#covid-19

Alzheimer’s disease is the most commonly found Dementia or brain disorder that slowly impairs memory and thinking skills and finally the ability to carry out most basic tasks. It is the most common cause of memory loss among the elderly and interferes with their cognitive functioning making them completely dependent on others for help. As per a report published by ARDSI (Alzheimer’s and Related Disorders Society of India), nearly 7.6 million Indians might be suffering this disease.

Every year on September 21, World Alzheimer’s Day is observed to promote awareness and educate the public about Alzheimer’s disease and dementia. To discuss more about the theme and significance of this day along with the possible prevention of the disease and its relation with Covid, Medically Speaking invited a panel of experts that included: Dr Manjari Tripathi, Professor in Department of Neurology, AIIMS; Dr Manish Kandpal, Professor of Psychiatry, Ram Manohar Lohia Hospital; Dr Anand, Senior Director of Neurology, BKL Max Hospital; Dr Renu Vohra, Member Secretary, Alzheimer’s Related Disorder Society Delhi Chapter (ARDSI(DC)).

Here are a few excerpts from the interview:

Why do you think we need to focus on Alzheimer’s disease, it’s observation and awareness?

Dr Manjari Tripathi: As our life expectancy increases due to better medical facilities in our country, there is a disorder related to ageing known as Alzheimer’s Dementia. But a lot of knowledge for this disease is available in the western world. In India, any elderly who starts declining in memory is often taken as normal age related issue. However, if the memory decline is significant, a person cannot recollect what is going on. This is significant enough to impact his daily life and functioning and make the person dependent on others. Then it qualifies to be a disorder known as Alzheimer’s Dementia. There is a huge treatment and diagnostic gap for this disease in India. There also is a condition known as advanced Dementia, so when person is in late stages of the disease, that is when they consult a doctor, which is not what doctors, counsellors and psychologists want. We need people to come it early so there can be a maximization of impact of any intervention (medical or psycho-social). This is not happening which is why the awareness is needed and therefore this 21st September is celebrated as World Alzheimer’s Day and the theme for this year is ‘No Alzheimer’s, No Dementia’.

What are the early signs of Alzheimer’s that one needs to watch out for and can it affect a person before a certain age as well?

Dr Manish Kandpal: Diagnosis is done through history only, we have certain investigations to rule out early causes where memory is sailing. It is very important when people are getting issues with their day-to-day life. Recent memory is the first that gets affected. It is at later stages that the memory loss interferes with daily chores. Do not label yourself with Alzheimer’s or Dementia, but let a doctor investigate you. More than Alzheimer’s, we need to increase awareness among people not to self diagnose themselves when having problem with brain functioning.

What is the foremost sign to worry about and to refer to a counsellor?

Dr Renu Vohra: Patients do come at a later stage but we need to counsel them at that point also. The counselling is mainly done to the caregiver because they are equally important as caregiving to patients of Alzheimer’s and dementia needs flexibility and patience. There are two types of activities, Daily and Instrumental. Daily activities involve laundry, dressing, grooming and other personal activities. Instrumental activities involve shopping, household, finance, etc. The caregiver has to be keen on these activities of the patient on a daily basis because this is a disease which will slowly progress. Therefore the caregiver needs to make changes in their schedule as well. Take them out for a walk, make them do morning rituals so that they are not confused. Do not make them dependent on you completely.

What are the risk factors that can trigger Alzheimer’s that one can probably prevent?

Dr Anand: Alzheimer’s is a degenerative disease but there are contributory factors that we can take care of at early stages so that the progression speed and the impact of Alzheimer’s can be decreased. Burden of any comorbidity like Diabetes or Hypertension can impact the brain that is afflicted by Alzheimer’s. The gist of preventing or even delaying this disease is active involvement on Social and Physical activities.

If we start adopting these measures before hand to avoid mid-life crisis, can it be prevented?

Dr. Tripathi: For Alzheimer’s, there are two basic kind of risk factors, one is the non-modifiable risk factor and the other one is modifiable risk factor, which is within our hand which we can take care of to not get Alzheimer’s. The unmodifiable risk factors are ageing, which can’t be reversed. Second is pre-disposing genetics. Mutation causing chromosomes affect certain abnormal proteins that finally get deposited in Alzheimer’s patient’s brain. If you carry that gene as a result if a vertical heredity from your grandparents, then you’re at a very high risk.

Then there’s a modifiable gene which is not the causative gene but if it is presented it increases the risk which is known as APOE gene. Genetics is like a loaded gun trigger of which is in our environment on our lifestyle.

Not following a healthy routine, consuming junks food, unhealthy oils, having disturbed sleep patterns, not interacting socially with your surroundings and sitting on the couch watching TV all day, add up with blood pressure, insomnia, hypertension, obesity, diabetes and other diseases to contribute to such brain related diseases.

Q. Basically it’s a mix of genetics which are a ticking time-bomb, unhealthy lifestyle add up to it. According to a study conducted in California, pollution is a contributing factor to such diseases. When talking about the Indian metropolitans, especially the national capital, how can we protect ourselves and our elderly from this pollution to avoid this disease?

