Alzheimer's Disease in India Consultancy Service

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Thursday, November 8, 2007

Alzheimer's Advances

Alzheimer's Advances

Watch this video to learn about Alzheimer's research developments, including the arrival of drug memantine or Namenda.

Slow Down Alzheimer's ... Naturally

Slow Down Alzheimer's ... Naturally

Could fish oil supplements be what it takes to slow the progression of Alzheimer's? See how in this video.

Experimental Gene Transfer Therapy for Alzheimer's

Experimental Gene Transfer Therapy for Alzheimer's

Learn how researchers are using gene transfer technology to treat Alzheimer's.

Detection and Diagnosis of Alzheimer's Disease

Detection and Diagnosis of Alzheimer's Disease

Dr. Dean Reports: As the numbers grow so does the likelihood you will face Alzheimer's in your life. Discover what researchers are learning about this mind robbing condition.

Mapping Alzheimer’s

Mapping Alzheimer’s

Researchers at UCLA have developed a way to give a detailed look at Alzheimer’s disease as it progresses.


Thursday, October 25, 2007

Practical Nursing Care for people with Alzheimer's Disease

Caregiver Tips: Washing and Bathing Someone wirh Alzheimer's Disease
Helping someone with Alzheimer's take a bath or shower can present a number of challenges. It can promote anxiety and embarrassment for previously independent people. Here are some caregiver tips to make washing and bathing more relaxing.

Preparing for a Hospital Admission
Preparing for a Hospital Admission. Advice for Alzheimer's Caregivers & Hospital Staff

Sundowning, Alzheimer's Disease and Dementia
Sundowning is the term used to describe the increased confusion and agitation that occurs later in the day and evening and sometimes into the night. I suggest some causes and ways of dealing with sundowning.

Restraint Use in Dementia and Alzheimer's Disease
Restraint use in dementia and Alzheimer's disease

First Dementia Care Centre in India, Kerala.

Programme Officer

Dementia Respite Care Centre

(Harmony Home)
Kottappady, Nr. Guruvayoor, Thrissur, Kerala, India
Telephone No- +91 487 2558524
Helpline- +91 984 619 8473

The first Dementia care centre which provide Round the clock care started its functioning on 27th August 2005 by Alzheimers and Related Disorders Society of India(ARDSI), the national Alzheimer's association in India. This is the first one of this kind in India where round the clock care is providing to the people with dementia.

This center is located near to Kottapady junction in between Guruvayoor and Kunnamkulam state highway(4 kms from Kunnamkulam town or 2 kms from Guruvayoor town)

This was a challenging initiative of Alzheimer’s and Related Disorders Society of India (ARDSI) .Here provides high quality care to the people with dementia. Now this is a model care centre in the country and is providing guidance to the care givers, family members, professionals in the health care field and the public.

The centre is functioning in an old bungalow surrounded by 8 acres of land in a very calm place away from all the disturbances of the town. Here maintains a homely atmosphere which helps the clients to feel they are in their own home.

In addition to respite care it provides Day care and Long term care services.

These are the main Attracation of the centre :

Round the clock care
Medical care
Occupational and physiotherapy
Group activities
Information and counseling
Day Care

Range of activities

Listening to music
Reading newspaper
Watching TV
Reminiscence therapy
Aroma therapy
Games and picnics
Interacting with children
Rearing pets
Drawing and painting

Food (both Veg. And NV) shall be provided

Morning tea/coffee
Evening tea and snacks

Medical care
Medical Officer
Visiting Psychiatrist
Social Worker
Ayurveda Physician
Neurologist and clinical Psychologist etc. shall provide necessary medical help.

For more information contact:

Programme Officer

ARDSI National Office

P.B.No.53,Kunnamkulam P.O,Thrissur

Wednesday, October 24, 2007

Preliminary study on the prevalence of Alzheimer's disease in Kerala, India.

Following is the report published in "The Hindu" National Daily regarding the preliminary finding of the research study by ICMR in association with CSRMS and ARDSI.:

Alzheimer’s disease was the most common cause of dementia in the elderly population and around 3 per cent of elderly people have dementia. This was the preliminary finding of a study done on a random sampling of elderly people over 65 years in Thrissur district.

Out of the total number of dementia cases in the study, 63 per cent was caused by Alzheimer’s disease while 30 per cent was bracketed as vascular dementia, which was caused by blocks in the blood supply to the brain. Diagnosis by exclusion was the tool used to arrive at a conclusion.

Loss of memory was generally categorised as dementia. While dementia due to Alzheimer’s disease is irreversible, other types of dementia can be arrested with proper treatment and care.

The study was a programme taken up by the Kochi-based Centre for Survey Research and Management Studies as part of an Indian Council of Medical Research project. Dr. Jacob Roy, chairman of the Alzheimer’s and Related Disorders Society of India (ARDSI), psychiatrist Dr. S. Shaji, and bio-statistician Dr. T. Sugathan were the investigators in the project.

The field sampling by Dr. Shaji was a combination of rural and urban population, which included four panchayats, three municipalities and the Corporation area. Punnayurkulam, Orumanayur, Chelakkara, and Payanannur were the four rural areas while Chalakudy, Kodungallor and Irinjalakuda were the three municipalities.

880 people underwent diagnosis in the rural area while in the urban area it was 1320. According to Dr. Shaji, there was high incidence of dementia in Chalakudy with 6 per cent, while in most other places the numbers indicated around 3 per cent. It was also found that more women were affected by dementia, he said. A similar study was done around two years ago in some of the wards of the Kochi Corporation area, which had revealed a similar conclusion. At that time, it was found that 53 per cent of dementia cases were because of Alzheimer’s disease.

Source :

No aging in India Alzheimer's, the bad family, and other moderne things.

No aging in India Alzheimer's, the bad family, and other modern things

de Lawrence Cohen; NetLibrary, Inc.

Type :Ressource Internet
Langue :Anglais
Éditeur :Berkeley : University of California Press, ©1998.
Éditions : 5 éditions
ISBN :0585068801 9780585068800
Sujets associés : Aging -- Anthropological aspects. | Ethnology -- India -- Vārānasi (Uttar Pradesh) | Aging -- Anthropological aspects -- India -- Vārānasi (Uttar Pradesh) | Plus de sujets ...
Références bibliographiques : Citer cet ouvrage | Exporter dans EndNote | Exporter dans RefWorks

Thanmathra, award winning indian movie on Alzheimer's Disease


From Wikipedia, the free encyclopedia

Directed by Blessy
Produced by Raju Mathew
Written by Blessy
Starring Mohanlal,
Jagathy Sreekumar, Meera Vasudev,
Prathap Pothan,
Nedumudi Venu ,
Arjun Lal
Music by Mohan Sithara
Distributed by Century Films
Release date(s) 2005
Running time 2 hrs 30 min.
Language Malayalam
IMDb profile

Thanmathra (Malayalam:Molecule) (2005) is a Malayalam film directed by Blessy which portrays the effects of Alzheimer's disease on the life of an individual and his family. The film bagged five Kerala state film awards for the Best Film, Best Actor, Best Director, Best Screenplay and a special mention for the debutant actor Arjun Lal.



Ramesan Nair (Mohanlal) is a Kerala government secretariat employee, cocooned in his own small and happy world. An honest and sincere man, Ramesan's family consists of his loving wife Lekha (Meera Vasudev), son Manu (Arjun Lal) who is a plus-two student, and daughter Manju (Baby Niranjana), a primary school student. His biggest ambition is to see that his son gets into the IAS (Indian Administrative Service), something he himself had failed to achieve despite being a brilliant student. Manu is a very loving son and an intelligent student who shares a strong emotional bond with his father. All in all, they form the very picture of loving family, with a bright future.

