated that a diet which includes fruit and vegetable, bread, wheat and cereals, fish and red wine may all individually or together reduce the risk and progression of Alzheimer disease. I told him that I won’t forget that.
It is of a sad note that those affected with this disease have a life expediency of 7 years and this is not good enough. So while there are around with us we should show them all the love we can with understanding on our part. Their aggression and off beat behaviors should be accommodated and regarded as one those things. Those who are involved in nursing them on daily basis should be appreciated, encouraged and compensated. And for our Nigerian citizens and all, we wish us graceful aging.