Updated: Oct 11, 2018
Alzheimer’s is a disease of the brain affecting memory, thinking and behavior with onset usually after 65 years. Worldwide it is the commonest type of dementia and in India, an incidence of around 4.7 per 1000 persons above 65 years has been noted. As our population ages, it is expected to be on the rise in India and may assume large proportions. The disease symptoms begin gradually and progress slowly. The initial feature is forgetfulness which becomes severe enough to affect their ability to function at home or at work, or to enjoy lifelong hobbies. Other symptoms include confusion, getting lost in familiar places, misplacing things and difficulty with language. As the disease advances, dementia gets deeper and patients loose all ability to look after themselves.
Patients usually do not complain of the illness but signs are more obvious to family members and friends. Diagnosis is often made by careful history and detailed neurological examination by a neurologist or psychiatrist followed by imaging of the brain. MRI scan is the most informative scan. In India as older population is growing, the prevalence is expected to increase and emergent steps for management have to be taken for future. Three aspects of care, the patient aspects, caregiver aspects and social aspects need to be assessed. The effective management is a multidisciplinary activity involving neurologists, psychiatrists, neuropsychologists and social workers. A concerned general practitioner knowing to the family is a useful addition to this group.
Patient needs be managed in early stages using medicines for improving cognition such as Donepezil and Rivastigmine but in later stages when abnormal behavior prevails, antipsychotics become necessary. Co morbid factors as cataract, ear wax, hearing problems need to be treated on priority basis. Emphasis should be given to maintaining oral and dental hygiene, nutrition and ensuring adequate sleep at night. Leveled flooring, padded clothing, well lit rooms, toilets close to the patients bed are necessary. The Caregiver needs to understand that the cognitive or behavioral problem in their loved ones is a part of disease and need a timely counseling for the patient management. In early stages patients should be encouraged to prepare a will, authorize a power of attorney and nominate a close one as a proxy decision maker. Day care centers for moderately advanced patients will be the key for management of our fast growing population and Government and NGO’s need to join hands for the same. Extensive research going on for cure of the disease and in future might get the treatment so, let’s be hopeful…