By: Lunga Memela (Communications Officer)
When we hear the name we automatically associate it with ageing – something far off, but the reality is that it's among us and must be managed with compassion and a collective investment in brain health.
Imagine waking up one day with your ability to speak suddenly impaired, not being able to think clearly, or to recollect what recently happened or what someone said just minutes ago? This experience is well-known to sufferers of Alzheimer's disease (AD).
"The condition is one of several types of disorders affecting the brain that cause damage to various areas of the brain resulting in loss of corresponding cognitive and bodily functions. This group of disorders are referred to as dementia or neurocognitive disorder," explains psychiatrist and academic leader at the University of KwaZulu-Natal's Nelson R Mandela School of Medicine, Dr Suvira Ramlall. "It starts insidiously and progresses slowly, its cause is unknown, no treatment or cure is currently available and it has a fatal outcome."
Amongst many equally important days listed on the global health calendar, September is marked as World Alzheimer's Month and World Alzheimer's Day falls on the 21st – calling for recognition of the impact of dementia but also action to support those affected globally. A co-ordinated global voice on dementia ensures that this action is taken to advance awareness, care and science all year round.
Nourish, stimulate, protect and detox the brain advises Dr Ramlall! Here's how:
Nourish: What you eat also feeds the brain. A healthy nutritious diet will provide the necessary fuel for healthy brain function. Certain nutritional deficiencies can, in themselves, cause dementia and worsen it if present. The important point is that these are preventable causes and if identified and corrected early, can reverse the dementia symptoms. Equally important, what you feed the brain through the senses – seeing, listening, thinking, feeling – also directly or indirectly impacts on the brain.
Stimulate: 'use it or lose it' is the adage. The more you use the brain the more nerve connections the brain makes between nerve cells. These connections make the brain more resilient against disease processes. 'Cognitive reserve' refers to such a 'positive brain balance' and the bigger the 'reserve' you build up in life, the more protected you will be against AD – it has been shown that even if you have AD, plaques in your brain, you may not show signs of the disease in life or show them much later and to lesser degrees of severity if you have more reserve. So, activities such as reading, learning new languages, doing intellectually stimulating work or games, playing musical instruments and engaging in hobbies are all stimulating for the brain. Exercise is also necessary for the brain and simply walking regularly has been shown to be healthy for the brain and protects against AD. Lastly, we need to engage in social interactions with other people; our brains thrive on healthy human interaction; social isolation is not healthy for the brain.
Protect: The brain must be protected from harmful substances and activities: smoking, alcohol consumption, head trauma, and stress all affect the brain size and functioning. Abusing drugs can also cause brain damage. Managing stress is important as chronic stress has a direct impact on the brain. Psychiatric disorders such as depression and bipolar disorder increase your risk for cognitive impairment and it's advised that you seek treatment for these.
Detox: Nature's priceless secret for good mental and physical health is a good night's sleep. Sleep is a brain tonic and essential for brain health as it is during sleep that the brain does its 'house-keeping' and flushes out toxins that have built up during the day, including those plaques associated with AD. Poor sleep increases your risk of AD, and AD in turn results in poor sleep. Maintaining regular and good sleep habits is a simple necessity for health.
Dr Ramlall says many mistake AD for normal age-related brain changes and vice versa. "AD is not inevitable as we age; its features are quite different from that of normal 'old age' but in the early stages, it may be difficult to make the distinction. The public should not try to self-diagnose; even trained clinicians can have difficulty making a diagnosis in the early stages of the disease so it is best to get assessed by a professional. A diagnosis is a lengthy but comprehensive process of assessment and investigations but if you are noticing changes in your functioning that are increasing in frequency or are causing you concern or affecting your functioning, consult a health professional."
"Apart from brain functions such as memory, concentration, executive functioning, and speech being affected, psychiatric symptoms can develop: mood changes, suicidal tendencies, psychosis (e.g. paranoia), behavioural disturbances (restlessness, wandering, aggression), and sleep disturbances. In the advanced stages patients may no longer be able to bathe, feed, or dress themselves or go to the toilet independently; urinary and faecal incontinence, inability to swallow and breathe may occur terminally."
