Garth Rattray
A FRIEND of mine had been taking Ginkgo Biloba for years in an effort to enhance his memory and combat mental fatigue, yet, one day he said to me, "Garth, that thing that I'm taking for my memory, what's it called again?" Everyone suffers the occasional 'senior moment' but dementia is an entirely different affair.
Dementia is a long-term, progressive brain dysfunction leading to increasing restriction in activities of daily living (ADL). The most well-known and common cause of dementia is Alzheimer's disease (AD). It affects the parts of the brain that control memory, thinking, behaviour, language and emotion. AD is devastating because it makes victims of those afflicted with the disease and their caretakers.
The greatest risk factor for AD is age, followed by a family history of the disease. The number of elderly people in society is growing, just about seven per cent of Jamaicans are over 65 years of age, and our life expectancy is currently 74.23 years for males and 78.45 years for females. Consequently, AD (which is associated with, but not necessarily caused by ageing) is on the rise. There are no figures for Jamaica but the incidence in the U.S.A. (and most likely here also) is about one per cent of 60-year-olds and 30 per cent (some say 50 per cent) of 85-year-olds.
PRODUCTION AND ACCUMULATION
In AD there is production and accumulation of a destructive amyloid protein in the brain along with plaques, tangles and cell death. The disease cannot be cured but some suggest that we can try to stave it off with high doses of vitamins E and C, along with good control of our cholesterol and blood pressure and increased physical, mental and social activities.
The diagnosis of AD is classified as 'definite' (requiring a clinical diagnosis and post mortem confirmation), 'probable' (typical clinical AD features but no post mortem confirmation) or 'possible' (atypical clinical AD features but with no other apparent diagnosis and no post-mortem confirmation). Classic features of AD are amnesia (first short then long-term memory loss), reduction in communication skills, visiospatial deficits, ADL decline, severe mood swings, psychosis and agitation. Motor and sensory abnormalities, gait disturbances, and (possibly) seizures are late manifestations. Intensive investigations must be done to rule out the many other causes of dementia (from toxins, chemical/endocrine imbalances in the blood and STIs to brain tumours or bleeds). High-tech brain scans may help to give a probable diagnosis of AD.
MISSING MILD DEMENTIA
Because family members and physicians have a 97 per cent chance of missing mild dementia and a 50 per cent chance of missing moderate dementia, treatment for AD is often started late and therefore not as effective as it should be. There is no cure, so available treatment is aimed at retarding the progression of AD. If started early, approved drugs like Aricept, Cognex, Exelon and Reminyl will most likely help. Namenda may help in moderate to severe cases. Other treatments are aimed at addressing agitation, insomnia, anxiety, wandering, depression and aggressiveness. On average, patients live for 8 to 10 years after AD is diagnosed although some report patients living for up to 20 years.
NAMED
The disease got its name from German physician, Dr. Alois Alzheimer (1915). In 1906, he discovered (at post mortem) cellular changes in the brain of his 51-year-old female patient who died from 'a peculiar disease of the cerbral cortex' (as he put it).
Alzheimer's mentor, Emil Kraepelin, was the first to use "Alzheimer's disease" in his textbook on mental illness. World Alzheimer's Day is observed on September 21 each year because it was first launched at the opening of Alzheimer's Disease International's annual conference in Edinburgh on September 21, 1994 to celebrate their 10th anniversary.
Tomorrow, all 69 Alzheimer associations worldwide will attempt to raise awareness about dementia. This year's theme is 'We can make a difference'. Jamaica has no Alzheimer's association but is in dire need of one. We too can make a difference by agitating for caretaker support groups and fitting institutions where any Alzheimer's victim (rich or poor) can be housed and cared for by professionals, voluntary workers and people sentenced to 'community service' by the courts.
Dr. Garth Rattray is a medical doctor with a family practice.