However, fate has other ideas. Ramesan starts to develop problems with his memory. What starts as commonplace omissions and absentmindedness, quickly grows into handicapping cognitive and behavioral impairments.

The first time we notice this is when Ramesan misplaces a very important office file at his home, inside the refrigerator. One day he arrives in office after buying a bag of vegetables and starts behaving as if he had reached home after his office hours. He begins acting strangely in the office, as if he has lost his sense of time and place. He is taken to the doctor by his family and close friend, Joseph (Jagathy Sreekumar).

In the hospital, Ramesan is diagnosed with Alzheimer's disease, a disease which causes a gradual loss of memory and cognitive abilities. The news comes as a grave shock for the happy family and turns their world upside down. The family is devastated by the sad news, but tries to adjust to the situation with a lot of determination underscored by strong emotional bonds. How they cope up with the trauma, insecurity and uncertainty caused by Ramesan's plight, forms the gist of the movie.

Director Blessy has brought out the manner in which the dreaded disease entangles Ramesan in its vice-like grip, with a few deft directorial strokes. These snapshots are devastating. One scene depicts Rameshan forgetting to switch on the scooter; another has Ramesan using his son’s toothbrush. Then there is the scene that shows Ramesan forgetting the way to his house. In a scene which is rather unusual for the staid malayalee, there is a love-making scene, where Ramesan gets distracted by a lizard on the wall. In a few fabulous frames, Blessy conveys to the audience the malignancy and horror of the disease.

Thanmathra is a must-watch film both for the serious student of films as well as the ordinary movie-buff who likes to watch good and clean films. A socially relevant theme has been brilliantly told intertwined with a portrayal of strong family bonds, strongly supported by excellent performances from the main actors.


The movie illustrates one of the finest performances by Mohanlal who is a spontaneous actor and an acting genius in his own right. He won the state best actor award for his unparalleled depiction of a middle aged man in the throes of a crippling disability. The movie was advertised as a return of the actor from a super-hero image which he had cultivated with a string of movies, back to that of an average man. The actor has taken full advantage of this opportunity to display a superb performance.

Newbie Arjun Lal who plays Mohanlal's son, is the surprise package of the movie, giving a performance which stands above his years of experience. His performance won him a special mention from the state film awards jury. The performance of Nedumudi Venu, who plays the role of Mohanlal's father, is also excellent. Meera Vasudev, a newcomer to Malayalam movies, plays a great supporting role and does justice to her character. Jagathy Sreekumar is in his elements as usual, and fits into the role of Joseph, as if it were tailor-made for him.

The bulk of the movie is carried on the shoulders of the three protagonists - the father (Mohanlal), the grand-father (Nedumudi Venu) and the son(Arjun Lal). It is very touching to watch the strong ties between them helping the family to cope with the disaster. In this age of the Internet and instant relationships, it is soothing to watch a story that rides on the strong ties among three successive generations.


Mohanlal - Ramesan Nair, a middle-class government servant who is a role-model family man and persona.

Meera Vasudev - Lekha, Ramesan's devoted wife who stands by him throughout his ordeal.

Arjun Lal - Manu, Ramesan's brilliant son whose life's aim is to get into the Indian Administrative Service (IAS), to fulfil his father's dreams.

Nedumudi Venu - Ramesan's father, a hapless spectator to the progressive mental degeneration of his son.

Jagathy Sreekumar - Ramesan's colleague and trusted friend.


The film Won

  • Best Regional Film (Malayalam) - National Film Awards 2006

The film won five Kerala State Film Awards for the year 2005.

These are:

The film won eight Asianet Film Awards 2006 for the year 2005. These are:

External links

Best Malayalam Film - National film award 2005


Agressivity in Alzheimer's Disease

Aggression is common with Alzheimer's

Aggressive behaviors may be verbal (shouting, name-calling) or physical (hitting, pushing). These behaviors can occur suddenly, with no apparent reason, or can result from a frustrating situation. Whatever the case, it is try to understand what is causing the person to become angry or upset.

Possible causes
Aggression can be caused by many factors including physical discomfort, environmental factors and poor communication. If the person is aggressive, consider the following:

Physical discomfort
Is the person tired because of inadequate rest or sleep?

Are medications causing side effects?

Is the person unable to let you know he or she is experiencing pain?

Environmental factors
Is the person overstimulated by loud noises, an overactive environment or physical clutter?

Does the person feel lost ?

Poor communication
Are you asking too may questions or making too many statements at once?

Are your instructions simple and easy to understand?

Is the person picking up on your own stress and irritability?

Are you being negative or critical?

How to respond

Try to identify the immediate cause. Think about what happened right before the reaction that may have triggered the behavior.

Focus on feelings, not the facts. Try not to concentrate on specific details; rather, consider the person's emotions. look for the feelings behind the words.

Don't get angry or upset. Don’t take the behavior personally. The person isn’t necessarily angry with you. Be positive and reassuring. Speak slowly in a soft tone.

Limit distractions. Examine the person's surroundings, and adapt them to avoid similar situations.

Try a relaxing activity. Use music, massage or exercise to help soothe the problem.

Shift the focus to another activity. The immediate situation or activity may have unintentionally caused the aggressive response. Try something different.

Decrease level of danger. Assess the level of danger — for yourself and the person with Alzheimer’s. You can often avoid harm by simply stepping back and standing away from the person. If the person is headed out of the house and onto the street, be more assertive.

Avoid using restraint or force. Unless the situation is serious, avoid physically holding or restraining the person. He or she may become more frustrated and cause personal harm.


Saturday, September 15, 2007

National Dementia Awarness Week Progam, Mumbai 16th to 22nd of Sept 2007, from
"National Dementia Awareness Week" - 16th Sep to 22nd Sep 2007
Date:Mon, 10 Sep 2007 22:34:49 +0530

On the occasion of World Alzheimer's Day on 21st Sep,Alzheimer's & Related Disorders Society of India (ARDSI) is celebrating "National Dementia Awareness Week" from 16th Sep to 22nd Sep 2007.

All senior citizens forum and associations,NGO's ,Well-wishers and supporters of the cause of Elderly are requested to participate in the following programme and show your support..

Following are the details of the week long programme of ARDSI,Mumbai Chapter:

Sep 17th :
In association with SNDT's L.T.College of Nursing Workshop on "Management of Patient suffering from Dementia",Time 9am to 4 pm,at 5th Flr,Patkar Hall Bldg.

Sep 18th:
"Memory Talk" at Sharan,Vashi.Time 11 am to 12.30 pm.

Sep 19th:
Programme in association with Helpage India( to be confirmed).

Sep 20th:
"Memory Clinic" at MSWC,Time 11 am to 12.30 pm

Sep 21st:
In association with Shree Manav Seva Sangh ,F ward Sr.Citizen associations and Sion Sr.Citizens club "Talk on Dementia" and launch of new programme at Shree Manav Seva Sangh Hall,Sion;Time 3.30 pm to 5.30 pm

Sep 22nd:
"Walkathon" , walk in support of care givers and creating awareness for AD,at Shivaji Park,Time 4 pm to 6 pm.To assemble near Shivaji Statue.

We also request all of you to organise similar programmes in your area and colony to create awareness with regards to Alzheimer's Diseases and Dementia in India. It will go long way to support the cause of the patients and the caregivers.

