With World Alzheimer’s Day being observed on September 21, the focus again will be on a health issue which has long been a matter of concern to health authorities due to the fact that it continues to remain a disease the exact cause/s of which continues to baffle scientists and for which there is still no cure. However, although the cure for Alzheimers is still beyond the reach of doctors, the good news is that its onset can be delayed and even those already struck by the disease can prevent the condition from worsening.
To get more insights into what causes and how to recognise symptoms of memory loss as well as find out if there were simple methods to follow early in order to prevent its devastating impacts, the Sunday Observer spoke to the President of Lanka Alzheimer’s Foundation of Sri Lanka, Professor Shehan Williams.
Excerpts:
Q: In two days time, on September 21, people the world over including Sri Lanka will observe World Alzheimer’s Day (AD). Could you explain what Alzheimer’s disease is in simple layman language?
A. Alzheimer’s disease is a condition in which the brain starts to lose its cells more rapidly than usual resulting in the person having difficulty in thinking and remembering.
Q: Is AD the same as Dementia which is also a memory loss related condition?
A. Dementia is an umbrella term that denotes cognitive decline in a person i.e a person losing their ability to think, remember and act. Dementia can be due to many conditions or reasons. These include brain injury due to trauma, strokes, bleeding into the brain, tumours or excessive collection of brain fluid known as cerebrospinal fluid. Others include certain infections that affect the brain like HIV, syphilis, tuberculosis and vitamin deficiencies, excessive alcohol use and genetic diseases like Huntington’s disease.
Q: What are the most common and most significant causes of dementia?
A. The commonest condition that causes dementia is Alzheimer’s disease. Other well known causes are vascular dementia and Parkinson’s related dementia.
Q: Who are those age-wise and gender- wise most vulnerable to AD and Dementia?
A. Age is the biggest risk factor to develop this condition. Our risk of getting this condition increases with age. If we live till the age of 90, one in three of us will develop this condition. Unfortunately, more women are affected by this condition than men. No one knows the exact reasons behind this although some suggest it may be due to hormonal changes that occur following menopause.
Q. Is Depression related to dementia?
A. People with depression can present with forgetfulness and impaired ability to think and act. This condition is called ‘depressive pseudo-dementia’ and should not be mistaken as dementia. This is why a proper evaluation is necessary. These persons will recover when the underlying depression is treated .Sometimes though, depression can also be an early sign of subsequent dementia.
Q: Are alcohol and smoking contributory causes?
A. The harm to the brain in those those who drink excess quantities of alcohol is immeasurable as recent studies have proved. . Alcohol related dementia is a well recognised entity affecting those who take alcohol. Smoking is perhaps the greatest risk factor for dementia. It contributes to both Alzheimer’s and Vascular dementia and smokers are at 50 percent higher risk of getting dementia. Smoking is a contributory cause for many non communicable diseases such as heart disease, high blood pressure, strokes and even dementia. It causes atherosclerosis in blood vessels leading to impaired blood supply to the brain. It is a definite contributor to vascular dementia and Alzheimer’s disease, - the two predominant causes of dementia and should be avoided completely. .
Q: Are AD and Dementia treatable or reversible with early detection and treatment?
A. There are treatable causes of dementia to reverse the condition if detected and treated early. Predominant among them are conditions like normal pressure hydrocephalus where there is excessive collection of cerebrospinal fluid in the brain, certain operable brain tumours, some vitamin deficiencies and hormonal deficiencies including thyroid hormone deficiency. Alzheimer’s disease unfortunately has no cure at this present moment in time. Treatment may delay the decline but will not cure the disease.
Q: What about pre-exisiting non communicable diseases ( NCDs) like diabetes , hypertension and cardiac problems in patients ?
A. It is important to manage these conditions optimally to prevent Alzheimer’s disease and dementia. These conditions when managed poorly result in changes in blood supply to the brain as the blood vessels are affected contributing to the onset of Alzheimer’s disease and dementia.
Q: Those who have had strokes - are they more vulnerable?
A. Stroke related dementia is called vascular dementia. Even minor strokes can make people vulnerable to dementia.
Q: Are there different stages in the progression of AD? If so, what are they ?
A. Dementia has many stages. We classify it as mild, moderate and severe. In the mild stages the person may continue to function normally and attend to all their activities including work. Except for forgetfulness and some mix-ups they may get by quite well. It is important to recognise the condition at this stage and help the person. Many persons though may be in denial and refuse assistance. Others however may recognise their deficits and take measures to overcome them with the help of others.
