World Alzheimer’s Day 2023: What you need to know about the neurological condition and here’s how you can help

There is more emphasis being placed on one's health and fitness now more than ever before, and this has probably been triggered because of the Covid-19 pandemic and its effects over the last three years.

With people across all age groups facing various illnesses, taking one's health for granted is no longer an option. Alzheimer's disease, particularly affecting the elderly, is among the concerns that demand attention.

Every year, World Alzheimer's Day is observed on September 21 to raise awareness and challenge the stigma about the neurological disease, which Dr Annu Aggarwal, consultant neurology, Specialist Cognitive and Behavioural Neurology, Kokilaben Dhirubhai Ambani Hospital Mumbai, says accounts for around 60 per cent of all cases of dementia. Simply, she explains, "Alzheimer's disease is a progressive neurodegenerative disorder that affects memory, thinking, and behaviour." While the cause for the disease is still not entirely known, and there is currently no cure for it, there is a need to raise awareness about the disease that affects 1 in 8 people aged 65 and older.

Mid-day.com spoke to Aggarwal and Dr Pradyumna Oak, director, Neurology and Stroke Unit, Nanavati Max Super Speciality Hospital, who shed light on the symptoms, effects and challenges. The Mumbai specialists also share the common misconceptions, how people around those with Alzheimer's disease can help them in daily life, and the need for awareness locally to help the patients better.

What is Alzheimer's disease and how do people get it?

Aggarwal: Alzheimer's disease is part of a group of neurological disorders known as dementia that result in decline in cognitive abilities, such as memory, thinking, planning, language skills, and change in personality and behaviour. In normal ageing, the loss of intellectual or cognitive faculties is minimal and people can live independent and productive lives. However, in dementia, this is affected, and the result is an interference with a person's ability to work and interact socially. Alzheimer's disease accounts for around 60 per cent of cases of dementia.

Alzheimer's disease is a progressive neurodegenerative disorder that affects memory, thinking, and behaviour. It is irreversible and over time, affects the ability to carry out even simple tasks. People affected by Alzheimer have progressive and frequent memory loss. It is associated with deposition of abnormal proteins in the brain such as amyloid plaques and tau tangles, which disrupt neuron function, along with brain cell death and brain shrinkage. Research has shown a loss of connections between nerve cells in the brain that result in messages not transmitted.

While the exact cause is not entirely understood and is the subject of ongoing research, it is believed to result from a combination of genetic, environmental, and lifestyle factors.

Oak: Alzheimer's disease is a progressive neurological disorder that affects the memory, thinking, and behaviour, primarily detected in the elderly population. While the exact cause of Alzheimer's disease is yet unknown, it's believed to be caused by a combination of genetic, environmental, and lifestyle factors. We have observed a number of cases where genetic factors, along with an age-related degeneration of the brain, results in the condition.

Which age group is prone to getting Alzheimer's disease? Does it affect any particular gender more than the other?

Aggarwal: Alzheimer's usually develops in men and women over the age of 65 years, making this age group more prone to the condition. However, there's a form of the disease called early-onset Alzheimer's that can affect people in their 40s or 50s. Women are somewhat more likely to develop Alzheimer's than men.

In India, there are 4 million people currently living with dementia, of which Alzheimer's disease accounts for over 60 per cent of the cases. This means that one in eight people aged 65 and older and nearly half of people aged 85 and older will develop dementia.

Oak: Most commonly, senior citizens, above the age of 65 are the high-risk population for developing Alzheimer's. In rare cases though, we have observed that individuals between the ages of 40 and 50 can also develop early-onset Alzheimer's. As per some research conducted in India, women seem to be slightly more affected than men, but the exact cause of this, needs additional research.

What are the signs and symptoms of Alzheimer's disease?

Aggarwal: Symptoms of Alzheimer's include loss of memory, difficulty in finding the right words or understanding what people are saying, disorientation about time and place, difficulty in performing routine tasks, difficulty recognising faces and surroundings, misplacing objects, problems understanding visual or spatial cues, issues with speech or writing, problems with language, personality and mood changes.

Oak: Alzheimer's proves difficult to diagnose at initial stages due to its subtle symptoms, such as forgetfulness, difficulty in performing familiar tasks, and trouble with language, which are often cited as results of old age. However, as the disease progresses, symptoms lead to confusion, disorientation, and behavioural changes. Families of some patients have also reported noticeable changes in personality and social withdrawal as well, mostly caused by inability to address the social group as effectively as in the past.

What are the effects of Alzheimer's on the person?

Aggarwal: As the disease progresses, individuals may misplace items more frequently, show decreased judgement, might not recognise their loved ones, may struggle with effective communication, withdraw from social or work activities, and undergo changes in mood or personality. There may be mood swings, bouts of depression, and increased agitation. These may appear in different degrees and it is advisable to consult a physician on noticing any of them. Diagnosis is based on clinical evaluation, laboratory tests and specialised brain imaging.

Oak: Alzheimer's proves difficult to diagnose at initial stages due to its subtle symptoms, such as forgetfulness, difficulty in performing familiar tasks, and trouble with language, which are often cited as results of old age. However, as the disease progresses, symptoms lead to confusion, disorientation, and behavioural changes. Families of some patients have also reported noticeable changes in personality and social withdrawal as well, mostly caused by inability to address the social group as effectively as in the past.

What are the challenges that a person with Alzheimer's disease can face in daily life?

