Alzheimer’s and Brain Awareness

Alzheimer’s and Brain awareness month is celebrated in the month of June with the aim of creating awareness about Alzheimer’s disease (AD) and other forms of dementia among the general population. This month Alzheimer’s associations all over the world do various activities to support the Alzheimer’s patients and their caregivers, discuss the disease with the general public and encourage people to involve in recognising the disease and the types of care required by someone suffering from it. It was initiated by President Roland Regan of the USA in 1983.

Dementia is defined as acquired deterioration in cognitive abilities that impair the activities of daily living. Memory is most commonly affected but apart from it, other cognitive domains like language, calculation, judgement, executive function, planning and visuospatial ability can also be affected. The occurrence of dementia goes back to 2000 BC among the Egyptians, before it was named, where it was described as memory disturbances in the elderly. The term was first coined by Saint Isidore, the archbishop of Seville in his book ‘Etymologies’ in 600 AD. In Latin ‘de’ meaning loss or deprivation, ‘ment’ meaning mind and ‘ia’ meaning state, so dementia means ‘loss of state of mind’. In 1906, German psychiatrist, Alios Alzheimer first described the disease in a 50-year-old lady but it was named after him by his colleague Emil Kraepelin who first use the term in his book “Psychiatrie”.

There are various causes of dementia. It can be divided into reversible or treatable causes and irreversible causes. The common reversible causes of dementia are Vitamin B1 deficiency (Wernicke’s encephalopathy), Vitamin B12 deficiency, Hypothyroidism, Liver failure, Kidney failure, Infections like HIV, Neurosyphilis, Tuberculosis, Head injury (Dementia Pugilistica, Chronic Subdural Haemorrhage), Normal pressure hydrocephalus, various brain Tumors, Vasculitis and other Connective tissue disorders, Chronic alcoholism, Exposure to heavy metals etc. Among the non-reversible causes of Alzheimer’s disease, Vascular dementia (multi-infarct state), Frontotemporal dementia are common.

Alzheimer’s disease is the commonest cause of dementia in the elderly. In a study from Southern India, it is estimated that the overall incidence rate for AD is 15.54 per 1000 person-years in those aged >65 years. The cognitive changes in AD begin with recent memory impairment and gradually spread to language and visuospatial abnormality. Few (20%) patients present with non-memory complaints like word-finding, organisational, and navigational difficulty. It can be mild (recent memory impairment, repetitive questioning, loss of interest in hobbies and surroundings, unable to name objects), moderate (decreased speech output, executive dysfunction) or severe (agitation, loss of independence, sleep disturbances). In the late stage there may be delusion, Capragas syndrome ( where the patient believes that the caregiver is replaced by an imposter), sleep- wake pattern gets disrupted, walking gets impaired, need help for walking, eating, dressing and lastly, the patient becomes rigid, mute, bedbound with incontinence of stool and urine. The commonest cause of death is malnutrition, and the secondary infection is most commonly aspiration pneumonia. The average duration of the disease is around 10 years but can range from 1 to 25 years.

Various risk factors for AD-like age, female sex, Hypertension, Diabetes and head injury are postulated but no direct correlation has been found.

The disease is diagnosed from history and clinical examination. Neuroimaging like CT or MRI Brain can help in diagnosis to some extent. FDG PET or SPECT scan can help in some cases where CT/MRI is non-conclusive. There is no role of any blood test for diagnosing AD.

The treatment of AD is challenging and the primary aim is long-term improvement in behavioural and neurological problems and caregiver support. In early-stage patients should be given memory aides like notebooks, daily reminders etc. The patient should be encouraged to solve various memory problems and puzzles. Family members and caregivers should help the patients and encourage them. There are various medicines like Donepezil, Memantine and Rivastigmine which help to slow the progression of the disease. Various medicines are also under study which can be of help. The kitchen, bathroom and stairways should be made safe. Diet rich in fruit, vegetable and fibre and maintaining proper hydration is very important. From time to time visits to the Neurologist and proper adjustment of medication dosage should be done. The family members and caregivers should have full support and sympathy for the patients.

So in this Alzheimer’s and Brain awareness month let us join hands and take the vow to support the Alzheimer’s patients so that they can lead a healthy and beautiful life.

Dr. Madhuparna Paul | Consultant – Neurologist | Narayana Multispeciality Hospital, Jessore Road, Kolkata