Media people are also invited to highlight the concern.

We need volunteers and supporters for the success of the above programme.

For more Information and to participate in above programme pls contact Mr.Pratap at 23742479.

Contact:President Mr.C.G.ThomasHon.Secretary Dr.Shirin Barodawala

ARDSI Mumbai Chapter,BMC School Bldg (II/room 127), JJ Hospital Complex, Byculla, Mumbai-400008.Tel; 23742479Email:

Together we all can do a lot for Alzheimer's people,so join the movement ........................................................


Warm Regards,Sailesh MishraAdvisor - Society for Serving SeniorsLife Member - ARDSI,Mumbai ChapterBlog:

Forget yourself for others, and others will never forget you.

World Alzheimer's Day : Let us remember those who cannot remember by M. Sailesh Mishra, Merinews

World Alzheimer's Day: Let us remember those who cannot remember
12 September 2007, Wednesday

On this World Alzheimer's Day, viz., the 21st of September, let us remember the plight of those who cannot remember; after all, by 2010, India will have 10 million people afflicted with the disease. The government has been sensitized to the issue.

ALZHEIMER’S & RELATED DISORDERS SOCIETY OF INDIA (ARDSI) is celebrating the “National Dementia Awareness Week" from the 16th Sep to 22nd Sep 2007. Organisations and other like-minded people are arranging and participating in the programme to support the cause of Dementia in India. It will go a long way in supporting the cause of the patients and caregivers.

I am not a doctor, psychologist or social worker by profession but have a passion to work for the elderly and for the cause of Alzheimer’s. I got interested because of my association with ‘Dignity Foundation’. My colleague Hendi Lingiah and I were instrumental in starting India’s first 24 x 7 Dementia Care Centre, near Mumbai. Working with the patients, care-givers and browsing through the internet, I gained knowledge about Dementia, which I would like to share with the society.

Dementia is a brain disorder that seriously affects a person’s ability to carry out daily activities. The most common form of dementia among older people is the Alzheimer’s disease, which initially involves those parts of the brain that control thought, memory and language. Alzheimer’s disease (AD) is a silent killer of the brain and lives off the world’s elderly people. It is the fourth leading cause of death among the older adults in the developed world. Named after Alois Alzheimer, the German physician who identified it in 1907, it remains elusive as to its cause and is resistive to treatment. It starts as a robber of memory and slowly erodes the intellectual and functional abilities leaving the patients bed-ridden and ultimately leading to their death, mostly through pneumonia (infection of the lungs). The course the disease takes and the pace at which the changes occur vary from person to person. On an average, patients live between eight and ten years after they are diagnosed with the disease, though some may live with the disease for as many as 20 years. Alzheimer’s disease is not senility and it is not a normal part of the aging process. It is a disease. It can strike anyone. It may be diagnosed only by a physician and only after a thorough physical, psychological, and neurological evaluation.

In India, by 2005, approximately 3 to 4 million had been afflicted by dementia. According to a study, about 4% of the population over 65 is afflicted with dementia; it means that by 2010, we will have around 10 million people afflicted with Alzheimer’s disease.

No treatment can cure Alzheimer’s disease. However, for those in the early and middle stages of the disease, the drugs terrine (Cognacs), donepezil (Precept), rivastigmine (Exeo), or glutamine (previously known as Romany) may help pre-vent some symptoms from becoming worse for a limited time. Most often, spouses and other family members provide the day-to-day care to the patient. As the disease gets worse, the patients need more and more care. This can be hard for caregivers and can affect their physical and mental health, family life, job and finances.

As my ex-colleague Ms Hendi Lingiah, Clinical Psychologist, France, says, “It would be a hard task, knowing for example the number of the Dementia population in India. Following a plan in the public health policy becomes a necessity – it involves recognition of the early symptoms of dementia, the different models of interventions, research on the disease, drug and non-drug therapies, infrastructure-training of professionals and homecare givers.” This challenge to public health is hardly accepted in developing countries; do we let the disease crush us or do we start working together? Research on Alzheimer’s disease in India is still in the initial stages. Medication is expensive. Among the family members, care for Alzheimer’s patients, even with the best of intentions, is accorded low priority. Professional support systems are non-existent. Against this background, general physicians and neurologists try their best to make things better for AD patients. We do not have enough day-care centres or assisted living communes as in the West. Are there any aids or gadgets that make life a little better for the AD-afflicted?”

Due to lack of awareness of AD, most patients / family members tend to ignore the symptoms of the disease as a normal part of the aging process. Clinical help is sought only after a drastic deterioration in the patient’s health has set in. Creating mass awareness about this tragic condition can help detect Alzheimer’s at an early stage and provide avenues for appropriate support and care for patients. What is needed is counselling and support services to help sustain the capacity of the caregivers. Training the volunteers and informal caregivers can be of immense help in supporting the family and caregivers. Also, all old age homes and hospitals should have wards for the AD-afflicted.

So if you know anyone suffering from Alzheimer’s or Dementia, take him to the doctor for diagnosis or to any organisation that offers psycho-social care. I know there are not enough specialists in this field or their action is limited, owing to lack of funds and goodwill. But presently in India, ageing and senior care has become an important issue and the government has started to react by integrating it in its policy for the old people. But let us not depend only on the ministry; let us come together and make a joint effort in our own way to make the life of seniors comfortable; let us offer support and care to people suffering from Alzheimer’s as also their care-givers.

Let us salute all the family members and the caregivers of the AD-afflicted patients. Together we can do a lot for the AD-afflicted; so, join the movement!

Thursday, April 19, 2007

Can curry slow down Alzheimer's ? - from

April 26, 2005
Can curry slow down Alzheimer's?

Can’t decide whether to eat Indian, Chinese or Continental? You'll probably have a yearning for a bit of chicken tikka masala or rogan josh after reading this: A study by University of California, Los Angeles-Department of Veterans Affairs, shows how turmeric, one of curry's key components, may be effective in slowing down the progression of Alzheimer's disease and possibly even curing it.

The study was conducted on genetically altered rats fed on foods flavoured with copious amounts of turmeric. Turmeric is rich in curcumin, a compound known for its antioxidant and anti-inflammatory properties. The discovery that curcumin may prevent the accumulation of destructive beta-amyloid plaques in people suffering from this degenerative brain disease and also break up existing plaques, probably explains why the incidence of Alzheimer’s in India is the lowest in the world.

As compared to other medications being tested on Alzheimer’s patients, turmeric appears to be more effective, possibly due to the structure and low molecular weight of curcumin that enable it to penetrate the blood-brain barrier. Human clinical trials to further evaluate the possible protective and therapeutic effects of curcumin are now on the anvil. So while scientists and researchers hunt for an allopathic cure, let’s give traditional wisdom a chance—spice up your taste buds with Indian curry and protect your brain cells.

link :

Scientific Observations on the spectrum of dementia in India - by Jha Sanjeev and R. Patel.

Some observations on the spectrum of dementia
Year : 2004 Volume : 52 Issue : 2 Page : 213-214

Diagnostic appraisal of dementia needs an optimistic approach for the benefit of the physician and the patient. With the advancement of new diagnostic tools it is easy to classify dementia into definite clinico-pathological groups. Epidemiological data about dementia appear conflicting as till the 80's MID was reported to be more prevalent than AD in Japan, Korea and China but in the 90's AD was documented as being twice as common as MID in these very countries.[3] AD has been consistently reported to be the commonest type of dementia by American and European studies.

