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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 :

Monday, March 26, 2007

Alzheimer's Disease, Indian cultural traditions and languages - by Dr M.S. Thirumalai


Old age creeps in slowly for the young adult. Sudden changes may take place for the old, however. The old person becomes forgetful. At first it becomes a matter for laughter and joke in the family. Soon one notices that the old person is more confused than ever. He has more frequent mood changes, and begins to act in strange ways. He forgets the names of people around him, names of his own children and grandchildren whom he loved deeply. He begins to suspect your motives and wants to avoid you. Soon the old person becomes a different person altogether. He does not know his name, does not recognize his environment, and does not recognize his family. He is a stranger in his own family. He leaves home at his will and does not know where he goes or how he could return home. Family members are greatly worried and do not know what to do. The disease progresses rather slowly.

Only when the disease shows some severity, the family members often begin to seek medical consultation and attention for the patient.

The Alzheimer's disease was not recognized as a devastating one until the 1980s. But, since then, we read about it almost daily, and come across people and families that have been affected by it. The German doctor Alois Alzheimer described the disease somewhat definitively in 1912, I think. The disease is named after him.

In India and South Asian nations, cultural traditions took the onset of senility as a natural process of aging. Since life expectancy was rather short in these nations until a few decades ago, the Alzheimer's disease was assumed to be an occurrence or the phenomenon of the Western materialistic nations. There is a greater recurrence of this disease now noticed in India, especially among the people of middle classes.

Sadly, the belief that the Alzheimer's disease is a Western phenomenon is not really true. Indian family traditions make us suffer from within, mourn our fate, and feel sorry for our dear old person who is now a stranger in his own family. We do not publicize our "fate," and we are trained to put up with what we are faced with. Our public caregiving or medical systems are not prepared to handle such cases. I know of several cases of suspected Alzheimer's disease in India and my heart breaks when I think of such cases.

In the country where I am now settled, I have come across several Alzheimer's patients. These men and women were good friends of mine a few years ago, but with the onset of the disease I became a stranger to them. I could watch these developments and recognized certain linguistic characteristics of these persons. With a heavy heart I present here some of my observations on language use in Alzheimer's patients.

In terms of Indian languages, the pronominal usage is much affected, at variance with what the person would have done if he were not an Alzheimer's patient. The verb inflection with appropriate pronoun endings is also affected. He has problems with number and person attached to the main verb, but his problem with the gender is not as intense as his problem with the number and person of his addressee.

The most significant early process (and this continues to deteriorate further) is the patient's frequent substitution of one word for another. This begins with the confusion between related items such as ripe fruit and unripe fruit in Indian languages. The substitution process takes place between the similar items in some sense. Similarity is usually related to the similarity in meaning and appearance of the object or quality or action referred to.

However, as the disease progresses, the patient may not restrict himself to the substitution of one word by another from a related field only. Some of his substituted words may come from the related fields and some others from totally unrelated fields. Perhaps the intensity and frequency of failure relating to the transfer of words from the unrelated fields may be used as a diagnostic tool to assess the deterioration of the condition".

M. S. Thirumalai, Ph.D.
Bethany College of Missions
6820 Auto Club Road #320
Bloomington, MN

Sunday, March 25, 2007

The Indian Scenario, Helpage India.

A silent revolution has occurred in the last 100 years - unseen, unheard, and yet so close. The biggest achievement of the century is longevity. All over the world life expectancy has risen, leading to a sharp rise in the number of Older Persons.

The Indian Scenario
In India life expectancy has gone up from 20 years in the beginning of the 20th century to 62 years today. Better medical care and low fertility have made the elderly the fastest growing section of society.

In France, it took 120 years for the grey population to double from 7 % to 14 %. But in India, the grey population has doubled in 25 years!

Year No Of Older Persons
1901 12 million
1951 19 million
2001 77 million.

By 2025 a whopping 177 million!

While the numbers have gone up, quality of life has gone down.
Industrialisation, migration, urbanisation and westernisation have severely affected value systems. The erstwhile joint family, the natural support system, has crumbled. The fast-changing pace of life has added to the woes of the older person.

In India:
90% of older persons are from the unorganized sector, with no social security at the age of 60.
30% of older persons live below the poverty line, and another 33% just marginally over it.
80% live in rural areas.
73% are illiterate, and can only be engaged in physical labor.
55% of women over 60 are widows, many of them with no support whatsoever.
There are nearly 200,000 centenarians in India.
Here are some key aspects of ageing.

An irreversible biological phenomenon
Survival of a growing number of people completing their traditional adult roles

Persons above sixty years of age are classified as aged persons

Advancements in medical / health technologies
Gradual fall in mortality rate
Increased awareness
Better nutrition
Increased life expectancy

Senior Day Care in Jaipur by Indian Gerontological Association.


The UMANG Day care centre was started by Indian Gerontological Association in the year 1996 ( 15th August,1996) in Jhalana Basti of Jaipur,302004, India.The centre has been given recognition by the State Government of Rajasthan’s Social welfare Department and is also receiving financial assistance from the Rajasthan State Governent to run this centre.
The Centre has 92 male registered members, out of which approximately 30 to 35 members turn up daily. Most of these members belong to the unorganised sector of the Society and are of different castes and religions. The age of these members varies from 60 to 85 years.
The centre is open between 10.30 am to 4-30 p.m. all the weekdays, except Sundays and government holidays. Members come to the centre according to their suitability. These members are given tea and snacks twice in a day i.e. 1 p.m. and 3-30 p.m.

Activities of the members:
The centre provides the members facility of indoor games and a fair number of reading material to keep them busy apart from giving a common platform to discuss different facets of life and their experiences. The centre has number of games to play such as chess, chopad, carrom board, playing- cards. The library of centre has important religious books such as Ramayan, Ramcharitmanas, Mahabharat, Gita, Bible (Hindi), complete works of Vivekanand, History of Dharm Shastras ( in 5 vols.) by P,V.Kane and books related to various diseases which are common in the old age .The centre also has story-books and novels of famous Hindi novelists. Apart from these four magazines (weekly /monthly) and three daily newspapers. Those who are literate read books and magazines of their choice. Books are also issued to the members to read at home.

Income generating Activities :
The centre also has two moulds of different sizes for candle making, and also has 25kg wax. Some of the members take interest in this activity as a source of income. We plan to start a new activity so that the needy members can earn some money for their livelihood.
Due to financial constraints we are unable to do more in this field.

Health Care of the Members:
On each Friday of the week doctor comes and takes care of the medical problems of the members. Approximately 15 members consult allopathic physician . Per month approximately 60 and 70 persons are benefited by this facility of the centre. The physician also gives advice regarding prevention and life style modifications to deal with health problems of elderly.
The centre has a sphygmomanometer (BP instrument) for the weekly check up of blood pressure. Medicines are given free of charge. Members who are patient of asthma, tuberculosis, and blood pressure etc are provided necessary medicines which requires extra expenditure than the routine care. The centre also provides financial assistance to purchase spectacles. From April 99 to March 2002, 37 members of Day care centre were provided spectacles. We need glucometer to check up the sugar level of the patients. We also plan to provide hearing aids and dentures to the members of the centre, but due to paucity of funds we are at present unable to do so.

Picnic and outings
Every year centre organises picnics and programmes for outing. The members decide the place of picnic in their executive committee. They generally like to visit religious places and places of historical importance.

Religious and Social activities:
Every month on any Saturday evening (depending on the Bhajan party of the Basti to give date) Kirtan-Bhajan is organised . This programme is generally attended by most of the members. Monthly satyanarayan katha is also organised. The members also organise monthly meetings themselves in which they discusse the problems of their basti. Association also organises quarterly meetings of the executive members of the Day care centre.
The members celebrate Independence Day, senior citizens day and festivals like Rakhshabandhan, Diwali and Holi and other programmes for their entertainment. They also take interest in social and political issues. These Senior citizens also take part in education programmes. Now all the members can write their names.

