Yesterday was World Alzheimer's Day :

When memory fails …

By Carol Aloysius

Memory loss caused by Alzheimers is increasingly affecting a significant number of persons worldwide. Worryingly, this condition, once commonly found in people over 70 years, is now seen in people less than 65 years of age and even among those in their fifties and late forties.

Dealing with the disease is harder for the caretakers than the patient when it reaches an advanced stage as the patient needs full time attention, since he or she is unable to perform even the most trivial daily tasks such as brushing one’s teeth, washing one’s face, using the toilet, bathing or changing one’s clothes.

For family members, the most distressing aspect of the disease is the inability of their parent/aunt to recognise them.

All this puts a severe psychological strain on all those closely involved in caring for an Alzheimer's patient. Yet, in spite of the fact that more people are now being afflicted with Alzheimer’s disease (AD), not many are aware of the symptoms or how to deal with it. To find out more of the disease, The Sunday Observer spoke Consultant Neurologist Sri Jayawardenapura Hospital, Dr Harsha Gunesekera.

Excerpts

Question: How would you describe Alzheimer’s? As an illness of the mind or a disease?

Answer: AD is a disease and not an illness of the mind. It is an irreversible, progressive brain disease that slowly destroys memory and thinking skills, and eventually the ability to carry out the simplest tasks.

Q: Is AD and Dementia the same illness? Or are they two different conditions?

A: Dementia is a group of symptoms characterised by a decline in intellectual functioning, severe enough to interfere with a person's normal daily activities and social relationships. There are different types of dementia and Alzheimer's disease is the most common type of dementia in older people.

Q: What causes AD and Dementia? A sudden shock? Loss of a loved one? Illness?

A: Scientists do not yet fully understand what exactly causes Alzheimer's disease. However, the complex series of pathological events that takes place inside the brain has been well established by research. What exactly triggers off this process is not known.

Sudden emotional disturbances do not cause AD. Age is the most important known risk factor for Alzheimer's disease.

Q: Do genes have anything to do with these illnesses? For example, if one has a family history of AD or Dementia is that person more at risk of getting either of the illnesses than those without a family history?

A: Five percent of patients with AD have familial Alzheimer's disease, which is an early onset form of the disease that appears to be inherited. In familial Alzheimer's disease, several members of the same generation in a family are often affected. Ninety five percent of patients have sporadic AD and their family members are not at increased risk of developing AD.

Symptoms

Q: What are the earliest symptoms? How can one detect them?

A: The early phase of the disease can be defined as Mild Cognitive Impairment (MCI) stage. MCI is a borderline condition between normal, age-related memory loss and early dementia. A person with MCI is characterised as having a memory deficit beyond what is expected for a person's age, yet without other clinical signs of dementia.

MCI is serious enough to be noticed by the individuals experiencing them or to other people, but the changes are not severe enough to interfere with daily life or independent function.

Q: Is memory loss the main symptom?

A: The classic sign of early Alzheimer's disease is gradual loss of short-term memory. Symptoms vary from person to person, but all people with Alzheimer's disease have problems with memory loss, disorientation and thinking ability, trouble in finding the right words to use, recognising objects (such as a pencil), recognising family and friends, and may become frustrated, irritable, and agitated.

Q: What are the symptoms at an advanced stage of the illness? How do they progress? How long does it take to reach the advanced stage?

A: As the disease progresses, physical problems may include loss of strength and balance, and diminishing bladder and bowel control. As more and more of the brain is affected, areas that control basic life functions, like swallowing and breathing, become irreversibly damaged, resulting eventually in death.

Symptoms progress at different rates and in different patterns.

The appearance and progression of symptoms will vary from one person to another.

On average, from onset of symptoms, people with Alzheimer's disease can live from eight years (the average) up to 20 years.

Treatment

Q: Can the symptoms be delayed with drugs? If so, for how long?

A: No treatment is yet available that can stop Alzheimer's disease. However, some drugs may help delay the progression of symptoms associated with Alzheimer's disease. Also, some medicines may help control behavioural symptoms, such as sleeplessness, agitation, wandering, anxiety, and depression. Treating these behavioural symptoms often makes people with Alzheimer's more comfortable and makes their care easier.

Q: What is the treatment available in Sri Lanka? Drugs? Injections? Or none?