We observed that AD, which is irreversible and common in the west, is uncommon in India. Similarly, prevalence of AD in Nigeria has also been observed as low.[3] Initially, it was attributed to poor suspicion, but in spite of adopting the NINCDS-ADRDA criteria,[2] we observed that about 75% patients in our study had a potentially treatable etiology or in whom progress of dementia could be halted. MID, infections, poorly distilled country-made liquor were other common yet treatable causes and so was nutritional dementia.

Most of the Indian studies have also reported MID to be more prevalent. In the first epidemiological study from the Indian subcontinent, the incidence of AD was reported to be amongst the lowest possible.[4] Explanations forwarded by the authors were short duration of follow-up, cultural factors and other potential confounders.

In a similar study in rural northern India an overall prevalence of AD has been described as very low (0.62% in the population over 55 years and 1.07% in those aged 65 and above). Of course this prevalence increased with age. Explanations postulated were low overall life expectancy, short survival with this disease and low age-specific incidence, potentially due to differences in the underlying distribution of risk and protective factors as compared with populations with higher prevalence.

[5]A community-based study in a rural population in Kerala reported 58% of patients with MID compared to 41% with AD. There were more women and positive family history was prominent in the AD group. Smoking and uncontrolled hypertension was associated with MID.

[6] A few Indian studies are also contradictory, with AD being suggested to be more prevalent than MID.[3] Interestingly, in another report from India the prevalence of dementia was observed to be higher in the rural population as compared to the urban settings.

[7]There is a difference in the incidence and prevalence of AD between underdeveloped and developed countries. Many interesting reasons have been cited. The widespread use of pesticides and the type of smoking has been directly correlated with MID, which is more prevalent in India. Another reason forwarded is the widespread use of electric lighting. Exposure to bright light suppresses the secretion of melatonin, a free radical scavenger, which inhibits progressive formation of beta sheets and beta amyloid fibrils. Its production is further reduced with aging, thus increasing susceptibility to age-related diseases like AD.[8]

Jha Sanjeev, Patel R
Department of Neurology, SGPGIMS, Lucknow, India.
Correspondence Address:
Associate Professor, Neurology Department, SGPGI, Lucknow,

link to the article :;year=2004;volume=52;issue=2;spage=213;epage=214;aulast=Jha

Alzheimer or a simple problem of Forgetfulness?

If elderly people have a problem with their memory is it possible that they may be developing Alzheimer's disease.(अल्ज्हेइमेर'एस दिसेअसे).

Part 1 / पार्ट १ .

Simple forgetfulness should not be confused with memory loss due to a disease।

The American Alzheimer's Association has developed these "10 warning signs" to look for to see if a person maybe developing this disease।
1।Is memory loss affecting job skills?
2।Does it affect the ability to perform familiar tasks?
3।Are there problems with language, such as finding the right words for familiar objects?
4।Is there frequent disorientation as to where and what time of day it is?
5।Is judgment poor or decreased?
6।Are there consistent problems with abstract thinking?
7।Are familiar objects frequently misplaced?
8।Are there noticeable changes in mood or behavior?
9।Are there noticeable changes in personality?
10।Is there a loss of initiative?

If these are the signs then one should consult and take the advice of the most experienced physician possible।
Alzheimer’s disease is not the only cause of memory loss and / or confusion। Other disorders, including depression, reactions to certain drugs, a series of small strokes (called multi-infarct dementia), hearing problems, vitamin deficiencies, and certain tumors and infections may look just like Alzheimer’s disease to friends and relatives, but are much more treatable।

Part 2 / पार्ट २

Have you often gone into a room and wondered why you came there in the first place? Do you frequently "misplace" your keys?Do not blame it on "Old Age"।
Here are some things you could do to get over simple forgetfulness।

१) Make a place in your house to put those things you frequently misplace। Make it a point to always keep your keys, wallet, ration card, milk card etc. in that place.

२) Though some things are better done by routine, try to do things differently, which will encourage the brain to work, and break the monotony। For example take a simple detour to reach the same place. Button your shirt from down to up. Read the newspaper from the last page.

३) Start using a note pad to jot down things you have to do, or phone numbers, details of bills and so on। Try to always carry this pad and a pen with you.

४) Organise yourself and get into the habit of putting things in their places। For example if you use a pair of scissors and forget to put it back, you may have to spend a lot of time looking for it.

५) Do not postpone anything that can be done just then। That way you will not have a chance to forget to do it.

६) While doing something you need to remember later, repeat to yourself that you are doing it। For example if you have deposited a cheque in the bank, tell yourself more than once "I have deposited the cheque in the bank". Even if you have to do somethimg you could say to yourself more than once "The electricity bill has to be paid tomorrow".

७) If you have to do something important, remember to leave reminder notes for yourself in places you will not miss seeing।

८) If you find yourself in a room wondering why you came there, try going back to the place where you came from। This usually brings back your memory.

९) Create a mental picture of what you have to do. For example if you have to pick up your grandchild from school, imagine the scene where you are picking him up and bringing him home. This kind of visualisation helps you remember.


Thursday, April 12, 2007

Shady old-age homes in India? Consumer bytes - by Sakuntala Narasimhan

Deccan Herald, Tuesday, July 27, 2004

An elderly parent who was hale and hearty and quite well for her age, was suddenly reported deceased.

If taking people for a ride is deplorable, it is more so when those being ripped off are dependents. The elderly and aged, for instance. A look at some of the homes for the aged that have mushroomed around Bangalore shows that one needs to make careful investigations and check details first, before choosing one, either for oneself or for one’s parents.

Thanks to factors like rising longevity, the disappearance of the extended family pattern of living, and children moving away as NRIs, there is a rising demand for old age homes.

An information directory brought out by the city’s Elders Helpline lists over 60 such homes, with charges ranging widely from Rs 700 to Rs 3,500 per month (and deposits of anything from Rs 10,000 to over one lakh and forty thousand). Some are also free, but in spite of the proliferation of homes for the aged we don’t yet have any regulatory body or legislation to protect the interests of those living in such places. With the result that there are reports of shady operators who collect money but do not provide proper facilities.

At least one such operator is reported to have moved from one place to another, setting up ‘homes’ and making money out of the enterprise at the expense of the aged.

The most common stories I heard pertained to medical bills. A doctor is often available for consultations once or twice a week, but some inmates have been asked to undergo unnecessary tests (for which extra payment has to be made) and that too, only at particular labs recommended by the doctor. In one case, a woman in her sixties was told that she should have expensive tests done for checking her heart. The receptionist at the clinic (perhaps a new appointee !) naively asked the , when she turned up with her report, if she was having respiratory or other problems, and when she said no, she was feeling fine, the girl at the counter wondered, “Then why have you been asked to go for an echo-cardiogram ?” The woman had herself wondered - but with age, physical infirmities, both apparent and hidden, become scary bogies, and unscrupulous staff take advantage of this, to scare the elderly into paying for extra tests.

In another case, the deposit which was supposed to be refundable, was returned after heavy deductions, with the explanation that the charges were “for medicines”. A doctor associated with an NGO who checked the details of the charges, says it is doubtful if one person could have consumed so many medicines in the course of just four weeks as the home claimed. There were also no proper receipts for purchases, no chemists’ bills or even doctor’s official prescriptions, only scraps of paper with lists of drugs purportedly given. The aged inmate , when queried by the family, could not remember whether all these medicines had indeed been consumed.