Dr. Manish Kandpal: A person living in Delhi could live medium or less because of air pollution, we have to make a certain balance. We have to adapt a healthy lifestyle like exercise and healthy foods. There are some fruits like tomatoes that are rich in antioxidants and hence help us to fight the side effects of air pollution. Apart from this there is something what we call Cognitive Stimulation in case of Dementia. You need to keep yourself busy in some sort of Cognitive exercise avoid cognitive reserve. People who are more socially active have lower chances of developing Dementia as compared to others.

How do you manage Alzheimer’s in times of Covid?

Dr. Renu Vohra: We on a helpline use to receive these calls from the care givers that earlier the main stream of therapy was making them socially active, taking them for walks and make them meet with relatives children and all. But all that have to stop during this time. They could not understand why is nobody visiting them and that made them even more confused. They can’t know the rationale around covid hence it was a difficult time for a care giver. We advised them to give them a social contacts on Facebook, Instagram, Whatsapp videos so that they can interact with people. Make sure that care giver as well as any person’s relative who comes to visit them should be fully vaccinated, wearing mask all the time because you know these people refuse to wear a mask. So make sure they visit an open place like in veranda. In certain cases, the main care giver was infected with covid. So, we told them they should never plan earlier and should not expect another either a friend or relative to take care of the patient at that time because they will not understand why suddenly my care taker has changed. Have a plan B.

What were the challenges you faced during this time and what will be you suggestion to the care givers during such difficult times?

Dr.Anand: covid has been and is devastating for people with Dementia. There have been maximum mortalities in nursing homes where people used to live.

In neurology and other facilities, we now have a term called Long-haul Covid that affects younger people also and they develop brain-fog like symptoms to which are advice is avoiding panic at all costs.

People with Dementia manifested these symptoms faster therefore it brought in new challenges for patients, doctors and the care-givers. Unfortunately, Alzheimer’s is not an individual’s disease and the one who got it does not even have an insight that he is suffering such a disease. He becomes a nuisance for the family and a responsibility. Covid has multiplied this problem several times more.

In consideration with Alzheimer’s what really the impact Covid has had on younger generation has it made few of them more susceptible?

Dr. Manjari Tripathi: As the COVID virus is very neurotrophic, so whether you like it or not, it’s going to affect the brain and the fact that during COVID many patients had hypoxia, i.e., their oxygen level fell. Many people, even after recovering from the Covid infection, will feel that they are not clear in their heads. They will feel as if they are not able to form memories, especially new memories for recent things. They may become aggressive, they may have negative emotions, and they might have depression. All these features are the manifestation of neuro Covid. There could be many reasons for it. It could be because of a neurotrophic virus, it could be because of hypoxia, it could be because of nutritional factors, and it could be because of Covid appetite goes down, and there are so many antibiotics and treatments a person is on. So the gut microbiota changes, which affects the memory. There are various mechanisms which are working here, so this must be discussed with the doctor. Medication for this, proper nutrition, and mindfulness and yoga should be done to impact the memory. It’s not dementia; it’s just an infection, but if it doesn’t improve, we’ll need to look into it.

What will be your suggestions for the people who see those early signs long haul Covid and might fear getting Alzheimer’s?

Dr Renu Vohra: We used to get calls from everywhere, not only during COVID but before also, with complaints like we are not forgetting things. We always told them that remembering that you have forgotten is not an issue, but the issue is when you don’t remember that you have forgotten something. In that case, we sent them to the memory centre at AIIMS and Ram Manohar hospital. The task of caregiving is very tough as they have to take care of everything right from taking baths to meals, and modesty should be kept in mind.

What about the treatment for Alzheimer’s and perhaps for further degeneration?

Dr. Manjari Tripathi: So there are several modalities of treatment. The first is, of course, pharmacological, so there are medicines available and very good medicines available in our country. We should start them as early as possible. Apart from that, each and every patient, as well as the caregiver, needs to be counselled about the disease so that that behaviour is taken as a part of the disease and you know, the elderly person should not be scolded or the caregiver shouldn’t get frustrated by those symptoms. For example, a patient can just have a harmless activity. You know, a harmless activity. Then we also need to take care of patients’ safety. We have to make sure if the memory is declining and they are losing their way, they must have a bracelet which is non-removable on which the patient’s name, address, and mobile number are written. This is very important because they have many patients who go out of the house and get lost, so safety is very important. There should not be any dangerous objects around them because they will have forgotten the use of objects and they can come to harm. Apart from that, it’s very essential that we put them in touch with an organisation like the Alzheimer’s Society of Delhi where there are volunteers, and who are these volunteers? These volunteers are rich in resilience because each one of them has had experience of either a spouse or a parent having dementia. They have first-hand knowledge of how to look after their spouse or parent and they enrich others’ experience by sharing it with others.

What about the oxygen therapy? Does it from early stages help Alzheimer’s?

Dr. Anand: There is no need to discuss this topic like this because there is nothing known as oxygen therapy for dementia. What was talked about was that COVID patients who had hypoxia in their brains may not function at that efficiency, so there is nothing known as oxygen therapy.

What will be your suggestions for those who are suffering from Alzheimer’s and don’t have much knowledge about?

Dr. Manjari Tripathi: So, you know, what we really need to do is be able to diagnose it early and also start the intervention modules early. It’s very important that the caregiver not be in denial. We still see a lot of families where the acceptance of Alzheimer’s as a diagnosis is not made, and if the acceptance is not made, they will not be able to fully intervene or usefully modify the life of the caregiver. board memory therapy, reminiscence therapy, by showing old photographs We still see this happening.