Management of the Aged in India by P. K. Misra

Development Problems and Traditional Cultures
Reflections on the Management of the Aged in India
P. K. Misra

Humans are one. They belong to a single species. They have a long history. Even in prehistoric times there were migrations, near and distant, all over the world. Seas, rivers, lakes, mountains, deserts and forests have not been able to deter human beings moving from one place to another. Come to think of it, migrations of people like the Jarawa (a classic food-gathering and hunting Negrito group) to another island in Car Nicobar or of the Toda to the Nilgiris, or of the Ladakhi to the Ladakh region, speak about the immense capacities of human beings. Some such movements might have been prompted by compelling natural, social or economic circumstances, but many were not. Being mobile at one stage and sedentary at another is a part of human nature. It appears that human beings are restless in either state (Misra 1986). They are curious about themselves, about the things around and beyond them, and are ever eager to impose order on them. Apart from the immense capacity to endeavour, to learn, to innovate and to adapt to any ecological condition, they add to their cultural baggage by borrowing. Any attempt to characterise people in terms of indigenous and non-indigenous amounts to taking a very short perspective of history. Such categories, if anything, are basically political.

To get full article, you can contact me, I'll be please to send it to you.

Indian Government Plans Law to Protect Senior Parents, Indian Catholic, India.

The government plans to enact effective laws aimed at promoting the care, maintenance and protection of parents and senior citizens, a minister said. Meira Kumar, Minister for Social Justice and Empowerment, said this while flagging off an Inter-generational Walkathon on the occasion of International Day of Older Persons on Oct. 1.

About 200 senior citizens and 500 school children participated in the Walkathon. Ministry of Social Justice and Empowerment organized the function in collaboration with National Institute of Social Defence and HelpAge India. The minister said that the government is concerned about the welfare and security of the older persons, especially those belonging to below-poverty line and families residing in remote and rural areas. She further stated that people’s life expectancy has increased dramatically and age structures of societies have undergone profound changes.

People are now living longer and this longevity revolution is changing the concept of ageing.To help the aged people the government would soon bring effective legislation aimed at promoting the care, maintenance and protection of parents and senior citizens, she said.The views of the all the state governments would be considered before giving final shape to the new bill. The health and security aspects as well as overall welfare of the senior citizens have been given due importance while drafting the Bill, she added. She stressed the need to sensitize society about the problems and needs of the older persons.

The Minister also sought that cooperation of NGOs and public, especially the youth in creating an environment where older persons get respect, care and due affection. There is need to inculcate the feeling of respect and care for older persons in the minds of young generations, she stressed. October 1 is observed as International Day of the Elderly to recognize the services rendered by the senior citizens and to reiterate the government’s commitment towards the cause of the elderly.

Indian Catholic,
October 2, 2006.

Wednesday, March 21, 2007

Alzheimer's Disease in India.

of Dr Deepak Arjundas, Chennai.

About Alzheimer’s disease in India :

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, with the best of intentions, is low priority. Professional support systems are non-existent. Against this background general physicians and neurologists try their best to makes things better for AD patients. Dr Deepak Arjundas, a noted neurologist, explains how.

Who is at risk of Alzheimer’s disease?

Usually people over sixty are at risk of Alzheimer’s disease (AD). We also see a few cases of early onset AD, where people in the forties or fifties are affected.

Have any epidemiological studies been conducted in India? Does AD affect both rural and urban populations? Are there any links between diet, racial characteristics, or lifestyle patterns and the disease?

We have very little data to rely on. Some epidemiological studies have been conducted, but these have been confined to small pockets of the population. These seem to suggest that the incidence in India is not very different from that in the West.

Researchers still have not been able to discover any causative factors for AD. From our experience we see that it affects both rich and poor, urban and rural populations and highly intelligent people as well as persons with average intelligence. I know of a senior ophthalmologist who pioneered corneal transplant in India who has dementia now. It is really tragic.

Are people aware of the disease? How do you explain to them?

There is very little awareness. By the time patients come to me, the disease has already entered the middle stage.
When we hint at the possibility of Alzheimer’s disease, the family member or friend who escorts the person, usually breaks down. So we try to prepare them. By the time they take all the diagnostic tests a few weeks lapse. This helps people to come to terms with the situation a little by little.

Do we have medicines to treat Alzheimer’s disease?

As of now there is no cure. But there is medication that will help delay the progress of the disease for some time. It helps to push suffering a little further away.
Drugs are expensive. There is no cure as of now.

How are persons expected to cope with this?

It is difficult. Right now dementia is like a death sentence.
We advise those who can afford it to buy medicines. To others, when possible, we give away some samples free. When both are not possible we advise caregivers how to reduce the suffering of Alzheimer’s patients by taking proper care.
“Just keep the person with AD happy and accept them as they are.” is my advice the families.

Do people die of Alzheimer’s disease?

Not directly. But they are often victims of neglect and their failing intellectual powers. For instance, we get AD patients with serious burns and patients who have been injured by pressure cooker blasts. Accidents happen owing to their declining mental alertness.
We do not have day care centres or assisted living communes as in the West.

Are there any aids or gadgets that make life a little better for AD persons?

Different type of urine bags and diapers are a great help for those who have lost bladder and bowel control. We advise water beds for those who are bedridden.

What about people in the lower income groups?

In fact they are more accepting of the situation. “ Oh he is very forgetful you know, and does silly things,’ they say and support him as well as they can. They tie a dhothi with a firm clasp or belt (otherwise some of them might undress in public without realising it), give him a meal and a bare bed (no mattress as he is likely to wet it). When it gets too much for them they abandon him at a bus stop or a place far way from home.

As I travel in the city I observe many Alzheimer’s patients among the poor people who live or wander on the streets. In a country where there is so much poverty and getting one square meal a day is a problem for millions, care of ailing elderly people gets very little attention.

Is the scene likely to change? Does research give us hope of a cure?

I think research in the field of genetics and gene therapy will give us some hope of better treatment possibilities.

Is there any treatment available in alternative systems of medicine?

One company is working on a herbal preparation that is of some help in the early stages of the disease.

Dr Deepak Arjundas is an MD in General Medicine and DM in Neurology and is a consultant with two leading Chennai hospitals namely Apollo Hospitals and Vijaya Hospital.

Wednesday, March 7, 2007

Dignity Foundation : the First Day Care Center of Mumbai for Alzheimers and dementia persons


First Day Care Centrefor Mumbai for Alzheimers and dementia persons
On September 21st 2004 at the Y B Chavan Centre Convention Hall, the Dignity Dementia Care was successfully launched by Dr Noshir H Wadia in a hall over flowing with senior citizens and family members of Dementia affected persons.

The occasion was World Alzheimer's Day. Partnering Wockhardt Hospitals, Dignity Foundation launched the first ever centre to be opened in the city to deliver day care services to dementia persons. Dignity Foundation President Dr Sheilu Sreenivasan announced the launch of four-pronged services:
Awareness building about what is dementia (as in Alzheimer's Disease ).
Day Care Centre for Alzheimer's afflicted at Dignity Foundation
Memory Gym (service for people who want to know how good is their memory)
Caregivers Support Group

Dr Noshir H Wadia, the world renowned Neurologist, Director and Head, Neurological Dept, Jaslok Medical Hospital and Research Centre called upon all the social groups working in the area of Dementia to come together, join hands and spread the awareness as well as support to family with dementia persons. Talking about the uselessness of depending upon Government help and assistance, he congratulated Dignity Foundation for taking the lead in the social management of the disease. He called upon Dignity Foundation and similar NGOs to take up the cause at the national level. He said Dignity Foundation could initiate a massive drive to bring all people working together in the area of Dementia to evolve a national level programme to combat the increasing dangers of the more and more people getting afflicted with this disease.

Dr Charles Pinto, of Nair Hospital, fresh from inaugurating his own Memory Clinic in the morning at the Nair Hospital, called upon all volunteers of Dignity Foundation and family members of Alzheimer's Disease present at the meeting to get to learn in the coping of the difficulties in handling such patients at home. He underlined the importance of multi-disciplinary joint action of the sciences of Medicine, Physiotherapy, brain research, social work, and psychology in the tackling of issues involved in the management of dementia.