In yet another case, an elderly parent who was hale and hearty and quite well for her age, was suddenly reported deceased, and the family was informed only after the lapse of two days. Why the delay, and why was the body sent for post mortem before the relatives were informed ? No proper explanations were forthcoming. The children of the deceased are even wondering if the organs were intact in the body, and whether there could be a racket of sorts. Nothing could be proved, however, and even the police declared that there was insufficient evidence to book a case.

Common complaints are about : insufficient or unsatisfactory food, and lack of facilities promised on paper. It is common practice to have no written agreements at the time of admission, listing rules and entitlements. Some homes deduct 10 per cent of the deposit for each year of stay although technically the deposit is ‘refundable’. Cases have been known of homes for the aged printing ‘donation coupons’ of small denominations (Rs 5, 10, which are affordable and do not call for scrutiny) and selling these by the roadside to collect money (which does not always go to benefit the inmates). Sometimes, those running such operations claim political connections, and so action against them is tardy or stalled. Dr Radha Murthy of The Nightingales Medical Trust offers some suggestions for those who are contemplating admissions into old age homes.

A booklet, published by the Elders Helpline is available free of cost, listing details of several homes and the facilities they offer, the charges etc. Take a look.Visit the place you have in mind, check out the credentials, and talk to the inmates. If you are not allowed access, for discussions, be wary because there might be something to hide that the people in charge do not wish to make known.

Not only the families which are thinking of admitting their elderly members but also senior citizens too should educate themselves - about medical ailments connected with old age, coping strategies, for example - and exercise their right to information and right to choice.

Check the location of the home,
the availability of hospital or clinical facilities nearby in an energency,
the nursing services offered or promised,
the type of food given,
facilities for pastimes,
security arrangements,
facilities for accompanying the elderly if they need to go to the bank or post office etc.
Get details in writing, rather than mere oral assurances.

A toll free elders’ helpline 1090 is available, 8 AM to 8 PM that offers counselling and legal advice. The services offered include police intervention in serious cases, and medical referrals.

And finally, a piece of advice from an inmate of a home for the aged - “How happy and contented you are, in an old age home, depends partly also on your own attitude,” she says. “Cultivate interests to keep yourself occupied, develop serenity, think positive, and grumble less. If there are issues to be addressed, do it without feeling that you are being victimised. Also, if you are healthy and mobile, reach out to the other inmates who may be less fortunate.”

That would be good advice for anyone, not merely for the aged. To that, another elderly inmate adds some advice for the children too - “If admitting your parent in a home for the aged is unavoidable , do not think that your duties end with paying the money. Make the effort to keep in touch, even if you are a NRI, visit as often as possible, and provide inputs that help fight the sense of abandonment that is often inescapable in an institution of this kind.

Pinch of salt:
You might think that buying an expensive multinational brand guarantees quality. Not necessarily, however, as one customer realised after paying Rs 400 for a watch strap at Safina Plaza, and seeing it fray within three weeks. The shop not only refused to accept a complaint from her but was even abusive, declaring that she “did not know how to wear a watch sufficiently loose.” For that price she could have bought a decent watch, not just a strap. Check regarding guarantees offered,in writing, if you are paying for something expensive.

Copyright 2004, The Printers (Mysore) Private Ltd., 75, M.G. Road, Post Box No 5331, Bangalore - 560001Tel: +91 (80) 25880000 Fax No. +91 (80) 25880523

Wednesday, April 11, 2007

India starts to cope with ageing millions- by Siddhartha Kumar.

Nov 22, 2006,

New Delhi - Sitting in the winter sun at an old-age home in Tilak Vihar in west Delhi, 71-year-old Veermati Devi is recovering from the shock of being thrown out of her home by her son and daughter-in-law.

'They were tormenting and harassing me all these months, saying I was useless and there wasn't enough space in the flat for me,' she says bitterly.

'It was better to take shelter at bus-stops than to suffer indignity...I don't want to go home now,' said Devi who endures a penniless existence in her twilight years.

Through the centuries Indian society has stressed deference and respect for elders, taking care of ones parents in their old age and the importance of living in a joint-family, however, there has been a perceptible erosion of these values as the country modernizes and embraces individualism and consumerism.

Perhaps more alarming are the frequent media reports on mental and physical abuse of parents by their children.

Manju Varshney who manages old-age homes says a majority of her clients were shown the door by their children - many before the ink dried on the transfer of property into their name.
'Some even suffered physical assault and were pushed, shoved or slapped in their own homes,' she said.

Down south in Bangalore city, Subodh Keskar, 66 was left in a lurch when his only son left him to take up a job in an IT firm in the US three years ago.

The Keskars were relatively fortunate in having found a 'family' in Non-Resident Indians Parents' Association (NRIPA), a support group having over 250 members, many of whom were struggling with the 'empty nest syndrome.'

'We find understanding and emotional support as all of us face the same predicament' Keskar said.

Forces of migration and urbanization are upsetting the Indian value systems as thousands of young Indians emigrate to Western countries or to other Indian cities for better employment opportunities, resulting in the mushrooming need of support groups.

'More such groups are needed as a number of parents have similar issues. After requests from different places, we are considering forming an all-India body and associations in a dozen cities,' NRIPA founder Ambuja Narayan said.

Lack of financial security, 90 per cent of India's estimated 80 million seniors over 60 have no social security, and healthcare are just a few of the issues facing India's growing elderly population.

'We seem to be staring at a big crisis as after 2025, the number of elderly will increase from 8 per cent of the population to 15 per cent of the population,' said Mathew Cherian Chief Executive Officer, HelpAge, the biggest NGO working for the aged in the country.

The main trends of the aging population in South Asia are the greater concentrations of seniors in rural areas, impeding delivery of services, and the feminization of the elderly, according to Ghazy Mujahid, advisor to the UN Population Fund.

Women will shortly constitute over 52 per cent of the population above 60, in India, Nepal and Sri Lanka, a daunting number in places where few women are financially independent.

'There is a general disaffection toward the old which should change. We need to urgently focus on areas like nutrition, healthcare and spiraling costs of medicine, tax benefits and social security especially in the rural areas,' said HelpAge's Cherian.

All these factors are forcing the government to wake up and face the situation.
GK Singh, Deputy Secretary, Social Justice Ministry, said under the Integrated Project for Older Persons, the government will construct an additional 340 old-age homes for the destitute-elderly, 220 day-care centres and 60 mobile medicare units across the country.

He added that the government will soon introduce the 'Welfare and Maintenance of Parent and Senior Citizens' legislation to protect the elderly.

Children and grandchildren not taking care of their elders could be jailed and aggrieved parents can approach tribunals to claim maintenance.

The legislation would also provide for the right of parents to revoke the transfer of property to their children in cases where the latter does not look after them.

Seniors, however, are angry that the decision-makers have neglected them far too long.
'What is needed is political will. The elderly lack pressure groups and lobbies,' said octagenarian Kishan Lal Tandon. 'It is ironic that though most of the Indian lawmakers and politicians are over 60 years, they have such a callous attitude towards the aged,' he added.
© 2006 dpa - Deutsche Presse-Agentur

From :

Monday, April 9, 2007

Indian curry may be the next Alzheimer's weapon - from

Medical Studies/Trials
Published: Tuesday, 28-Dec-2004

A dietary staple of India, where Alzheimer's disease rates are reportedly among the world's lowest, holds potential as a weapon in the fight against the disease.

The new UCLA-Veterans Affairs study involving genetically altered mice suggests that curcumin, the yellow pigment in curry spice, inhibits the accumulation of destructive beta amyloids in the brains of Alzheimer's patients and also breaks up existing plaques.

