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24 October 2016 22:10 (South Africa)
South Africa

Health-E News: The Age of Alzheimer’s

  • South Africa
Photo: My Mom's Hands by Ann via Flickr.

An ageing population brings with it the challenge of a host of health issues. Dementia is only one nettle that must be grasped. There are many measures that could slow this down this mental deterioration, food as medicine is just one. By KERRY CULLINAN for HEALTH-E NEWS.

When I first met Margaret (not her real name) a few months ago, her impeccable manners had outlasted her memory. She observed polite greeting rituals with people she no longer remembered.

“How do you do, dear?” she would ask with a slight frown as she scanned your face, dimly aware that some of the people she greeted had significance.

Margaret started to ask for help with what were once simple tasks – buttoning a cardigan, unzipping a jacket –often pointing at what she needed in frustration, unable to find the words to express herself.

More recently, Margaret’s memory has slipped away even further.

She no longer remembers most of the words of greeting. No she makes small sounds that make no sense. She has forgotten how to use cutlery and needs someone to feed her. She had started to eat the paper serviettes instead of the food.

It is not that her body cannot function; it is her brain that is less and less able to instruct her body how to work.

Margaret has Alzheimer’s disease. As it progresses, she is going to forget how to do almost everything she has learnt; thinking, eating, walking, washing and going to the toilet.

Alzheimer’s is the most common form of dementia. It is a catch-all word to describe a decline in mental capacity that is severe enough to undermine daily life. Alzheimer’s is a degenerative brain disease that affects the functioning of neurons, the nerve cells that carry messages to and from the brain. People with Alzheimer’s develop an abnormal build-up of sticky proteins and fibres in their brains that are believed to block the neurons, eventually causing brain cells to die and the brain to shrink.

There is no cure for dementia but there are a number of things that can be done to slow its progression – diet and vitamins for example.

Professor Celeste de Jager from the Division of Geriatric Medicine at the University of Cape Town was part of a study published last month in The Journal of Alzheimer’s Disease which found that Omega 3 (found in fatty fish) combined with Vitamin B could slow down “cognitive decline” in people over the age of 70.

The two-year trial involved 266 people. All were tested for Omega 3 levels at the start of the trial, and half were given Vitamin B supplement and the other half were given a placebo. The Vitamin B supplements only slowed down memory loss in the people who had high Omega 3 levels at the start of the study.

For De Jager, there are two immediate priorities for addressing dementia in South Africa.

“First, we need more research on how nutritional interventions can slow down cognitive decline. Ageing and dementia are not seen as priorities for research.”

Secondly there is medicine available to slow down the effects of dementia, some of which work by exciting neural transmission. More people need access to this, and more research is needed to find other effective medicines.

“People don’t know what nutritious food is, these days. Fast food and cheap food that lacks protein contribute to poor neural function and cognitive impairment,” says De Jager.

Other conditions such as depression and HIV infection are risk factors for the progression of dementia, but these conditions are treatable. Women are more likely than men to get it, with some speculation that this is linked to the depletion of oestrogen during menopause.

Exercise, music, dance and art therapy are novel areas of research that show promise for slowing the brain’s degeneration and even for the building up of new neural pathways. These creative therapies may reduce behavioural symptoms of dementia such as agitation and anxiety and reduce the need for antipsychotic medication.

It is hard to say exactly how many South Africans suffer from dementia. Alzheimer’s SA, a non-profit organisation that helps patients and their families to cope, including by organising support groups, counselling and training for caregivers, believes it is around 2.2 million people but large-scale research has never been done to determine prevalence.

De Jager is involved in a large project in the Eastern Cape, together with the Donald Woods Foundation and Dementia SA, to measure the prevalence of dementia in a rural Xhosa-speaking population. Some 1 500 older people have already been screened and blood tested.

Although she is still working on the analysis, De Jager believes there is evidence of dementia being prevalent in the population surveyed.

