21 September is World Alzheimer's Day: Here's what you need to know about this disease

21 September is World Alzheimer's Day: Here's what you need to know about this disease

Alzheimer’s is a form of dementia that slowly progresses with age. Though it is more common in older people — above the age of 60 — it can at times show up between the ages of 30 and 60 (early-onset Alzheimer’s). 

Data suggests that globally, 44 million to 50 million people have one or the other kind of dementia, and nearly 4 million people have Alzheimer’s in India.

Even as there is greater awareness around the disease today, globally there is still a lack of understanding as to how it progresses. World Alzheimer’s Day, celebrated every year on 21 September, is designed to address this gap in understanding.

The theme for this year is raising awareness and challenging stigma.

What is Alzheimer’s? 

Alzheimer’s is a degenerative disease of the brain. It slowly degrades brain cells (neurons) - the disease often goes unnoticed until significant damage has occurred. According to Alzheimer’s Disease International, a group of more than 80 Alzheimer’s associations in the world, it takes about 20 years before an Alzheimer’s patient starts to show symptoms. Most people just live with this disease, unaware. 

While the exact cause of Alzheimer’s is unknown, certain factors put a person at a higher risk for developing this condition. The Alzheimer’s Society, U.K., lists some of these factors:

• Age: Older people are more susceptible to this disease. The risk of Alzheimer’s doubles every five years after the age of 65. 
• Gender: If you are a woman, you are twice as likely to develop Alzheimer’s as a man. Hormonal changes during menopause and the fact that women usually live longer contribute to this. 
• Family history: Contrary to popular belief, most cases of Alzheimer’s are not inherited. In those rare few cases where a heredity pattern is seen, the disease starts well before the age of 65. 
• Lifestyle and health: People who live an unhealthy lifestyle are at higher risk of developing Alzheimer’s. Experts say that even if someone in your family has Alzheimer’s, you can reduce your risk by following a healthy lifestyle. 
• Certain diseases such as diabetes, hypertension, obesity and depression are associated with an increased chance of dementia and Alzheimer’s.

Early signs 

Usually, the first sign of Alzheimer’s is memory loss. The person starts to forget things they have been told recently - important dates as well as everyday things. 

Along with this, a gradual decline in learning capability and reasoning and judgement are noticed in the early stages. Eventually, the symptoms progress to confusion and difficulty in performing everyday tasks. 

The person starts misplacing things and losing their sense of time and space. Withdrawal from social activity, depression and anxiety are some other symptoms. 

However, not every kind of dementia is Alzheimer’s.

As people get older, they start to forget things. But more often than not, they are aware of the fact that they have forgotten something and they eventually remember it. Alzheimer’s patients, however, usually aren't even aware of their dementia.

Pathophysiology: what happens in the brain 

The human brain is a complex network of cells that work together to control the overall functioning of the body. Even a small change in a tiny part of the brain can potentially disrupt the whole process. 

Alzheimer’s patients have been found to have two such problems in their brain - beta-amyloid protein and tau fibres. While beta-amyloid collect between nerve cells and form plaques, tau fibres collect inside brain cells. Together, they disrupt the communication between brain cells, leading to malfunctioning of the brain. 

It is important to note that even healthy people develop some amount of both these compounds. But people with Alzheimer’s tend to develop them in a much higher quantity - starting from the memory section these compounds then spread to the other parts of the brain.

Diagnosis and treatment 

Alzheimer’s is most commonly identified through patient and family history, and by talking to the immediate family about the presence of symptoms. Also, brain imagining may be suggested to check for beta-amyloid protein deposits. As of today, there is no curative treatment for Alzheimer’s. Drugs are usually administered to manage symptoms and healthy lifestyle changes. 

Despite this, Alzheimer’s is one of the most expensive diseases to get treatment for. The global cost of dementia is estimated to be around $1 trillion currently. This includes medical expenses, expenses of caregivers and reduced economic productivity of the family. 

Dementia patients and their caregivers also pay indirect costs in the form of reduced quality of life and the feeling of loss of a family member while they are still there.

In his book I am still here, Creating a better life for a loved one living with Alzheimer's, author John Zeisel explains the most common problems of the people living with Alzheimer’s and their family. Most people, he wrote, don’t really see the dementia patient as the same person; this is what agitates and irritates them more and leads to social withdrawal. He suggested being honest with the patient and staying in the moment instead of worrying about the future. 

Zeisel wrote that it isn't a good idea to talk about them like they are not there or to do things that they can still do for themselves. Instead, encouraging them to do their chores might help them keep their brain more active and instil greater confidence in them.