Reporting in the Dec. 7, 2004, online edition of the Journal of Biological Chemistry, the research team also determined curcumin is more effective in inhibiting formation of the protein fragments than many other drugs being tested as Alzheimer's treatments. The researchers found the low molecular weight and polar structure of curcumin allow it to penetrate the blood-brain barrier effectively and bind to beta amyloid.

In earlier studies (Journal of Neuroscience, 2001; 21:8370-8377; Neurobiology of Aging, 2001; 22:993-1005), the same research team found curcumin has powerful antioxidant and anti-inflammatory properties, which scientists believe help ease Alzheimer's symptoms caused by oxidation and inflammation.

The research team's body of research into curcumin has prompted the UCLA Alzheimer's Disease Research Center (ADRC) to begin human clinical trials to further evaluate its protective and therapeutic effects. More information about enrolling in this and other clinical trials at the Center is available by calling (310) 206-3779 or online at

"The prospect of finding a safe and effective new approach to both prevention and treatment of Alzheimer's disease is tremendously exciting," said principal investigator Gregory Cole. He is professor of medicine and neurology at the David Geffen School of Medicine at UCLA, associate director of the UCLA Alzheimer's Disease Research Center, and associate director of the Geriatric Research, Education and Clinical Center at the VA Greater Los Angeles Healthcare System at Sepulveda, Calif.

"Curcumin has been used for thousands of years as a safe anti-inflammatory in a variety of ailments as part of Indian traditional medicine," Cole said. "Recent successful studies in animal models support a growing interest in its possible use for diseases of aging involving oxidative damage and inflammation like Alzheimer's, cancer and heart disease. What we really need, however, are clinical trials to establish safe and effective doses in aging patients."

The research was funded by the Siegel Life Foundation, Veterans Affairs, Alzheimer's Association, UCLA Alzheimer's Disease Research Center and private donors.

Alzheimer's disease (AD) is an irreversible, progressive brain disorder that occurs gradually and results in memory loss, unusual behavior, personality changes, and a decline in thinking abilities. These losses relate to the death of brain cells and the breakdown of the connections between them.

The disease is the most common form of dementing illness among middle and older adults, affecting more than 4 million Americans and many millions worldwide. The prevalence of Alzheimer's among adults ages 70-79 in India, however, is 4.4 times less than the rate in the United States.

Widely used as a food dye and preservative, and in some cancer treatments, curcumin has undergone extensive toxicological testing in animals. It also is used extensively in traditional Indian medicine to treat a variety of ailments.

Other members of the research team are Fusheng Yang, Giselle Lim, Aynun Begum, Mychica Simmons, Suren Ambegaokar, Ping Ping Chen of UCLA; Rakez Kyad and Charlie Glabe of the University of California at Irvine; and Sally Frautschy of UCLA and the Greater Los Angeles VA Healthcare System at Sepulveda.

The Alzheimer Disease Research Center at UCLA, directed by Dr. Jeffrey L. Cummings, was established in 1991 by a grant from the National Institute on Aging. Together with grants from the Alzheimer's Disease Research Center of California and the Sidell-Kagan Foundation, the center provides a mechanism for integrating, coordinating and supporting new and ongoing research by established investigators in Alzheimer's disease and aging.

Veterans Affairs Greater Los Angeles Health Care System and Sepulveda Ambulatory Care Center combine resources to form a unified Geriatric Research Education and Clinical Center, one of 20 nationwide. These centers of excellence are designed to improve health care and quality of life to older veterans through the advancement and integration of research, education and clinical achievements in geriatrics and gerontology into the total VA health care system and broader communities.

Friday, April 6, 2007

Demographic transition in India, how to tackle Alzheimer's Disease- by Dr Balasubramaniam.

Body or mind: use it or lose it

Online edition of India's National Newspaper
Thursday, Oct 20, 2005

THE DEMOGRAPHIC transition happening in India is striking. Fifteen years ago, of the 820 million people in the country, about 8.5 per cent (or 70 million people) were over 60 years of age. Today, the proportion of these geriatrics has increased to 10 per cent, and by the year 2021, every seventh Indian will be a senior citizen.

This ageing of India poses health issues of a kind not as pronounced a generation ago. With age come problems of ageing disorders and diseases. The most challenging of these is the set of neurodegenerative diseases, notably dementia or loss of mental functions.

Increasingly prevalent Alzheimer's disease, or senile dementia, is an increasingly prevalent form of these. The Kerala-based Alzheimer's and Related Disorders Society of India (ARDSI) has been doing praiseworthy work in recognising this growing geriatric problem and suggesting ways and means of tackling it, including starting a Respite Care Centre for Alzheimer's disease patients.

The disease is named after the German physician Alois Alzheimer who described its symptoms and pathology about 100 years ago, when he was treating an elderly lady who was progressively losing memory, speech, displaying hallucinations and delusions, and finally became totally helpless. Autopsy of her brain showed strands of thick, insoluble deposits, which presumably interfered with normal brain function, by disturbing the electrical activity there. (Interesting how some diseases are named after the doctor who described them while some others are named after the patient who suffers from them, e. g., Lou Gehrig disease, after the baseball hero).

Cause not clear
What causes these Alzheimer's plaques is not clear, but a variety of factors seem to do so. Mutations or variants of the gene for the blood protein called Apolipoprotein E (ApoE) are associated with the disorder.

Life-style habits, diet and drugs are known to be involved as well. The mere process of ageing is a factor — hence the name senile dementia.

How can we affect the course of human ageing? The clue stares us in the face when we ask the opposite question — what hastens ageing? Smoking, drinking, bad eating habits and impaired nutrition, abuse of the body through lack of exercise, excessive exposure to the sun and the elements and such do.

Gymnasts, health clinicians and yoga teachers show us how controlling our diet and habits, and regular physical exercise keeps the body young. Taking care of the body helps it keep young. Look at the 36-year-old Andre Agassi, who rebirthed himself in world tennis for the second time and almost won the US open this year, more than a decade later.
Or the bicycling hero Lance Armstrong, who became the champion of the Tour de France after successfully overcoming testicular cancer.

If physical exercise and proper habits can delay the course of physical ageing, why can we not do the same about mental ageing or senility? Gratifyingly, the answer seems to be in the affirmative. Mental exercise appears to affect the course of mental ageing in desirable ways.
Herein lies the hope for Alzheimer's and related conditions of dementia. There is now increasing evidence that an intellectually stimulating lifestyle may help modify late-life mental health in a positive manner.

Dr. R. Katzman asked in 1995, in an issue of the Journal of the American Geriatrics Society, whether late-life social and leisure activities delay the onset of dementia.

Testing the idea
The question was posed in order to focus attention of the increasing hints that lifestyle can delay mental ageing, and to provoke studies to test the idea. Since then, several papers have appeared, supporting the idea. In an article titled `Exercise, experience and the aging brain', in the journal Neurobiology of Ageing three years ago, J.D. Churchill and others suggest that "mental exercise provided by frequent engagement in intellectually demanding activity at work may facilitate the maintenance of inherent cognitive reserve, leading to more sophisticated cerebral networks in old age".

