Unlocking Minds: Understanding the core of Alzheimer’s disease and dementia

Alzheimer’s disease, a progressive neurodegenerative disorder, primarily affects memory and cognitive function. It is the most common cause of dementia, gradually impairing daily life. Research aims to understand its complex pathology and develop effective treatments for this widespread and challenging condition.

Ayushi Thapliyal, Senior Research Fellow
All India Institute of Medical Sciences, New Delhi

All of us have heard about neurological disorders like dementia and Alzheimer’s disease (commonly abbreviated as AD). However, general population is typically quite ignorant about these conditions and they fail to understand if there is any major difference between dementia and AD. To put in simple words, dementia is a generic term used for decline in mental ability of a person to the extent that it interferes with day-to-day activities. Common symptoms may include deterioration of memory, language, reasoning, and beyond. Various health conditions that cause damage to brain cells, like AD, depression, cardiovascular diseases, and others can cause these symptoms.  Other causes may include excess consumption of alcohol, vitamin deficiencies, side effects of certain drugs, thyroid problems, etc. However, the most common cause of these symptoms is AD, diagnosed in 60-80% of dementia cases.  

On the other hand, AD is a neurodegenerative disease characterized by complex changes in brain causing neuronal cell damage, which eventually leads to dementia. In addition to memory loss, people with AD experience difficulty finishing even basic chores. Changes in personality or mood swings are also common in these cases. Some people may become confused regarding names, locations, and events. Visual anomalies can also happen, such as trouble in understanding pictures. According to science, AD causes accumulation of aggregated proteins in the brain, such as phosphorylated tau and beta-amyloid and neuronal degeneration. Because all human functions—such as thinking, walking, and talking—depend on brain neurons, AD causes damage to the brain areas that govern these functions.  As a result, cognitive, language, and memory problems become the initial onset signs of AD. Such patients can undergo behavioral, personality or emotional changes. One particular behavior that warrants attention is wandering, and being unable to find their way back. With time, more areas of the brain are affected and even performing daily tasks like dressing and bathing require professional caregivers. Even while AD appears to be a simple example of neuronal degeneration, it is really more complicated due to its 20-year latent phase. It is a degenerative disease, which worsens over time and its progression varies from person to person. The progression of AD from the unnoticeable brain changes to eventual physical disability is termed as the Alzheimer’s disease continuum. It includes three primary phases- preclinical AD, mild cognitive impairment (MCI), and Alzheimer’s dementia. Alzheimer’s dementia is usually noticed after 65 years and this is referred as late onset AD, and like other chronic illnesses, it develops as a result of various factors including genetics, cardiovascular health, traumatic brain injury, smoking, physical activity, diet, etc. People who experience cognitive changes should speak with a doctor to determine whether these changes are normal for their age, reversible, or indicative of Alzheimer’s disease or another dementia. Dementia cases are typically disregarded because of ignorance, stigma, or fear, but a diagnosis can assist medical professionals and caregivers in establishing a prognosis that can enable Alzheimer’s patients lead reasonably normal lives. 

According to the most recent estimates, the condition affects about 57.4 million individuals globally and poses a significant health burden. The Global Burden of Disease Study (GBDS) 2019 projects that by 2050, the number of dementia cases would soar to 166%, affecting the lives of around 152.8 million people; these projections are in line with the predictions made by the WHO. In addition, it is anticipated that the rise in dementia cases would be greatest (up to 330%) in nations with poor sociodemographic index scores, such as India.1 According to recent estimates, 8.8 million Indians over 60 have dementia, with varying burden in different states and subpopulations in India.2 The prevalence of dementia is greater in women (9.0%) than in males (5.8%). Additionally, if the frequency stays the same, there may be 16.9 million instances of dementia by 2036 due to the growing older Indian population.  

The Alzheimer’s condition can be tricky to diagnose, and only a comprehensive medical assessment including blood tests, mental status evaluations, and brain imaging can help in diagnosing AD. Fortunately, these AD workups are easily assessable in India. Getting AD as the diagnosis will be definitely heartbreaking as currently no definite cure for it is known; nonetheless, certain medications are available for those suffering from mild to moderate Alzheimer’s condition. Alzheimer’s dementia symptoms, like depression and restlessness can also be treated and managed. These medications do not treat AD; but in certain cases, they shortly halt the disease’s progression of symptoms ensuring a relatively quality life for the patients. For more information about the available medication, individuals should get in touch with the professionals. According to new guidelines by the World Health Organization (WHO), people can also lower their risk of dementia by exercising regularly, abstaining from tobacco and alcohol that can be harmful, controlling their weight, eating a healthy diet, and maintaining healthy blood pressure, cholesterol, and blood sugar levels. 

Not only for the patients, AD can also be very difficult and stressful for the family members/ caregivers at times. There are, however, ways to deal with such situations. Some helpful tips for the caregivers’ are-

  1. Establish simple normal routines of the AD individual. 
  2. Encourage self-reliance in the individual.
  3. Support them to keep their dignity.
  4. Try to avoid confrontation/ conflicts that might cause unnecessary stress to the patient.
  5. Try to maintain communication and a happy environment around them.
  6. Safety should be the priority.
  7. Promote health and fitness.
  8. Above all, remember to look after your physical and emotional health. Eat well, do regular exercise, and get enough sleep. 

It is crucial to remember that some people have dementia-like symptoms but do not exhibit the progressive brain abnormalities associated with AD or other neurodegenerative diseases. Depression, untreated sleep apnea, delirium, medication side effects, Lyme disease, thyroid issues, specific vitamin deficiencies, and excessive alcohol consumption can also cause similar symptoms. Unlike AD, these problems can be treated to reverse them. Therefore, it is important to identify whether the root cause of the dementia is AD or any other condition. Extensive scientific research on Alzheimer’s disease is underway globally, with some advances seen in the presymptomatic years. In the meanwhile, public awareness has to be raised, since we can only prolong the lives of those afflicted with the disease by staying one step ahead of the disease. 

  1. Ray S, Kumar A, Kapil S, Sharma R, Gayathri J. Early Detection & Management of Alzheimer’s Disease & Dementia in India: A Policy Perspective. CSIR-NIScPR Policy Bulletin/February-2023/01. https://niscpr.res.in/includes/images/bulletin/bulletin-2023-03-15.pdf

2. Lee J, Meijer E, Langa KM, et al. Prevalence of dementia in India: National and state estimates from a nationwide study. Alzheimer’s Dement. 2023;19:2898–2912. https://doi.org/10.1002/alz.12928

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