Would you know if you were developing Alzheimer’s disease?
In order to know if you or someone you know is at risk, you’ll need to know how Alzheimer’s Disease is defined, and how it differs from normal age-related forgetfulness.
The symptoms of dementia – the umbrella term for progressive brain diseases that result in cognitive decline – are caused by a loss of connectivity between cells in the brain.
In Alzheimer’s – the most common type of dementia, accounting for up to 70% of all global dementia cases – this usually occurs first in an area of the brain known as the hippocampus, where new memories are formed, leading to classic signs such as forgetting new names or recent events.
In normal ageing, memory lapses are mild, don’t disrupt everyday tasks and, most importantly, don’t progress significantly.
While there are no local stats, reports from Australia say that over 25 000 people under 65 are living with dementia; in the UK, the figure is 40 000, and it’s over 200 000 in the US.
Women are also slightly more at risk, says geriatrician Dr Trisha Macnair, although it could be because we live longer, and the risk increases the older we get, especially over 80.
What’s certain is many of us fear it. So what’s the difference between the usual age-related forgetfulness, and the early signs of Alzheimer’s?
Alzheimer’s disease symptoms
Problems associated with dementia include:
- Planning and organising
- Struggling to find the right word
- Concerns about judging distances and seeing objects properly (when you don’t have poor eyesight)
- General confusion about the day or month, or where you are.
David Bell, a nurse specialising in dementia, says, “It might be a general deterioration in mental function: you might be gardening and not recognise what a trowel is, or you might lose the ability to stay in a conversation.”
Signs of Alzheimer’s include:
- Unusual levels of frustration or anger
- Social withdrawal
- New feelings of depression
Often relatives will link an event – such as a fall – to the onset of Alzheimer’s. But the disease may have been quietly brewing; suddenly a fall or an illness adds too much extra pressure, and the mental confusion becomes obvious.
Rule out other causes, as older people are more susceptible to infections that can affect mental health, causing sudden, temporary confusion (delirium).
Getting a diagnosis
See your GP and say why you are worried. It may be your own memory changes, or you may be concerned about a relative who is neglecting themselves – not washing, not paying bills, leaving food around, leaving their home filthy, or perhaps they’ve been found wandering. Your GP will check for infections, and nutritional deficiencies such as anaemia that can also lead to mental fogginess.
Next may be a cognitive screen that includes blood tests and a brain scan, which may rule out tumours or small bleeds in the brain; and this is often followed by a specially-designed questionnaire, the Mini Mental State Examination (MMSE), which helps to assess mental sharpness.
Your GP may also refer you to an organisation such as Alzheimer’s South Africa, which works in collaboration with a number of doctors and therapists (from occupational therapists to social workers) to come up with a care plan for the patient, and offer support to carers and families.
In some cases, patients are diagnosed in hospital after being admitted for a different problem, such as a kidney infection or a broken bone, says Dr Macnair. “Often, it’s a diagnosis of exclusion,’’ she says, “as the only way to see the changes in the brain is still postmortem.’’
Depending on the stage of the disease (as earlier stages are more difficult to diagnose), patients may be diagnosed in two to three weeks, but in complex cases, where other physical illnesses are involved, final confirmation can take a month or so.
How is Alzheimer’s disease treated?
There are two main types of medication: cholinesterase inhibitors (such as Aricept) and NMDA receptor antagonists (such as Ebixa). Inhibitors, which are usually prescribed for mild- to moderate cases, improve the communication between neurons (brain cells), which may help stabilise the symptoms of dementia.
Further research is looking into whether inhibitors could be useful for patients with more advanced and severe types of Alzheimer’s.
Drugs like Ebixa are often prescribed for moderate- to severe cases, and are more protective, shielding healthy neurons from the effects of a chemical called glutamate, which is released when brain cells are damaged by Alzheimer’s. They can help slow down the progression of the illness, and may also help with symptoms of aggression.
Neither are a cure, and many medical aids don’t cover Alzheimer’s medication. These drugs don’t work for everyone, says Dr Macnair, with some patients finding the side effects make them feel worse.
Caring for those with Alzheimer’s
If you or a loved one end up being diagnosed with Alzheimer’s, it’s important to accept the diagnosis as soon as possible, so you can plan for the future, and be organised.
“If someone close to you is diagnosed, try not to talk down to them,” says David Bell. “They may not remember what you say, but they often recall tone or emotion. Rephrase language to make it easy to understand. And use eye contact.”