Tomorrow is World Alzheimer's Day:
When memory dies...
With an increasing ageing population, Sri Lanka is
likely to have more patients being diagnosed with Alzheimer's Disease
Memory loss is now an increasingly common brain related condition
worldwide. Recent reports reveal how once vibrant, self reliant persons,
have been reduced to total dependency, requiring help for even simple
daily chores such as using the toilet, brushing their teeth, or eating.
Although on-going research studies have shown promising results, curing
Alzheimers however remains an elusive dream.
Dr. Harsha Gunesekara
Consultant Neurologist, Sri Jayawardenepura Hospital, Dr. Harsha
Gunesekara discusses treatment options available to Lankan patients in
this interview with the Sunday Observer.
Q: The number of Alzheimer patients, seem to have risen
dramatically in recent years. What contributes to this?
A: The most important reason for this is the increase in the
ageing population, which could also be seen in developing countries like
Sri Lanka, as the greatest known risk factor for Alzheimer's Disease
(AD) is advancing age. So it is likely that more patients with AD will
be detected. Improved awareness of the disease among the public also
contributes to increased detection of patients.
Q: Dementia and Alzheimer's - are they the same thing?
A: Dementia is a group of symptoms characterized 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: Are there different types of dementia and Alzheimer's?
A:The other common types of dementia include Vascular Dementia
(decline in memory skills caused by conditions that block or reduce
blood flow to the brain), Fronto-temporal Dementia (caused by
progressive nerve cell loss in the brain's frontal lobes - the areas
behind your forehead and its temporal lobes - the regions behind your
ears) and dementia associated with other diseases such as Parkinson's.
More than one type of dementia may exist in the same person (mixed
Q: What are the main causes for Alzheimer's?
A: Most experts believe that the majority of Alzheimer's
Disease occurs as a result of complex interactions among genes and other
risk factors. Age, family history and heredity are all risk factors we
can't change. Now, research is beginning to reveal clues about other
risk factors we may be able to influence through general lifestyle and
wellness choices and effective management of other health conditions.
Growing evidence links brain health to heart health. The risk of
developing Alzheimer's or vascular dementia also appears to increase
when certain pre- conditions damage the heart or blood vessels, such as
high blood pressure, heart disease, stroke, diabetes and high
cholesterol. Studies have found an association between lifelong
involvement in mentally and socially stimulating activities and reduced
risk of Alzheimer's disease. These include higher levels of formal
education, a stimulating job, mentally challenging leisure activities,
such as reading, playing games or playing a musical instrument and
frequent social interactions.
Q: Who are most at risk of Alzheimer's?
A: The likelihood of developing Alzheimer's doubles about
every five years after age 65. After the age of 85 years, the risk
reaches nearly 50 percent. People with rare genetic changes may develop
Alzheimer's symptoms as early as in their 30s.
Q: Symptoms to look for?
A new ad campaign, shot by Tom Hussey, captures the
confusion Alzheimer sufferers may endure - fullym.
A: A common symptom is memory loss, especially forgetting
recently learned information. Others include forgetting important dates
or events and asking for the same information repeatedly. Some people
may experience changes in their ability to develop and follow a plan
(e.g. a recipe) or work with numbers (e.g. bills).
Apathy and depression are also often early symptoms. Late symptoms
include impaired communication, poor judgment, disorientation,
confusion, behavioural changes and difficulty speaking, swallowing and
Q: How early do they present?
A: Pathological changes in the brain probably start 10-20
years before any visible signs or symptoms of the disease appear. Memory
loss, the first visible sign, is the main feature of mild cognitive
Q: Can Alzheimer's be treated?
A: Currently there is no cure for Alzheimer's Disease.
However, some drugs may help delay the progression of symptoms
associated with the 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 procedure in Sri Lanka?
A: The first step in the process is to diagnose AD. There is
no single test that can show whether a person has AD or not. While
doctors can almost always determine if a person has dementia, it may be
difficult to determine the exact cause. Diagnosing Alzheimer's requires
careful medical evaluation and tests (such as blood tests and brain
imaging) to rule out other causes of dementia-like symptoms. Among drugs
recommended for treatment in AD, only two drugs are available in Sri
Lanka. These drugs are recommended only for mild to moderate disease.
