Online edition of Sunday Observer

Increasing memory loss may be an early sign of dementia. Old age does not cause memory loss but when memory loss starts to disrupt everyday life, it is time to get help. The Lanka Alzheimer's Foundation, set up for this reason by Tami Tamitegama, invited eminent psychiatrist and former Chairperson of Alzheimer's Diseases International (ADI) to visit Sri Lanka early this year.

For the benefit of our readers we reproduce some of Dr. Nori Graham's comments and recommendations from the latest newsletter of the Lanka Alzheimer's Foundation.

Courtesy -Red Cross Red Crescent

Alzheimer's is a disease of the brain and it is the commonest cause of dementia, which accounts for about 50% - 60%.

Dementia is a generic term for a number of disorders of the brain. There are perhaps 100 - 200 causes of dementia.

The second most popular cause is vascular dementia, which is associated with symptoms of stoke, either minor or major, but dependant on which part of the brain is affected.

Each disease which causes dementia has physical, emotional and behaviourial differences. However, there are commonalities. Loss of short term memory is initially witnessed. Long-term memory may remain for an indefinite period. However, that is lost as well, towards the final stage of the disease.

Aside from memory problems, other initials manifestations of the disease are, language problems - difficulty remembering words; sense of time, place and personhood; remembering sequences of activities, which are taken for granted in daily living - personal hygiene, dressing and eating, muddled and confused thought processes requiring help from carers.

From onset of the disease, the worsening of the symptoms and progression cannot be stopped or reversed. appropriate medication has not yet been discovered.

The disease will eventually cause the manifestation of other life threatening problems. Alzheimer's disease and related disorders are not primary life threatening diseases, but the progression is irreversible. Life span from onset of the disease can be 5-20 years or more.

Age is considered the primary risk factor. Many countries have conducted epidemiological studies on dementia. The general consensus among the Alzheimer's Association network is that one in 1000 persons under 55 years may show early onset dementia; up to 80 years some 6% per cent will be affected; and beyond 80 years the prevalence could increase to 20 per cent.

There isn't any way of preventing early or late onset dementia. However, vascular dementia may have some connection to lifestyle, habits and other manifestations of non-communicable diseases, specifically; substance abuse' lack of dietary control; lack of exercise; uncontrolled diabetes and hypertension are risk factors. Furthermore, some recent findings indicate that vascular lesions have been detected in the brains of persons who have died to Alzheimer's through post-mortem examinations.

Lifestyle factors are important in preventing Alzheimer's, although, it has not been definitely substantiated.

Diagnosis of Alzheimer's is principally based on the recent history of the person afflicted and changed behaviour and personality, which family carers have observed and experienced. A composite picture and story of the person's changed personality emerges as a result of the investigation.

On that story, a diagnosis is virtually complete. A final confirmation is a routine physical examination and blood tests; the results of which will indicate whether dementia has actually taken hold, or whether some other condition, which may exhibit symptoms similar to dementia is present, such as, depression, a thyroid problem, anaemia, chronic infection, etc.

It is a traditional belief that loss of recent memory results from old age, which is not necessarily valid as forgetfulness is a common condition for all. The degree of forgetfulness depends on a host of other factors, such as stress, lack of focus, or lack of attention, etc. Forgetfulness, in the realm of dementia, is the complete removal of all traces of what happened a minute or two ago, which is often very scary for the afflicted as well as the carers.

When a person afflicted with dementia finally does not recognize members of the immediate family, it is a tragic event. Suspicion, blame, tears and wandering are common symptoms attributed to Alzheimer's/ All of those behaviourial manifestations have severe implications of relationships and family life. Finally, the person afflicted loses much of personhood and independence.

The Alzheimer's International organisation was initiated by a family caregiver, some 20 years ago. Since those beginnings family members have bonded together, found common ground to support each other, formed associations and focused on raising awareness, lobbying for support for the public and private sectors.

Persons afflicted with dementia need to be managed, loved, cared and supported as whole persons by the family carers and the community. The key is acceptance. Those persons have a disease, but do have some areas of functional capacity.

The carers and the community work within those areas, and provide those afflicted with a sense of self worth.

The families that do not keep the affliction a secret and make those persons belong to family units; make a real difference to persons with dementia.

Age is an important risk factor for dementia but it is not the only one. About 20 % of people over the age of 80 have dementia which means that 80% do not.

Fact: Poor memory is not normal at any age and should be investigated. Memory and mental speed decline slightly with age but this does not usually interfere with everyday life.

