ALZHEIMER’S DISEASE – the most common form of DEMENTIA

“May all the different parts of my body remain healthy and in good condition. May my mind and spirit be joyous. May I attain the full length of life. May I attain happiness and fulfillment in all respects. Purifying myself, may I attain the state of perfect, spiritual bliss.” – Atharva Veda

PERSPECTIVE

Alzheimer’s is the most tragic and heartbreaking of age-associated neurological diseases. The inexorable destruction it wreaks on the patients’ mind eventually incapacitates them totally, causing severe mental and physical impairment. Named after a German physician, Dr. Alois Alzheimer, who first discovered this brain disease in 1906, it has been defined as a progressive neurodegenerative disease that is irreversible and causes continuous decline in thinking, memory, behavior and social skills; thus, reducing the patient’s ability to function independently.

WHO statistics reveal that over 55 million people suffer from Dementia globally and Alzheimer accounts for 60-70% of cases. This figure is expected to rise to 78 million by 2030. Currently the 7th leading cause of death, Alzheimer has a debilitating physical, psychological/emotional social and economic impact, not just for the patient, but for families and society at large.

In India, around 5 million people are estimated to be suffering from Alzheimer’ – the 3rd highest after China and USA. But there is a lack of awareness about this terrible malady and only a small percentage of patients are formally diagnosed. Most people still think that memory loss is an inevitable part of ageing, till more serious symptoms appear. Social stigma is a reality and a lack of understanding and empathy results in ignorant and insensitive people mistaking it for insanity. Ageing parents with Alzheimer’s are often left to fend for themselves, especially in rural India and in lower income families. Persons suffering from it tend to wander off and can’t find their way back home. Delhi Police alone gets hundreds of complaints of missing Alzheimer’s patients.

ASPECTS of ALZHEIMER’S

There is no definite cure for Alzheimer’s as of now. However, intensive research is being conducted on all aspects of AD and there is more in-depth understanding of its impact on the brain; leading to innovative treatments and fresh approaches which could help prevent or control this condition. Early therapeutic interventions can delay the onset and progression of AD. It affects each patient differently – initial symptoms may vary from person to person and the timing and severity can differ.

It is estimated that the brain has 100 billion nerve cells – neurons, which connect to form communication networks. Alzheimer’s onset leads to the destruction of the nerve cells, causing extensive damage to the brain, resulting in irreversible changes in the brain. Scientists say there are two abnormal structures called Plaques and Tangles, that damage and kill nerve cells progressively, particularly in the Hippocampal area of the brain.

Though AD is an age-associated disease, and elders above 65 years of age are more susceptible, today even younger people are being afflicted with it, with some early onset cases being linked to genetic factors. Dr. S. Trivedi, a Neurologist, says he’s getting patients with early signs of AD between the ages of 30-55! Often, persons suffering from this disease, particularly in the initial stages, do not recognize the affliction. It is others around them who notice the signs of dementia. Women are more prone to Alzheimer’s/dementias and 65% of deaths that eventually occur due to AD, are of women.

IMPORTANT – It is therefore imperative to consult a doctor at the first signs of the disease, in order to get accurate diagnosis, guidance and treatment, including lifestyle changes.

DIAGNOSIS

Diagnosis is done by ruling out other conditions with similar symptoms. Several other factors, like a Stroke or major Trauma can cause similar symptoms. Very important also, to realize the difference between age-related changes, memory lapses and AD. As we grow older, our brains too age and slower thinking and movement becomes normal for many seniors. But seriously major changes would mean the brain cells are affected. There is no single test for diagnosing AD, but may include the following:

• Mental status test – Neurological motor and sensory examination – for cognitive and thinking skills.
• Neuro-psychological testing.
• CT or CAT scan.
• Electroencephalogram – EEG.
• MRI.
• Lumber puncture.
• Chest X-Ray.
• Blood and Urine tests.
• Genetic testing (optional)

CAUSES

Scientists are not absolutely certain, as to what exactly leads to Alzheimer’s in otherwise healthy and productive people. May include:

• Age – high risk factor in elders.
• Immune system disorders – infections like HIV.
• Genetics – family history.
• Abnormal protein deposits in the brain.
• Strokes and Trauma – injury to the brain.
• Severe Nutritional deficiencies.
• Environmental factors.

