As the world celebrates Alzheimer’s Disease Day today, a consultant psychiatrist with the Lagos State University Teaching Hospital, Dr. Rotimi Coker, speaks with MOTUNRAYO JOEL on the disease
What are the signs of aging and which of them calls for concern?
Aging is a growing process of change that occurs in one’s life over a period of time. The process of aging also depends on many factors such as family (genetic) patterns of aging, the environment, diet, habits and lifestyle choices.
As we grow old, changes occur in three categories: physically, psychologically and socially. We, however, do not grow at the same rate in the same way. When we grow old, changes that are obvious at 60 to 70 years actually begin from about the age of 30. The physical changes include weak muscles, which can lead to shrinking of muscles. This can also affect the pumping muscles of the heart, which can also lead to high blood pressure and hypertension. Enlarged prostate can cause frequent urination. With regards to sexual activities, penile erection and ejaculation are diminished. The skin becomes wrinkled, due to loss of body fats and elasticity of the skin, reflexes become slower. The ears and eyes are affected. There are difficulties in seeing and hearing. The aged also have increase in the frequency in urination.
What is Alzheimer’s disease and what are its symptoms?
Alzheimer’s disease is a disease of some parts of the brain, which causes memory loss, difficulties in orientation to places and time, inability to have attention and concentration. It starts mild and gets progressively worse with age. The illness was named after a German Psychiatrist, Alos Alzheimer, who first described it in 1906. The illness starts in people above the age of 60 years.
When symptoms of Alzheimer’s disease start, they are often mistaken as age-related. Alzheimer’s disease is the most prevalent cause of dementia (dementia is progressive decline in brain functions that deal with logic, emotions and behaviour). AD was reported to account for about 70 to 80 per cent of all cases of dementia. However, the first noticeable sign is frequent forgetfulness, inability to remember recent events- events that occurred within the past 48 hours.
As the illness progresses, the individual becomes more confused, he may become irritable, verbally hostile, overtly happy or may even be sad or depressed. Later, the individual may forget events of the distant past, have trouble explaining daily issues or recognising faces or names of their children. The individual may even find it difficult to move around from one room to another within the house. Due to the frequent confusion experienced by the individual, it may make them withdraw from social and family functions.
Does AD have stages?
There is what we call pre-dementia stage. This is when the illness is mistaken as being age-related. Forgetfulness or memory loss is the initial sign. The individual finds it difficult to remember recently-learned information and also may find it difficult to acquire new sets of information. The person may develop apathy for germane issues. Initial signs of depression may also be noticed. For the early signs of AD – the memory problems worsen and not just ordinary forgetfulness, the individual may even find it difficult to express himself verbally and in written language. At this stage, they need some form of supervision.As the AD progresses, the activities of daily living become very difficult to perform. Sufferers of AD may urinate on themselves. The memory problem becomes severe and the person finds it difficult to recognise children and close relatives. The ability to recall long-term memory also becomes impaired. The speech becomes un-expressive; he says irrelevant and incoherent things. The confusion may increase. The individual may also start to manifest with psychiatric symptoms such as low moods, frequent crying spells, short temper, irritability, aimless wandering, and outbursts of violence towards children and close family members and even towards care givers. The sufferer may also develop severe psychiatric symptoms such as visual and auditory hallucinations (seeing things other people do not see or hearing voices of people in the absence of none); there may be suspiciousness to the point of being paranoid. The irony is that the individual may not even recognise that he is suffering from the illness. The apparent lack of insight into the illness brings about panic reactions from children and close relations.
What of the advanced stage?
At the very severe stage of the illness, the individual appears to be confused most times, finds it difficult finding his way round the house or vicinity, the speech does not make any sense, and may depend upon emotional signs. At this stage, persons with AD may not be able to even perform simple daily living task and may have to completely depend upon those taking care of them.
What causes AD?
The causes of AD remain unknown. However, the illness develops as a result of multiple factors rather than a single cause. There are many suggested causes of AD. It could be hereditary with some genetic factors. Individuals who have a parent, brother or sister with AD are more likely to develop the disease than those who do not have the illness in their families. It has also been postulated to be caused by some viral infections and too many trace elements from ingestion of aluminium and mercury. The illness is caused by some disorders of some parts of the brain which can be observed when one carries out scan of the brain. The manifestation of the disease may be different from one individual to another. When AD occurs in individuals before the age of 60 years, it is referred to as early-onset Alzheimer’s disease.
How do doctors confirm the diagnosis of AD?
Clinicians, family physicians or general practitioners confirm the diagnosis of Alzheimer’s disease either from the affected person’s history or history from children and close relatives about changes in the person’s memory and behaviours. The diagnosis may be further confirmed through computer scan of the brain. The clinician will also carry out some psychological test specifically designed for those suffering from AD.
How important is early diagnosis in the treatment of AD?
It is essential to diagnose AD before symptoms manifest. This can be carried out by investigating the cerebrospinal fluid (fluid within the brain) for some protein that can indicate future manifestation of AD have been conducted in the USA especially those with unexplained memory loss.
Is there a treatment for the disease?
As at today, there is no available treatment to slow or stop Alzheimer’s disease. However, there are some medications that can temporarily improve the observed symptoms of AD. The illness often leads to death usually seven to 10 years after being diagnosed. The individual suffering from AD gets confused frequently, therefore, they most times rely on family members for their personal hygiene and other forms of assistance. It is very tasking to take care of those suffering from AD because a lot of burden is placed on the care givers. Care givers of individuals with AD were noted to also suffer from burnout and emotional stress. Nonetheless, medical management of AD can still improve quality of life of persons living with the illness through appropriate use of medications approved for the illness, effective management of coexisting medical and psychiatric illnesses, frequent counselling of the carrier to avoid carrier burnout.
Who are those at risk?
Those who frequently carry out moderate brain-challenging activities such as playing chess, board games, completing crossword puzzles, reading, playing any type of musical instrument, learning a second language and also interacting socially were found to have reduced risk for developing Alzheimer’s disease.
Researchers have found that those who eat Mediterranean foods have lower risk of developing AD while those who eat fatty food with carbohydrates have a higher risk of developing it. It has been suggested that food that contains caffeine, cocoa and tea may also reduce the risk of developing AD. Some use of minerals such as selenium and zinc and vitamins such as vitamin A, C, and E and the B complex group can also reduce the risk of developing AD including Ginko medications.
What can one do when they think someone has Alzheimer’s disease?
AD is the popular suggestion for those who have different types of dementia. Again, dementia is when someone is confused, poorly oriented in time and place, with prominent behaviour changes that last for more than one month. Dementia and Alzheimer’s disease are not part of normal adult aging. When we observe these behaviour changes in our elderly loved ones we need to take them to our family physicians for complete physical and mental health assessments. This is because Alzheimer-like disorders are treatable and mostly reversible.
How can the government help those living with AD?
AD can be managed at the initial stages by primary health care workers, family physicians and general practitioners. However, in the later stages they may need the inputs of medical specialists such as the neurologists, psychiatrists, clinical psychologists and social workers. The specialist can be found in all general hospitals of every state in Nigeria, teaching hospitals and specialist psychiatric hospitals nationwide. There are many support groups for those living with the condition, prominent among them is the Dementia Nigeria.com, they are known for promoting quality of life of Nigerians living with Alzheimer’s disease.
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