September 21 of every year is a day on which Alzheimer’s organizations around the world concentrate their efforts on raising awareness about Alzheimer’s and dementia. Alzheimer’s disease is the most common form of dementia, a group of disorders that impairs mental functioning. Every 68 seconds, someone develops Alzheimer’s disease. At current rates, experts believe the number of Americans living with Alzheimer’s will quadruple to as many as 16 million by the year 2050 (The Fisher Center for Alzheimer’s Research Foundation, 2016). The theme for 2016 campaign is REMEMBER ME, a campaign to raise awareness and challenge stigma.
Alzheimer’s disease is often called a family disease, because the chronic stress of watching a loved one slowly decline affects everyone (The Fisher Center for Alzheimer’s Research Foundation, 2016). It is named after a German physician, Alois Alzheimer, who first described it in the early 20th century. It has rapidly emerged as a major public health issue throughout the world. The cost of caring for those afflicted is enormous and most probably beyond the capability of most developing countries including Nigeria (Salawu, Umar and Olokoba, 2011).
What is Alzheimer’s disease?
According to Alzheimer’s Foundation of America (2016), Alzheimer’s disease is a progressive, degenerative disorder that attacks the brain’s nerve cell, or neurons, resulting in loss of memory, thinking and language skills, and behavioural changes. It is the most common cause of dementia, or loss of intellectual function among people aged 65 and older.
More than 25 million people in the world today are affected by dementia, most suffering from Alzheimer’s disease. In both developed and developing nations, Alzheimer’s disease has had tremendous impact on the affected individuals, caregivers, and society (Qiu, Kivipelto and Strauss, 2009).
The rates of dementia differ greatly around the world, from the lowest rates in Africa, India, and South Asia, to the highest rates in Western Europe and especially North America. The incidence of dementia and Alzheimer’s disease is significantly lower for Africans in Nigeria than for African Americans in Indianapolis, for example—up to five times lower.When people move from their homeland to the United States, Alzheimer’s rates can increase dramatically. Therefore, when Africans or Asians live in the United States and adopt a Western diet, their increase in Alzheimer’s risk suggests that it’s not genetics (Greger, 2015).
Alzheimer’s Association (2016) highlighted the risk factors for Alzheimer’s as follow:
Age: Although Alzheimer’s is not a normal part of growing older, the greatest risk factor for the disease is increasing age. After age 65, the risk of Alzheimer’s doubles every five years and after age 85, the risk reaches nearly 50 percent.
Family history: Research has shown that those who have a parent, brother, sister or child with Alzheimer’s are more likely to develop the disease. The risk increases if more than one family member has the illness. When diseases tend to run in families, either heredity (genetics) or environmental factors or both may play a role.
Genetics: There are two categories of genes that influence whether a person develops a disease: risk genes and deterministic genes. Researchers have found several genes that increase the risk of Alzheimer’s. APOE-e4 is the first risk gene identified, and remains the gene with strongest impact on risk. Deterministic genes directly cause a disease, guaranteeing that anyone who inherits one will develop a disorder. Scientists have found rare genes that cause Alzheimer’s in only a few hundred extended families worldwide.
Nevertheless, increasing evidence strongly points to the potential risk roles of vascular risk factors and disorders (eg, cigarette smoking, midlife high blood pressure and obesity, diabetes, and cerebrovascular lesions) and the possible beneficial roles of psychosocial factors (eg, high education, active social engagement, physical exercise, and mentally stimulating activity) in the pathogenetic process and clinical manifestation of the dementing disorders (Qiu, Kivipelto and Strauss, 2009).
The most striking early symptom of Alzheimer’s disease is the loss of memory (amnesia), which usually manifests as minor forgetfulness that becomes steadily more pronounced with the progression of the illness, with relative preservation of older memories. As the disorder progresses, cognitive (intellectual) impairment extends to the domains of language (aphasia), skilled movements (apraxia), recognition (agnosia), and those functions closely related to the frontal and temporal lobes of the brain (such as decision-making and planning) as they become disconnected from the limbic system, reflecting extension of the underlying pathological process (Bhat, 2011).