Q: What are the most positive/negative outcomes of such
A: As AD progresses, brain cells die and connections among
cells are lost, causing symptoms to worsen. While current medications
cannot stop the damage AD causes to brain cells, they may help lessen or
stabilize symptoms for a limited time by affecting certain chemicals
involved in carrying messages among the brain's nerve cells.
Q: Can certain foods delay onset of Alzheimer's?
A. Strongest evidence for antioxidant protection against
Alzheimer's Disease rests with high food intake of vitamin E. The
richest food sources of vitamin E include vegetable oils, margarine,
nuts (especially almonds), and seeds (especially sunflower seeds).
Moderate amounts of vitamin E are found in whole grains, egg yolk, and a
limited number of vegetables (eg, cabbage, broccoli) and fruits (eg,
avocados, apples, melon).
Q: Is there a genetic link to Alzheimer's?
A: 95% of patients have sporadic AD (without a family history
and onset after 65 years) and their family members are not at increased
risk of developing AD.
The most common gene associated with late-onset Alzheimer's disease
is called apolipoprotein E (APOE). Presence of this gene increases the
risk of AD but does not cause AD. 5% 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.
Q: What part of the brain is most vulnerable?
A: Alzheimer's Disease damages and kills brain cells. Early in
the disease, destruction of neurons is particularly widespread in parts
of the brain that control memory, especially the hippocampus (this is in
the area marked as memory in the diagram comparing normal and brain
affected by AD).
Providing the needed
The Lanka Alzheimer's Foundation, through
its modernized centre at Ketawalamulla lane, at Maradana,
provides day care and rehabilitation, mind and brain
stimulating activities to dementia patients to give care
givers time to engage in other activities. Founding
Executive Director & President Lanka Alzheimer's Foundation
(LAF), Lorraine Yu says the centre also conducts lectures by
experts, for caregivers who list communication problems as
one of their greatest challenge when interacting with
Alzheimer's patients, and raises awareness about the disease
with its annual walks, on Alzheimer's Day in which thousands
of people participate. "There will be one this month as
well" she says.
The other part of the brain that sustains major damage is the
cerebral cortex, particularly the areas responsible for language,
reasoning, perception, and judgment (the temporal, frontal, and parietal
Q: Does alcohol and smoking aggravate Alzheimer's?
A: Smoking and alcohol abuse are indirectly linked risk
factors for AD.
Q: What new breakthroughs or advances have there been in
A: Several clinical trials of investigational drugs targeting
the disease process are underway. In addition to investigating these
experimental drugs, many clinical trials are in progress to find various
brain imaging studies and testing of blood or spinal fluid for a
biomarker to diagnose Alzheimer's Disease in its earliest, most
treatable stages - possibly even before symptoms appear. Several
professional organizations have published updated guidelines on
management of AD and are available for use locally.
Q: What are the gaps in treating Alzheimer patients in Sri
A: Patients with AD should be managed by a multidisciplinary
team including Neurologists, Psychiatrists, Neuropsychologists,
Specialist Nurses, Occupational Therapists, Social Workers and Care
Givers. Non-availability of new drugs and treatment cost are some
From a diagnostic and monitoring point of view, lack of
Neuropsychologists in the country is a major problem in managing
patients with AD. Patients own family members or relatives are the main
care givers in Sri Lankan society. At present, the biggest burden on the
health sector is from diseases affecting the elderly. Out of this,
Stroke and Dementia (of which 60% is Alzheimer's) are the commonest, and
impose a major burden on the family members as care givers.
Q. Does your hospital have any plans to meet these challenges?
Does the Health Ministry?
A:The emerging threat of health issues concerning a rising
elderly population has been foreseen by the Health Authorities in many
countries including Ministry of Health in Sri Lanka. Strategies are
already underway to meet this threat in terms of both prevention and
care, but a lot more needs to be done. Non-communicable diseases (NCD)
unit of the Ministry has set up island wide NCD prevention clinics
National Organizations such as Stroke Association and Alzheimer
Society needs to carry on awareness programs on promoting brain health
among the public.
Furthermore, Geriatrics (Care of the Elderly) needs to be recognized
as a medical sub specialty (a diploma programme has already been started
by the Postgraduate Institute of Medicine). Some hospitals (including
Sri Jayewardenepura General Hospital) have started special clinics for