A century ago, a woman in Tubingen, Germany, died. The woman had been suffering from depression, loss of memory, loss of ability to reason, and progressive jealousy as neuropathologist Alois Alzheimer described it at a meeting of the South West Germa n Society of Neurologists in November 1906. Similar symptoms had been observed in other patients by doctors long before Alzheimer, and those symptoms had always been dismissed as a natural part of the aging process. But the German woman had not been elderly, and was only 51. Hence the symptoms were termed presenile dementia and the disease was named Alzheimer’s Disease (AD). Dementia is the medical term for a group of symptoms and it is not the name of any disease. Neurologists now agree that the dementia that occurs in the elderly is similar to the presenile condition. It is usually called Senile Dementia of the Alzheimer’s Type (SDAT).
Alzheimer’s disease sounds like OLDTIMER’S disease. It is a dementing disease, a destroyer of personalities and a wrecker of family resources. It can strike people in their 40s; in rare cases, their 20s; but most victims are among the growing number of persons above 60. It also is a killer. Alzheimer’s Disease usually leads to death in about seven to 10 years, but it can progress more quickly (three or four years) or more slowly (as much as 15 years). The causes of dementia are varied. Depending upon this, some forms of dementia are treatable and reversible. Alzheimer’s dementia is of insidious onset. It is progressive and irreversible. So far no drug is available either to prevent the disease or to cure it.
Dr. Rajkumar, former Professor at Madras Medical College, conducted a survey sponsored by the WHO, which coordinated a multicentre study on estimating the prevalence of dementia in the elderly above the age of 65. It was found that the prevalence rate of dementia was 27 per 1000 in urban and 35 per 1000 in rural populations, respectively. Around 35 to 40 per cent of these were diagnosed as Alzheimer’s Disease. Though this epidemiological survey was on a small number, the research design and screening instrument used were internationally comparable. According to Dr. Rajkumar, the prevalence of AD among the community may be even higher than what his study had estimated conservatively because of the following factors: (a) family members may consider the memory disturbance and the associated behavioural problems as a part of normal ageing; (b) there is no confirmatory test to diagnose AD; (c) associated illness like depression may mask it; and (d) early death of these patients due to co-morbid illnesses.
The victims of Alzheimer’s Disease are both the patient and the caregiver. Caregiving to an AD patient affects an individual in many ways. The care of a family member with AD demands a range of skills, patience, good health and mental ability to cope with continued stress. Services for those with AD include support groups, day care centres, nursing home care and respite care programmes designed specially to help those with a dementing illness. Family members need information about the nature of AD and how their daily lives could change. In the United States, it has been estimated that the total disease-related costs of all AD families (excluding loss of productivity) will be a staggering amount of $750 billion by 2030.
The medical community called Alzheimer’s Disease as the disease of the 20th century. But the disease was almost unknown among the general public. In the past, a doctor, often unsure of the nature of the disease, would label the patient “senile”, which merely means “old”. Because of the stigma attached to mental illness, even well-placed families may prefer not to get the disease properly diagnosed. Jerome Stone, former president of the Alzheimer’s Disease and Related Disorders Association (ADRDA) of the United States, termed the disease “a silent epidemic”. It is silent no longer. Even more than 100 years after Alzheimer presented the dreadful disease, there is no real remedy for AD, which is a progressive degenerative disease leading ultimately to death.
“I am now beginning a journey into the twilight of my life”, wrote former President of the United States, Ronald Reagan, in a letter addressed to the American people in 1995. He was then 84 and suffering from Alzheimer’s Disease. In the popular Malayalam film “Thanmatra”, Mohanlal, one of the greatest actors of the country, lives the role of an Alzheimer’s patient. Ramesan, an honest government official, a caring husband, a nurturing parent, and a popular person in the community, becomes a victim of pre-senile Alzheimer’s Disease. From a cheerful and active person, Ramesan slowly loses all his faculties and drifts into death. “Thanmatra” is a classic creation of filmmaker Blessy which portrays the degeneration of an Alzheimer’s Disease patient and the stresses faced by the family. The film has created some awareness among the public, which needs to be sustained, widened and spread all over the country.
Alois Alzheimer did not get any recognition for his discovery during his lifetime. Instead, his contribution was ignored. But, today, millions of families of the victims of AD all over the world would pay tributes to Alois Alzheimer for identifying the devastating disease.
Dr. T.K.Nair is a Gerontologist and
is Chairman of the Centre for
the Welfare of the Aged. Watch out for:
The symptoms of Alzheimer’s Disease are a gradual decline in many areas of intellectual abilities and an accompanying physical decline. Early in the illness, only memory may be noticeably impaired. The person may have difficulty learning new skills or difficulty with tasks that require abstract reasoning or calculation. The person may have trouble on the job. The personality of the person may change. Later, impairment in both language and motor abilities is seen. At first the person will be unable to find the right word for things or will use the wrong word, but the person will gradually become unable to express himself or herself. The person will also have increasing trouble understanding explanations. The person may give up reading or stop watching television. The person may have increasing difficulty doing tasks that were once easy for him or her. The person may walk with a stoop or become clumsy. The person may get lost easily. Families often do not notice the beginnings of language and motor problems, but, as the disease progresses, all of these symptoms will become apparent. Late in the illness, the person becomes severely impaired, incontinent, and unable to walk or may fall frequently. The person may be unable to say more than one or two words, and may recognise no one or only one or two people. The person will be physically disabled as well as intellectually impaired.
6 months ago