We all forget where we kept the first-aid box, or the unpaid bill or even where we dropped the keys. But there is a more serious loss of memory that progressively begins to disrupt one’s normal day-to-day functions. Alzheimer’s disease is the commonest form of dementia, a disease of old age, becoming increasingly frequent with every passing decade after sixty years. Over the age of eighty, more than 20% of people have mild dementia. Currently, over three million people suffer from dementia in India alone. In about twenty years time, the numbers are expected to double, thanks to a greater life-span and better identification of patients in large areas of our country.
Many elderly couples live alone these days. They are frail and particularly vulnerable. Their children may not live close by and could even be in a different geographical location, finding it difficult even to come down for festivals. What would be the impact of Alzheimer’s disease on such a couple?
Imagine the pain of seeing your partner slowly forget everything that was once special and precious to you. Forgetting all likes and dislikes, friends and relatives, or how to be happy or sad. And one day, even forgetting who you are! Imagine the pain of watching your loved one slowly decline. Such is the impact of Alzheimer’s disease. It affects two people – the patient, but enormously more, the caregiver.
Facts about forgetting
We all forget things, all the more as we age. A certain degree of forgetfulness is normal for every age group, especially in the elderly. That is not dementia. Some people are naturally bad with names, telephone numbers or addresses, as the case may be. That is ‘normal’ for them and is not dementia either. Ask their families and you will find that they have always been like that. The worry is, when the memory loss exceeds what is normal for the person’s age, education or nature. In such situations, a decline in day-to-day activities may also be noticed. Appointments may be forgotten and constant reminders become necessary. Shopping lists may be difficult to remember. Misplacement of things may be a recurring problem. There may be difficulty remembering names and even recognizing people not seen in few years. Objects that have not been used recently may also be forgotten. Wrong names may be used. Some may start losing their way, initially in unfamiliar and later in familiar places. They may have great difficulty in locating their seats in a train or in flight, for example. And gradually, even forget the way to their own house.
While any or all of these symptoms may be seen in Alzheimer’s disease, loss of memory is typically the most prominent. Very often it is this loss of memory that draws the attention of the caregivers and other close relatives.
The memory test
There are tests to screen for Alzheimer’s disease. Some of these are simple questionnaires that take around ten minutes to finish. More detailed memory tests are done later. Screening tests are easy to administer, require minimum training for the test administrator and can be performed in almost all settings like screening camps, general out-patient clinics and special clinics exclusively set up for memory disorders.
Besides picking out those with Alzheimer’s disease or other forms of dementia, memory tests help us separate those who do not have dementia from those who have very mild memory impairments (mild cognitive impairment or MCI). The latter group is particularly important. Most people with MCI will be forgetful, but only a few will develop Alzheimer’s disease. While some will experience mild but significant forgetfulness for several years, a fortunate few are likely to become normal again. Identifying patients with MCI and trying to treat them early is an area of major interest in Alzheimer’s disease research today.
New horizon in treatment
Until now, much of the treatment of Alzheimer’s disease has been symptomatic and not really geared to treat the root cause. This is now changing.
Current international research is looking to find molecules that can act against the very proteins that cause Alzheimer’s disease. Many such drugs are now in the pipeline and could be expected to hit the shelves over the next few years. These drugs seem to work best on patients with early and mild Alzheimer’s disease. A heightened awareness and an early diagnosis of the disease are therefore essential.