Job Osazuwa
Alzheimer is a disease that robs people of their memory. It is a major type of dementia and usually referred to as old-age ailment as more than 95 per cent of the people affected by the disease are above age 65.
It is a neurological disorder in which the death of brain cells causes memory loss and cognitive decline. When Alzheimer sets in, laymen hastily conclude that such a person is undergoing a normal circle of life. Those with the belief take a step further to say the person has only succeeded in growing from infancy to adulthood and that it is time to reverse gradually through the same process to infancy, and, finally, death.
However, experts in old age psychiatry, neurology and psychology have countered and explained that it is not normal for everyone at old age to suffer Alzheimer and other forms of memory loss. They describe it as a condition that requires clinical examination and treatment, even as it could be prevented by leading a relatively stress-free life.
At first, Alzheimer patients have a hard time remembering recent events, though they might easily recall things that happened years ago. As time goes on, other symptoms can appear, including: trouble focusing; a hard time doing ordinary activities; feeling confused or frustrated, especially at night and dramatic mood swings – outbursts of anger, anxiety, and depression.
According to experts, others signs as indicators that Alzheimer has crept into your life could be feeling disoriented and getting lost easily; physical problems, such as an odd walk or poor coordination and trouble in communication.
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It is instructive to note that people with the condition might also forget their loved ones, misplace personal belongings, get lost on familiar routes and apathy. They might forget how to dress themselves, feed themselves, and use the toilet.
The disease makes brain tissue break down over time. It usually happens to people over age 65. The older the higher the chance of developing Alzheimer.
A person can live with Alzheimer’s disease for just a few years or for a few decades. It could progressively get complicated and ultimately lead to death, especially when not effectively managed. More often, however, most people are said to live with it for about nine years.
About one in eight people of 65 years above has the disease. Researches have shown that women are more likely to have the disease than men. In a health talk show recently on a national television, a neurologist based in Abuja, Dr. Gerald Onwuegbuzie, defined Alzheimer as a manifestation of dementia, the loss of mind resulting in difficulty in reasoning, taking initiative and making sound judgment.
Also contributing, Vincent Udenzi, a psychiatrist based in Birmingham, United Kingdom (UK), described the disease as progressive and usually irreversible symptoms characterised by an impairment of global mental function.
A clinical psychologist based in Abuja, Chinyereugo Udensi, agreed with other experts and said the condition was a group of symptoms that affect the human brain and the human ability to remember things and interact with people and the environment. She said some cases grow rapidly while others could be very slow in manifestation.
An expert in dementia care and consultant in old age psychiatry at the University College Hospital, Ibadan, Oyo State, Akinsola Ojagbemi, described it as a deterioration of the brain process that helps us to understand and acquire knowledge through our senses and experience throughout an individual’s lifetime.
On that ground, he said when a stroke happens and affects a strategic part of the brain that coordinates that process of acquiring knowledge, the patient could come down with memory loss.
On whether too much alcohol could be responsible for memory loss, he said: “This cause is one of the reversible factors. It is simply through long-term abstinence. However, if alcohol must cause dementia or memory loss, it has to be a long-term dependence on it, which causes damage to the liver and the brain. Actually, moderate use of alcohol is protective against dementia.”
He also spoke on the link between age and memory loss as well as its prevalence in men or women. Ojagbemi said: “I need to correct a popular misconception. The disease is not caused by aging. Aged people should not have Alzheimer or dementia. Although, for most types of dementia, the propensity to develop the signs and symptoms increases with age, there are also types of dementia that are common with people younger than 65 years. Age is simply a risk factor, not necessarily a cause.
“Because of a lot of misconceptions, patients don’t usually present early until they begin to have bewildering behaviours. We have heard of people accused of witchcraft. And when family members see their loved one behave this way that is when they come to the hospital.
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Most times, it is too late to reverse at this stage. If the person you have known and respected begins to manifest some behaviour unbecoming of him, there must be urgent medical help instead of labelling and condemning the person.
“Regarding gender, it depends on the types of dementia. Alzheimer, which is most common in Nigeria, can be found more in women. This is because women usually live longer than men. Most of the men that would have developed dementia would have died before they clocked 80 or 90.
On the other hand, vascular dementia is more common in men. If you look at the condition globally, you could say it is more common in women.”
