DEMENTIA AND ALZHEIMER’S DISEASE
Imagine a scenario, where your spouse of the past 50 years is unable to recognize you or other family members. He or she sits in a corner with a blank stare, disinterested to eat, speak or bathe. At times the person just walks out of the door and gets lost in the street, and you must search and bring the person back home. The neighbors advise you to be more careful. These are not imaginations, but can really happen to anyone when dementia sets in. About 50 million people worldwide have dementia and the number is expected to rise.
People sometimes ask: Is dementia and Alzheimer’s disease one and the same. If not, what is the difference?
Dementia and Alzheimer's disease are related but not the same. Dementia is an umbrella term that describes a set of cognitive impairments that interfere with a person's ability to perform daily activities and interact with others. Alzheimer's disease is one of the specific disorders that can cause dementia.
In dementia, there is a progressive decline in cognitive function, that leads to memory loss, impairment of reasoning, problem-solving, language and judgment, resulting in disorientation, difficulty with communication, personality changes and inability to perform daily activities. Dementia is not a specific disease but a syndrome that ensues from various underlying causes. It can stem from various conditions, including Alzheimer's disease, vascular dementia, Lewy body dementia, frontotemporal dementia and other factors.
Alzheimer's disease is named after a German physician by name Alois Alzheimer who described the condition in detail in 1906, after following patients with the symptoms for many years. It is a specific disorder accounting for a significant portion of dementia cases. Underlying cause is accumulation of abnormal protein deposits (amyloid plaques and tau tangles) in the brain, which lead to gradual destruction of brain cells and cognitive decline. About 25% of cases can be due to genetic transmission, with certain chromosomal abnormalities.
Diagnosis is mostly by the symptoms noticed by the family, neighbors and the patient. Careful history will reveal episodes of memory loss, confusion and language problems. Blood tests and CT scan or MRI of brain are done mostly to rule out other neurological disorders. Slight reduction in size of hippocampus part of brain is noted and PET scan shows enlargement of ventricles with consequential reduction in brain volume. Cognitive tests to evaluate cognitive and mental status are performed for further verification. It is not uncommon for older individuals to have mild cognitive impairment (MCI) with some loss of memory and slow response to questions. Early onset of dementia is often ignored because of this. Onset in the 60s is likely to be Alzheimer’s disease. Late onset in the 80s is likely to be dementia-related other causes.
The treatment of dementia depends on the underlying cause. In some cases, dementia may be reversible if the core reasons such as medication side effects or nutritional deficiencies are addressed. However, many forms of dementia, including Alzheimer's disease, have no cure, and treatment focuses on managing symptoms and improving the individual's quality of life.
Studies show lifestyle changes can delay the onset of Alzheimer’s disease. Attention to diet, physical exercise, cognitive activities and social engagement are known to be beneficial. The Mediterranean diet of vegetables, fruits, nuts, legume, beans, avocados, pulses, fish and whole grain is considered appropriate. Alcohol and smoking are avoided. Regular exercises and walking, and socialization is useful. Cognitive activities such as reading, writing, and board or card games are helpful. Mind-altering drugs or medications are avoided. Adequate sleep is beneficial.
There is no cure for Alzheimer's disease, but various medications and interventions are available to manage symptoms, improve cognitive function, and enhance the quality of life. Standard medications are Aricept (Donepezil), Razadyne (Galantamine) or Namenda. Newer medications are monoclonal antibodies. More recently, FDA approved Lecanemab (Leqembi) as useful in delaying the progression of Alzheimer’s disease, if started early on. This and other similar monoclonal antibodies such as Donanemab and aducanumab target the harmful amyloid proteins reducing the plaque formation.
