An Expert Tells You Everything About Alzheimer’s Disease
“Come on dad, let’s go,” said the son. “Which way is out?” asked the father, of a house where he has spent over five decades of his life! This is not fiction.
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This may be a common scenario in households where a member suffers from Alzheimer’s disease (AD). Although in India, we consider forgetfulness as a part of the natural ageing process, it is high time that we understand the gravity of the situation. AD is not just about forgetting things or people, it is a debilitating condition that adversely affects the quality of life of an individual. In this article, we will highlight some salient features of the condition, preventive and therapeutic approaches.
The onset of Alzheimer’s disease
Alzheimer’s disease is a neurodegenerative condition that gradually destroys memory and thinking ability and, eventually, the ability to carry out the simplest tasks. Symptoms first appear generally in individuals above 60 years of age and AD is the most common cause of dementia (in over 80% cases). However, in recent times, an increase in early-onset Alzheimer’s disease is being observed in individuals in their 40s and 50s. The exact cause of the condition remains unknown; however, some cases (especially the early-onset variant) may be linked to genetic changes or familial inheritance. One must be aware that AD is not a part of the normal ageing process. It is a progressive condition, which shows worsening of symptoms over the years.
The pathogenesis of the condition involves the accumulation of amyloid β peptide in the brain. Also, neurofibrillary tangles are formed containing a protein called ‘tau’ which is due to the imbalance between formation and clearance of the amyloid β peptide. Loss of connections between nerve cells (neurons) in the brain also occurs gradually.
How to identify the onset or progression of Alzheimer’s disease?
As with many other diseases, AD almost goes undiagnosed in the early stages. Although there are no specific criteria, one may keep in mind these features to identify the onset or progression of the condition. In the very-initial stage, there will be no clinical symptoms and PET scan or MRI may be the only way to diagnose the condition. It may be possible to catch the disease at this point, if the individual consistently undergoes comprehensive annual health checks.
How can family members identify the symptoms of Alzheimer’s disease?
In the next stage, close family members may be able to pick out subtle changes in behaviour or mild degree of forgetfulness in the affected individual. Look out for signs where the patient may misplace objects or randomly forget a word. Understand that these changes may not be evident to even your family physician; therefore, as a family, it is important to keep an eye out for such instances. Having said this, it could well be possible that even normally, the person is absent-minded, which is being exacerbated with age.
As the condition progresses, mild cognitive decline sets in, wherein the patient may forget things just read or seen, names (especially of persons he has met recently), tends to repeatedly ask the same questions. Ideally, by this stage, diagnosis of AD should be made and some therapeutic intervention must be initiated, in order to attempt to slow down the progression of cognitive decline.
The decline in the health of the patient in later stages
In later stages, cognitive decline progresses to the extent that the patient may not remember his own name and other details about himself, forget how to cook, read, et cetera, forget dates, and sometimes even the ability to tell the time. In further advanced stages, the patient will begin to forget his family members, awareness of day and night/ seasons et cetera. With time, the person may lose the ability to remember self-feeding, dressing, and toilet habits making him completely dependent on others.
The role of the family in each stage of Alzheimer’s disease
The role of the family changes with each stage of AD.
- Early stages: While in early stages, the affected individual may not require assistance with daily chores or other activities; it is important to extend support by encouraging him to perform tasks independently. You may even consider playing memory-based and other games that stimulate brain activity.
- Advanced stages: In more advanced stages, especially when the individual starts to lose the ability to remember things consistently; they often tend to get irritated or aggressive (in certain situations), due to the feeling of helplessness. This is especially true of individuals who have otherwise lived a disciplined, independent life. It is important to support them in their routine, but not overtly make them feel dependent. Ensure that they take their medications on time. If possible, try to incorporate calming/relaxation techniques in daily routine, which will ease their minds of their struggle. Unfortunately, not much can be done in advanced stages, where the individual is completely dependent. Ensure that hygiene is maintained and the safety of the individual becomes paramount. Patients will require round-the-clock supervision in extreme cases.
Is there a cure for Alzheimer’s disease?
There is no cure for AD. Management only includes supportive care and medications such as cholinesterase inhibitors etc.
What do researches and studies reveal about Alzheimer’s disease?
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New research has reported advanced pharmacological interventions and vaccines that appear to address the early pathogenic changes in AD. For example, a vaccine has been tested in an animal model, which eliminated the neurofibrillary tangles in the brain. While such researches are welcome, it will take several years for such breakthroughs to be implemented on human patients.
Another interesting field of research is Regenerative medicine and Cell-based therapy. It was believed earlier that regeneration of damaged nerves is not possible. This thought has now been challenged and it is known that stem cells exist in the brain, which functions to repair neurological damage.
Studies have also shown that stem cells derived from other parts of the human body such as bone marrow, fat tissue etc. as well as committed progenitor cells can survive, migrate, and differentiate into cholinergic neurons, astrocytes, and oligodendrocytes, thereby, ameliorating memory deficits. Additionally, stem cells can also stimulate endogenous neural precursors, downregulate pro-inflammatory activity, and prevent the death of nerve cells.
Dr Pradeep Mahajan is Regenerative Medicine Researcher at StemRx Bioscience Solutions Pvt Ltd, Mumbai. He is also a Health Council member at Healthhunt.