Alzheimer’s disease is named after Dr Alois Alzheimer, a German psychologist and neuropathologist. His assessment of a female patient with symptoms of pre-senile dementia (those under 65), along with the findings of an autopsy of her brain, led him to two neurological substances—senile plaques and neurofibrillary tangle. These two would later be recognised as markers of the disease.
Alzheimer’s is the most common type of dementia, an umbrella term for conditions that occur when the brain no longer functions properly. While there is no cure for it, symptoms can be alleviated. The average life span after symptoms first appear is eight years.
Understanding Alzheimer’s
A disease that gradually destroys brain cells. Patients eventually lose some cognitive abilities, such as memory and language. This is different from the minor effects on memory that ageing can have.
The most affected
This and other varieties of dementia become more common with age, affecting one in every 14 people over 65.
Comparison with dementia
While dementia is a broad term, Alzheimer’s is a specific condition. It first affects the area of the brain responsible for learning, so early signs may include abnormalities in memory, thinking and reasoning abilities.
What families should look out for
Early in the condition, people might find it difficult to recall recent events. Memory deteriorates over time, accompanied by other symptoms. Non-memory components such as finding the proper word, difficulty interpreting visual imagery and impaired thinking, might indicate early stages.
Symptoms and progression
Alzheimer’s typically begins slowly and worsens over time. It eventually spreads across the majority of the brain. The condition can affect memory, thinking, judgment, language, problem solving, personality and movement.
Behavioural changes
Moodiness, apathy, personality changes, unsocial behaviour and linguistic difficulties are all possible indications of the condition.
Comprehending confusion
Patients might be forgetful and struggle to keep up with conversations. They may grow agitated because of this. Noise, speech, crowds and movement can be overwhelming.
Causes
A combination of hereditary, lifestyle and environmental variables that work together to alter the brain over time. Alzheimer’s is caused by unique genetic abnormalities in less than 1 per cent of the population.
Amyloid plaques and tau (neurofibrillary) tangles
The disease is thought to be caused by an abnormal build-up of proteins in and around brain cells. One of the proteins involved is amyloid, which accumulates in plaques (clumps) around brain cells. The other protein is called tau, whose deposits form tangles within brain cells. These are visible only under a microscope during autopsy.
The risk of misdiagnosis
Vitamin B12, folate, vitamin D deficiency, thyroid problems, depression, sleep disorders, infections and drug side effects can all mimic Alzheimer’s symptoms. Proper testing is necessary to avoid misdiagnosis.
Women more at risk
They are twice as likely as men to develop Alzheimer’s because of biological or genetic variations, as well as societal conditions associated with gender, such as education level, occupation and sexism. (The last includes lower economic and social status, higher levels of stress due to greater caregiving burdens, masking of symptoms, etc.)
Disease progression in women
They have a faster cognitive decline, lose their freedom earlier and spend more time with a higher level of disability. The reasons are most likely biological and societal.
The menopause connection
According to research, fluctuating and declining oestrogen levels following menopause may predispose women to Alzheimer’s disease.
Diagnosis
There is no single test to tell if someone has Alzheimer’s. Physicians use diagnostic methods such as neurological exams, cognitive and functional assessments, brain imaging and cerebrospinal fluid or blood testing, in conjunction with medical history. Current tools detect changes years before symptoms, yet accuracy varies.
Treatment and management
Mainly involves the use of cholinesterase inhibitors (that prevent the breakdown of a specific neurotransmitter, leading to improved communication between nerve cells). These drugs may help improve cognitive ability and memory and maintain capability to carry out daily activities, but they do not stop the disease from progressing. The effectiveness of these medications is variable.
Early diagnosis and treatment make maximum impact; however, most people will need ongoing assessment and dose adjustment.
Lifestyle changes
Regular physical activity helps with blood flow to the brain and may decrease neurodegeneration. A diet rich in antioxidants, omega-3 fatty acids and low in processed food supports brain health. Cognitive stimulating activities, such as completing puzzles, reading books and learning new skills, strengthen neural connections. While lifestyle changes will not cure Alzheimer’s, they can help preserve function, postpone symptom progression when combined with medical management, and improve overall wellbeing.
Occupational therapy or social engagement in care
Occupational therapists—who help patients with daily activities—create individualised schedules and approaches to help sustain independence in daily life. Social interaction through family engagement, support groups or planned activities benefits emotional health and decreases feelings of loneliness, depression and anxiety.
New treatments and research
Focused more than just on symptom relief. Disease-modifying treatments, speci fically monoclonal antibodies directed against amyloid-beta proteins, can slow the neurodegeneration. Non-invasive brain stimulation, gene therapy and stem cell mediated repair of neural circuits are being researched. Additionally, clinical trials are examining anti-inflammatories, neuroprotective agents and personalised treatment approaches. Although this research is still largely experimental, it has the potential to change the trajectory of the disease.
Caring for loved ones
Support independence by creating recognisable routines that lessen confusion and anxiety. Dividing tasks into easy-to-follow steps alongside visual cues and gentle assistance promote independence. Supporting participation in chores, interests or self-care supports confidence. Positive redirection and patience are important, as is balancing supervision with independence.
Managing agitation
Learn the possible triggers, provide reassurance and use distraction or other activities like listening to music or walks. Creating safe spaces, minimising communication and creating regular routines can help reduce frustration and limit challenging behaviours from being exacerbated.
Difficult situations like sundowning
Minimise noise, reduce bright lighting and utilise familiar cues to alleviate confusion or sundowning (feelings Alzheimer’s patients get when the sun sets). Soothing words, familiar routines, plenty of fluids and rest help promote soothing. Avoid arguing, and let them take their time to process information to alleviate agitation and anxiety.
Home safety modifications
Ensure lighting is bright, remove items that could lead to falls and use floor mats. Install door-locking hardware, label rooms, keep medications in a safe place and place sharp objects out of reach.
The impact on relationships
People with Alzheimer’s could become more irritable and impatient, making it difficult for those around them. Caretakers of Alzheimer’s are more likely to experience worry, depression and a lower quality of life than other caretakers.
Use support systems
Adult day care services provide day-to-day help. These choices offer short-term care for a person with dementia while allowing the caregiver to take a break. Day-to-day support may include supervision, home-delivered meals and/or transportation.
The numbers in India
Around 88 lakh people over the age of 60 suffer from dementia; the prevalence is projected to double by 2050.
The rural-urban divide
A study found that the prevalence of dementia was greater in the rural elderly (30 per 1,000) than in seniors in urban areas (20 per 1,000). Lower education level, poorer income and co-morbidities such as diabetes and cerebrovascular illness were the most commonly identified risk factors.
Indian family structures
Joint family systems in India often ensure the care of the elderly with Alzheimer’s or dementia as responsibilities are divided among family members. But traditional gender roles still influence this experience. Women, especially daughters-in-law, have been taking on the lion’s share of this work, which adds to the emotional and physical burden.
Challenges in India
There is a general lack of awareness and understanding of Alzheimer's, which leads to undetected or misdiagnosed cases. This delays therapy. There is an overall stigma associated with mental health. Rural areas have limited access to health care institutions and specialised Alzheimer’s care.
Indian initiatives
The National Dementia Strategy and National Mental Health Programme seek to promote disease awareness while also improving patient treatment and access to mental health services. Memory clinics and dementia day care centres have been established in multiple locations. Furthermore, the Ayushman Bharat initiative includes financial help for Alzheimer’s patients’ treatment.