GEORGE NEWS - September is Alzheimer's Month, an international campaign to raise awareness and challenge the stigma that surrounds dementia.

Alzheimer's disease is the most common cause of dementia worldwide. Those over the age of 60 are most vulnerable to the illness, but it can occur in younger people too, especially when there is a family history of early-onset dementia.

"Alzheimer's dementia (AD) differs from normal brain ageing," says Dr Kim Laxton, a psychiatrist at Akeso Clinic.

"With age, the brain, like any organ and muscle in the body, becomes weaker and less effective in its functioning, particularly in its cognitive capacity. Alzheimer's dementia is a pathological ageing of the brain. Loss of memory and cognitive abilities is the most common symptom and, with time, the person becomes wholly dependent on others for the basic activities of daily living."

Genetic component
There is a genetic component that renders someone susceptible to the onset of the disease, but genetics is not the only factor involved in the development of older-age AD. "Certain genetic alleles [genetic mutation] present in a person might predispose them to AD, but other factors such as hypertension and high cholesterol are also implicated as risk factors."

The Lancet published an article in 2017 describing high education levels, metabolic risk factor control and the early use of hearing aids in those with presbycusis (hearing loss) as being protective factors against the development of dementia. Early stages of AD present with word-finding and short-term memory difficulties, such as losing keys, forgetting to pay bills, forgetting names of people and objects, and becoming lost in familiar places.

"Two abnormal structures called plaques and tangles are prime suspects in damaging and killing nerve cells in the brain," says Laxton. "Though autopsy studies show that most people develop some plaques and tangles as they age, those with Alzheimer's tend to develop far more and in a predictable pattern, beginning in the areas important for memory before spreading to other regions."

Diagnosis and treatment
The diagnosis of AD is essentially a clinical one. A doctor, predominantly a neurologist, geriatrician and/or psychiatrist, will take a thorough history, perform a physical examination and administer bedside screening questionnaires, one being the Folstein's Mini-Mental State Examination (MMSE).

"It is important that the doctor treats any underlying medical and/or psychiatric illness that could potentially mimic the symptoms of Alzheimer's dementia, such as a major depressive disorder," Laxton says. 

"Blood investigations routinely performed are those for thyroid function, vitamin B12, syphilis and HIV screening. This forms an important part of the workup as certain illnesses, such as hypothyroidism, can be treated."

The doctor may request that the patient has radiological investigations which may assist in excluding other neurological illnesses.

"The treatment of AD does not cure the illness but it may slow the progression of the disease," she adds. "There are currently clinical trials underway in Johannesburg that are attempting to screen patients and intervene early in those who are susceptible to the disease."

For further information regarding Alzheimer's dementia, visit Alzheimers.org.za and Dementiasa.org.

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