Latest paper
Dr. L. Fratiglioni and coworkers note in Lancet Neurology last year that an active and socially integrated life style in late life might protect against dementia.
The latest in the series of papers is a detailed population-based study of thousands of twins, all of them senior citizens, from Sweden. There is an inherent advantage in studying twins — they share the same genes, so that we can study the effect of `nurture', and not worry about factors of `nature', particularly with identical twins. Dr. Ross Andel of the University of South Florida has collaborated with colleagues in Sweden and analysed the connection between the incidence of Alzheimer's in these twins and their education, work pattern and the complexity of the work they had been involved in.

This is a classic `co-twin' study, where one of the twins has the disease while the other does not. In addition, they compared demented individuals with non-demented ones in a case-control study.

Complexity of the work involved demands on working with data, with people, and with things.

Work on data involved synthesising, coordinating, analysing, compiling, computing, copying and comparing.

Work with things involved setting up, operating, precision, driving, manipulating, tending and such.

Working with people involved teaching or mentoring, negotiating, supervising, persuading, serving and such.

The results, published in the September issue of the Journal of Gerontology, suggest that greater complexity of work, and particularly complex work with people, may reduce the risk of Alzheimer's disease.

What then is the take-home message? Bend your brain so that you keep it in good order. Play with children, take up a new hobby, do crossword puzzles, solve Sudoku, learn a new language, interact with people — whatever! These are tonics for the mind and easy and enjoyable.


General attitude toward Alzheimer's and Dementias in Western and Asian countries? From Alzheimer'

In contrast to many other cultures, where dementia is not seen as a particularly significant public health problem, modern Western societies seem intolerant. Industrial societies increasingly emphasise youth, productivity, self-control, and self-centred attitudes - 'I'm worth it'.

Global telecommunications and the age of the computer have placed greater worth on technology and, in relation to this, the way the brain functions. Cognitive psychology orginally had a particularly intimate relationship with computer science. The emphasis on memory, problem solving, reasoning, calculation, capacity and storage provided a particularly useful analogy for how the brain might work. As we embrace technology more and more it is easy to see the relative ease with which we associate worth with ease of functionality.
With the loss or lack of cognitive skills comes the danger of a new form of prejudice against those who don't function properly.

Such is the respect given to computers that Turkle (1984) described them a form of 'second self' for much of the population. Any slight deviation, even mild changes associated with old age, have become pathologized. If it can't be fixed then it isn't valuable and perhaps should really be discarded.

What might we learn from other cultures? In China, itself an advancing technological nation, a certain level of 'childish' behavior is accepted in the very old and is not seen as a reason for treatment. In India, dementia is either less severe or less frequent, because there is greater tolerance. Neither country is perfect and abuse of the elderly does exist. Perhaps we can step back a little and learn that industrial-based cultures don't have to be intolerant. Hopefully as countries such as China and India progress, they won't choose to learn their intolerance from us.

Updated: September 30, 2006

Thursday, April 5, 2007

Alzheimer's Disease in India, a huge gap to fulfill- from Times of India.

Study: Socially active life prevents Alzheimer's
Kounteya Sinha

NEW DELHI: New research conducted in the US says that staying active socially may help prevent Alzheimer's disease in the elderly. Alzheimer's, which is a progressive brain disorder that gradually destroys a person’s memory and ability to reason and make judgments, affects 5% of the population above the age of 60 in India.

According to David Bennett and his team from Rush University Medical Centre, loneliness increases the chances of having Alzheime's symptoms.

The team followed 823 people in and around Chicago with an average age of 80, none of whom had dementia at the start of the study.

Over the past four years, researchers asked the participants about their social activity — whether they felt they had enough friends, whether they felt abandoned or experienced a sense of emptiness. They were given scores between 0 (least lonely) and 5 (most lonely).

During the study, 76 people developed Alzheimer's. Those who did were more likely to have poor social networks. Those with a score of 3.2 or more (the loneliest 10%) had double the risk of those scoring below 1.4.

This study of the old man's disease proves to be of prime importance for India where by 2050, the average Indian might live from the current 64.7 years to 75.6 years.

Dr J D Mukherji, HoD (neurology) at Max Super Specialty Hospital, said, "Besides genetic factors, mental, physical and social activities are being seen as protective factors against Alzheimer’s. Symptoms such as minor forgetfulness and improper language functions aren't understood by family members, leading to the patient feeling isolated. India, which is ageing, needs to have proper caretaker groups who can understand these patients and help them through a fresh re-learning process.

" Dr Sanjay Saxena of Fortis Hospital, Noida, added, "A patient with Alzheimer's undergoes personality changes as the disease progresses. Loneliness leads to behavioural problems. Such patients are prone to go into dementia. The caretaker plays a very important part in the patient’s well-being. The patient needs to interact more and feel wanted.

" According to the 2006 World Population Prospects, by the UN Department of Economic and Social Affairs, by 2050, the number of Indians aged above 80 will increase more than six times from the current number of 78 lakh to nearly 5.14 crore. At present, 20% of this category in India suffer from Alzheimer's. The number of people over 65 years of age in the country is expected to quadruple from 6.4 crore in 2005 to 23.9 crore, while those aged 60 and above will increase from 8.4 crore to 33.5 crore in the next 43 years.

Dr Kameshwar Prasad, professor of neurology at AIIMS, said, "Social stigma against Alzheimer's, that is rampant in India, has to be eliminated. There is tremendous lack of awareness about the disease both among the population at large and care givers. With India ageing, the number of trained care givers has to increase substantially." According to one estimate, Alzheimer's kills one out of four Indians over the age of 80. The early stage of Alzheimer's is often overlooked and incorrectly labelled as normal old age outcomes.

Wednesday, March 28, 2007

ALZHEIMER'S DISEASE : facts regarding Asian and South Asian Population.

Some facts and figures
Why did my father get Alzheimer’s disease? He was such a good man.
It is estimated that there are currently about 18 million people worldwide with Alzheimer’s disease. This figure is projected to nearly double by 2025 to 34 million. Much of this increase will be in the developing countries, and will be due to the ageing population. Currently, more than 50% of people with Alzheimer’s disease live in developing countries and by 2025, this will be over 70%.

Effect of age on risk of Alzheimer’s disease
Alzheimer’s disease can occur at any age, even as young as 40 years, but its occurrence is much more common as the years go by. In fact, the rate of occurrence of the disease increases exponentially with age, which means that it occurs very rarely among those 40-50 years old, increases between 60 and 65 years, and is very common over 80 years. In November 2000, the National Institute on Aging (USA) estimated that up to 50% of Americans aged 85 years or more may have Alzheimer’s disease. Combining the results of several studies, the following rates of occurrence of Alzheimer’s disease are estimated in the general population in the West:

Since the risk of getting the disease increases with age, the number of patients with the illness to be found in any community will depend on the proportion of older people in the group. Traditionally, the developed countries had large proportions of elderly people, and so they had very many cases of Alzheimer’s disease in the community at one time. However, the developing countries are now undergoing a demographic transition so that more and more persons are surviving to an old age. For example in India, the 1991 census revealed that 70 million people were over 60 years. This number increased in 2001 to about 77 million, or 7.6% of the population. Similar demographic changes are occurring in other Member Countries of the SEA Region.

In Sri Lanka, the life expectancy is 74.1 (with 9.6% of the population being over 60 years), which is the highest in the Region, followed by Thailand (life expectancy 70, with 8.7% of the population over 60 years). With this increased number of elderly people, there will be many cases of Alzheimer’s disease. Thus, the time has come to discuss issues related to Alzheimer’s disease in the Member Countries of the Region.

