Alzheimer’s: The Most Common Cause of Dementia

Alzheimer's disease is named after German psychiatrist Dr. Alois Alzheimer, who discovered it in 1906. The disease is the leading cause of dementia, a condition that leads to a gradual decline in cognitive ability, reasoning, and memory.

According to Alzheimer’s News Today, an estimated 44 million people live with the condition globally. The disease is reportedly common in Western Europe and less common in Sub-Saharan Africa. While reports indicate that the number of people living with Alzheimer’s globally is increasing, only one person among four people with the condition is diagnosed. According to the World Health Organization (WHO), Alzheimer’s and Dementia contribute to 1.01 percent of the total annual deaths in Kenya.

The World Alzheimer’s Report 2021 indicates that 75 percent of people with dementia (including Alzheimer’s) are not diagnosed. The percentage could be as high as 90 in low and middle-income countries like Kenya. One of the reasons for the lack of diagnosis is the lack of information about the condition, making it necessary to create awareness.

The symptoms of Alzheimer’s start manifesting long after the brain is attacked, a stage of the condition referred to as the pre-clinical stage. During this stage, brain wasting, and the death of brain cells happen without any symptoms.

Over time, people with the condition become dependent on others due to the deterioration of the symptoms. They lose their social skills, and in the very last stage of the condition, they may lose their mobility and start using wheelchairs and other mobility assistive devices.

In the early stage of the disease, also referred to as the mild stage, all the symptoms look like minor life happenings. The symptoms may be hardly noticeable to both patient and family and are different for every person. They may include but are not limited to the following:

·      Being disorganized; forgetting where you placed items like wallets, remotes, phones, etc.

·      Trouble remembering names of people you have not seen for long.

·      Trouble making simple plans to organize day’s activities.

·      Difficulty managing basic budgets and money.

·      Forgetting recent events.

In the middle stage, also known as the moderate stage, the symptoms start manifesting clearly and continue to be obvious to both the victim and family as the disease progresses. This stage is the longest-lasting stage of Alzheimer’s disease, and the symptoms may include:

·  Trouble remembering even their name.

·   Difficulty remembering some close members of family and friends.

·   Extremely slow or difficulty in learning new simple things.

·   Reading, writing, and making simple calculations becomes difficult.

·   Losing track of time, day, and place.

·   May start wandering from home and get lost in familiar places.

·   May need a little help getting dressed, brushing teeth, showering, and other self-care activities.

·   Changes in moods and personality.

At this stage, also known as the severe stage, a person with Alzheimer's disease becomes completely dependent on others. Symptoms in this stage include:

·   Mobility problems.

·   Bowel and bladder control problems.

·   Incoherence in conversations.

·   Poor immune leading to attack by other illnesses.

·   Needing help doing everything and constant monitoring.

Most Alzheimer's disease symptoms, especially early-stage are ignored since they look normal to the victim, family, and friends. There are also symptoms of other treatable memory disorders that mimic Alzheimer's disease leading to misdiagnosis.

Therefore, it is advisable to see the doctor as soon as you start observing the middle stage signs, no matter how normal they seem to you and your family.

Though the disease is degenerative, early diagnosis, helps slow down its progression rate.

There is no known definite cause of Alzheimer's disease. Researchers, however, attribute the condition to a combination of lifestyle, genetic and environmental factors.

Researchers are studying the proteins beta-amyloid and tau to understand what causes the brain to fail, resulting in the damage and eventual death of neurons in the brain.

Age:  The probability of getting Alzheimer's disease increases with age, age is the biggest risk factor of the disease.

Severe head trauma:  You will be at significant risk of getting Alzheimer's disease if you have had a traumatic brain injury.

Down Syndrome:  People with Down syndrome are more likely to develop Alzheimer's disease than the general population. The disease starts manifesting 10-20 years earlier for people with Down syndrome.

Family History:  Genetic factors also come to play, and you are at a higher risk of developing Alzheimer’s if your sibling or parent has the condition.

Sex:  There are more women than men with the disease, but experts argue that it is because women live longer than men do.

Mild Cognitive Impairment (MCI):  People with MCI are at a higher risk of acquiring Alzheimer's disease

Other risk factors:  Include poor sleeping patterns, irresponsible alcohol consumption, pollution of air, physical inactivity, high cholesterol levels, and other lifestyle conditions and diseases.

Alzheimer's disease has no cure; it is only managed by treating complications from living with the condition.

To control the fast progression of the disease and increase life expectancy, people living with Alzheimer's disease should strive to lead a healthy lifestyle including and not limited to:

1.  Eating healthy and balanced diet.
2.  Exercising.
3.  Avoiding heavy alcohol consumption.
4.  Management of diabetes, high blood pressure, cholesterol levels and other diseases that may accelerate progression of Alzheimer's disease.

Complications resulting from the fast progression of the condition and poor management include:

• Aspiration-related complications
• Diarrhoea, constipation, and other bowel-related complications.
• Bladder-related complications like frequent Urinary Tract Infections (UTIs)
• Weak bones that could lead to fractures.
• Pressure sores caused by staying for too long in one position.
• Mobility problems, passing out and frequent falls.
• Tooth decay, mouth ulcers, and other dental-related complications.
•  Permanent disability, which requires total care.

Awareness Creation: - Many people do not understand Alzheimer’s well. The lack of knowledge leads to stigma, delay in diagnosis, or misdiagnosis, as evidenced in the World Alzheimer’s Report 2021. The report notes that stigma is the primary barrier to diagnosis, with a 33 percent of clinicians believing they can do nothing to better the lives of persons with the condition. Educating the general population and health professionals about the disease will facilitate better care and inclusion of people living with the illness.

Family Support: People living with Alzheimer's disease deserve to lead a dignified life, and their families have a responsibility to guarantee them the same. Some of these people lead a solitary life due to a lack of proper care and neglect by their families, who write them off. To ensure a dignified life for people with Alzheimer's disease, families should ensure that such people are:

• Well-fed with a balanced diet.
• Medically attended in case of opportunistic illnesses.
• Provided with physiotherapy care.
• Assisted in attaining the highest standards of hygiene.
• Exercised regularly.
• Equipped with requisite assistive devices like wheelchairs.
• Afforded comfortable sitting and sleeping places to avoid pressure sores.
• Taken for regular check-ups.

Psychological Support to caregivers- Alzheimer’s worsens with time, and in its severe form, persons with the condition become entirely dependent on others. Consequently, they require round-the-clock care. Offering such care can be emotionally draining for the caregivers. It would be helpful to provide them with counselling services and training on caring for their loved ones. Such a move will ensure that persons with Alzheimer’s receive the best care.

Financial support-Alzheimer’s denies the patient an opportunity to work and earn a living, especially in its advanced stages. Similarly, the primary caregivers and their families also suffer, as breadwinners often have to quit work to offer care to the sick person. The Kenyan Government should ensure that such families benefit from the Cash Transfer for Persons with Severe Disabilities (PWSD-CT).

Development of a national Alzheimer's action plan-With developing countries like Kenya having a high percentage of undiagnosed cases, there is a need for the government to create a national action plan. The plan will guide the country's efforts to address issues related to Alzheimer's.