Recognising Alzheimer’s

It’s a terrifying disease and its onset can be bewildering for family members. But the signs are recognisable. It all begins with uncle Vivek having no memory of what he ate earlier that day, but recalling every detail of a wedding that took place 30 years back. He forgets the year, then birthdays and anniversaries. He forgets to lock doors, and loses keys and his watch. He doesn’t remember where he put them, he says; maybe someone stole them? Then he grumbles that he hasn’t had lunch although he just did. He forgets the name of his son, misidentifies him as his brother. He struggles to find his way in his own house. He becomes slow — physically, in thought, and in speech. He floats away from his own memories and he is not even aware that this is happening.

Uncle Vivek suffers from Alzheimer’s disease, the most common type of dementia affecting the elderly. The population of those aged 60 and above in India has risen from 5.6% in 1961 to 8.6% in 2011, according to the 2011 Census — perhaps because of increasing life expectancy. More than 4 million in India suffer from some form of dementia, with Alzheimer’s being the most common cause. September 21 was World Alzheimer’s day. What can be done about this degenerative disease?

Alzheimer’s dementia not only affects the patient but those around too. Progressive memory loss and reduced emotional reactions and motivation from the patient cause a lot of stress for care-giving relatives, usually the spouse. The speech area in the brain weakens and reduces the patient’s ability to understand words and respond. Consequent communication problems could result in his screaming or aggressive body language. Behavioural problems are commonly caused by an inability to complain of pain, or to empty the bladder, or from pain that comes from not emptying the bowels. The patient’s sleep cycle is altered with loss of sleep. Gradually, the patient requires partial or full assistance in brushing his teeth, washing, shaving, dressing, and eating.

When severe dementia strikes, behavioural problems such as agitation show. Some patients could act on their misperceptions or misinterpretations. A patient may descend from having short-term memory loss to severe memory loss any time from six months of early noticeable signs to 20 years.

The patient could be in a sudden severe state of confusion because of associated chest or urinary tract infection. This would require hospital nursing care. Such states of confusion take weeks to recover — long after the infection is treated — and so the patient might need a trained, paid caregiver who can stay with him and help with early morning chores, personal hygiene, and eating and medication.

A specialist psychiatrist could diagnose the condition early and educate the family on what to expect. Medications that slow down the speed of dementia could be tried. But the most important is group or day-care activities. Caregivers and support groups need to empowered, educated, and supported. Alzheimer’s may not have a cure yet, but plenty can be done to help the patient lead a dignified life.

Vijaykumar Harbishettar is a Bengaluru-based consultant psychiatrist