It is dead of night and the household is asleep. But one person is up and about. Sleep just won't come her way. "Sun-downing" or agitation in the night and inability to sleep may be a signal, to those around that person, that something is wrong.
Remaining awake at night but sleeping during the day, called sun-downing, along with behavioural problems such as anxiety and depression, should alert loved ones that medical help is needed, explains Professor Charles Pinto, Consultant Psychiatrist at Holy Family Hospital in Bandra, Mumbai, and Prof. of Psychiatry at Nair Hospital, going into the early symptoms of Alzheimer's disease.
"Dementia is one of the main disorders in the aged and one of the main causes of dementia is Alzheimer's," says Prof. Pinto who was in Sri Lanka recently to hold a series of workshops to sensitize psychiatrists, neurologists and physicians on this important disease which affects the aged, in a country with an aging population.
Dementia is derogatorily associated with aging, but it’s not true and is being studied as a disorder of cognition, he says, adding that memory changes being one of the symptoms, if caught early gives hope to the patient with early treatment.
The usual onset of Alzheimer's is when one is over 60. It is more prevalent in women than in men. Estimates indicate that 2.5-3.5% are prone to Alzheimer's with a shocking 24-40 million Alzheimer's victims predictedworldwide in 2040, MediScene learns. Some of the well-known personalities who have suffered from Alzheimer's include former American President Ronald Reagan, author William Pratchett and former British Prime Minister Margaret Thatcher.
Studies in India indicate a prevalence of 2.5%, says Prof. Pinto, stressing however that age-associated memory loss is not dementia. "If memory loss is accompanied by loss of cognitive ability which affects daily living such as going about one's banking work or doing a job, then it could be Alzheimer's. Later even basic actions of daily living such as taking a bath are seriously affected."
He gives the ABCs of Alzheimer's, a combination of which would indicate the onset of this disease. A - activity of daily living is affected; B - behavioural problems, loss of sleep, being moody; and C - cognitive changes which include memory, planning and organizing and language are impaired.
Explaining how Alzheimer's comes about, he says that deposits of the protein beta-amyloid (plaques) that accumulate in the spaces between nerve cells and deposits of the protein tau (tangles) that collect inside nerve cells may block the ability of the nerve cells to communicate with each other, making survival of nerve cells difficult. Although plaques and tangles develop much earlier, dementia may occur later.
The indications of Alzheimer's in the early stages could be forgetting the names of familiar people and places, forgetting where everyday objects are kept and having trouble finding the right word to express oneself. "Recent memory goes off but past memories remain intact," says Prof. Pinto, adding that some even confuse their wife as their sister.
As the disease progresses, there will be personality changes, with even paranoia and delusions occurring. In the final stages there may be total loss of self and functions
Reassuring that dementia including Alzheimer's disease is not a disorder due to aging, Prof. Pinto says there is no cause for alarm as everybody will not get it as it has a genetic predisposition called the APOE4 gene. If there is just forgetfulness don't worry as it could very well be age-associated memory loss. Only if there are behavioural and mood changes with impairment of activities of daily living that heed must be taken.
If someone over 50 is worried about memory problems, a memory clinic evaluation could be done. This involves blood tests, X-rays or imaging like MRI and neuropsychological tests to assess whether it is dementia or not, reversible or not and what type of dementia it is as there are other causes too like vascular dementia.
The causes of Alzheimer's have not been determined yet but some of the risk factors are:
Advancing age – 1 of 8 people over 65 and 1 of 2 over 85 have Alzheimer's.
Genetic vulnerability – those who have a parent or sibling with Alzheimer's are two to three times more likely to get it. A 'risk gene' - APOE-e4 - which increases the chances of a person getting Alzheimer's has been identified along with a 'deterministic gene' found in a few hundred extended families around the world. If a 'deterministic gene' is inherited, it is learnt, a person will develop Alzheimer's at an earlier age, than the usual 60 years.
Lifestyle factors – Links have been established between Alzheimer's and those who have had a serious head injury, used tobacco and also between heart health and brain health. "Those who have heart disease with risk factors such as high blood pressure, smoking, obesity and diabetes have a higher risk of developing Alzheimer's," says Prof. Pinto, adding that exercise, a healthy diet and intellectually stimulating activities may ward off the disease.
Environmental toxins and high stress and anxiety levels, depression and head injury could also be contributory factors, it is learnt.