Dr Dilip Panikar, Psychologist, said that Alzheimer's Disease and other dementia bring upon difficult to handle behavioural problems where personality changes, mood, and memory get affected. The person loses all his bearings and becomes a child. Hence great deal of sensitivity has to be learnt to deal with them a t home. He praised Dignity Foundation for setting up a Day Care Centre in South Mumbai and offered all help and counsel to manage the patients well.

Nimesh Shah, President Rotary Club of Bombay Pier launched the brochure sponsored by them on the special occasion. The brochure is an educative tool for lay people to understand the complex issues of dementia types such as Alzheimer's Disease, Parkinson’s, Lewy bodies and Multi-infarct dementia.Wockhardt Hospital Group’s Mumbai Head, Dr Lloyd Nazareth announced his Hospital’s tie-up with Dignity Foundation offering whole-hearted assistance from awareness building presentations to technical assistance in setting up centres all over the city.

Dignity Foundation, BMC School Building, Topiwala Lane, Opp. Lamington Road Police Station, Mumbai 400 007. India.Telephone: 23898079 / 23841845 / 23814356 · Fax: 23898082 · Email:

Monday, March 5, 2007

ARDSI's Activities and its Services- Kerala, India.

The Main activities undertaken by the Society :

Day care
Domiciliary care
Memory Clinic
Geriatric Care Training
Awareness programs
Care givers’ meeting
Guidance and counseling
Dementia Care Fund


Light exercises
Listening to music, watching TV
Newspaper & book reading,
Recreational & Educational activities.
Indoor games like chess, caroms, cards, ball passing, bowling etc.
Activities like drawing, painting, stitching, clay modeling etc.
Using life story books.
Aromatherapy: This involves making the patients smell spices, leaves and other materials, which may invoke pleasant, old memories thereby enhancing the faculty.
Orientation sessions.
Photographs of events are also displayed at the center.
Reminiscence therapy

On an average, now we are providing domiciliary services to 81 clients. Community Geriatric Nurses, CGN students and the newly identified community workers provide the care services. The nurses visit each person with dementia once in a fortnight. These visits help to increase social interaction, to educate caregivers, to provide counseling and to provide necessary nursing care for the patients.

The memory clinic in Indira Gandhi Co-operative Hospital, Kadavanthra, Cochin, is functioning every day from 10.00 a.m. to 1.00 p.m. To apprise the facility of memory clinic, frequent visits by officials are made to nearby hospitals and clinics.

In the academic year 2004 – 2005, 12 students underwent this training course. The duration of the course is 10 months. The syllabus for the course covers general nursing, community health and welfare and more specifically the challenges of geriatric nursing in the field of dementia. The Christian Medical Association accredits the course.

Regular awareness lectures about dementia are conducted in schools and colleges. Members of Kudumbashree, Anganwadi and other community workers were also included in the program. Notices, brochures, newsletters and other publications are distributed at frequent intervals among public. Also wide publicity is given through mass media. BPL Help lines are extensively used for dementia awareness programs.

We organize caregivers’ meetings at regular intervals. The meetings are conducted for the caregivers at the dementia care center. Formation of Support Group was discussed in the last meeting in addition to normal discussions. Such Support Group could act as care givers and offer their services working in the field of dementia.

Counseling is provided to care givers on regular basis. Caregivers are encouraged to discuss their experiences while staff and Psychiatrist offer constructive advice at these meetings.

ARDSI launched the project in September 2004. Under the guidance of Dr. K Jacob Roy, Chairman ARDSI, Dr. S Shaji, Consultant Psychiatrist, ARDSI, and Dr. Mathew Abraham, Consultant Neurologist, ARDSI, a research program commenced with an aim to find out the prevalence of Dementia cases in Cochin Corporation, Ernakulam District. The research team includes10 community workers surveyors), 5 Community Geriatric Nurses lead by Ms Hena, the care manager. Sqn. Ldr. K. A. R. Nair (Rtd), Chief Co-Coordinator & Treasurer of ARDSI monitors the progress of the survey on a weekly basis.The community workers were identified and trained to conduct the survey. Their efficiency in conducting the survey as well as their willingness and ability to provide community care to the patients of dementia is being evaluated periodically.

Summary: Population screened 4899 Cases identified 125 Clients in day care 13 Clients availing home care 81 Total availing our services 94

Concerted efforts are made to generate funds for dementia care services. Our main source is from funding agencies and donations. Committees have been formed to achieve better results.

Madavana Temple Road, Vennala P.O, Palarivattom, Cochin-682028, Kerala, India
Ph: 0484-2808088, Help line: 9846198471, 9846198786
E-mail:,, Web:

Alzheimer's and Related Disorders Society of India, In term of Action and creation of Mass Awarness.

The Society’s objectives :

1.To give support, succor, help and information to families of persons affected by dementia.

2. To initiate and encourage formation of chapters of the Society, support groups and dementia care centers through out India.

3. To secure from Governmental and non-governmental sources, better facilities for care, for and on behalf of, those affected by dementia.

4. To promote and support research into the causes, and prevalence of dementia.

5. To bring to the attention of various Governmental agencies the needs of the demented, especially the need to have dementia recognized as a handicap of the elderly, so that they are placed on par with people suffering from other handicaps and resources reallocated in a more equitable manner.

5. To encourage training of health personal in geriatric care and dementia.g. To educate the general public about dementia through all available media.

6. To develop “help lines” to those who have to take care for the demented by setting up help groups and by linking and creating net works of such support services to make them more productive and economical and to integrate them with in the social and cultural milieu of India.

7. To arrange and conduct training programs for care givers and to organize seminars, medical camps and relief work.

8. To provide incentive and encouragement to other voluntary associations and individuals engaged in research in Alzheimer’s and related disorders and in the care and management of the demented.

9. To collaborate with various national, state and local governmental agencies concerned, especially health and welfare departments, non-governmental organizations, other National Alzheimer’s organizations, Alzheimer’s Disease International, World Health Organization and other International agencies in the pursuit of all or any of the above objectives and, further, promote exchange of medical and research personnel between institutions.

10. To provide guidance in legal matters to the demented and to intervene on their behalf wherever or whenever necessary or feasible.

11. To do all such things as are incidental or conductive to the attainment of the above objectives or any one of them.

ARDSI, Guruvayur Road,
680 503, Kerala, India.
Phone: 0091-488-523801/522939
Fax: 0091-488-523801/522347
E-mail :

Alzheimer’s and Related Disorders Society of India,Madavana Temple Road, Behind P.O.C.,Palarivattom, Cochin 28Phone:

JURISDICTION: The Society operate all over India. How ever, for legal matters the Society shall come under the jurisdiction of the courts in Ernakulam district.

Alzheimer's and Related Disorders Society of India, Origins and Objectives.

The Man Behind :
Dr. K. Jacob RoyChairman

It was the personal traumatic experience of caring his father late Rev. O.C. Kuriakose Kor Episcopa, that led Dr. Jacob Roy, a Paediatrician by profession, to turn zealously to form a society for the care and support of people affected with dementia. Even in late 80's none of the medical centres in the country were in a position to offer any significant help to those affected. In 1991, Tropical Health Foundation of India, a registered Charitable Society, working for the disabled, took the initiative at the instance of Dr. K. Jacob Roy and late Maj. A.V. Thomas (Rtd.) to organize, the first National Seminar, on Dementia, on 16th and 17th November 1991 at the Renewal Centre in Cochin

The seminar, attended by early 200 delegates from all over the country, unanimously decided to form a national organization for the welfare of people with dementia. They felt the growing need to create awareness about dementia and to initiate programmes, to provide support for the people affected and their families. Dr. Monty Barker, consultant Psychiatrist, University of Bristol, UK, delivered the keynote address. The notable speakers included Dr. Vijay Chandra, then Director of Central Aging and Research, New Delhi, Dr. Venkoba Rao from Madurai Medical College and Dr. Vinod Kumar, AIIMS, New Delhi

The World Federation of National AD Societies and Alzheimer's Disease International (ADI) awarded provisional membership for ARDSI in 1992, at the 8th annual Conference held in Amsterdam. Subsequently in 1993 ADI admitted ARDSI as a full member, thus becoming the first Afro-Asian Organisation to get this unique distinction.

