by Dr. Makini McGuire-Brown
At the first sign of forgetfulness, many state some variation of the “I’m getting old” statement. While the majority of, I forgot what I came into the room for, forgetful moments are not because of age, some are! Decline of cognitive function, that which allows our brain to obtain, interpret, remember and analyse information, does decline with age, naturally. When this natural process of decline is accelerated through pathological means, this is called dementia.
The pathology that accelerates the process may vary, giving rise to different types of dementia. Some get dementia after years of unhealthy blood vessels causing mini strokes in the brain, this is called vascular dementia. Some however get dementia, from abnormal protein deposits that disrupt the neurons, the nerve cells of the brain, and this type of dementia is called Alzheimer’s disease, named after the scientist that discovered it. What causes a person to develop abnormal deposits is mostly unclear. Although research on Alzheimer’s encourages good physical health, and avoiding things like high blood pressure and high blood sugars, Alzheimer’s has a lot to do with age, genetics and family history, none of which we can control. Alzheimer’s is a progressively deteriorating disease and so, a diagnosis of Alzheimer’s therefore can evoke a feeling of hopelessness. It is therefore the responsibility of all of us to educate ourselves as much as we can to be the much needed support to those diagnosed.
First step to being able to offer support is to understand the illness and its progression. Incidence rates vary by country and can be as low as 1% worldwide at around age 65, but increasing age increases the chance of dementia, with rates as high as 39% over age 90. Alzheimer’s is the most common cause of dementia. The disease affects the deep memory centres of the brain first, such as the hippocampus, and then progress to affecting the frontal regions which are heavily involved in thinking, analysing and decision-making. This leads to the characteristic symptoms of memory loss and an ever decreasing ability to perform the activities of daily living.
Our neurons, nerve cells of the brain, help us to think, analyse, remember, make decisions, move, and use all of our senses through a combination of electric impulses and chemicals or hormones called neurotransmitters. These impulses and transmitters travel efficiently through an intricate structural network inside of the neuron. In Alzheimer’s disease, abnormal protein deposits and tangled neural fibres destroy this efficient infrastructure and this leads to the dysfunctional neurons that cause the symptoms of the disease and as dysfunction progresses to cell death, so too does the disease progress and become fatal. There is no way of knowing currently if you will get these abnormal deposits and tangles, no way known to prevent it and no cure. Getting Alzheimer’s is no one’s fault.
While treatment involves medication that helps increase the level of different neurotransmitters to help them overcome the faulty infrastructure and still be able to do their work, and exercises to challenge cognition are paramount, support remains the most important thing that one can give to someone with Alzheimer’s disease. Allow them to live, enjoy their hobbies, and respect their contributions while keeping them safe with memory aids, driving support, financial management support and eventually probably round the clock personal aid support for all activities of daily living. We should never believe that they don’t have desires and can’t think for themselves but instead listen, and guide toward to safest decision because we understand the limitations of their decision making ability.
Alzheimer’s can cause changes from memory loss of activity through to people, loss of language, analytic and numeric ability, straight through to paranoia, delusions, aggressive behaviour, loss of bowel and bladder control and eventual death. We know that their neurons are being progressively damaged and so they cannot control it. It is our job to adapt and support in the best way we can.
I hope this reminds us of the heavy burden that those with Alzheimer’s disease and their families carry and encourages us lend support whenever and however we can. Lest we forget!