Alzheimer’s and Brain Awareness | Narayana Health

Alzheimer’s and Brain awareness month is celebrated in the month of June with the aim of raising awareness about Alzheimer’s disease (AD) and other forms of dementia among the general population. This month, Alzheimer’s associations around the world are undertaking various activities to support Alzheimer’s patients and their carers, discuss the disease with the general public and encourage people to be involved in recognizing the disease and the types of care that someone who suffers from it need. It was initiated in 1983 by US President Roland Regan.

Dementia is defined as acquired impairment of cognitive abilities that affects activities of daily living. Memory is usually affected, but aside from that, other cognitive domains such as language, math, judgment, executive functions, planning, and visual-spatial ability can also be affected. The occurrence of dementia dates back to 2000 BC in the Egyptians before it was mentioned where it was described as memory impairment in the elderly. The term was first coined by Saint Isidore, the Archbishop of Seville in his book ‘Etymologies’ in 600 AD. In Latin, “the” means loss or deprivation, “ment” means mind, and “ia” means condition, so dementia means “loss of mood.” In 1906, the German psychiatrist Alios Alzheimer first described the disease in a 50-year-old lady, but it was named after him by his colleague Emil Kraepelin who first used the term in his book “Psychiatrie”.

There are several causes of dementia. It can be divided into reversible or treatable causes and irreversible causes. The most common reversible causes of dementia are vitamin B1 deficiency (Wernicke’s encephalopathy), vitamin B12 deficiency, hypothyroidism, liver failure, renal failure, infections such as HIV, neurosyphilis, tuberculosis, head injury (pugilistic degeneration, chronic subdural hemorrhage), hydrocephalus under normal pressure, Various brain tumors, vasculitis and other connective tissue disorders, chronic alcoholism, exposure to heavy metals, etc. Among the irreversible causes of Alzheimer’s disease, vascular dementia (multi-infarct state) and frontotemporal dementia are common.

Alzheimer’s disease is the most common cause of dementia in the elderly. In a study from South India, the overall incidence of AD is estimated to be 15.54 per 1000 person-years in persons aged >65 years. The cognitive changes in AD begin with recent memory impairment and gradually extend to language and visual-spatial abnormalities. Few (20%) patients present with non-memory complaints such as word finding, organization and navigation problems. It may be mild (recent memory impairment, repetitive questioning, loss of interest in hobbies and surroundings, unable to name objects), moderate (decreased speech production, executive dysfunction), or severe (agitation, loss of independence, sleep disturbances). In the late stage, there may be delusions, Capragas syndrome (in which the patient believes that the caregiver has been replaced by an impostor), sleep-wake pattern is disrupted, walking is impaired, needs help walking, eating , dressing and finally the patient becomes stiff, dumb, bed bound with incontinence of faeces and urine. The most common cause of death is malnutrition and the secondary infection is usually aspiration pneumonia. The average duration of the disease is about 10 years, but can range from 1 to 25 years.

Several risk factors for AD-like age, female gender, hypertension, diabetes and head injury have been postulated, but no direct correlation has been found.

The disease is diagnosed on the basis of anamnesis and clinical examination. Neuroimaging such as CT or MRI Brain can aid in diagnosis to some extent. FDG PET or SPECT scan can help in some cases where CT/MRI is inconclusive. There is no role of a blood test in diagnosing AD.

The treatment of AD is challenging and the primary goal is long-term improvement of behavioral and neurological problems and caregiver support. At an early stage, patients should be given mnemonic devices such as notebooks, daily reminders, etc. The patient should be encouraged to solve various memory problems and puzzles. Family members and caregivers should help and encourage patients. There are several drugs such as Donepezil, Memantine, and Rivastigmine that help slow the progression of the disease. Several medications are also being studied that may help. The kitchen, bathroom and stairs must be made safe. A diet rich in fruits, vegetables and fiber and maintaining good hydration is very important. From time to time, the neurologist should be visited and the medication dosage should be adjusted correctly. The relatives and caregivers should provide full support and empathy for the patients.

So in this Alzheimer’s and Brain Awareness Month, let’s join hands and take a vow to support the Alzheimer’s patients so they can live a healthy and beautiful life.

Dr. Madhuparna Paul | Consultant – Neurologist | Narayana Multispecialty Hospital, Jessore Road, Kolkata

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