Adeyanju said African-Americans were more predisposed to the condition because of the stress they go through, untreated high blood pressure, poor accessibility to health care, unaffordable medicare and other factors that
Nigerians were grappling with.
“Poor access to health care has caused Nigerians a lot and we are still suffering it till date,” he lamented.
On his part, Ojagbemi advised patients and family members to quickly start seeking expert’s advice when symptoms persist for six months or one year. He described the symptoms as abnormal and argued that not everyone is necessarily ill because of old age.
Also contributing to the issue, the chairman of the Gerontology Association of Nigeria (GAN), Mr. Usman Sarki, said apart from the clinical remedy, his association was looking at the social issues associated with memory loss,
especially for elderly persons.
He said the body was also into creating awareness and advocacy, where it prevails on government to render financial assistance to elderly persons, especially to those with dementia and other conditions that threaten their well-being and general standard of living.
On the state of care for people suffering memory and similar conditions as a result of old age, particularly with little or no family support, he said: “Ideally, there should be two levels of care, formal and informal. To be honest with you, it is difficult to assess the level and scope of care for these sets of persons in Nigeria because of the lack of statistics. But from the general studies we have made, the level of care is very low. It is something that needs to be scaled up.
“This group of persons had spent their youthful age in contributing to the development of Nigeria in their various capacity. As it is done in any organised system, it is expected that the government makes sufficient plans to take care of their basic needs after their retirement age.”
Sarki urged government to pay special attention to the condition of elderly persons, particularly as part of the broader framework of public policy and implementation in the ministries of health and women affairs and social development.
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Stages of Alztheimer
The progression of Alzheimer can be broken down into three main stages, which include: pre-clinical (before symptoms appear), mild cognitive impairment (when symptoms are mild) and ultimately, dementia.
Experts, however, say in old age management there are seven stages along a continuous cognitive decline, based on symptom severity. The scale ranges from a state of no impairment, through mild and moderate decline and eventually reaching a very severe decline.
Causes of Alzheimer’s disease
People who get Alzheimer’s disease are usu- ally older, but the disease isn’t a normal part of aging, experts have revealed. Scientists aren’t sure why some people get it and others don’t. Like all types of dementia, Alzheimer is caused by brain cell death. It is a neuro-degenerative disease, which means there is a progressive brain cell death that happens over time.
In a person with Alzheimer, the tissue has fewer and fewer nerve cells and connections. Autopsies have shown that the nerve tissue in the brain of a person with Alzheimer has tiny deposits, known as plaques and tangles, which build up on the tissue. The plaques are found between the dying brain cells, and they are made from a protein known as beta-amyloid.
Researchers do not fully understand why these changes occur. Several different factors are believed to be involved. Specialists have discovered that its causes seem to come from two main types of nerve damage. Your nervous system is involved in everything your body does, from regulating your breathing to controlling your muscles and sensing heat and cold.
There are three types of nerves in the body: Autonomic nerves, which control the involuntary or partially voluntary activities of your body, including heart rate, blood pressure, digestion, and temperature regulation.
Motor nerves, on the other hand, control your movements and actions by passing information from your brain and spinal cord to your muscles.
The third, sensory nerves, relay information from your skin and muscles back to your spinal cord and brain. Since nerves are essential to human activities, nerve pain and damage can seriously affect your quality of life, especially at old age.
There are more than 100 different types of nerve damage. The various types may have different symptoms and may require different types of treatment. It is estimated that over 80 million people suffer from peripheral nerve damage. This type of damage becomes increasingly common with age. Up to 70 per cent of people with diabetes
have some nerve damage.
Researchers aren’t sure what causes this damage or how it happens, but it could be presence of protein in blood called ApoE (apo-lipoprotein E), which the body uses to move cholesterol in the blood. There are a few types of ApoE that may be linked to a higher risk of Alzheimer.
Some scientists think it plays a role in building the plaques in the brains of people with Alzheimer’s. Whether or not ApoE partly causes Alzheimer, genes almost certainly play a role in the disease. Someone with a parent who had the disease is more likely to have it, too.
There are some evidences that people with high blood pressure and high cholesterol have a greater chance of getting Alzheimer. More rarely, head injuries may be a reason, too – the more severe they are, and the greater the risk of Alzheimer later in life.
