Psychiatry Consultations and Counselling Services  in  Goa, India 

Dr Ashutosh Prabhu Dessai
Bhandare hospital
Fontainhas , Mala
Panaji, Goa 403001
India
ph: 91 - 9420162750
alt: 91 832 2224966 , 2424966

Dementia

What is Alzheimer's
http://alz.org/alzheimers_disease_what_is_alzheimers.asp
 

Introduction

Alzheimer’s disease is a brain disorder named for German physician Alois Alzheimer, who first described it in 1906. Scientists have learned a great deal about Alzheimer’s disease in the century since Dr. Alzheimer first drew attention to it. Today we know that Alzheimer’s:

  • Is a progressive and fatal brain disease. As many as 5.3 million Americans are living with Alzheimer’s disease. Alzheimer's destroys brain cells, causing memory loss and problems with thinking and behavior severe enough to affect work, lifelong hobbies or social life. Alzheimer’s gets worse over time, and it is fatal. Today it is the seventh-leading cause of death in the United States. Learn more: Warning Signs and Stages of Alzheimer’s Disease.

  • Is the most common form of dementia, a general term for memory loss and other intellectual abilities serious enough to interfere with daily life. Alzheimer’s disease accounts for 50 to 70 percent of dementia cases. Other types of dementia include vascular dementia, mixed dementia, dementia with Lewy bodies and frontotemporal dementia. Learn more: Related Dementias.

  • Has no current cure. But treatments for symptoms, combined with the right services and support, can make life better for the millions of Americans living with Alzheimer’s. There is an accelerating worldwide effort under way to find better ways to treat the disease, delay its onset, or prevent it from developing. Learn more about recent progress in Alzheimer research funded by the Alzheimer’s Association in the Research section.

Alzheimer's and the brain

Just like the rest of our bodies, our brains change as we age. Most of us notice some slowed thinking and occasional problems with remembering certain things. However, serious memory loss, confusion and other major changes in the way our minds work are not a normal part of aging. They may be a sign that brain cells are failing.

The brain has 100 billion nerve cells (neurons). Each nerve cell communicates with many others to form networks. Nerve cell networks have special jobs. Some are involved in thinking, learning and remembering. Others help us see, hear and smell. Still others tell our muscles when to move. In Alzheimer’s disease, as in other types of dementia, increasing numbers of brain cells deteriorate and die.

Take the Brain Tour to learn more about how the brain works and how Alzheimer's disease affects it.

The role of plaques and tangles

Two abnormal structures called plaques and tangles are prime suspects in damaging and killing nerve cells. Plaques and tangles were among the abnormalities that Dr. Alois Alzheimer saw in the brain of Auguste D., although he called them different names.

  • Plaques build up between nerve cells. They contain deposits of a protein fragment called beta-amyloid (BAY-tuh AM-uh-loyd). Tangles are twisted fibers of another protein called tau (rhymes with “wow”).

  • Tangles form inside dying cells. Though most people develop some plaques and tangles as they age, those with Alzheimer’s tend to develop far more. The plaques and tangles tend to form in a predictable pattern, beginning in areas important in learning and memory and then spreading to other regions.

Scientists are not absolutely sure what role plaques and tangles play in Alzheimer’s disease. Most experts believe they somehow block communication among nerve cells and disrupt activities that cells need to survive.

Early-stage and younger-onset Alzheimer's disease

Early-stage is the early part of Alzheimer’s disease when problems with memory, thinking and concentration may begin to appear in a doctor’s interview or medical tests. Individuals in the early-stage typically need minimal assistance with simple daily routines. At the time of a diagnosis, an individual is not necessarily in the early stage of the disease; he or she may have progressed beyond the early stage. 

The term younger-onset refers to Alzheimer's that occurs in a person under age 65. Younger-onset individuals may be employed or have children still living at home. Issues facing families include ensuring financial security, obtaining benefits and helping children cope with the disease. People who have younger-onset dementia may be in any stage of dementia – early, middle or late. Experts estimate that some 500,000 people in their 30s, 40s and 50s have Alzheimer's disease or a related dementia.

About Dr. Alzheimer

At a scientific meeting in November 1906, German physician Alois Alzheimer presented the case of “Frau Auguste D.,” a 51-year-old woman brought to see him in 1901 by her family. Auguste had developed problems with memory, unfounded suspicions that her husband was unfaithful, and difficulty speaking and understanding what was said to her. Her symptoms rapidly grew worse, and within a few years she was bedridden. She died in Spring 1906.