It is important to reiterate that there are both reversible and irreversible causes of dementia/NCD or similar symptoms. It is therefore important to be thoroughly assessed, as early as possible after symptoms are first noticed, to exclude possible treatable/reversible conditions such as vitamin deficiencies such as Vitamin B12; thyroid hormone deficiency, and a brain bleed/tumour.
Why raise Alzheimer's awareness?
Even though AD is not a function of growing old, it is diagnosed most frequently in older persons >60 years. However, research has shown evidence that the disease starts much earlier in life –-the characteristic brain plaques of AD have been detected in people in their 30s. With advancing age, these plaques accumulate until they reach a critical level when functioning starts to be affected and symptoms manifest. Raising awareness is important for three reasons:
Early recognition is important to make a correct diagnosis. Even though there is no treatment or cure, early diagnosis will ensure that risk factors are treated early to minimise the exacerbation of the symptoms and patient functioning. Treatable conditions that can also cause further brain damage can be better controlled, e.g. it is common to find AD together with brain damage due to vascular disease (e.g. hypertension) or heart disease. The adverse effects on the brain become additive so treating and controlling blood pressure and diabetes, for example, helps to limit further insult to the brain. This, in turn, means that the patient's deterioration can be slowed and this makes a difference in terms of the level of care that will be needed over time.
The world is greying, meaning that people are living longer than ever before. We are therefore more likely to see people with the disease.
People are becoming more aware of their health in general, but while they remember to check their blood sugar and pressure and go for cancer screening, few people remember that the brain also has needs. It is the organ in your body that controls all other bodily functions as well as the ability to walk, talk, hear, see, smell, taste, think, remember and do all the simple and complex tasks of daily living and your job. We need to be taking care to nourish it, stimulate it and protect it from the day we are born; we can replace a kidney or heart that has failed but not the brain. So few people consciously remember to look after their brains… until it is too late.
A call to collective action:
Caring for a loved one who has AD or any dementia is a painful, stressful, demanding, financially costly and heart-breaking experience. It can also be a rewarding, loving, blessing to care for an ailing partner or parent. Families should ensure they are equipped with knowledge, but guided by a professional in their approach because each patient is unique in how they present and progress in their care needs. "Caring for the patient starts with caring for the carer: the caregiving can take its toll on the caregiver emotionally, physically and financially and caregiver burnout and depression are real and frequent occurrences so they should get the necessary support for all these domains. It is important to seek emotional and mental health support to deal with grief, depression, anger and the various emotions the illness and the patient will evoke in you."
AD in the South African context summarised:
Poverty, malnutrition, low education levels, high rates of trauma, substance abuse, hypertension and diabetes mellitus – which are often poorly or not treated at all – are risk factors that are more prevalent locally and place our population at higher risk for cognitive impairment. Another challenge locally are traditional beliefs about the cause of dementia in African communities. The belief that those suffering from dementia are possessed by evil spirits or are witches have led to the abuse, ostracisation and even murder of patients. Financial difficulties also result in families neglecting or abandoning patients. There are inadequate community support services for patients or their families and there is no government policy or service dedicated to dementia care.
AD healthcare for the eThekwini District
A Memory Clinic is held monthly at Inkosi Albert Luthuli Central Hospital in Durban which offers diagnostic and treatment services, however, community-level education, health promotion and psychosocial support for affected persons and their caregivers are sorely needed. The Bessie Makatini Foundation works with people living with dementia and the elderly with mental illness. Their services are free and they are community-based with offices in Lamontville butwork all over eThekwini and surrounding areas (Umlazi, KwaMashu, Klaarwater, Wentworth, Chatsworth, Amanzimtoti, Inanda, Mbumbulu etc). You can reach them on 071 451 7551 / 072 339 5953.
"AD is a devastating disease that robs people of the essence of what it means to be 'alive' – we take so much of what we are able to do and enjoy every second of our lives for granted. As AD evolves, sufferers lose essential functions and feelings, adults become more helpless than babies, a parent or spouse you have known and loved for decades no longer recognises you… these are humbling moments when we need to appreciate and preserve the faculties we have been blessed with. Start taking care of your brains TODAY; it is too late to start worrying about AD when you feel you are 'getting old'," Ramlall says.
Alzheimer's SA National Office
011 792 2511
HEALTH SYSTEMS TRUST - CONTACT DETAILS
34 Essex Terrace, Westville, Durban, 3630
+27(0)31 266 9090