Scientists are still studying many of these theories, but it’s clear that the biggest risks linked to Alzheimer’s disease are being older and having Alzheimer in your family.
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Unavoidable risk factors
Unavoidable risk factors for developing the condition include: aging, a family history of Alzheimer and carrying certain genes. Genes are the basic building blocks that direct almost every aspect of how you’re built and how you work. They’re the blueprint that tells your body what colour your eyes should be or if you’re likely to get some kinds of diseases. You get your genes from your parents.
They come grouped in long strands of DNA called chromosomes. Every healthy person is born with 46 chromosomes in 23 pairs. Usually, you get one chromosome in each pair from each parent.
Scientists have found evidence of a link between Alzheimer’s disease and genes on four chromosomes, labelled as 1, 14, 19, and 21. One connection lies between a genes on chromosome 19, called the APOE gene, and late-onset Alzheimer. That’s the most common form of the disease that affects people over age 65.
Several studies around the world have shown that when a person has one type of the APOE gene, called APOE4. It increases their chances of getting Alzheimer at some point in their lives. But the link isn’t completely clear-cut. Some people who have APOE4 don’t get the disease.
Diagnosis
There is no single test for Alzheimer’s disease, so doctors will look at the signs and symptoms, take a medical history, and rule out other conditions before making a diagnosis. They may also check the person’s neurological function. For example, by testing their balance, senses, and reflexes. Other assessments may include a blood or urine test, a CT or MRI scan of the brain, and screening for depression.
Sometimes the symptoms of dementia are related to an inherited disorder such as Hunting- ton’s disease, so genetic testing may be done. After ruling out other possible conditions, the doctor will carry out cognitive and memory tests, to assess the person’s ability to think and remember.
A public health expert, Ogundele Olu said: “Early diagnosis is key to helping people and their families cope with loss of memory, navigate the health care system, and plan for their care in the future.
“It is important for people who think their daily lives are impacted by memory loss to discuss these concerns with a health care provider. An early assessment and diagnosis is key to planning for their health care needs, including
long-term services and supports, as the disease progresses.”
Treatment
There is no known cure for Alzheimer’s disease because the death of brain cells cannot be reversed. However, there are therapeutic interventions that can make it easier for people to live with the disease.
According to the American Alzheimer Association, the following are important elements of dementia care: effective management of any conditions occurring alongside the Alzheimer’s
activities and day-care programmes, as well as involvement of support groups and services.
Prevention
Some of the modifiable factors that may help prevent Alzheimer are: getting regular exercise; maintaining a healthy cardiovascular system and managing the risk of cardiovascular disease, such as diabetes, obesity, smoking and high blood pressure.
Other ways to help prevent the disease are to follow a varied and healthful diet and participating in lifelong learning and cognitive training. Some studies have also suggested that staying mentally and socially engaged might possibly reduce the risk of Alzheimer.
Health specialists have warned that the risk could be increased for people undergoing severe or repeated traumatic brain injuries. There could also the risk for people who are exposed to some environmental contaminants, such as toxic metals, pesticide, and industrial chemicals.
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Alzheimer rate to increase in near future
According to an American health magazine, HealthDay News, published on September 20, 2018, a new study projects that by 2060, almost 14 million Americans will suffer from Alzheimer’s disease, a number that’s nearly three times as high as today.
The study shows that as the world population increases, the number of people affected by the
disease and related dementias will rise. Stakeholders in Centers for Disease Control and Prevention (CDCP) have called increased in proactive measures to curb the disease. They urged caregivers to increase the level of care given to loved ones and others with memory loss. The experts emphasised the need of spot- ting the disease early even more important in tackling the disease.
The agency report noted that five million Americans, comprising 1.6 per cent of the population, had Alzheimer’s disease in 2014. Currently, Alzheimer’s disease is the fifth leading cause of death for Americans age 65 and above. The new report finds that white Americans will continue to be the majority of Alzheimer’s cases, simply due to their sheer numbers.
By 2060, the CDC researchers estimated that 3.2 million Hispanics and 2.2 million black Americans would be afflicted with Alzheimer or a related dementia. One reason for the increase in U.S. Alzheimer’s cases could be inroads made against other diseases of aging.
As people are able to live longer with chronic illnesses, such as heart disease or diabetes, their tendency for developing a dementia in old age rises.