Human life comprises a lot of memories as every action and thought in our life is a combination of memories.
Memory is a way of holding on to the things we love.
However, those memories can slowly decline, and for some people, it may come to a stage when it becomes difficult to lead a normal life as dementia sets in.
Dementia is a general term that refers to a decline in cognitive ability severe enough to interfere with activities of daily living.
Alzheimer’s disease is the most common type of dementia, accounting for at least two-thirds of cases in those aged 65 and older.
It is a neurodegenerative disorder caused by neuronal cell death.
It is associated with loss of memory, cognitive impairments, and changes in personality and behaviour.
With the disease progressing gradually, patients find themselves more and more dependent on others – usually their immediate family members – for survival.
In 1907, German psychiatrist Dr Alois Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness.
These changes and the unusual mental illness were later named after him as Alzheimer’s disease.
Two primary forms of the disease exist: early-onset (familial) and late-onset (sporadic) types.
Early-onset Alzheimer’s is very rare and accounts for less than 5% of cases.
It is initiated by mutations in certain genes.
Late-onset Alzheimer’s is the more common type.
Several risk factors have been associated with Alzheimer’s disease, including:
- Increasing age – the most important risk factor
- Traumatic head injury
- Depression
- Cardiovascular and cerebrovascular disease
- Higher parental age
- Smoking, and
- Family history of dementia.
On the other hand, factors known to decrease the risk of Alzheimer’s disease include:
- Higher education
- Use of oestrogen by women
- Use of anti-inflammatory agents
- Leisure activities like reading or playing musical instruments
- A healthy diet, and
- Regular aerobic exercise.
Progression and symptoms
Alzheimer’s disease typically progresses in three general stages: mild (early stage), moderate (middle stage) and severe (late stage).
The first stage usually lasts two to three years, during which time the patients show short-term memory impairment, often accompanied by symptoms of anxiety and depression.
During the moderate phase, the symptoms appear to be neuropsychiatric manifestations, such as visual hallucinations, false beliefs and reversal of sleep patterns.
The severe stage includes motor signs such as motor rigidity and noticeable cognitive decline.
Alzheimer’s affects people in unique ways – the timing and level of dementia symptoms vary as each patient progresses through the stages of the disease differently.
The hippocampus – a part of the brain situated deep inside the temporal lobes – is where the disease process occurs.
This part of the brain plays an important role in the consolidation of information from short-term memory to long-term memory, and in spatial memory, which enables navigation.
Early symptoms of Alzheimer’s disease are:
The most important sign that indicates a person is affected by Alzheimer’s is memory loss.
For example, if one visits a place, and within a day or two, forgets completely about it; or if one is confused about familiar places like the house bathroom; or repeatedly forgets where the keys are kept.
Another early sign is when a person finds it difficult to make basic calculations, handling money or paying the bills.
They may also find difficulty in making decisions or in completing tasks that have several stages, such as getting dressed.
A person who is suffering from Alzheimer’s may experience unusual mood changes.
Depression is actually a very early sign of Alzheimer’s, and may, in many cases, precede it.
A previously normal person may develop difficulties with thinking of common words, or they may make more speech, spelling or writing errors.
The patient may have problems concentrating on work that they used to do well before.
A person may become less able to recognise faces or objects, or less able to use basic tools – and it is not due to problems with eyesight.
They may not be able to recognise relatives, become restless, or may make some movements repeatedly.
Sometimes, they might have hallucinations or withdraw from work and social activities.
Usually, the patient is not aware of the problem and their unusual behaviour is noticed by their family members.
If one feels something is amiss in the behaviour of their loved ones, do take them to the doctor immediately.
Prevalence and prevention
The global prevalence of dementia is estimated to be as high as 24 million, out of which about 70% is Alzheimer’s.
This number is predicted to double every 20 years through to 2040, leading to a costly burden of the disease.
The prevalence in Malaysia was estimated at 0.126% in 2020, and is expected to increase to 0.454% by 2050.
According to the Alzheimer’s Disease Foundation Malaysia, it is estimated that there are currently about 50,000 people in the country with this disease.
A study found that it takes up to 16 months for caregivers to seek medical advice from health professionals, due to their misinterpretation of dementia as a normal sign of growing old.
Knowing the early signs of Alzheimer’s allows us to be on the lookout for the first manifestations of the disease.
Some actions can be taken to promote our cognitive health.
First of all, intellectual stimulation is important: reading books, doing Sudoku, crossword or other puzzles, playing board games and social activities can improve resistance to developing cognitive disorders.
Also, a healthy lifestyle is important.
Regular physical activity, a good diet and good sleep habits are as beneficial to cognitive health as they are to physical health.
Caregiving
A person with Alzheimer’s requires huge social and family support, apart from medication and therapy, as it is an incurable, progressive condition, which will eventually result in the person not being able to care for themself.
It is crucial to raise awareness and remove stigma from dementia, especially among potential caregivers.
In order to improve the patient’s quality of life, the caregiver needs to be knowledgeable in managing them.
Caring for a person with dementia can often seem like a series of grief experiences as you watch your loved one’s memories disappear and skills erode.
The person with dementia will change and behave in different – sometimes disturbing or upsetting – ways.
For both caregivers and patients, these changes can be confusing, frustrating and sad.
Caregiving in dementia includes:
- Accepting the diagnosis
- Dealing with conflicting emotions
- Learning all you can about your loved one’s dementia
- Making use of available resources
- Asking for help
- Preparing for the road ahead, and
- Joining a support group.
By always focusing so diligently on your loved one’s needs throughout the progression of their dementia, it’s easy to fall into the trap of neglecting your own welfare.
ALSO READ: Caregivers, care for yourself too
If you’re not getting the physical and emotional support you need, you won’t be able to provide the best care.
So, do plan for your own care – talk to someone, stay active and/or practice a relaxation technique.
By doing these things, it will hopefully be a less stressful situation for both patient and caregiver.
- Tell your loved one who you are if they appear to have doubts about your identity.
- Listen attentively
Avoid distractions such as the TV or your mobile phone, and focus your attention on your loved one.
- Use distraction or avoid telling the whole truth if it upsets the person.
For example, to answer the question, “Where is my mother?”, it may be better to say, “She’s not here right now”, instead of “She died 20 years ago”.
- Use repetition as much as necessary.
Be prepared to say the same things over and over as the person can’t recall them for more than a few minutes at a time.
- Say things like: “Do you remember?”, “Try to remember!”, “Did you forget?” and “How could you not know that?!”
- Point out the person’s memory difficulty.
Avoid remarks such as “I just told you that“; instead, just repeat it again and again.
- Talk in front of the person as if they weren’t present.
Always include them in any conversation when they are physically present.
- Use lots of pronouns such as “there”, “that”, “him” and “it”.
Use nouns instead, e.g. instead of saying “Sit there”, say “Sit in the blue chair”.
Dr Vishnumukkala Thirupathirao is a lecturer in anatomy, and Associate Professor Dr Venkatesh R. Naik is the academic lead for pathology at the Perdana University Graduate School of Medicine. This article is courtesy of Perdana University, which is celebrating their 10th anniversary this year. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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