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ALZHEIMER’S DEMENTIA

Updated: May 20, 2020



INTRODUCTION-

You might have seen or heard stories of old people who are declared missing by their children or caregivers. Usually, they leave home unaccompanied for an evening stroll, or to visit friends, but did not return home. Typically, these senior citizens get confused, miss the routes and turns to their homes/destination and find themselves in a different place than intended. And when questions like “where they are going to or coming from or the phone number of someone that could be reached to come pick them up” are asked, they are unable to give the right answers. This is not deliberate; it is because they cannot remember! In some situations, these elderly individuals are wearing tattered clothing, are unkempt, hungry looking and are not oriented to time or the day. For a society that thrives on sensationalism and love to spin tales, these helpless individuals with no memory of who they are or who to call, end up being labelled as witches or wizards who are suffering the repercussion of their evil deeds. Wait for it…. “they dropped from the sky in bird form and transformed into the old person”.


Wandering, loss of memory, lack of orientation in time, place and person, decline in personal

hygiene, etc. are symptoms of Dementia due to Alzheimer’s disease.


WHAT IS ALZHEIMER’S DEMENTIA?

Alzheimer’s disease is the most common form of degenerative neuro-psychiatric disease

affecting elderly people (>65 years) among other types of dementias. It is a neurocognitive disorder characterized by progressive and gradual decline in cognition. Common impairments are found in memory, orientation, judgement, and reasoning. Individuals with Alzheimer’s dementia do not have the ability to learn new information. Important events are forgotten, as well as position, or the existence of objects. They tend to lose interest in people which leads to a more withdrawn disposition. As a progression in the disorder occurs, they show more signs of agitation, apathy, confusion, depression, anxiety, or physical aggression. Disorientation to time, place and person, will in time, affect their daily schedule, meetings and functioning.

HOW COMMON IS ALZHEIMER’S DISEASE?

Globally, it is estimated that about 47.5 million individuals are living with dementia. The

prevalence of all Dementias increases with age. This can be explained as 1% of individuals

diagnosed with Alzheimer’s are 65 years, 10% at 80 years and 40% at 90 years and older.

Studies carried out in Nigeria reported low prevalence of 2.4 % among individuals aged 65 years and above, and 1.9% among those aged 60 years and above. This may not be unrelated to under reportage of these conditions in Nigeria.


CAUSES OF ALZHEIMER’S DISEASE.

Alzheimer’s disease is a pathology in the aging process, which often leads to improper care and sometimes of abuse of individuals that manifest this disorder. The development of the disorder can be attributed to three major factors: Age, Genetics and Environment.

  • The genetic factors include mutations of genes, which then run in the families.

  • According to researchers, lifestyle choices and factors such as low educational attainment, diabetes mellitus, depression, physical and mental inactivity could be associated with dementia, especially Alzheimer’s disease.

  • Increasing Age is associated with the development of Alzheimer’s disease.

PROGRESSION OF ALZHEIMER’S DEMENTIA

Alzheimer’s disease shows a gradual progression in decline in cognitive functioning. The age of onset cannot be accurately determined, as the disease starts, with slow development over many years, and develops into severe dementia and death. The mean age of onset for early Alzheimer’s disease is between 50-60, and with the disease lasting between 5-8 years, ending with death of the individual. Shorter survival of individuals with Alzheimer’s dementia is attributed to a later age of onset which brings about a rapid decline in cognitive abilities. Individuals with early onset, are more likely to survive the full course of the disease, in comparison to the later onset, who might have other medical conditions in addition to the disorder.


SYMPTOMS OF ALZHEIMER’S DISEASE

As noted earlier, the first symptom of Alzheimer’s disease is attributed to memory, as the individual tends to forget new information, events or people. Other symptoms include:

  • Decline in overall use of language (finding words, naming objects, recognizing people, inability to construct sentences which makes passing instructions difficult).

  • Changes in behavior and personality are common, as these new behaviors, are of concern to individuals around.

  • They usually suffer sleep problems, may wake up at mid-night disturbed, confused and attempting to leave the house.

  • The individual also tends to be disorganized, as they cannot organize schedules and meeting with people and misplace their belongings often.

  • Individuals may often experience depression, hallucination and delusions.

  • Physical and verbal aggression may be a new finding in them, especially in situations that involve personal care.

  • Wandering off into unknown, and often dangerous environments.

  • Change in weight due to overeating or undereating.

  • Decline in personal hygiene, and inappropriate social and sexual behaviors are some symptoms seen in them too.

MANAGEMENT AND TREATMENT OF ALZHEIMER’S DISEASE

  • A diagnosis of Alzheimer’s disease, can be made on the basis of general medical or psychiatric evaluation. Information involved in the diagnosis of Alzheimer’s disease include the use of clinical assessment, and information from a third party.

  • For the cognitive symptoms, medications are used in slowing down the cognitive decline of the disorder; the drugs slow down the progression of the disease, as there is no available cure for now.

  • The behavioral and psychological symptoms (agitation/aggression, anxiety, depression, hallucination) are treated using antipsychotics, antidepressants, anxiolytics.

  • Music therapy, Reminiscence therapy and environmental manipulation and social support are other frontline approaches in managing this type of dementia.

  • Nursing home placement should be considered if it will remove the risk of elder abuse which can be physical, neglect, psychological, financial and sexual in types.

CONCLUSION

Alzheimer’s disease is a disorder that is commonly experienced by individuals aged 65 years and above. In Nigeria, elderly people also suffer from Alzheimer’s dementia but hardly make it to clinical attention, because it is dismissed as ‘old age’. This leaves them to become a danger to themselves or come to harm from being abused by their family or care givers. It is important that we become enlightened about the mental health needs of our senior citizens, so they are cared for in this vulnerable period. There are treatments available to help manage the disease and this can only happen if the symptoms are recognized and they are taken for treatment promptly.

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