What is "Alzheimer's Disease" :

Alois Alzheimer, Eminent German Neurologist and Psychiatrist described the symptoms of Aguste D as a disease in 1906, which was named after him. Great strides have been made in the early diagnosis and treatment of this mind crippling illness. In a totally bleak scenario, where nothing could have been done, four drugs are available now to manage some of the distressing symptoms and help the affected person lead a better life. It is estimated that there are nearly 22 million people suffering from this dreadful condition out which, over 3 million are estimated to be in India. By 2030 this number is expected to double.

Are we capable managing this large number of elderly people with dementia?

With dwindling family support, care of these frail, confused elderly will fall on the community. This is going to be even more difficult in countries like India, where there is gross ignorance coupled with total lack of services for providing a reasonable quality life for the victims and their families in distress.

We at ARDSI would like to embark on a yearlong “National Dementia Awareness Programme” starting from the January 2006.

ARDSI's aims and activities :

1 Series of publications in regional languages on different aspects of AD in print and electronic media.
2a Launch “Parliamentary Friends of Dementia”, to sensitize our parliamentarians and to raise the growing problem of dementia in the parliament and in State legislate assembly.
2b Launch “Media Friends of Dementia” to sensitize the media personal on the growing Problem of dementia and help in raises awareness.
3 Conduct memory walks, painting, photography competition, essay competition, street play etc.
4 Help in setting up services like, memory clinic, day care, and home care, Respite Care etc.
5 Rope in popular film actors, sports personalities, industrialists, parliamentarians an spokes men and Ambassadors to promote the cause – identify brained ambassador..
6 Recognize key persons and institutions that have contributed to develop ARDSI and promote the cause of dementia in the country.
7 To work with the postal department to issue a postal stamp / first day care cover to commemorate the centenary of Alzheimer’s disease.
8 To encourage the President, Prime Minister and other important public figures to speak on behalf of the cause of dementia.
9 To work with the Ministry of Health to include dementia in the National Mental Health Programme
10 To encourage Ministry of Social Justice and Empowerment to fund, dementia care services.
11 Screening of films on Alzheimer’s in popular TV channels.
12 Involve art, music, street plays, drams to promote the cause
13 Bridge the gap – introduce programmes to bring all generations to come together to talk and share
14 Main events in New Delhi – to coincide with the 12th National conference of ARDSI..

If you have any innovative ideas to promote the cause of dementia by demystifying and destigmatizing this growing public health problem. Please contact the National Office. You could help us by becoming : - Life members- A volunteer- To write/ speak on dementia- To provide funds and materials for the various services.

For more details, please contact :
Programme Officer,ARDSI,
National Office,Guruvayoor Road,
Kunnamkulam – 680 503,
Kerala, India.
Tel. 04885-223801
Helpline: 098461 98473,09846198471
Fax: 04885-222347

The Indian Association of Gerontology, Banares University, a brief presentation.

Association of Gerontology India, creation and aims :

Founded: 1982. Members: 205. Regional Groups: 6. Languages: English. Description: Health care professionals treating the elderly; scientists and clinicians with an interest in the aging process and diseases of the aged. Works to insure high standards of research and practice in gerontology, and to maximize availability of gerontological services. Conducts research in biological, clinical and psycho-social aspects of gerontology. Publications: Newsletter, semiannual.

The rapid increase in the aged population is a global phenomenon. Like many developed countries, India has a large proportion of the elderly in the population. This demographic change is a result of the decline in child death and increased life expectancy due to advancements made in medical sciences for the control of infectious diseases. India has currently an aged population (60 plus) that comprises nearly 7% (75 million) of the total population. This is expected to increase to nearly150 million by the year 2025.

Thus it becomes very essential that scientists of different disciplines and workers of various social organizations, interested in the welfare of the elderly, get together and make a united effort to keep the aged people healthy and happy.

With the above objective in mind, the Association of Gerontology (India) (AGI) was established in December 1981 with its headquarters at the Department of Zoology, Banaras Hindu University, Varanasi 221005, where pioneering research in biological aspects of aging is going on since 1965. AGI is a non-profit organization registered under U.P. government Society Registration act XXI 1860 No.41 VI-268. In 1982 the association was affiliated to the International Association of Gerontology (IAG) as its sister society. The IAG was established in 1950 in Liege. The IAG has four regional associations: North American, South American, European and Asia-Oceania region. In 2005, the name of IAG has been changed to IAGG (International Association of Gerontology and Geriatrics).

Objectives :
· To promote advancement of knowledge both by research and training in Biological, Clinical and Psycho-social aspects of gerontology.
· To organize scientific meetings, either under its own auspices or jointly with other organizations, and
· To publish journals, reviews, abstracts, newsletter, etc. on Gerontology.

Contact Information :
Telephone number:91 11 26593639
FAX number:91 11 26862663
Postal Address:Association of Gerontology (India) (AGI)
Anasri Nagar,
New Delhi 110 029,
Delhi, India

Banaras Hindu University,
Varanasi-221005, India

Tel: 0542-2307149,2313958,
Fax: 091-(0542) 2368174

Email :,,

Alzheimer's Risk Factors, Are you at Risk of Alzheimer's?- by Mr Sailesh Mishra, from Karmayog, India.

Mr Sailesh Mishra having 3 years experience in Development sector in Mumbai and very involved in the cause of Senior's Community in India is sharing with us in the following article a few facts allowing us to better understand Alzheimer's Disease. The article describes us the many risks factors, Genetics and Environmental, in volved in this "Disease", as the importance of our lifestyle. As Indian population will face the problem at a very large scale, it is good to start creating awarness from this day on.

Alzheimer’s disease begins to damage the brain years before symptoms appear. Why pathological changes occur in the brain leading to such profound damage is not clear. Risk factors are things that increase your chances of developing Alzheimer's disease. Some are preventable, such as exercise, some not, for example genetic factors and age.Lets look at some risk factors for Alzheimer's disease.

Age is the biggest risk factor for Alzheimer's : At 65 to 70 years your risk is about 1.5%At 70 to 74 years your risk is about 3.5%At 75 to 79 years your risk is about 6.8%Your risk of Alzheimer's nearly doubles every 5 years so by the age of 95 nearly one half will have Alzheimer's disease.

Genetic risk factor and Alzheimer's : Genetic risk factors as a cause of Alzheimer's disease is an area of intense investigation. Having a parent or sibling with Alzheimer’s increases your risk by two to three and a half times. The more individuals in a family with Alzheimer's, the greater the risk of developing the disease (but it is not always the case).

Cardiovascular risk factors for Alzheimer's : Vascular means vessels that carry or circulate fluids, such as blood. Cardio is the heart. It is known that cardiovascular risk factors such as high blood pressure, diabetes, hypertension, heart disease, stroke increases your risk factor for Alzheimer's disease. The good news is that you can do something to help prevent vascular problems such as giving up smoking, a healthy diet, lowering your cholesterol and by regular exercise.

Diet and Alzheimer's risk factor : The evidence on the effects of diet and Alzheimer risk are somewhat confusing. Research on antioxidants such as vitamin E and vitamin C have conflicting results, as has Omega-3 fatty acids, found mostly in cold water fish. A healthy balanced diet is linked to a healthy heart and reduced vascular disease, all of which help prevent Alzheimer's disease.

Lifestyle risk factors and Alzheimer's Smoking: There is conflicting research but there are indications that nicotine is a protector against Alzheimer's disease! However, smoking is also known to cause cardiovascular and respiratory diseases that are Alzheimer's risk factors.
Lack of exercise:An increasing amount of research indicate that moderate regular exercise helps to prevent Alzheimer's.

