Alzheimer: Dr. Rahul Chakor

Alzheimer: Dr. Rahul Chakor
Pyschological Problems

Alzheimer

In a recent interview with Dr. Rahul Chakor – A Neurologist from Mumbai, few facts about Alzheimer are listed below.  Symptoms of Alzheimer?

The main symptoms of AD are progressive memory loss/forgetfulness that impairs day to day functioning of the person. He/she is not able to work as efficiently as before. There is decline in other higher mental functions/cognition. Like decision making, planning, judgement, finding ones way in unfamiliar or familiar surroundings. Difficulty in reading / writing. Inability to recognise people, getting the right word. Change in personality like becoming uninterested or getting irritable.

These symptoms may be mistaken initially as normal ageing but continue to worsen and the patient is not able to take care of him/her self in the late stage of AD.

Causes of Alzheimer?

There is no one cause for AD. Ageing itself is a risk factor. Genetic mutations have been identified as causes. Other risk factors are repeated head injury, down syndrome, late life depression, sedentary lifestyle, lack of exercise, cholesterol etc.

It is believed that a combination of these factors are responsible and the changes in brain leading to AD develop over many years before clinical AD develops.

Scientists are working to find out a biological marker to make an early diagnosis of AD.

Preventive Measures

There is no sure way to prevent AD.

1- A healthy lifestyle
2- Good Exercise Cardio etc.
3- Omega three fatty acids in diet
4- Remain mentally engaged.
5- Eating brain healthy foods like nuts, coloured vegetables, crucuferous fruits, fish, green leafy vegetables, turmeric etc
6- Regular exercise is associated with reduced memory and thinking problems.

Treatment options?

There is no cure for AD. Slowing disease progression is what scientists aim. Memory can be improved with medications like donepezil rivastigmine which work in early stage to some extent. Other drug is memantine.

Behaviour control with medictaions. Memory aids in the early stage.

A care giver is necessary as AD progresses. Support and eduction for family and caregiver in order to be able to cope with a progressive neurological disease.

Any hope that Alzheimer will be curable one day? Is research on the condition currently making progress?

Researchers are working in this direction. Gene therapy, stem cell therapy offer hopes for a breakthrough. But may take a long time.

Can the development of the disease be slowed down following diagnosis?

Not really

Are there any organisations or community services that can help?

ADRSI is one of the society which helps people with AD

Is there anything that we can change at home to make things easier or safer?

They require a caregiver and people who understand their problem regarding forgetfulness and the progressive nature of the disease.

If a member of a family has Alzheimer's disease, are others at increased risk for developing it?

Not necessarily. Unless it is Inherited AD, that it runs in family.

What are the stages in the development of Alzheimer's disease?

1- Normal ageing forgetfullness and progressive forgetfullness.
2- Mild cognitive decline
3- MIld AD
4- Moderate AD
5- Moderately severe AD
6- Severe AD

STAGES OF AD Elaborated

Stage 1: Normal

Stage 2: Normal aged forgetfulness

– Subjective complaints of cognitive and/or functional difficulties.
– Difficulties in concentration and in finding the correct word when speaking, at least half of those over age 65 say that they are more forgetful than they were when they were younger, experiencing “senior moments” about things like where they put things or recalling somebody's name.
– We now know the early warning signs of Alzheimer’s disease can begin some 15 years before symptoms of mild cognitive impairment, or long before the beginning signs of a dementia surface
– Seniors with subjective memory complaints are, over many years, 4.5 times more likely to develop mild cognitive impairment or dementia than those who do not have such memory complaints.
– Someone with early dementia, though, might repeatedly forget names or plans, and forget all about the incident soon afterwards
– Forgetting social engagements at an increasing rate, or that you repeat questions often
– While most people who are forgetful don't have dementia, Medical and mental health conditions, like depression or a deficiency in vitamin B12, can also make someone forgetful. These conditions are treatable and reversible

Stage 3: Mild cognitive impairment

– Manifest deficits which are subtle
– Noticeably repeat queries.
– Executive functions also becomes compromised
– Job performance may decline
– A substantial proportion of these persons will not decline, even when followed over the course of many years. However, in a majority of persons with stage 3 symptoms, overt decline will occur, and clear symptoms of dementia will become manifest over intervals of approximately 2 to 4 years
– In persons who are not called upon to perform complex occupational and/or social tasks, symptoms in this stage may not become evident to family members or friends of the MCI patient.

Stage 4: Mild Alzheimer's disease (duration -2 yrs)

– A decreased ability to manage instrumental (complex) activities of daily life. Examples of common deficits include decreased ability to manage finances (amount, date on check), to prepare meals for guests, and to market for oneself and one's family
– Recent visit to a relative, may, or may not, be recalled
– Day of the week, month or season of the year
– Can still potentially survive independently in community settings

Stage 5: Moderate Alzheimer's disease (duration – 1.5 yrs)

– Independent community survival not possible
– Impaired ability to choose proper clothing to wear
– Cannot recall such major events and aspects of their current lives as the name of the current prime minister, correct current address
– Characteristically, some of these important aspects of current life are recalled, but not others. Also, the information is loosely held, so, for example, the patient may recall their correct address on certain occasions, but not others.
– Difficulty counting backward from 20 by 2s.

Stage 6: Moderately severe Alzheimer's disease ( duration 2.5 years)

– Compromised activities of daily living – bathing, brushing teeth, toileting
– Urinary incontinence
– Confuse their wife with their mother or otherwise misidentify or be uncertain of the identity of close family members
– They may, or may not, recall such basic life events as the names of their parents, their former occupation and the country in which they were born.
-Emotional changes -verbal outbursts, and threatening, or even violent, behavior
– Stuttering (verbigeration), neologisms, and/or an increased paucity of speech

Stage 7: Severe Alzheimer's disease (Six sub-stages, Each substage lasts an average of 1-1.5 years.)

– Require continuous assistance with basic activities of daily life for survival.
– Half dozen intelligible words or fewer
– Lose ability to ambulate independently (without assistance).Able to sit independently.
– Unable to sit up independently
– Fall over when seated unless there are arm rests to hold the patient up in the chair
– Become immobile co the extent that they require support to sit up without falling. Lose the ability to hold up their head independently.
-Rigidity, contractures. 

For more details on Alzheimer, contact:

Dr. Rahul Chakor

Dr. Rahul Chakor

Dr Rahul Chakor
MD, DM
Assoc Prof
Incharge of Neurology
T. N. Medical College
B. Y. L. Nair Hospital
Consultant Neurologist & Epileptologist
Prince Aly Khan Hospital
Mumbai
Email: drchakorrt@yahoo.co.in
Website : http://www.drrahulchakor.com

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