Observation of World Alzheimer's Day on 21st Sept 2014

Prof N. Heramani Singh, *

Combination of two brain diagrams in one for comparison. In the left normal brain, in the right brain of a person with Alzheimer's disease
Pix - wikipedia/Garrondo

World Alzheimer's Day, September 21st of each year, is a day on which Alzheimer's organizations around the world concentrate their efforts on raising awareness about Alzheimer's and dementia. Every 68 seconds, someone develops Alzheimer's disease. Alzheimer's disease is often called a family disease, because the chronic stress of watching a loved one slowly decline affects everyone. With the increases in life spans and baby boomers coming of age, support for Alzheimer's research is more critical to our families than ever.

What is Dementia?

Dementia is a syndrome characterised by progressive, usually irreversible, global cognitive deficits. Often memory impairment is the first symptom with progression to other deficits including dysphasia, agnosia, apraxia, impaired executive function, and personality disintegration. Alzheimer's disease (AD) is the most common form of dementia, a group of disorders that impairs mental functioning.

Many scientists believe that Alzheimer's disease results from an increase in the production or accumulation of a specific protein (beta-amyloid protein) in the brain that leads to nerve cell death. Generally, Alzheimer's disease is diagnosed in people over 65 years of age, although the less-prevalent early onset of Alzheimer's can occur much earlier. Alzheimer's is predicted to affect 1 in 85 people globally by 2050. Alzheimer's disease progress through distinct stages.

Early Symptoms:
o Changes in mood (often depression or anxiety)
o Changes in personality (especially apathy or irritability)
o Memory problems (particularly for recent events & the names of people or things)
o Word-finding difficulties
o Difficulty calculating change & managing financial affairs

Later Symptoms:
o Disorientation & obvious confusion
o Difficulty with complex tasks
> Using the computer; Programming the video recorder
> Planning a trip
> Completing a tax return
o Difficulty recognizing people & objects
o Difficulty following a conversation & making oneself understood
o Difficulty dressing & doing other everyday tasks
o Delusions, Hallucinations

Much Later Symptoms:
o Challenging behaviours
> Agitation
> Noisy behaviour
> Aggressive behaviour
o Difficulty eating & walking

Risk factors – can we reduce the risk?
Alzheimer's is a complex disease that progresses over many years, like diabetes, heart disease, and other chronic conditions.

Age is the best known risk factor for Alzheimer's disease. The risk of developing the disease doubles every 5 years after age 65. Alzheimer's becomes increasingly common as people reach their 80s, 90s, and beyond. These facts are significant because the number of older adults is growing. The more researchers learn about Alzheimer's disease, the more they realize that genes play an important role in its development. Scientists have found genetic links to both early-onset and late-onset Alzheimer's disease.

Unlike age and genetics, certain health and lifestyle factors associated with Alzheimer's disease risk may be controlled. Scientists are exploring prevention strategies to determine whether or not things like exercise, diet, and "brain games "can help delay or prevent Alzheimer's disease and age-related cognitive decline. They are also investigating how certain medical conditions, such as high cholesterol, high blood pressure, and diabetes, influence risk for cognitive impairment.

Exercise and other types of physical activity have many benefits. Studies show that they are good for our hearts, waistlines, and ability to carry out everyday activities. Epidemiological studies and some intervention studies suggest that physical exercise may also play a role in reducing risk for Alzheimer's disease and age-related cognitive decline.

A number of studies suggest that eating certain foods may help keep the brain healthy—and that others can be detrimental to cognitive health. A diet that includes lots of fruits, vegetables, and whole grains and is low in fat and added sugar can reduce the risk of many chronic diseases, including heart disease and type 2 diabetes. Researchers are looking at whether a healthy diet also can help preserve cognitive function or reduce the risk of Alzheimer's.

Studies have found, for example, that a diet rich in vegetables, especially green leafy vegetables and cruciferous vegetables like broccoli, is associated with a reduced rate of cognitive decline. One epidemiological study reported that people who ate a "Mediterranean diet" had a 28 percent lower risk of developing Mild Cognitive Impairment (MCI) and a 48 percent lower risk of progressing from MCI to Alzheimer's disease. A Mediterranean diet includes vegetables, legumes, fruits, cereals, fish, olive oil, mild to moderate amounts of alcohol, and low amounts of saturated fats, dairy products, meat, and poultry.

Age-related diseases and conditions such as vascular disease, high blood pressure, heart disease, and type 2 diabetes may increase the risk of Alzheimer's and cognitive decline. Many studies are looking at whether this risk can be reduced by preventing or controlling these diseases and conditions through medication or changes in diet and exercise. Staying cognitively active throughout life via social engagement or intellectual stimulation is associated with a lower risk of Alzheimer's disease. Several observational studies link continued cognitive health with social engagement through work, volunteering, or living with someone.

Mentally stimulating activities such as reading books and magazines, going to lectures, and playing games are also linked to keeping the mind sharp. Intellectually stimulating activities may also reduce the risk of Alzheimer's, studies show. One large observational study looked at the impact of ordinary activities like listening to the radio, reading newspapers, playing puzzle games, and visiting museums and found stimulating intellectual functions.

Scientists are studying hormones especially those taken by older women as menopausal hormone therapy for their potential ability to prevent or delay Alzheimer's disease and age-related cognitive decline. Several clinical trials are testing forms of estrogen as well as testosterone and other hormones in both healthy older adults and those with MCI. Other hormones being studied in clinical trials for their effects on Alzheimer's and cognitive decline include testosterone, which is being tested in older men with MCI and low levels of the hormone; growth hormone releasing hormone (GHRH), in healthy older adults and those with early MCI; and Dehydroepiandrosterone (DHEA), in healthy postmenopausal women. Several pharmaceutical companies are testing potential vaccines for safety and effectiveness in clinical trials.

So, What Can You Do?

Many actions lower the risk of chronic diseases and boost overall health and well-being. As we learn more about the role they may play in Alzheimer's disease risk, health experts encourage all adults to:
* exercise regularly
* eat a healthy diet rich in fruits and vegetables
* engage in social and intellectually stimulating activities
* control type 2 diabetes
* lower high blood pressure levels
* lower high blood cholesterol levels
* maintain a healthy weight
* stop smoking
* get treatment for depression

Conclusion

Dementia is a degenerative condition with no known cure. Symptoms, such as memory loss, cognitive impairment, difficulty communicating and changes in mood get worse over time. These experiences are distressing for the individual and upsetting for their loved ones. However, people living with dementia can still have a good quality of life throughout the dementia journey, provided the right long-term care plan is in place and being delivered. We believe that everyone, everywhere, can and must do their bit to help people with dementia live well throughout the dementia journey. There is enormous power and possibility in families, friends, carers, healthcare professionals, commissioners or purchasers of care, providers, society and governments working together to improve long-term care in a country.