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The twilight years

Tuesday, September 18, 2018

Older people fear Alzheimer’s more than any other disease. Ronita Torcato explains why

First, some grim stats. Every three seconds, there is one new case of dementia in the world making the disease a global health crisis.

Current estimates put worldwide figures at 46 million people, of which 60% to 80% suffer from dementia’s most dreaded form, Alzheimer’s. Thirty years from now, the number of people affected will increase to 130 million plus. By 2050, developing countries will account for 71% of the global prevalence. In India, more than four million people have some form of dementia.

Memories, good memories, can provide solace in old age but Alzheimer's disease denies these simple joys to its victims.

Discovered  by a German psychiatrist,  Alois  Alzheimer, after whom it is named,  the disease causes memory loss and cognitive impairment. Slowly and insidiously, it destroys the brain cells of victims, and their ability to read and write, to think, reason and remember. Even remember who they are!

Futile to exhort them, like the poet Dylan Thomas urged his aged father to,  “not go gentle into that good night, (but) rage,rage against the dying of the light.”

For, Alzheimer's is incurable: in the process of ravaging the mind and memory, it destroys the ability to perform the simplest  of tasks. Victims  get disoriented and lose their bearings completely. Should the unattended wander away, chances are they will get lost and never be found. Which is why 24×7  caregivers   are an integral part of  health facilities like the Dr A Dias Nursing Home in Bandra where they tend to patients with Alzheimer's. Patient who are bewildered. Confused. Moody. Incoherent. Childlike.

Scientists say Alzheimer’s disease is caused by cell death and tissue loss on account of the abnormal build-up of plaques and tangled protein in the brain. Various studies have linked low levels of formal education with an increased risk of Alzheimer’s. But truth is stranger than fiction; so it will forever remain a mystery why it consumes people of deep and vast intellect. I have personally known quite a few.

Alzheimer’s disease is (only)  the seventh-leading cause of death across all ages according to the World Health Organization but older people dread dementia even more than cancer,  as university surveys have found.

But do we need surveys from the groves of academia to tell us which disease to fear most?  Imagine not knowing where you are, who you are, the way you were. Imagine forgetting speech and language, which sets us apart from beasts.

The idea of language as a marker for Alzheimer’s gained momentum after German and British university researchers analysed writing samples from the Anglo-Irish  novelist Dame Iris Murdoch and mystery writer Agatha Christie (who was not formally diagnosed as an Alzheimer’s victim.) Funded by the European Union's Horizon 2020 research and innovation programme, and the Swedish Brain Foundation, the  findings of  researchers from the Karolinska  Institute, Sweden,   Cambridge University, England, the Ludwig Maximilian University and the Centre for NeuroDegenerative Diseases, both in Germany, were published in the British Medical Journal.

Unlike lifestyle diseases like AIDS, dementia does not discriminate. An estimated 5.7 million Americans have Alzheimer's. The UK’s ex Prime Minister, Margaret Thatcher was felled by Alzheimer’s; Murdoch’s debilitation  has been poignantly depicted in the movie Iris  starring Kate Winslet and Judi Dench. US ex-President Ronald Reagan suffered from Alzheimer's for 10 years; his wife Nancy was an ardent supporter of the controversial embryonic stem cell research, which she believed might some day lead to a cure for the  disease. (Ethicists and the  Vatican disapprove because it involves the destruction of human embryos.)

Doctors suggest reading books and continuous mental stimulation through word games like Scrabble, crossword puzzles, painting, learning music or a foreign language as well as  dietary interventions (consuming turmeric, fruits and veggies, avoiding trans fats and reducing  sugar and  alcohol intake), physical exercise and sleeping well can help in the treatment of Alzheimer's.

The Alzheimer’s Research and Prevention Foundation states that regular physical exercise can reduce the risk of  Alzheimer’s disease by up to 50%.

Doctors also say it is important to protect the head and thereby the  brain by wearing proper headgear. Repeated blows to the head during boxing bouts resulted in Mohammed Ali (the former Cassius Clay)  developing Parkinsons, another form of dementia.

What must we do to prevent Alzheimer's?

Easier said than done, try to win over ignorant spouses and disapproving family members to make new friends and develop new hobbies,  even get on the social media bandwagon via Twitter and Facebook. Crucial too, to remain or try to be stress- free. For, stress adversely impacts both brain and body. (Sadly, India is high up in the list of suicides by married women)

Last and very important, stay alert for tell-tale symptoms like memory loss and then,  consult a doctor.

Interestingly, more women are care-givers and more women are affected by dementia than men. Worse, the symptoms women live with are more severe. Merciful God, may we remember those who cannot.

The global action plan

Risk factors include  being older than 65, a family history of the disease, Down's syndrome,  previous head trauma, isolation or  poor engagement with people for extended periods.

WHO’s Global Action Plan on Dementia mandates all governments to come up with a country plan  by 2025.  India is also included in the Global Dementia Observatory study, a knowledge exchange platform developed by WHO.

As we go to press, the Alzheimer’s and Related Disorders Society of India (ARDSI) is holding an international symposium  and its  22nd national conference in  Bengaluru.

Set up in 1992 as an advocacy group, ARDSI is part of an international research project called STRiDE to assess the socio economic burden of care in seven low and middle income countries. This is a four-year project, initiated by the London School of Economics and Political Science (LSE), Alzheimer’s Disease International (ADI) and Dementia Alliance International (DIA), for building research capability  to address the needs of persons with dementia and  find new ways to treat the disease.

World Alzheimer’s day

September 2018 marks the 7th edition of World Alzheimer's Month, an international campaign conducted every September by Alzheimer's Disease International (ADI)  a federation of Alzheimer's associations worldwide, to raise awareness about dementia and its most extreme form.

The campaign was launched in 2012 to spotlight the fact that Alzheimer's has serious implications for the global community as well as governments about aging citizenry.

World Alzheimer's Day is observed on September 21 each year, marking the pinnacle of the month.It was launched at ADI's Edinburgh Conference  on  September 21, 1994, on the occasion of ADI's 10th anniversary. Ever since, ADI and affiliates worldwide including our very own Alzheimer's and   Related Disorders Society of India  (ARDSI ) have rendered yeoman service in the cause.

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