Aggarwal: In their daily life, an individual with Alzheimer's might grapple with remembering names or appointments, misplacing items frequently, difficulty in managing finances with trouble counting change or paying for a purchase, making decisions, and navigating familiar places. If going out alone, they can forget the way back and get lost. There's also the risk of social withdrawal and isolation due to fear or confusion, which can make them vulnerable to scams or accidents.

Oak: An Alzheimer's patient faces difficulties in every task of the routine life. They fail to remember recent conversations or events, manage finances, or be an effective part of any social group or situation. As the disease advances, they may struggle with physical tasks such as dressing, eating, and maintaining personal hygiene, which further increases their dependency on the family members or caregivers.

Can Alzheimer's be treated?

Aggarwal: There is no cure for Alzheimer's, but certain drugs can alleviate and slow down symptoms and help improve cognitive abilities. It can delay functional decline to an extent. Treatment is also aimed at managing the behavioural problems such as depression, agitation, and aggression. Non-drug strategies like cognitive stimulation and regular physical activity have shown promise in symptom management.

Oak: There are a number of treatments available to manage Alzheimer's disease. Though reversing the loss of brain function is impossible, with early intervention, we can manage the condition, slow down the progression and improve the quality of life. These include better memory issues and slower cognitive decline as compared to absence of treatment.

When should a person or the family consider getting expert advice for Alzheimer's?

Aggarwal: At the first signs of cognitive difficulties or memory lapses, it's imperative to seek a medical evaluation. With early detection, patients can get the maximum benefit from available treatments to maintain their independence for a longer period. Early diagnosis allows patients to participate in decisions about living options, medical treatment, financial and legal matters.

Oak: It's advisable to seek a specialised neurology opinion at the first sign of memory loss or cognitive decline. Early intervention can potentially help in managing the progression of the disease more effectively.

What are the common misconceptions about Alzheimer's?

Aggarwal: The misconceptions surrounding Alzheimer's include the belief that it is a normal part of ageing, while others think it only affects the elderly. Another common myth is that memory loss is the sole symptom, overlooking the range of cognitive and behavioural changes that accompany the disease.

Oak: Most common misconception in India, which thwarts the early intervention in patients with Alzheimer's, is that the condition is just a part of normal ageing, which is not the case. Additionally, many believe that it solely affects memory, whereas it can have a broader impact on cognitive and physical abilities.

Are there foods that can be eaten to delay the onset of Alzheimer's?

Aggarwal: There is no specific food that can guarantee prevention. However, diets rich in fruits, vegetables, whole grains, nuts, fish, and olive oil have been associated with a potentially reduced risk of developing Alzheimer's. The Mediterranean diet and the MIND diet as well as eating healthy have been associated with cognitive benefits in studies. The link between diet and Alzheimer's is still being evaluated. The possible reasons certain diets may be of benefit includes the diet affecting biological mechanisms, such as oxidative stress and inflammation, that trigger Alzheimer's, the diet working by impacting other risk factors of Alzheimer's such as diabetes, obesity and heart disease, and a relationship between gut microbes and aging-related processes that lead to Alzheimer's. However, studies are still in progress as researchers continue to seek answers.

Oak: Alzheimer's is the most common cause of dementia and a balanced diet rich in antioxidants, vitamins, and minerals, coupled with regular physical activity, can help in delaying the onset of dementia. Incorporating a diet rich in fruits, vegetables, whole grains, and lean proteins can be beneficial. However, in no scenario, the diet or non-clinical therapies should be considered as a sole therapeutic option to manage the symptoms of Alzheimer's.

How can people who have Alzheimer's deal with the disease?

Aggarwal: Staying socially active, engaging in cognitive stimulating activities such as solving puzzles, maintaining a routine, using memory aids like calendars and reminders can help patients and their families deal with the changes that come with Alzheimer's. One can also join support groups or seek counselling.

Oak: A number of factors such as structured daily routine, engaging in cognitive therapies, and staying socially connected can help in managing the disease. Most important being an adequate family and friend support network, which can improve the quality of life for Alzheimer's patients. It is also crucial to maintain a healthy lifestyle with regular medical check-ups.

How can family or friends of those with Alzheimer's help them deal with it?

Aggarwal: Family and friends can play a crucial role by showing patience and understanding along with unstinted support. Assisting with daily tasks, encouraging social interaction, and creating a predictable, safe environment is something that is invaluable. Caregivers must learn more about the disease to offer better support.

Oak: The emotional support network of family and friends plays a vital role in management of Alzheimer's, alongside clinical therapy. Acting to their emotional needs, assisting with daily tasks, and encouraging physical and cognitive activities is known to provide the much-needed moral boost to the patients. Being patient and empathetic is vital in helping them cope with the disease.

How can society and the local government body help people with Alzheimer's at the civic level?

Aggarwal: At a societal level, there is a need to create awareness about dementia and Alzheimer's among people. There must be support for community programmes and training for caregivers. There must be a focus on ensuring accessible and affordable medical care and long-term management of Alzheimer's patients. Policies should ensure that the legal rights of a patient must be protected, and the patient is taken care off as the disease progresses and the patient's condition worsens.

Oak: There is very little awareness about Alzheimer's, its causes, effects and how to seamlessly make these patients a part of a sensitive community. We can start with creating awareness about the condition at community level, include educational institutes, and establish support groups to provide resources. The government can establish specialised healthcare facilities and initiate community screening programmes for early detection and management of Alzheimer's.