Alcohol : Low alcohol intake can be beneficial to your health. However high alcohol intake is known to increase your risk of dementia significantly.

Intelligence, education risk factor for Alzheimer's disease : A higher standard of education has been identified as offering some protection against Alzheimer’s disease. Smaller brains and head size leading to fewer connections within the brain have also been suggested in causation of Alzheimer's disease. It is likely that poor education may mask other factors such as poverty which may well help the development of Alzheimer’s disease.

Head injury and Alzheimer's risk factor : Where amyloid is deposited in the brain immediately after a head injury a positive link to dementia has been found. As has head trauma following vascular damage from such diseases as stroke, high blood pressure, diabetes mellitus and atherosclerotic disease.

Stress as Alzheimer's risk factor : Only one study has linked stress to Alzheimer's disease. It is thought that stress hormones (glucocorticoid hormones) may cause damage in the brain that then can contribute to the development of Alzheimer's disease.

Hormones and Alzheimer's risk factor : Women have an increased risk of Alzheimer's disease even once their longer life is factored out. Estrogen loss following menopause may be the reason.The findings on testosterone decline in older age require more research before a link is positively demonstrated.

Environment risk factor and Alzheimer's : Attempts have been made to associate environmental causes, such as high levels of aluminum with Alzheimer's. This theory is now less popular as more research is carried out.

Source :

Warm Regards,
Sailesh Mishra

Sunday, March 4, 2007

The Indian Governement Initiative, NISD implementing geriatric and gerontological care.

National Institute of Social Defence (NISD), is an autonomous body under the Ministry of Social Justice and Empowerment, Government of India.

The Institute is dedicated to developing and facilitating comprehensive, effective and specialized interventions in the area of Social Defence.

NISD functions as an advisory body for Ministry of Social Justice & Empowerment, Government of India and Resource and Training Centre of Excellence in the field of Social Defence.

The Institute’s areas of concern are Juvenile Justice, Child Protection, Old Age Care, Drug Abuse Prevention and related sectors.

In order to cope up with the problems faced by the Aged, it is necessary that the care givers be made aware of the physical and mental conditions and problems of the elderly people so as to meet their needs as far as possible in the home setting.

Under this initiative, the NISD runs a series of Programmes/Certificate Courses to educate and train persons who can provide care to older persons in the family and community settings. The Institute is also carrying out orientation programmes in several regions of the country to generate awareness among senior citizens on the welfare facilities/programmes available for them and also sensitize government and non-government functionaries on special needs of the elderly.

Target Audience
Under this Project, the Institute runs a series of Programmes/Certificate courses to educate and train persons who can provide care to older persons in the family and community settings. The Institute is also carrying out orientation programmes in several regions of the country to generate awareness among Senior Citizens on the welfare facilities/programmes available for them.

Aims & Objectives :
The main aim of conceptualizing the course under Government of India's project-'NICE' is to develop a cadre of frontline personnel of Geriatric Care Givers (Geriatric Animators) and to generate skilled manpower focused on intervention in the family & community settings. The younger generations and others concerned with the welfare of older persons are to be encouraged to attend to the needs of the older persons. The objectives of the Programme are:
To develop a cadre of professionals for the care & welfare of older persons
To provide a comprehensive and scientific knowledge base on various aspects relating to the Geriatric care
To develop aptitude and skills for working with older persons
To orient the students on various techniques/ interventions of understanding and working for the welfare of the elderly with focus on programme development and management

It also aims to develop a cadre of frontline personnel of Geriatric Care Givers (Geriatric Animators) and to generate skilled manpower focused on intervention in the family & community settings. The younger generations and others concerned with the welfare of older persons are to be encouraged to attend to the needs of the older persons.

Saturday, March 3, 2007

NDTV, giving clear answers about Alzheimer's Disease - by Dr R.S. Wadia, Pune, India.

Alzheimer's Disease also known as Organic Brain Syndrome

Written by: DoctorNDTV team Checked by: Dr. R.S. Wadia, Professor of Neurology

What is Alzheimer's disease? How does it occur?What are the symptoms? How is it diagnosed?How is it treated?How long will the effects last?What can be done to help prevent Alzheimer's disease?

What is Alzheimer's disease? Alzheimer’s disease is a degenerative disorder, which destroys brain cells. It leads to a decline in mental function affecting memory, thinking, language and behavior. The disease affects people more than 65 years old. Dementia is a general decline in mental ability and Alzheimer's disease is the most common cause.

How does it occur? In Alzheimer’s disease, changes in the chemistry and structures of the brain hinder the ability to process, store, and retrieve information. The exact cause of these changes is not known. Some people with Alzheimer’s disease have a family history of the disease and show signs of the disease earlier in life, i.e. before the age of 65.

What are the symptoms? The symptoms of Alzheimer’s disease vary and change as the disease gets worse. The first symptom is increasing forgetfulness. Most people begin to have some memory problems, as they get older. For a person in the early stages of Alzheimer’s disease, however, these problems are more obvious than in others of the same age. Their attention span becomes shorter. They have a harder time concentrating.
Over time, memory loss becomes more severe. Friends notice the memory loss and that the person has problems dealing with written matter. They may misplace or lose important objects. More importantly, recent memory is affected more than long-term memory. Memory is usually the first to be affected. Then thinking is impaired and the patient becomes increasingly disoriented. He is unable to locate his whereabouts i.e., he cannot tell where he is, whether it is morning or evening, or what he had for breakfast. Furthermore, the patient loses the ability to read, write and care for his personal hygiene, so he dirties himself while eating, does not dress properly, and later may pass urine or stools in clothes. Because memory is impaired, confusion and restlessness are common and these conditions worsen with fever.

How is it diagnosed? Alzheimer's disease can be diagnosed with a careful study of the patient’s medical history and physical examination. While there is no single diagnostic test, memory testing can be helpful. Blood tests and brain scans are done to see whether there is a recognizable cause of the decline in brain function. It is especially important to rule out depression, a treatable condition that can cause symptoms similar to Alzheimer’s disease. Generally in Alzheimer’s disease there is atrophy of the brain seen on CT Scan or MRI and there is no other abnormality. Thus, if there is clear dementia, the brain shows cerebral atrophy and there is no obvious explanation for this, such as alcoholism, drug abuse or stroke, Alzheimer’s disease is clinically diagnosed. However, a definite diagnosis can only be made by examining brain tissue after death.

How is it treated? There is no cure. The goal of treatment is to preserve mental and physical function as much, and as long as possible. The best approach seems to be to control other illnesses, consuming a healthy diet and regular exercise. Medicines may be sometimes helpful if used early in Alzheimer’s disease to slow memory loss. Recent research suggests that the disease may be due to the deficiency of a chemical, acetylcholine, the replacement for which is being worked upon. Associated depression should be treated.

How long will the effects last? The brain function of a person having Alzheimer's disease continues to get worse until their death. What can be done to help prevent Alzheimer's disease? It is difficult to prevent Alzheimer’s disease until its causes are better understood. People with a family history of this disease should see their doctor regularly. Early diagnosis will allow them to take advantage of new treatments as they become available. It must be noted that Alzheimer’s is a degenerative disease, i.e., it gets worse with time, so the diagnosis, if possible, should be made even before significant symptoms are visible, through genetic tests and brain scans. Obviously no treatment can help once the brain cells die, so the emphasis is on early diagnosis.

Checked by: Dr. R.S. Wadia,
Professor of Neurology,
BJ medical college, Pune

Last updated: 27 March 2004

The Indian Society of Gerontology, Creating mass awarness regarding Alzheimer Disease in India to provide appropriate support and care.

Alzheimer's - Grey Menace

In the absence of any known cure, Alzheimer's disease, a debilitating malaise that afflicts the elderly, continues to be regarded as the most dreaded manifestation of ageing.Alzheimer's inspires many fears and misconceptions. Anxious queries about the disease range from the normal "Is it a mental disease, is it hereditary or is it the result of normal ageing", to the more ludicrous "Are past life events responsible for the onset of Alzheimer's disease".