The only other community-based prevalence study was conducted in Mangaung in the Free State. Around six percent of the 200 people screened showed signs of dementia, according to news reports.

Debbie Beech, the manager of the Gauteng branch of Alzheimer’s SA, also flags risk factors that exacerbate the disease – “high cholesterol, high blood pressure, diabetes, trauma and stress”.

“We offer basic cognitive testing in Gauteng, KwaZulu-Natal and the Eastern Cape and refer people with memory problems to doctors,” says Beech, who says it takes about ten years for Alzheimer’s to completely debilitate a person.

Often a family member has to be assigned to look after their relative with Alzheimer’s on a full-time basis. Medicines to slow the progression of the disease are not on the essential drug list, which means that it is hard to get access to without a medical aid.

While most universities have introduced courses on geriatric medicine in the last decade, De Jager says it is “very difficult to get clinicians interested in specialising in geriatric care”.

“In 2011, SA had fewer than ten geriatricians and fewer than five specialists in old-age psychiatry for a population of 3.8 million persons aged over 60 years,” De Jager and colleagues noted in a guest editorial in the SA Medical Journal last March. “Dementia drugs to improve cognitive function and treat underlying depression and/or behavioural disorders are expensive and unavailable on the Essential Drug List, and are therefore beyond the reach of the majority of older persons.

“There is a great need for family support and care services for problems encountered with daily living and behaviour. A study in Cape Town found that 79% of a memory clinic’s clients were being cared for by family members. Some of whom had given up their jobs to do so.”

Two-thirds of South Africans are under the age of 35, while more than a third is children under the age of 18. It thus makes sense that our health sector is oriented towards children and young people, but this should not be at the expense of older people.

Aside from deserving of a decent standard of living in their old age, many families are dependent on older relatives to care for the household’s children while their pensions are a key source of household income. The health of the old is intrinsically bound with the future of the young. DM

Ten warning signs of Alzheimer’s disease:

  1. Memory loss that disrupts daily life. One of the most common signs of Alzheimer’s, especially in the early stages, is forgetting recently learned information. Others include forgetting important dates or events; asking for the same information over and over; relying on memory aides (e.g., reminder notes or electronic devices) or family members for things they used to handle on their own.
  2. Challenges in planning or solving problems. Some people may experience changes in their ability to develop and follow a plan or work with numbers. They may have trouble following a familiar recipe or keeping track of monthly bills. They may have difficulty concentrating and take much longer to do things than they did before.
  3. Difficulty completing familiar tasks at home, at work or at leisure. People with Alzheimer’s often find it hard to complete daily tasks. Sometimes, people may have trouble driving to a familiar location, managing a budget at work or remembering the rules of a favorite game.
  4. Confusion with time or place. People with Alzheimer's can lose track of dates, seasons and the passage of time. They may have trouble understanding something if it is not happening immediately. Sometimes they may forget where they are or how they got there.
  5. Trouble understanding visual images and spatial relationships. For some people, having vision problems is a sign of Alzheimer's. They may have difficulty reading, judging distance and determining color or contrast. In terms of perception, they may pass a mirror and think someone else is in the room.
  6. New problems with words in speaking or writing. People with Alzheimer's may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. They may struggle with vocabulary, have problems finding the right word or call things by the wrong name.
  7. Misplacing things and losing the ability to retrace steps. A person with Alzheimer’s disease may put things in unusual places. They may lose things and be unable to go back over their steps to find them again. Sometimes, they may accuse others of stealing.
  8. Decreased or poor judgment. People with Alzheimer's may experience changes in judgment or decision making. For example, they may use poor judgment when dealing with money.
  9. Withdrawal from work or social activities. A person with Alzheimer's may start to remove themselves from hobbies, social activities, work projects or sports. They may also avoid being social because of the changes they have experienced.
  10. Changes in mood and personality. The mood and personalities of people with Alzheimer's can change. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, at work, with friends or in places where they are out of their comfort zone. DM

Photo: My Mom's Hands by Ann via Flickr.

  • South Africa

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