SYMPTOMS and WARNING SIGNS

• Initial short-term memory loss – affecting job skills, forgetting names, locations, own address and phone numbers.
• Difficulty in performing daily chores and completing familiar tasks.
• Neglectful of personal hygiene and grooming.
• Disorientation, confusion-regarding time and place, dates, and even seasons.
• Loss of cognitive abilities.
• Problems with speech and language-struggling with vocabulary.
• Personality and behavior changes-mood swings, irritable, unreasonable.
• Loss of initiative-inability to solve problems or plan-lack of concentration.
• Difficulty in understanding visual images.
• Poor judgement, due to impaired thought processes.
• Misplacing things and being unable to find them- may accuse others of stealing them.
• Withdrawal from work or social activities due to lack of self-confidence.
• Emotional apathy.
• Loss of mobility, difficulty in walking.

In advanced stages, as the disease progresses, the symptoms become more severe – patients become suspicious of family, friends and caregivers-becoming anxious, depressed and fearful. Unable to recognize familiar people and even spouses. They lose their ability to talk, swallow and walk, and suffer from incontinence constantly. They are unable to eat, bathe, dress, or go to the bathroom on their own. As AD advances further, loss of memory is complete. At this stage, the patient becomes totally dependent on others and requires round the clock caregiving.

THE GLOBAL DETERIORATION SCALE – GDS, which details the 7 clinical stages of Alzheimer’s was developed by Dr. Barry Reisberg at NYU Grossman School of Medicine. This guideline is used by professionals and caregivers all over the world to help identify the stage of the disease in AD patients. He believes the first 3 stages are pre-dementia.

Stage 1.– Pre-Clinical AD – can last from 10-15 years. Changes in the brain related to AD begin, but no overt signs.

Stage 2.-Subjective Cognitive Decline – also pre-dementia-same time span. No overt signs.

Stage 3.-Mild Cognitive Impairment – can last up-to 7 years. Time to seek medical help.

Stage 4.-Moderate Cognitive Decline – visible decline in ability to manage daily activities. Increasing memory loss. Emotional withdrawal-less responsive. Decreased intellectual capacity-aware of problems, but often in denial. Can last up to 2 years.

Stage 5.-Moderately Severe Cognitive Decline – can no longer manage on their own. Patients need assistance in dressing, eating and daily activities. Remote memory loss too – unable to recall major events or own personal details. Inability to choose correct clothing. Behavior changes, resulting in anger, suspicion. Can last up to 1.5 years.

Stage 6.-Severe Cognitive Decline – moderately severe Alzheimer’s – 6a, 6b, 6c, 6d, 6e – gets progressively worse. Patient unable to bathe, brush teeth or dress. Toiletry problems and incontinence. At this stage, cognitive deficits are so huge, the person can’t recognize friends, family and spouse-or misidentify. Ability to speak breaks down. Emotional changes and the psychological reaction of the patient to their condition, results in a sense of shame, frustration and fear, leading to frequent outbursts, fidgeting, pacing etc. Unable to live independently makes them afraid of being left alone. Coherent speech seriously impacted. Can last up to 2.5 years in otherwise healthy persons.

Stage 7.-Very Severe Cognitive Decline – patient needs continuous 24×7 assistance for survival. Speech is limited to a few coherent words at the beginning of this stage and as the disease gets even worse, intelligible speech and independent movement or ambulation cease totally. The unfortunate patient loses the ability to sit on their own, raise their head or even smile. Physical rigidity sets in, and overt deformities sometimes occur in the immobile person. Though patients can survive up to 4-5 years at this stage with devoted care, but as a vegetable. Most patients die at various points of this 7th stage, due to pneumonia, infections and ulcerations. Towards the end, the ravaged brain’s neurological changes result in “infantile, primitive and developmental reflexes.” Death is certain now, but via the common causes of mortality in elders – heart attack, stroke, cancer and Pneumonia.

TREATMENT OPTIONS

Medical science has not found a specific cure for this terrible disease, but new research is encouraging.

Treatment consists of counselling and medication which is patient-specific and determined by the following:

• Age, medical history and overall health of patient.
• Extent and stage of the disease.
• Analysis of the course of the disease.
• Patient’s tolerance for certain medicines, procedures and therapies.
• Medication for Depression and sleep disruption caused by AD.
• Lifestyle Changes – can reduce or prevent onset of cognitive decline– being more physically active, doing Yoga, keeping weight in check and maintaining Cholesterol, Blood Sugar and Blood Pressure levels.
• Being socially active and engaged.
• Eating nutritious, balanced and healthy food.
• Not consuming Alcohol or smoking.
• Calm and positive environment.

Ayurveda, our thousands of years old system of holistic healing encompassing mind, body and spirit, has treatment options for this terrible disease that are time-tested.

TRADITIONAL INDIAN AYURVEDA TREATMENTS.

Various Ayurvedic plants referred to as nervine, strengthen the functional activity of the nervous system and aid in the restoration of memory. Ayurveda texts deal extensively with the nervous system and associated disorders. Direct references to age-related memory loss, preventive care and therapeutic interventions.

