We all forget where we kept that box of firecrackers, or the bill that needs to be paid. But there is a more serious loss of memory that progressively begins to disrupt one's normal day-to-day functions. Alzheimer's disease is the commonest form of dementia, a disease of old age, and becomes increasingly frequent with every passing decade after 60 years.

1. Alzheimer's Disease: Progressively
Forgetting
By:- Dr Amitabha Ghosh

2. • We all forget where we kept that box of firecrackers, or the bill that
needs to be paid. But there is a more serious loss of memory that
progressively begins to disrupt one's normal day-to-day functions.
Alzheimer's disease is the commonest form of dementia, a disease of
old age, and becomes increasingly frequent with every passing
decade after 60 years.
• Over the age of 80, more than 20% of people have mild dementia.
Currently, over 3 million people suffer from dementia in India alone.
In about 20 years time, the numbers are expected to double, thanks
to a greater life-span and to better identification of patients in large
areas of our country.

3. The impact
• Many elderly couples live alone these days. They are frail and
particularly vulnerable. Their children may not live close by and
could even be in a different country altogether, finding it difficult
even to come down for Diwali. What would be the impact of
Alzheimer's disease in such a couple?
• Imagine the pain of seeing your partner slowly forget everything
that was once special and precious to you. Forgetting all likes and
dislikes, friends and relatives, or how to be happy or sad. And one
day, even forgetting who you are! Imagine your helplessness on
being left alone, caring for the one you care for most, but not
knowing how to care. And then there is the grocery, the banks, the
pension, the medical bills, all that for you to sort out. You are old
and frail yourself but there is no time for all that. Medicines help a
bit, but for you there are no balms of comfort. Such is the impact
of Alzheimer's disease. It affects two people - the patient, but
enormously more, the caregiver.

4. Alzheimer's is not an obscure illness but an ailment affecting real
people in real families like yours and mine. I want you to learn to
recognise the signs of Alzheimer's disease, but at the same time be
reassured that all forgetfulness is not dementia.

5. Facts about forgetting
We all forget things, all the more as we age. A certain degree of
forgetfulness is normal for every age group, especially in the elderly.
That is not dementia. Some people are naturally bad with names,
telephone numbers or addresses, as the case may be. That is 'normal'
for them and is not dementia either. Ask their families and you will
find that they have always been like that.
The worry is, when the memory loss exceeds what is normal for the
person's age, education or nature. In such situations, a decline in
dayto- day function may also be noticed. Appointments may be
forgotten and memos may need to be kept. Shopping lists may be
difficult to remember. Things may be misplaced and lost a bit too
frequently. There may be difficulty remembering names and even
recognising people not seen for a few years. Objects that have not
been used recently may also be forgotten.

6. Wrong names may be used. Some may start losing their way, initially in
unfamiliar and later in familiar places. They may have great difficulty in
locating their seats in a train or in flight, for example.
And gradually, even forget the way to their own home. Conversation may be
affected in many. Some cannot stop speaking while others sit quietly by
themselves with almost nothing to say. Some speak with stutters and trip
over words. Finding the right words may be difficult for many of them.
Reading and handwriting may be affected; pronunciation and spelling errors
may be prominent. Signing a cheque could become a harrowing experience.
Dressing, cooking, handling a remote control, a mobile phone or a push-
button telephone may become difficult.

7. While any or all of these symptoms may be seen in Alzheimer's
disease, loss of memory is typically the most prominent. Very often it
is this loss of memory that draws the attention of the caregivers and
other close relatives. At other times, a worried patient himself rings
the doctor first.

8. The memory test
• There are tests we can do to screen for Alzheimer's disease. Some of
these are simple questionnaires that take around 10 minutes to finish.
More detailed memory tests can be done later. Screening tests are
easy to administer, require minimum training for the tester and can be
performed at almost all settings like screening camps for Alzheimer's
disease, general outpatient clinics and special clinics exclusively set up
for memory disorders.
• Besides picking out those with Alzheimer's disease or other forms of
dementia, memory tests help us separate those who do not have
dementia from those who have very mild memory impairments (mild
cognitive impairment or MCI). This last group is particularly important.
Most people with MCI will be forgetful - but only some will develop
Alzheimer's disease. Others may have mild but significant
forgetfulness for several years, while a few may even improve and be
back to normal. Identifying patients with MCI and trying to treat them
early is an area of major interest in Alzheimer's disease research today.

9. New horizon in treatment
Until now, much of the treatment of Alzheimer's disease has
been symptomatic and not really geared to treat the root
cause. This is now changing. Current international research is
looking to find molecules that can act against the very
proteins that cause Alzheimer's disease. Many such drugs are
now in the pipeline and could be expected to hit the shelves
over the next few years. These drugs seem to work best on
patients with early and mild Alzheimer's disease. A
heightened awareness and an early diagnosis of the disease
are therefore essential.

10. Lowering the risks
Can you reduce your risk of having Alzheimer's disease? Researchers have
been finding links between the occurrence of Alzheimer's disease and
diseases of the small blood vessels of the brain.
MRI scans of the brain can sometimes pick up patchy, mini-stroke like
areas in the brains of patients with Alzheimer's disease. This has led to the
suggestion that good food, lots of green vegetables and an otherwise
healthy lifestyle could reduce the chances of having Alzheimer's disease
much as it reduces the risks of brain strokes and heart attacks. Turmeric,
frequently used in Indian food, is also believed to be one of the protectors
against Alzheimer's disease.

11. Caregivers' care
Looking after the caregivers and their needs is as much a part of
Alzheimer's disease care as is looking after the patient. In this regard
our social service systems leave a lot to be desired. The Alzheimer's
disease and Related Disorders Society of India (ARDSI), in its own
way, is trying its best to fill this vacuum. One day, drop in at one of
their offices, share a thought, and show them that you care. Don't
wait a whole year till the next World Alzheimer's Day – 2016
September 21st. Who knows how long you will remember the
'forgotten ones'?

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Dr Amitabha Ghosh is Senior Consultant Neurologist and Honorary
Consultant-in-charge, Memory Clinic, Alzheimer's disease and Related
Disorders Society of India at Apollo Gleneagles Hospitals, Kolkata