World Alzheimer's Day: Has the foremost cause of dementia become a public health crisis?

In 1906, a German psychiatrist and neuropathologist  — Alois Alzheimer — is thought to be credited with identifying the first published case of "pre-senile dementia". His colleague Emil Kraepelin would later identify as Alzheimer's disease AD). The etymology of the word dementia can be found in Latin where ‘de’ means deprivation or loss; ‘ment’ means mind and ‘ia’ is a state.

Today, Alzheimer's is thought to be the most common cause of dementia and it begins its onset mostly after the age of 65 years. According to the World Health Organisation,

An estimated five million people living in India are thought to have Alzheimer's, but this figure is also thought to be widely underestimated and there may be numerous undetected cases.

The term dementia includes symptoms not only of memory loss but may also include abnormalities of various other cognitive domains such as language functions, social and behavioural aspects, inability to navigate and directional confusion occurring in a person with previously intact such abilities. AD is the commonest cause of dementia and accounts for approximately half of all dementia cases.

The early features of Alzheimer's include gradually progressive memory loss mainly for recent events and episodes. The patients’ memory for past events of life remains unaffected in the early years of the illness. However, as it progresses — disorientation, confusion and behavioural/personality changes like anxiety, depression, agitation or hallucination can all set in. Dementia slowly progresses to an end-point where there are profound memory dysfunction, reduced mobility and reduced control over bladders and bowel movements.

The incidence and prevalence of Alzheimer’s disease dramatically increase with age. Approximately 80 percent of patients with AD are older than 75 years, with disease incidence increasing from two per 1000 at ages 65-75 years to a whopping 37 per 1000 at age 85 and older. The number of patients with AD is projected to nearly triple by 2050, with the majority of the growth attributed to the older age group. It is also estimated that for every one patient with Alzheimer’s disease there are two additional patients with MCI-Alzheimer’s. Minimal Cognitive impairment is the early phase of any dementia.

The total number of people living with Alzheimer’s has doubled the world over in the past decade. The most probable reasons for the rapidly increasing numbers are two-pronged. Firstly, as the life span increases due to better medical facilities, we have a larger elderly population and AD being an illness mainly of the elderly, the numbers are bound to grow. However, what is more worrisome is the fact that a major reason is a rise in other poor life-style illnesses like diabetes mellitus, hypertension, obesity, obstructive sleep apnea and many more. These, in turn, are linked to the rise in poor lifestyle habits including poor diet habits, lack of any exercises, bad sleeping habits amongst many others. Thus indicating that the numbers could be controlled by widespread changes in human habits.

Studies strongly indicate that the brain abnormality leading to AD starts at a much earlier age and hence the ideal investigations and therapy would be those that detect AD in the early/pre-clinical (before symptoms arise) stages. Tests in experimental stages include examining the Cerebrospinal fluid for certain molecules like tau and amyloid, and brain scans also trying to detect the accumulation of these same molecules in the brain tissue. As regards therapy too, there is much left to desire. Despite massive funds being invested all over the world on experimental studies for early detection and medications for Alzheimer’s disease, there has yet not been any major breakthroughs.

The therapy mainly remains symptomatic with medications that help replace some chemicals in the brain to partially boost the memory and slow down the rate of progression of symptoms. However, there is no medication to reverse or even halt the underlying pathology. Stimulating the mind with brain games, social interaction with family/friends, music therapy or any hobby that interests the patient helps slow down symptom progress.

So what is the best way to halt this disease? As the old adage goes 'Prevention is better than Cure', hence, maintaining a healthy lifestyle with strict control of contributory illnesses like diabetes mellitus, hypertension, obesity, sleep apnea are the best ways to fight this fiercely progressive condition.

The author is a Consultant Neurologist with Jaslok Hospital & Research Centre in Mumbai

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