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Posted at: Sep 21, 2019, 2:23 AM; last updated: Sep 25, 2019, 1:57 PM (IST)

When mind slows down

As India’s population ages, nearly 2.7 million people will be affected by Alzheimer’s by 2030
When mind slows down

Dr Atul Prasad

Alzheimer’s disease is an irreversible, progressive brain disorder and starts with minor cognitive problems. It mainly affects elderly above the age of 60. Symptoms usually appear in their mid-60s. 

However, Alzheimer’s can occur even at earlier age as well, though it is rare. Called early-onset Alzheimer’s, it can affect a person between his thirties to mid-sixties.

According to the India Ageing Report 2017, among chronic diseases, prevalence of Alzheimer’s in India was 1.4 per cent in 2011. It is expected to affect nearly 2 million elders by 2030. The report projects that by 2030, nearly 2.7 million people will be affected by the disease. Over 4.6 million people are expected to suffer due to this by 2050.

Early signs

Alzheimer’s is a progressive disease; it moves from one part of the brain to another in a fairly predictable pattern. Memory problems are one of the first signs of Alzheimer’s, though initial symptoms may vary from person to person. Mild cognitive impairment (MCI) is a condition that can be an early sign of Alzheimer’s, but not everyone with MCI will develop the disease. 

Alzheimer’s disease starts in the hippocampus, deep within and part of the temporal lobe of the brain. The hippocampus is the structure accountable for creating new memories from our experiences. A decline in other aspects of thinking, such as finding the right words, forgetfulness, loss of insight, and impaired judgment, mood and behaviour changes, apathy and depression may also signal the very early signs of Alzheimer’s disease.

Various stages

From the hippocampus the disease moves outward into the cerebral cortex, the outer layer of the brain, beginning in the temporal lobes. The temporal lobes, along with the prefrontal cortex, play an important role in processing sounds and language comprehension 

From the pre-frontal cortex Alzheimer’s disease spreads toward the back of the brain, into the parietal, then the occipital lobes

The early stage of Alzheimer’s may start within 20 years or more before diagnosis. During this stage plaques and tangles begin to form in parts of the brain. 

As Alzheimer’s reaches to moderate stages, more damage occurs. The plaques and tangles develop in areas of the brain which is vital to memory, thinking and planning, and areas that affect speech. Often, Alzheimer’s is diagnosed at this stage.

Mild to moderate Alzheimer’s stages can last from two to 10 years. The affected person may also experience a lot of change in his/her personality and behaviour.

The most rigorous stage of Alzheimer’s can last from one to five years. During this stage most of the brain’s outer layer has been permanently damaged. Widespread cell death causes the brain to shrink. This severely affects thinking, memory, movement and other functions.

Causes

Specific genetic changes that are present in at least 5 per cent of cases lead to the development of the disease. 

- Family history is a risk factor for developing Alzheimer’s. 

- Head injury.

- Sleep apnea.

- Blood pressure, diabetes and modern lifestyle may increase the chances of getting this disease. 

Treatment

Alzheimer’s disease is incurable. However, some medicines can help in relieving the symptoms. It can only be controlled by regular screening and symptomatic treatment in the early stages of the disease.  

— The writer is director and head, neurology department, BLK Super Speciality Hospital, New Delhi.

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Symptoms

Loss of memory: It becomes common to forget names, misplacing things, forgetting plans.

Loss of reality: The affected person may not be able to judge physical surroundings, season or time. For example, if it is summer, he/she may wear a sweater or forget whether it is day or night, whether the patient has eaten or not.

Lack of reasoning ability: An Alzheimer's patient  may find it difficult to recognise letters and numbers or calculate. 

Trouble in speaking: The affected person may not be able to speak properly, or understand words or written letters.

Behaviour modification: Mood swings; needless anger.

Confusion: Being confused about people or things. For example, believing that a dead person is alive.

State of insanity: Hysteria increases due to excessive anxiety and fear. Patients become emotional, suspicious, irritable, introverted, depressed, stubborn, jealous, selfish, reclusive, bitter, etc.

Myths and Facts

Myth: Alzheimer’s patients are aggressive

Fact: They only get aggressive when they are in severe pain. Therefore, it’s important to seek medical help immediately. 

Myth: Alzheimer’s can be cured. 

Fact: There is no permanent cure. Regular screening and treatment in early stages can help in managing the disease. A balanced and healthy diet, especially a diet rich in antioxidants, helps in controlling the progression of the disease.  

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