On the eve of World Alzheimer’s Day on September 21, a look at the disease from its early signs and risk factors to its progression, complications and the importance of a healthy and supportive environment
DR R. G. WISEMAN PINTO
Alzheimer’s disease gradually destroys memory and thinking skills and eventually affects a person’s ability to carry out simple tasks. It is a major cause of dementia and the seventh leading cause of death.
September is observed as World Alzheimer’s Month, with September 21 marked as World Alzheimer’s Day. Named after Dr Alois Alzheimer from Bavaria, Germany, who studied medicine in Berlin; he was born on June 14, 1864 and died on December 19, 1915, at the age of 51.
On November 3, 1906, Dr Alzheimer described changes in the brain of a woman who had died following an unusual mental illness. The patient, Auguste D, had paranoia, sleep and memory disturbances, confusion and aggression. She died five years later. In 1910, Dr Emil Kraepelin used the term ‘Alzheimer’s disease’ in his published work.
As populations age, Alzheimer’s disease is becoming increasingly important. An ageing society has 7% elderly people, an aged society 14% and a super-aged society 21%.
There are an estimated 50 million cases of dementia worldwide, with Alzheimer’s disease accounting for 60% to 70% of cases. Early problems include forgetting recent events, repeating statements or questions, misplacing possessions, getting lost, forgetting the names of family members, difficulty with numbers and mathematics, and an inability to multitask.
Personality and behaviour may also change. Depression, apathy, social withdrawal, mood swings, aggression and irritability can occur. Sleep patterns may change, while some patients may wander or lose inhibitions. As neurons become damaged and die, the brain undergoes atrophy, affecting thinking and behaviour.
The incidence of Alzheimer’s disease increases with age. Between 60 to 74 years, there are four new cases per 1,000 people. Between 75 to 84 years, there are 32 new cases per 1,000, while among those above 85, there are 76 new cases per 1,000.
Genetic causes account for about 1% of cases. A family history involving parents or siblings is important. The apolipoprotein E gene (APOE), particularly the APOE 4 variant, is associated with the disease. Both sexes are affected, although women live longer and therefore represent a larger proportion of older populations. Other associated factors include lifestyle and environmental factors, head trauma, air pollution, poor sleep, lack of exercise, obesity, alcohol consumption, smoking, hypertension, high cholesterol and type 2 diabetes.
In the brain, senile or neuritic plaques containing beta-amyloid and neurofibrillary tangles containing tau proteins are characteristic features. Amyloid and tau proteins can be assessed in plasma and cerebrospinal fluid. Imaging techniques include MRI, CT, PET-CT, amyloid PET and tau PET.
With increasing age, changes may include generalised brain atrophy, tauopathy, hydrocephalus ex vacuo, neuronal loss, gliosis, angiopathy and lobar haemorrhages. Down syndrome, trisomy 21, the APOE 4 variant and presenilin mutations are also associated with Alzheimer’s disease.
Complications may include aspiration pneumonia, influenza, fractures, falls, pressure sores, malnutrition, dehydration, diarrhoea, constipation and dental problems. The disease may progress over five to 10 years and can eventually leave a person severely disabled, unable to speak or immobile.
Prevention and healthy living are important. Regular exercise, a healthy diet low in saturated fat, and control of blood pressure, cholesterol and diabetes are recommended. Avoiding smoking and excessive alcohol consumption is also important. Reading, drawing, creative activities, learning new things and participating in social activities can help maintain mental and social engagement. Adequate sleep and maintaining social connections are also encouraged.
A safe environment and adequate support are essential. Keys, mobile phones, wallets and medicines should be kept in designated places. Finances should be organised, while mobile phones with location tracking can provide additional safety. Alarm sensors may be installed on doors and windows. Appointments should be kept at consistent times, and furniture, footwear and railings should be arranged to reduce the risk of falls. Calendars can provide reminders.
Vitamin E, omega-3 fatty acids, turmeric and Ginkgo have also been discussed as complementary approaches. Newer drugs include lecanemab and aducanumab. Research is also exploring the possibility of an autoimmune component in Alzheimer’s disease.
Healthy eating, regular exercise, adequate sleep, control of blood pressure and blood sugar, avoidance of smoking and excessive alcohol consumption, and continued mental and social engagement remain important.
(The writer is a professor of pathology, former head of department and former dean, Goa University, and president, South Asian Academy of Cytopathology and Histopathology)
