Lost memories in the forest of the Mind

 

Written by Dr. Arun Bhat P., Consultant Psychiatrist
Read time - 5 minutes

            Every year on September 21, we celebrate World Alzheimer's Day in order to create awareness, reduce stigma, and clear the misconceptions associated with Alzheimer’s Dementia. Dementia consists of a broad group of illnesses, of which Alzheimer’s dementia is also one and the most common. It is a chronic, slowly progressing illness that leads to the loss of many cognitive functions along with memory disturbances.

Here's how people with dementia typically present to the clinic. An elderly couple in their 70s came to me for a consultation. The distressed wife recounted her sorrows like this: "Nowadays there is a significant change in my husband’s behaviour. I thought it was age-related forgetfulness at first. But it is much more severe, and it is gradually worsening. He keeps forgetting any new information. Within a few minutes of having food, he complains that I don’t give him any food. He goes to the toilet repeatedly, claiming he has not passed stools or urine. Although he retired as a school teacher a long time ago, he would get ready as if he had to go to work and go out of the house. He would end up losing his way back home, and while roaming, some local familiar people would bring him back home. He doesn’t recognise his relatives and calls them different names. He behaves rudely with people. He would doubt me and accuse me of stealing his money, and he would verbally abuse me. He's been acting like a small child lately.

This illness places a significant burden not only on the carer but also on the country's society, growth, and economy. According to the 2015 census, in the whole world, there are around 4.8 crore people suffering from this illness, and by 2050, it is estimated to cross 13 crore. This illness claimed the lives of approximately 13 lakh people in 2013. 

Alzheimer's disease, along with memory dysfunction, affects other cognitive functions as well. As cognitive functions deteriorate, the affected individual has difficulty remembering recent events, recognising faces, identifying objects, inability to use common household items, mispronouncing words and sentences, deterioration of self-care, difficulty doing daily activities, suspiciousness, anger, irritability, use of abusive language, assaultive behavior, sleep deprivation, and hoarding unwanted waste (paper pieces, stones, and glass shards). As the illness progresses, the person will lose the ability to fully communicate, develop urinary and faecal incontinence, and become bedridden. 

What are the risk factors for this illness? Is there a way to prevent this illness? There is no single correct answer to what causes this illness. But research has shown that regular exercise, managing a healthy weight, eating a balanced diet, abstaining from alcohol and tobacco, reducing LDL cholesterol levels, learning multiple languages, and regular mental exercises in the form of puzzles, crosswords, music, and dance can delay or even prevent this illness. 

Because of the impairment in neurotransmitters and the deposition of unwanted proteins, neurons (nerve cells) slowly degenerate and the illness worsens. Hence, there is no definitive cure for this illness. However, some medications have been shown to slow the progression of this illness, improve quality of life, and increase the affected individual's life expectancy. Also, some medications can help control behavioural problems like suspiciousness, anger, etc. At the same time, some changes in the environment in which the individual lives have to be considered. The place where the individual lives should be familiar and calm in order to prevent a "Catastrophic reaction". Communication should be non-provocative and clear. All household items should be clearly labeled; keep an identity card with address inside the pocket; wear easy-to-put-on clothes; use adult diapers; and educate the neighbourhood about the patient and his or her condition. By taking these steps, managing the patient becomes easier, and the burden on carers becomes less. "Reminiscence therapy" (discussing about past events and people with the help of photographs), listening to favourite songs, and encouraging the person to recollect old events can prevent old memories from fading away. Alzheimer’s disease causes a heavy burden on the patient and the caregiver, but timely treatment, tender loving care, and patience can improve the quality of life of the patient and reduce the caregiver's burden immensely.