A number of carers who individually provide care for a family member with dementia met in August 2002. Those present and by proxy agreed to form the first dementia caregiver support group in Sri Lanka. The members agreed to:

* Learn more about the progression of dementia and the various ways in which it manifests;

* Assist community groups elsewhere in the country to establish similar services;

Every person is unique and dementia affects people differently. An individual's personality , general health and social situation are all important factors in determining the impact of dementia . The common symptoms of dementia are...

A high percentage of Sri Lankans both in urban and rural areas consume alcohol . Misuse of alcohol in and of itself is one of the most preventable health problems in Sri Lanka. Excessive consumption of alcohol contributes significantly to five out of the 10 leading causes of death in Sri Lanka. Tobacco interacts with alcohol in a way that reinforces its effects in causing oesophageal and oral cancer.

People aged 20 to 50 drink the most alcohol. Drinking among Sri Lankans begins earlier among school boys and University undergraduates. The earlier in life that alcohol abuse begins, the more likely alcoholism will result.

The American Medical Association defines alcoholism as an illness characterized by significant impairment directly related to persistent excessive use of alcohol. Impairment can involve physiological, psychological and social dysfunction. Causes of alcoholism include genetic, psycho-social and environmental factors.

Some studies suggest that as much as 50 percent of person's risk for alcoholism comes from genetic factors. Children of people with alcoholism have a four-fold increased risk of alcoholism even when adopted by people with no history of alcoholism.

Therefore people with family history of alcoholism need to be especially alert for early signs of alcoholism. Ability to "hold one's liquor" is one indicator for genetic risk and is an important screening test for potential alcoholic problems. After a person drinks ethanol (alcohol) his or her blood concentration rises rapidly.

Ethanol is rapidly absorbed into blood from all parts of gastrointestinal tract including stomach and it is not advisable for a person to drink on an empty stomach as alcohol absorption depends on the rate of stomach emptying. Food shows the stomach emptying rate and stimulates secretions such as gastric juice which dilutes the alcohol and slows the absorption into blood stream.

A social drinker who weighs about 150 pounds and has a normal liver function metabolizes about 7-14 grams of alcohol per day. This is about 8-12 ounces of beer or 1.5 ounces of gin, rum, brandy, cognac, 4 ounces of red or white wine, 1.5 ounces of Martini or 3 ounces of sour whisky. When the rate of alcohol consumption exceeds the liver's metabolic capacity, the blood alcohol rises and symptoms of intoxication appear.

When a man or woman of similar size drinks the same amount of alcohol, the woman retains more alcohol in her blood stream; women cannot metabolize as much in their stomach cells. They also have lower amounts of liver enzymes that metabolize alcohol In addition, women more quickly develop alcohol related diseases such as hepatic (liver) cirrhosis than men with same drinking history. Alcohol then goes on to affect the brain more than any other organ. Acting as a sedative alcohol tends to relieve the drinker's anxiety, cause slurred speech, reduce coordination in walking, impair judgement and sleep and encourage uninhibited behaviour.

Because alcohol lowers inhibition it appears to act as a stimulant, but in fact, it is a powerful depressant. Because it reduces the secretions of the body's antidiuretic hormone, alcohol increases urination. It also causes blood vessels to dilate releiving the body heat.

Excessive alcoholic drinking increases the risk of some types of heart disease, high blood pressure, nerve disease and nutritional deficiencies, damage to a pregnant woman's foetus, abdominal obesity, and many other diseases. A major cause of lasting mental retardation that begins in infancy stems from foetal exposure to alcohol.

Social consequences of alcoholism include family violence, divorce, unemployment and poverty. A large number of Sri Lankan children are more likely to develop abnormality in psychological skills and relationships because their parents especially the father abuses alcohol.

Long term alcohol use causes liver cirrhosis which is a relentlessly progressive disease, characterized by fatty infiltration of liver. Eventually the fat chokes off the blood supply depriving the liver cells of oxygen and nutrients. Liver cells then die and are replaced by scar tissue.

In Sri Lanka, majority of cases of cirrhosis are caused by alcohol consumption. Once a person develops cirrhosis there is a 50 per cent chance of death within 4 years which is worse prognosis than in many forms of cancer. Most of the deaths from alcoholic cirrhosis occur in people between the ages 40 to 65. nutritious diet help to prevent some of the complications associated with alcoholism but alcohol can cause destruction of liver in spite of as adequate diet.

Majority of alcoholic cirrhosis in Sri Lanka occurs in people who take large quantities of alcoholic beverages such as arrack and "Kasippu" without taking a nutritious diet. Deficient nutritious status compounds the problem of cirrhosis as it makes the liver more vulnerable to toxic substances by depleting supplies of antioxidants such as vitamin C which can reduce the free radical damage to the liver if present in adequate amounts.