Dr. Alzheimer had never before seen anyone like Auguste D., and he gained the family’s permission to perform an autopsy. In Auguste’s brain, he saw dramatic shrinkage, especially of the cortex, the outer layer involved in memory, thinking, judgment and speech. Under the microscope, he also saw widespread fatty deposits in small blood vessels, dead and dying brain cells, and abnormal deposits in and around cells.

The condition entered the medical literature in 1907, when Alzheimer published his observations about Auguste D. In 1910, Emil Kraepelin, a psychiatrist noted for his work in naming and classifying brain disorders, proposed that the disease be named after Alzheimer.

 

 

 

Alzheimer Myths

http://alz.org/alzheimers_disease_myths_about_alzheimers.asp 

Myth 1: Memory loss is a natural part of aging.

Reality: In the past people believed memory loss was a normal part of aging, often regarding even Alzheimer’s as natural age-related decline. Experts now recognize severe memory loss as a symptom of serious illness.

Whether memory naturally declines to some extent remains an open question. Many people feel that their memory becomes less sharp as they grow older, but determining whether there is any scientific basis for this belief is a research challenge still being addressed.

Myth 2: Alzheimer’s disease is not fatal.

Reality: Alzheimer's disease has no survivors. It destroys brain cells and causes memory changes, erratic behaviors and loss of body functions. It slowly and painfully takes away a person's identity, ability to connect with others, think, eat, talk, walk and find his or her way home.

Myth 3: Only older people can get Alzheimer's 

Reality: Alzheimer's can strike people in their 30s, 40s and even 50s. This is called younger-onset Alzheimer's. In 2009, it is estimated that there are as many as 5.3 million people living with Alzheimer’s disease in the United States. This includes 5.1 million people age 65 and over and 200,000 people under age 65 with younger-onset Alzheimer’s disease.

Myth 4: Drinking out of aluminum cans or cooking in aluminum pots and pans can lead to Alzheimer’s disease.

Reality: During the 1960s and 1970s, aluminum emerged as a possible suspect in Alzheimer’s. This suspicion led to concern about exposure to aluminum through everyday sources such as pots and pans, beverage cans, antacids and antiperspirants. Since then, studies have failed to confirm any role for aluminum in causing Alzheimer’s. Experts today focus on other areas of research, and few believe that everyday sources of aluminum pose any threat.

Myth 5: Aspartame causes memory loss.

Reality: This artificial sweetener, marketed under such brand names as Nutrasweet and Equal, was approved by the U.S. Food and Drug Administration (FDA) for use in all foods and beverages in 1996. Since approval, concerns about aspartame's health effects have been raised. 

According to the FDA, as of May 2006, the agency had not been presented with any scientific evidence that would lead to change its conclusions on the safety of aspartame for most people. The agency says its conclusions are based on more than 100 laboratory and clinical studies. Read the May 2006 FDA statement about aspartame. 

Myth 6: Flu shots increase risk of Alzheimer’s disease

Reality: A theory linking flu shots to a greatly increased risk of Alzheimer’s disease has been proposed by a U.S. doctor whose license was suspended by the South Carolina Board of Medical Examiners. Several mainstream studies link flu shots and other vaccinations to a reduced risk of Alzheimer's disease and overall better health. 

Myth 7: Silver dental fillings increase risk of Alzheimer's disease

Reality: According to the best available scientific evidence, there is no relationship between silver dental fillings and Alzheimer's. The concern that there could be a link arose because "silver" fillings are made of an amalgam (mixture) that typically contains about 50 percent mercury, 35 percent silver and 15 percent tin. Mercury is a heavy metal that, in certain forms, is know to be toxic to the brain and other organs.

Many scientists consider the studies below compelling evidence that dental amalgam is not a major risk factor for Alzheimer's. Public health agencies, including the FDA, the U.S. Public Health Service and the World Health Organization, endorse the continued use of amalgam as safe, strong, inexpensive material for dental restorations.

Myth 8: There are treatments available to stop the progression of Alzheimer's disease
Reality: At this time, there is no treatment to cure, delay or stop the progression of Alzheimer's disease. FDA-approved drugs temporarily slow worsening of symptoms for about 6 to 12 months, on average, for about half of the individuals who take them.

The personal and emotional stress of caregiving and looking after yourself

http://www.alz.co.uk/carers/yourself.html

Alzheimer's disease not only affects the person with dementia, it affects the entire family. The greatest burden is placed on the caregiver. The personal and emotional stress of caring for a person with dementia are enormous and you need to plan ways of coping with the disease for the future. Understanding your emotions will help you successfully cope with the person's problems as well as your own. You are an important person in the life of the person with dementia. Without you the person would be lost. This is why it is essential to take care of yourself.