A: Out of the four drugs recommended for treatment in AD, only two drugs, are available in Sri Lanka. These drugs are recommended only for mild to moderate disease.

For moderate to severe AD, a drug called Memantine is recommended but this drug is not registered in Sri Lanka. However they should only be taken with a physician’s guidance.

Q: It has been said that dementia affects half of the over 85 population and A.D is responsible for about 2/3 of all dementia. Is this correct?

A: The incidence of AD increases with age; one in nine people (11 percent) over the age of 65 years have AD - one third of people (33 percent) over the age of 85 years have AD. Out of all forms of dementia, AD accounts for 60 percent of patients.

Q: It has been reported by Dr Sam Gandy a Prof. of Alzheimer’s disease Research in the US that the signature change in the brains of AD patients is the build up of structures called plaques that are composed of a substance called amyloid-B. Could you tell us more about this plaque and its role?

A: The main pathological features of Alzheimer’s disease are presence of beta-amyloid plaques, neurofibrillary tangles within the nerve cells (neurons), and the loss of connections between neurons in the brain. The plaques are formed by an abnormal protein called “Tau”.

Therefore, AD is now identified as a “Taupathy”(there are some other diseases as well, where Tau is present). Formation of amyloid plaques is thought to be genetically based.

Q: Since AD patients can’t look after themselves what is the role of the carer?

A: As the disease progresses, more and more patients will become dependent for self-care and activities of daily living (feeding, washing, toileting, grooming, dressing etc). This stage will require constant carer support. Even in the early stages, carers may be needed to accompany patients when they go out as they have problems with orientation.

Q: Since caring is a full time job the carer too may be in need to counselling and suffer from mental impacts.

A: Both the patient and the carer may need this at different stages.

Depression and anxiety may commonly co-exist and will need referral for counselling/ interventions such as cognitive behaviour therapy, relaxation therapy, multi-sensory stimulation etc. Drug treatment may be considered in severe cases.

Q: Does counselling a carer help?

A: Yes. In advanced stages of AD, the carers may be burdened both physically and mentally. This has to be avoided as much as possible by planning a care package which will not burden one individual, whom often in our society is the spouse or another immediate family member. In Sri Lanka unfortunately, there is no provision for carer support through the health services and therefore families have to bear the funding of external care services.

Q: What about support groups in reducing their burden both physical and mental?

A: People with mild to moderate dementia of all types should have an opportunity to participate in a structured group cognitive stimulation program provided by appropriately trained health and social care staff. This intervention should be offered irrespective of drug treatment for cognitive symptoms.

Q: Your message to the public and to carers?

A: Dementia and Stroke account for over 2/3 of patients with neurological disability which could be collectively prevented by adopting a lifestyle that promotes brain health.

A healthy diet with more of vegetables and fruit and less of salt, sugar and saturated fats, regular physical activity, avoidance of smoking and excessive alcohol intake, control of stress and treatment of high blood pressure and diabetes are the key factors for a healthy lifestyle. Even with the presence of mild symptoms of memory impairment, medical attention should be obtained early so that treatment could be initiated without delay after investigation.

The role of the carers should be reviewed regularly to see how they are coping with the situation so that they could be helped whenever the need arises.

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Sri Lanka Alzheimer's Foundation

The Sri Lanka Alzheimers Foundation set up to improve the quality of life of those with Alzheimer's and related dementia and enhance the well-being of their families and carers has made a significant contribution towards supporting both Alzheimer's patients and their carers.

The Lanka Alzheimer's Foundation (LAF) is an approved charity (Gazette Notification No 1225), incorporated in 2001 and registered with the Ministry of Social Services. LAF is the first non-statutory organisation dedicated to advocating and addressing the needs of those diagnosed with cognitive impairment and dementia.

The services of LAF are open to all on a no-charge basis, regardless of ethnicity or religious background. “If you are concerned about your memory or that of a loved one, if you are a family carer of a person with dementia (PWD), if you are interested in receiving education and training, or if you are a health professional wishing to refer a PWD to our services, we invite you to talk to us. The right to confidentiality is maintained at all times”, says Lorraine Yu Founding Director and President of the Foundation.

Services provided by LAF include: Raising awareness and eradicating stigma - thereby creating a dementia-friendly environment so that PWDs and their carers do not feel trapped in the home environment.

