Focus On... Alzheimer's
Alzheimer's disease is the most common cause of dementia, affecting around 417,000 people in the UK. The term 'dementia' is used to describe the symptoms that occur when the brain is affected by specific diseases and conditions.
Dr. Gillian Moss, Consultant in Old Age Psychiatry at the Woodlands Hospital in Salford, provides an insight into this debilitating condition.
What is Alzheimer’s disease?
It’s a condition that causes loss of brain cells, initially from the areas of the brain concerned with memory, and later on can affect reasoning, language, perception, judgement, co-ordination, personality and behaviour.
It’s a degenerative disease which causes progressive decline and is usually irreversible. The appearance of the brain under the microscope is characteristic, and Amyloid plaques, which look like pink blobs, cans be seen as well as Neurofibrillary tangles, which look like tangled up black lines.
What causes the disease?
The cause of Alzheimer’s is unknown; however it is associated with increasing age. In some cases, there is a family history of it, but very few cases are hereditary.
Head injuries may be associated with later development of the disease, and people with Downs Syndrome or a gene known as Apolipoprotein E4 are more likely to develop the disease.
What are the symptoms?
Alzheimer’s disease starts slowly and insidiously, with impairment of memory. Family and friends may notice that sufferers become repetitive. They may develop problems with their speech, having difficulty in naming common items, and eventually in the advanced stages speech may be jumbled up.
Difficulties with reading, writing and calculating are common. Disorientation in time and place are common, and in the later stages failure to recognise familiar people. Ability to undertake everyday tasks may become more difficult. In the late stages, problems such as wandering, agitation, hallucinations and delusions may arise.
What’s the prognosis?
There is no cure for Alzheimer’s disease, however it can be treated with tablets, which may bring about some improvement in the early stages, and slow the rate at which the illness deteriorates. These tablets do not work for everyone, and the effects are not permanent, but in some cases they are undoubtedly helpful. Anti-Alzheimer’s tablets are not helpful in other types of dementia.
Alzheimer’s disease may last for many years, and the progress of the illness varies from person to person. In the later stages, Alzheimer’s disease is a terminal illness, and management is aimed at relieving distressing symptoms, and supporting carers.
Once it becomes severe, anti-Alzheimer’s tablets are no longer appropriate and should be stopped. In the later stages of the disease, pain is common for various reasons, and this often needs vigorous treatment.
I think a friend or family member might have Alzheimer’s. What should I do?
Early diagnosis and early intervention is important in Alzheimer’s disease. It is helpful for many sufferers to understand what is happening at a stage when they are still able to understand. This enables them to make plans for the future, and to ensure that as far as possible their wishes will be taken into account.
The Government recently published the Dementia Strategy, which stipulates that Memory Clinics should be set up in every town for early diagnosis and early intervention of dementias of all types, including Alzheimer’s disease.
Anyone who is concerned about his or her memory, or thinks that a family member or friend may be developing Alzheimer’s disease, should try to have this investigated. Considerable tact and diplomacy may be needed when suggesting to someone else that he or she may have a memory problem.
The first port of call in most cases should be the family GP, who would be able to undertake some investigations and make a referral to the local Memory Clinic. If no Memory Clinic has been set up as yet, a referral may be made to an Old Age Psychiatrist, a Physician in Health Care for the Elderly or a Neurologist, depending on local interest and availability.
If Alzheimer’s disease is diagnosed, this enables treatment with medication to be prescribed if appropriate. The Mental Capacity Act 2005 enables individuals with early dementia to plan effectively for the future.
This may be by making an Advance Directive, or by nominating a Lasting Power of Attorney for finance and/or for personal welfare. More information about this is available on www.publicguardian.gov.uk
Support for family members and other carers is important, and the Memory Clinic and the local Social Services Department, as well as general practices, should have information regarding support services that are available locally. In Salford there is an excellent Carer’s Support Outreach Service run by Age Concern.