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Living & Managing Alzheimer’s

Alzheimer’s Disease (AD) or a form of dementia is a memory disorder, which is severe enough to affect life on a daily basis. It involves loss of short-term memory but also other things like the ability to express yourself with language, the ability to perform certain routine tasks. Alzheimer’s disease is not an inevitable part of aging, it’s a disease process. Unfortunately, the number of cases of AD in Nepal seems to be growing evidently. And in many cases, AD patients either go unnoticed, being stigmatised as ageing gone wrong, or not diagnosed correctly. Hence to shed more light on the disease that has been scarring mostly elders, WOW caught up with Neurologist Dr. Pankaj Jalan.

health-interviewIn your opinion, what is the quality of ageing process in Nepal?
Compared to Western countries, Nepal’s ageing process is much better because of our culture. There is a lot of social support. We respect our parents and support them emotionally as well as financially whereas in foreign countries they’re usually sent to old-age homes.

What are some of the illnesses prevalent in the ageing population?
If you have to focus only on neurology, most common illnesses are Alzheimer’s and Parkinson’s disease both of which are common in old age. Most of us believe that old people are slow and forget things easily which isn’t true. Even a 100-years-old person’s memory can be in depth. Such abnormalities could actually mean that they are sick. There may be other psychiatric problems like depression, anxiety, vision problem and arthritis.

Are cases of mental and neurological disorders frequently reported, especially Alzheimer’s and Dementia?
Yes because media is more active, there’s more coverage of these kinds of diseases. Five years ago, people just blamed their parents for ageing when they forgot things. But now, I can see people taking their parents to doctors for proper check-ups as families are more educated now. However, they are usually late in consulting doctors. I didn’t expect to see so many cases of Alzheimer’s and Parkinson’s diseases in Nepal and that too from urban areas. I am not quite sure about rural areas though. Immense awareness is required as people with AD need tremendous amount of care. It’s the family members who equally suffer in the process. Therefore, counselling is a must.

Main causes of Alzheimer’s
The biggest factor behind AD is age. People from all socio-economic status from any part of the world can get it. Even though numerous researches have been done on Alzheimer’s, the exact main cause is yet to be unknown. However, several studies have shown the linkage. Initially, some researchers thought people only with low education or from certain parts of the world got it. There is no clear-cut, well-defined reason behind this disease. We just know that it is a disease of old-age. The more we live; there are more chances of having Alzheimer’s. In Nepal, we don’t have proper data but based on my experience, I can say that Alzheimer’s is quite common here.health-interview-foto-1

Is it hereditary?
It could be hereditary especially if it is detected at a younger age. Alzheimer’s has also been seen in 40s and early 50s. There is a 3-5 percent chance of inheriting the disease, which is again uncommon. However, since we don’t do genetic testing here, we cannot be sure about it. And even if you conduct those tests and detect it, there’s nothing you can do about it.

Are people adequately aware about this disease?
Not in the case of Nepal. There is no awareness or government programmes. We don’t have many organisations specifically dedicated to Dementia and Parkinson’s patients; but there are old age homes to cater the need. Several rehab and old age homes here are helping to spread awareness. But obviously we need more programmes to educate the public about it. As of now, it’s not adequate.

What are the main symptoms?
The disease can be divided into four stages. First one is called Pre-clinical which cannot be noticed from the outside. It is called so because changes can be seen in their brain biopsy. People don’t even come to the doctor at this stage. Second one is Mild stage where Alzheimer’s isn’t detected but involves casual absentmindedness. Slowly, patient starts forgetting schedules, days and dates. In this stage, they don’t need much care as its just occasional confusion. Problem arises in Moderate stage. They start forgetting recent activities yet remember the old ones which they keep talking about and may give others the idea that they still have a sharp mind at the age of 85. This phase may also find them talking inappropriately in public and finding it hard to grasp information or register a new memory. That is when family is likely to start noticing due to their abnormal behaviour. Then comes the last one that is the Severe phase where patients are bedridden. They need 24-hour care as they can’t handle their own bladder, bowel or eat, which slowly goes from bad to worse. All the complications caused by this lead to death. For instance, in the Severe stage, they start choking while eating that leads to pneumonia or sores that can again cause life-threatening infection. But the main one is aspiration pneumonia.

Is it preventable?
So far there is no concrete evidence whether we can prevent Alzheimer’s or not. But population study found out that Mediterranean diet is good for brain. Also, people who do moderate amount of physical activities can prevent dementia because the disease has also been linked to diabetes and hypertension. Then there is mental exercise. People, who solve lots of puzzles or mathematical problems, socialise or read a lot, have less chances of getting it. But there’s no guarantee. Some even believed that smokers don’t get it which is completely false. We can’t really predict or prevent it.

How is it identified and detected?
It is usually first noted by family members. When they take their affected elders for check up, the doctor interrogates about history, and examines it. Sometimes we make them do an MRI or a CT-Scan and even blood test as deficiency of Vitamin B12 causes memory problems. There is no cure to it so when I diagnose someone with Alzheimer’s, I make sure that I am not missing out on a single detail. I’ll make sure to check the brain scan to see if there is any tumour or something else because there are numerous other factors causing memory problems. If everything else turns out to be normal, then it can be confirmed that the person has Alzheimer’s.

What should caretakers know?
It’s a big stress on the family and specifically on the person looking after the patient and who needs to be educated. For example, if a husband has the disease, it will probably be very burdensome on the wife. The caregivers first need to accept that this disease cannot be cured since it only worsens with time. Secondly, they should not argue with the patients because they do nothing on purpose. If the patients say it’s Sunday every day, don’t try and correct them. Don’t get upset about it either. What they really need is tender love and care. When things get difficult to handle, remember it’s the disease doing it not the patient.

What are the treatment methods?
Although the disease cannot be cured completely, there are four medicines that can help in delaying the progression. If the patients don’t take them, the disease will worsen drastically. Most of them suffer insomnia, so there are medicines to help with sleep. Antibiotics are given to those with infection. And there are other health issues that come with age like diabetes and arthritis for which related medications are prescribed. Even physiotherapy and rehabilitation, soothing music, and hymns/bhajans are advised.
Besides, researches are still going on. So we may have better solutions in the future.

What are your suggestions for preventing memory loss?
There is no clear-cut formula but keeping your brain active is important. The more you read or socialise the better. Not to forget, proper diet with exercise. Cognitive decline occurs when people stay aloof, don’t read, and watch too much television.

Dr. Pankaj Jalan
American Board Specialised Neurologist
Deputy Medical Director/ Consultant Neurologist
Norvic International Hospital
Thapathali, Kathmandu
Tel: 4258554