In the moderate stage it may become difficult to work, drive or do focused activities. However, they should be able to manage their dressing, toileting and other activities reasonably with some prompting and guidance. This stage is perhaps the longest stage. Irritability, anger outbursts, social withdrawal and disinterest, suspiciousness, anxiety and significant memory problems are expected.
Q: How long will it take a patient with AD to advance to the final stages?
A. The length of time can be very variable. For most it is 5-8 years but for a few it can even last as long as 20 years. At this stage the person will have poor bowel and bladder control and will not be able to indicate the need for toileting. They may wander around aimlessly and not recognise even those close to them. They may have sleep disturbance and cry out or make various unintelligible utterances. They may eventually stop swallowing or eating.
Q: How is AD diagnosed?
A. A doctor would conduct numerous tests on a person before arriving at a diagnosis of Dementia or Alzheimer’s disease. They would look for objective evidence of memory and cognitive impairment by asking certain questions and giving the person certain tasks. This may involve a memory test such as the Mini mental state examination which gives a maximum score of 30. Anyone with a score less than 25 out of 30 will need further assessment.
There are numerous blood tests conducted to exclude some of the treatable causes of dementia and to correct other associated conditions which may contribute to the memory and cognitive problems such as diabetes and nutritional deficiencies. Finally the doctor may request an MRI or CT scan of the brain and an EEG depending on their clinical findings. These scans will help identify tumours, strokes and evidence of shrinking of the brain with large spaces between the brain substance. However, the diagnosis of Alzheimer’s is not based on a single finding. It is a clinical diagnosis based on a combination of factors.
Q: Is this treatment available in all state hospitals?
A. Yes, all state hospitals all over the country provide this service. All doctors are trained to identify and refer persons with dementia for specialist opinion to appropriate clinics.
Q: Yoga, mild exercise, reading, crocheting and engaging in easy life skills are some solutions offered to patients . What’s your take on this?
A. In terms of current scientific evidence, physical and mental exercise is the only sure way to delay the onset of Alzheimer’s and prevent deterioration once someone develops the condition. All of the above you mentioned, do just that. The need to keep active both mentally and physically cannot be emphasized more. ‘If you don’t use it, you lose it !’
Q: As President of the Lanka Alzheimer’s Foundation (LAF) tell us briefly why the Association was founded , and what your objectives are ?
A. Although Dementia and Alzheimer’s is a significant disease which has the potential to affect all of us as we age, the understanding of the condition and the need for a health and social response to address the issue is lacking. The primary objective of our Foundation is to provide awareness and advocacy on the condition to the government, health sector and the public, while improving the lives of those affected by the condition and their caregivers. The co-founder, Lorraine Yu, who was a civilian volunteer, invested her time and energy to raise funds and awareness of the condition for over 15 years to set up the Foundation.
Q: The theme of this year’s AD is “Know Dementia, Know Alzheimer’s” - a continuation of last year’s theme. What is its significance globally and to Sri Lanka in particular?
A. The theme sums up the goal of all Alzheimer’s associations globally. Understanding and knowing about the condition as a first step is very important as that will lead to better preparedness, health promotion, prevention, early diagnosis, treatment and support for the patient, the family, and the caregivers.
Q: AD is a disease that requires a 24 hour plus duty. What has your Foundation done to help ease that huge burden from the Caregiver?
A. In the early stages of dementia many people are able to look after themselves with some guidance. It is only in the later stages that a person needs constant supervision. We provide many services to support the caregiver. The state of the art activity centre, custom built for persons with dementia, offers therapeutic activities during the day. In a sense, the carer has some respite when they drop off the person with dementia for the day. Dedicated volunteers take over the care of their loved one with dementia till around 3 pm when they can come and pick them up again. We conduct a carer support group over zoom and have a 24-hour hotline for carers to call if they need any information, guidance or support.
Q: Your message and guidelines on how to prevent risks of Alzheimer’s Disease?
A. It is important for us to remember that each of us can develop this condition as we age. So we should make healthy lifestyle choices early. Management of high blood pressure, diabetes, blood cholesterol and maintaining a healthy weight are important prerequisites that will prevent or delay the onset of Alzheimer’s and other forms of dementia. It is also extremely important that we need to keep ourselves mentally and physically active and stimulated all the time.