Relatively little is known about Alzheimer's in India; and doctors here caution that people must now sit up and take notice of a disease which, according to one estimate, kills one out of four Indians over the age of 80.

Without getting into the numbers game, Dr Kalyan Bagchi, President of the Society for Gerontological Research, a Delhi-based NGO, says, "It is quite possible that today, there may be thousands of patients totally undetected and undiagnosed."Seema Puri, senior lecturer (her PhD work is related to gerontology) at the Institute of Home Economics, Delhi University, describes Alzheimer's as a condition of unknown origin that causes a gradual loss of abilities in memory, thinking, reasoning, orientation and concentration. It is not the result of ageing but it does occur more frequently in persons 65 years of age or older, she explains.

The early stage of Alzheimer's is often overlooked and incorrectly labeled both by professionals as well as by family and friends as "old age" or a normal part of the ageing process.

In an illustrative case, a 69-year-old retired Colonel in south Delhi started exhibiting moody behavior, alternating between bouts of animation and depression. His family however, attributed what they felt were temper tantrums to the onset of advancing years. They realized something was wrong only when he began to show signs of disorientation and uncharacteristic behavior which included cracking inappropriate jokes before guests.

Dr Bagchi explains that Alzheimer's affects each patient in a different way. The symptoms can broadly include difficulties with language, significant short-term memory loss, time disorientation, difficulty in making decisions, showing signs of depression and aggression and lack of initiative and motivation.In the case of the retired Colonel, he started referring to the calendar to remember dates and had major gaps in memory. Most of his behavioral problems began in the evenings when he fell into a state of cognitive decline or dementia.Dementia is defined as the loss of intellectual functions severe enough to interfere with an individual's daily function. Dementia is not a disease in itself but a group of symptoms that may appear in certain diseases or conditions; Alzheimer's is the most common among such conditions.

With the rapid increase of the grey population in India, Alzheimer's and other forms of dementia are becoming more prevalent among the elderly. Life expectancy has gone up from 20 years at the beginning of the 20th century to 62 years today, says Ms Nidhi Raj Kapoor of the Delhi-based NGO, HelpAge India. At present, India has an ageing population of 77 million; by 2025, the country will have 177 million elderly people.Creating mass awareness about this tragic condition can help detect Alzheimer's at an early stage and create avenues for appropriate support and care to patients, says Dr Bagchi.

The Society forGerontological Research (SGR) has taken a concrete step in this direction with the recent launch of a publication titled 'Alzheimer's Disease in India'.The book covers all aspects of the disease, presented by eminent experts who have spent decades in researching its various facets. Dissemination of this information is of great importance to the masses, or the people who are the real caregivers when Alzheimer's strikes someone in the family, observes Dr Bagchi.

The book is also an invaluable guide for general practitioners to diagnose the symptoms early on. Age-associated cognitive decline as well as dementia are substantially prevalent in elderly people seeking health care. And therefore, it is essential for the geriatrician to be able to differentiate between the two, points out Dr A B Dey, Chief of Geriatric Services at the All India Institute of Medical Sciences (AIIMS), Delhi.

In a chapter devoted to early detection of dementia, Dr Dey observes that cognitive impairment should be suspected when the patient is passive and unresponsive, easily irritable, suspicious or misinterprets auditory and visual stimuli. Other indicators for assessment include inability of the patient to get the appropriate words to express what he or she wants to say, difficulty in learning and retaining new information, or performing tasks such as cooking, and loss of interest in usual hobbies, activities and current events. At the same time, the clinician needs to be judicious and depend on his/her own skill and clinical judgement since these mental assessment instruments have some degree of false positivity.

In addition, factors such as the patient's educational level, cultural background and socio-economic status need to be kept in mind when choosing appropriate tools for assessment and also while interpreting the results.

In the second stage - when Alzheimer's is most often detected - the disease takes a more serious turn; the glaring signs and symptoms are complete forgetfulness regarding events and faces, inability to speak in a coherent manner and the inability to write a logical sentence.What is perhaps much more worrisome is the night wandering and spatial disorientation. Gradually, urinary and faecal incontinence, and finally the loss of mobility follow.

"All said and done, the most important aspect of taking care of a patient with Alzheimer's is care giving; in the late stages, the attention of the caregiver is needed not only throughout the day, but even during the night," notes Dr Bagchi. Consequently, the psychological stress on caregivers can be tremendous, he adds. What is needed, he says, is counseling and support services to help maintain the capacity of the caregivers.

The training of volunteers and informal caregivers can be of immense help in supporting family caregivers. Pointing out that there are few trained geriatric caregivers in India, Dr Bagchi emphasizes that this area needs immediate attention, particularly in the National Plan of Action for Older Persons.

– Nitin Jugran Bahuguna

In Psychogeriatrics Review, Progression of Dementia symptoms, study from India

Volume 6 Issue 4 Page 154 - December 2006

To cite this article: Charles PINTO, Ramanathan SEETHALAKSHMI (2006) Longitudinal progression of behavioral and psychological symptoms of dementia: a pilot study from India Psychogeriatrics 6 (4), 154–158. doi:10.1111/j.1479-8301.2006.00155.x

Longitudinal progression of behavioral and psychological symptoms of dementia: a pilot study from India

· Charles PINTO and Ramanathan SEETHALAKSHMI
· Department of Psychiatry, BYL Nair Charitable Hospital, Mumbai, India.
Dr Ramanathan Seethalakshmi, DPM, Department of Psychiatry, King Edward Memorial Hospital, Mumbai, India. Email:


Introduction: Behavioral and psychological symptoms of dementia (BPSD) vary across different types, stages and different time spans of dementia. BPSD form an important determinant in the effective management of dementia as they contribute significantly to the prognosis and outcome of dementia.

Methods: Thirty-three individuals with dementia were assessed across three different time periods for changes in behavioral problems as noted on the BEHAV-AD. Of the 33 individuals, eight had received medications that primarily consisted of low-dose typical antipsychotics.

Results: Although, it was noted that behavioral problems fluctuate over time; significant variations in intensity were noted only in delusions. BPSD variations were similar in both Alzheimer's and vascular dementia. Individuals on medications showed significant improvement in nearly all behavioral problems and a decrease in caregiver distress.

Discussion: Behavioral symptoms vary across different time spans and follow a general pattern. Detailed analyses of these longitudinal variations in BPSD can be useful in planning cost-effective treatment strategies.

Alzheimer's and Related Disorders Society of India, Kerala, India.

Alzheimer's & Related Disorders Society of India (ARDSI) Alzheimer's Disease is the most common type of dementia. See for details.

Alzheimer's & Related Disorders Society of India (ARDSI) - Mumbai Chapter has recently got a place in J J Hospital Premises. So if any family member or friend suffers from Alzheimer's, do ask them to visit ARDSI at J J Hospital Municipal School Building, Room no. 27, 2nd floor, on any Wednesday between 12 and 2 p.m. Dr. Shirin Barodawala, neuro-pathologist, 23513253, will be available. ARDSI has 70 life-members. The one-time fee is Rs. 1000 only so do consider joining. ARDSI is starting homes so if you can offer such a space, it would be appreciated.

ARDSI start activities in the areas of Day care centre, Domiciliary care services, Guidance and Counseling, Memory clinic, Caregivers meeting, Dementia care fund, Awareness programmes, Geriatric nursing training.

If you are able to volunteer or get involved in any way, do contact Mr. C.G. Thomas, President, ARDSI Mumbai Chapter, Residence: A-1, Anand Niketan,Plot No. 46, Sector 9-A, Vashi, Navi Mumbai - 400 703Tel. 022 - 27667768 / 27668324 Other committee members who you could also contact are: Mrs. Lena Tawares, Founder, Bandra. Tel: 26428421 Mr. Jacob Kurian, Treasurer, Thane W. Tel 25893048

Rise of the Alzheimer's Disease cases foreseen in India too, by Mr Sailesh Mishra.