Here we look more closely at your emotions and needs as a carer. The topics we will talk about include:

Grief

"Try to accept that feelings of grief are a natural response to the situation."

Because of Alzheimer's disease, you may feel that you have lost a companion, friend or parent, and grieve for the way they used to be. Many caregivers find themselves shifting between hope and despair, thinking the person may get better, then knowing they will not. Also, because dementia is progressive, just when you think you have adjusted, the person may change again. It may be devastating when the person no longer recognises you.

Try to focus on what makes life as pleasant as possible for you both, and look for the parts of the person's personality that still remain.

It is important that you find someone to talk to. Sharing your feelings with family, friends and other caregivers is one way of coping with the grief. Many caregivers have found that joining support groups is a good way to get encouragement and assistance to keep going.

Guilt

"It is common to feel guilty."

It is common to feel guilty for being embarrassed at the person's behaviour, for anger at the person, or for feeling that you can not carry on and are thinking about nursing home placement.

The decision to move someone you care about or love into a nursing home is a difficult and painful decision to make. Yet caring for someone with dementia can become a 24-hour occupation and there comes a time when short breaks of respite care will not provide sufficient relief. Eventually, you risk damaging your own health if you do not consider moving the person to a home, where they can get the 24-hour help they need.

You may find it helpful to talk to other caregivers and friends about the feelings of guilt. Just because the person you are care for goes to a nursing home, it does not mean giving up your caregiver responsibilities. Indeed the care home may be grateful for your help at mealtimes or with bathing. Continuing to help in this way will help relieve your feelings of guilt.

Anger

"Getting angry is normal."

It is important to remember that you are not perfect. It is normal for you to lose your temper and get angry at times - as do all other caregivers. Your anger may be mixed. It may be directed at the person, yourself, the doctor, or the situation, depending on the circumstances. It is important to distinguish between your anger at the person's behaviour, resulting from the disease, and your anger with the person, as this will help you to cope better.

Try to understand the person's behaviour that is upsetting you and see if you can stop or reduce it, as it will not help either of you to lose your temper. If you think you are going to lose your temper, go into another room or into the garden and give vent to your feelings away from the person with dementia.

It may be helpful to seek advice from friends, family, or a support group. Sometimes people feel so angry that they are in danger of hurting the person they care for - if you feel like this, you must seek professional help. Many local support groups have caregivers' contacts, with whom you can talk to and get advice from. Use these people to get help when you need it.

Embarrassment

"Ease any embarrassment by taking the courage to explain the situation to people around you."

You may feel embarrassed when the person displays inappropriate behaviour in public or disrupts the neighbours. It may take some courage, but by explaining the disease and the concept of dementia to friends and neighbours, you will help them understand the person's behaviour.

Look for support from other caregivers who have experience of similar problems. Sharing your feelings with other caregivers will enable you to cope better and the embarrassment may fade.

Loneliness

"Try to maintain friendships and keep social contacts, as loneliness makes caregiving harder."

Many caregivers withdraw from society and, along with the person with dementia, are confined to and around their homes. Being a caregiver can be lonely - you may have lost the companionship of the person, as well as social contacts, due to the demands of being a caregiver.

Loneliness makes coping with the problems of caregiving harder, so try to keep in contact with friends, and see if they can offer extra help. Explain the problems of dementia and that they, as friends, can help by providing you, or the person with dementia, some companionship.

Maintain your own social engagements and take breaks from looking after the person. This will give you time and space to recharge your batteries and help you feel better about yourself.

Consider joining a support group. Here you will find people with similar problems, who can help you get over the rough patches and provide a social life, where you do not have to be separated from the person you are caring for.

Family support

"The family can be the greatest source of help."

For some caregivers their immediate family is the greatest source of help. For others it is the biggest source of distress. If this is the case, you may feel that you have been left to cope as a caregiver on your own, which can lead to bitterness and resentment. If you are feeling distressed because family members are not supporting you, try to find out why they are not helping. It may be helpful to call a family meeting to discuss the care of the person.

If you cannot get help from your immediate family then try to get help from elsewhere. Accept help from other family members and do not take on the burden of caring alone. Try to arrange breaks from caring to give you the respite care you need. You may find that by looking after yourself, you feel less stressed about the lack of family support.

Sharing problems

"Share your problems."