Studies have shown the very positive impact of specific herbal plants on the nervous system disorders and Dementias, including Alzheimer’s. Phytochemical studies reveal the presence of many valuable compounds such as flavonoids, tannins, polyphenols, triterpenes, sterols and alkaloids that have strong anti-inflammatory, anti-amyloidogenic, anti-cholinesterase, hypolipidemic and antioxidant effects.

Listed below are some of the most powerful and effective plant-based Ayurvedic remedies for a plethora of ailments and deficiencies of the mind and body. Their healing properties have been known since ancient times in India and they have no side effects.

ASHWAGANDHA ( Withania Somnifera)

This well-known herb has been extensively used as a nervine tonic and adaptogen for centuries. It has free-radical, scavenging, stress-relieving and calming attributes. Builds immunity.

TURMERIC ( Curcuma Longa)
Used for centuries as a spice and traditional medicine in India. It is renowned for its multiple and amazing healing effects. It is antiseptic, anti-inflammatory, anti-bacterial, and helps detoxify Liver, control Cholesterol, fight allergies and boost immunity. Most importantly, known to reduce plaque deposition in the Brain, thus hampering and preventing growth of Alzheimer’s disease.

BRAHMI (Bacopa Monnieri)

Commonly used as a nerve tonic, cardio-tonic, diuretic and to treat Epilepsy, Asthma, Rheumatism and Insomnia. Traditionally used to enhance Memory and Cognitive function. Studies have revealed that Brahmi extracts protected neurons from beta-amyloid induced brain-cell death by suppressing cellular acetylcholinesterase activity.

SHANKHPUSHPI (Convolvulus Pluricaulis)

Various parts of this wondrous plant are used for treating Nervous disorders like mental fatigue, stress, anxiety and insomnia. As a nervine tonic which enhances memory and cognitive function by increasing the functional growth of neurons.

GOTU KOLA (Centella Asiatica)

An amazing rejuvenating herb for nerve and brain cells. Enhances intelligence, memory and longevity. Studies suggest that it inhibits beta-amyloid cell-death “in-vitro”. Immensely beneficial for the treatment and prevention of Alzheimer’s.

JYOTISHMATI (Celastrus Pamiculatus)

Revered for sharpening memory, improving cognition and cognitive function. It protects neuron cells against H2O2 induced toxicity due to its strong antioxidant properties.

JATAMANSI (Nardostachys Jatamansi)

Widely used since centuries for alleviating symptoms of chronic fatigue, improving memory and learning ability. Known to help restore memory of elders and age-related Dementia patients. It is also a powerful antioxidant.

GUGGULU 

Indian Sages and subsequently Vedacharyas, discovered the amazingly beneficial attributes of this Oleogum Resin exuding from the bark and cuts of several plants thousands of years ago. It is used in multiple treatments: arthritis, inflammation, obesity and disorders of lipid metabolism. Significantly lowers serum LDL Cholesterol and Triglycerides levels. Low cholesterol inhibits the progression of Alzheimer’s. Guggulu’s antioxidant and anti-acetylcholinesterase properties make it a powerfully effective anti-dementia medicine.

Amongst other Ayurvedic therapies that have been impactful in brain-related ailments are traditional oil-massages and inhalations. Specific Essential Oil steam inhalation combined with Herbal-medicated Oil massage – especially on the head, like Shirodhara, Shiroabhyanga etc. have been proven to calm agitation and improve cognitive function in patients of Dementia and Alzheimer’s disease. Significant brain functional changes with increased cerebral blood flow having a most positive effect, have been observed post-massage.

While Ayurveda has been prescribing herbal formulations and therapies for the treatment and prevention of growth of neurodegenerative diseases for thousands of years, it is only in the last few decades that mechanistic studies and research has been conducted on Alzheimer’s Disease and other Dementias in the West.

IMPORTANT – Please do consult a well-qualified Ayurveda Vaidya/doctor for proper guidance regarding specific usage of the Ayurvedic remedies. Even though most Indians are aware of their attributes and benefits.

There is urgent need to sensitize people and society at large regarding Alzheimer’s disease and other Dementias. Humanity must show understanding, empathy and compassion towards the unfortunate people afflicted with these conditions and be supportive of the families and caregivers who must deal with a loved one suffering from this condition. Remember, it can happen to anyone. Though, we must all strive to prevent it from happening as much as possible, by following the preventive tips suggested by experts.

EMOHA Eldercare is dedicated to the holistic well-being of our beloved elders. We provide at-home healthcare, along with emergency, safety, convenience and engagement services. Please do contact us any form of assistance. For us, it is always #EldersFirst.