Advanced dementia needs special attention and constant care. Patients can neglect themselves in personal care, nutrition or health care or may not remember their own information or recognize friends and family. They can wander away, get lost and disappear. Risk of accidents, injuries are high. A caregiver must be supervising the patients constantly for safety. Caregivers are to avoid confrontations and arguments by understanding that these individuals have lost independent decision-making skills. Caregivers are advised to maintain routines and familiarity as much as possible to reduce the number of options/choices and avoid asking questions. Just tell the patients what to do next since there is no comprehension of logic/reason.
Caregiving needs much empathy and patience. The worst we can do is to chain the patients, lock them up or abuse or neglect, or place them in a mental asylum, calling them insane or psychotic. Sad to say, that was the way they were treated for many years in the past before we understood of the disorder better.
Dr. Venkit S. Iyer, MD, FACS, is a retired General and Vascular Surgeon. He has authored four books – “Decision making in clinical surgery,” “Aging well and reaching beyond,” “The Clinic” and “Geriatrics Handbook.” They are available through Amazon or from the author. His website venkitiyer.com has necessary links and contact information.
Editor’s Note: Khaas Baat sincerely thanks Dr. Ravindra Nathan for his valuablecontributions through his monthly health column starting with our first year of publication.
EYE CARE
Diwali Eye Safety: Protecting Sight during the Festival of Lights
As the enchanting festival of Diwali approaches, the vibrant celebrations and dazzling fireworks become the focal point of the festivities. While Diwali is a time for joy and togetherness, it's crucial to be mindful of potential eye safety hazards that accompany the grandeur of the annual event. In this article, we delve into the medical and health aspects of ensuring eye safety during the Festival of Lights.
Eye safety amidst the fireworks
The resplendent fireworks displays that light up the Diwali night sky are a sight to behold. However, they come with inherent risks to eye health. To protect your vision during these dazzling displays:
a. Maintain a safe distance: It's essential to stand at a safe distance from the fireworks to avoid potential eye injuries from flying debris.
b. Wear protective eyewear: Certified safety glasses or goggles offer a robust defense against sparks and debris, significantly reducing the risk of eye injuries.
c. Leave it to the experts: For those unfamiliar with handling fireworks, it is advisable to leave this to the experts or responsible adults who can ensure safe practices.
d. Prompt medical attention: If an eye injury occurs due to fireworks, it's crucial to rinse the eye gently with clean water and seek immediate medical attention. Avoid any rubbing or applying pressure to the injured eye.
Candle and diya safety
The traditional lighting of diyas and candles is a heartwarming Diwali tradition, but it's essential to be cautious to prevent eye injuries:
a. Secure placement: Ensure that diyas and candles are placed in stable containers to prevent accidental tipping, which could lead to burns or fires.
b. Minimize fire hazards: Position diyas and candles away from flammable materials like curtains and tablecloths to reduce the risk of fires.
c. Use candle golders: Candle holders not only add to the aesthetics but also prevent wax spills and the potential for burn injuries.
d. Supervised use: Do not leave candles or diyas unattended, especially if children or pets are in the vicinity. Always extinguish them properly before leaving the area.
Air quality concerns
Diwali's extensive use of fireworks can have significant consequences for air quality, indirectly affecting eye health. Smoke, dust and pollutants in the air can lead to eye irritation and discomfort.
a. Limit outdoor exposure: During peak firework hours, consider reducing outdoor activities when air quality deteriorates.
b. Air purification: The use of air purifiers can mitigate indoor air pollution, creating a safer environment for the eyes.
c. Lubricating eye dops: Over-the-counter lubricating eye drops can provide relief from eye irritation caused by airborne pollutants.
Child eye safety
Children are particularly vulnerable to eye injuries during Diwali, given their curiosity and limited awareness of potential risks. Ensuring their eye safety is paramount:
a. Constant supervision: Always closely supervise children around fireworks, candles and diyas to prevent accidents.
b. Education: Educate your children about the potential dangers of fireworks and the importance of eye safety.
c. Child-appropriate eye protection: Ensure that children participating in firework activities wear suitable eye protection that fits their age and size.