(Source: The
Sunday Star, 28 September 2014, contributed by Geriatricians, Dr Rizah Mazzuin
Razali & Dr Alan Pok Wen Kin of Hospital Kuala Lumpur in conjunction with Alzheimer’s
Disease Foundation Malaysia’s Royal Charity Concert “Konsert Amal DiRaja - Forget Me Not” to be held on 5 December 2014 at the Plenary
Hall, KLCC, in celebration of the 69th Birthday of his Royal Highness The
Sultan of Selangor, DYMM Sultan Sharafuddin Idris Shah Al-Haj, to raise funds for
the building of a Dementia Training and Care Centre in Section One, Petaling
Jaya.
The 72-piece Orchestra to be led by Malaysian Conductor, Eugene Pook will feature the renowned Shanghai Symphony Orchestra, with
special guest stars, multiple award winning singer-songwriter Najwa Mahiaddin and prize-winning
violinist, Huang Bin. For event enquiries,
please call ADFM at 03-7956 2008/7958 3008 or email office.adfm@gmail.com. For ticketing enquiries, call TicketCharge at 03-9222 8811 or visit www.ticketcharge.com.my)
Alzheimer’s disease is a progressive degenerative
disease of the brain which causes gradual depletion of brain cells and
resultant loss of mental capability.
The personality and behavioural
changes of loved ones who suffer Alzheimer’s disease are often incomprehensible
to family members, oftentimes leading to conflicts and dilemmas.
Aloysius Alzheimer, a German
neuro-pathologist, first described this illness in 1907 in Auguste Deter, a
51-year-old lady who had been experiencing memory, language, as well as
psychological problems like hallucination and disorientation.
After she passed away, the
postmortem of her brain showed presence of abnormal protein deposits that have
now become synonymous with Alzheimer’s disease.
These abnormal proteins result in
loss of connection between nerve cells, or neurons, in the brain, and
eventually, lead to the death of these cells.
Anatomically, the hippocampus is
one of many areas in the brain that play a big role in encoding new memories,
and it is one of the first regions of the brain to suffer damage in
Alzheimer’s.
Generally, there are three types
of Alzheimer’s disease: young-onset that occurs at age 60 years or younger,
which is fortunately rare; late-onset, which is the most common type occurring
at age 60 and above; and familial Alzheimer’s disease, entirely inherited and
occurs at a much younger age, often in the 40s.
The worldwide prevalence of
dementia is estimated to be around 30 million people, with 4.6 million affected
annually.
The forecasted rate of increase
is estimated to be more than 300% in India, China, South Asia and the Western
Pacific, including Malaysia, where the prevalence of the elderly with Alzheimer’s
disease is likely to exponentially increase with the increasing ageing of the
population, resulting in substantial financial and social impact on our
society.
Alzheimer’s disease is a
progressive degenerative disease of the brain, which causes gradual depletion
of brain cells and resultant loss of mental capability.
The most prominent feature of
this disease is short-term memory loss.
Events from long ago are
remembered well, but those that have occurred recently are recalled with
difficulty.
Those with Alzheimer’s may
constantly repeat themselves, and forget things that transpired just moments
ago.
They may also frequently misplace
belongings such as their glasses, keys and money.
Other symptoms include problems
with language, which may present as difficulty in finding the right word for
everyday objects; being unable to recognize familiar faces or items; losing the
ability to use familiar tools and objects; and having trouble performing
complex tasks such as driving and banking.
These features may begin very
subtly at first, but become more obvious as the disease progresses.
As people with Alzheimer’s
deteriorate, they will find it more and more challenging to manage their
day-to-day lives.
They will first lose skills that
have been acquired over their lifetime, such as managing finances, cooking
meals or using a phone.
At more advanced stages,
relatively simple activities such as bathing, dressing and toileting, will be
impaired.
The rate of progression of
Alzheimer’s disease varies from person to person.
However, there is a persistent
and inexorable decline from minimal deficit to complete dependence, at which
time the person will lose the ability to walk, speak and control their bladder
and bowels.
Death occurs at the end, usually
from infections such as pneumonia.
The time a person with
Alzheimer’s has from symptom onset to death, is between five and 15 years
(average eight to 10 years).
A person with Alzheimer’s may
also present with behavioural changes and psychiatric manifestations.
The person’s mood may be
affected, with the person experiencing depression, anxiety or apathy, or he may
develop psychosis, with hallucinations and delusional thoughts.
Some people become disinhibited
or aggressive, and others may exhibit purposeless repetitive behaviour, such as
constantly fidgeting or wandering aimlessly at night.
Generally, disturbing conduct
becomes more common in moderately severe disease.
The enormous physical,
psychological and financial impact on the caregivers, however, are not often
understood by friends and relatives.
Caregivers may not know how to
get help or are sometimes embarrassed by these bizarre behaviours of their
loved ones.
Too often, they try to handle
such difficult situations on their own, and this usually results in more
frustration and guilt.
Often, caregivers have to quit
their jobs to give fulltime care to this highly demanding person with
Alzheimer’s, and as a result, suffer significant loss of income.
The situation may disrupt their
future plans and create much conflict within them.
Alzheimer’s disease is not
curable, but there are ways to help caregivers cope and manage a person with
this illness.
Caregivers need to have a sound
understanding of this disease to enhance optimal care, and with pharmacological
and non-pharmacological methods, the outcome of care is more likely to be
successful.
There are a few drugs that can be
used to improve cognition, function and behaviour, but these drugs do not
change the course of the illness and may not be effective for everyone.
Non-pharmacological treatment
should be considered in all patients with Alzheimer’s, and it has to be
tailored to the individual to achieve a balance, as excessive stimulation or over-activity
may be counterproductive.
Examples of non-pharmacological
therapy include making changes to the environment by moderating noise and other
levels of stimulation, using signage, easier access to toilets, well-lit
surroundings, improving time orientation by using a prominent calendar/clock,
and recreational activities that may enhance quality of life such as exercise,
gardening, music, art, pet therapy etc.
Avoiding confrontations and using
distraction techniques are useful in preventing anger outbursts that usually
end with more agitation and irritabilities.
Using simple words rather than
multi-layered sentences help the patient understand instructions, and thus,
help them perform their tasks more efficiently.
Knowing the diagnosis earlier means
supporting people earlier, and timely and useful information, advice or
assistance from either a healthcare professional or support group such as
Alzheimer’s Disease Foundation Malaysia (ADFM) can help both the person and
caregiver cope better as the disease advances.
Prompt diagnosis allows for
future planning.
Early strategizing gives time to
work through complex legal, financial and personal matters such as making a
will, sorting out property issues and making changes to living arrangements.
Being diagnosed early also
enables people with Alzheimer’s to be actively involved in discussions about
their future while they still retain their mental capacity, particularly
regarding treatment choices and end-of-life care.
This eliminates guesswork and potentially
avoids future conflict among caregivers.
Therefore, a timely diagnosis
allows a person with Alzheimer’s disease and the caregiver to have the best
quality of life possible.
The goal is for the person to
live a good life and stay independent for as long as possible despite having
Alzheimer’s disease, as life does not stop with the diagnosis.