How is Alzheimer’s disease managed?
According to Geriatric Mental Health Foundation (n.d.)., the primary goals of treatment for individuals with AD is to improve the quality of life of the patient and caregiver as well as maximize functional performance by enhancing cognition, mood, and behavior. Treatments include pharmacological and non-pharmacological approaches.
Ensuring that someone with AD feels mentally and physically secure is an important and meaningful part of care giving. People with AD need help minimizing confusion and maintain a sense of stability and comfort in their lives. Establishing a daily routine in familiar surroundings is one way to help.
It is also important to provide nutrious meals on a regular schedule for optimal health. Keeping patients in touch with family and friends and reminding them of past memories, current events, and important dates are good mental exercises.
Several drugs have been developed to alleviate some of the cognitive as well as the behavioral symptoms of AD. Pharmacological treatments for the cognitive symptoms includes: drugs such as tacrine (cognex), donepezil (Aricept) and rivastigmine (Exelon). These agents may also have beneficial effects on behavioral symptoms in some patients and prolonged therapy may delay nursing home placement. Clinical trials of other agents to improve cognitive function are ongoing.
Treatment of behavioral and mood changes is also critical as these symptoms can be dangerous to both the patient and the caregiver. Co-morbid conditions associated with AD are common and treatable. They include AD with delirium, AD with depression, and AD with delusions.
In addition, many patients developed agitated or aggressive behaviors. All of these conditions can lead to functional disability.
Antipsychotic drugs can produce a modest improvement in some behavioral symptoms in dementia such as risperidone, olanzapine, quetiapine, oxazepam, lorazepam, fluphenazine, haloperidol, thloridazine, and clozapine.
People with AD should visit their physician on a regular basis.
According to Bhat (2011), Alzheimer’s disease can be prevented in the following ways:
- Intellectual stimulation (e.g., playing chess or doing crosswords
- Regular physical exercise
- Regular social interaction
- Cholesterol-lowering drugs (statins) reduce Alzheimer’s risk in observational studies but so far not in randomized controlled trials
- Long-term usage of non-steroidal anti-inflammatory drugs (NSAIDs), used to reduce joint inflammation and pain, is associated with a reduced likelihood of developing AD, according to some observational studies.
Alzheimer’s Association (2016). What we know today about Alzheimer’s disease. Retrieved from http://www.alz.org/research/science/alzheimers_disease_causes.asp
Alzheimer’s Foundation of America (2016). About Alzheimer’s disease. Retrieved from http://www.alzfdn.org/AboutAlzheimers/definition.html
Bhat, S. P. (2011). Alzheimer’s disease – Clinical features, diagnosis and treatment. Retrieved from http://www.positivehealth.com/article_favorites/add/2972
Geriatric Mental Health Foundation (n.d.). Alzheimer’s and related dementias. Retrieved from http://www.aagponline.org/index.php?src=gendocs&ref=Dementia_factsheet&category=Foundation#backtotop
Greger, M. (2015). Where are the lowest rates of Alzheimer’s in the world? Retrieved from http://nutritionfacts.org/2015/11/12/where-are-the-lowest-rates-of-alzheimers-in-the-world
Qiu, C., Kivipelto, M. & Strauss, E. (2009). Epidemiology of Alzheimer’s disease: Occurrence, determinants, and strategies toward intervention. Dialogues Clinical Neuroscience, 11 (2). Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181909
Salawu, F. K., Umar, J. T. & Olokoba, A. B. (2011). Alzheimer’s disease: A review of recent developments. Annals of African Medicine, 10 (2).
The Fisher Center for Alzheimer’s Research Foundation (2016). World Alzheimer’s day: September 21. Retrieved from https://www.alzinfo.org/articles/world-alzheimers-day/
Agbonze, Peter O.
Faleti, Daniel D.
For: Institute of Nursing Research, Fellowship of Christian Nurses, South West Zone, Nigeria