Experts foresee alarming rise in Alzheimer’s disease cases

Developing countries like India, China will be among the countries worst hit by Alzheimer’s disease in the next decade, according to global experts.

“It is estimated that there are currently about 18 million people worldwide with Alzheimer’s disease,” according to the World Health Organisation. “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 per cent of people with Alzheimer’s disease live in developing countries and, by 2025, this will be over 70 per cent.”

“Over the years, India has been patting itself on the back as the percentage of Alzheimer’s/ dementia patients has been 4 per cent as compared to, for instance, 10-15 of those in the 65+ plus age group in the United States,” says Dr Sheilu Sreenivasan, President, Dignity Foundation, a 10-year charitable organisation with 20 different social support deliveries for senior citizens and Alzheimer’s disease patients.

In the year 2000, India had 3.5 million Alzheimer’s/ dementia patients as against the United States’ 4.5 million. With our population greying faster (India’s 60-plus population was around 80 million in 2000), the growth rate being fastest among the 80+ segment among all other segments, the number of Alzheimer’s/ dementia patients has been growing at a phenomenal rate.

The percentage of 60+ persons in the total population has seen a steady rise from 5.1 percent in 1901 to 6.8 per cent in 1991. It is expected to reach 8.9 per cent in 2016. Projections beyond 2016, made by the United Nations, have indicated that 21 per cent of the Indian population will be 60+ by 2050. In China, the population of 60+ is projected to increase from 130 million in 2000 to 370 million in 2050. According to Alzheimer's Australia,the projected increase of dementia between 1995-2041in Australia is 254% percentage.

The Rotterdam Study, 1995 (the US), indicates the dramatic rise in the Alzheimer's disease prevalence as age advances:-- Prevalence of dementia in each age category
Age No (%) of No (%) of
(years) women men Total
55-59 4/688 (0.6) 1/493 (0.2) 5/1181 (0.4)
60-64 3/807 (0.4) 3/625 (0.5) 6/1432 (0.4)
65-69 7/735 (1.0) 5/624 (0.8) 12/1359 (0.9)
70-74 15/712 (2.1) 10/492 (2.0) 25/1204 (2.1)
75-79 37/597 (6.2) 22/365 (6.0) 59/962 (6.1)
80-84 92/477 (19.3) 28/204 (13.7) 120/681 (17.6)
85-89 118/361 (32.7) 29/102 (28.4) 147/463 (31.7)
>/=90 86/212 (40.6) 14/34 (41.2) 100/246 (40.7)
Total 362/4589 (7.9) 112/2939 (3.8) 474/7528 (6.3)

Barring social scientists and medical experts dealing with dementia, few in India seem to be aware of the grave situation. Five years have passed, but no governmental effort has been made to update data on the number of Alzheimer’s/ dementia cases in the country though the threat has been widening.

Research indicates that people with heart ailments and diabetes are prone to Alzheimer’s disease. “Some of the strongest evidence links brain health to heart health,” says US-based Alzheimer's Association. “The risk of developing Alzheimer’s or vascular dementia appears to be increased by many conditions that damage the heart and blood vessels, including heart disease, diabetes, stroke and high blood pressure or cholesterol.’’

India today has over 33 million diabetics, according to the International Diabetes Federation. By 2025, India will become the "diabetes capital of the world" with over 57 million diabetics. As for heart patients, the number is expected to increase from the present 30 million to 100 million by 2020.

Despite the mounting risk, few people are aware of the disease and its symptoms. So much so that experts feel that innumerable Alzheimer’s patients are mistaken as victims of senility and offered little medical help. In some cases, medical help is sought too late.

The need of the hour is to spread awareness about the disease. “Though the situation has been deteriorating, the Indian Government and people seem to be rather indifferent,’’ says a Mumbai-based leading neurosurgeon.

What are the symptoms? Do any foodstuffs prevent it? Consider these facts :

In India, prevalence of dementia is 33.6 per 1000
Alzheimer's disease was the most common type (54 per cent), followed by vascular dementia (39 per cent)
Alzheimer’s disease is incurable

Turmeric prevents Alzheimer’s disease. Fish too helps (new research, one of the reasons why India’s dementia incidence is lower))

B-vitamin nutrients found in oranges, legumes, leafy green vegetables and folic acid supplements are more effective in limiting Alzheimer's disease risk than antioxidants and other nutrients

Reasons for dementia: 7 per cent of cases are due to causes such as infection, tumour and trauma. Family history of dementia is also a risk factor for Alzheimer's disease. History of hypertension is a risk factor for vascular dementia.

Alzheimer’s disease symptoms may include memory loss, personality changes, trouble finding words and feeling lost in familiar places

Sniff test: Patients with early Alzheimer's disease may be unable to smell certain odours including strawberry, smoke, soap and cloves

Physical exercise helps: Walk, run, dance, swim, pump iron

Mental exercise too: Learn a new language, play bridge or chess, do crossword puzzles and read.

Best Regards,
Sailesh Mishra, Chief Coordinator

Health Counselling Centre at Bandra for Alzheimer Disease.

The HEALTH COUNSELLING CENTRE, an initiative of the Innovation Centre of the Society for Service to Voluntary Agencies (SOSVA).

The Centre begins Counselling and a Caregiver Support Group for Alzheimer’s Disease and Spina Bifida. Counselling on symptoms, prevention, treatment, rehabilitation, coping skills, care and other aspects is offered.

All caregivers of Alzheimer’s Disease and Spina Bifida patients.

2:00 p.m. to 5:00 p.m. on Saturdays
(On the 2nd and 4th Saturday of every month for Alzheimer’s Disease
and on the 3rd and 5th Saturday of every month for Spina Bifida).

Health Counselling Centre,
Society for Service to Voluntary Agencies (SOSVA)
Room No. 2& 3, Ground Floor,
Petit Municipal School,
Opp. K.B. Bhabha Hospital,
Bandra (W), Mumbai 400 050.

Contact details: Tel. no. 2655 5704 / 2641 1205; Email:;
Counsellor: Ms. Ashita Barrot (98218 52899)

The Centre is open to all those who need support in dealing with patients of Alzheimer’s Disease or Spina Bifida in the family, and there is no charge for the counselling.

Alzheimer Disease management in Mumbai- from Times of India.

Helping Hand

Counsellors form support base Mumbai: It is a nightmarish existence: you forget your past, don’t recognise your loved ones and can’t communicate your thoughts. Alzheimer’s, previously dismissed as mere forgetfulness caused by old age, is slowly being recognized as a serious problem with the mushrooming of support cells, counseling centers and a day care center over the past year.

Mumbaikars have strongly endorsed the ‘We can make a difference’ theme as they approach yet another World Alzheimer’s Day this year. Alzheimer’s—a progressive and irreversible neurological disorder—has afflicted nearly 18 million aged persons worldwide.

With zero cure, it is often a more trying experience for relatives than for sufferers. “We went through a tough phase when my mother began forgetting things and had difficulty even in recognizing us,’’ said Hoofers Wada, a Marine Lines resident, recalling her mother’s degeneration four years ago.

“It was a trying experience as she began living in a world of her own and demanding more attention. It was almost like living with a child,’’ she added. Wada's worries were alleviated when a support group instituted at Gammadion Road last year, enabled her to share her experience with other Mumbaikars in a similar plight. She learnt of others who were coping with patients who had turned aggressive or wandered aimlessly.

“There has been an improvement in the management of Alzheimer’s as we can at least identify an Alzheimer’s case and counsel relatives on how to deal with them,’’ said Dr Shirring Boardwalk, who has 76 caregivers enrolled at the center run by the Alzheimer’s and Related Disorder Society of India in I I Hospital.

“Patient care in a day care center is easier as they get together, listen to music and are always attended to,’’ said Sheilu Sreenivasan, president of Dignity Foundation, a voluntary organization that runs the city’s only day care center for Alzheimer’s patients. They are also launching a ‘memory gym’ on Wednesday, to test patients’ memory and conduct mental exercises that will help doctors to detect early signs of degeneration.