Urban/rural differences
Recent research in India and Africa suggests that the risk of Alzheimer’s disease was possibly higher for urban as compared to rural areas.
This has raised several important issues for research: What is the deciding factor? Is it increased life expectancy? Is it lifestyle? Is it diet?

Gender differences
It is generally believed that men and women are equally at risk of Alzheimer’s disease. However, in developed countries, it is commonly observed that more women than men patients are to be found in old age homes and special care facilities. This is a reflection of the higher longevity of women as compared to men, and since this is a disease which strikes older people, there are more women patients than men. There is no evidence that women are at an increased risk of the disease than men, when the age factor is correlated in existing data. Also, women are better able to care for male patients than men are able to care for female patients. Thus, a woman with Alzheimer’s disease has a higher chance of being put into an institution because of her husband’s inability to take care of her. However, a man with Alzheimer’s disease has a higher chance of his wife taking care of him at home. Thus, a greater number of women patients are found in institutions.

Some research studies have suggested that those with higher education are at a lower risk for Alzheimer’s disease than those with less education. Although this has been repeatedly demonstrated in several projects, the reason for this association is unknown.

East-West differences
Studies done in South India, Mumbai and the northern state of Haryana in India have reported very low rates of occurrence of Alzheimer’s disease in those at 65 years of age or older, ranging from about 1% in rural north-India (the lowest reported from anywhere in the world where Alzheimer’s disease has been studied systematically) to 2.7 in urban Chennai.

Studies from China and Taiwan have also shown a lower risk of Alzheimer’s disease as compared to western countries. The low rates of occurrence of Alzheimer’s disease in the eastern countries is in striking contrast to data from the western countries.

Community-based studies are of particular interest when they look at populations similar in origin but subject to relocation. Some Japanese reports are important in this respect. Two recent investigations in the rural areas of Japan revealed that Alzheimer’s disease occurred in about 3.5% of individuals aged 65 or more. Reported research in 1996 among older Japanese Americans living in Washington and in Hawaii revealed that the number of Alzheimer’s disease cases was much higher than that estimated in Japan and closely resembled the findings for North America and Europe.

Similarly, research studies comparing the Yorba’s living in Ibadan, Nigeria, and African-Americans living in Indianapolis, USA, are also of interest as the groups share an ethnic background but live in widely different environments. In the Ibadan group, the proportion of Alzheimer’s disease cases was a low 1.4% (similar to rates in India), while the rate for Alzheimer’s disease among the African-Americans was estimated at 6.2%.

From the available evidence, it would appear that the number of cases of Alzheimer’s disease in Asia, and particularly in India and Africa, is lower than that reported from studies in developed countries. This raises a major question - why?

There are several possible reasons. Perhaps physicians do not diagnose Alzheimer’s disease but use non-specific terms such as senility. Other postulates refer to the socioeconomic realities and the lack of awareness of Alzheimer’s disease in the populations studied. It is likely that there is a low survival rate after the onset of the disease. Poor access to technologically-advanced health care may especially hasten the demise of patients, resulting in lower estimates of number of cases. Some have also speculated that the traditional attitude towards the elderly being one of respect, "family members will not force medical care or even food on an older relative who takes to his bed and refuses to eat" - a contributory factor in low survival.

It is possible that there is a lower occurrence of underlying risk factors (or the concomitant presence of protective factors) in the populations surveyed. For example, there is some evidence that the occurrence of a specific gene, Apolipoprotein EÎ4, which is a known risk factor in Alzheimer’s disease, is lower in the Indian population than elsewhere. This theory seems to be corroborated by the preliminary results from a genetic study of patients and comparable subjects without Alzheimer’s disease, which indicated a lower occurrence of Apolipoprotein EÎ4 gene in North India compared to the west. Additionally, gene-environment interactions have also been postulated as responsible factors for the lower number of cases in eastern countries.

Risk factors for Alzheimer’s disease
Millions of dollars have been spent worldwide in trying to determine why certain people get Alzheimer’s disease. However, only two established risk factors, i.e., factors that increase a person’s risk of getting Alzheimer’s disease have been discovered.
The first identified risk factor is increasing age. As already discussed, the risk of getting Alzheimer’s disease increases exponentially with age. But this does not mean that everyone living to a certain age or beyond will get Alzheimer’s disease.

What are my risks, Doctor?
There is increasing awareness of a genetic predisposition to Alzheimer’s disease, i.e., children of patients are afraid that they may inherit the disease. The risk of inheritance on a genetic basis is extremely small.

The other identified risk factor is a genetic predisposition.
Since Alzheimer’s disease is common among older people, even if many members in a family are affected by Alzheimer’s disease, it does not necessarily mean that the disease is being transmitted within the family on a purely genetic basis.

To date, three genetic defects considered as "causative genes" have been identified in patients of Alzheimer’s disease. In other words, people inheriting these genes from their parents will get the disease. One defect each is situated on chromosome 14, chromosome 19 and on chromosome 21. There may be other possible genetic defects, as yet unidentified, in patients of Alzheimer’s disease. These genetic defects manifest themselves by aggregation of multiple cases of Alzheimer’s disease within families affecting multiple generations. However, it must be emphasized that the proportion of all cases of Alzheimer’s disease which are inherited on a genetic basis is less than 1-2% of all known cases of Alzheimer’s disease.

Another mechanism of genetic effect is the inheritance of a "susceptibility gene". The best known susceptibility gene identified by medical research is the Apolipoprotein E Î4 gene. Inheriting this gene does not mean that the person will get Alzheimer’s disease; there are numerous patients who have these genes and do not get Alzheimer’s disease, while there are numerous patients who do not have these genes and yet get Alzheimer’s disease. Researchers believe that external factors must interact with this susceptibility gene to precipitate Alzheimer’s disease. This interaction is referred to as "gene-environment interaction" by medical researchers. The external factors are still unknown.

However, since Apolipoprotein E Î4 is known to affect cholesterol metabolism, research in India and Nigeria has suggested that a high-fat diet, as is typical in western countries, may be one of the factors which interacts with Apolipoprotein E Î4 gene to increase the risk of Alzheimer’s disease in the West. This is a subject of intense research and remains to be proved.

At the current stage of knowledge, it is impossible to predict who will get Alzheimer’s disease. It can strike anyone irrespective of gender, caste, creed, culture or socioeconomic status.

Other factors linked to Alzheimer’s disease
Increasingly, reports suggest that the use of certain drugs has been associated with reduction of risk of Alzheimer’s disease. These include hormones such as the oestrogens in menopausal women, non-steroidal anti-inflammatory drugs, antioxidants such as vitamin E, vitamin B and lipid-lowering agents.

Many other factors have been implicated such as viral infection, aluminium poisoning, as also family history of other genetic defects, and the risk to children born to elderly mothers. However, none of these factors has been proven to increase the risk of Alzheimer’s disease.

Cost of Alzheimer’s disease
Alzheimer’s disease is a chronic and progressive neurodegenerative disorder. It is, therefore, to be expected that the cost of caring for these patients is enormous. Keeping in mind the 1991 levels and future generations of patients of Alzheimer’s disease, a researcher in the US estimated that in the year 2000, the direct and total national cost to the US was approximately US$ 536 billion and US$ 1.75 trillion respectively. These are minimum estimates of the long-term dollar losses to the US economy at 1991 levels caused by Alzheimer’s disease. Similar detailed costing is not available in respect of other countries.

Besides the monetary cost, many spouses, relatives and friends take care of people with Alzheimer’s disease. During years of care-giving, families experience emotional, physical, and financial stresses. It is impossible to quantify this suffering.

Link :