You need to share your feelings about your caregiving experiences with others. If you keep them to yourself, it may be more difficult for you to look after the person with dementia, as you may begin to resent them or get angry with them. Try to think ahead and have someone to turn to in an emergency.

You will most likely find that your friends have not stopped liking or caring about you, and would probably be quite happy to listen or help if you let them know how. Try to accept support when others offer it, even if you do feel you are troubling them.

If you can realise that the problems and feelings you are experiencing are a natural response to your situation, it will be easier for you to cope. If you do not want to bother your friends then seek professional help from the person's doctor or the local support group.

Taking time-out

"Make time for yourself."

It is essential to make time for yourself. As a caregiver you risk isolation by looking after someone with dementia. This can cause loneliness and sometimes anger or resentment towards the person with dementia. Taking time-out allows you to spend time with others. Enjoy your favourite hobbies and, most importantly, enjoy yourself.

Support groups, social services and some nursing homes provide day care help, where you can leave the person with dementia in safety and comfort while you can enjoy time to yourself or with the rest of your family. Use the support available to you, so that you can have a rest.

Know your limits

"Be aware of how much you can take, and seek help if caring becomes too much for you."

How much can you take before it becomes too much? Looking after someone with dementia is a demanding role, which may be complicated by:

  • your own physical or health problems
  • lack of sleep
  • financial uncertainty.

Most people will come to realise how much they can take before caring becomes too demanding. If your situation is too much to bear, take action, seek additional support, and call for help to prevent or avoid a crisis.

Not blaming yourself

"Dementia is no one's fault, the disease is the cause."

Do not blame yourself or the person with dementia for the problems you encounter. This is particularly hard if the person cannot remember who you are or if they are violent. Remember the disease is the cause not the person.

If you feel your relationships with friends and family are fading, don't blame them or yourself. Try to find what is causing the breakdown and discuss it with your friends and family. These relationships can be a valuable source of support for you and the person with dementia.

Seeking and taking advice

"Learning to seek and take advice can help you be a better caregiver."

Learning to accept help may be new to you. More often than not, family, friends and neighbours may want to do something to help you and the person with dementia.

Self-help groups (a group for caregivers) can be another source of help for you. They provide an opportunity to get together with other helpers and caregivers, who may already have experienced the problems you are facing. Through their combined experience, these groups can be an invaluable source of help, comfort and encouragement.

Your doctor, community nurse or social worker may also be able to help you. They will be able to provide you with help and advice about looking after the person and the support available. If they cannot answer your problems themselves, they will usually be able to put you in contact with someone who can.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2491668

 

"Perispinal Etanercept Produces Rapid Improvement in Primary Progressive Aphasia: Identification of a Novel, Rapidly Reversible TNF-Mediated Pathophysiologic Mechanism"
Edward Tobinick, MD, Assistant Clinical Professor of Medicine; Medical Director
Abstract
Primary progressive aphasia (PPA) is an uncommon form of progressive dementia for which there exists no established treatment. The underlying pathology may be that of either frontotemporal dementia or Alzheimer's disease. Increasing evidence suggests that excess tumor necrosis factor (TNF) may play a central role in Alzheimer's disease. Additionally, excess TNF has been documented in patients with frontotemporal dementia. Excess TNF may therefore represent a therapeutic target in PPA. Etanercept, an anti-TNF fusion protein, binds to TNF, thereby reducing its biologic effect. Emerging evidence suggests that perispinal administration of etanercept may have therapeutic efficacy for Alzheimer's disease. This evidence, in combination, supports a rationale for the use of perispinal etanercept for the treatment of PPA. This report documents rapid improvement in verbal abilities, beginning within 20 minutes of perispinal etanercept, in a patient with severe PPA. With repeated weekly dosing, sustained improvement at 1 month is documented, with a more than 10-point improvement in the patient's abilities to perform activities of daily living as measured by a standardized instrument, the Alzheimer's Disease Cooperative Study-Activities of Daily Living inventory. Rapid clinical improvement in PPA following perispinal etanercept administration may be related to TNF's role as a gliotransmitter and modulator of synaptic communication in the brain. These results may provide insight into the basic pathophysiologic mechanisms underlying PPA and related forms of dementia and suggest the existence of novel, rapidly reversible, TNF-mediated pathophysiologic mechanisms in both PPA and Alzheimer's disease. Further study of this therapeutic method is indicated.
 
  
 
  

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Dr Ashutosh Prabhu Dessai
Bhandare hospital
Fontainhas , Mala
Panaji, Goa 403001
India
ph: 91 - 9420162750
alt: 91 832 2224966 , 2424966