Publication: Times Of India Mumbai; Date: Sep 21, 2005; Section: Times City

Alzheimer Disease, role of the perception of lonelisness among elders, from Karmayog India.

Alzheimer's disease is an incurable one that slowly destroys memory and cognitive abilities. The progressive brain disorder that gradually destroys a person's memory and ability to reason and/or make judgements.
Two things that go towards being responsible and contributory for Alzheimer's disease are: loneliness and high-collesterol diet. Loneliness is unavoidable for the 'older elderly' these days. Added to that is the ever increasing gap between them and the third generation.

Part I
First let's see how loneliness impacts Alzheimer's disease.
Though not much is being undertaken in India, studies are almost continuous elsewhere in foreign Universities. Researchers under Prof Robert Wilson of Rush University Medical Centre studied more than 800 elders who were followed over a period of four years. It has been found that apart from emotional impact, loneliness has a physical impact too. Also people who are lonely are twice as likely to develop Alzheimer's disease.

It must be that loneliness affects brain systems dealing with cognition and memory. This makes lonly people more vulnerable to effects of age-related decline in natural pathways.

Rebecca Wood, Chief Executive of Alzheimer's Research Trust accepts it is an impressive study. Has come up with startling findings that back up earlier studies examining social interactions and Alzheimer's risk. What she finds particularly interesting of this study is that it is an individual's perception of being lonely rather than their actual degree of social isolation that seems to correlate most closely with their Alzheimer's risk.

Social isolation has already been established to be linked to dementia. But this is the first time researchers have looked at how lonely people actually felt.

Part II
Now let's consider the effects of high cholesterol diet on Alzheimer's disease.
An unhealthy diet filled with high cholesterol foods can increase the risk of Alzheimer's disease, says study of scientists

It has been discovered that eating lots of food containing saturated fats, such as butter and red meat, can boost levels of proteins in the brain linked to dementia.
It is doubted that such diets might affect cholestrol-clearing substances in the brain. It is earnestly hoped that this discovery could lead to new drugs which lead to the clogging fats to be cleared more effectively. This would help slow down the progression of the debilitating brain condition.

One key characteristic of people with this condition is the formation of clumps, or 'plaques' of beta amyloid proteins which are believed to destroy brain cells. Scientists increasingly believe diet and life-style may affect the build up of these damaging proteins.
There is growing evidence that taking cholestrol lowering statins makes people less likely to develop Alzheimer's disease. Drugs that increase expression of these proteins might slow the progression of Alzheimer's disease. Similar drugs are already in use for research into heart disease.

University of Virginia scientists have identified one of the major missing link in the process that destroys nerve cells in in Alzheimer's disease. This discovery might actually lead a pathway to the development of some essential new drugs that target and disrupt specific proteins that conspire in the brain to cause Alzheimer's disease.

In Alzheimer's disease, two kinds of abnormal structures accumulate in the brain - amyloid plaques and neurofibrillary tangles - contain fibrills made from protein fragments called beta-amyloid peptides and another different substance called 'tau' respectively. During their study the researchers found a deadly connection between beta amyloid and tau proteins, one that occurs before they form plaques and tangles.


Alzheimer Disease, implications for Asia and the World, Mr Kannan Sivaprakasam

Alzheimer’s Disease: Loss of a beautiful memory, mind, ….. and life. Implications for Asia and the world

Alzheimer’s disease (AD) is a silent killer of brain and lives of 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 leads to death, mostly by pneumonia (infection of the lungs).

It enormously affects the patients as well as the caregivers considering the long period of suffering (8-20 years). Over the last few decades AD has dramatically changed from an obscure disorder to a major public health problem affecting millions of people worldwide. Besides the emotional and social issues at stake the economic costs of AD to society is massive.

This disease is a major contributor to increasing health care, bankrupting families and draining more than US$100 billions from the US economy.Age is a major risk factor: the longer one lives, the greater the possibility of getting AD (about 50 percent of Americans over 85 have AD). AD seldom occurs before the middle age in a clinically obvious form, and then the likelihood doubles exponentially every five years. Given the fact that the elderly are the fastest growing group in the world population AD is termed as the epidemics of the elderly.

With no cure in sight this deadly disease is estimated to hold 37 millions in its grip by 2050.In Asia, China's elderly population over 60 is projected to increase from 130 million in 2000 to 370 million in 2050, from 11% to 26% of the total population, with an annual rate of 3.2 %. The graying of the middle kingdom will not only cause demographic transformation but the economic and social challenges it poses will affect China's competitiveness in the global economy. In addition to being the world's second most populous country, India has one of the largest populations of older adults.

India’s 60-plus population (around 80 million) is increasing by 3 % annually and is likely to double over the next 25 years. Besides, a large section of the older population in India is illiterate and lives in rural areas which lack infrastructure. Due to lack of awareness of AD most patients/family members tend to ignore the symptoms of the disease as normal part of aging process. Clinical help is sought only after a drastic deterioration of patient’s health.

Number of PeopleAffected by Demntia/AD
US 4.5 million
India 3.5 million
Japan 1.7 million
Brazil 1.5 million
United Kingdom 750,000
Canada 354,000
Pakistan 157,000
Australia 100,000
Western Europe 6–7 million
World 18 million

AD is the major single cause of dementia. Declaration of 1990s as “decade of brain” and the Ronald Reagan family’s dedication to the cause stimulated scientific efforts to understand AD. While it is true that our enhanced awareness of this deadly disorder as a result of extensive research has changed our understanding of this disease, we still face major hurdles as far as the diagnosis and treatment is concerned. There is no definite diagnosis at an early stage of this disease. In addition, in the developing nations the lack of facilities and public awareness tend to add to the problem.

The pathway of Alzheimer's disease remains unknown, although a number of risk factors are apparent including a small percentage (5 - 10%) of getting it through familial inheritance. AD involves death of neurons in specific parts of brain. The brain shrinks (atrophy) in these parts and as a result mental functions associated with these areas are affected. Currently there is no treatment that can stop or reverse AD.

The approved therapeutics targets the symptoms (loss of chemical messenger systems) not the probable cause (neuro-degeneration – loss of neurons).Post-mortem examination of the brains of the people affected by AD showed two characteristic features: Amyloid plaques outside the cells and tangles inside the nerve cells. The pathway by which these two abnormal features are formed and affect the functioning of the cells is being investigated so that interventions can be developed to alter the course of the disease.

Apart from memory loss AD patients have other symptoms including loss of language skills, disorientation in space and time and inability to do familiar tasks. Physicians often use checklists of symptoms, and other behavioral assessment tools, to help them detect Alzheimer's. In addition, noninvasive neuro-imaging tools are increasingly used to understand the disease better.

Advances in sensitive imaging techniques to visualize the brain functions including X-ray computerized tomography (CT), Magnetic resonance imaging (MRI) and Positron Emission tomography (PET) have helped to diagnose malfunction in brain. CT scan uses a computer to reconstruct a three-dimensional view of the brain from separate x-ray images taken at different angles. The MRI scanner uses strong magnetic fields to create images. While MRI and CT scans provide structural information PET yields functional image of the brain. PET helps to monitor the level of chemical activity going on in different regions of the brain. By studying the parts of brain that are implicated in AD one can confirm the disease using PET imaging. PET scan is expensive and only a few centers (even in US) have access to these facilities. Recently in US medicare coverage has been expanded to avail PET for suspected AD cases.

With the explosion of knowledge during the past few decades on Alzheimer’s disease, the stage is set for a promising outlook in the distant horizon. The future builds upon the events and experiences of the past and present. Mankind, waging a constant battle against diseases, has conquered some of them with advances in science and technology. One day, we may be able to prevent or even cure this terrible disease, which robs our loved ones of their most precious faculty - their minds.

– Kannan SivaprakasamApril 10, 2005

Dr Kannan Sivaprakasam
department of genetics, neurosciences
and pharmacology,
Cornell University,
New York, USA.