Education on Risk reduction

Helpline 0112667080 (Weekdays 9 am to 5 pm)

Befriending/Counselling

Memory Screening

Activity Centre (for persons diagnosed with Mild Cognitive Impairment or dementia - our clients engage in social interaction, mental stimulation and physical activity, which has a positive impact resulting in the retarding the progression of the illness)

Quarterly Newsletter Secretariat/Information and Resource Material Caregiver Support Group (CSG) Meetings Hygienic Products Website: www.alzlanka.org

How you can help

By volunteering at the Activity Centre or by participating in the annual Dementia Awareness Campaign and other fund raising events organised throughout the year

By establishing working partnerships with LAF, in the form of sharing services, knowledge and professional expertise By making a donation to the Foundation and helping to sustain the services offered to the community.

Why do young adults smoke?

The risk of becoming a smoker among young adults who have never smoked is high: 14 percent will become smokers between the ages of 18 and 24, and three factors predict this behaviour. “Smoking initiation also occurs among young adults, and in particular among those who are impulsive, have poor grades, or who use alcohol regularly,” said Jennifer O'Loughlin, a Professor at the University of Montreal School of Public Health (ESPUM) and author of a Journal of Adolescent Health study. O'Loughlin believes smoking prevention campaigns should also target young adults aged 18 to 24.

With smoking rates declining markedly in the past three decades, the researchers cited several studies suggesting that the tobacco industry is increasing its efforts to appeal to young adults. In the United States, there is a 50 percent increase in the number of young adults who start smoking after high school.

This trend prompted O'Loughlin and her team at the ESPUM to identify predictors of young adults starting to smoke which may lead to avenues for prevention.

They analysed data from a cohort study called “NDIT” (Nicotine Dependence in Teens), which began in 1999 in the Greater Montreal Area, in which nearly 1,300 young people aged 12-13 took part.

In this cohort, fully 75 percent tried smoking. Of these young people, 44 percent began smoking before high school; 43 percent began smoking during high school, and 14 percent began after high school.

Not all, however, continued smoking, but among the “late” smokers, the researchers found that smoking onset is associated with three risk factors: high levels of impulsivity, poor school performance, and higher alcohol consumption. Some late smokers showed greater impulsivity compared to the other participants in the study.

According to O'Loughlin, it is possible that impulsivity is more freely expressed when one becomes an adult, since parents are no longer there to exert control. “We can postulate that parents of impulsive children exercise tighter control when they are living with them at home to protect their children from adopting behaviours that can lead to smoking, and this protection may diminish over time,” she said.

In addition, school difficulties increase the risk of becoming a smoker because they are related to dropping out of school and, seeking employment in workplaces where smoking rates are higher. Finally, since young people are more likely to frequent places where they can consume alcohol, they are more prone to be influenced by smokers, or at least be more easily tempted.

“Since alcohol reduces inhibitions and self-control, it is an important risk factor for beginning to smoke,” warns O'Loughlin. Smoking prevention campaigns usually target teenagers because studies show that people usually begin to smoke at age of 12 or 13. The phenomenon is well known, and numerous prevention programs are geared toward teenagers. “Our study indicates that it is also important to address prevention among young adults, especially because advertizing campaigns of tobacco companies specifically target this group,” says O'Loughlin.

“This is particularly important because if we can prevent smoking onset among young adults, the likelihood that they will never become smokers is high,” she says.

– Medicalxpress

Social breaks help workers cope with workplace stress

Coffee breaks are an important part of workplace culture as they provide a crucial coping mechanism for stressful work, according to new research from Symbolic Interaction . A group of public workers in Denmark were studied after a large-scale merger. The study found that the stress from their jobs and the merger was relieved by forming “communities of coping” during coffee breaks with coworkers.

These communities allowed for social interaction with fellow employees, allowing them to share both professional opinions and personal frustrations with their work. However, the study also found that these communities were difficult for a newcomer to enter due to their informal nature.

“Coffee breaks should not be considered a ‘waste’ of productivity,” said Dr. Pernille Stroebaek from the University of Copenhagen. “Coffee breaks have important social, and potentially monetary, value for organisations.

Coffee breaks should be treated as communal practices that allow communities of coping to develop.”

- MNT