BY DR. BASHIR AHMAD SANAIE and DR. SAJAD AHMAD TAK
21ST of September is celebrated as World Alzheimer’s Day every year, and the theme for this year (2022) is know Dementia, know Alzheimer’s.
In 1906 Alois Alzheimer, a German psychiatrist, reported a case of a woman in her 50s with paranoia and memory loss. This was the first reported case of Alzheimer’s disease (AD) and the disease got its name as Alzheimer’s disease.
AD is the Neurodegenerative disorder and it is the leading cause of dementia worldwide. There are an estimated 10 million new cases of dementia each year worldwide, implying one new case every 3.2 seconds (WHO, 2019.).
It is estimated that 5.3 million people above the age of 60 have dementia in India in 2020 .It equals to, one in 27 people above the age of 60 in India, has dementia.
In India the incidence rates per 1000 person‑years for AD was 11.67 % for those aged ≥55 years and higher (15.54%) for those aged ≥65 years. According to the Alzheimer’s Association in 2018, 5.7 million Americans have AD dementia (2018) which represents 70% of dementia in the United States. The prevalence of Alzheimer dementia increases with age from 3% of people between the ages of 65 and 74 to 32% of people age 85 and older.
Risk Factors:
In addition to age and female gender, many other risk factors for AD dementia include Hypertension, diabetes, elevated cholesterol levels, head trauma, impaired sleep, smoking, and cerebrovascular disease.
Protective Factors:
Education/leisure activities/early-life cognitive abilities.
Alzheimer Disease Symptoms:
Typical AD dementia initially presents with an episodic memory impairment. Episodic memory relates to our ability to remember information specific to a time and place when that memory was formed (e.g., “What did you eat for dinner? What did you do on a trip?”). It is followed by progressive cognitive decline and involvement of other cognitive domains . The typical symptom progression in AD dementia has been divided into following three stages:
Mild AD (recent memory impairment, repetitive questions, loss of interest in hobbies, anomia, impaired instrumental ADLs), Moderate AD (aphasia, executive dysfunction, impaired basic ADLs), severe AD (agitation, complete loss of independence, sleep disturbance).
Alzheimer Genetics:
The lifetime risk of AD dementia in first-degree relatives is approximately 39% and this risk increases to 54% by age 80 if both parents have AD dementia. Three rare, early-onset, fully penetrant gene mutations have been described to cause Alzheimer dementia which include Amyloid precursor protein (APP), Presenilin 1 and presenilin 2 .
Alzheimer Pathophysiology:
The basic hypothesis is that abnormal Aβ metabolism altering the Aβ42/Aβ40 ratio in the brain causes Aβ oligomer formation and aggregation to form fibrils, which form the amyloid plaque. This oligomer formation and aggregation results in a cascade of events, including tau protein tangle formation, increased inflammatory response, and oxidative injury, to cause neurotoxicity and neuro-degeneration.
Diagnosis of AD:
According to DSM-V (diagnostic and statistical manual of mental disorders) criteria which includes …a). clinical symptoms
b). Neuroimaging …MRI Brain , FDG-PET and Amyloid PET etc.
c). Exclusion of Alternate etiology.
Management of AD:
Multifactorial tailored management of AD is required. We need to discuss the disease with the family / caregiver, educate them which is possible only in specialised dementia clinics . Our department of Neurology super speciality, hospital, Srinagar has started Dementia clinic on every Wednesday at 2 pm to 4pm for such patients. Management has following components:
a) Open Doctor ( NEUROLOGIST), caregiver and patient communication
b) Behavioural approaches including cognitive behavioural therapy, calm interactions, pleasurable activities etc.
c) Caregiver Support
d) Pharmacological Interventions : FDA approved medications for AD include ACHEIs….Donepezil, Galantamine, Rivastigmine and the NMDA antagonist …memantine.
Future drugs which are presently in clinical trials are monoclonal antibodies including…aducanumab, gantenerumab and Donanemab.
Prof. Bashir Ahmad Sanaie, Head, Department Of Neurology, Super Speciality Hospital, Srinagar.
Dr. Sajad Ahmad Tak, Senior Resident ( DrNB neurology scholar), Department of Neurology, SSH, Srinagar.